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Administering Enema

OVERVIEW
  • To evacuate the bowel of stool caused by constipation.
  • To cleanse the bowel prior to surgery or other procedures for which the bowel, colon, and rectum are visualized.

PREPARATION

  • Determine patient’s ability to understand procedure.
  • Assess patient’s ability to participate in procedure, such as holding contents when administered.

SPECIAL CONSIDERATIOS

  • Patients who have had recent surgery, or who have arthritis, a cast, lower limb amputations, or fractured pelvis may need additional time for the procedure, owing to limited physical mobility.
  • Patients with cardiac history or spinal cord injury may be at risk for complications from vagal stimulation.

Elderly and Physically and Mentally Challenged Patients

  • May need more time and instruction of the procedure for optimal participation and results.

Pediatric Patient

  • Care should be taken in insertion of the enema tube and instillation of the solution to prevent injury to anus and colon during the procedure.
  • Parents should be allowed to comfort infants and children and participate in the procedure.

RELEVANT NURSING DIAGNOSES

  • Constipation related to decreased peristalsis
  • Chronic pain related to abdominal discomfort and distention from bowel malfunction
  • Potential for injury related to abdominal distention and trauma to the anus and colon during the procedure

EXPECTED OUTCOMES

  • Patient will return to an optimal bowel elimination pattern
  • Patient is able to assist/participate
  • Patient will be able to evacuate feces from rectum and colon after the enema
  • Patient experiences minimal discomfort during procedure and no injury to the colon and/or anus
  • Patient experiences relief and comfort after procedure

EQUIPMENT/SUPPLIES

  • Regular bedpan, fracture pan, or bedside commode
  • Water-soluble lubricant
  • Clean gloves
  • Toilet paper
  • Disposable, absorbent bed pads
  • Skin care items (i.e., soap or skin cleanser,water, towels)
  • IV pole
  • Enema container with tubing, normal saline, tap water, soap solution, or commercially prepared enema.

IMPLEMENTATION

  • Check prescriber’s order; identify patient; explain purpose, procedure, and how patient can assist. Assess patient’s ability to participate.
  • Confirms order; meets patient’s right to be informed; encourages cooperation and participation.
  • Gather all equipment and place in an easy to access area in patient’s room; adjust lighting as needed.Promotes organization of equipment; saves time; and adjusted lighting enhances visualization for procedure.
  • Explain to the patient the benefits of relaxing and taking periodic deep breaths. Reduces anxiety and promotes comfort.
  • Wash hands, and don clean gloves. Reduces transmission of infectious microorganisms, and prevents contact with urine and/or feces.
  • After determining patient’s ability to assist, place disposable waterproof pad under patient. Have patient lift hips or roll from side to side.
  • Bed pad protects against soiling of linens.
  • Place patient in a left side-lying position with knees flexed. To facilitate flow of solution using contour of the bowel.
  • Place bedpan next to patient. For easy access in case patient cannot hold enema solution.

Enema Bag (For Cleansing Enemas Using Soap Suds,Tap Water, or Saline)

  • Fill enema container with 750 mL to 1000 mL of warm solution and check temperature by dripping some solution on inner wrist. If too warm, empty container and refill. Add soap solution if ordered. This amount of solution is the standard volume unless a specific amount is ordered by the physician. This amount is normally what is tolerated; solutions that are too hot or too cold can cause cramping, damage to the rectal mucosa, or extreme shock.
  • Allow the solution to run through the tubing to clear out the air; clamp tubing and hang on an IV pole approximately 12 to 18 inches above the patient’s buttocks. Aids in removing air from the tubing that could cause abdominal cramping if instilled into the colon during the procedure; 18 inches is considered a high height, and 12 inches is considered a low height. The higher the pole, the faster the solution will enter the colon.
  • Lubricate tip of tubing with generous amount of water-soluble lubricant. Facilitates easier insertion of tubing into the rectum.
  • Spread the buttocks, and gently insert the tip of the tubing 3 to 4 inches while the patient is instructed to take slow deep breaths. 3 to 4 inches is the correct placement of tubing in the rectum to allow solution to enter the colon without leakage; slow, deep breaths aids in relaxation of the rectal sphincter.
  • Open the regulating clamp and allow the solution to flow slowly. When the solution is instilled slowly, less cramping is experienced by the patient, and the patient will be able to tolerate more volume of the solution.
  • Hold the tubing in place in the patient’s rectum at all times, and keep the bedpan nearby. The tubing will slip out easily if not held in place; the patient may need to expel contents before expected.
  • Lower the solution container or clamp tubing if the patient complains of cramping, then resume after a few minutes. Lowering the container will slow down the flow of solution and aid in decreasing cramps.
  • After solution is instill, clamp tubing and gently remove. Prevents siphoning out enema solution as tube is removed.
  • Instruct the patient to hold the solution about 10 to 15 minutes or longer as tolerated. The longer the solution is retained, the more effective the results.
  • Provide bedpan or assist to commode as needed. Aids in evacuation of solution and feces.
  • Instruct patients with cardiovascular disease not to strain when expelling contents. Avoids creating the Valsalva maneuver, which can lead to sudden cardiac arrest.
  • Assist patient with personal hygiene as needed. Provides patient comfort, and reduces transmission of infectious microorganisms.
  • Assist patient back to bed as needed and into a comfortable position. Patient comfort.
  • Dispose of enema equipment and clean bedpan or bedside commode as needed. Prevents transmission of infectious microorganisms.
  • Remove gloves and wash hands. Prevents transmission of infectious microorganisms.

Commercially Prepared Enema (Fleet’s, Oil, or Medicated)

  • Prepare patient and environment as described in first section.
  • Lubricate tip of enema container as needed (most are prelubricated). Facilitates easier insertion into the rectum.
  • Spread buttocks and insert the tip into the rectum.
  • Gently squeeze entire contents of the container. Aids in optimal results if all solution is instilled.
  • Remove the tip while continuing to squeeze the container. To prevent the solution from being siphoned back into the container.
  • Instruct the patient to hold the solution at least 5 to 7 minutes. To ensure optimal results.
  • Provide bedpan or assist to commode as needed. Aids in evacuation of solution and feces.
  • Instruct patients with cardiovascular disease not to strain when expelling contents. Avoids creating the Valsalva maneuver, which can lead to sudden cardiac arrest.
  • Assist patient with personal hygiene as needed. Provides patient comfort, and reduces transmission of infectious microorganisms.
  • Assist patient back to bed as needed and into a comfortable position. Patient comfort.
  • Dispose of enema equipment, and clean bedpan or bedside commode as needed. Prevents transmission of infectious microorganisms.
  • Remove gloves and wash hands. Prevents transmission of infectious microorganisms.

EVALUATION AND FOLLOW-UP AC T I V I T I E S

  • Evaluate patient compliance and ability to tolerate procedure
  • Administration of an enema is done correctly, safely, and successfully
  • An optimal pattern of elimination is maintained or restored

KEY POINTS FOR REPORTING AND RECORDING

  • Record date, time, type, and results of enema administration, as well as amount and other important characteristics of stool (as required in the designated area on the patient record).
  • Record patient’s tolerance of procedure and any complications that occurred.
  • Report patient teaching about prevention of constipation.
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