Instillation of a solution into the rectum and

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instillation of a solution into the rectum and sigmoid colon; primary reason to promote defecation by stimulating peristalsis; volume of fluid breaks up the fecal mass, stretches the rectal wall, and initiates the defecation reflex; also a vehicle for medications that exert a local effect on rectal mucosa; most common use for temporary relief of constipation; NEVER use enema to irrigate a colostomy -Cleansing enemas: promote the complete evacuation of feces from the colon; act by stimulating peristalsis through the infusion of a large volume of solution or through local irritation of the colon mucosa; include tap water, normal saline, soapsuds solution, and lower volume hypertonic saline - Tap water: hypotonic ; exerts lower osmotic pressure than fluid in interstitial spaces; escapes from bowel lumen into the interstitial spaces; infused volume stimulates defecation before large amounts of water leave the bowel; do not repeat because water toxicity or circulatory overload will develop if the body absorbs large amounts -Normal saline: safest solution to use because it exerts the same osmotic pressure as fluids in interstitial spaces; does not create danger of excess fluid absorption -Soapsuds: soapsuds added to tap water or N/S to create effect of intestinal irritation to stimulate peristalsis; only pure castile soap safe; -Oil retention: lubricate the rectum and colon; feces absorb oil and become softer and easier to pass; client retains enema for several hours if possible -Kayexalate : sodium polystyrene sulfonate; Medicated enema; treats clients with dangerously high serum potassium levels; contains resin that exchanges sodium ions for potassium ions in large intestine Excoriation: linear abrasion from mechanical means (NG tube irritation) FOBT (fecal occult blood testing)/Guaiac test: common lab test that can be performed at home or at client’s bedside; measures microscopic amounts of blood in feces; useful diagnostic screening tool for colon cancer; noninvasive; one does not confirm GI bleeding; need to repeat test three times while client refrains from ingesting foods and medications that could cause false positives; blue color indicates positive test Flatulence: gas accumulation in the lumen; stretches bowel wall (can cause feeling of fullness, pain, or cramping) Hematemesis: bleeding in the GI tract - blood in the vomit Hemorrhoids: dilated, engorged veins in the rectum lining; either external (clearly visible skin protrusions) or internal (outer mucous membrane); caused by increased venous pressure, such as defecation, pregnancy, heart failure, and chronic liver disease Polyps: abnormal growth of tissue from mucous membrane; potential concern for colon cancer Incontinence: inability to control passage of feces and gas from the anus; harms body image;
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Skills Test 3 often leads to social isolation Impaction: results from unrelieved constipation; collection of hardened feces, wedged in the rectum that a person cannot expel; severe cases can extend up to sigmoid colon; continuous
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