The nurse assesses a client’s abdomen several days after abdominal surgery. It is firm, distended, and painful to palpate. The client reports feeling “bloated” . The nurse consults with surgeon, who orders an enema. The nurse prepares to give what kind of enema?

Correct Answer: C. Return flow

This provides relief of postoperative flatus, stimulating bowel motility. Options one, two, and four manage constipation and do not provide flatus relief. A return-flow enema, or Harris flush, is used to remove intestinal gas and stimulate peristalsis. A large volume fluid is used but the fluid is instilled in 100-200 ml increments. Then, the fluid is drawn out by lowering the container below the level of the bowel. This brings the flatus out with the fluid.

• Option A: The soapsuds enema uses a mixture of a mild soap and warm water injected into the colon in order to stimulate a bowel movement. Normally given to relieve constipation or for bowel cleansing before a medical examination or procedure.
• Option B: An enema that may be used to provide nourishment, medication, or anesthetic. It should be made from fluids that will not stimulate peristalsis. A small amount of solution (e.g., 100 to 250 mL) is typically used in adults.
• Option D: If fecal material is hardened, an oil-retention enema may be given to soften the feces. Commercially packaged enemas contain 90-120 ml solution. The patient should retain the solution to at least one hour for the enema to be effective. This enema is usually followed by a cleansing enema.