N105: Essentials of Nursing Care - Health Differences

Essentials of Nursing Study Guide

©2017 Achieve Test Prep Page 46 of 160 used to expel flatus; an alternating flow of 100 to 200 ml of fluid into and out to stimulate peristalsis; this process is repeated 5-6 times until the flatus is expelled Administering an Enema When administering an enema to a client you change the client’s position from left lateral to dorsal recumbent and then to the right lateral position during administration to promote the flow of the solution through the intestinal tract and into the entire large intestine. A low enema is intended only for the rectum and sigmoid colon, and the client stays in the left lateral position during administration. The volume of the enema can be a low volume (60-120ml), as in Fleets enema or high volume (500- 1000ml) cleansing enema which uses an enema bucket and tubing. The height of the solution container should never be more than 12 inches above the rectum unless a high cleansing enema is ordered for a colonoscopy or diagnostic procedure, in which case, the solution is held up to 18 inches above the rectum. Enema temperature should be that of normal body temperature, 37.5°- 37.7°C or 95°- 100°F degrees. Hypertonic solutions or oil contain 90-120mls. Hypotonic, isotonic and soapsuds enemas contain 500-1000mls. 2.6 Laxatives Types of Laxatives • Irritant (and vegetable) laxatives : These stimulate the intestinal mucosa, increasing motility and secretion. Figs, prunes, pears, raisins, and rhubarb have known laxative effects. The active ingredient of rhubarb, oxalic acid, is concentrated in the plant’s leaves, a serious threat of poisoning ifeaten. Rhubarb also contains tannin, an astringent that produces constipation as a side effect. Irritants should not be used with chronic inflammatory bowel diseases (ulcerative colitis or Crohn’s disease). Examples are Bisacodyl (Dulcolax, Correctol), Senna (Sennakot, Ex- Lax), Cascara, and castor oil. Cramping and fluid with feces may occur with use. Prolonged use will cause fluid and electrolyte imbalance. • Hyper-osmotic laxatives: These draw water into the intestine by osmosis and distend the bowel stimulating peristalsis. Examples are glycerin, sorbitol, lactulose, milk of magnesia, magnesium citrate, sodium phosphate and fleet phosphosoda. These laxatives are rapid acting and can cause fluid & electrolyte imbalances in children or elders with heart and renal disease. • Bulk-forming laxatives: These mimic the action of dietary fiber in the digestive tract. They are not absorbed, but are carried out of the body in feces. Contraindicated with clients with dysphagia. Examples are psyllium (Metamucil) and methylcellulose (Citrucel). This laxative can cause GI obstruction without sufficient water intake. • Lubricant laxatives : These use various oils to retard the reabsorption of water from the fecal mass in the colon. Mineral oil can interfere with the absorption of fat-soluble nutrients Vitamins A, D, and K. An example is mineral oil (Haley’s M-O). Prolonged use interferes with fat-soluble vitamin absorption. solutions are used to treat infections; antihelminthic enemas are used to killintestinal worms or parasites; nutritive enemas are used to administer fluid and nutrients • Return-flow enema: