Enema administration. Suppository administration. Digital rectal examination. (1).pptx

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1. Enema administration. Suppository administration. Digital rectal examination. Lecture N5

2. Definition An enema is the administration of a substance in liquid form into the rectum, either to aid bowel evacuation or to administer medication.

3. Indications To clean the lower bowel before surgery, X-ray examination of the bowel using contrast medium or endoscopy examination To treat severe constipation when other methods have failed To introduce medication into the system To soothe and treat irritated bowel mucosa To decrease body temperature (due to contact with the proximal vascular system) To stop local haemorrhage To reduce hyperkalaemia (calcium resonium ) To reduce portal systemic encephalopathy (phosphate enema)

4. Contraindications In paralytic ileus In colonic obstruction Where the administration of tap water or soap and water enemas may cause circulatory overload, water intoxication, mucosal damage and necrosis, hyperkalaemia and cardiac arrhythmias Where the administration of large amounts of fl uid high into the colon may cause perforation and haemorrhage Following gastrointestinal or gynaecological surgery, where suture lines may be ruptured (unless medical consent has been given) Frailty Proctitis The use of microenemas and hypertonic saline enemas in patients with infl ammatory or ulcerative conditions of the large colon Recent radiotherapy to the lower pelvis unless medical consent has been given

5. Essential equipment: Disposable incontinence pad Disposable apron and gloves Rectal tube and funnel (if not using a commercially prepared pack) Solution required or commercially prepared enema Gauze squares Commode or bedpan if required Lubricating gel

6. Equipment: 2 par of non-sterile gloves

7. Equipment: 2 drape

8. Eqipment : Water-soluble libricant

9. Equipment: Cleansing enema

10. Equipment: Bed pen

11. Equipment: Folding screen

12. Procedure: Explain and discuss the procedure with the patient, ask permition . Ask about allergy 2. Wash hands, put non sterile gloves 3. Draw curtains around the patient or close the door to ensure privacy. 4 Turn patien to left side 4. Ensure that a bedpan, commode or toilet is readily available

13. Procedure:

14. Suppositories: Definition A suppository is 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.

15. Indications: To empty the bowel prior to certain types of surgery and investigations. To empty the bowel to relieve acute constipation or when other treatments for constipation have failed. To empty the bowel before endoscopic examination. To introduce medication into the system. To soothe and treat haemorrhoids or anal pruritus.

16. Contraindications : Chronic constipation, which would require repetitive use. Paralytic ileus. Colonic obstruction. Malignancy of the perianal region. Low platelet count. Following gastrointestinal or gynaecological operations, unless on the specific instructions of the doctor.

17. Pharmacology: There are several different types of suppository available. Retention suppositories are designed to deliver drug therapy, for example analgesia, antibiotic, non-steroidal anti-inflammatory drug (NSAID). Those designed to stimulate bowel evacuation include glycerine , bisacodyl and sodium bicarbonate. Lubricant suppositories, for example glycerine , should be inserted directly into the faeces and allowed to dissolve.

18. Equipment Disposable incontinence pad Disposable apron and gloves Gauze squares or tissues Lubricating gel Suppository( ies ) as required (check prescription before administering any suppository) Bedpan or commode if required

19. Procedure: Explain and discuss the procedure with the patient. If you are administering a medicated suppository, it is best to do so after the patient has emptied their bowels Wash hands. Draw curtains around the patient or close the door Ensure that a bedpan, commode or toilet is readily available. Assist the patient to lie on the left side, with the knees fl exed , the upper knee higher than the lower one, with the buttocks near the edge of the bed.

20. Place a disposable incontinence pad beneath the patient’s hips and buttocks. Wash hands and put on apron and gloves. Place some lubricating jelly on a gauze square and lubricate the blunt end of the suppository if it is being used to obtain systemic action. Separate the patient’s buttocks and insert the suppository blunt end first, advancing it for about 2–4 cm. Repeat this procedure if a second suppository is to be inserted. Ask the patient to retain the suppository( ies ) for 20 minutes, or until they are no longer able to do so. If a medicated suppository is given, remind the patient that its aim is not to stimulate evacuation and to retain the suppository for at least 20 minutes or as long as possible.

21. Digital rectal examination: Definition A digital rectal examination (DRE) is an invasive procedure that can be carried out, as part of a nursing assessment. The procedure involves inserting a lubricated gloved finger into the rectum.

22. Indications : To establish whether faecal matter is present in the rectum and, if so, to assess the amount and consistency • To ascertain anal tone and the ability to initiate a voluntary contraction and to what degree. • To teach pelvic floor exercises. • To assess anal pathology for the presence of foreign objects. • Prior to administering rectal medication to establish the state of the rectum. • To establish the eff ects of rectal medication. • To administer suppositories or enema prior to endoscopy. • To determine the need for digital removal of faeces (DRF) or digital rectal stimulation and evaluating bowel emptiness. • To assess the need for rectal medication and to evaluate its efficacy in certain circumstances, for example in patients who have diminished anal/rectal sensation. • For digital stimulation to trigger defaecation by stimulating the rectoanal reflex

23. Before carrying out a DRE, the perineal and perianal area should be checked for signs of rectal prolapse, haemorrhoids , anal skin tags, fi ssures or lesions, foreign bodies, scarring, infestations or a gaping anus.

24. Essential equipment: • Disposable incontinence pad • Disposable apron and gloves (check if patient allergic to latex) • Lubricating gel • Gauze squares or tissues • Bedpan or commode if required

25. Procedure: Explain and discuss procedure with the patient. Ensure privacy Ensure that a bedpan, commode or toilet is readily available. Assist the patient to lie in the left lateral position with knees fl exed , the upper knee higher than the lower knee, with the buttocks towards the edge of the bed Place a disposable incontinence pad beneath the patient’s hips and buttocks. Wash hands with bactericidal soap and water or bactericidal alcohol handrub and put on disposable gloves.

26. Observe anal area prior to the insertion of the fi nger into the anus for evidence of skin soreness, excoriation, swelling, haemorrhoids , rectal prolapse and infestation. Palpate the perianal area starting at 12 o’clock, clockwise to 6 o’clock and then from 12 anticlockwise to 6 o’clock Place some lubricating gel on a gauze square and gloved index fi nger . Inform the patient you are about to proceed. To minimize discomfort as lubrication reduces friction and to ease insertion of the fi nger into the anus/rectum. With fi nger inserted in the anus, sweep clockwise then anticlockwise, noting any irregularities

27. Sources: The Royal Marsden Manual of Clinical Nursing Procedure Edited by Lisa Dougherty and Sara Lister (pages N179-186) ევროპის უნივერსიტეტი

28. Thank you for attention!! ევროპის უნივერსიტეტი