授课题目

Enema

授课形式

Bilingual lecture

Demonstrate

授课时间

2006．11．2

授课学时

2

教学目的

与 要 求

1.  discuss what kinds of patients are suitable for enema

2.  demonstrate the steps in administering an enema to an adult client

3.   describe the precautions necessary when performing enema

基本内容

1.  Objective

2.  Preparation

3.  Procedure

4.  Principle

重 点

难 点

1.  Procedure for enema

2.  How to give enema safely

主要教学

媒 体

PPT

主 要 外

语 词 汇

Enema, Rectal tube, Unretentive macro enema  

有关本内容的新进展

Disposible enema equipment

主要参考资料或相关网站

1、Zhou Kexiong. Basic Nursing Skills

2、SABDRA F.SMITH. Clinical Nursing Skills. Prentice Hall Health.

系、教研室

审查意见

已审合格，同意授课。

课后体会

1.  多交流使课堂气氛活跃，学生学习积极性高。

2.  医学术语较多，需要预习。

3.  沟通及时，学生基本能听懂和理解。

教学内容

时间分配和

媒体选择

Administering an enema

enema

Definition: the introduction of fluid through a tub医.学全在线www.med126.come into the lower intestinal tract.

Objectives:

Cleanse bowel, before some surgery or child-birthl.

defecate or remove the air in bowel.

instill medicine to treat some diseases

methods: unretentive macro enema; unretentive micro enema; cleansing enema or colon irrigation; retention enema.

unretentive macro enema

Definition

unretentive macro enema

Objective

To cleanse the bowel prior to surgery, childbirth, or diagnostic examination.

To relieve constipation. To relieve abdominal distention.

To detoxicate.

To lower the temperature of a fever client.

Preparation

Equipment

Middle-sized therapeutic tray

Fluid container with attached tube, hemostatic forceps

Kidney basin with rectal tube(size 22-30,straight, or French, for adults), gauzes with lubricant; toilet tissue

Clean bedpan, bed protector under the car

In addition: Water-soluble lubricant, thermometer, muddler, warm water, soft soap

Intravenous pole

Solution

Soap solution, Normal saline, Tap water

volume of solution for adult: 500ml~1000ml; temperature: 39~42℃.

To reduce body temperature: 28~32℃; For heat stroke: 4℃. 

Client

Explain

Ask the client urinate before the procedure.

Tell client prepare paper tissue

Environment

Provide privacy:

Keep warm:

Procedure

Introduce key points:

Position: left side-lying position.

Height: the height from surface of solution to anus is 45~60cm.

Length: 7~10cm.

Retention time: 5~10 minutes.

Relaxing skill: taking periodic deep breaths. when we begin to insert rectal tube or client feel uncomfortable and want to expel waste things during the procedure.

1.   check physician’s orders and client care plan

2.   gather equipment

3.   place a medium-sized therapeutic basin on a equipment car.

4.   wash hands, wear a mask.

5.   pick out a sterile kidney basin, a rectal tube and three pieces of gauzes into the kidney basin, pour a little lubricant on the gauze, move the kidney basin into the medium-sized therapeutic basin.

6.   open package on the center of table, check the label of package to make sure the fluid container isn’t expired. And then pick out fluid container, clamp the tubing. 

7.   fill water container with solution. soap solution. move it into the medium-sized therapeutic tray.

8.   place bed protector under the equipment car.

9.   identify correct client and explain the procedure. Ask the client if he had urinated. Tell client take a deep slow breath at the moment we insert the rectal tube.

10.  place client on left side-lying position.

11.  remove client’s clothing near hips.

12.  place bed protector under client’ hips.

13.  move the intravenous pole to the side of the bed. Raise it to a proper height, 40-60 centimeters

14.  place kidney basin and paper tissues on bed near the client’s hips.

15.  hang container on intravenous pole.

16.  attach rectal tube with tubing tightly. lubricate tip of rectal tube with generous amount of water-soluble lubricant

17.  open clamp, allow solution to run through the tubing so that air in the tubing is remwww.med126.comoved. Make sure solution flow into kidney basin. Clamp tube.

18.  gently spread buttocks using paper tissue, instruct client to take a slow deep breath, and gently insert rectal tube 7~10 centimeters into the client’s rectum using the gauze to hold the rectal tube.

19.  open regulating clamp and allow solution to flow slowly.

20.  hold the tubing in place in the client’s rectum at all times with paper tissue. Keep a bedpan nearby.

21.  after you have instilled the solution, clamp tubing，gently remove the tubing. Separate the rectal tube and the fluid container, put rectal tube into kidney basin, hang tubing on intravenous pole.

22.  dispose of equipment.

23.  help client turn to supine position.

24.  wash hands. Instruct client to hold solution for 5~10 minutes or as long as tolerated.

25.  write down the times of defecation in the form of N/E, “N” means the times of defecation after enema; “E” means enema.(“/” be called slash)

Precaution

1. make the client feel self-respect.

2. know exactly solution’s volume, temperature, concentration, press

3. pay attention to the follow special situation: 

u  for the client who is old person, child, or who has encephalopathy, cardiopathy: press should be low, speed should be slow.

u  for the client who has hepatic encephalopathy(HE,hepatic coma: don’t use soap solution. Because soap solution can produce Ammonia.

u  For the clients who has congestive heart failure and Sodium retention, should not use saline, in case of sodium’ absorption. And then increase his burden of heart.

u  for the client who has typhoid: pay attention to the press of solution. Volume should not be more than 500 ml, height between solution’s surface and client’s anus should not be more than 30cm.

u  if to lower the body temperature, tell the client to retain the solution at least 30 minutes, and then 30 minutes after expelling we take the client’s temperature.

3. observe the state of illness at all times:

u  if the flow of solution is impeded or an obstruction is felt: maybe it’s the fecal matter stop the flow. withdraw tube slightly, change the direction, and reinsert.

u  Cramp is a common symptom of enema. Lower solution container, tell client to take deep breaths. If it doesn’t work, clamp tubing for a few minutes, after client feel better continue the procedure.

u  client complains of severe and sudden abdominal pain, nausea, and distention: remove tubing, and notify physician immediately of possible perforation

4.   contraindication: pregnancy woman(cause abortion), gastrointestinal hemorrhage，acute abdomen

summary

Objective

Preparation

Procedure

Principle

Question

1. what’s enema?

2. what’s the precaution?

3. How to give enema to a typhoid patient?

4’

Use examples to introduce the objective of enema

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30’

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15’

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summary

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