Enema Simplex – Nursing is a profession within the healthcare sector focused on the care of individuals, families, and communities so they may attain, maintain, or recover optimal health and quality of life. Nurses may be differentiated from other healthcare providers by their approach to patient care, training, and scope of practice. Nurses practice in many specialisms with differing levels of prescriber authority.
Many nurses provide care within the ordering scope of physicians, and this traditional role has shaped the public image of nurses as care providers. However, nurses are permitted by most jurisdictions to practice independently in a variety of settings depending on training level. In the postwar period, nurse education has undergone a process of diversification towards advanced and specialized credentials, and many of the traditional regulations and provider roles are changing.
Nurses develop a plan of care, working collaboratively with physicians, therapists, the patient, the patient’s family, and other team members, that focus on treating illness to improve quality of life. Nurses may help coordinate the patient care performed by other members of an interdisciplinary healthcare team such as therapists, medical practitioners, and dietitians. Nurses provide care both interdependently, for example, with physicians, and independently as nursing professionals.
Enema Simplex
Definition of Enema Simplex
Enema is the instillation of a solution into the rectum and sigmoid colon. The primary reason for an enema is promotion of defecation by stimulating peristalsis.
Or,
Enema is a solution inserted into the rectum and sigmoid colon to remove feces and / or flatus. Enema can also be used to instill medications or nutrition.
Or,
Introduction of solution into the large intestine for removing feces and cleaning the bowel is called enema.
Purpose of Enema Simplex:
1. To relieve constipation or fecal impaction.
2. To prepare colon for specific surgical or diagnostic procedures.
3. To dilute and remove toxic agents that may be present in large intestine. E.g. Hepatic encephalopathy.
4. To reduce temperature in hyperpyrexia and heat stroke.
9. To relieve retention of urine by reflex stimulation of bladder.
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6. To supply fluids and electrolytes that is absorbed from intestines.
7. To help establish regular bowel function during a bowel training program.
8. To stimulate peristalsis.
9. To relives inflammation.
10. To relieve çorstipation, flatulence, and distension
Classification of Enema:
1. Evacuant enema.
2. Retention enema.
3. Diagnostic enema.
A. Evacuant enema: Soap water to remove the faecal matter and the flatus. The quantity of fluid administered at a time about 600ml.
➤ Indications of evacuant enema:
• Before surgical operation.
• Before delivery.
• Before radiological examination of GIT.
B. Retention enema: The fluid containing the drugs is retained in the rectum so that the drug
may act locally or systematically. C. Diagnostic enema: BaSCO₂ suspension or emulsion is injected into the rectum for X-ray examination of the colon.
Indication of Enema Simplex:
1. To relieve constipation or fecal impaction.
2. To clean the bowel before surgery.
3. To soften hard faecal matter, e.g.- oil enema.
4. To introduce medication into the system.
5. To smooth and treat irritated bowel mucosa
6. To destroy intestinal parasites, e.g. – antihelminthic enema.
7. To decrease body temperature,
8. To stop local hemorrhage.
9. To reduce hyperkalemia.
10. To induce anesthesia.
11. To stimulate a person in shock and collapse.
12. To induce peristalsis.
13. To administer fluids and nutrients, e.g. – nutritive enema.
14. To relieve gaseous distension.
15. To establish regular bowel function during a bowel training program.
16. To make diagnosis e.g. barium enema
Contraindications of Enema Simplex/Bowel Wash:
1. Bleeding hemorrhoids
2. Chronic diarrhea.
3. ‘Rectal surgeries, infection.
4. Intestinal obstruction.
5. Rectal polyps.
6. Massive colon carcinoma
7. Loose anal sphincter.
8. Debilitation
9. Anal fistula.
10. Intestinal diverticulum.
11. Painful skin lesions around anus
Principles for Giving Enema:
1. Be sure that the equipment is in good working condition.
2. Check doctor’s order for enema.
3. Maintain patient’s privacy.
4. General condition of the patient like pulse, temperature and respiration should be assessed before giving enema.
5. Prevent air from entering the rectum by expelling the air and clamping the tube before inserting it into the rectum.
6. Use lubricant to prevent friction.)
7. Do not let the fluid run completely out of the container.
8. Tell the patient to take a deep breath while the rectum tube is inserted and to hold the fluid inside the rectum until the procedure is finished.
9. Maintain the temperature of fluid about 105 degrees.
10. Proper advice should be obtained before giving enema to pregnant women.
11. A patient complaining pain or other discomfort, enema should be postponed and doctor should be informed.
Solutions for Enema Simplex:
1. Plain water
2. Cold water.
3. Normal saline.
4. Sodium carbonate solution 1 to 2 percent
5. Antiseptic solution such as silver nitrate 1: SUUU
6. Potassium permanganate …1: 5000
7. Thymol…..1:100
8. Alum…….1:100
9. Boric solution…. 1.2%
10. Tannic acid……..1:1000
Amount of solutions used 2:3 liters or till the return flow is clear.
Procedure of Enema Simplex:
A. Articles need for enema simplex;
1. Disposable gloves.
2. Enema container.
3. Tubing and clamp (if not already attached to container).
4. Appropriate size rectal tube.
- Adult: 22 to 30 Fr.
- Child: 12 to 18 Fr.
5. Correct volume of warmed solution.
- Adult: 750 to 1000 ml 40.5° to WC 100° to 105° F.
- Child: 35-38°C (98.6°F), (Quantity 300-500ml)
- Infant: 150 to 250 ml
- Neonate: 200 ml.
- Toddler: 250 to 350 ml
- 201 wode into
- School-age child: 300 to 500 ml,
- Adolescent: 500 to 700 ml.
6. Bath thermometer.
7. Water soluble lubricant.
8. Washbasin, wash cloths, towels, soap.
9. Water proof, absorbent pads.
10. Bath blanket.
11. Toilet tissue.
12. Bed pan, bedside commode, or access to toilet.
13. IV stand.
- Assess the patient’s needs, ascertaining if there are specific needs that necessitate particular assistance.
- Gather equipment, check the medication (enema), examine the enema packaging noting the medication has not expired, remove packaging and read the manufacturer’s instructions.
Check that the enema has been prescribed. - Ask the patient to empty their bladder, if necessary, before the procedure.
- Assist the patient to remove their clothing from the waist down or if the patient is able to do this themselves, ask them to do so. Ensure that they are not unnecessarily exposed and they are kept warm.
- Assist the patient to adopt the left lateral position (if there are no contraindications, such as the presence of any musculoskeletal disorders), with the knees drawn up towards the chest
- Warm the enema by submerging it in the jug of hand-hot water; check the manufacturer’s instructions.
- Place the protective bed cover under the person.
- Wash and dry your hands, put on the apron and non-latex gloves.
- Continuously explain to the patient the procedure and what you are doing.
- Gently part the buttocks and observe the perineal and perianal areas. Note, document and report any abnormalities, for example haemorrhoids, rash, rectal prolapse, discharge, infestation or bleeding.
- You may be required to make an assessment of the rectum by gently inserting a lubricated gloved finger into the rectum to ascertain if the rectum is empty or full if an evacuant enema is required.
- Remove the protective cap from the enema. Place the lubricating gel on the gauze swab, and use this to coat the end of the enema nozzle.
- Expel any excess air from the enema.
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