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Administering an Enema

Prepackaged enema or enema container Disposable gloves Water-soluble jelly Waterproof pad Bath blanket Bedpan or commode Washcloth and towel Basin Toilet tissue

PROCEDURE Nursing Action Rationale

Preparatory phase 1. Assess the patient's bowel habits (last bowel 1. Enema should not be given if there movement, laxative usage, bowel patterns) and is a suspicion of appendicitis or physical condition (hemorrhoids, mobility, external bowel obstruction. sphincter control). 2. Provide for privacy, and explain procedure to patient. 2. Provides comfort. Performance phase 1. Wash hands. 1. 2. Place patient on left side with right knee flexed (Sims' 2. position). Place waterproof pad underneath patient, and cover with bath blanket. 3. Place bedpan or bedside commode in position for 3. patients who cannot ambulate to the toilet or who may have difficulty with sphincter control. 4. Remove plastic cover over tubing, and lubricate tip of 4. enema tubing 3-4 inches (7.5-10 cm) unless prepackaged (tip is already lubricated). Even prepackaged enema may need more lubricant.
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Promotes hygiene. Allows for enema solution to flow by gravity along the natural curve of the sigmoid colon and rectum. Allows for easy accessibility. Prevents trauma and eases application.

5. Apply disposable gloves. 6. Separate buttocks, and locate rectum. 7. Instruct patient that you will be inserting tubing and to 7. Allows for patient relaxation and take slow, deep breaths. readiness. 8. Insert tubing 3-4 inches for adult patients. 8. Prevents tissue trauma of rectum. 9. Slowly instill the solution using a clamp and the height 9. Rapid infusion can cause colon of the container to adjust flow rate if using an enema distention and cramping. Container bag and tubing. For high enemas, raise enema container elevated past 12-18 inches and 12-18 inches (30.5-45.5 cm) above anus; for low controller on tubing not regulated enemas, 12 inches. If using a prepackaged enema, contribute to rapid infusion. slowly squeeze the container until all solution is instilled. 10 Lower container or clamp tubing if patient complains . of cramping. 11 Withdraw rectal tubing after all enema solution has 11 Until clear means until results do . been instilled or until clear (usually not more than three . not contain fecal matter and are enemas). clear. 12 Instruct patient to hold solution as long as possible and 12 Promotes better results. . that a feeling of distention may be felt. . 13 Discard supplies in the appropriate trash receptacle. 13 Maintains hygiene, minimizes . . patient embarrassment. 14 Assist patient on the bedpan or to the bedside 14 Prompt action will prevent soiling. . commode or toilet when urge to defecate occurs. . 15 Observe enema return for amount, fecal content. 15 If enema has not had sufficient . Instruct patient not to flush toilet until the nurse has . time to absorb, result may be seen the results. mostly clear with little fecal material. NURSING ALERT Enemas should not be given routinely to treat constipation because they disrupt normal defecation reflexes and the patient becomes dependent. Follow-up phase 1. Document the type of enema given, volume, and results on the appropriate chart forms. 2. Assess and document presence or absence of 2. abdominal distention after enema was given. 3. Assist the patient with washing perineum and rectal 3. area, if indicated; may also need a clean gown or linen change.

Relief of abdominal distention indicates success of gas relief. Fecal soiling may result, especially in bedridden patients.

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