A solution introduced into
the rectum and sigmoid colon to remove feces and/or flatus.
Prevent the escape of feces
during surgery. Prepare the intestine for certain diagnostic tests such as x-ray
or visualization tests (e.g. colonoscopy). Constipation or
Large volume cleansing
total of ___ to ___ml of solution should be administered. Small volume
cleansing enema. Amount of solution administered depends on (name 2):
Given to cleanse as much of the colon as possible. Left lateral position to the
dorsal recumbent position and then to the right lateral position during the
administration so that the solution can follow the large intestine. The solution
container is usually held 12 to 18 inches above the rectum because the fluid is
instilled farther to clean the entire bowel. Cleansing enema
Cleanse the rectum and sigmoid colon. Maintains a left lateral position during
Distends the rectum and
colon with gas released from the enema solution. For an adult, 60 to 80 mL is
Introduces oil or medication
into the rectum (types):
______ ______. Alternating
flow of 100 to 200 mL of fluid into and out of the rectum and sigmoid colon
stimulates peristalsis. Repeated five or six times until the flatus is expelled
and abdominal distention is relieved.
Commonly used enema
solutions (Table 46-4; p. 1241)
Hypertonic: 90 to 120 mL of solution
(e.g. sodium phosphate). Example: _____ _________ _____. Action:
Draws water into the colon. Effective in 5 to 10 minute. Adverse effects: Retention of
sodium. Critical thinking: Sylvia tells the nurse she routinely uses a
Fleets Enema to keep her bowels regular. The nurse asks Sylvia, Are you taking
any vitamin supplements? Why should Sylvia take vitamin supplements with
prolonged use of Fleets enema?
Hypotonic: 500 to 1,000 mL of tap water. Distends
colon, stimulate peristalsis, and softens feces. Effective in 15 to 20 minutes.
Fluid and electrolyte imbalance; water intoxication.
Isotonic: 500 to 1,000 mL of NS.
Distends colon; stimulates peristalsis, and softens feces. Effective in 15 to 20
minute. Adverse effects: Possible sodium retention.
Soapsuds: 3-5 mL soap to 1,000 mL
water. Irritates mucosa, distends colon. Effective in 10 to 15 minutes.
Adverse effects: Irritates and may damage mucosa.
Oil: 90 to 120 mL. Name 3 types:
Lubricates the feces and the
colonic mucosa. Effective in ½ to 3 hours.
Case Study: You are teaching, Mr.
Rose, about the various types of enemas. What type of enema solutions poses the
greatest risk for fluid and electrolyte imbalances and water intoxication?
Mr. Rose will be undergoing
a sigmoidoscopy requiring visualization of the anus, rectum, and sigmoid colon.
What type of enema do you plan to administer?
A fellow nursing student asks you, What
type of enema distends the rectum and colon with gas released from the enema
solution? How would you respond?
clients may wish to administer their own enemas. If this is appropriate,
validate the clients knowledge of correct technique and assist as
Assess: Last bowel movement (amount, color, and
consistency), abdominal distention, and sphincter control. Whether the client
Is a physicians order
required? If the client has kidney or cardiac disease that contraindicates the
use of a _________solution. Delegation to the UAP. Equipment: Disposable linen-saver
pad, bath blanket, bedpan or commode, clean gloves, water-soluble lubricant if
tubing not prelubricated, and paper towel.
Solution container with tubing of correct size and tubing clamps, correct
solution, and amount. IV pole. Temperature of the solution is between ____ to
prepackaged container of enema solution with lubricated tip.
Lubricate about 2 inches of
the rectal tube. Run some solution through the connecting tubing of a
large-volume enema set and the rectal tube to expel any air in the tubing; then
close the clamp.
Wash hands and apply clean
gloves. Provide for client privacy. During an enema, the client
should be asked to lie in the ____ _______ position. The right leg as acutely
flexed as possible and the linen saver pad under the buttocks.
For clients in the left
lateral position, lift the upper buttock to ensure good visualization of the
anus. Insert the tube smoothly and slowly into the rectum, directing it toward
Adult: Insert the tube ___to
___inches. Infant: 1 to 1.5 inches. Child: 2 to 3 inches. Critical Thinking: You encounter
resistance at the internal sphincter during insertion of an enema tube into the
Mr. Rose. What should you do?
Never force tube or solution
Raise the solution
container, and open the clamp to allow fluid flow OR compress a pliable
container by hand. During low enemas hold or
hang the solution container no higher than 12 inches and high enema (18 inches).
During a tap water enema, Mr. Staples complains of abdominal cramping. What
should be your first response to the complaint?
If you are using a plastic
commercial container, roll it up as the fluid is instilled. Prevents suctioning
of the solution.
After all the solution has
been instilled or when the client cannot hold any more and feels the desire to
defecate, close the clamp, and remove the rectal tube from the anus. Place the rectal tube in a
disposable towel as you withdraw it. Ask the client to remain lying down.
Request that the client
retain the solution for the appropriate amount of time.
Assist the client to
defecate in a sitting position on the bedpan, commode, or toilet. Ask the client who is using
the toilet not to flush it so feces can be observed. If a specimen of feces is
required, ask the client to use a bedpan or commode.
After the rectal tube is
inserted, the client assumes a supine position on a bedpan. HOB elevated 30
degrees. Pillows to support the clients head and back.
Type of solution, length of
time solution was retained, the amount, color, and consistency of the returns,
and the relief of flatus and abdominal distention. Critical Thinking: A
nursing student, Shawn Brown, charts the following information after an enema
procedure. What information did Shawn forget to document? Enema administered. Pt
retained solution for 5 minutes with return of 500 cc light brown liquid stool.
Pt reports + relief of flatus and abdominal distention. Shawn Brown, GCSU, SN I.
Considerations, p. 1244). True or False. Tap water enemas are not usually
given to children and infants because of the danger of fluid imbalances.
Items A through G are the
steps for enema administration. Number these steps in the order that should be
Lubricate the tip of the
tube with a water-soluble lubricant. ___
Reclamp the tube and remove
it; instruct the client to retain the solution as long as possible.
Position the client in a
Sims position. ___
Raise the container 18
inches above the anus; allow the solution to flow for 5 to 10 minutes.
Separate the anus and assess
the anus area; insert the tube gently while instructing the client to take a
deep breath. ___
Open the clamp on the tubing
to remove air and reclamp the tubing. ___
Answers: a). 4 b). 7 c). 2
d). 6 e). 1 f). 5 g). 3
After viewing the 15 minute
Bowel Elimination Video, answer the fecal impaction case study.
Mr. Johnson is scheduled to
be disimpacted. What type of enema should be given before this
removing a fecal impaction, the nurse uses a hooking motion of the index
The digital removal of an
impaction should be carried out gently because of vagal nerve stimulation that
could (decrease or increase) the cardiac rate?