A. Definition Huknah / enema
Huknah / Enema is introducing a solution into the rectum and the sigmoid colon. The main reason is to improve defecation enema to stimulate peristaltic. Fluid volume, which is inserted, breaking mass of stool, stretching the walls of the rectum, and initiate defecation reflex. Enema is also given as a means of transportation of drugs that cause local effects on the mucosa rectum.Enema most often used to relieve constipation for a while. Other indications include: throwing feces impacted, emptying the bowel before undergoing diagnostic examination, surgery or childbirth, and start a bowel training program
B. Indications
- Constipation
- The habit of defecating irregular.
- The use of excessive laxative.
- Increased psychological stress
- Impaction fases
- The habit of regular bowel movements
- Preoperative preparation
- For example pemariksaan neurology diagnostic measures
- Patients with malaena
             C. Contra Indications
1. Patients with diverticulis, ulcerative colitis, crhon's disease.
2. Post surgery
3. Patients with impaired cardiac function or renal insufficiency, hemorrhoids, tumors of the rectum and colon.
4. Impact of Giving Huknah
1. Positive impact
- Clean the lower colon (descending) ahead of surgery
- As an alternative way of drug administration.
- Eliminates intestinal distension.
- Facilitate defakasi process.
- Improve body mechanics.
2. Negative impact
If using a solution too hot will burn the intestinal mucosa and if the solution is too cold given will cause abdominal cramps.
If the client has a poor sphincter control will not be able to withstand the enema solution (perry, peterson, potter.2005).
D. Kind and Purpose Enema / huknah
Enema can be classified into 4 groups according to how it works include: cleansing (cleaning), carminative (to treat flatulence), retention (holding), and restore the flow (enema rinse harris).
           A. Cleansing Enema
Clensing enema stimulates peristalsis by irritating the colon and rectum and or by stretching by entering into the intestinal fluid volume. There are two cleansing enemas are:
A. HUKNAH LOW (LOW Enema
Is a nursing action by entering the warm liquid into the colon through the anus dessendens using rectal cannula. Cannula entry into the rectal 10-15 cm with a height of 50 cm irigator position sims left.
B. Purpose
1. Stimulating intestinal peristalsis, so that the patient can defecate because of difficulty in defecation (constipation obstipasi)
2. Empty the bowel preparation for surgery
3. As treatment measures
4. Preparation surgery / delivery / preparation for radiological examinations.
5. Providing a sense of comfort
C. Indications
1. Patients who obstipasi
2. The patient will be in operation
3. Preparation for example diagnostic measures (radiological examination)
4. Patients with melaena (black stools due to gastrointestinal bleeding)
             D. Preparation
1. Preparation tool
a. Clean gloves / handscoon
b. Bath blanket or fabric cover
c. Perlak and buttocks pengalas
d. Irigator complete with canule recti, hoses and klemnya
e. The warm liquid as needed (eg NaCl fluid, soapy water, plain water)
f. Crooked
g. Lubricants (petroleum jelly, sylokain, Jelly 2% / lubricant soluble in water
h. Pole mounting irigator
i. If you need to provide a chamber pot, water purifier and cotton wipe / tissue toilet
2. Preparation of the patient
a. Greetings therapeutic
b. Introduce myself
c. Explain to clients and families about the procedures and objectives of action to be implemented.
d. Explanations are given to understand client / family
e. During communication used clear language, systematic and non-threatening.
f. Client / family were given the opportunity to ask for clarification
g. Client privacy during communications appreciated.
h. Show patience, empathy, courtesy, and concern and respect for communicating and taking action
i. Creating the contract (time, place and actions to be taken)
j. Patients are prepared in a sleeping position tilted to the left (position sim)
3. Preparation Environment
a. Keeping patient privacy
b. Provide comfort and safety of patients
4. Preparation
a. Washing hands
b. Assess the patient's general condition
c. Measuring vital signs
d. The ability to mobilize
E. Procedures
1. Door closed / pair sampiran
2. Wash hands
3. The nurse standing to the right clients and pairs of gloves
4. Install perlak and pengalas
5. Put a blanket bath while clothing bottom uninstalled clients
6. Adjust the position of the left sim clients
7. Connect the hose and clamps (enclosed) with irigator
8. Fill irigator with a liquid that has been provided
9. Hanging irigator with a height of 40-50 cm from the butt clients
10. Remove the air from the hose to drain fluid into the crooked
11. Install kanule rectal and spread with jelly
12. Enter the kanule to the anus, the clamp is opened, enter the liquid slowly
13. If the fluid runs out, hose clamps and remove the cannula and enter into crooked
14. Rearrange the position of the client and ask the client hold briefly
15. Help clients to the toilet if it is able, if not fixed in a tilted position and then attach the potty dibokong clients.
16. Clients dirapihkan
17. Tool trimmed back
18. Washing hands
19. noted the results of action taken
A. HUKNAH HIGH (HIGH Enema)
Is a nursing action by entering the warm liquid into the colon through the anus assendens using rectal cannula. Cannula entry into the rectal 15-20 cm with a height of 30 cm irigator position right sims
B. Purpose
1. Help remove faeces due to constipation
2. Stimulate intestinal peristalsis
3. Measures of treatment / diagnostic examination
C. Preparation
1. Preparation tool
a. Net gloves
b. Bath blanket or fabric cover
c. Perlak and buttocks pengalas
d. Irigator complete with canule recti, hoses and klemnya
e. The warm liquid as needed (eg NaCl fluid, soapy water, plain water)
Warm water :
1. Infants: 150-250 cc
2. Child: 250-350 cc
3. School age: 300-500 cc
4. Teens: 500-700 cc
5. Adults: 700-1000 ml low Huknah
f. Crooked
g. Lubricants (petroleum jelly, sylokain, Jelly 2% / lubricant soluble in water
h. Pole mounting irigator
i. If you need to provide a chamber pot, water purifier and cotton wipe / tissue toilet
2. Preparation of the patient
a. Greetings therapeutic
b. Introduce myself
c. Explain to clients and families about the procedures and objectives of action to be implemented.
d. Explanations are given to understand client / family
e. During communication used clear language, systematic and non-threatening.
f. Client / family were given the opportunity to ask for clarification
g. Client privacy during communications appreciated.
h. Show patience, empathy, courtesy, and concern and respect for communicating and taking action
i. Creating the contract (time, place and actions to be taken)
j. Patients are prepared in a sleeping position tilted to the left (position sim)
3. Preparation Environment
a. Keeping patient privacy
4. Preparation of Nurses
a. Washing hands
b. Assess the patient's general condition
c. Measuring vital signs
d. The ability to mobilize
D. Procedures
1. Door closed / pair sampiran
2. Wash hands
3. Nurse standing next to the right clients and pairs of gloves
4. Install perlak and pengalas
5. Put a blanket bath while clothing bottom uninstalled clients
6. Adjust the position of the left sim clients
7. Connect the hose and clamps (enclosed) with irigator
8. Fill irigator with a liquid that has been provided
9. Hanging irigator with a height of 40-50 cm from the butt clients
10. Remove the air from the hose to drain fluid into the crooked
11. Install kanule rectal and spread with jelly
12. Enter the kanule to the anus, the clamp is opened, enter the liquid slowly
13. If the fluid runs out, hose clamps and remove the cannula and enter into crooked
14. Rearrange the position of the client and ask the client hold briefly
15. Help clients to the toilet if it is able, if not fixed in a tilted position and then attach the potty dibokong clients.
16. Clients dirapihkan
17. dirapihkan tool back
18. Washing hands
19. noted the results of action taken
B. Retention Enema
Retention enema, put oil (lubricant) into the rectum and the sigmoid colon, the lubricant is retained for a long time (1-3 hours). It works to lubricate the rectum and anal canal, which eventually facilitate the way fases.
C. Carninative Enema
Carminative enema is mainly given to issue flatus. The solution is inserted into the rectum to release gas which he stretched peritaltik. For adults included 60-180ml. Examples carminative enema is a solution of GMW, which contains magnesium 30ml, 60ml glycerin, and 90ml water
, Enema rinse D. Harris
Rinse Harris enema (Enema backflow), sometimes leads to flushing the colon, used to issue flatus. This is a recurrent fluid intake to the director and the drainage of fluid from the rectum. First of all solutions (100-200ml for adults) is inserted into the rectum and sigmoid colon client, then the solution container is lowered so that the liquid drops back out through a rectal tube into the container. Exchange flow of fluid into and out this repeated 5-6 times, until (stomach) lost bloating and discomfort is reduced or lost. Many kinds of solution used for enemas. A special solution may be requested by a doctor.
            6.DOKUMENTASI / EVALUATION:
a. Record the actions taken and the results on the client record sheet
b. Record the client's response
c. Note the number of the exit fases
d. Note the color and consistency of fases that came out after the action
e. Record the date and time of action and the name of the nurse who did and signatures / initials on the client record sheet
