rectal and vaginal meds Flashcards
cleansing enemas are for:
how do they act :
for promoting complete evacuation of feces from colon
act by stimulating peristalsis through infusion
-to prevent the escape of feces during surgery
-prepare the intestine for certain diagnostic tests eg radiography
-remove feces in instances of contipation or impaction
-establish reg bowel function as part of a bowel routine of lg volumes of solution
oil retention enemas
lubricate rectum and colon to allow feces to absorb oil and become softer and easier to pass
why are medicated enemas used
some are to reduce dangerously high serum potassium levels or to reduce bacteria in the colon before bowel surgery
how does an enema stimulate the defecaton reflex
the volume or type of fluid that breaks up the fecal mass stretches the rectal wall
position to give enema in
position for kids
why these positions?
left side lying (sims) w right knee flexed
kids=dorsal recumbent
allows enema solution to flow down w gravity along natural curve of sigmoid colon and rectum. this improves retention of solution
does prolapse contraindicate enema
yes
unless specified otherwise how much of tube dyou lube (enema)
5cm or P&P says 6-8cm
what do you do about air in package (enema)
expel air by running some solution through
what do you point toward when inserting enema
umbilicus
how far dyou insert enema
7-10cm
if youre struggling to insert tube what dyou do (enema)
let a little fluid out to soften and infuse into the feces. remove. then try reinserting slowly
if pt has impaction how dyou admin the enema
remove impaction
diff between high and low cleansing enemas
- High is to cleanse as much of the colon as possible. Pt changes from l lateral to dorsal recumbent to r lateral while administered to facilitate it following the lg intestine
- low enema cleans sigmoid colon and rectum only
how high dyou raise enema container. how quickly dyou do this
do slowly
30-45cm for high
30 for regular
7.5cm for low (in
what can you hold enema bag up with
IV pole once fluid flow is established
is abdominal cramping and distension normal w enema
yes
how long dyou tell pt to hold enema
as long as possible until urge to defecate.
after instillation of solution to child enema what dyou do while waiting for defecation
may need to gently hold buttocks. infants also
if pt is unable to hold enema solution during installation what do
slow rate of infusion
do rectal meds generally have many side effects?
is it predictable in r/t absorption and distribution?
no. theyre relatively safe
unpredictable
contraindications for rectal suppositories
recent surgery on rectum, bowel, prostate
rectal bleeding or prolapse
very low platelet counts
where should you place rectal suppository within anus
past internal anal sphincter and against the rectal mucosa
position for rectal suppository
left side lying sims position w upper leg flexed forward
postion for immobile pt for suppository
lateral position. put pillow under upper arm nd leg
if impation is suspected for rectal suppository what do
palpate rectal walls as necessary. dispose of gloves if you do
what dyou lubricate for suppository
finger, anus, suppository. thoroughly
instructions to pt just before insertion of suppository
take slow, deep breaths through mouth and relax anal sphincter
hiw to insert suppository
retract pts buttock w nondominant hand. w gloved index finger insert suppository gently through anus past internal sphincter and against rectal wall 10cm or 4inches in adults.
what should you feel when inserting rectal suppository
rectal sphincter close around finger
how deep dyou insert supp for adults or kids
adult 10cm 4 inches
kid 5cm or 2inches
how long dyou ask pt to stay lying flat or on side after rectal supp
5min
if supp was given for constipation and pt is able to go to toilet what dyou remind them
dont flush. nurse should ispect stool first
why would pt experience dec heart rate
vagal stimulation may occur. monitor their heart rate if this happens
whats larger a vaginal or rectal supp
vaginal
procedure vaginal supp
Procedure • Ask pt to void • Normally painless • Assess and clean peri area • Lube the rounded end of the suppository • Lube finger Suppository • Insert 8-10cm or as far as possible along posterior wall as its 2.5cm longer • Ask pt to remain supine 5-10min
why are vaginal instillations given
to treat infection or relieve vaginal discomfort
what is a vaginal irrigation
its a douche (washing of vagina w liquid at low pressure
why is vaginal irrigation used
not nec for reg hygiene. its for removing discharge, preventing infection, to prevent inflm or (to prevent hemmorhage by using hot or cold)
position for vaginal supp
back lying w knees flexed and hips rotated laterally
or w hips elevated on pillow
how far do you insert vaginal supp
alog posterior or anterior wall of vagina
8-10cm along posterior wall, or as far as it will go
procedure vaginal supp
Procedure
• Ask pt to void
• Normally painless
• Assess and clean peri area. ask abt any discomfort in the area
• Lube the rounded end of the suppository
• Lube finger
expose area by holding labia w nondominant hand
Suppository
• Insert 8-10cm or as far as possible along posterior wall as its 2.5cm longer
• Ask pt to remain supine 5-10min
how far dyou insert vaginal cream jelly or foam
procedure
vaginal creams, jellies, foams insert applicator 5cm
• put applicator on towel after
• askpt to remain lying 5-10min
vaginal irrigation procedure
vaginal irrigation
• place on bedpan
• clamp tubing. Hold irrigating container abt 30cm away from vagina (so theres not too much pressure)
• run fluid into bedpan to moisten nozzle
• insert nozzle 7-10cm towards sacrum, start flow, rotate to irrigate all parts of vagina. let irrigating olution flow out into bedpan
• assistpt to sitting to allow drainage
• dry
how does hyertonic solution work as enema
• hypertonic solutions (sodium phosphate, saline): exert osmotic pressureto draw fluid into colon. Commonly used=fleet enema
how does hypotonic solution work as enema
• hypotonic (tap water) cause water to move from colon to interstitial space. Don’t repeat this to avoid circulatory overload
how does isotonic solution work as enemas
• isotonic solution; saline. Safest. No fluid movment. Only the distension causes defecation
how do soapsuds work as enema
• soapsuds:stim peristalsis by inc the volume in colon and the irritating the mucosa. Only use pure soap\
why is return flow enema used
return flow enema-to expel flatus. (occasionally used)
• alt 100-200ml of fluid into and out of rectum and sigmoid colon to stimperistalisis
• repeat 5-6 times until abd distension/flatus is relieved
infant and kid enema what type of solution do you give hypo iso or hypertonic
isotonic
position for enema according to kozier
dorsal recumbent
• for infants and kids dorsal recumbent freq used. Secure the legs by placing a diaper under the bedpan and then over and under the thigh
what type of solution should always be used for kids and infants
isotonic eg normal saline
max height of an enema for an infant
7.5cm
procedure and considerations for enema delivery to infant or child
Infants and children
• Explain carefully (to preschool age)
• Use isotonic solution
• Infants and small kids don’t have sphincter control yet and must be assisted to retain the enema
• Nurse gives the enema with the infant/kid lying down w butt on bedpan. Nurse firmly presses buttocks together to prevent premature expulsion
• Enema temp 37.7
• for infants and kids dorsal recumbent freq used. Secure the legs by placing a diaper under the bedpan and then over and under the thigh
• insert tube 5-7.5cm in kid and 2.5-3.75cm in infant
• to assist small child in retaining the solution apply firm pressure over the anus w tissue wipes or press cheeks tog firmly
what does a high enema require
a medical prescription
large volume enemas for infants and kids (3)
- Large volume 50-200ml in kids under 18mo old
- 200-300ml kids 18mo-5yr
- 300-500ml 5-12
how long should client retain a retention enema
30min
how long should client retain cleansing enema
5-10min
instructions for pt before giving vaginal supp
please void
which do you insert farther, a aginal cream jelly or foam OR an irrigation
irrigation approx 7-10cm and the others are 5cm
