What type of enemas are used to expel flatus, stimulate peristalsis, and relieve abdominal distention?
Return-flow
These types of enemas are used to remove feces when a pt is constipated, has fecal impaction, or is unergoing preparation for surgery or diagnostic procedures.
Cleansing enema
This type of enama is given to reduce bacteria in the colon prior to surgery or to exert a systemic effect.
Medicated Enema
This type of enema is used to lubricate the colon and the rectum, making feces softer and easier to pass.
Oil retention enemas
A nurse is going to give a cleansing enema to a patient who had fecal incontinence and will most likely no retain the enema. What should the nurse do?
Place the patient in the dorsal recumbant position on a bedpan.
What position should the pt be in who recieving an enema?
left lateral with the right leg flexed.
A nurse is administering a cleansing enema, the pt reports abdominal cramping. what should the nurse do?
Lower the enema fluid container
while giving an enema, the nurse notices that the pt's abdomen becomes rigid and distended and has rectal bleeding. What should the nurse do?
Stop the enema instillation
How long should a pt retain an oil-retention enema?
30 min, but preferable as long as he can. it takes between 30 min to 3 hours for the oil to exert its theraputic effect
How far should you insert an enema for a an infant?
1 to 1.5 in
How far should you insert an enema for a child?
2 to 3 in (5cm- 7.5 cm)
How far should you insert an enema for an adult?
3 to 4 inches (7.5 to 10cm)
A nurse is giving a return flow enema to a pt. After giving 100ml of fluid what should the nurse do next?
Lower the container to allow the solution to flow back out. This is repeated 5 or 6 times
What is the maximum height the nurse should hold/hang the bag when giving a cleansing enema?
18 inches. hanging the bag higher can cause rapid instillation.
True of False. Tab water enemas can be given more than once
False. Tap water is a hypotonic solution that moves from the colon into the interstitial spaces and can cause circ overload and electrolyte imbalances
For a large volume enema, what is the recommended amt to instill for an adult pt?
750 to 1,000 ml
A wet to dry dressing is used for which type of debridement?
Mechanical
Applying larvae to the wound bed is what type of debridement?
Biological
Using a topical enzyme solution for debridement is what type of debridement?
Chemical debridement
True of false. The nurse would apply Zinc oxide to a stage 1 pressure ulcer.
True. Barrier creams and ointments are used for pts prone to skin breakdown.
True of false. the nurse would apply nystatin to a pt with a stage 1 pressure ulcer
false. this is a antifungal agent
A nurse is caring for a person suffering from wounds acquired in a car crash. Would the nurse include oygen at 2L/min via nasal cannula?
Yes. Following an acute injury, the body responds by increasing perfusion to the location of the injury during the inflammatory phase of wound healing. Oxygen is essential for healing
what is Hemostasis?
Stopping the bleeding.
Why is Asprin not advised for pain releif during the first part of the healing process (inflammatory phase)?
Hemostasis (stopping the bleeding) is an essential process of the inflam phase of healing. Asprin inhibits platelet action which could cause anticlotting prolonging healing
True or false. Corticosteroids delay wound healing.
True. Corticosteroids suppress the immune system and therefore can delay wound healing
True of false. Beta blockers delay wound healing.
False
The action of this certain medication that inhibit the transmission of parasympathetic nerve impulses and thereby reduce spasms of smooth muscle (such as that, for example, in the bladder)
Anticholinergics
True of False. Tricyclic antidepressants delay wound healing.
False.
Which of the following types of dressings should the nurse select to help minimize pain during dressing changes?
1)Wet-to-dry
2)Antimicrobial
3) Gauze
4) Hydrogel
4) hydrogel
These types of dressing help establish hemostasis while providing a moist environment for healing and good absorption of exudate. They do not adhere to the wound.
Alginate dressings
True or false. Biologic dressings promote hemostasis
False. they have no effect on hemostasis
True or False. Hydrofiber dressings promote Hemostasis
False. they no have effect on hemostasis
True or false. Transparent dressings promote hemostasis.
False. They have no effect on hemostasis
this type of wound exudate is watery in consistency and light red in color
Serosanguineous
This type of wound exudate is thin in consistency but is bright red in color.
Sanguineous
This type wound exudate is clear or light yellowish in color
serous
This type of exudate can be thick in consistency and is tan, yellow, or brown.