A nurse is advised to give enema for patient with chronic liver disease. What position is used to administer… - AIIMS Delhi NO- 2019

AIIMS Delhi NO- 2019

Fundamental of Nursing

Easy

Appeared in: AIIMS Delhi NO- 2019

Explanation

The Sim's position, specifically the left Sim's position, is the standard for enema administration.
This position aligns with the natural anatomy of the large intestine; the sigmoid colon curves towards the left side before the rectum.
Placing the patient on their left side allows the enema solution to flow downward by gravity into the descending and sigmoid colon, maximizing the effectiveness of the procedure.
The flexion of the upper leg (right leg) helps to relax the abdominal muscles and provides better exposure of the anus for tube insertion.

Option A: The prone position (lying on the abdomen) is incorrect. It makes accessing the rectum difficult and does not use gravity to help the fluid flow into the colon.
Option B: The supine position (lying on the back) is incorrect. The enema solution would pool in the rectum and would not flow effectively into the colon against gravity.
Option D: The Trendelenburg position (head down, feet up) is incorrect and unsafe for an enema. It would cause the solution to flow too rapidly and high into the colon, leading to severe cramping and potential complications.

Clinical Relevance

Nursing practice connection: Use the key finding related to Correct positioning for enema administration to guide bedside assessment, documentation, and the next nursing action.
Correct positioning is a fundamental nursing skill that directly impacts the effectiveness, safety, and comfort of many procedures, including enema administration.
Failure to use the correct position can lead to procedural failure, patient discomfort, and incomplete bowel cleansing, which may affect subsequent diagnostic tests or treatments.
What if the patient cannot assume the left Sim's position due to an injury or other condition? The nurse should assess the situation. A modified position, such as the right lateral position, could be used, but it is less effective. The knee-chest position is another alternative, though it can be difficult for many patients to maintain.

How to Approach the Question

First, identify the key procedure in the question, which is 'administer enema'.
Recognize that the patient's diagnosis ('chronic liver disease') is background information and does not typically change the standard positioning for this procedure.
Recall the anatomy of the lower gastrointestinal tract. The sigmoid colon is on the left side of the body and is the entry point from the rectum to the rest of the colon.
Evaluate each position based on the principle of gravity. The goal is to have the fluid flow 'downhill' into the colon.
Conclude that lying on the left side (Sim's position) places the sigmoid colon at the lowest point, making it the most logical and effective position.

Concept Tested & Keywords

Concept Tested: Correct positioning for enema administration
Stem keywords: enema, chronic liver disease, position
Lead-in keywords: What position is used
Clinical cues: The mention of 'chronic liver disease' is contextual information but does not alter the standard procedure for enema positioning.
Negative lead-in flag: false

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E6 Nursing Fundamentals Taylor pp. 210-212, 208-210