State the Purpose - Indications - Contraindications of Enemas - Retention Enemas. 2-List the Types of Solutions Used for Enemas - Retention Enemas.

- Clean gloves

2.5.2.3. Other tools:

- Nylon sheet

- Towels

- Bean tray or paper bag.

- Disinfectant solution basin.

2.5.3. Procedure

- Bring the tools to the procedure site.

- Communication; let the patient sit in a chair with legs hanging down or let the patient lie down with head elevated.

- Cover the patient's chest with a nylon cloth and a towel on the outside.

- Place a bean bowl next to your cheek or under your chin (if sitting) to catch phlegm.

- Cut the tape

- Wash hands, open sterile tray.- Wear gloves

- Pour the oil into the cup.

- Measure the distance of the catheter and mark it with a pen or tape, then roll the catheter up. The distance of the catheter is measured from the tip of the nose to the earlobe and then from the earlobe down to the tip of the sternum.

- Roll the tube in the palm of your hand. Lubricate the tip of the catheter.

- The person performing the procedure stands facing the patient, to one side. The left hand holds the rolled catheter, the right hand holds the tip of the catheter like holding a pen, the dominant hand holds the end of the catheter, holding it 10 - 15cm from the tip of the catheter.

- Ask the patient to open his mouth and gently insert the catheter into one nostril. When the tip of the catheter reaches the throat (15 cm), ask the patient to tilt his head forward and swallow, gradually push the catheter in until it reaches the marked line, then stop. Secure the catheter to the bridge of the patient's nose or one cheek with tape.

+ While inserting the tube, avoid touching the tip of the tube to the throat as this will irritate the patient and cause them to vomit. Stop for a few seconds and encourage them to cooperate. If the patient coughs, has difficulty breathing, or turns purple, the tube must be immediately removed and reinserted.

Insert gently to avoid scratching the patient's nostril. Use a tongue depressor, have the patient open his mouth, and check the tube.

+ Suction or wipe away mucus from the patient's nose and mouth before inserting the catheter.

+ When inserting the catheter, tell the patient to open their mouth and breathe evenly or let the patient hold some water in their mouth and drink it while swallowing the catheter.

+ Always observe the patient. If the patient coughs, chokes, produces a lot of phlegm, has difficulty breathing, or turns purple, stop, remove the tube, and reinsert it.

- Check to see if the catheter tip has reached the stomach by one of the following three ways:

+ Use a 50 ml syringe to draw through the outer end of the tube. If you see gastric juice flowing out, it is okay.

+ Use a 50 ml syringe to draw 10 - 20 ml of air and pump it into the stomach through the outer end of the catheter. At the same time, place the stethoscope over the epigastric region and put headphones in your ears to listen while pumping. If there is a sound of air, it means the catheter has reached the stomach.

+ Dip the outside end of the catheter into a cup of water. If you don't see bubbles, it's okay.

- Gastric aspiration:

- Gently suck slowly with low pressure.

- In case the patient has bloating, suction until the bloating subsides.

- In order to determine the amount of gastric juice, it is necessary to aspirate until the liquid stops flowing out.

- If you are looking for tuberculosis bacteria, just draw 5ml into a test tube.

- After suctioning, clamp the catheter and slowly pull it out, using gauze to wipe as you pull it out and roll cotton around your hand until there is about 20 cm left, then bend the catheter and quickly pull it all out and soak it in a basin of antiseptic solution.

- Let the patient rinse his mouth with boiled water. - Wipe his mouth and nose.

- Collect towels, nylon, and bean bags.

- Adjust the patient's bed and place the patient in a comfortable position.

- Send specimens for testing if required.

2.5.4. Cleaning up tools:

- Return all used tools to the cleaning room for disposal according to regulations.

- Return other tools to their original places.

2.5.5. Record keeping:

- Date and time of procedure

- Amount of fluid aspirated, color, properties.

- General condition of the patient.

- Tests done.

- Name of the performer.

SELF-ASSESSMENT

Short questions (questions 1-6)

1. List two purposes of gastric suction

2. List 3 cases of gastric aspiration

3. List 3 cases where gastric aspiration is not applicable

4. List two possible complications that can occur when performing gastric aspiration.

5. Cases where gastric lavage is applied.

6. Points to note when washing the stomach.


Fill in the blanks (sentence 7-8)

7. Gastric lavage is a procedure of putting water into the stomach to suck……(A)…… in the stomach for the purpose of……(B)……

A……………………………… B……………………………..

8. While washing the stomach, if the patient complains of abdominal pain or bleeding in the washing water, ………(A)……and……(B)……

A……………………………… B………………………………


True/False Questions (Questions 9-10)

9. How to determine if the Levine tube is in: use a gastric aspirate pump, if there is a lot of gastric juice, the tube is definitely in the stomach.

10. To prevent abdominal distension, a nasogastric tube should be placed.

Choose the best answer (question 11)

Question 11: In enema technique, what is the temperature of the enema solution in degrees Celsius?

A. 37- 40 0 ​​C

B. 35 0 C

C. 50 0 C

D. 28 0 C

Question 12: In the enema technique, what will the nurse record?

A. Date and time indentation.

B. Enema solution - quantity.

C. Enema results, stool characteristics.

D. All are correct

Question 13: In the enema technique, how many centimeters above the bed should the enema be hung?

A. 20 -30 cm

B. 40 - 50 cm

C. 50 - 80 cm

D. 100 cm

Question 15: Effects of lubricants

A. Lubricant is required when performing nasogastric intubation.

B. Lubricant should be present when performing nasogastric intubation.

C. Lubricant may be needed when performing nasogastric intubation

D. Lubricant needs to be applied at the tip of the catheter when performing nasogastric tube placement.


LESSON 18

ENZEAL – RETENTION TECHNIQUE


TARGET

1- State the purpose - indications - contraindications of enemas - retention enemas. 2- List the types of solutions used for enemas - retention enemas.

3-Present correctly the points to note when performing enema.

4. Perform enema according to correct procedure

CONTENT

1-ENOMETRY

1.1-Purpose:

Pumping water or other solutions into the large intestine to stimulate intestinal motility to help the intestines expel stool easily.

1.2. Indications - contraindications:

1.2.1. Indications:

-Constipation.

-Before surgery, anesthesia or gastrointestinal surgery.

-Before enema - before birth.

-Before colonoscopy.

1.2.2. Contraindications:

-Typhoid fever.

-Appendicitis.

-Intestinal obstruction.

1.3. Technical process

1.3.1. Patient preparation:

- Inform and explain to the patient and their relatives about the upcoming procedure; encourage the patient to feel secure and cooperate during the procedure, in case the patient is a child or is not calm.

- Instruct the patient on necessary things. Do not delay during mealtimes or visiting hours.

1.3.2. Prepare tools:

- Wash hands before preparing tools

- 1 enema with rubber tube and lock

- 1 enema cannula or rectal catheter suitable for the patient. If a catheter is used, an extension tube must be provided. Catheters should be used for enema in paralyzed patients and children.

- 1 enema bottle.

+ Boiled water: Infants and young children should use saline solution.

+ The amount of enema depends on the instructions, usually for adults: 500 - 1,000 ml, not more than 1,500 ml.

+ For children: The amount of enema depends on age. But should not exceed 500ml.

+ Temperature of enema: 37- 40 0 ​​C

- 1 tray of beans

- Some gauze.

- Lubricants

- 1 nylon sheet

- 1 blanket or sheet.

- 1 flat pot

- Toilet paper

- Suspension column

- Screen if used in hospital room.

1.3.3. Procedure:

- Bring the tools to the procedure site.

- Change the cover.

- Pull up the screen to avoid affecting other patients when working in the sick room.

- Place a nylon sheet under the patient's buttocks.

- Remove the patient's pants completely if the patient cannot walk.

- Place the patient in an appropriate position depending on the condition:

+ Usually the patient lies on the left side.

+ In case of paralysis, place the patient on his back on a bedpan and raise the patient's head.

- Insert the cannula or catheter into the rubber tube of the enema. Clamp the tube.

- Pour water into the enema.

- Hang the enema on a pole 50 - 80 cm above the bed. Do not hang the enema too high because if hung too high, the water will flow in with strong pressure, causing irritation, increasing intestinal motility, preventing the water from going deep, affecting the enema results and making the patient uncomfortable.

- Lubricate the cannula or catheter tip.

- Open the clamp to let the water flow into the bean tray to expel the air and cold water in the tube, and check the rubber tube, cannula or catheter for drainage. Then clamp the tube again. You can check the temperature of the enema water by letting a few drops flow onto the back of your hand. If it feels too hot or too cold, you must adjust it.

- Remove the cloth to expose the patient's buttocks, use one hand to spread the patient's buttocks to expose the anus, use the other hand to gently insert the cannula or catheter into the anus until 2/3 of the cannula or catheter is inserted, about 12-15cm deep.

+ While inserting the cannula or catheter, tell the patient to open their mouth and breathe evenly.

+ If using a cannula, first direct the cannula towards the anus and navel about 2-3cm, then direct the cannula towards the spine. According to the anatomical position of the rectum.

- Open the clamp to let water flow in slowly.

+ One hand must always hold the cannula or catheter to prevent the cannula or catheter from popping out.

- Check if water is entering the colon:

+ Observe the amount of water in the pot.

+ Ask the patient if he or she feels water entering the intestines.

+ If the fluid does not flow, the cannula or catheter must be checked. The cannula can be pulled out a little and then pushed back in while raising the cannula to create a change in pressure.

+ While the fluid is flowing in, if the patient complains of pain, discomfort, or the urge to defecate, the tube must be immediately closed and the patient must rest for a while; when the above signs subside, continue to let the fluid flow in at a lower pressure.

- When the water in the steam has almost drained, clamp the tube, gently pull out the cannula or catheter, wrap the cannula in toilet paper and place it on the bean tray or wipe it and put it in the disinfectant solution container. Hang the rubber tube on the pole.

- Have the patient lie on his back and tell him to try to hold the water in his intestines for 10-15 minutes.

- Give the patient a bedpan or help the patient go to the toilet.

- When the patient has finished defecating, help the patient clean up.

- Wash the patient's hands, or help the patient clean himself.

- Take out the nylon sheet.

- Adjust the patient's bed and help the patient lie in a comfortable position.

1.3.4. Cleaning and storing tools:

- Take dirty tools to the cleaning room for disposal according to regulations.

- Return other tools to their original places.

1.3.5. Record keeping:

- Date and time of withdrawal.

- Enema solution - quantity.

- Enema results, stool characteristics.

- Name of the person performing the procedure.

1.4. Points to note:

- While the water is entering the colon, if the patient complains of abdominal pain or wants to defecate, stop the water flow immediately and notify the doctor.

- Check the water temperature before enema to avoid damaging the mucosa.

- Monitor general condition (pulse, blood pressure, breathing rate, temperature) to detect unusual changes after enema (abdominal pain).

TECHNICAL CHECKLIST FOR ENEMIES


TT

CONTENT

Have

Are not


* Prepare the patient



1

View medical orders and compare with patient



2

Inform, explain, and reassure patients




* Prepare the nurse



3

Nurses wear hats, masks, and wash hands regularly.



4

* Prepare tools




Rectangular tray, glycerin gauze, clean gauze, water temperature thermometer, cannula or rectal probe (for paralyzed patients)




Enema, water scoop, hanging pole, potty, toilet paper, nylon bag for dirty clothes




Plastic sheet, gloves, patch, bean tub




* Technical implementation



5

Take the patient to the procedure room or cover the screen



6

Check the water temperature, pour water into the pot, hang the pot on a pole 50 - 80 cm above the bed surface.



7

Replace blanket with cloth , put plastic sheet under buttocks



8

Place the patient on his side (lower leg straight, upper leg bent). Pull the patient's pants away from the buttocks.



9

Wear gloves, attach cannula or catheter, apply lubricant. Expel air.



10

Open the gauze. Spread the buttocks. Ask the patient to open his mouth and breathe evenly. The nurse holds the gauze with one hand to spread the anus, inserting about 2/3 of the cannula or 12-15cm (catheter).



11

Unlock the water to flow slowly, hand holding the canuyun

Check the amount of water in the cup, ask the patient's reaction.



12

When the enema is almost finished, lock it and gently pull out the cannula. Wrap the cannula in paper and place it in the bean-sized basin.



13

Remove the plastic wrap, change the cloth cover, and help the patient lie on his back again.



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State the Purpose - Indications - Contraindications of Enemas - Retention Enemas. 2-List the Types of Solutions Used for Enemas - Retention Enemas.

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