Module 6 - Enteral, Rectal, and Vaginal Medications

Constipation

Infrequent or difficult defecation d/t ecreased gastric motility.

Normal: 3/day to 3/week

Causes: pain, stress, GI paralysis, medications, decreased activity, dehydration, diet (low fibre), surgery, age (risk factor).

Hemorrhoids

Swollen and/or distended veins in the anorectal area.

Can be internal or external.

Leads to intense pain, itchiness, and/or bleeding.

Causes: increased pressure in the anorectal area (sitting for a long time, pregnant women, straining to have a bowel movement).

Medicated Treatment Options

Laxatives: must be stool already

• Bulk forming - only oral; absorb water as they move through GI system; should only be used prophylactically.

• Osmotic - oral and rectal; pulls water from GI wall into stool; requires patient to be hydrated.

• Stimulant - oral and rectal; irritates the bowel to cause contractions.

• Surfactant - only oral; pulls water and fat into stool; should only be used prophylactically.

Cathartics: works on entire system

Medicated Treatment Options

Can be administered for local or systemic effects.

Forms:

• Suppositories - solid form of medication, shaped to assist with insertion.

• Enemas (Liquid):

  • Hypotonic - lower salt content than body fluids, water moves from colon into tissues; not great for patients at risk of fluid overload.

  • Isotonic - has same salt content as body fluids

  • Hypertonic - higher salt content than body fluid, pulls water into colon; not great for patients at risk of dehydration.

  • Medicated - liquid medication to treat localized conditions

Requires:

• Cannot have frequent diarrhea.

• Needs to be able to retain medication.

• Need to be able to be positioned correctly (on side).

• A lot of feces may get in the way.

Enteral Medication Administration

Medication going directly to stomach or intestine via a tube.

Reasons for tube insertion:

• Trauma, impacting their ability to eat.

• Comatose for long periods of time.

• Severe mental head disorder (loss of appetite, anorexia)

Types of Tubes:

• PEG - tube directly to stomach

• DPEJ - tube into the jejunal

• PEG/J - dual port for the stomach and jejunal

Types of Medications:

• Oral medications - must be liquid, or able to be crushed.

• All must be administered separately.

Vaginal Medication Administration

Always used for local effect.

Have patient empty bladder before administration.

Forms:

• Suppositories

• Foam - always comes with an applicator.

• Cream/Gel - always comes with an applicator.