Sunday, September 27, 2009

How To Administer An Enema To A Patient

The other day was the presentation day for all the nursing procedure that Miss Tracey has given us. Each group presented their respective nursing procedure. so in few days i will be posting here some of the the different nursing procedure that we are going to undertake during our clinical posting.

The first nursing procedure i will give you is how to administer an enema to a patient.


An enema is a solution introduced into the large intestine. The action of an enema is to distend the intestine and sometime to irritate the intestinal mucosa , thereby increasing peristalsis and the excretion of feces and flatus.


Enema are classified into 4 groups: 
  • Cleansing - Cleansing enemas are intended and remove feces.
  • Carminative - A carminative enema is given primarily to expel flatus.
  • Retention - A retention enema introduces oil or medication into the rectum and sigmoid colon
  • Return- flow enema - A return- flow enema is used occasionally to expel flatus. 
Why You Should Perform The Procedure?
Purpose
  • To achieve one or more of following actions; cleansing, carminative, retention or return-flow.
Assessment 
  • When the client last had a bowel movement and the amount, color and consistency of the feces.
  • Presence of abdominal distention ( the distended abdomen appears swollen and feels firm rather than soft when palpated)
  • Whether the client has sphincter.
  • Whether the client can use a toilet or must remain in bed and use a bedpan. 
Steps Of The Procedure?
  • Introduce yourself and verify the client’s identity using agency protocol. Explain to the client what you are going to do.
  • Perform hand hygiene, apply clean gloves, and observe appropriate infection control procedure.
  • Provide for client privacy.
  • Assist the adult client to a left lateral position, with the right leg as acutely flexed as possible and the linen-saver pad under the buttock
  • Insert the enema tube. 



  • Insert the tube smoothly and slowly into the rectum, directing it towards the umbilicus.




  • If resistance is encountered at the internal sphincter, ask the client to take a deep breath, then run a small amount of solution through the tube to relax the internal anal sphincter.




  • never force the tube or solution entry.


    •  Slowly administer the enema solution.


  • Compress a pliable container by hand.




  • During most low enemas hold or hang the solution than 30 cm (12 in) above the rectum.




  • Administer the fluid slowly.




  • Using the plastic commercial container, roll it up as the fluid is instilled. This prevent subsequent suctioning of the solution.




  • After the solution , close the clamp and remove the enema tube from the anus.




  • Place the enema tube in a disposable towel as you withdraw it.




    • Encourage the client to retain the enema.


  • Request that the client retain the solution.




  • ask the client to remain lying down


    • Assist the client to defecate.  
    • Assist the client to a sitting position on the bedpan or toilet. A sitting position facilitates the act of defecation.
    • Ask the client to using the toilet but not to flush because needs to observe the feces.





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