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Maintaining/Assessing enemas
- •Explain procedure – make sure pt knows what they have to do
- •Caution to giving more than 3 – get okay from physician before giving more than 3
- •“Give till clear” enema is repeated until the client passes fluid that is clear and contains no fecal material
- •Gather quipment
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What equipment is needed for giving an enema?
- –Clean gloves
- –Water soluble lubricant
- –Absorbent pads
- –Bath blanket
- –Good to have bedside commode ready just in case client wouldn’t make it in time
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What do you do if client has pain, bleeding, or abdomen becomes rigid during an enema?
- Pain: slow down enema
- Bleeding/abdom becomes rigid: stop enema immediately and call the physician (happens rarely, but something it means that intestinal wall could have become perforated)
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Interventions for constipation
- Encourage fluid intake or appropriate fluids, fruit juice, and water
- Encourage activity within the limits of client’s mobility regimen
- Provide laxitives/stool softeners as ordered
- Provide privacy
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Interventions for diarrhea
- Use of OTC anti-diarrheals like immodium
- MOST EFFECTIVE = prescriptive opiates such as codeine phosphate, opium tincture (paregoric) and diphenoxylate (Lomotil) these decrease muscle tone to slow passage of feces
- Recommend foods low in fiber content
- Discourage foods that typically cause gastricupset or abdominal cramping
- If client can’t tolerate foods po, IV therapy (with potassium supplements) may be necessary
- At times, it is also necessary to administer IV therapy to ensure proper electrolyte balance
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How can antibiotics affect the GI tract?
antibiotics can case diarrhea
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Normal bowl sounds occur...
- Normal bowl sounds occur every 5 -15 seconds and last 1 to several seconds
- Normal sounds also occur 5 to 35 times/minute
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bowl sounds: increase in pitch/tinkling
- abdominal distention
- hyperactive bowl sounds and small intestine obstruction or inflammatory disorders
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bowl sounds: tympanic sound
gas/flatulence
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borborygmi
- Hyperactive sounds are often loud, growling, called borborygmi, indicates increased GI motility.
- Could be caused by inflammation of bowel, anxiety, diarrhea,m bleeding, excessive ingestion of laxatives, and reaction of intestines to certain foods
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35 sounds or more/minute
hyperactive
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Less than 5 sounds/minute
hypoactive
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Absence of bowl sounds
- You must listen for at least 5 minutes continuously before declaring absent bowl sounds
- called paralytic ileus, due to recent abdominal surgery or abdominal obstruction
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