An enema is prescribed for a client with suspected appendicitis. Which of the following actions should the nurse take?
A. Prepare 750 ml of irrigating solution warmed to 100° F.
B. Question the physician about the order.
C. Provide privacy and explain the procedure to the client.
D. Assist the client to the left lateral Sims position.
Correct Answer: B. Question the physician about the order.
Enemas are contraindicated in an acute abdominal condition of unknown origin as well as after recent colon or rectal surgery or myocardial infarction. People with symptoms of appendicitis should not take laxatives or enemas to relieve constipation because these medicines could cause the appendix to burst. The other answers are correct only when enema administration is appropriate.
Option A: Warming the enema solution to body temperature may be beneficial as heat stimulates the rectal mucosa. Dougherty and Lister (2004) recommend a solution temperature of 40.5-43.3°C for non-oil-based enemas. Cold solutions should be avoided as they may cause cramping.
Option C: Obtain informed consent, identifying allergies and any contraindications. Provide the patient with reassurance. Assess patient privacy and dignity and take steps to maximize both.
Option D: Position the patient on the left side, lying with the knees drawn to the abdomen. This eases the passage and flow of fluid into the rectum. Gravity and the anatomical structure of the sigmoid colon also suggest that this will aid enema distribution and retention.
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