SKILL POWER INSTITUTE, INC.
TARLAC CITY BRANCH RECTAL SUPPOSITORY ADMINISTRATION NAME:___________________________________________ BATCH/SESSION:___________________________________ DATE:___________________ GRADE:__________________ SCORE 2 1
3 I. KNOWLEDGE AND SKILLS 1. Purposes of rectal suppository. 2. Discuss the reason why procedure is indicated to the patient. II. SKILLS AND ATTITUDE 3. Checking doctors order. 4. Handwashing. 5. Assemble materials needed. -Suppository ordered by the doctor -Lubricant (optional) -Tissue wipes -Gloves 6.Greet and Explain the procedure to the patient. 7. Take the mqterials to the bedside and screen the unit. 8. Have the material turn on side with buttocks close to the edge of the bed near the nursing aid. Place the patient in Sim s position. (Assist patient if necessary). 9. Fanfold top bed covers down to below patient s buttocks. Fold up back of gown to expose anal area. Avoid over exposure of patient. 10. Put on rubber gloves. 11. Insert the suppository beyond the anal sphincter. 12. Press the folded tissue against anus for a few minutes until the patient s urge to defecate has passed. 13. Leave the patient dry and comfortable then wash your hands. 14. Document and Record: Date and Time, Procedure: Rectal Suppository, Medication ordered by physician, Patient s Reaction, Nurse s Observation.
How to Grade: 1. The student is graded from 0-3 in all the indices depending on his/her performance. 2. 3 means a very satisfactory performance; 2 satisfactorily; 1 unsatisfactorily, 0 means very unsatisfactorily. 3. Scores in all the indices are added and transmuted using a transmutation table. Student s Remarks: _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________
____________________________ Student s Signature _____________________________ Laboratory Instructor
SKILL POWER INSTITUTE, INC. TARLAC CITY BRANCH ENEMA ADMINISTRATION NAME:___________________________________________ BATCH/SESSION:___________________________________ DATE:___________________ GRADE:__________________ SCORE 2 1
3 I. KNOWLEDGE AND SKILLS 1. Define Enema Administration 2. What are the purposes of enema 3. Enumerate the types of enema II.SKILLS AND ATTITUDE 4. Assessment 1. Physician s order for type of enema 2. Agency policy and physician s order regarding performance of procedure 3. Time of bowel movement and usual bowel evacuation pattern 4. Indicators of complications 5. Hx of factors that may contraindicate enema or present complications during enema administration 6. Client s dietary habits 7. Abdominal status: presence of bowel sounds 8. Client s mental status and any fears associated with procedure 9. Status of anus and skin surrounding buttocks 10. Vital signs, before, during and after enema 11. Client knowledge regarding promotion of normal bowel evacuation 12. Client medications that decrease peristalsis, such as narcotics IMPLEMENTATION Preparation: 5. Lubricate about 5 cm (2inch) of the rectal tube (some commercially prepared enema sets already have lubricated nozzles) * Lubrication facilitates insertion through the sphincters and minimizes trauma 6. Run some solution through the connecting tubing of a large-volume enema set and the rectal tube to expel any air in the tubing; then close the clamp. * Air instilled into the rectum, although not harmful, cause unnecessary distention. PERFORMANCE/PROCEDURE 7. Explain procedure to the client. * What you are going to do * Why it is necessary * How he/she can cooperate * Discuss how the results will be used in planning further care or treatments Rationale: Reduces anxiety. Gain patient s trust and cooperation * Indicate that the client may experience a feeling of fullness while the solution is being administered 8. Perform hand washing. Apply clean gloves and observe appropriate infection control procedure. Rationale: Reduce the transfer of microorganism 9. Provide for client privacy. Rationale: To protect the patient from embarrassment 10. Assist the adult client to a left lateral, with right leg as acutely flexed as possible, and the linen server pad under the buttocks. Rationale: This position facilitates the flow of solution by gravity into the sigmoid and descending colon, which are on the left side
Having the right leg acutely flexed provides adequate exposure of the anus. 11. Insert the rectal tube. * Gently spread the buttocks with non dominant hand Rationale: To ensure good visualization of the anal opening * Insert the tube smoothly and slowly into the rectum, directing it toward the umbilicus. Rationale: the angle follows the normal contour of the rectum Slow insertion prevents spasm of the sphincter muscles, facilitating entry * Insert the tube adult 7 to 10 cm (3-4 inches) because the anal canal is about 2.5 to 5 cm (1-2 inch) long infant (1 to 1.5 inches) child (2-3 inches) Rationale: Prevents rectal trauma; places tube in far enough to cleanse colon * If resistance is encountered at the internal sphincter, ask the client to take a deep breath, then run a small amount of solution through the tube Rationale: To relax the internal anal sphincter * Never force tube or solution entry. * If resistance persists, end the procedure and report the resistance to the physician and the nurse in charge, 12. Slowly administer the enema solution. Rationale: Administering the enema slowly and stopping the flow momentarily decrease the likelihood of intestinal spasm and premature ejection of the solution. * Raise the solution container, and release the clamp to allow fluid flow. Rationale: Administer all solution or as much as client can tolerate; be sure to clamp tubing just before all of the solution clears the tubing * Administer the fluid slowly. If the patient complains of fullness or pain, lower solution container, use the clamp to stop the flow to 30 seconds and then restart the flow at a lower rate. Rationale: Delivers enough solution for proper effect; prevents infusion of air 13. Slowly remove rectal tubing while gently holding buttocks together Rationale: Prevents accidental evacuation of solution * Remind client to hold solution for amount of time appropriate for type of enema -reposition client for comfort -place call light and bedpan or bed side commode within easy reach Rationale: Ensures optimal effect Facilitates comfort Provides means of contacting nurse; provides receptacle for enema solution. 14. Discard or restore equipment appropriately Rationale: Promotes clean environment 15. Discard gloves and perform hand hygiene Rationale: Reduces microorganism transfer 16. Check client every 5-10 minutes to assess if client is still able to retain enema Rationale: Reassess client s condition and retention of enema 17. Assist the client to defecate * Assist the client to a sitting position on the bedpan, commode or toilet after retention time have expired or when client can no longer retain enema. Rationale: A sitting position facilitates the act of defecation * Ask the client who is using the toilet not to flush it. Rationale: The nurse needs to observe the feces * If a specimen of feces is require, ask the client to use a bedpan or commode 18. Apply glove and perform perineal care with soap and water. Spray room deodorizer after evacuation. Rationale: Removes residual stool spoilage; eliminates odor
19. Perform hand washing Reduces microorganism transfer 20. Document the following: * Type and amount of solution used * Procedure completion with date and time and color, consistency and amount of stool expelled * Condition of anus and surrounding area before and after procedure * Vital signs before and after enema * Description of and interventions for any adverse reactions experienced during the procedure How to Grade: 1. The student is graded from 0-3 in all the indices depending on his/her performance. 2. 3 means a very satisfactory performance; 2 satisfactorily; 1 unsatisfactorily, 0 means very unsatisfactorily. 3. Scores in all the indices are added and transmuted using a transmutation table. Student s Remarks: _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________
____________________________ Student s Signature _____________________________ Laboratory Instructor
