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242 and 170 > rectal and vaginal meds > Flashcards

rectal and vaginal meds Flashcards

1
Q

cleansing enemas are for:

how do they act :

A

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

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2
Q

oil retention enemas

A

lubricate rectum and colon to allow feces to absorb oil and become softer and easier to pass

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3
Q

why are medicated enemas used

A

some are to reduce dangerously high serum potassium levels or to reduce bacteria in the colon before bowel surgery

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4
Q

how does an enema stimulate the defecaton reflex

A

the volume or type of fluid that breaks up the fecal mass stretches the rectal wall

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5
Q

position to give enema in
position for kids
why these positions?

A

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

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6
Q

does prolapse contraindicate enema

A

yes

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7
Q

unless specified otherwise how much of tube dyou lube (enema)

A

5cm or P&P says 6-8cm

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8
Q

what do you do about air in package (enema)

A

expel air by running some solution through

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9
Q

what do you point toward when inserting enema

A

umbilicus

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10
Q

how far dyou insert enema

A

7-10cm

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11
Q

if youre struggling to insert tube what dyou do (enema)

A

let a little fluid out to soften and infuse into the feces. remove. then try reinserting slowly

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12
Q

if pt has impaction how dyou admin the enema

A

remove impaction

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13
Q

diff between high and low cleansing enemas

A
  • 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
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14
Q

how high dyou raise enema container. how quickly dyou do this

A

do slowly
30-45cm for high
30 for regular
7.5cm for low (in

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15
Q

what can you hold enema bag up with

A

IV pole once fluid flow is established

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16
Q

is abdominal cramping and distension normal w enema

A

yes

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17
Q

how long dyou tell pt to hold enema

A

as long as possible until urge to defecate.

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18
Q

after instillation of solution to child enema what dyou do while waiting for defecation

A

may need to gently hold buttocks. infants also

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19
Q

if pt is unable to hold enema solution during installation what do

A

slow rate of infusion

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20
Q

do rectal meds generally have many side effects?

is it predictable in r/t absorption and distribution?

A

no. theyre relatively safe

unpredictable

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21
Q

contraindications for rectal suppositories

A

recent surgery on rectum, bowel, prostate
rectal bleeding or prolapse
very low platelet counts

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22
Q

where should you place rectal suppository within anus

A

past internal anal sphincter and against the rectal mucosa

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23
Q

position for rectal suppository

A

left side lying sims position w upper leg flexed forward

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24
Q

postion for immobile pt for suppository

A

lateral position. put pillow under upper arm nd leg

25
Q

if impation is suspected for rectal suppository what do

A

palpate rectal walls as necessary. dispose of gloves if you do

26
Q

what dyou lubricate for suppository

A

finger, anus, suppository. thoroughly

27
Q

instructions to pt just before insertion of suppository

A

take slow, deep breaths through mouth and relax anal sphincter

28
Q

hiw to insert suppository

A

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.

29
Q

what should you feel when inserting rectal suppository

A

rectal sphincter close around finger

30
Q

how deep dyou insert supp for adults or kids

A

adult 10cm 4 inches

kid 5cm or 2inches

31
Q

how long dyou ask pt to stay lying flat or on side after rectal supp

A

5min

32
Q

if supp was given for constipation and pt is able to go to toilet what dyou remind them

A

dont flush. nurse should ispect stool first

33
Q

why would pt experience dec heart rate

A

vagal stimulation may occur. monitor their heart rate if this happens

34
Q

whats larger a vaginal or rectal supp

A

vaginal

35
Q

procedure vaginal supp

A 
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
36
Q

why are vaginal instillations given

A

to treat infection or relieve vaginal discomfort

37
Q

what is a vaginal irrigation

A

its a douche (washing of vagina w liquid at low pressure

38
Q

why is vaginal irrigation used

A

not nec for reg hygiene. its for removing discharge, preventing infection, to prevent inflm or (to prevent hemmorhage by using hot or cold)

39
Q

position for vaginal supp

A

back lying w knees flexed and hips rotated laterally

or w hips elevated on pillow

40
Q

how far do you insert vaginal supp

alog posterior or anterior wall of vagina

A

8-10cm along posterior wall, or as far as it will go

41
Q

procedure vaginal supp

A

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

42
Q

how far dyou insert vaginal cream jelly or foam

procedure

A

vaginal creams, jellies, foams insert applicator 5cm
• put applicator on towel after
• askpt to remain lying 5-10min

43
Q

vaginal irrigation procedure

A

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

44
Q

how does hyertonic solution work as enema

A

• hypertonic solutions (sodium phosphate, saline): exert osmotic pressureto draw fluid into colon. Commonly used=fleet enema

45
Q

how does hypotonic solution work as enema

A

• hypotonic (tap water) cause water to move from colon to interstitial space. Don’t repeat this to avoid circulatory overload

46
Q

how does isotonic solution work as enemas

A

• isotonic solution; saline. Safest. No fluid movment. Only the distension causes defecation

47
Q

how do soapsuds work as enema

A

• soapsuds:stim peristalsis by inc the volume in colon and the irritating the mucosa. Only use pure soap\

48
Q

why is return flow enema used

A

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

49
Q

infant and kid enema what type of solution do you give hypo iso or hypertonic

A

isotonic

50
Q

position for enema according to kozier

A

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

51
Q

what type of solution should always be used for kids and infants

A

isotonic eg normal saline

52
Q

max height of an enema for an infant

A

7.5cm

53
Q

procedure and considerations for enema delivery to infant or child

A

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

54
Q

what does a high enema require

A

a medical prescription

55
Q

large volume enemas for infants and kids (3)

A
  • Large volume 50-200ml in kids under 18mo old
  • 200-300ml kids 18mo-5yr
  • 300-500ml 5-12
56
Q

how long should client retain a retention enema

A

30min

57
Q

how long should client retain cleansing enema

A

5-10min

58
Q

instructions for pt before giving vaginal supp

A

please void

59
Q

which do you insert farther, a aginal cream jelly or foam OR an irrigation

A

irrigation approx 7-10cm and the others are 5cm

242 and 170 (5 decks)

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