Presentation patient with enema in hospital.pptx

Presentation patient with enema in hospital

1. ENEMA Definition Purposes Indication Articles General instruction Steps of procedure After care and documentation

2. Introduction Enema are used to treat constipation or empty the bowel before diagnostic procedures or abdominal surgeries. Frequent enemas disrupt the normal defecation reflexes resulting in dependence on them for elimination. Cleansing enemas promote complete evacuation of feces and medicated enemas contain pharmacological agents.

3. Definition ACCORDING TO POTTER AND PERRY; An enema is the instillation of a solution into rectum and sigmoid colon to promote defecation by stimulating peristalsis. ACCORDING TO SR.NANCY: An enema is introduction of fluid into lower bowel through the rectum for the purpose of cleansing or to introduce medication or nourishment.

4. Enemas promote defecation by stimulating peristalsis. The volume or type of fluid breaks up the fecal mass, stretches the rectal wall, and initiates the defecation reflex. A warmed enema solution is more comfortable and better tolerated by the patient.

5. Purposes To treat constipation To empty the bowel before diagnostic procedures or certain types of abdominal surgery.

6. Classification of enema Enema Evacuant Enema Retained Enema Stimulant Anaesthetic Simple Emolient Nutrient Medicated Cold Sedative Oil Carminative Anti Helminthic Astringent Purgative

7. Types of enemas include Type Constituent Action Carminative solution: provides relief from gaseous distention. MGW solution, which contains 30 ml of Magnesium, 60 ml of Glycerin , and 90 ml of Water The solution instilled into the rectum releases gas, which in turn distends the rectum & colon, thus stimulating peristalsis Harris flush enema: a return flow enema that helps expel intestinal gas. 100-200 ml of Fluid alternately flows into and out of the large intestine, stimulating peristalsis and assisting with gas expulsion Oil-retention enema: which is an oil-based solution. Mineral, olive, cottonseed oil 90-120 ml The stool absorbs a small volume of oil, which softens it for easier evacuation. The oil also acts as a colon lubricant, further aiding evacuation

8. Types of enemas include Type Constituent Action Hypertonic solution enema: used for patients who cannot tolerate large volumes of fluid 90 -120 ml of solutions eg . Sodium phosphate Small amounts (4 to 6 oz) are adequate to stimulate defecation. Draws water into the colon Isotonic solution enema: Physiologic 9% sodium chloride solution enema, which is considered to be the safest enema 500-1000 ml of normal saline Distends colon, stimulates peristalsis, and softens feces Infants and children tolerate only this type because of their predisposition to fluid imbalance.

9. Types of enemas include Type Constituent Action Hypotonic (Tap water) enema: used for patients who can tolerate large volumes of fluid 500-1000 ml of tap water Distends colon, stimulates peristalsis, and softens feces which should not be repeated after the first instillation because the patient may develop water toxicity or circulatory overload. Soapsuds enema: , consists of a pure castile soap added to either tap water or 0.9% sodium chloride solution, 500-1000 ml 3-5 ml soap to 1000 ml of tap water or normal saline Irritates mucosa, Distends colon depending on the patient’s condition and the frequency of administration. Only pure castile soap should be used.

10. General Instructions for Enema Appropriate size catheter or rectal tube needs to be used. For cleansing enema adults-22f, infant-12f, school age-14-18f. Rectal tube should be smooth and flexible. Sharp or ragged tube should be avoided as it may cause damage to mucus membrane. Rectal tube is lubricated with water soluble lubricant or with Vaseline to facilitate insertion and to decrease irritation of rectal mucosa.

11. The temperature of enema solution should be accurately between 105-110°F(40.5-43°C) for adults and 100°F(37.7°C) for children ( evacuant ) and retained to be given at body temp. Amount of solution depends on the type of solution. Evacuant : 500-1000 ml (adults), 250-500 ml (child), ≤250 ml (infant) Retained: not more than 100-150 ml

12. Client should assume left lateral position. Insertion of tube depends on age and sex of client. Adults: 7.5-10 cm ( 3-4 inches), children: 2.5-3.7 cm ( 1-1.5 inches)

13. Height of can, can be adjusted to regulate the flow of solution. Cleansing enemas: 18 inches (45cms) from anus, retention enemas: not more than 8 inches from anus (20 cms ) Oil retention enema is retained usually for 2-3 hrs and cleansing enema are for 5-10 mins . Prevent air entry into rectum by- Removing froth from solution Expelling air from tube Not letting fluid run incompletely in tube

14. These are recommended fluid volumes of warmed solution for enemas: Adult: 750 to 1000 ml Adolescent: 500 to 700 ml School-age child: 300 to 500 ml Toddler: 250 to 350 ml Infant: 150 to 250 ml When a rectal tube is used for enema administration, the appropriate tube size for an adult is 22 to 30 Fr; for a child, it is 12 to 18 Fr.

15. Methods of giving enema Using enema container and tube Using proctolysis (Prepackaged disposable enema bag) Glycerin syringe and catheter method Funnel and catheter method

16. Supplies Gloves Water-soluble lubricant Waterproof, absorbent pads Toilet tissue Bedpan, bedside commode, or access to toilet Basin, washcloths, towel, and soap Bath blanket • • Enema container • Tubing and clamp (if not already attached to container) • Appropriate-size rectal tube • Correct volume of warmed solution • IV pole

17. Enema Bag Administration Enema container Tubing and clamp (if not already attached to container) Appropriate-size rectal tube Correct volume of warmed solution IV pole

18. Prepackaged Enema Prepackaged enema container with rectal tip

19. Preliminary assessment Check the diagnosis Check date and type of surgery Check abilities and limitations concerning movement Check consciousness and ability to follow direction Check nature of enema ordered and special precautions if any Check general condition of client indability to retain fluid Check for any perineal lesions or abscess

20. ALERT Do not administer an enema while the patient is sitting on the toilet because the curved rectal tubing may abrade the rectal wall. If the patient experiences pain or if resistance is felt during the procedure, stop the enema and consult with the practitioner.

21. Preparation of client Explain the procedure to client to win confidence and cooperation Provide privacy with curtains Cover the client with bedsheet or blanket Remove back rest and pillows Place mackintosh and towel under clients buttocks to protect from soiling Place client in left lateral position with buttocks close to the edges Adjust IV stand to hold the enema as required

22. Steps of procedure Video

23. After care of Client & Articles Encourage client to retain the fluid for 10-15 mins . Encourage slow breathing with open mouth. Observe enema results, noting the color, consistency and amount. Obtain specimens if needed. Remove bedpan, dry client, put on garments, change bed linen if needed, adjust the position of client in bed to make him comfortable

24. take all articles to utility room. Disinfect rectal tube, clean it and store it properly. Record type of enema, its results, untoward results if any with date and time in nurses notes.

25. Special considerations Pediatric The use of oral stool softeners is often recommended in treatment of constipation Geriatric Older adults may tire quickly and are at risk of fluid and electrolyte imbalances. Teach older adults and caregivers the need for dietary fibers and measures to avoid constipation. Older adults may have difficulty in retaining.

26. Home care Assess patients and family caregivers ability to administer enema in home. Assess patients ability to manipulate equipment to administer enema. Instruct patient and caregiver not to exceed volume of enema.

27. Bloating Vs Distention Bloating refers to the sensation of abdominal (tummy) swelling, sometimes described as the feeling of an inflated balloon in the belly. By contrast, abdominal distention refers to an actual increase in measured abdominal size.