Definition
Administering rectal suppositories is a fundamental nursing procedure used to deliver medications when oral routes are not feasible such as in cases of vomiting, unconsciousness, or local rectal conditions.
Purposes
- To stimulate peristalsis.
- To promote defecation.
- To act as analgesic and/or antipyretic.
Contraindications
- Rectal surgery.
- Active rectal bleeding.
Articles
- Rectal suppository.
- Lubricating jelly.
- Clean gloves
- Tissue paper
- Kidney tray.
Procedure
| Nursing action | Rationale | |
| 1. | Before procedure Review physician’s order for patient’s name and drug and explain the procedure to the patient. | Ensures safe and correct administration of medication. |
| 2. | Review patient information related to medication including action, purpose, and side effects. | Allows nurse to administer drug correctly and to monitor patient’s response. |
| 3. | Review medical record for history of rectal surgery or bleeding. | Identifies contraindication. |
| 4. | Review patient’s knowledge of purpose of drug therapy and interest in self-administering of suppository. | May indicate need for health teaching. Level of motivation influence teaching approach. |
| 5. | Provide privacy by pulling curtains. | Minimizes embarrassment for patient. |
| 6. | If patient is interested and capable of self-administration, provide instructions for it and send him to toilet with articles. | |
| 7. | During procedure Wash hands, arrange supplies at bedside and don gloves. | Reduces transfer of microorganisms, helps nurse to perform procedure in an organized manner. |
| 8. | Assist patient in assuming left lateral position with upper leg flexed. | Position exposes anus and helps patient to relax external anal sphincter. The position lessens the, such Asli hood of the suppository or feces being expelled. |
| 9. | Keep patient draped with only anal area exposed. | Maintains privacy and facilitates relaxation. |
| 10. | Examine the condition of anus externally and palpate rectal walls as needed. | Determines presence of active bleeding. Palpation determines whether rectum is filled with feces. |
| 11. | Remove suppository from foll wrap and lubricate rounded end with jelly. Lubricate gloved index finger of dominant hand. | Lubrication reduces friction as suppository enters rectal canal. |
| 12. | Ask patient to take low deep breaths through mouth and to relax anal sphincter. | Forcing suppository through constricted sphincter causes pain. |
| 13. | Retract patient’s buttocks with dominant hand. With gloved index finger of dominant hand, insert suppository gently through anus, past internal sphincter and against rectal wall 10 cm in adults, 5 cm in children and infants. | Suppository must be placed against rectal mucosa for eventual absorption and therapeutic action. |
| 14. | Withdraw finger and wipe patient’s anal area with tissue. | Provides comfort. |
| 15. | Discard gloves, turning them inside out and dispose in appropriate receptacle. | Reduces transfer of microorganisms. |
| 16. | Ask patient to remain flat or on the side for 5 minutes. | Prevents expulsion of suppository. |
| 17. | Check within 5 minutes to determine if suppository is in place. Instruct patient to retain suppository for 30 to 45 minutes (or as per manufacturer’s instruction). | Reinsertion may be necessary, if expelled. |
| 18. | Ask if patient experienced localized anal or rectal discomfort during insertion. | Determines whether insertion of suppository was irritating. |
| 19. | Discard gloves and wash hands. | |
| 20. | Record and report patient’s response to medication including any unusual reactions. | Documents effect of medication. |
SPECIAL CONSIDERATION
- Instruct patient to walk if ambulatory to help promote peristalsis. Do not palpate rectum, if patient has had rectal surgery.
Paediatric Variations
- Position smaller children in prone position for insertion of suppository.
- If there is a tendency for the suppository to be expelled, hold the buttocks together for few minutes.
- Suppositories containing drugs should not be ejected. Deep insertion is necessary and the child informed that a bowel action is not needed.
REFERENCES
- Annamma Jacob, Rekha, Jhadav Sonali Tarachand: Clinical Nursing Procedures: The Art of Nursing Practice, 5th Edition, March 2023, Jaypee Publishers, ISBN-13: 978-9356961845 ISBN-10: 9356961840
- Omayalachi CON, Manual of Nursing Procedures and Practice, Vol 1, 3 Edition 2023, Published by Wolters Kluwer’s, ISBN: 978-9393553294
- Sandra Nettina, Lippincott Manual of Nursing Practice, 11th Edition, January 2019, Published by Wolters Kluwer’s, ISBN-13:978-9388313285
- Adrianne Dill Linton, Medical-Surgical Nursing, 8th Edition, 2023, Elsevier Publications, ISBN: 978-0323826716
- Donna Ignatavicius, Medical-Surgical Nursing: Concepts for Clinical Judgment and Collaborative Care, 11th Edition ,2024, Elsevier Publications, ISBN: 978-0323878265
- Lewis’s Medical-Surgical Nursing, 12th Edition,2024, Elsevier Publications, ISBN: 978-0323789615
- AACN Essentials of Critical Care Nursing, 5th Ed. Sarah. Delgado, 2023, Published by American Association of Critical-Care Nurses ISBN: 978-1264269884.
- Ernstmeyer K, Christman E, editors. Nursing Fundamentals [Internet]. 2nd edition. Eau Claire (WI): Chippewa Valley Technical College; 2024. PART IV, NURSING PROCESS. Available from: https://www.ncbi.nlm.nih.gov/books/NBK610818/
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