ADMINISTRATION OF ENEMA

BY MISS VISHALNI

LEARNING OUTCOMES
By the end of this session students : 1) Will be able to identify what is enema. 2) Will be able to list out 4 classifications of enema. 3) Will be able to understand the purposes of

enema administration. 4) Will be able to practise administration of enema using the correct techniques. 5) Will be able to identify the complications of enema.

WHAT IS ENEMA?
A solution introduced into the rectum &

sigmoid colon. Its function is to remove faeces &/flatus. There are 4types of enema such as cleansing, carminative, retention and return flow enema.

CLASSIFICATIONS OF ENEMA
1) CLEANSING ENEMA - Stimulates peristalsis by irritating the colon & rectum by distending the intestine - Effective to be held for 5-10 minutes only. -High Enema to clean the colon as much as possible. 1 Litre of solution is used - Low Enema to clean the rectum & sigmoid colon only. O.5Litre solution is used.

2) CARMINATIVE ENEMA - Primarily given to expel flatus. - Solution is instilled into the rectum to release gas, which distends the rectum & colon, thus stimulating peristalsis. - Usually 60-180mls of fluid is instilled.

3) RETENTION ENEMA - A retention enema introduces oil into the rectum & sigmoid colon and retained for almost 1 to 3 hours. - Softens the faeces and lubricate the rectum & anal canal.

4) RETURN FLOW ENEMA - Referred to as Harris flush/ colonic irrigation. Used to expel flatus. - Alternating flow of 100-200mls of fluid into & out of the large intestines stimulates peristalsis and expulsion of faeces.

PROCEDURE : ADMINISTRATING ENEMA

Objective : To facilitate bowel elimination Purposes : 1) Bowel preparation for diagnostic

test/surgery etc xray & colonoscopy 2) Delivery of medication into the colon( enemas containing neomycin to decrease bowels bacteria count or carminative enema to remove gases.

Continuation.....
3) To soften the stool( oil retention enema) 4) To relieve gas ( return flow enema) 5)To remove faeces in instances of

constipation / impaction

EQUIPMENTS FOR ADMINISTERING ENEMA

1) INCOPAD/ DRAW SHEET 2) BATH BLANKET 3)TRAY WITH : - Clean gloves -Lubricant-K.Y Jelly - Enema solution -Galipot with gauze/paper towel 4)RECEIVER 5)BEDPAN

PROCEDURE FOR ADMINISTRATING ENEMA

STEPS
1) Check doctors order. 2)Explain the procedure to the patient. Inform that there may be a feeling of fullness while the solution is being administered. 3)Prepare equipments. 4)Wash hands 5)Provide privacy

RATIONALE

6)Assist adult and school aged This position facilitates the flow of patients to a left lateral position, solution by gravity into the sigmoid with the right leg acutely flexed and and descending colon, which are on drape with bath blanket. the left side. Having the right leg acutely flexed provides for adequate exposure of the anus.

LEFT LATERAL POSITION

STEPS
7)Place a incopad / drawsheet under the patient's buttocks.
8)Cover unnecessary patients body part with a bath blanket. 9)Open enema package 10)Lubricate the tip of the enema using K.Y Jelly

RATIONALE

To protect the bed linen.

Lubrication facilitates insertion through the sphincters and minimizes trauma.

STEPS
11)Wear gloves, Insert enema to anus while asking patient to take deep breaths .Note any discomfort or obstruction on insertion.

RATIONALE

12)If resistance is encountered at Deep breathing and inserting a the internal sphincter, ask the small amount of the solution may patient to take a deep breath. If relax the sphincter. the resistance persists, withdraw the tube and report the resistance to the nurse in charge/physician.
13)Administer all the solutions by rolling up the enema container.

STEPS
14) Remove enema nozzle from the anus.

RATIONALE

15)Clean the patients anus using gauze/ paper towel.

16) Encourage patient to retain the enema by lying down about 5 to 10 minutes. It is easier for a person to retain the enema while lying down than sitting or standing because gravity promotes drainage and peristalsis.

STEPS

RATIONALE

17)Assist the patient to a sitting A sitting position promotes position on a bed pan, commode or defecation toilet. 18)Ensure patients comfort 19)Clear the equipments 20)Record the procedure, the amount, colour, consistency of returns, the presence of unusual constituents ( e.g. worms ) and relief of abdominal distension or flatus and all assessment. Proper recording enhances accountability.

COMPLICATION / RISKS OF ENEMA

Enema is a relatively safe procedure. Main dangers are : 1) Irritation of the rectal mucosa by too much

soap or irritating to the skin Osmosis if hypertonic solution is used(because fluid drawn into colon from surrounding tissues). 3) Water intoxication. 4) Electrolyte imbalance.

NURSING RESPONSIBILITY Teach the client practises that develop regular and normal defecation
1) Eating a balanced diet with adequate

roughage. 2)Cereals, raw fruits & raw vegetable. 3) Adequate fluid intake(1500mls/day) 4)Eating regular meals 5)Regular pattern of defecation 6)Regular exercises.

WHIZZ QUIZ !!
1) What is enema? a) A solution to eliminate food b) A substance of oil and gas c) A solution introduced into the anus d) A solution introduced into the rectum and

sigmoid colon

 2) Cleansing enema stimulates peristalsis by

irritating colon& rectum and by ______ the intestine. a) distending b) constricting c) closing d) opening

3)A return flow enema is commonly referred to as the colonic irrigation or ________. a)Garry flush b)Harris flush c)Pokemon flush d)Bieber flush

 4)Which enema is given primarily to expel

flatus? a)Cleansing Enema b)Carminative Enema c)Retention Enema d)Return flow Enema

5) A retention enema introduces _____ into the rectum & sigmoid colon. a)Soap b)water c)oil d)Petrol

 6)What is the objective of administrating the

enema? a) To improve peristalsis b) To maintain good metabolism c) To encourage bowel elimination d) To minimize impacted stool

 7) Assisting patient in the left lateral position

when administrating enema is to____? a) Facilitate the flow of solution into the sigmoid following gravity. b) Encourage patients comfort c) Making the process of administrating enema much faster. d) Hold the enema fluid properly once inserted into the sigmoid.

 8)Deep breathing technique in

administration of enema is important a) To expand both lungs. b) To minimize secretion c) To expand the sigmoid d) To relax the sphincter.

 9)Below mentioned are complications of

enema administration except: a) osmosis b) Irritation to the skin c) Overweight d) Electrolyte imbalance

10)As a nurse, its important to educate the patient regarding as stated as below except : a) Regular exercises. b) Eating balanced diet. c) Decreasing fluid intake. d) Adding roughage in diet.

THANK YOU FOR YOUR ATTENTION