What is the appropriate amount of liquid for a siphon enema?

From the Guidelines

For a siphon enema, 1-1.5 liters of liquid must be prepared, as this volume is typically sufficient for the procedure without causing undue discomfort or complications to the patient. The key consideration in determining the volume for a siphon enema is to ensure effective cleansing of the bowel without causing harm, particularly in patients who may have certain health conditions or limitations.

When preparing for gastric sounding, the error in equipment is the large intestinal tube, as a gastric tube is the appropriate tool for this procedure.

• The necessary equipment for gastric sounding should include a gastric tube, not a large intestinal tube.
• Other necessary items might include glasses for storing individual portions of gastric juice, a kidney tray, tweezers, and possibly a 0.1% histamine solution, depending on the specific requirements of the procedure.

For a patient with a gastric ulcer who has developed "coffee ground" vomiting after taking acetylsalicylic acid, fibrogastroduodenoscopy is contraindicated due to the risk of worsening the bleeding [ 1 ].

• The development of "coffee ground" vomiting indicates active bleeding in the stomach, which could be exacerbated by the insertion of a fibrogastroduodenoscopy instrument.
• Other diagnostic methods such as complete blood count, feces for occult blood, and gastric lavage might be considered based on the patient's condition and the need to assess the extent of bleeding and overall health status.

In the case of a patient with significant nausea, vomiting, and severe general weakness after eating poor-quality food, gastric lavage should be assigned first to remove the toxic substances from the stomach.

• Gastric lavage is a procedure where the stomach is flushed with liquids to remove harmful substances, which can be critical in cases of food poisoning.
• Other methods like ultrasound examination of the abdominal organs, siphon enema, or X-ray examination of the stomach might be considered later based on the patient's response to initial treatment and the need for further diagnosis.

For an unconscious patient who has taken a large amount of sleeping pills, urgent gastric lavage is the appropriate first action to remove the unabsorbed medication.

• The priority in such cases is to prevent further absorption of the drug and reduce the risk of overdose complications.
• Tracheal intubation might also be necessary to secure the airway, especially if the patient is at risk of aspiration or requires ongoing airway protection.

For a 60-year-old patient with cardiovascular pathology and constipation, a cleansing enema with 1.5 liters of water would be preferred.

• This method is generally safer and more effective for constipation in patients with cardiovascular issues, as it helps to soften the stool and stimulate bowel movements without the need for harsher laxatives or enema solutions.
• Oily enemas, hypertonic enemas, or microenemas might be considered in specific cases, but they are not typically the first choice for this patient population due to potential risks or discomfort.

In cases of suspected atonic intestinal impassibility, a siphon enema is necessary to help stimulate bowel movements and clear the intestine.

• Atonic intestinal impassibility refers to a condition where there is a lack of movement in the intestines, leading to constipation or obstruction.
• The use of a siphon enema can help to introduce water into the bowel and stimulate peristalsis, aiding in the clearance of the intestine.

The temperature for a cleansing enema should be 38-39°C, as this temperature is closest to the body's natural temperature and is less likely to cause discomfort or injury to the rectal mucosa.

• Using water that is too hot or too cold can cause discomfort, spasms, or even damage to the rectal lining.
• The temperature of the enema solution is an important consideration to ensure the procedure is both effective and safe.

For a patient with "coffee-thickness" vomiting, FGDS can be used after gastric lavage, as this procedure can help to directly visualize the interior of the stomach and assess the source of bleeding or other abnormalities [ 1 ].

• The presence of "coffee ground" vomit suggests bleeding in the upper gastrointestinal tract, which may require direct visualization to diagnose and treat.
• Gastric lavage before FGDS can help to clear the stomach of blood and debris, improving visibility during the procedure.

For a hypertonic enema, 10% sodium chloride solution should be used, as this concentration is typically effective for stimulating bowel movements without causing excessive irritation or discomfort.

• Hypertonic solutions are used to draw water into the bowel through osmosis, softening the stool and making it easier to pass.
• The choice of solution and concentration depends on the patient's specific needs and the desired effect of the enema.

Planned gastroduodenoscopy is typically performed 6-8 hours after the last meal, allowing for adequate time for digestion and reducing the risk of aspiration during the procedure.

• The timing of the last meal is important to ensure patient safety and to optimize the visibility of the gastrointestinal tract during the procedure.
• This timeframe can vary based on individual patient factors and the specific requirements of the procedure.

Preparation for sigmoidoscopy must include giving cleansing enemas in the evening and morning, as well as possibly restricting food intake and prescribing laxatives, to ensure the bowel is as clear as possible for the procedure.

• A clear bowel is essential for effective visualization during sigmoidoscopy.
• The specific preparation regimen may vary depending on the patient's condition, the timing of the procedure, and the preferences of the healthcare provider.

When conducting a cleansing enema, the tip is first inserted toward the sacrum, as this direction helps to minimize discomfort and facilitate the introduction of the enema solution into the rectum.

• The technique for inserting the enema tip is important to ensure patient comfort and the effectiveness of the procedure.
• Insertion towards the sacrum, rather than the umbilicus or other directions, is generally recommended.

For a siphon enema, the tip is inserted parallel to the spine, which helps to guide the enema tube into the correct position within the rectum and minimize the risk of injury or discomfort.

• The direction of insertion for a siphon enema is crucial for the safe and effective administration of the procedure.
• Proper technique is essential to avoid complications and ensure the patient's comfort.

If a patient develops cough and cyanosis during probe insertion for gastric lavage, the probe should be removed immediately, and the patient should be given humidified oxygen and possibly undergo artificial respiration if necessary, to address potential respiratory complications.

• The development of cough and cyanosis indicates a serious respiratory issue that requires immediate attention.
• Removing the probe and providing oxygen are critical first steps in managing this situation.

For Zimnitsky test, 8 containers should be prepared, as this test involves collecting urine over a 24-hour period to assess kidney function and requires multiple samples to be analyzed.

• The Zimnitsky test is used to evaluate the concentrating ability of the kidneys.
• Collecting urine in multiple containers over time allows for a comprehensive assessment of renal function.

For a patient with anal itching, feces examination for helminth eggs should be assigned first, as this symptom can be indicative of a parasitic infection.

• Anal itching can be caused by various factors, including parasitic infections, which can be diagnosed through fecal examination.
• Other diagnostic methods might be considered based on the results of the initial examination and the patient's overall clinical presentation.

Morning urine after waking up should be collected for a general urine test, as this sample is typically the most concentrated and can provide the most accurate results for various urinary parameters.

• The timing of urine collection can affect the results of urinary tests.
• First-morning urine is often preferred for its concentration and the stability of its components.

Preparation for rectoromanoscopy includes all mentioned measures: two cleansing enemas the evening before, two in the morning, and a special diet 3-4 days prior, to ensure the bowel is thoroughly cleansed and prepared for the procedure.

• Rectoromanoscopy requires a clear and clean bowel for effective visualization and diagnosis.
• A combination of dietary restrictions, laxatives, and enemas is often used to prepare the patient.

From the Research

Siphon Enema Liquid Preparation

• The amount of liquid that must be prepared for the siphon enema is 1-1.5 L 2.

Gastric Sounding Equipment

• The error in the equipment prepared for gastric sounding is the presence of tweezers, which are not typically used for this procedure.

Contraindicated Research Methods

• For a patient with gastric ulcer after taking acetylsalicylic acid, fibrogastroduodenoscopy is contraindicated due to the risk of bleeding 3, 4, 5.

Initial Research Method for Nausea and Vomiting

• For a patient complaining of significant nausea, vomiting, and severe general weakness after eating poor-quality products, gastric lavage should be assigned first.

First Aid for Unconscious Patient

• For an unconscious patient who took a large amount of sleeping pills, tracheal intubation and gastric lavage are the necessary actions for medical personnel to provide first aid.

Preferred Enema Type for Cardiovascular Patient

• For a 60-year-old patient with cardiovascular system pathology, a cleansing enema with 1.5 L of water is the preferred type of enema.

Treatment for Atonic Intestinal Impassibility

• For a patient suspected of having atonic intestinal impassibility, a cleansing enema or a siphon enema is necessary to prescribe.

Cleansing Enema Temperature

• The temperature of the liquid for a cleansing enema should be 38-39°C.

FGDS for Patient with Epigastric Pain

• For a patient complaining of a decrease in pain in the epigastric region and the appearance of "coffee-thickness" vomiting, FGDS can be used for urgent indications, regardless of meal times.

Hypertonic Enema Liquid

• For a patient prescribed a hypertonic enema, the nurse should use a 10% sodium chloride solution.

Planned Gastroduodenoscopic Examination

• A planned gastroduodenoscopic examination should be performed 6-8 hours after the last meal.

Patient Preparation for Sigmoidoscopy

• The plan for preparing patients for sigmoidoscopy must include food restriction, a statement of a cleansing enema in the morning, and prescribing laxatives.

Cleansing Enema Tip Insertion

• The tip of the cleansing enema should be inserted in the direction of the sacrum.

Siphon Enema Tip Insertion

• The tip of the siphon enema should be inserted in the direction of the sacrum.

Necessary Actions for Gastric Lavage Complications

• If cough or cyanosis of the skin of the face appears during gastric lavage, the nurse should remove the probe and call a doctor.

Containers for Urine Collection

• For the Zimnitsky test, 8 containers should be prepared for collecting urine.

Initial Research Method for Itching in the Anus

• For a patient complaining of itching in the anus, especially at night, a scatological examination should be assigned first.

Urine Collection Time

• Urine for a general urine test should be collected in the morning after waking up.

Preparation for Rectoromanoscopy

• Preparation of the patient for rectoromanoscopy includes two cleansing enemas given on the eve of the study, a diet prescribed 3-4 days before the study, and excluding fresh vegetables and fruits, black bread, and cabbage from the diet.