This is a process of administering medication through the rectum to achieve a local or systemic effect. This route is used/preferred when the child has high risk of vomiting, having a seizure or there is the risk of the medication being destroyed in the gastrointestinal tract when taken by mouth. Rectal medications can also be given if the child has an obstruction in the upper gastrointestinal tract.
Aims
· Provide therapeutic effects such as; reduce hyperthermia/fever and seizures
· Relieve constipation/facilitate bowel action
Requirements
a. Tray containing:
· Medication - rectal suppository
· Lubricating gel/water
· Examination Gloves
· Receiver
· Gallipot
· Water
· Single-edge razor blade (if necessary)
b. Medication chart
c. Patient health records
Steps
1. Support child/caregiver to assume a comfortable position
2. Perform five (5) moments of hand hygiene
3. Establish rapport (refer steps)
4. Explain procedure to child/caregiver (refer steps)
5. Incorporate developmentally appropriate strategies in dealing with the child
6. Verify the medication order with the child’s medical records
7. Observe the Rights of Medication administration:
· Right medication
· Right dosage
· Right child
· Right time
· Right route
· Right reason
· Right of child/caregiver to refuse medication
· Right documentation
8. Assess child’s medication/allergy history
9. Provide privacy
10. Place suppository in refrigerator for few minutes or put on ice pack to harden or hold it under cold water while it is still in the rubber wrapper.
11. Set and send tray to bed side of child
12. Assist child to the washroom to empty bowels; encourage child to pass stool
13. Assist child/caregiver to remove clothing to expose buttocks while maintaining child’s dignity
14. Assist/support child into left lateral position
15. Encourage child to relax buttocks to make it easier to insert the suppository or provide diversional therapy with child’s favourite toy or a portable play device to facilitate relaxation of child
16. Don gloves and squeeze the suppository gently to check if it is firm enough to insert
17. Remove wrapping from the suppository gently or use a clean, single-edge razor blade to cut the suppository lengthwise, not across the middle
18. Moisten the tip of the suppository with water or lubricating jelly or water-based lubricant (Do not use petroleum jelly or vaseline to lubricate the suppository as it can stop the suppository from melting)
19. Insert the tip of the suppository through the rectum about ½ to 1inch
20. Support caregiver to keep child in the left lateral position with buttocks held firm for 1 – 3 minutes to facilitate melting, quick absorption and control the urge to push out medication
21. Remove gloves and perform hand hygiene
22. Keep child lying down under close observation in the left lateral position for about 5 -10 minutes
23. Instruct child/caregiver to avoid exercise or lots of child movement for about one hour
24. Support caregiver to assist child to the washroom if the suppository has laxative effect
25. Provide safety for child if seizure occurs and intervene accordingly
26. Monitor vital signs every 15-30 minutes
27. Observe for desired outcomes and adverse drug reactions
28. Discard tray and decontaminate appropriately
29. Express gratitude to child/caregiver for cooperation
30. Document procedure in the nurse’s notes
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