1. NUR 213 Enema Teacher Maryam AL Anazi

2. Outline Definition Purpose Action positions Types Commonly used Solution Nursing intervention Precautions

3. Enema Is the procedure of introducing liquids into the rectum and large intestine (colon) via the anus.

5. Purpose 1.Cleanse the lower bowel. (most common reason) 2.Soften feces. 3.Expel flatus. 4.Administer medications (worm and parasite infestations, corticosteroids) 5.Outline the colon during diagnosis x-ray.

6. Action of enema to distend the intestine and sometimes to irritate the intestinal mucosa, thereby increasing the peristalsis and the excretion of feces and flatus.

7. positions

8. Types of Enema A. according to the purpose B. according to the volume

9. Types of Enema according to the purpose CleansingCarminativeRetention Return – flow Enema

10. 1- Cleansing Enema Is intended to remove feces, It is given chiefly to: 1- prevent the escape of feces during surgery. 2- Prepare the intestine for certain diagnostic tests as x-ray or colonoscopy. 3- Remove feces in instances of constipation.

11. 2- Carminative Enema Is given primarily to expel flatus. The solution instilled into the rectum and the colon thus stimulate peristalsis.

12. 3- Return – flow Enema - Is used occasionally to expel flatus. - Alternating flow of 100- 200 ml of fluid into and out of the rectum and sigmoid colon stimulate peristalsis. - This process is repeated five to six times until the flatus is expelled and abdominal distention is relived.

13. 4- Retention Enema -Introduces oil or medication into the rectum and sigmoid colon. The liquid is retained for relatively long period (1-3 hours). - An oil retention enema acts to soften the feces and to lubricate the rectum and anal canal, thus facilitating passage of stool. - -Antibiotic enemas are used to treat infections locally as warm or parasites. - Nutritional enema to administer fluids and nutrients to the rectum.

14. Barium test

15. B- According to the volume : 1- Large volume Enema

16. Large-volume enemas, which typically contain 500 to 1000 ml fluid, are administered to cleanse the bowel

17. 2- Small – Volume Enema Small-volume enemas are used for the purpose of evacuating stool or instilling medications in the lower bowel. These are usually found as prepackaged solutions, which contain 150 to 240 ml fluid.

18. Commonly Used Enema Solution SolutionconstituentsActionTime to take effect Adverse effect 1- Hypertonic90-120 ml of sodium phosphate +500-1000 tape water Draws water into the colon 5-10 minRetention of sodium 2- Hypotonic500-1000 tape water - Distended colon -stimulates peristalsis - Softens feces 12-20 minFluid and electrolyte imbalance 3- Isotonic500-1000 ml Normal saline Irritate mucosa, distended colon, Softens feces 15-20 minPossible sodium retention

19. Commonly Used Enema Solution SolutionConstituentsActionTime to take effect Adverse effect 4- Soap suds500-1000 ml (3- 5ml soap to 1000 ml water ) Irritates mucosa, distended colon, Softens feces 10-15 minIrritates and may damage mucosa. 5- oil ( olive, cottonseed oil) 90-120 mlLubricates the feces and the colonic mucosa. ½ - 3 hourIrritates and may damage mucosa

20. Nursing intervention Check doctor`s order Provide privacy Promote relaxation Position the patient Adult-left lateral position Infant/small children-dorsal recumbent position

22. Precautions Improper administration of an enema may cause: 1.electrolyte imbalance (with repeated enemas) 2.ruptures to the bowel or rectal tissues resulting in internal bleeding. (feces are unusually dark or have a red hue). 3.The enema tube and solution may stimulate the vagus nerve, which may trigger an arrhythmia such as bradycardia. 4.Enemas should not be used if there is an undiagnosed abdominal pain since the peristalsis of the bowel can cause an inflamed appendix to rupture. 5.Regular treatments should be avoided by people with heart disease or renal failure. 6.inappropriate for people with bowel, rectal or anal pathologies where the pathology contributes to the risk of bowel perforation.