What are cleansing enemas used for?
Treat severe constipation or impaction.
Clear colon in prep for colonoscopy
Empty the colon when starting bowel training
Hypotonic solution enemas
Use saline, tap water, and soap
Introduce a large volume (500-1000 mL for adults, 100 to 250 mL for infants)
May be CI in pt with weakened intestinal walls
Hypertonic solution cleansing enemas
Usually smaller in volume (70-120 mL for adults)
Attracts water into the colon
May be CI for pt who tend to retain sodium or water (renal failure and CHF)
Low-given standard procedure
High-clears as much of colon as possible. Initial left lateral for instillation then dorsal recumbent and then the right lateral position for remainder of instillation.
What are retention enemas for?
Introduce a solution into the colon that is meant to be retained for a prolonged period.
Small volume-usually 90 to 120 mL
Instill 90-120 ml of oil into the rectum to soften stool and lube the rectum.
Given at least 1 hour prior to the cleansing enema.
Can be used to assist passing of hard stool or prior to digital removal.
Carminative retention enemas
Instill 60-150 ml of solution into rectum to help expel flatus and relieve bloating and distension.
Used after abdominal or pelvic surgery.
Medicated retention enemas
Used to instill antibiotics to treat infections in rectum or anus.
Nurtritive retention enemas
Admin fluid and nutrition through the rectum for dehydrated and frail pts. Commonly used in hospice care.
What are return flow enemas used for?
Known as a Harris flush. May be ordered to help a pt. expel flatus and relieve abdominal distension.
100-200 mL of tap water or saline is instilled into the rectum.
T or F
Hypertonic solutions are easier to retain and are less irritating.
Hypotonic and isotonic solutions are easier to retain and less irritating.
T or F
An ileostomy stoma is generally smaller than a colostomy stoma.
T or F
Output from on ostomy further on into the GI tract will have more digestive enzymes and increases the risk for skin breakdown.
Ileostomy stoma contains more digestive enzymes.
What is the primary goal for a pt. who just received an ostomy?
To have the pt. assume self-care
What is the first step in having the pt. assume self care of an ostomy?
Allowing the pt to adjust to the presence of an ostomy.
What should be done if you notice a stoma that is pale, dusky, black in color, or dry, or with sloughing tissues?
Report to the surgeon. These are signs of inadequate blood supply to that portion of the intestine.
T or F
A stoma above the descending colon usually has liquid output that cannot be controlled therefore it is not irrigated.
Enemas and stomas