1.  Warm Up  TO: Students will learn how to care for enemas and rectal treatments  Students will practice administering enemas and rectal treatments  Closure 7:1 Demonstrate principles of infection control related to transmitting or transmission based precautions (gowns, gloves, masks, etc.) Recognize the difference between transmission based precautions and standard precautions. 7:4 Discuss implications of hazardous materials. 9:2 Describe strategies for prevention of diseases including all health screenings and examinations.

2. 1. A man suddenly stops chewing, looks frightened, and points to his throat. What should the healthcare worker do FIRST? A. Ask the man to sit up straight and raise his arms above his head. B. Ask the man are you choking? C. Move the man to a safe location and give 5 abdominal thrusts. D. Perform a mouth sweep. 2. The jejunum and ileum are parts of the small intestine. 3. TRUE/FALSE: The BEST way a healthcare worker can be sure that a patient clearly understands directions he/she has been given is to ask whether the patient understands. FALSE 4. Most healthcare facilities permit male employees to wear what type of jewelry when providing patient care? A. A charm bracelet B. Body jewelry C. Small pierced earrings D. Tongue piercing jewelry 5. A client has an advanced directive that states he/ she does not wish to be resuscitated incase of emergency. The nurse assistant does not agree with this decision. What should be done if the patient goes into cardiac arrest? A. Encourage the client to find a new healthcare provider. B. Ask the family for their decision in this situation. C. Begin CPR as the client Is unable to currently voice their request. D. Notify the supervisor and refrain from administering CPR.

3.  DEF: › Injection of fluid into the large intestine and through the rectum.  PURPOSE: - Remove feces - Remove flatus - Relieves intestinal congestion - Give medicine  Before surgeries, imaging procedures, and childbirth you would do an enema.  Physicians order is required to know what type or amount of solution you would need.

4.  Small amount of solution kept in intestine for a specific period of time after given. USES: 1. Instill medications 2. Soften stool 3. Elimination of intestinal parasites 4. Lubricate rectum 5. Expel flatus

5.  Larger amounts of solution is given USES: 1. Clean bowel of feces and flatus.

6. 1. Cleansing enema - Soap-solution, tap-water, normal saline solution SOAP SOLUTION  Not used as much because it irritates the intestine. NORMAL SALINE  Isotonic solution that does not cause fluid imbalances. (isotonic solution - a solution having the same osmotic pressure as blood) (osmotic pressure - dissolved substance exerts on a semipermeable membrane, through which it cannot penetrate, when separated by it from pure solvent.) TAP WATER  Regular tap water.

7. 2. Disposable Enema - A prepared disposable container solution - draws fluid from the body to stimulate peristalsis and elimination of stool and flatus.

8. 3. Oil retention enema - mineral or olive oil is usually used to soften fecal material followed by a cleansing enema.

9.  Impaction › Large, hard mass of fecal material in the intestine or rectum.  oil retention enemas must be preformed and if oil retention enemas don’t work you would put a lubricated gloved finger into the patients rectum.

10.  Expels flatus  Fecal matter may drain through the tube.

11.  Cone shaped  Based with cocoa butter or glycerin (Glycerin - A sugar based compound, having the same texture as lotion.)  Inserted through rectum  Melts from body heat  Expels feces

12.  Medication added to base material  Relieve pain  Decreases body temperature  Stops vomiting

13. 1. Ck MD order or obtain authorization from immediate supervisor; verify the type of enema. 2. Assemble equipment. 3. Remove enema from its package. Remove cover from the tip. Add additional lubrication as needed by placing the tip in a paper towel with lubricating jelly. 4. Place all equipment on tray and cover with a towel. Go to the patients unit. 5. IWIPE 6. Close door and screen unit. 7. Wash hands. Put on gloves. 8. Place bed pan near bed on a chair. Position all equipment conveniently. 9. Elevate bed to a working height. Lower the side rail on the side of the bed you are working. 10. Cover patient with a bath blanket. Fanfold the top bed linens to the foot of the bed. Place an under pad or bed protector under the patients buttocks. 11. Position the patient in the Sims position. Fold the bath blanket at an angle to expose the buttocks. 12. Squeeze container slightly to get the solution to the top of the tip and eliminate air in the container. 13. Use one hand to raise upper buttocks and expose anus. With your other hand, gently insert the tip approximately 2 in. explain each step to the patient to reduce anxiety and apprehension.

14. 14. Expel solution, gently squeeze container, starting from the bottom and progressing toward the tip in a spiral manners. Hold the container at a slight upward angle to prevent air bubbles. Encourage the patient to breathe deeply and retain the enema solution. 15. when the solution has been injected and the container is empty, gently remove tip from the rectum. Inform the patient as you do this. Place the container in an infectious waste bag. 16. Place bed pan under patient or assist the patient to the bathroom or on to a bed side commode. Encourage 5-10 mins of retention. 17. Position pt comfortably. Leave the call signal and toilet tissue within easy reach of the patient. Wash hands and remove gloves before leaving the room. 18. Answer the call signal immediately. Wash hands put on gloves. Remove bed pan. Assist the patient in cleaning the anal area, as needed. 19. Provide wash cloth and towel. Allow the patient to wash his/her hands with soap and water. Assist with perianal care as needed. 20. Replace top bed linens. Remove the bed protector and bath blanket. Position the patient comfortably and in correct body alignment. 21. Observe all check points before leaving pt ; elevate the side rails (if indicated), lower the bed to its lowest level, place the call signal and supplies within easy reach of the patient, and leave the area neat and clean. 22. Take the bed pan to bathroom. Observe the contents in the bed pan before emptying. Note amount, color, type, and any abnormalities. Record the results of effectiveness of the enema. 23. Empty bed pan and rinse with cold water. Clean it with a disinfectant. Rinse, dry, and return the bed pan to the patients unit. 24. Clean and replace equipment used.

15. 25. Remove gloves. And wash hands. 26. Report, record required info on the patients chart or the agency form, for example, date; time; fleets enema given poor results, expelled one small formed dark brown stool, patient complaining of “gas pains”; and your signature and title. Report any unusual observations immediately.

16. 1. Ck MD orders or obtain authorization from your immediate supervisor. Note time required. 2. Assemble equipment. Place the tip of the rectal tube in lubricating jelly on a paper towel. Connect the opposite (open) end to the flatus bag. 3. IWIPE 4. Elevate the bed to a working height. Lower the side rail on the side where you are working. 5. Position the pt in Sims position. Place an under pad under the patients buttocks. Fold the bed linen at an angle to expose the buttocks. 6. Use one hand to raise the upper buttocks & expose the anus. With your other hand, insert the rectal tube 2-4 in into the rectum. Tell the patient what you are doing. 7. Tape tube to the pts buttocks to hold the tube in place. 8. If a flatus bag is not in use, place free end in a basin, bed pan, or specimen bottle. 9. Ck pt comfort as possible before leaving. Elevate side rails, if indicated. Leave the call signal within easy reach of the patient. 10. Remove gloves and wash hands thoroughly. 11. Return at intervals to check the patient and rectal tube. 12. Wash hands put on gloves. Remove the tube promptly at the end of the time period, usually 20-30 mins. Tell the patient what you are doing. Remove the tube gently. 13. Place rectal tube and bag in infectious waste bag. Clean pt, as needed. Remove the under pad and replace the bed linens. 14. Ask the pt how much flatus (gas) was expelled or if the patient feels better.

17. 17. Observe all check points before leaving the patient; position the patient in correct body alignment, elevate the side rails, lower the bed to its lowest level, place the call signal and supplies within easy reach of the patient, and leave the area neat and clean. 18. Note any result in collection of air (flatus) in bag, drainage, patients comments following the procedure. 19. Clean and replace all equipment 20. Remove gloves and wash hands. 21. Report and record all required information on the patients chart or the agency form, for example, date; date; time; rectal tube inserted for 20 mins, expelled larger amounts of flatus, no drainage noted, patients stated “ I feel much better”; signature and title. Report any unusual observations immediately.

18.  What have you learned from todays lesson?