Chapter 57 Evolve

A client is scheduled for discharge after surgery for inflammatory bowel disease. The client's spouse will be assisting home health services with the client's care. What is most important for the home health nurse to assess in the client and the spouse with regard to the client's home care? Ability of the client and spouse to perform incision care and dressing changes Effective coping mechanisms for the client and spouse after the surgical experience Knowledge about the client's requested pain medications Understanding of the importance of keeping scheduled follow-up appointments

Ability of the client and spouse to perform incision care and dressing changes

A client who had surgery for inflammatory bowel disease is being discharged. The case manager will arrange for home health care follow-up. The client tells the nurse that family members will also be helping with care. What information is critically important for the nurse to provide to these collaborating members? A list of medical supply facilities where wound care supplies may be purchased Proper handwashing techniques to avoid cross-contamination of the client's wound The amount of pain medication that the client is allowed to take in each dose Written and oral instructions regarding symptoms to report to the health care provider

Written and oral instructions regarding symptoms to report to the health care provider

The RN receives a change-of-shift report about four clients. Which client does the nurse assess first? A 20-year-old with ulcerative colitis (UC) who had six liquid stools during the previous shift A 25-year-old who has just been admitted with possible appendicitis and has a temperature of 102° F A 56-year-old who had a colon resection earlier in the day and whose colostomy bag does not have any stool in it A 60-year-old admitted with acute gastroenteritis who is reporting severe cramping and nausea

A 25-year-old who has just been admitted with possible appendicitis and has a temperature of 102° F Correct

Which is a correct statement differentiating Crohn's disease (CD) from ulcerative colitis (UC)? Clients with CD experience about 20 loose, bloody stools daily. Clients with UC may experience hemorrhage. Correct The peak incidence of UC is between 15 and 40 years of age. Very few complications are associated with CD

Clients with UC may experience hemorrhage.

A male client with a long history of ulcerative colitis experienced massive bleeding and had emergency surgery for creation of an ileostomy. He is very concerned that sexual intercourse with his wife will be impossible because of his new ileostomy pouch. How does the nurse respond? "A change in position may be what is needed for you to have intercourse with your wife." Correct "Have you considered going to see a marriage counselor with your wife?" "What has your wife said about your pouch system?" "You must get clearance from your health care provider before you attempt to have intercourse"

"A change in position may be what is needed for you to have intercourse with your wife." Correct

The health care provider prescribes prednisone (Deltasone) for a client with ulcerative colitis. What health teaching is most important before the client begins the medication? .

D. Teach the client the importance of avoiding crowds.

A nurse is teaching a client with Crohn's disease about managing the disease with the drug adalimumab (Humira). Which instruction does the nurse emphasize to the client? "Avoid large crowds and anyone who is sick." Correct "Do not take the medication if you are allergic to foods with fatty acids." "Expect difficulty with wound healing while you are taking this drug." "Monitor your blood pressure and report any significant decrease in it."

"Avoid large crowds and anyone who is sick." Correct

Which is a correct statement differentiating Crohn's disease (CD) from ulcerative colitis (UC)? A. Very few complications are associated with CD. B. Clients with UC may experience hemorrhage. C. Clients with CD experience about 20 loose, bloody stools daily. D. The peak incidence of UC is between 15 and 40 years of age.

B. Clients with UC may experience hemorrhage. Incorrect: Five to six stools daily is common with CD. Correct: Hemorrhage is commonly experienced in clients with UC. Incorrect: The peak incidence of UC is between 15 to 25 and 55 to 65 years of age. Incorrect: Fistulas commonly occur as a complication of CD

The health care provider prescribes sulfasalazine (Azulfidine) for a client with ulcerative colitis. What nursing action is most important before the client begins the medication? A. Determine if the client's insurance pays for the drug. B. Ask the client if he smokes or drinks alcohol. C. Ask the client if he has any allergies to sulfa-type drugs. D. Teach the client the importance of avoiding crowds

C. Ask the client if he has any allergies to sulfa-type drugs. Sulfasalazine is in the same family as sulfonamide antibiotics. Therefore a client who has an allergy to sulfonamide or other drugs that contain sulfa should not take this drug. Determining whether the client's insurance company will cover the medication should never be a priority when the client's health is at stake. Consumption of alcohol and smoking should be discouraged in all clients with ulcerative colitis regardless of the drug therapy prescribed. Sulfasalazine does not suppress the immune system, so the client is not required to avoid large crowds

A client has vague symptoms that indicate an acute inflammatory bowel disorder. Which symptom is most indicative of Crohn's disease (CD)? Abdominal pain relieved by bending the knees Chronic diarrhea, abdominal pain, and fever Epigastric cramping Hypotension with vomiting

Chronic diarrhea, abdominal pain, and fever Correct

A client has vague symptoms that indicate an acute inflammatory bowel disorder (IBD). Which symptom is most indicative of Crohn's disease (CD)? A. Hypotension with vomiting B. Epigastric cramping C. Abdominal pain relieved by bending the knees D. Chronic diarrhea, abdominal pain, and fever

D. Chronic diarrhea, abdominal pain, and fever Incorrect: Abdominal pain that is relieved by bending the knees is indicative of peritonitis or pancreatitis. Correct: Chronic diarrhea, abdominal pain, and fever are symptoms more indicative of Crohn's disease (CD) than of other acute inflammatory bowel disorders. Incorrect: Epigastric cramping is a symptom more indicative of appendicitis. Incorrect: Hypotension with vomiting is not characteristic of Crohn's disease (CD).

A client diagnosed with ulcerative colitis is to be discharged on loperamide (Imodium) for symptomatic management of diarrhea. What does the nurse include in the teaching about this medication? "Be aware of the symptoms of toxic megacolon that we discussed." "If diarrhea increases, you should let your health care provider know." "Pregnancy should be avoided." "You will need to decrease your dose of sulfasalazine (Azulfidine)."

"Be aware of the symptoms of toxic megacolon that we discussed." Correct

A client with an exacerbation of ulcerative colitis has been prescribed Vivonex PLUS. The client asks the nurse how this is helpful for improving symptoms. How does the nurse reply? "It is absorbed quickly and allows the affected part of the GI tract to rest and heal." Correct "It provides key nutrients and extra calories to promote healing." "It is bland and reduces the secretion of gastric acids." "It does not contain caffeine or other GI tract stimulants."

"It is absorbed quickly and allows the affected part of the GI tract to rest and heal."

A client with ulcerative colitis (UC) has stage 1 of a restorative proctocolectomy with ileo-anal anastomosis (RPC-IPAA) procedure performed. The client asks the nurse, "How long do people with this procedure usually have a temporary ileostomy?" How does the nurse respond? "It is usually ready to be closed in about 1 to 2 months." "This is something that you will have to discuss with your health care provider." "The period of time is indefinite—I am sorry that I cannot say." "You will probably have it for 6 months or longer, until things heal.

"It is usually ready to be closed in about 1 to 2 months." Correct .

A client has been newly diagnosed with ulcerative colitis (UC). What does the nurse teach the client about diet and lifestyle choices? "Drinking carbonated beverages will help with your abdominal distress." "It's OK to smoke cigarettes, but you should limit them to ½ pack per day." "Lactose-containing foods should be reduced or eliminated from your diet." "Raw vegetables and high-fiber foods may help to diminish your symptoms."

"Lactose-containing foods should be reduced or eliminated from your diet." Correct

A client newly diagnosed with ulcerative colitis (UC) is started on sulfasalazine (Azulfidine). What does the nurse tell the client about why this therapy has been prescribed? "It is to stop the diarrhea and bloody stools." "This will minimize your GI discomfort." "With this medication, your cramping will be relieved." "Your intestinal inflammation will be reduced." Correct

"Your intestinal inflammation will be reduced." Correct

A client with ulcerative colitis (UC) has stage 1 of a restorative proctocolectomy with ileoanal anastomosis (RPC-IPAA) procedure performed. The client asks the nurse, "How long do people with this procedure usually have a temporary ileostomy?" How does the nurse respond? A. "You will probably have it for 6 months or longer, until things heal. B. "It is usually ready to be closed in about 1 to 2 months." C. "The period of time is indefinite-I am sorry that I cannot say." D. "This is something that you will have to discuss with your health care provider."

A client with ulcerative colitis (UC) has stage 1 of a restorative proctocolectomy with ileoanal anastomosis (RPC-IPAA) procedure performed. The client asks the nurse, "How long do people with this procedure usually have a temporary ileostomy?" How does the nurse respond? A. "You will probably have it for 6 months or longer, until things heal. B. "It is usually ready to be closed in about 1 to 2 months." C. "The period of time is indefinite-I am sorry that I cannot say." D. "This is something that you will have to discuss with your health care provider." B. "It is usually ready to be closed in about 1 to 2 months." A client with ulcerative colitis (UC) has stage 1 of a restorative proctocolectomy with ileoanal anastomosis (RPC-IPAA) procedure performed. The client asks the nurse, "How long do people with this procedure usually have a temporary ileostomy?" How does the nurse respond? A. "You will probably have it for 6 months or longer, until things heal. B. "It is usually ready to be closed in about 1 to 2 months." C. "The period of time is indefinite-I am sorry that I cannot say." D. "This is something that you will have to discuss with your health care provider." B. "It is usually ready to be closed in about 1 to 2 months."

A nurse is teaching a client with Crohn's disease (CD) about managing the disease with the drug adalimumab (Humira). Which instruction does the nurse emphasize to the client? A. "Do not take the medication if you are allergic to foods with fatty acids." B. "Avoid large crowds and anyone who is sick." C. "Expect difficulty with wound healing while you are taking this drug." D. "Monitor your blood pressure and report any significant decrease in it."

B. "Avoid large crowds and anyone who is sick." Correct: The client should avoid being around large crowds to avoid developing an infection. Immunomodulators don't work well by themselves, but with a steroid yes. In addition to adalimumab (Humira) another immuomodulator is infliximab (Remicade). Incorrect: The client should not take the medication if he or she is allergic to certain proteins. Incorrect: Although immune suppression may occur to some degree, the client should not experience difficulty with wound healing while taking this particular medication. Incorrect: The client should not experience a decrease in blood pressure from taking this drug.

A client has newly diagnosed ulcerative colitis (UC). What does the nurse tell the client about diet and lifestyle choices? A. "Drinking carbonated beverages will help with your abdominal distress." B. "Lactose-containing foods should be reduced or eliminated from your diet." C. "It's OK to smoke cigarettes, but you should limit them to ½ pack per day." D. "Raw vegetables and high-fiber foods may help to diminish your symptoms."

B. "Lactose-containing foods should be reduced or eliminated from your diet." Incorrect: Carbonated beverages are GI stimulants that can cause discomfort. They should be used rarely or should be eliminated from the diet of the client with UC. Incorrect: Cigarette smoking is a stimulant that can cause GI distress symptoms. Nurses should not advise clients that any amount of cigarette smoking is "OK." Correct: Lactose-containing foods are often poorly tolerated and should be reduced or eliminated from the diet of clients with UC. Incorrect: Raw vegetables and high-fiber foods can cause GI symptoms in clients with UC.

The nurse is caring for an older client who experiences an exacerbation of ulcerative colitis with severe diarrhea. What is the nurse's priority for care? -Monitor skin for breakdown -monitor heart rate and rhythm -Maintain intake and output -Auscultate bowel sounds frequently

B. Monitor heart rate and rhythm.

Situation: A 21-year-old woman has abdominal pain, cramping, and diarrhea. She reports having 10 to 12 liquid bloody stools per day. A stool sample for ova and parasites is negative. A diagnosis of ulcerative colitis (UC) is made, and she is prescribed sulfasalazine (Azulfidine) and corticosteroid therapy. As the disease improves, what change does the nurse expect in her medication regimen? A. Stop the corticosteroid therapy. B. Taper the corticosteroid therapy. C. Taper the sulfasalazine (Azulfidine). D. Stop the sulfasalazine (Azulfidine).

B. Taper the corticosteroid therapy. Incorrect: Stopping corticosteroid therapy abruptly is unsafe. Steroids must be gradually decreased in clients. Usually the amount that they have been taking dictates how quickly or slowly they can be stopped. Incorrect: Sulfasalazine (Azulfidine) therapy for the client will be given on a long-term basis. It may be increased or decreased, depending on the client's symptoms. These decisions are made over a long period of therapy. Correct: Once clinical improvement has been established, corticosteroids are tapered over a 2- to 3-month period. Incorrect: Sulfasalazine (Azulfidine) therapy for the client will be given on a long-term basis. It may be increased or decreased, depending on the client's symptoms. These decisions are made over a long period of therapy. This drug would not be decreased any time soon (if ever) for the client

Situation: A 21-year-old woman has abdominal pain, cramping, and diarrhea. She reports having 10 to 12 liquid, bloody stools per day. A stool sample for ova and parasites is negative. A diagnosis of ulcerative colitis (UC) is made, and she is started on sulfasalazine (Azulfidine). What does the nurse tell her about why she is receiving this therapy? A. "This will minimize your GI discomfort." B. "With this medication, your cramping will be relieved." C. "Your intestinal inflammation will be reduced." D. "It is to stop the diarrhea and bloody stools."

C. "Your intestinal inflammation will be reduced." Incorrect: Although it is hoped that reduction of inflammation will cause the diarrhea and bloody stools to stop, this is not the way that the drug works. Incorrect: The drug's action as an anti-inflammatory will diminish the client's pain as the inflammation subsides. This is not the purpose of the drug-it is not an analgesic. Incorrect: The drug's action as an anti-inflammatory will diminish the client's cramping as the inflammation subsides. This is not the purpose of the drug-it is not an analgesic. Correct: Sulfasalazine (Azulfidine) is one of the primary treatments for UC. It is thought to inhibit prostaglandin synthesis and thereby to reduce inflammation.

A client with ulcerative colitis is prescribed sulfasalazine (Azulfidine) and corticosteroid therapy. As the disease improves, what change does the nurse expect in the client's medication regimen? Corticosteroid therapy will be stopped. Sulfasalazine (Azulfidine) will be stopped. Corticosteroid therapy will be tapered. Sulfasalazine (Azulfidine) will be tapered.

Corticosteroid therapy will be tapered. Correct

Situation: A 21-year-old woman has abdominal pain, cramping, and diarrhea. She reports having 10 to 12 liquid bloody stools per day. A stool sample for ova and parasites is negative. A diagnosis of ulcerative colitis (UC) is made. She is to be discharged on loperamide (Imodium) for symptomatic management of diarrhea. What does a nurse include in the teaching about this medication? A. "You will need to decrease the dose of sulfasalazine (Azulfidine)." B. "If diarrhea increases, you should let your health care provider know." C. "Pregnancy should be avoided." D. "Be aware of the symptoms (as we discussed) of toxic megacolon."

D. "Be aware of the symptoms (as we discussed) of toxic megacolon." Correct: Antidiarrheal drugs may precipitate colonic dilation and toxic megacolon. Toxic megacolon is characterized by an enlarged colon with fever, leukocytosis, and tachycardia. Incorrect: Loperamide (Imodium) will decrease diarrhea rather than increase it. Constipation is sometimes a problem. Incorrect: No contraindication for pregnancy is noted. Incorrect: The administration of sulfasalazine (Azulfidine) continues. It is usually used on a long-term basis.

The nurse is caring for a client with an exacerbation of ulcerative colitis. Which laboratory finding for the client will the nurse expect? A. Decreased platelet count B. Decreased C-reactive protein C. Decreased erythrocyte sedimentation rate D. Decreased serum potassium

D. Decreased serum potassium Rationale: Blood levels of sodium, potassium, and chloride may be low as a result of frequent diarrheal stools and malabsorption through the diseased bowel. The ESR, WBC, and C-reactive protein will be elevated in a client with ulcerative colititis as a result of the inflammatory process. Platelet counts remain unchanged by the disease process of ulcerative colitis.

A client with a history of osteoarthritis has a 10-inch incision following a colon resection. The incision has become infected, and the wound requires extensive irrigation and packing. What aspect of the client's care does the nurse make certain to discuss with the health care provider before the client's discharge? Having a home health consultation for wound care Requesting an antianxiety medication Requesting pain medication for the client's osteoarthritis Placing the client in a skilled nursing facility for rehabilitation

Having a home health consultation for wound care