Equipment
■ Washcloths, towels, disposable towelettes and/or toilet tissue.
■ Bath blanket.
■ Waterproof pad.
■ Bedpan with cover or bedside commode, if needed.
■ Water-soluble lubricant.
■ Procedure gloves.
■ IV pole.
■ Enema administration container and solution, or prepackaged enema depending on the type of enema ordered:
■ Enema kit: A package of supplies that includes a small plastic bucket or a 1-liter plastic bag with attached tubing, disposable toweling, lubricant, and castile soap.
■ Prepackaged enema solution:You may need to obtain a prepackaged enema from the pharmacy or central supply department.
Assessment
■ Check for history of bowel disorders (e.g., diverticulitis, ulcerative colitis, recent bowel surgery, abdominal pain, abdominal distention, hemorrhoids) and for increased intracranial pressure, glaucoma, or recent rectal or prostate surgery.
■ Be Smart! Review lab results (especially BUN, creatinine, and electrolytes). Hypertonic, hypotonic, and phosphate enemas have been linked to fluid and electrolyte changes.
■ Inspect the abdomen for distention. Note the patient’s last bowel movement, recent bowel movement pattern, and bowel sounds.
■ Assess cognitive level and mobility status, degree of rectal sphincter control, and for presence of a fecal impaction.
Post-Procedure Reassessment
■ Observe the amount, color, and consistency of the stool.
■ Evaluate the patient’s tolerance of the procedure (e.g., cramping, discomfort).
■ Determine whether subsequent enema administration is required (e.g., a prescription for “enemas until clear”).
Key Points
■ Be Smart! Generously lubricate the rectal tube and insert it gently.
■ Instill warm solution at a slow rate.
■ Be sure patient is properly positioned.
■ Instruct her to retain the solution for 3 to 15 minutes, depending on the type of enema.
■ Assist the patient to a sitting or squatting position to promote defecation.
■ Be Safe! Before leaving the bedside, implement fall prevention measures appropriate for your patient.
■ Be Safe! Use nursing judgment to modify the procedure based on the patient’s mobility and ability to follow instructions.
Documentation
■ Document the type of enema given and, if applicable, the amount of the solution instilled.
■ Document the patient’s tolerance of the procedure and the characteristics and amount of the stool.
■ If the prescription is to administer enemas until the returns are clear, document the color of the returned solution and the amount of stool seen.
■ Be Smart! For prepackaged enemas, some facilities require documentation on the MAR.
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| Start at the level of the patient’s hips; then raise the container to 12 to | 18 in. above hip level |
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| Administering a prepackaged enema |
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