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Nursing Skills Laboratory Procedure


Administering an Enema

Achievement of SATISFACTORY in all categories is necessary

Student's Name: ____________________

Grade (circle one):

P = achieved 3 or above in all categories

F = achieved 2 or below in one or more categories

The following scale is utilized:

1 = Failing 2 = Unsatisfactory 3 = Satisfactory 4 = Good 5 = Superior

ACTION
S
G SA U
F
  • Gather the supplies
5 4 3 2 1
  • Explain the procedure to the patient
5 4 3 2 1
  • Wash and dry hands carefully
5 4 3 2 1
  • Place the supplies in the patient's bathroom
5 4 3 2 1
  • Close the clamp on the enema administration set
5 4 3 2 1
  • Fill the enema administration set with the appropriate type and amount of solution
5 4 3 2 1
  • Open the clamp on the enema administration set and run some of the enema solution through the tubing into the sink to expel and air out of the tubing
5 4 3 2 1
  • Take the filled enema administration set to the patient's room and hang it on an IV pole near the patient's bed
5 4 3 2 1
  • Draw the curtain around the bed for privacy
5 4 3 2 1
  • Go to and stand near the right side of the bed
5 4 3 2 1
  • Lock the wheels of the bed
5 4 3 2 1
  • Raise the bed to waist level and lower the head of the bed to a horizontal position or as low as the patient can tolerate
5 4 3 2 1
  • Lower the siderail nearest you
5 4 3 2 1
  • Unfold the top linen down past the patient's hips
5 4 3 2 1
  • Assist the patient in assuming a left lateral position with his/her righrt leg flexed as acutely as possible
5 4 3 2 1
  • Don clean gloves
5 4 3 2 1
  • Place a proective pad under the patient's hips
5 4 3 2 1
  • Lift the enema bag off the IV pole and place it on the protective pad under the patient's hips
5 4 3 2 1
  • Open a package of water soluble lubricant
5 4 3 2 1
  • Luricate two inches of therectal tube portion of the enema administration set
5 4 3 2 1
  • Lift the patient's upper buttock to ensure good visualization of his/her anus
5 4 3 2 1
  • Insert the rectal tube portion of the enema administration set into the patient's anus, directing it toward his/her umbilicus
5 4 3 2 1
  • Continue inserting the rectal tube portion of the enema administration set three to four inches into the patient's rectum
5 4 3 2 1
  • Hold the rectal tube portion of the enema administration set near the patient's anus with your left hand
5 4 3 2 1
  • Open the clamp on the enema admnistration set with your right hand
5 4 3 2 1
  • Raise the enema admnistration set 12 inches above the patient's rectum with your right hand
5 4 3 2 1
  • Administer the enema solution slowly
5 4 3 2 1
  • If the patient complains of fullness, cramping, or pain, close the clamp on the enema admnistration set, stop the flow of the enema for 30 seconds, and restart the flow of the enema solution at a slower rate
5 4 3 2 1
  • Close the clamp on the enema admnistration set after all the enema solution had been instilled or when the patient cannot hold any more enema solution and wants to defecate
5 4 3 2 1
  • Withdraw the rectal tube portion of the enema admnistration set from the patient's rectum and anus
5 4 3 2 1
  • Place the rectal tube portion of the enemas admnistration set on the protective pad under the patient's hips
5 4 3 2 1
  • Remve the protective pad with the rectal portion of the eneam admnistration set on it out from under the patient's hips
5 4 3 2 1
  • Assist the client to assume a comfortable position
5 4 3 2 1
  • Unfold the top linens over the patient's hips
5 4 3 2 1
  • Encourage the patient to retain the enema solution for the appropriate length of time
5 4 3 2 1
  • Wait the appropriate length of time
5 4 3 2 1
  • When the appropriate length of time had passed, assist the patient to a sitting position on a bedpan, commode, or toilet
5 4 3 2 1
  • Wash and dry hands carefully
5 4 3 2 1
  • Record administering an enema per agency policy (e.g., type of enema solution administered; length of time the enema solution was retained; the amount, color and consistency of the return; and the relief of flatus and abdominal distention)
5 4 3 2 1
Comments:

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This page was last modified on 6/1/01