Enemas & Ostomies Flashcards
what is an enema?
solution into the rectum and sigmoid colon
what are the 3 things enemas do ?
- break up fecal mass
- stretch rectal wall
- initiate defecation reflex (peristalsis)
what is the most common use for an enema?
temporary relief of constipation
what are the less common indications of enemas?
- medications
- bowel training
- emptying bowel before diagnostic tests, surgery or childbirth
What are the 2 types of enemas?
- Cleansing enemas
- Oil-retention Enemas
What are the 4 types of cleansing enemas?
- Tap water
- Normal saline
- Hypertonic solution
- Soapsuds
how does tap water act as an enema?
- hypotonic
- lower osmotic pressure than interstitial space fluid
- tap water moves from bowel into interstitial spaces
- Water stimulates defication before water leaves the bowel
why should we not repeat tap water enemas?
because water toxicity or circulatory overload can occur if too much is absorbed
how does normal saline act as an enema?
- isotonic
- same osmotic pressure as fluids in body
- saline stimulates peristalsis
Which type of enema should only infants and children receive and why?
normal saline
because they are sensitive to fluid shifts
how do hyptertonic solutions act as an enema?
- exert osmotic pressure
- pressure pulls fluid out of interstitial spaces into the bowel
- low volume (120-180 ml)
what is the most common type of hypertonic enema?
Fleet enema
who should not have a hypertonic /fleet enema?
patients who are dehydrated
patients who are young infants
How do soapsuds act as enemas?
- intestinal irritation
- stimulates peristalsis
- only use pure castile soap
what type of soap should not be used for enema?
harsh soaps
detergents
= bowel inflammation
how do oil-retention enemas help ?
- lubricate the rectum and colon
- feces absorb oil and become softer
- keep enema in several hours if possible
What 4 things can rectal manipulation do that we have to be cautious about?
- irritation to mucosa
- bleeding
- perforation of the bowel wall
- Stimulation of the vagus nerve
What is the most common use for an enema?
temporary relief of constipation
what is peristomal skin?
the skin around the stoma
needs to be kept clean and dry
what are concerning findings to report of the stoma/peristomal skin?
pale/discoloured
dark spots
lesions on stoma
peristomal skin irritation
signs of infection or trauma
how often is the stoma pouch changed?
2X/week
Q3 days in hospital
what is the maximum wear time of a bag?
7 days if the skin in intact and healthy without leakages
When do we have to change the bag regardless of time?
if it’s leaking (do not tape it)
if the patient notices itchiness or burning around the stoma
when do we measure a stoma?
each pouch change for the first week
then weekly or if leakages occur post op
