Nursing Care of patient while giving enema. Enemas are injections of fluids used to cleanse or stimulate the emptying of your bowel. This procedure has been used for years to treat constipation and similar issues. Constipation is a severe condition that slows down the movement of your stool. It also makes the stool hard and difficult to excrete. # Study Purpose # For nursing students

1. ENEMA

2. Define Enema
An enema is the administration of a substance in
liquid form into the rectum

3. CLASSIFICATION
OF ENEMA
Retension
Enema
(Retaining
Enema)
Non Retension
Enema
(Returning)
M Medical Enema
A Anaesthetic Enema
N Nutrient Enema
S Sedative Enema
S Stimulating Enema
S Soap Water Enema
A Anthelmintic Enema
I Ice water Enema
C Cleansing Enema
C Carminative Enema

4. Non
Retension
Enema
SMALL ENEMA
(Less than 10
ounce liquid)
LARGE ENEMA
(More than 10
ounce liquid)
G Glycerine Enema
O Oil Enema
A Anthelmintic Enema
S Soap Water Enema
A Anthelmintic Enema
I Ice water Enema
C Cleansing Enema
C Carminative Enema

5. General purposes of Enema
To check diarrhea
e.g. starch opium
enema.
To relieve
flatulence e.g.
carminative enema.
To stimulate
evacuation and
cleansing the large
bowel e.g. soap
solution enema.
To supply fluids and
nutrients. e.g.
nutritive enema.
To soften hard fecal
matter, e.g. oil
enema.

6. General purposes of Enema
To stimulate a patient
in shock and collapse.
e.g. stimulant enema.
To reduce
temperature e.g.
cold enema.
To make diagnosis.
e.g. barium enema.
To cleanse the bowels
before x-ray studies,
surgery or delivery of a
body - e.g. saline enema.
To induce
anesthesia -
anesthetic enema.
To stimulate
peristalsis. e.g.
purgative enema.

7. Large enema / SOAP - WATER
ENEMA
PURPOSE
■ To stimulate defecation and treat constipation of two to
three days.
■ To cleanse the bowel before surgery and child birth.
■ To soften fecal matter.
■ To relieve retention of urine by stimulating reflex action of
the bladder.
■ To relieve gaseous distention by stimulating peristalsis.
■ To cleanse the bowels before any type of retention enema.
RETURNING ENEMA

8. Articles Needed
■ A tray containing –
1. Enema can, rubber
tubing, glass connection,
screw clamp,
2. Mackintosh and draw
sheet,
3. A sterile catheter in a
bowl no. 8 or 12.
4. Lubricant,
5. Hot water in a jug,
6. Pint measure,
7. Soap jelly in a bottle,
8. I.V. Stand.
9. Toilet tray,
10.Bed pan-2.

9. Solutions Used
■ Soap water - soap jelly 50 ml to 1 litre of water.
■ Tap water -Amount of solution
 Infants - 250 ml or less.
 Children - 250 ml to 500 ml.
 Adults - 500 ml to 1000 ml.
Temperature of solution
 Children - 100 deg. F [ 37 deg. C ]
 Adults - 105 to 110 deg. F [ 40.5 to 43 deg. C ]

10. Precautions
See that the whole apparatus is in working condition
The catheter or rectal tube must be soft and flexible to
avoid injury to the mucus membrane of the rectum.
The catheter should be lubricated to avoid friction.

11. Precautions
The amount of solution should be depended upon the age
and size of the person.
While giving enema, left lateral position is given so that
sigmoidcolon is below rectum, so that instillation of fluid
becomes easy.
The catheter should be inserted 3 to 4 inches in adults, and
1 to 1.5 inches in children.

12. Precautions
Regulate the flow of fluid.
Don't allow the air to enter into the rectum
so -remove the froth from the solution.
Expel air from the tube.

13. Precautions
Clamp the tube before emptying the can
completely.
Listen to the complaints of the patient and don't
ignore any discomfort however small it is.

14. Procedure ENEMA
■ Attach rubber tubing to the can,
apply clamp and close it.
■ Pour 1000 ml of soap solution in the
enema.
■ Apply Vaseline on the tube / catheter
and hang the can on the stand 45 cm
above the bed or 30 cm from the
body.

15. Procedure
• Keep the articles ready on the bed side
locker.
• Explain the procedure to the patient.
• Screen the patient

16. Procedure
■ Assist the patient to turn
to left lateral position
because the colon
descends on left side,
there fore flow of
solution is better.
■ Bring patient's hip toward
edge of bed.

17. Procedure
■ Turn top bedding down while covering the patient with
bath blanket.
■ Place the mackintosh and draw sheet under patient's
buttocks.
■ Arrange bath blanket so that the anus is exposed.
■ Wash hands to prevent cross infection.

18. Procedure
■ Expel air from the tubing by allowing a small amount
of solution to flow into kidney tray and close it again,
this also expels the air.
■ Separate the buttocks so that anus can be seen easily.
■ Instruct the patient to breathe deeply through his
mouth.

19. Procedure
■ Insert gently catheter 3 to 5 inches, then open enema
clamp and gently let the water run in.
■ Continue the fluid administration to give about 500 to
1000 ml of solution. If the patient develops
discomfort, stop the procedure.
■ Clamp the tubing before emptying the can completely
so that the air will not enter into the tubing and getting
to patient.

20. Procedure
■ Slowly withdraw the catheter, cover it with gauze
pieces and place it in the kidney tray.
■ Place the bedpan under the patient's buttocks, or assist
the patient to bathroom if possible. Give a call signal
and leave him alone.

21. After care of patient and
Articles
■ Remove all articles while patient is on the bedpan
clean it with soap and water ., clean, dry and place to
their usual places.
■ Remove patient's bedpan.
■ Assist the patient for perineal care.

22. ■ Give patient soap and water to wash hands, dry the
patient, put on the garments, change the linen if wet,
make the patient comfortable.
■ Observe the enema results, noting the colour,
consistency and the amount, obtain specimens if
required wash hands.

23. Recording, Reporting
■ Record the type of enema, the results observed if any,
with date and time on the patient's chart and on the
nurses record and sign.
■ Send the specimens, if any to the laboratory.

24. ■ CLEANSING ENEMA -It is given to cleanse the
bowel before x-ray studies, surgery and retension
enema. Normal saline one TSF to half litre of water or
soda bi carb solution is used for it.
■ CARMINATIVE ENEMA -It is given to relieve
gaseous distention of the abdomen, by increasing
peristalsis and expulsion of flatus. 8 to 16 ml of
turpentine is mixed with 500 to 1000 ml of soap
solution. It is also called as antispasmodic enema.

25. ■ ANTHELMINTIC ENEMA -It is given to destroy and
expel worms from the intestines. Hypertonic saline 60 ml
with 600 ml of water is mainly used for the enema. The
amount should be 250 ml. Cleansing enema must be given
prior to the anthelmintic enema, so that the drug can come
in direct contact with the worms and the lining of the
intestines.
■ ICE WATER ENEMA -This is given to reduce body
temperature in hyperpyrexia and heat stroke. It is given by
drip method. The temperature of the solution should be 65
to 75 deg. F.

26. Small Enema
■ In this type the amount of solution is 500 ml or less
than that so it is called as small enema. The sub types
are as follows Glycerine Enema

27. GLYCERINE ENEMA-
■ [Glycerin syringe] -It is given especially
in children and in fever patients.
■ The quantity of the solution depends
upon the age of patient.
■ Pure glycerin 2 to 4 dram is given with
rubber catheter and glycerin syringe.
■ 2 ounce water and 1 ounce glycerin.
■ 2:1. Pure glycerin can be used.

28. Purpose
■ When there is a constipation in children.
■ When there is 7 to 8 days constipation, the stool has
become hard.
■ Patient's with fever.

29. Articles
■ 1) Screen.
■ 2) Pure glycerin or mixture of glycerin and water.
Keep in the bowl in a hot water ,
■ 3) glycerin syringe,
■ 4) catheter,
■ 5) Kidney tray,
■ 6) mackintosh and draw sheet,
■ 7) Bed pan - 2,
■ 8) Toilet tray.

30. Procedure
■ Wash hands to prevent cross infection.
■ Collect the required articles and keep it to bed side
locker of the patient.
■ Screen the patient.
■ Explain the procedure to the patient and relatives.
■ Place mackintosh and draw sheet under the buttocks of
the patient and give left lateral position to the patient.

31. ■ Taken glycerine in the glycerine syringe and attach
catheter to the nosal.
■ Remove complete air.
■ Lubricate the catheter.
■ Insert the catheter gently 3 to 4 inches, and the
solution will go in.

32. ■ Push the piston slowly, so that the glycerine will go
into the rectum.
■ Slowly withdraw the catheter, cover it with gauze
pieces and place it in the kidney tray.
■ Encourage patient to retain the solution at least for 20
to 25 minutes.
■ Assist patient to bathroom if possible or bedpan.

33. After care of patient and Articles
■ Remove equipment, wash it with soap and water,
clean, dry and place to their usual places.
■ Remove patient's bedpan.
■ Assist the patient for perineal care.
■ Give patient soap and water to wash hands, dry the
patient, put on the garments, charge the linen if it is
wet, make the patient comfortable.
■ Observe the enema results, noting colour, consistency
and the amount, obtain specimens if required.

34. Recording, Reporting
■ Record the result of glycerine syringe with date and
time on the patient's chart and on the nurses notes and
sign.
■ Report any untoward observation to the ward sister.

35. OIL ENEMA
■ Oil enema is given to soften fecal matter in cases of severe
constipation and after operation on the rectum and
perineum.
■ It is given to avoid straining and injury to the sutures and
wounds.
■ The enema must be retained for half to one hour to soften
the faeces.
■ Olive oil or sweet oil is used for the enema.

36. ANTHELMINTIC ENEMA
■ It is given to destroy and expel the worms from the
intestines.
■ Cleansing enema must be given prior to the anthelmintic
enema, so that the drug can come in direct contact with the
worms and the lining of the intestines.
■ Hypertonic saline 60 ml with 600 ml of water is mainly
used for the enema. The amount should be 250 ml.

37. ■ Retention enemas are given slowly with small rectal
catheter and funnel.
■ Usually are given for retention and absorption.
■ The amount is usually 6-8 ounces. [ 150 - 200 ml ].
■ Temperature is usually at body temperature except
stimulating enema which is given at 107 to 110 deg. F.
RETENTION ENEMA

38. NUTRIENT ENEMA
■ It is given to supply nutrients to the body.
■ Fluids are given according to the ability of the colon to
absorb it.
■ Normal saline, glucose saline, glucose 5%, 10%,
peptonized milk 120 ml etc. are used for nutrient enema.

39. ■ The amount of solution is taken about 110 ml to 1700
ml in 24 hours or 180 to 200 ml every 4 hourly.
■ The temperature of the solution should be 100 deg, F.

40. SEDATIVE ENEMA
■ This type of enema contains a sedative drug and it is
given to induce sleep, paraldehyde, chloral hydrate,
and potassium bromide are used to give sedative
enema.
■ The dose is according to the patient's condition and
physician's order.

41. STIMULANT ENEMA
■ It is given to treat the shock and collapse condition.
■ It is also given in poisoning cases e.g. coffee enema in
opium poisoning.
■ Following solutions are used to give stimulant enema.
■ Brandy - 15 ml of brandy in 120 to 180 ml of glucose
saline.

42. ■ Black coffee - ITSF coffee powder to 300 ml of water.
The amount of solution to be taken is 180 to 240 ml.
■ The temperature of solution should be 108 to 110 deg.
F. or 42 to 43 deg. C.

43. ANAESTHETIC ENEMA
■ This type of enema contains an anesthetic drug to
produce anaesthesia in patient.
■ The commonly used drugs are paraldehyde and
avertin.

44. MEDICAL ENEMA
■ Few medicines are administered by giving enema. e.g. in
diarrhoea cases starch opium enema is given or bland solution is
given into the rectum to soothe and relieve irritation on an
inflammed mucus membrane of the rectum.
■ Solution { Starch opium - Tr. opium 1 to 2 ml added to 120 to 180
ml of rice water. }
■ Temperature of the solution - should be 100 to 105 deg. F. or 37.8
to 40 deg C.

45. Scientific Principles
Anatomy and Physiology –
■ The large intestine is made up of the cerum, the colon, and the
rectum, its length is 5 feet in adult .
■ Ileocecal valve separates the small intestine from the large
intestine.
■ lleocecal valve opens in one direction, so prevents the passage of
material in opposite direction.
■ Fluid injected in a treatment cannot go beyond the ileocecal
valve.

46. ■ Colon is divided into the ascending colon, transverse colon, the
descending colon and the sigmoid flexure.
■ Rectum is five to six inches long and ends at the anus. It is guarded
by internal and external sphincter.
■ The walls of the large intestine are made up of longitudinal and
circular muscles.
■ Peristalsis is produced due to contraction and relaxation of the
involuntary muscle tissue.

47. ■ The large intestine is lined with mucous membrane. Which is not
so sensitive as the skin, so the temperature of the solution used for
treatments must be tested.
■ When the veins in the rectum and anal areas become dilated it is
called haemorrhoids.
■ The action in the intestine is controlled by the autonomic nervous
system.
■ Cellulose acts as mechanical stimulus to peristalsis.

48. Microbiology
■ Wash hands before and after the procedure to prevent cross
infection.
■ Provide the patient with hand washing facilities after he has used
the bed pan.
■ Sterilization of used rectal tubes and catheters is done by boiling
or autoclaving.
■ Other equipments are also sterilized by boiling or autoclaving.

49. Physics & Chemistry
■ The rate of flow of a solution in a rectal treatment varies with the
pressure, the caliber of the tube and the density of the fluid.
■ Fluid will flow only when there is a difference in pressure between the
solution in container and the end of the out flow tube.
■ Pressure depends upon the height of the column of fluid.
■ If pressure is too great, muscles of the intestinal walls contract too
quickly and cause so much pain that the patient will not be able to take
sufficient fluid for the treatment to be effective. Too much pressure may
cause injury to the mucous membrane.

50. ■ A thick fluid e.g. milk increases friction and flows slower than a thin
solution, because specific gravity of a fluid influences pressure.
■ Pressure of the gas against a walls of the intestines causes pain.
■ Pressure against the small veins in the anal region causes
haemorrhoids.
■ Fluid flows into the rectum and colon by the force of gravity.
■ Gravity supposes a flow from a high level to a low level. Gravity aids
the distribution of fluids.

51. ■ In the left lateral position, gravity will aid the inflow of solution.
■ Friction is reduced by using lubricants,
■ Water is a good conductor of heat, and heat travels through the
pelvic tissues by conduction.

52. ■ The nurse should stand with her feet apart in giving a treatment in
order to provide a wide base of support for her body.
■ Bending should be at the hips or at the knees.
■ When carrying a bedpan, carry it close to the body to prevent
strain on to back muscles

53. ■ Absorption of water through the intestinal wall is by osmosis.
■ Soap lowers surface tension of water and causes the water to
combine more quickly with fecal material.
■ Carminative enemas aid in expelling gas.
■ Glycerine is adhesive to the mucous membrane and will be
retained longer than water.

54. Pharmacology
■ When mild solutions are not efficient, sometimes more irritating
drug is used.
■ Mineral oil may be given by rectum to soothe the irritated mucosa
or to lubricate hardened fecal material to make its passage easier.
■ Barium sulphate is opaque to x-ray. It is injected in the colon in
order to outline the colon, in x-ray examination.

55. ■ Coffee is given by rectum as a stimulant.
■ Sodium bromide, chloral hydrate and paraldehyde are given by
rectum to quiet the patient.
■ The dose of a drug given by rectum is larger than the dose given
by mouth for the same effect because the absorption is slower in
the rectum.

56. Psychology
■ Explain the procedure to the patient to get the co-operation.
■ Maintain privacy throughout the procedure, so that the patient
will not be tense.
■ Listen to the complaints of the patient, and don't ignore any
discomfort however small they are.
■ Distract the attention of the patient by conversation.