rectal and vaginal meds

Question 1

cleansing enemas are for:

how do they act :

Answer 1

for promoting complete evacuation of feces from colon
act by stimulating peristalsis through infusion
-to prevent the escape of feces during surgery
-prepare the intestine for certain diagnostic tests eg radiography
-remove feces in instances of contipation or impaction
-establish reg bowel function as part of a bowel routine of lg volumes of solution

Question 2

oil retention enemas

Answer 2

lubricate rectum and colon to allow feces to absorb oil and become softer and easier to pass

Question 3

why are medicated enemas used

Answer 3

some are to reduce dangerously high serum potassium levels or to reduce bacteria in the colon before bowel surgery

Question 4

how does an enema stimulate the defecaton reflex

Answer 4

the volume or type of fluid that breaks up the fecal mass stretches the rectal wall

Question 5

position to give enema in
position for kids
why these positions?

Answer 5

left side lying (sims) w right knee flexed
kids=dorsal recumbent
allows enema solution to flow down w gravity along natural curve of sigmoid colon and rectum. this improves retention of solution

Question 6

does prolapse contraindicate enema

Answer 6

yes

Question 7

unless specified otherwise how much of tube dyou lube (enema)

Answer 7

5cm or P&P says 6-8cm

Question 8

what do you do about air in package (enema)

Answer 8

expel air by running some solution through

Question 9

what do you point toward when inserting enema

Answer 9

umbilicus

Question 10

how far dyou insert enema

Answer 10

7-10cm

Question 11

if youre struggling to insert tube what dyou do (enema)

Answer 11

let a little fluid out to soften and infuse into the feces. remove. then try reinserting slowly

Question 12

if pt has impaction how dyou admin the enema

Answer 12

remove impaction

Question 13

diff between high and low cleansing enemas

Answer 13

• High is to cleanse as much of the colon as possible. Pt changes from l lateral to dorsal recumbent to r lateral while administered to facilitate it following the lg intestine
• low enema cleans sigmoid colon and rectum only

Question 14

how high dyou raise enema container. how quickly dyou do this

Answer 14

do slowly
30-45cm for high
30 for regular
7.5cm for low (in

Question 15

what can you hold enema bag up with

Answer 15

IV pole once fluid flow is established

Question 16

is abdominal cramping and distension normal w enema

Answer 16

yes

Question 17

how long dyou tell pt to hold enema

Answer 17

as long as possible until urge to defecate.

Question 18

after instillation of solution to child enema what dyou do while waiting for defecation

Answer 18

may need to gently hold buttocks. infants also

Question 19

if pt is unable to hold enema solution during installation what do

Answer 19

slow rate of infusion

Question 20

do rectal meds generally have many side effects?

is it predictable in r/t absorption and distribution?

Answer 20

no. theyre relatively safe

unpredictable

Question 21

contraindications for rectal suppositories

Answer 21

recent surgery on rectum, bowel, prostate
rectal bleeding or prolapse
very low platelet counts

Question 22

where should you place rectal suppository within anus

Answer 22

past internal anal sphincter and against the rectal mucosa

Question 23

position for rectal suppository

Answer 23

left side lying sims position w upper leg flexed forward

Question 24

postion for immobile pt for suppository

Answer 24

lateral position. put pillow under upper arm nd leg

Question 25

if impation is suspected for rectal suppository what do

Answer 25

palpate rectal walls as necessary. dispose of gloves if you do

Question 26

what dyou lubricate for suppository

Answer 26

finger, anus, suppository. thoroughly

Question 27

instructions to pt just before insertion of suppository

Answer 27

take slow, deep breaths through mouth and relax anal sphincter

Question 28

hiw to insert suppository

Answer 28

retract pts buttock w nondominant hand. w gloved index finger insert suppository gently through anus past internal sphincter and against rectal wall 10cm or 4inches in adults.

Question 29

what should you feel when inserting rectal suppository

Answer 29

rectal sphincter close around finger

Question 30

how deep dyou insert supp for adults or kids

Answer 30

adult 10cm 4 inches | kid 5cm or 2inches

Question 31

how long dyou ask pt to stay lying flat or on side after rectal supp

Answer 31

5min

Question 32

if supp was given for constipation and pt is able to go to toilet what dyou remind them

Answer 32

dont flush. nurse should ispect stool first

Question 33

why would pt experience dec heart rate

Answer 33

vagal stimulation may occur. monitor their heart rate if this happens

Question 34

whats larger a vaginal or rectal supp

Answer 34

vaginal

Question 35

procedure vaginal supp

Answer 35

``` Procedure • Ask pt to void • Normally painless • Assess and clean peri area • Lube the rounded end of the suppository • Lube finger Suppository • Insert 8-10cm or as far as possible along posterior wall as its 2.5cm longer • Ask pt to remain supine 5-10min ```

Question 36

why are vaginal instillations given

Answer 36

to treat infection or relieve vaginal discomfort

Question 37

what is a vaginal irrigation

Answer 37

its a douche (washing of vagina w liquid at low pressure

Question 38

why is vaginal irrigation used

Answer 38

not nec for reg hygiene. its for removing discharge, preventing infection, to prevent inflm or (to prevent hemmorhage by using hot or cold)

Question 39

position for vaginal supp

Answer 39

back lying w knees flexed and hips rotated laterally | or w hips elevated on pillow

Question 40

how far do you insert vaginal supp | alog posterior or anterior wall of vagina

Answer 40

8-10cm along posterior wall, or as far as it will go

Question 41

procedure vaginal supp

Answer 41

Procedure • Ask pt to void • Normally painless • Assess and clean peri area. ask abt any discomfort in the area • Lube the rounded end of the suppository • Lube finger expose area by holding labia w nondominant hand Suppository • Insert 8-10cm or as far as possible along posterior wall as its 2.5cm longer • Ask pt to remain supine 5-10min

Question 42

how far dyou insert vaginal cream jelly or foam | procedure

Answer 42

vaginal creams, jellies, foams insert applicator 5cm • put applicator on towel after • askpt to remain lying 5-10min

Question 43

vaginal irrigation procedure

Answer 43

vaginal irrigation • place on bedpan • clamp tubing. Hold irrigating container abt 30cm away from vagina (so theres not too much pressure) • run fluid into bedpan to moisten nozzle • insert nozzle 7-10cm towards sacrum, start flow, rotate to irrigate all parts of vagina. let irrigating olution flow out into bedpan • assistpt to sitting to allow drainage • dry

Question 44

how does hyertonic solution work as enema

Answer 44

• hypertonic solutions (sodium phosphate, saline): exert osmotic pressureto draw fluid into colon. Commonly used=fleet enema

Question 45

how does hypotonic solution work as enema

Answer 45

• hypotonic (tap water) cause water to move from colon to interstitial space. Don’t repeat this to avoid circulatory overload

Question 46

how does isotonic solution work as enemas

Answer 46

• isotonic solution; saline. Safest. No fluid movment. Only the distension causes defecation

Question 47

how do soapsuds work as enema

Answer 47

• soapsuds:stim peristalsis by inc the volume in colon and the irritating the mucosa. Only use pure soap\

Question 48

why is return flow enema used

Answer 48

return flow enema-to expel flatus. (occasionally used) • alt 100-200ml of fluid into and out of rectum and sigmoid colon to stimperistalisis • repeat 5-6 times until abd distension/flatus is relieved

Question 49

infant and kid enema what type of solution do you give hypo iso or hypertonic

Answer 49

isotonic

Question 50

position for enema according to kozier

Answer 50

dorsal recumbent • for infants and kids dorsal recumbent freq used. Secure the legs by placing a diaper under the bedpan and then over and under the thigh

Question 51

what type of solution should always be used for kids and infants

Answer 51

isotonic eg normal saline

Question 52

max height of an enema for an infant

Answer 52

7.5cm

Question 53

procedure and considerations for enema delivery to infant or child

Answer 53

Infants and children • Explain carefully (to preschool age) • Use isotonic solution • Infants and small kids don’t have sphincter control yet and must be assisted to retain the enema • Nurse gives the enema with the infant/kid lying down w butt on bedpan. Nurse firmly presses buttocks together to prevent premature expulsion • Enema temp 37.7 • for infants and kids dorsal recumbent freq used. Secure the legs by placing a diaper under the bedpan and then over and under the thigh • insert tube 5-7.5cm in kid and 2.5-3.75cm in infant • to assist small child in retaining the solution apply firm pressure over the anus w tissue wipes or press cheeks tog firmly

Question 54

what does a high enema require

Answer 54

a medical prescription

Question 55

large volume enemas for infants and kids (3)

Answer 55

* Large volume 50-200ml in kids under 18mo old * 200-300ml kids 18mo-5yr * 300-500ml 5-12

Question 56

how long should client retain a retention enema

Answer 56

30min

Question 57

how long should client retain cleansing enema

Answer 57

5-10min

Question 58

instructions for pt before giving vaginal supp

Answer 58

please void

Question 59

which do you insert farther, a aginal cream jelly or foam OR an irrigation

Answer 59

irrigation approx 7-10cm and the others are 5cm