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46 Cards in this Set

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enemas are for ...
promoting defecation
relieving pain
what is an enema?
installation of fluid into the rectum, sigmoid colon

enemas work in different ways
what are the ways enemas work?
volume of fluid stretches rectal walls and distends it.
what is hypotonic solution?
****************************
hypotonic solution pull fluid from tissue.

softens stool
stimulates peristalsis
what should you be aware of before giving an enema to a patient?
if they are on anti-coagulants for bleeding
again, what 3 ways do enemas work?
volume stretches bowel wall
pulls fluid from tissue
softens stool
stimulates peristalsis
what questions do we ask before doing an enema?
when was your last bowel movement?
what is your normal B/M pattern?
do you have any rectal problems?
fissures or hemorhiods or incontinence?
what is the patient's mobiity?

I don't understand but there are 2 answers
medications

cardiac problems
the assessment b/f doing this
why?
increased ICP (intercranial pressure)
Glaucoma
Recent rectal or prostate surgery
the order says "enemas until clear" why?
ofter prior to surgery or tests
goal is to empty the bowel
considered clear when return is colored but w/o solids
max # is 3 X
max volumes for ages are:

infant: 150-250
toddles: 250-350
school age 300-500
what are vol.s for adolescents and adults?
adolescence = 500-700
adult 750-1000
you use 12 - 18 gauge hose on
kids

adults use 22 - 30 french gauge hose
there are all types of content enemas:
what is tap water for?
hypotonic - w/h goes out of the bowel & into the tissue, don't repeat b/c danger of electrolyte imbalance
what is physiologic NS ?
safest...has osmolarity similar to interisitial tissues around colon
what do hypertonic solutions do?
pulls fluids into bowel & distends. small volume like Fleets
what does soap suds (SSE) made of?
castile pure soap used (5mL to 10mL of water)
Oil retention - oil based solution, small volume, what else?
lubricates and softens
when is it appropiate to use normal saline?
in infants to prevent fluid imbalances
small bodies are easy to throw out of balance
there are 3 heights to enemas:
high, regular, and low enemas. what are these heights?
12-18" above hips is high
12" above hips is regular
3" above hips is low
the higher the enema bag, the what?
farther up into the colon the fluid flow w/ more force
how far up the butt do you stick the tube?
adult 3 - 4 "
child 2 - 3 "
infant 1 - 1.5 "
you have to get the hose past the ...
2nd sphynter. Go in to the length of the forefinger to it past the 2nd shphinctor. insert tube towards the abdomen
temp should be warm. room temp is nice but approx...
105 for adults and 98.6 for kids. careful not to burn tissuess.
why is the tube hard while an NG tube is soft?
to pierce a stool impaction.
what are some precautions?
rectal abnormalities will cause the patient pain...pollups, hemrhoids,fissures, etc.
what about having to do an enema with a patient w/ a heart problem?
tell them to let you know if they feel dizzy. what you've done is stimulated the vagal nerve which is dropping their blood pressure!
how do you prep a patient?
explain the procedure
position in sims
warn of precautions, discomfort
length of time to retain fluid
do not flush toliet after expelling
what assessment questions would you ask b/f doing this?
when was last B/M
normal bowel habits
mobility
external sphincter control
what are things to do b/f doing this that doens't involve the patient?
review MD order
ID how pt will expel (BD, bedpan, commode)
Id pt
provide privacy
prime tube (don't shoot air into patient)
rectal tube:
what is its purpose?
to assist patient pass gas

distance can be inserted is:
kids 6 "
child 2 - 4 "
what about having to do an enema with a patient w/ a heart problem?
tell them to let you know if they feel dizzy. what you've done is stimulated the vagal nerve which is dropping their blood pressure!
how do you prep a patient?
explain the procedure
position in sims
warn of precautions, discomfort
length of time to retain fluid
do not flush toliet after expelling
what assessment questions would you ask b/f doing this?
when was last B/M
normal bowel habits
mobility
external sphincter control
what are things to do b/f doing this that doens't involve the patient?
review MD order
ID how pt will expel (BD, bedpan, commode)
Id pt
provide privacy
prime tube (don't shoot air into patient)
rectal tube:
what is its purpose?
to assist patient pass gas

distance can be inserted is:
kids 6 "
child 2 - 4 "
what do you do after inserting a rectal tube?
tape it to lower buttock
allow tube to remain no longer than ...
30 minutes
put a pad in place to collect an y drainage.

what is a Harris return flow?
for passing flatus. Raise bag up fluid in, then lower bag and gas comes out
Impaction results from ...
unreleived constipation, collection of harden feces, can't be expelled
who's at risk for an impaction?
debilitated
confused
unconscious
long term narcodic use
why do you dig an impaction out. whats going on here?
can't pass it, too large
person continues to want to take a crap but can't
ooze of diarrhea
loss of appetite
abdominal distention
cramping
rectal pain
who or what kind of patient has problems like this all the time?
paraplegics
what are cautions to the nurse with all this?
uncomfortable
embarrissing
irritation to mucosa
bleeding
sitmulating the vagus nerve
maybe contraindiced in cardiac patients
how you get the tube ready to use?
lub w/ water soluable lub
periodiclly assess heart rate
**************************
allow rest periods if necesary
what are last considerations?
some places only let MD do this
ck policy books
MD may order analgesic prior
Md may order cleaning enema or laxative after
always provide peri care after
what is another thing enemas can be good for other than cleaning the bowel?
administering narcodics for pain and etc.