A rectal suppository is a small, solid, medicated mass that may be inserted to stimulate peristalsis or defecation; relieve pain, vomiting, or local irritation; reduce fever; or induce relaxation. Rectal suppositories melt at body temperature and are absorbed slowly. They may be used when the medication interacts poorly with digestive enzymes or have a taste too offensive for oral use.
An ointment is a semisolid medication used to produce local effects. It may be applied externally to the anus or internally to the rectum. Rectal ointments commonly contain drugs that reduce inflammation or relieve pain and itching.
Rectal suppository or tube of ointment and applicator 
patient's medication record and chart gloves water-soluble lubricant 4'' × 4'' gauze pads optional: bedpan.
Store rectal suppositories in the refrigerator until needed to prevent softening and decreased effectiveness. A softened suppository is also difficult to handle and insert. To harden it again, hold the suppository (in its wrapper) under cold running water.
- Verify the order on the patient's medication record by checking it against the doctor's order.
- Make sure the label on the medication package agrees with the medication order. Read the label again before you open the wrapper and again as you remove the medication. Check the expiration date.
- Perform hand hygiene and confirm the patient's identity using two patient identifiers.
- Explain the procedure and the purpose of the medication to the patient and provide privacy.
Inserting a rectal suppository
- Place the patient on his left side in Sims' position. Drape him with the bedcovers to expose only the buttocks.
- Put on gloves, remove the suppository from its wrapper, and lubricate it with water-soluble lubricant.
- Lift the patient's upper buttock with your nondominant hand and have him take slow deep breaths.
Here's the tough part
- Using your index finger, insert the suppository—tapered end first—about 4'' (8.6 cm), until you feel it pass the internal anal sphincter. Try to direct the tapered end toward the side of the rectum so that it contacts the membranes.
- Encourage him to retain the suppository for the appropriate length of time to be effective.
- Remove and discard your gloves. Perform hand hygiene.
Applying rectal ointment
- Put on gloves and squeeze the directed amount of ointment slowly onto a gauze pad or your gloved hand and apply externally over the anal area.
- To apply internally, attach the applicator to the tube of ointment and coat the applicator with water-soluble lubricant.
- Lift the patient's upper buttock with your nondominant hand to expose the anus and have him take several deep breaths through his mouth to relax the anal sphincters and reduce anxiety or discomfort during insertion.
- Gently insert the applicator, directing it toward the umbilicus, and slowly squeeze the tube to inject about 1'' (2.5 cm) of the medication.
- Remove the applicator and place a folded 4'' × 4'' gauze pad between the patient's buttocks to absorb excess ointment.
- Detach the applicator from the tube and recap it. Then clean the applicator thoroughly with soap and warm water.
- Because insertion of a rectal suppository may stimulate the vagus nerve, this procedure is contraindicated in patients with potential cardiac arrhythmias. It may have to be avoided in patients with recent rectal or prostate surgery, rectal bleeding, rectal prolapse, or very low platelet counts because of the risk of local trauma or discomfort during insertion.
Mind the blinking light
- Make sure the patient's call button is handy and watch for his signal because he may be unable to suppress the urge to defecate.
- Be sure to inform the patient that the suppository may discolor his next bowel movement. (See Documenting use of rectal medications.)
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