Bowel elimination ati-2 PDF

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Bowel Elimination ATI • •

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Bedside commode o Can get out of bed but can't walk to bathroom Bedpan o Hard plastic, curved, smooth upper end o For clients who can lift hips Fracture bedpan

Enemas • • • • • • • • • •

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Instilling solution into rectum and the sigmoid colon to stimulate peristalsis and promote defecation Common reason: relieve constipation, expel flatus, empty bowels before diagnostic procedure or surgery, instill medication, initiate bowel training program Have patient lay on left side or left lateral with right knee flexed. (allows solution to flow downward by gravity along the curve of the sigmoid colon and rectum, improving the enema) Adult: 3-4 in Adolescent: 3-4 in Child 2-3 in Infant 1-1.5 Stop if resistance or pain If enema says administer until clear; do not administer more than three enemas Cleansing enema o Either small or large volume o Solution instilled; bowel wall stretched which stimulates peristalsis o Tap water, normal saline, and soapsuds ▪ Solution has osmotic effect that will influence shift of fluid between colon and interstitial spaces ▪ 10-15 min o .9% sodium chloride is an isotonic solution (does not pull electrolytes from body or shift fluids in or out of the colon) ▪ Reduces risk of electrolyte imbalance and fluid volume excess or deficit ▪ Infants and children at risk for fluid and electrolyte imbalances, should only receive normal saline enemas o Hypotonic solutions like tap water will exert osmotic pressure which causes water to move from colon to interstitial space o Hypertonic solutions like sodium phosphate pull fluid from interstitial space into colon ****should be avoided in young infants and clients who are dehydrated o Soapsuds enemas act by stimulating peristalsis through intestinal irritation ▪ Must be pure castile soap ▪ 5 mL of soap is added to 1 liter of solution ▪ ****use cautiously in pregnant clients and older adults bc it can lead to electrolyte imbalance and damaged intestinal mucosa Small-volume cleansing enema and oil retention enema

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o Prepackaged o Lubricate rectum and at room temperature o Oil absorbed by feces (making them easier and softer to pass o Retain enema for as long as possible, usually for a minimum of 30 min o Hypertonic: draw fluids into colon from interstitial spaces, stimulating peristalsis Large volume cleansing enema o Infant: 150-250 mL o Toddler: 250-350 mL o Child: 300-500 mL o Adolescent 500-750 mL o Adult: 750-1000 mL o Return or flush flow enemas expel intestinal gas ▪ Instill large volume of fluid in small increments usually 100-200 mL at a time into rectum to stimulate peristalsis Medicated enema o Given for local effect they exert on rectal mucosa o Common example: antibiotic neomycin (reduce bacteria in colon before bowel surgery) o Can also be given to produce a systemic effect ▪ Example: sodium polystyrene sulfonate • Treat clients who have dangerously high serum potassium levels o Carminative enemas: used to relieve flatus and abdominal distention: small amount of fluid instilled into rectum, usually with additives (like magnesium and glycerin) which distends the rectum and colon and stimulates peristalsis Contradictions for enemas o Increased intracranial pressure, glaucoma, rectal or prostate surgery ▪ Can have serious complications ▪ Check client's history prior to administration of enema to be sure they do not have any problem that might make enema administration unsafe How long does a client have to retain the enema solution? o For a cleansing enema, ask client to retain solution for 5-15 min o For retention enema, at least 30 min is minimum Enema solution at specific temperature o Warm enema solution prior to prevents abdominal cramping o Test temp of solution on arm prior to administering enema o Hypertonic and oil retention enemas should be administered at room temp How high should the bag be o Hold or hang container no higher than 45 cm above level of anus Client with poor sphincter control might not be able to retain the enema solution Complications: o Rigid, distended abdomen, abdominal pain and cramping, and bleeding o Abdomen becomes rigid or distended, stop immediately o Client reports pain or cramping, slow rate of instillation Documentation o Date, time, type

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Volume and type Outcomes How client tolerated procedure Any adverse reactions or unexpected outcomes

CASE 1 • • •

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Client will have an elective gynecological outpatient procedure Hypertonic enema for bowel preparation Person is nervous which of the following is a correct response o Simple procedure most people do at home o If you don’t give yourself enema, provider cannot perform procedure o Appears you are uncomfortable with administering yourself an enema ▪ Focusing on someone else rather than the client ▪ Enforcing rules without addressing client's anxiety about self-administering enema ▪ Good communication to hear what they have to say Where can the client get an enema o Just take your prescription to your local pharmacy. Pharmacist will dispense the enema solution o A hypertonic enema is an over the counter item o Just ask for an enema kit at the pharmacy counter. It will contain the bag and solution

CASE 2 • •

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Bowel surgery next day Which of the following is used to administer enemas until clear o Tap water o Hypertonic enema o .9 sodium chloride ▪ Tap water is hypotonic and limited to one instillation, further instillations of tap water may result in water toxicity or circulatory overload ▪ This type of enema works rapidly, small volume of solution will stimulate bowel to evacuate, hypertonic enemas limited to one instillation, occasionally two due to possible extreme irritation of mucosa of bowel wall ▪ Safest and less likely to result in fluid and electrolyte imbalances The following is correct procedure o Preheat normal saline solution to lukewarm prior to administration o Lubricate tip o Point tip of enema tube toward client's umbilicus while inserting it You evaluate that the enemas have had the desired effect when you find which of the following o Large amount of slightly discolored solution with no solid fecal matter o Large amount of clear solution with several pea sized flecks of stool o Large formed stool in a large amount of clear solution You evaluate that the nursing assistant knows how to prepare solution correctly when they state which of the following? o I can add castile soap to tap water but not to normal saline o I put the castile soap in the enema bag first, then I add 250 mL of fluid o I should use about 1 teaspoon of soap in 1 L of fluid

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You observe that supplies that the nursing assistant has brought to the client's room. Which of the following supplies are correct for this task? o 1,000 mL lukewarm tap water o Water soluble lubricant o Iv pole Which of the following actions should the nursing assistant take first if the client reports cramping? o Place client on bedpan to evacuate enema solution immediately o Remind client that cramping can occur during enema administration o Lower the height of the solution bag to slow the instillation rate o...