Question about enemas...

[jnette]

OK, all you seasoned nurses, I need advice. :)

I should know this from my days in school, but we all know how that goes, and how QUICKLY that goes "bye-bye" ! :chuckle

If you give an enema and it is does not produce the desired result, (as in NADA)... is it appropriate/policy to give another? And if so, how long should one wait before administering another? Could it not mess up the electrolytes to give two successively within a relatively short period of time.. or would it not have any adverse affect?

I remember reading this before in school, but really cannot remember now, and I'm too sorry to go digging through my books to find out. You guys are a whole lot quicker "reference"!

Thanx for any input in advance.

[NRSKarenRN, BSN, RN]

sounds like this patient needs a stimulant type oral med too due to decreased bowel paralysis.

sometimes in those with paralysis, need to get liquid higher up in ractal vault to stimulate bowel try applying old foley cath on end of fleets unit can wiggle cath higher to deliver enema liquid.

for your dinner table conversation, previous threads re enemas:

bowel care basics...what makes sense?

slimeball enema urgent

milk and molasses enema

[janluvscats]

I am a new LPN working third shift in a LTC. The other night a pt had severe diarrhea and i didn't do the SSE. The morning nurse( also an LPN) said i should have done it anyway. This didn't make any sense to me since the poor guy was already doing what that was designed to do. Your thoughts please?

[thehipcrip]

Your para definitely needs to change not just his bowel care but his whole bowel program. That means getting 20-25 g of fiber per day and drinking at least 2-3 liters of water. He can also add up to 1000mg/day of docusate sodium (Colace) to keep the stool from getting hard (stool softeners do not soften stool that is already formed). Probiotics help (Align). Many paras and quads also use things like Miralax (laxative), magnesium supplements (laxative), senna (stimulant), prunes (fiber and stimulant).

He needs to pick a set time to do bowel care, preferably within 30 minutes of eating a meal so peristalsis is working for him. Most of the paras and quads I know get their bowel care started with a Magic Bullet suppository (which is bisacodyl) or a mini-enema such as Enemeez. Both the MB and Enemeez are available by mail order only. The folks at Enemeez will send you ten free samples to try of regular Enemeez or Enemeez Plus, which also contains lidocaine and helps ease discomfort and prevent autonomic disreflexia in those prone to it.

My biggest concern is hearing that your patient can't do his own care. What's preventing him from transferring himself from his chair to the commode or shower and back? That he has to rely on HHC to give him enemas and clean him up after is just wrong -- he should have been taught how to do independent bowel care and basic hygiene, getting dressed, etc. on his own in rehab. With some training, strength building, and some adaptive equipment like a shower chair, there's just no reason for a para to be so dependent upon others for daily care.

The next time you see him, please let him know about the CareCure Community, a site for people with spinal cord injuries/damage and those who care about/for them. In addition to peer support on subjects ranging from health and care issues, relationships and sexuality, pain, equipment, family, and care giving, the site is also staffed by a group of experienced rehab nurses.

[ZippyGBR, BSN, RN]

Thanx, peeps. It is my paraplegic... and he gets fleets QOD or so. But recently he's been having trouble.. the last time I had no results after 40 minutes.. not even a tiney bit of fluid return, nothing. Wasn't sure about giving another fleets, so I went after it. Apparantly the nurse the other day couldn't get any results after 20 minutes, and gave another fleets... I just couldn't remember if that was the thing to do or not.

Thanx again. :)

if the patient is a paraplegic s/he will probalbvy have some kind of neurogenic bowel ... failure to produce from an enema could do with so hands-on Or is that 'hands -in' investigation i.e. a PR check ...

i'm suprised that a fleet enema is his/her usual routine rather thansupps / micro enema +/- manual ...

[rkitty198, BSN, RN]

Is it okay to even perform disimpactions without an order? I read somewhere that we weren't supposed to, but I forgot my source.

I did one on a patient (elderly) and he had a vagal response, which was very scary!

I won't do them now because of it, without an order.

My collegue just did one the other day after inserting a suppository.

[carolmaccas66, BSN, RN]

Not in Oz no. You need to inform the Dr to see if he/she wants to do any scans/bowel procedures. The patient may have an impacted bowel and need other interventions.

With any gastro patients, or after gastro/bowel surgery NEVER give enemas or laxatives ever. Always check with their doctor if normal bowel/gastro function has not returned within 12-24 hours.

[ZippyGBR, BSN, RN]

for a patient with an an established neurogenic bowel from a spinal cord injury NOT performing a manual evacuation could have greater adverse effects especially if they are T6 or above ...