Administering A Cleansing Enema Quizlet

Administering a Cleansing Enema: A Comprehensive Guide

Administering a cleansing enema is a common nursing procedure used to clear the bowel of feces before surgery, diagnostic procedures like colonoscopy, or to relieve severe constipation. While seemingly straightforward, the procedure requires meticulous attention to detail and adherence to strict aseptic techniques to prevent complications. This comprehensive guide will delve into the process, highlighting crucial steps, potential risks, and necessary precautions. This information is for educational purposes only and should not be considered a substitute for professional nursing education or training.

Introduction: Understanding Cleansing Enemas

A cleansing enema involves introducing a fluid into the rectum and sigmoid colon to stimulate bowel evacuation. The fluid softens stool, distends the bowel, and initiates peristalsis, the natural wave-like contractions that move stool through the intestines. Several types of enemas exist, each with specific uses and characteristics, but cleansing enemas are most commonly administered using tap water, normal saline, or commercially prepared solutions. Understanding the indications, contraindications, and potential complications is vital for safe and effective administration. This article will cover the practical aspects of administering a cleansing enema, including preparation, procedure, and post-procedure care.

Indications for Cleansing Enemas:

Cleansing enemas are indicated in various clinical situations, including:

• Preparation for diagnostic procedures: Colonoscopy, sigmoidoscopy, and other lower gastrointestinal tract examinations require a clean bowel for optimal visualization.
• Preparation for surgery: Surgical procedures involving the abdomen or pelvis often necessitate a clean bowel to minimize the risk of infection and complications.
• Relief of severe constipation: When other methods fail, a cleansing enema can provide relief from severe constipation and fecal impaction.
• Removal of impacted stool: In cases of fecal impaction, a cleansing enema can help soften and remove hardened stool.
• Bowel cleansing before childbirth: In some cases, the physician might order a cleansing enema to prepare the bowel for delivery.

Contraindications for Cleansing Enemas:

There are several situations where administering a cleansing enema is contraindicated:

• Recent rectal or bowel surgery: Enemas can disrupt the healing process and increase the risk of complications.
• Severe abdominal pain or distention: Enemas could exacerbate existing pain or cause perforation.
• Active bowel inflammation or infection: Conditions such as diverticulitis, ulcerative colitis, or Crohn's disease can be worsened by enemas.
• Certain heart conditions: Patients with congestive heart failure or other heart conditions might not tolerate the fluid volume.
• Electrolyte imbalances: Enemas can alter fluid and electrolyte balance, which poses a risk for patients with existing imbalances.
• Suspected bowel perforation or obstruction: Administering an enema in these circumstances could lead to serious consequences.

Equipment and Supplies:

Before administering a cleansing enema, ensure you have all necessary equipment and supplies readily available. These typically include:

• Enema solution: Tap water, normal saline, or a commercially prepared solution (following hospital protocol). The amount of solution varies depending on the patient's age and clinical condition.
• Enema container: A plastic container with a calibrated scale for accurate measurement of the solution.
• Enema tubing: A flexible tube with a clamp to regulate fluid flow.
• Lubricant: A water-soluble lubricant, such as KY Jelly, to facilitate insertion.
• Waterproof pad: To protect the bed linens.
• Gloves: Clean or sterile gloves, depending on hospital protocol.
• Bedpan or commode: For bowel evacuation.
• Toilet paper or wipes: For hygiene.
• Basin of warm water and washcloths: For perineal cleansing.
• Patient gown and drape: For patient comfort and privacy.
• Thermometer (optional): To check the temperature of the enema solution.

Procedure for Administering a Cleansing Enema:

1. Assessment: Assess the patient's bowel sounds, abdominal distention, and vital signs. Obtain a thorough medical history, noting any contraindications.
2. Preparation: Explain the procedure to the patient, addressing any concerns or anxieties. Position the patient on their left side (Sims' position) with the right leg flexed. Assist the patient with removing clothing as necessary and apply a waterproof pad beneath the buttocks.
3. Solution Preparation: Warm the enema solution to body temperature (approximately 105°F or 40°C). Verify the solution's type and amount prescribed.
4. Lubrication: Lubricate the tip of the enema tubing generously.
5. Insertion: Gently insert the lubricated tubing into the rectum approximately 3-4 inches (7.5-10 cm). Avoid forcing the tube.
6. Fluid Administration: Slowly administer the enema solution, allowing it to flow into the bowel. Control the flow rate using the clamp on the tubing to avoid rapid distention and cramping.
7. Retention: Instruct the patient to retain the solution for as long as possible (usually 5-15 minutes).
8. Bowel Evacuation: Assist the patient to the toilet or bedpan for bowel evacuation.
9. Post-procedure Care: Assess the character and amount of stool evacuated. Assist with perineal cleansing and ensure adequate hydration. Monitor vital signs and observe for any signs of complications.
10. Documentation: Meticulously document the procedure, including the type and amount of solution administered, the patient's response, and any complications observed.

Different Types of Cleansing Enemas:

While tap water and normal saline are commonly used, other solutions may be employed based on the patient's needs and clinical circumstances. Examples include:

• Hypertonic saline enema: Draws water into the bowel, stimulating evacuation. It requires a smaller volume than isotonic solutions.
• Soap suds enema: The addition of soap helps to irritate the bowel lining, promoting peristalsis. However, its use is becoming less frequent due to potential adverse effects.

Potential Complications:

Although generally safe, administering a cleansing enema carries potential complications:

• Electrolyte imbalances: Excessive fluid absorption can lead to hyponatremia (low sodium) or other electrolyte disturbances.
• Fluid overload: This is particularly a risk in patients with compromised cardiac function.
• Bowel perforation: This is a rare but potentially life-threatening complication.
• Vagal stimulation: Distention of the rectum can stimulate the vagus nerve, leading to bradycardia (slow heart rate) or even syncope (fainting).
• Infection: Improper aseptic techniques increase the risk of infection.
• Electrolyte imbalances: Excessive fluid absorption can lead to hyponatremia (low sodium levels) or other electrolyte imbalances.

Post-Procedure Monitoring:

After administering a cleansing enema, it's crucial to monitor the patient closely for any complications. This includes:

• Monitoring vital signs: Regularly check blood pressure, heart rate, and respiratory rate.
• Assessing bowel sounds: Listen for the return of normal bowel sounds.
• Observing for signs of fluid overload: Watch for edema, shortness of breath, and increased heart rate.
• Monitoring for electrolyte imbalances: Assess for symptoms of hyponatremia, such as nausea, vomiting, and confusion.
• Assessing for abdominal pain or distention: Report any increase in pain or distention immediately.

Frequently Asked Questions (FAQs):

• Q: How much fluid is typically used in a cleansing enema?

  A: The amount varies depending on the patient's age, condition, and type of enema solution used. Typically, 500-1000 mL is used for adults.

• Q: What if the patient experiences cramping during the procedure?

  A: Slow down the infusion rate or temporarily stop it until the cramping subsides. Encourage the patient to take slow, deep breaths.

• Q: What should I do if the enema solution doesn't flow easily?

  A: Check for kinks in the tubing and reposition the tube gently. Ensure the container is elevated sufficiently.

• Q: How long does it take for the bowel to evacuate after an enema?

  A: This varies depending on individual responses but typically occurs within 15-30 minutes.

• Q: What are the potential complications of a cleansing enema?

  A: Potential complications include electrolyte imbalances, fluid overload, bowel perforation, vagal stimulation, and infection.

• Q: Can I give a cleansing enema at home?

  A: Cleansing enemas should be administered by trained medical professionals. Attempting to administer an enema at home without proper training can lead to complications.

Conclusion:

Administering a cleansing enema is a skilled nursing procedure that requires careful preparation, precise technique, and close monitoring. Understanding the indications, contraindications, potential complications, and post-procedure care is crucial for safe and effective administration. This detailed guide provides a comprehensive overview, but it is vital for nurses and healthcare professionals to receive formal training and education in this procedure before undertaking it. This information should not be used as a substitute for professional medical advice. Always consult with a healthcare provider for any health concerns or before making any decisions related to your health or treatment.