LECTURE 3 (Enema) Flashcards
What is an Enema?
The administration of a substance in liquid form into the rectum, either to aid bowel evacuation or to administer medication
What are the indications for enema?
- To clean lower bowel before surgery, X-ray examination of bowel using contrast medium or endoscopy examination
- To treat severe constipation
- To introduce medication into the system
- To soothe + treat irritated bowel mucosa
- To decrease body temperature
- To stop local haemorrhage
- To reduce hyperkalemia
- To reduce portal systemic encephalopathy
What are the contraindications for enema?
- Paralytic ileus
- Colonic obstruction
- Where the administration may cause circulatory overload, water intoxication, mucosal damage and necrosis, hyperkalemia and cardiac arrhythmia
- Where the administration of large amounts of fluid may cause perforation and haemorrhage
- After GI or gynaecological surgery
- Frailty
- Proctitis (inflammation of lining of rectum)
What is a Suppository?
A solid or semi-solid, bullet-shaped pellet that is prepared by mixing a medication with a wax-like substance that melts once inserted into the rectum
What are the indications for suppositories?
- To empty the bowel before surgery + investigations
- To empty bowel to relieve acute constipation or when other treatments for constipation have failed
- To empty bowel before endoscopic examination
- To introduce medication into the system
- To soothe and treat haemorrhoids/anal pruritus
What are the contraindications for suppositories?
- Chronic constipation
(this would require repetitive use) - Paralytic ileus
- Colonic obstruction
- Malignancy of the perianal region
- Low platelet count
- Following GI or gynaecological operations (unless allowed by doctor)
What are the different types of suppositories?
- Retention suppositories = designed to deliver drug therapy (e.g analgesia, antibiotic, NSAIDs)
- Suppositories designed to stimulate bowel evacuation (e.g glycerine, bisacodyl and sodium bicarbonate)
- Lubricant suppositories = inserted directly into faeces + allowed to dissolve
What is a Digital rectal examination?
An invasive procedure that can be carried out as part of the nursing assessment. It involves inserting a lubricated gloved finger into the rectum.
What are the indications of Digital rectal examination (DRE)?
- To establish whether faecal matter is present in the rectum
- To assess anal tone and ability to initiate voluntary contraction
- To assess for foreign objects
- Prior to administrating rectal medication to establish state of rectum
- To determine digital removal if faeces
What must happen before carrying out a Digital Rectal Examination (DRE)?
The perineal area should be checked for signs of rectal prolapse, haemorrhoids, anal skin tags, fissures or lesions, foreign bodies, scarring, infestations or gasping anus
