Your comments and remarks dont need to focus on the same issue each time, but you will find that some issues really is usefull to focus on each time and in each session. If you focus consistant on certain issues you will see a use full outcome of your effords.
Introduce this examin form to your patient by your authority and inform about the purpose of the examines and then try to make a daily routine.
Temperature taking is a generally deciplin for making a time line on which the enemas and the examins can be noted during a periode. And in an other way the temperaturetakings will be like ”waypoints”. If only the temperature is taking without in a context of enemas or examin it will be noted on a seperate tp-chart.
OBS! Its important to take the temperature rectally several times a day in between the examins /enemas.
You need as soon as possible to start when the patient arrive. The very first examin will tell you how to perform the very first clean out and if any kind of prerinse is needed. If you start with taking the temperature you can get an image by looking at the tip of the thermometer afterwards. Then you can begin the examin it’self. You can ask the patient about if there have been bm lately or do a test with a lubricated gloved finger up rectum.
Its important to note observations and do some remarks. These notes can be useful. If you decide to insert a suppos or give an enema - maybe both.
There is no need for enemas the day after unless you decide there is a need for it but each time when taking the temperature if the patient will have bm soon. In that case you can wait until the patient have had bm. In anyway you can check that out every morning when taking the temperature or with a gloved finger with KY. Sometimes it would be better to do enemas in the evening before bedtime. This time you can combine the enemasession with an rectalexamin.
If you in the morning recognize that an enema should be giving the evening before you can insert a suppos as deep as possible.
(use one form for each enema/examin)
Total numbers of enemas:
Rectaltemperature at session start: F
Beside the temperaturetaking you also get an first impression about the condition of rectum.
Stool in lower part of rectum: y/n
Stool in upper part of rectum: y/n
This examin will tell you if the patient have had bm recently. And for that reason its important that you immediately soon after the patient has arrived start the session. As probe a rectalthermometer can be used or you can use a gloved finger with KY. The examin will tell you how you should go further with the clean out and which kind and how much clean out that is needed.
Serious clean out is required (even low or high): y/n
In the light of the examin above you answer this question. Over a period of time you will see how this answer is changing. This issue is very important and you need to follow up
Here the results of the examin eventually can be noted as well as your comments or if you can feel a kind of resistence or embarressing from the patient. You can also do note based on your visual observations.
Suppositories given as prerinse:
Rectaltemperature before prerinsing: TP: time:
Temperaturetaking before inserting of the suppossitories
Time: Amount: Inserted: low/high BM: y/n – time for BM:
Note the apx-time when you inserts the suppositories and eventually the amount of suppositories. Over the period you will see if there is a connection to how high the suppossitorie is inserted and if the patient have bm. Note the time if bm. This issue and the examin above have a connection to each other. You will remark that in the first 2-3 days of the periode of time.
Rectaltemperature after prerinsing: TP: time:
Remarks etc: [color=red]You can do some comments about the benifit of inserting suppositories high or low and the ”holdingtime” compared to the patient urge to void or having bm. You can also do a note about how embarressing the treatment is to the patient.[/color]
Visual observ.: [color=red]Is the area about rectum looking sore ?[/color]
Time: Position: knees/chest left/right on the back
soap(castil/ivory) Salt Fleet enema Baking soda
Olive oil Coffee Water/glycerine Urine
Soap: Castil Ivory
Type of nozzle: Bulb: Higginson:
Enema bag: Colontube: inserted length in inch
Amount of solution:
Time of expelling:
Clear water y/n Cloudy Very cloudy Dark/dirty
This issue is usefull and helps you to decide if an other enema is needed in an enemasession you will see after how many enemas the water will turn from dark/dirty to being more clear. And you can compare this issue from session to session.
Here you can add some coments to the expelling (the waterflow) and about the transparentcy of the water.
Visual observ.: [color=red]Here you can add comments about how the muscle open and close while expelling. At this step you also can check rectum with a gloved finger concerning to the clean out if you feel that its needed [/color]
Rectaltemperature after enema: TP: time:
Rectaltemperature: TP: time:
Every examin starts with temperature taking
Digital rectal massages: Deep/Low Forced y/n
Number of fingers:
Lenght of time:
Did it produce an erection: y/n Ejaculation: y/n
Rectal speculum/anoscope examin y/n
Analrespons: Did rectum relax and tighten on demand: y/n
Without any finger inserted.
Resistence when inserting a finger: y/n
Are there some dirt on the finger: Nothing Less More
If you do only a DRE and if its long time since an enema is given this point give you an idea og what kind of treatment is needed next time. This item is in that way pointing both backwards and forward to next treatment.
Comments and visual observ.:
Here you can do a note about if you are using an anoscope or other equipment. Look for haemorrhoids outside and inside rectum. Qualifi if erction. Maybe you also find it reasonable to comment if the patient coorparate or is embarressed.
Colour: a light medium dark b clear cloudy
Final Remarks and conclusion:
Here you can consider in general during the past session (enema / examin) or you can note about the goals for next session – things which need to be followed up based on your observations or you can look back to the previous sessions to compare.