Fleet enema for a confused dementia patient

[Sjade]

I am a final year nursing student working in a hospital as an assistant nurse.

I was asked by an RN to assist with an enema for a patient. On entering the room this little old lady was so confused as she has advanced Alzheimer's and was admitted for increased confusion/carers stress.

She has just had a just had a large BM, and I tried explaining to her that we needed to clean her up but I still had a hard time getting her pants down as she couldn't understand why we were doing it no matter how much I tried to reassure her.

You can only imagine trying to give the enema she just about jumped out of the bed and I swear half of it ended up on the bed rather than intended place.

We sat the poor little thing on the toilet and she sat there shaking asking why we would do that and saying she's calling the police. She felt violated, and I felt horrible for it and couldn't calm her down.

Anyway long winded but my question is how do you go about an enema in the very confused patient? And where is the line draw for them to be able to refuse when they're that confused?

[Double-Helix, BSN, RN]

Why was she given an enema if she had just had a large bowel movement?

[Sjade]

I honestly don't know. I queried the RN on this, but as an AIN not everyone thinks your opinion or advice is relevant.

[TheCommuter, BSN, RN]

The easy answer...you prevent the need for an enema in the first place.

I worked in the nursing home industry for six years. Most demented elders received a daily combo of a stool softener, usually Colace or Surfak, plus a senna glycoside laxative to prevent constipation.

If a demented elder became constipated, they received a "butt blaster" concoction of PRN Dulcolax chased down by warm PRN Milk of Magnesia mixed with prune juice.

If a demented elder with combative behaviors ever reached the point of needing an enema (which was rare), we would premedicate with a PRN benzodiazepine or antipsychotic prior to administration.

[Jules A, MSN]

OP, kudos for having compassion and considering the ethical concerns we encounter so often in this field.

[TheCommuter, BSN, RN]

Moved to the Patient Medications forum for more suggestions.

[Sjade]

This is such a great point, prevention first! Enema is generally the last option, especially for patients such as this?

Thanks so much for your input! :)