Irritable Bowel Syndrome & Appendicitis

4. "I have noticed mucus in my stools. Rationale: Mucus in the stools is a sign of IBS. Clients with this syndrome may have diarrhea, but it is not bloody.

During a hospital admission history, a nurse suspects irritable bowel syndrome (IBS) when the client says: 1. "I am having a lot of bloody diarrhea." 2. "I have been vomiting for 2 days." 3. "I have lost 10 pounds in the last month." 4. "I have noticed mucus in my stools.

2. Leukocytosis with a shift to the left Rationale: Laboratory findings do not establish the diagnosis of appendicitis, but there is often an elevation of the white blood cell count (leukocytosis) with a shift to the left (an increased number of immature white blood cells). Options 1, 3, and 4 are incorrect because they are not associated findings in acute appendicitis.

The nurse is caring for a client admitted to the hospital with a suspected diagnosis of acute appendicitis. Which laboratory result should the nurse expect to note if the client does have appendicitis? 1. Leukopenia with a shift to the left 2. Leukocytosis with a shift to the left 3. Leukopenia with a shift to the right 4. Leukocytosis with a shift to the right

2. Irrigate the nasogastric (NG) tube. Rationale: After an appendectomy, the client who develops peritonitis typically has an NG tube in place. When a client complains of nausea, the nurse would fi rst check to ensure that the NG tube is functioning correctly, because the client's nausea may be related to a blockage of the NG tube. If the tube is clogged, it can be irrigated with normal saline. An antiemetic may be given, but only after the nurse has determined that the NG tube is functioning properly.

An adolescent who has had an appendectomy and developed peritonitis has nausea. Which of the following should the nurse do first? 1. Administer an antiemetic. 2. Irrigate the nasogastric (NG) tube. 3. Notify the surgeon. 4. Take the blood pressure.

2. Notify the primary health care provider (PHCP). Rationale: On the basis of the signs and symptoms presented in the question, the nurse should suspect peritonitis and notify the PHCP. Administering pain medication is not an appropriate intervention. Heat should never be applied to the abdomen of a client with suspected appendicitis because of the risk of rupture. Scheduling surgical time is not within the scope of nursing practice, although the PHCP probably would perform the surgery earlier than the prescheduled time.

The nurse is monitoring a client admitted to the hospital with a diagnosis of appendicitis who is scheduled for surgery in 2 hours. The client begins to complain of increased abdominal pain and begins to vomit. On assessment, the nurse notes that the abdomen is distended and bowel sounds are diminished. Which is the most appropriate nursing intervention? 1. Administer the prescribed pain medication. 2. Notify the primary health care provider (PHCP). 3. Call and ask the operating room team to perform surgery as soon as possible. 4. Reposition the client and apply a heating pad on the warm setting to the client's abdomen.

1. Offer an ice pack. 3. Encourage the child to assume a position of comfort. 4. Limit the child's activity. Rationale: Cold is a vasoconstrictor and supplies some degree of anesthesia. The child is usually more comfortable on his side with his legs fl exed to take the strain off the infl amed appendix. Limiting the child's activity puts less stress on the infl amed appendix and lessens the discomfort. Heat increases circulation to an area, causing more engorgement and pain and, possibly, rupture of the appendix. Heat is contraindicated in any situation where rupture or perforation is a possibility. A cathartic is contraindicated when appendicitis is suspected. Increasing peristalsis can cause the appendix to rupture.

A child is admitted with a diagnosis of possible appendicitis. The child is in acute pain. Which of the following nursing interventions would be appropriate prior to surgery to decrease pain? Select all that apply. 1. Offer an ice pack. 2. Apply a heating pad. 3. Encourage the child to assume a position of comfort. 4. Limit the child's activity. 5. Request an order for a cathartic.

3. Application of an ice bag. Rationale: Application of an ice bag may help to relieve pain by decreasing circulation to the area. A heating pad is contraindicated because heat may increase circulation to the appendix, possibly leading to rupture.

When developing the plan of care for a school-age child with a suspected diagnosis of appendicitis who is complaining of severe abdominal pain, which of the following measures should the nurse expect to include in the child's plan of care? 1. Application of a heating pad. 2. Insertion of a rectal tube. 3. Application of an ice bag. 4. Administration of an intravenous narcotic.

2. "I'm worried about the size of my scar." Rationale: Adolescents are concerned about the immediate state and functioning of their bodies. The adolescent needs to know whether any changes (e.g., illness, trauma, surgery) will alter her lifestyle or interfere with her quest for physical perfection.

Which of the following is a normal response from an adolescent who has just returned to her room after an appendectomy? 1. "I'll need plastic surgery for this scar." 2. "I'm worried about the size of my scar." 3. "I don't want to have any pain." 4. "What will my boyfriend say about the scar?"

4. Allow the client to interact with others in his or her same age group. Rationale: Adolescents often are not sure whether they want their parents with them when they are hospitalized. Because of the importance of their peer group, separation from friends is a source of anxiety. Ideally, the members of the peer group will support their ill friend.

A 16-year-old client is admitted to the hospital for acute appendicitis and an appendectomy is performed. Which nursing intervention is most appropriate to facilitate normal growth and development postoperatively? 1. Encourage the client to rest and read. 2. Encourage the parents to room in with the client. 3. Allow the family to bring in the client's favorite computer games. 4. Allow the client to interact with others in his or her same age group.

1. Anxiety related to situational crisis Rationale: While all of these diagnoses are important, the client has expressed that the major concern is anxiety about this school situation.

A 22-year-old college senior has just been diagnosed with acute appendicitis requiring surgery. The client has been nauseated for 2 days, rates the pain as 4 out of 10 on a numeric scale, and tells the nurse, "I can't believe this is happening. I have final exams starting in 3 days. What am I going to do?" A nurse develops the following preoperative diagnoses for this client. Which nursing diagnosis should be priority? 1. Anxiety related to situational crisis 2. Acute pain related to tissue injury 3. Risk deficient fluid volume related to nausea 4. Risk for delayed development related to illness and need for recovery

4. FACES Pain Rating Scale. Rationale: The nurse should use the FACES Pain Rating Scale for children or cognitively impaired clients so that the client can use a picture to identify the pain. The visual analog and numerical scales are used with adults. The Short Form McGill Questionnaire allows the client to give simple descriptions of pain by sensation and perception, which is inappropriate for a child.

A 7-year-old child is experiencing pain after an appendectomy. Which data collection tool should the nurse use to assess the pain? 1. Visual analog scale. 2. Short Form McGill Questionnaire. 3. Numerical pain scale. 4. FACES Pain Rating Scale.

1. Apply heat to abdomen to decrease pain Rationale: Applying heat to the abdomen when appendicitis is suspected is contraindicated because heat increases circulation, which, in turn, could cause the appendix to rupture

A health-care provider writes the following admission orders for a client with possible appendicitis. Which order should the nurse question? 1. Apply heat to abdomen to decrease pain 2. Withhold analgesic medications to avoid masking critical changes in symptoms 3. Keep client NPO (nothing per mouth) 4. Start lactated Ringer's solution intravenously (IV) at 125 mL/hr

1. "Where did the pain start?" Rationale: The most helpful question would be to determine the location of the pain when it started. The pain associated with appendicitis usually begins in the periumbilical area, then progresses to the right lower quadrant. After the nurse has determined the location of the pain, asking about what was done for the pain would be appropriate.

When obtaining the initial health history from a 10-year-old child with abdominal pain and suspected appendicitis, which of the following questions would be most helpful in eliciting data to help support the diagnosis? 1. "Where did the pain start?" 2. "What did you do for the pain?" 3. "How often do you have a bowel movement?" 4. "Is the pain continuous, or does it let up?"

1. The dressing on the surgical site. Rationale: The priority assessment after an appendectomy would be the dressing over the surgical site to determine whether there is any drainage or bleeding. The surgical dressing should be clean, dry, and intact. Once the dressing has been assessed, the nurse would assess the intravenous infusion site, assess the NG tube to be sure it is functioning, and finally, determine the degree of pain the client is experiencing.

Which of the following should be the priority assessment for an adolescent on return to the nursing unit after an appendectomy? 1. The dressing on the surgical site. 2. Intravenous fluid infusion site. 3. Nasogastric (NG) tube function. 4. Amount of pain.

1. "All of a sudden it doesn't hurt at all." Rationale: Sudden relief of pain in a client with appendicitis may indicate that the appendix has ruptured. Rupture relieves the pressure within the appendix but spreads the infection to the peritoneal cavity. Periumbilical pain (pain centered around the navel), vomiting, and abdominal tenderness on palpation are common fi ndings associated with appendicitis.

An adolescent male client scheduled for an emergency appendectomy is to be transferred directly from the emergency room to the operating room. Which of the following statements by the client should the nurse interpret as most significant? 1. "All of a sudden it doesn't hurt at all." 2. "The pain is centered around my navel." 3. "I feel like I'm going to throw up." 4. "It hurts when you press on my stomach."

2. Help the client find information on the Internet. Rationale: Part of providing client-centered care is to honor the client's preferred method of learning. The nurse should help the adolescent fi nd accurate information about the procedure. By assisting with the information search the nurse can verify learning.

The nurse prepares to teach an adolescent scheduled for an appendectomy about what to expect. The adolescent says, "I would rather look this up on the Internet." The nurse should: 1. Explain that completing a teaching checklist is required by the hospital. 2. Help the client find information on the Internet. 3. Provide the client with written information instead. 4. Explain that information found on the Internet cannot be trusted.

1. The semi-Fowler's position. Rationale: After an appendectomy for a ruptured appendix, assuming the semi-Fowler's or a right side-lying position helps localize the infection. These positions promote drainage from the peritoneal cavity and decrease the incidence of subdiaphragmatic abscess

When developing the postoperative plan of care for an adolescent who has undergone an appendectomy for a ruptured appendix, in which of the following positions should the nurse expect to place the client during the early postoperative period? 1. The semi-Fowler's position. 2. Supine. 3. Lithotomy position. 4. Prone.

2. Bowel sounds are heard twice in 2 minutes Rationale: Manifestations of appendicitis include decreased or absent bowel sounds. Normally, bowel sounds are heard every 10 to 30 seconds. Therefore, bowel sounds heard twice in 2 minutes suggests appendicitis. Normally, the contour of the male adolescent abdomen is flat to slightly rounded, and tympany is typically heard when auscultating over most of the abdomen. A cremasteric reflex is normal for male adolescents.

Which of the following assessment findings should alert the nurse to suspect appendicitis in a male adolescent complaining of severe abdominal pain? 1. Abdomen appears slightly rounded. 2. Bowel sounds are heard twice in 2 minutes. 3. All four abdominal quadrants reveal tympany. 4. The client demonstrates a cremasteric reflex.

1. Insisting on wearing a T-shirt and gym shorts rather than pajamas. Rationale: Adolescents struggle for independence and identity, needing to feel in control of situations and to conform with peers. Control and conformity are often manifested in appearance, including clothing, and this carries over into the hospital experience. The adolescent feels best when he is able to look and act as he normally does-for example, wearing a T-shirt and gym shorts

Which of the following client actions should the nurse judge to be a healthy coping behavior for a male adolescent after an appendectomy? 1. Insisting on wearing a T-shirt and gym shorts rather than pajamas. 2. Avoiding interactions with other adolescents on the nursing unit. 3. Refusing to fill out the menu, and allowing the nurse to do so. 4. Not taking telephone calls from friends so he can rest.