What is an enema?
instillation of a solution into rectum & sigmoid colon.
Why are enemas performed?
- stimulate peristalsis
- evacuate stool from the rectum
- soften stool
- surgical or procedure prep
- administer meds
- introduce barium sulfate for diagnostic purposes
- remove flatus
What are cleansing enemas for?
promote complete evacuation of feces from the colon.
when should you not give an enema to a patient?
- recent colon, rectal, or porstate surgery
- rectal bleeding
- recent MI
- undiagnosed abdominal pain
- increased intracranial pressure
What are problems with tap water (hypotonic) enema solution?
Should not be used after first installation because of water toxicity or circulatory overload can develop. Its OK for adults but not for infants.
Which is the safest type pf enema solution?
normal saline. used for infants and children
What is a hypertonic solution used for?
Patients who cannot take in a large volume of fluid.
What are the rectal tubing sizes for adults, children, and infants?
- adults: 14-30 Fr
- children: 12-18 Fr
- infants: 12 Fr
What are the different types of enemas?
- oil retention
- carminative return flow
What are examples of cleasing enemas?
- tap water
- normal saline
- "castile" soap suds
what does it mean of an order for "enemas until clear"?
the water expelled may be colored but should not contain solid fecal material.
What is the max of enemas to give?
3x a day before electrolyte and fluid imbalance.
What is a hypotonic solution?
Tap water, ok for adults not for infants. lower osmotic pressure than fluid in intestinal tissues means net low of water is out of bowel into tissues.
What is a isotonic cleansing solution?
Normal saline, produces equal concentration of solutes on both sides of the emipermeable membrane means no net water flow.
what is a hypertonic solution?
Fleet enema, higher concentration of solutes than interstitial fluid means net flow of water into the colon. Good for patients who cant tolerate large volumes of fluid.
What are medicated enemas for?
- ie. Kayexalate, lactulose
- pharmocological effect related to meds.
- Treats:elevate potassium levels (Kayexalate), chronic constipation (lactulose), elevated ammonia levels r/2 hepatic disease (lactulose), bowel inflammation (steroids), infection (antibiotics)
What is a carminative enema used for?
- ie. MGW (magnesium, glycerin, water)
- relieves gas and stimlates peristalsis, retention time 5-10 mins
What is a return flow enema?
- ie. Harris flush
- relieves gas by stimulating peristalsis.
- no retention time repeat raising and lowering bag until gas is removed.
what is oil rentention enema used for?
helps treat constipation by facilitating defectation via lubricating rectum/colon and softening feces. Need 100-250 ml. Hold for 30-60 seconds.
What is the reccommended volume of enema solution for adults, adolescents, children, toddlers, and infants?
- adults: 750-1000 ml
- adolescents: 500-700 ml
- childrens: 300-500 ml
- toddlers: 250-300 ml
- infants: 150-250 ml
If its a soap enema when should add the soap to the water?
after water is in place to reduce excessive suds.
What temperature should an enema be before administering?
warm tap water
what happens if the enema is cold or hot?
- cold cause abdominal cramping and difficult to retain.
- Hot cause damage to mucous.
What do you assess for in patient?
- MD order-type, volume, solution, reason
- medical record for contraindications
- level of understanding
- abdominal assessment
- last bowel movement
- any abdominal pain or cramping
- client mobility
what are some expected outcomes to giving an enema?
- stool is evacuated
- enema return in clear
- abdomen is soft and nondistended
- decrease gas
An enema administration can be done by a NAP.
what is the purpose of an high enema?
to increase the water pressure to deliver the fluid higher into the bowel.
How hig should raise the bag for high enema, regular enema, and low enema?
above anus for high enema 12-18 inches, regular enema 12 inches, low enema 3 inches.
What should you do if a patient is unable to hold enema?
- if it happens while instillation, slow rate of infusion.
- postion on bedpan while adminstering solution.
what should you do if a patient has severe cramping, bleeding, or sudden severe abdominal pain and is unrelieved by temporaily stopping or slowing flow of solution?
- stop enema
- notify health care provider
what should you do if an order for "enemas until clear," after three enemas and there is still solid fecal material?
notify health care provider.
should you use an enema or stool softner for treating constipation in children?