Learningobjectives：
1. outline the essential steps inadministering an enema to an adult client
2. describe the precautions（注意事项) necessary when performing enema
3. compare and contrast all kinds of enema
Definition: the introduction of fluid through a tubeinto the lower intestinal tract.
Types: mass enema(大量不保留灌肠); fleet enema（小量不保留灌肠); cleansing enema（清洁灌肠); retention enema（保留灌肠);
1. To relieve constipation（便秘)or abdominal distention（腹胀)
2. To cleanse the bowel（肠)prior to surgery（手术), childbirth, or diagnostic examination（诊断性检查)
3. To introduce an exchange resin
4. To lower the temperature of a fever client
Fluid containerwith attached tube, forceps（钳子) on tube
Plate with twogauzes（纱布), rectal tube（肛管)(size 22-30,straight, or French, for adults); toilet tissue（卫生纸)
Clean bedpan（便盆), bed protector under a equipment car
In addition:Water-soluble lubricant（润滑剂), thermometer（温度计), muddler（搅拌棒), warm water, soft soap
Bath blanket
Intravenous pole（输液)
Clean gloves（手套)(necessary)
Soap solution,Normal saline（生理盐水), Tap water（自来水)
Soap solution:mild soap solutions stimulate（刺激) and irritate（刺激以至不适) intestinal（肠) mucosa（黏膜), and then canfacilitate the fecal elimination（排便).
Normal saline:these solutions are mildly irritating to the mucous membrane（膜)of the colon（肠). Hypertonic（高渗) solutions drawfluid into the colon from the body tissues.
Tap water: Tapwater is a hypotonic（低渗) solution. Give with caution to infants（婴儿) or to adults with altered cardiac and renal reserve（心肾储备).
Normally :volume: 500ml~1000ml; temperature: 39~42℃.
For relieving theheat: 28~32℃; For heat stroke（中暑): 4℃.
Explain theprocedure and objective for the client and his family members in order toobtain their cooperation.
Ask the clienturinate（小便) before the procedure in case of urinatingduring the procedure because of the increase of abdomen press（腹压).
Tell client whocan move himself to prepare paper tissue（纸巾)
Provide privacy:usually, administrate an enema at treatment room. if the client can’t movehimself, enema can be done at ward. At this moment, please pay attention togiving privacy, such as using screen（屏风).
Keep warm: coverclient with bath blanket, close door or windows.
1. check physician’s orders and client careplan
2. gather equipment
3. place a medium-size square plate（中方盘) on a equipment car.
4. wash your hands, wear a mask（口罩).
5. pick out a pan from sterile storagecontainer（无菌储物罐), and then pick out a rectal tube and twogauzes into the pan, grasp one gauze, pour a little lubricant on the gauze, andput it back to the pan, move the pan into the medium-size square plate. Havesome paper tissues with you.
6. fill water container with solution: openpackage on the centre of table, first check the label of package to make surethe fluid container isn’t expired（期满). And then pick out fluid container, clamp（夹)the tubing（管), pour 750-1000 millimeters of lukewarm（温)solution(boiled water) into the container, 39-42℃. insert athermometer to the solution to make sure the temperature is right, wipe thetemperature with a gauze. solutions that are too hot or too cold (or solutionsthat are instilled too quickly) can cause cramping（痉挛), damage to rectal（直肠) tissues, and extreme shock（休克).
7. pour liquid soap into the container, usinga measuring cup（量杯) to make sure the correct quantity. Theproportion（比例) is one millimeter of liquid soap to 100millimeters of boiled water. Use muddler to mix them, wipe the muddler with thesame gauze wiping temperature, throw the gauze into a trash can（垃圾箱).
8. place the fluid container to themedium-size square plate.
9. place the bedpan and bed protector underthe equipment car.
10. identify correct client and explain the procedure.Instruct the client take some paper tissues. Explain the benefits of relaxingand the skills of how to relax, such as taking periodic deep breaths. This isimportant for the client, because the client will feel uncomfortable and wantto expel（排) waste things during the procedure that isnot what we want. Because taking a deep breath relaxes the anal sphincter（肛门括约肌) and prevents tissue trauma（伤) during tubeinsertion, and the client may feel better and relaxed.
11. provide privacy
12. place client on left side-lying position.To facilitate flow of solution using contour（轮廓) of bowel(normalcurve of rectum and sigmoid colon（乙状结肠)).
13. remove client’s clothes near hips.
14. place bed protector under client’ hips.place bedpan within easy reach.
15. place the pan and paper tissues on bednear the client’s hips.
16执业医师. move the intravenous pole to the side ofthe bed.
17. hang container on intravenous pole. Raisethe solution container to a height of 45-60 centimeters.
18. attach rectal tube with tubing tightly.lubricate tip of rectal tube with generous amount of water-soluble lubricant
19. open clamp, allow solution to run throughthe tubing so that air is removed. Make sure solution flow into pan. Clamptube. if air is instilled during the procedure, the client experiencesdiscomfort as a result of distension of the colon.
20. gently spread buttocks（臀部) using paper tissue, instruct client to take a slow deep breath, andgently insert rectal tube 8-10 centimeters into the client’s rectum using thegauze with lubricant on it to hold the rectal tube.
21. open regulating clamp and allow solutionto flow slowly. if the flow is slow, the client experiences fewer cramps. Theclient will also be able to tolerate and retain a greater volume of solution.
22. hold the tubing in place in the client’srectum at all times. Keep a bedpan nearby.
23. if client experiences cramps, or is unableto retain solution, or exhibits anxiety, lower solution container ormomentarily clamp tubing. resume infusion of solution after a few minutes.
24. after you have instilled the solution,clamp tubing，gently remove the tubing. Instruct clientto hold solution for 10-15 minutes or as long as tolerated. The longer thesolution is retained the more effective the results.
25. clean and dispose of equipment.
26. wash hands
27. assist client to toilet or use the bedpan.
28. after client has expelled the total volumeof the instilled solution, assist client to assume a comfortable position onbed
29. write down the times of defecation（排便) in the form of N/E, “N” means the times of defecation after enema; “E”means enema.
1. makethe client feel self-respect（自尊)
2. payattention to the follow situations:
u forold person, child, woman at the beginning or the end of pregnancy or for theclient who has encephalopathy（脑病),cardiopathy（心脏病): pressshould be low, speed should be slow.
u forthe client who has hepaticencephalopathy(HE,hepatic coma, 肝性脑病) : don’t use soap solution.
u forthe client who has typhoid(伤寒): volume should not be more than 500ml, press should be low, height between solution’s surface and client’s anusshould not be more than 30cm. Typhoid’s pathological change parts（病变部位) are always at cecum(盲肠)，wherecomplication----intestinal perforation(肠穿孔) usually takesplace.
u if to lower the temperature, the clientshould retain the solution at least 30 minutes, 30 minutes after expelling youshould take the temperature and record it.
3. observe the state of illness at all times:
u if the flow of water is impeded or anobstruction is felt: withdraw tube slightly, and reinsert.
u clientcomplains of severe and sudden abdominal pain, nausea, and distention: removetubing , and notify physician immediately of possible perforation
4.contraindication: pregnancy woman,gastrointestinal hemorrhage(消化道出血)，acute abdomen(急腹症)
