AQ Chapter 57
A patient reports pain midway between the anterior iliac crest and the umbilicus in the right lower quadrant. The nurse documents that the patient is experiencing pain in which location?
McBurney's point McBurney's point is located midway between the anterior iliac crest and the umbilicus in the right lower quadrant. Pain in this area is common in the later stages of appendicitis.
What instruction should the nurse give to a patient with inflammatory bowel disease regarding skin care?
Tell the patient to apply a thin coat of A+D ointment or aloe cream. Skin irritation in inflammatory bowel disorders can be prevented by applying a thin coat of A+D ointment or aloe cream because the application causes a smoothening effect. Medicated wipes should be used to avoid irritation. The skin should be patted dry, not rubbed. Mild soaps and water should be used for skin care after each bowel movement.
A patient is being discharged following a laparotomy for treatment of peritonitis. What complications should the patient report to the primary health care provider immediately? Select all that apply.
signs of wound dehiscence unusual or foul-smelling drainage A temperature higher than 101°F (38.3°C) Signs of wound dehiscence may be due to rupture of the wound and should be reported. Unusual or foul-smelling discharge may be found near the incision, which indicates infection. A temperature rise in the body may be due to infection at the incision site. Incisional tenderness should be expected following a laparotomy, and active bowel sounds is a normal finding.
The nurse is caring for a patient with chronic inflammatory bowel disease. What parameters should be monitored? Select all that apply.
skin in perianal area physical and emotional rest color, volume, consistency of stools The patient's skin in the perianal area should be assessed for irritation and ulceration that may result from loose and frequent stools. The patient's physical and emotional rest should also be monitored because these parameters are important considerations in managing the disease. The color, volume, consistency, and frequency of stools should be monitored to determine the severity of the problem. Monitoring the body temperature, heart rate, and rhythm is not necessary to manage inflammatory bowel disorder.
The nursing instructor is teaching a group of student nurses about giardiasis. What statement made by a student indicates a need for further learning?
"The chronic phase of infection lasts for months." Giardiasis is a parasitic infection affecting the intestinal system. This disorder causes acute or chronic diarrhea. The chronic phase of the giardiasis infection lasts for years. Giardiasis causes inflammation of the mucosa in the small intestine. Humans who eliminate cysts are considered infectious because cysts can remain alive for weeks or months. Beavers and dogs may indeed be reservoirs for infection.
The nurse is instructing a patient with recently diagnosed diverticular disease about diet. What food does the nurse suggest the patient include?
A slice of 5-grain bread Whole-grain breads are recommended to be included in the diet of patients with diverticular disease because cellulose and hemicellulose types of fiber are found in them. Dietary fat should be reduced in patients with diverticular disease. If the patient wants to eat beef, it should be of a leaner cut. Foods containing seeds, such as strawberries, should be avoided. Tomatoes should be avoided unless the seeds are removed. The seeds may block diverticula in the patient and present problems leading to diverticulitis.
Which statement about appendicitis is accurate?
It occurs mostly in young adults. Appendicitis occurs mostly in young adults. It causes pain in the right lower quadrant and is an acute inflammation of the appendix. It is caused primarily by the obstruction of lumen of the appendix with hard pieces of feces composed of calcium phosphate-rich mucus and inorganic salts. It is less commonly caused by helminthes (worms).
Which medication would be beneficial to the patient with gastroenteritis who has increased peristaltic movements?
loperamide Antiperistaltic agents are used to decrease peristaltic movements in the gut. Loperamide is used as an antiperistaltic agent. Ciprofloxacin is an antibiotic. Trimethoprim is an anti-infective agent. Acetaminophen is an analgesic.
A patient who has viral gastroenteritis asks the nurse why the provider has not ordered a medication to reduce diarrhea. What does the nurse tell this patient about antidiarrheal medications?
"They may prolong exposure to the causative organism." Antidiarrheal medications are typically used for severe symptoms to reduce fluid loss and minimize discomfort, but are avoided with viral gastroenteritis because slowing peristalsis can increase exposure to the organism by slowing elimination from the body. Antidiarrheals do cause side effects such as drowsiness and drug dependence, but this is not the primary reason why they are not given with viral gastroenteritis. Antibiotics are not given for viral gastroenteritis.
A patient has vague symptoms that indicate an inflammatory bowel disorder. Which symptom is most indicative of Crohn's disease (CD)?
Chronic diarrhea, abdominal pain, and fever Chronic diarrhea, abdominal pain, and fever are symptoms more indicative of CD than of other acute inflammatory bowel disorders. Abdominal pain that is relieved by bending the knees is indicative of peritonitis or pancreatitis. Epigastric cramping is a symptom more indicative of appendicitis. Hypotension with vomiting is not characteristic of CD.
A patient is admitted with peritonitis due to a perforated appendix. Which intervention can be delegated to unlicensed assistive personnel (UAP)?
Measuring intake and output UAPs can measure intake and output. Administering pain medication, performing nasogastric tube suctioning, and assessing for signs of sepsis would be beyond the scope of practice for UAP and should be performed by a registered nurse.
Which surgical procedure for removal of an inflamed appendix involves minimal intervention?
Transluminal endoscopic surgery Transluminal endoscopic surgery is a new procedure that does not require an external skin incision. Instead, an endoscope is inserted through a natural orifice such as the mouth or anus and then an internal incision is made into the colon, thus avoiding any external incision. Laparotomy is an open surgical method used for complicated or atypical appendicitis. Uncomplicated appendectomy procedures are performed through laparoscopy. An exploratory laparotomy is a surgical opening into the abdomen to remove or repair the inflamed or perforated organ.
What diagnostic test is preferred to differentiate between ulcerative colitis and Crohn's disease?
X-ray examination with barium enema An X-ray examination with a barium enema is preferred over other tests to differentiate between ulcerative colitis and Crohn's disease due to its accuracy. A CT scan is done to confirm the disease or its complications. A colonoscopy may be done to aid in diagnosis. A magnetic resonance enterography helps to assess the status of a patient's inflammatory bowel disease.
What measures should be taken by a patient who has gastroenteritis to prevent transmission of the infection?
Maintain clean bathroom facilities. Gastroenteritis can be transmitted via the fecal-oral route. Maintaining a clean bathroom facility helps to avoid exposure to infected stool. The sharing of glasses, dishes, and eating utensils with others should be avoided to prevent transmission of an infection. The preparation and handling of food that will be consumed by others may promote the spread of infection and should be avoided. Informing the primary health care provider if symptoms persist beyond 3 days prevents further progression of the disease.
The registered nurse is supervising a student nurse providing preoperative care to a patient with ulcerative colitis who is scheduled for surgery. Which action of the student indicates effective learning?
The student nurse explains what an ileostomy is to the patient and family. If a temporary or permanent Ileostomy is planned, an in-depth explanation should be provided to the patient and the family to prepare them mentally and promote home care after discharge. Antidiarrheal drugs are administered postoperatively when bowel incontinence occurs. The surgeon is responsible for explaining laparoscopy surgery to the patient. Parenteral antibiotics are administered an hour before the surgery.
The nurse is caring for a patient with ileo-anal pouch anastomosis who has undergone a restorative proctocolectomy. What pouch care advice given by the nurse will provide effective treatment?
"Change the entire pouch system every 3 to 7 days." The entire pouch system must be changed every 3 to 7 days to avoid discomfort and leakage. The pouch should be emptied when it is one-third to one-half full. The pouch should be changed even during inactive times, such as before meals, before retiring at night, and 2 to 4 hours after eating.
A patient with a new ileostomy is distressed because of the large amount of green liquid stool that must be emptied from the pouch several times each day. What does the nurse tell this patient?
"Eventually, the amount and consistency of the stool will change." Over time, the small intestine will begin performing some functions of the colon, and the stool from an ileostomy will become thicker and will decrease in amount. Patients with an ileostomy will always have to wear a pouch, since stool drainage is continuous. The initial stool color is typically green, which does not indicate infection. Telling the patient that a larger pouch may be necessary will only increase the patient's distress.
A patient has been newly diagnosed with ulcerative colitis. Which statement by the patient indicates a need for further teaching about the complications of the disease?
"I may have an increased risk of bladder infections caused by fistulas." Patients with Crohn's disease have an increased risk for fistula. Gastrointestinal hemorrhage; increased risk of colorectal cancer; and frequent liquid, bloody stools are all complications that are typical of ulcerative colitis
A parent of a patient suffering from chronic inflammatory bowel disease informs the nurse, "My son leaks stools while he is sleeping." The nurse teaches the parent necessary steps to manage the child's nocturnal stool leakage. Which statement made by the parent indicates a need for further teaching?
"I should encourage my son to drink more milk." Lactose-containing food such as milk and milk products may be poorly tolerated and should be avoided because they can change the consistency of the stool and potentially cause leakage. Carbonated beverages should not be given to a patient with bowel disease because they are gastrointestinal stimulants that can cause discomfort. Food items such as citrus fruits as well as cabbage and broccoli should be avoided because they can be difficult to digest and cause odor and gas.
What is the typical incubation period of the Norwalk virus in a person with a normal immune system?
48 hours The Norwalk virus has an incubation period of 48 hours. The incubation period for shigellosis is 1-7 days. The period that campylobacter enteritis is communicable is 2-7 weeks. None of the disorders discussed in the chapter has a specific incubation period of 72-96 hours.
Which factors should the nurse inquire about when taking the medical history of a patient with suspected appendicitis?
Abdominal pain followed by nausea and vomiting Abdominal pain followed by nausea and vomiting indicates appendicitis. Abdominal pain that increases with cough occurs in patients with peritonitis. Anorexia, not polyphagia, followed by nausea and vomiting indicates appendicitis. Abdominal pain before nausea and vomiting indicates gastroenteritis.
What postoperative measures are typically implemented for patients who have undergone abdominal surgery for peritonitis?
Irrigating the drain via sterile technique Sometimes manual irrigation of the peritoneum must be performed through a drain as prescribed by the health care provider. The postoperative patient is maintained in a semi-Fowler's position to promote drainage of peritoneal contents into the lower region of the abdominal cavity. Respiratory rate and vital signs are monitored every hour immediately after abdominal surgery.
Which statement about the procedure for an appendectomy is correct?
Laparoscopy is an invasive procedure used to remove the inflamed appendix. Laparoscopy is an invasive procedure used to remove an inflamed appendix. One or more small incisions are created near the umbilicus through which a small endoscope is placed. NOTES does not require an external skin incision; the endoscope is placed through natural orifices such as the vagina. Patients having laparoscopy are typically discharged the same day of surgery. Patients can return to usual activities in 1 to 2 weeks.
What would be the drug of choice for a patient with gastroenteritis who is prescribed antiperistaltic agents?
Loperamide Loperamide has antiperistaltic action and is used in patients with gastroenteritis. Ciprofloxacin is an antibiotic. Acetaminophen is not indicated in the treatment of gastroenteritis. Docusate sodium is a drug used for softening stool.
Which is a correct statement differentiating Crohn's disease (CD) from ulcerative colitis (UC)?
Patients with UC may experience hemorrhage. Hemorrhage is commonly experienced by patients with UC. Five to six stools daily is common with CD. The peak incidence of UC is between 15 to 25 and 55 to 65 years of age. Fistulas commonly occur as a complication of CD.
A patient demonstrates the manifestations of diverticulitis with a suspected complication of peritonitis. What is the priority nursing intervention?
Preparing the patient for emergency surgery The highest priority for this patient is to prepare him or her for emergency surgery so that the source of the infection can be removed. It is expected that the patient will experience changes in vital signs as a result of the infectious process and accompanying pain. Although monitoring the patient's vital signs is important, the patient has an immediate need to go to surgery. Determining whether the patient is experiencing changes in mentation and medicating the patient for pain are important, but are not the highest priority.
What is a clinical manifestation of Crohn's disease?
abdominal pain Abdominal pain located in the right lower quadrant due to inflammation is a clinical manifestation of Crohn's disease. Nausea and vomiting are common symptoms in many bowel disorders. Dryness of the mucous membranes is due to dehydration.
What is the common symptom associated with anorexia?
vomiting Common symptoms of anorexia are nausea and vomiting. Gastroenteritis may manifest as diarrhea and abdominal cramping. Perforation of the appendix may result in peritonitis with a temperature greater than 101°F.
A patient newly diagnosed with ulcerative colitis (UC) is started on sulfasalazine. Which explanation will the nurse give the patient about the reason for use of this drug?
"This medication causes intestinal inflammation to be reduced." Sulfasalazine is one of the primary treatments for UC. It is thought to inhibit prostaglandin synthesis and thereby reduce inflammation. 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. Antidiarrheal drugs "stop" diarrhea. The drug's action as an anti-inflammatory will diminish the patient's pain as the inflammation subsides, but this is not the purpose of the drug—it is not an analgesic.
Which complication is seen exclusively in patients with ulcerative colitis?
colorectal cancer Colorectal cancer is a major complication of ulcerative colitis that is seen in patients who have a history of that disease for more than 10 years. Cholelithiasis is an extraintestinal complication observed in patients with both ulcerative colitis and Crohn's disease. Malabsorption is a common complication seen both in ulcerative colitis and Crohn's disease; however, this condition is more common in Crohn's disease. Abscess formation is also seen in patients with both ulcerative colitis and Crohn's disease.
Which findings does the nurse expect with a diagnosis of acute peritonitis? Select all that apply.
fever vomiting tachycardia rigid abdomen Fever, vomiting, tachycardia, and a rigid, boardlike abdomen accompany the diagnosis of peritonitis from the inflammation of the peritoneal cavity. Diarrhea would not be present, as bowel motility slows, bowel sounds become more distant, and the passage of flatus and feces cease.
A patient with peritonitis has developed bacterial contamination of the peritoneal cavity. What could be the most probable cause of the contamination?
gangrenous gallbladder Gangrenous gallbladder may contaminate the peritoneal cavity, which is prone to bacterial infections. Leakage of bile can cause chemical peritonitis. Perforating tumor is a less common reason for contamination of the peritoneal cavity. Skin pathogens can infect a patient undergoing continuous ambulatory peritoneal dialysis but are a not a common cause of bacterial contamination of the peritoneal cavity.
A patient with ulcerative colitis complains of severe diarrhea with exacerbations. What is the drug of choice in this condition?
glucocorticoids Glucocorticoids such as prednisone and prednisolone are prescribed during exacerbation of ulcerative colitis. Aminosalicylates are used to treat mild to moderate ulcerative colitis. Immunomodulators alone are not effective in treating ulcerative colitis. Antidiarrheal drugs provide symptomatic management of diarrhea.
A patient admitted with severe gastroenteritis has been started on an IV, but the patient continues having excessive diarrhea. Which medication does the nurse ask the health care provider about prescribing?
loperamide If the health care provider determines that antiperistaltic agents are necessary, an initial dose of loperamide 4 mg can be administered orally, followed by 2 mg after each loose stool, up to 16 mg daily. Balsalazide is not the best choice for control of diarrhea in this scenario. Mesalamine is used for patients with ulcerative colitis for long-term therapy. MOM is a laxative.
Which medication is the drug of choice for the treatment of giardiasis?
metronidazole Metronidazole is the drug of choice for treating giardiasis and is taken orally, 250 mg three times daily, for 5 days. Tinidazole is used as an alternative for treating giardiasis. Diloxanide furoate is commonly used to treat amebiasis. Atropine sulfate is often used to control bowel motility.
A patient has been diagnosed with ulcerative colitis (UC) and reports having between four and five bloody stools per day. How does the nurse classify the intensity of the patient's UC?
moderate In moderate UC, the patient will experience more than 4 bloody stools per day. In mild UC, there are fewer than 4 bloody stools, and more than 6 with severe UC. With fulminant UC, there are more than 10 bloody stools per day.
What are the common signs and symptoms of gastroenteritis?
nausea and vomiting Nausea and vomiting are the first symptoms in a patient who has gastroenteritis. Fecaliths usually occur when the lumen of the appendix is obstructed. Anorexia is associated with gastroenteritis but not polyphagia. Abdominal pain that increases with cough or movement and bending the right hip or the knees suggests peritonitis and perforation.
What interventions should the nurse provide to a patient with inflammatory bowel disease who complains of abdominal pain?
observe for signs and symptoms of peritonitis Abdominal pain in a patient with inflammatory bowel disease may indicate complications such as peritonitis. Administration of analgesics is recommended to relieve abdominal pain. Milk should be avoided because it may cause discomfort and lead to cramping and bloating. Avoiding physical activity can help to control pain.
The nurse is assessing four different patients with ulcerative colitis. Which patient is likely to have a fulminant infection?
patient D A patient with a fulminant infection may have more than 10 stools per day, and his or her lab tests would show colon distention due to paralysis of the colon. Thus, patient D is most likely to have a fulminant infection. A patient with mild ulcerative colitis may have up to 4 stools a day without the presence of blood and have normal laboratory values. A patient with moderate ulcerative colitis may have more than 4 stools per day, and lab tests may show an increase in C-reactive protein. A patient with severe ulcerative colitis may have more than 6 stools a day, and the lab tests may show elevated C-reactive proteins and a high erythrocyte sedimentation rate.
Gangrene of the bowel and sepsis are some of the most common indications for emergency surgery. With which inflammatory bowel disorder are these complications associated?
peritonitis Peritonitis is an acute inflammation and infection of the visceral or parietal peritoneum and endothelial lining of the abdominal cavity. Gangrene and sepsis can occur within 24 to 36 hours, are life threatening, and may need emergency surgery. Abdominal pain followed by nausea can indicate appendicitis. Gastroenteritis causes diarrhea and vomiting because of inflammation of the mucous membranes of the stomach and intestinal tract. Ulcerative colitis is inflammation of the rectum and recto sigmoid colon.
Which of the following are classic symptoms of celiac disease? Select all that apply.
steatorrhea abdominal pain diarrhea and/or constipation Classic symptoms of celiac disease include weight loss, anorexia, diarrhea and/or constipation, steatorrhea, abdominal pain and distention, and vomiting. Atypical symptoms include osteoporosis, joint pain, lactose intolerance, iron deficiency anemia, depression, and migraines.
The nurse is caring for a patient who underwent exploratory laparotomy for a ruptured appendix. Which is the most important nursing intervention in the postoperative care to promote wound healing?
Maintaining sterile technique during peritoneal irrigation Peritoneal irrigation through a drain may be required for wound healing. Sterile technique should be maintained during manual irrigation to avoid infections. Assessing fluid retention is a typical postoperative intervention but is unrelated to wound healing. Measuring intake and output of fluids may help in assessment of fluid retention. Identifying infection at the site of incision is a good postoperative intervention but is not the most important intervention to prevent infection, which will promote wound healing.
A patient is scheduled for discharge after surgery for inflammatory bowel disease. The patient's spouse will be assisting home health services with the patient's care. What is most important for the home health nurse to assess in the patient and the spouse with regard to the patient's home care?
Ability of the patient and spouse to perform incision care and dressing changes Assessing the patient's and the spouse's ability to carry out incision care and dressing changes is essential for avoiding further development of the infectious process, as well as infection of the surgical incision itself. Assessing coping mechanisms and knowledge of the patient's pain medication are important but are not the priority. Understanding the importance of scheduled follow-up appointments is important but is not the priority.
What physiological change is seen in a patient with ulcerative colitis?
Increase in white blood cell levels An increased white blood cell count is consistent with inflammatory conditions such as ulcerative colitis. Due to chronic blood loss, hemoglobin levels decrease in patients with ulcerative colitis. Serum albumin levels decrease due to loss of protein (albumin) in the stool. Blood levels of sodium, potassium, and chlorine decrease due to frequent diarrhea stools and malabsorption.
A patient with ulcerative colitis is scheduled for an ileostomy. Which preoperative information should the nurse provide to the patient and family members?
Empty the pouch when it is one-third to one-half full. Emptying the Ileostomy pouch when it is one-third to one-half full helps to prevent leakage of the fecal matter. The pouch does not need to be changed before eating. The pouch should be changed at inactive time because there will be less stool output through the stoma. Changing the entire pouch system every 3 to 7 days prevents itching, leakage, and odor.
A home health patient has had severe diarrhea for the past 24 hours. Which nursing action does the RN delegate to the home health aide (unlicensed assistive personnel [UAP]) who assists the patient with self-care?
Checking and reporting the patient's heart rate and blood pressure in lying, sitting, and standing positions Obtaining the patient's blood pressure and heart rate is included in the education of home health aides and other UAP. Patient teaching and medication administration are complex skills that should be performed by licensed nurses who have the education and scope of practice needed to safely implement these actions.
What changes take place in a patient after a total proctocolectomy with a permanent ileostomy?
Stool volume decreases and becomes thick. After undergoing a total proctocolectomy with a permanent ileostomy, the stool volume decreases and becomes thick or pastelike due to increased absorption of sodium and water. Effluent has little sweet odor; a foul odor only occurs when there is a blockage or infection. After the procedure, the stool becomes yellow-green or yellow-brown in color. If the stool is red in color, the surgery was not successful.
A laparotomy performed on patient revealed abscesses in the abdominal cavity. What treatment strategies might be included in the care plan? Select all that apply.
inserting wound drains inserting a nasogastric tube administering intravenous (IV) antibiotics Abscesses are tissues filled with pus. Wound drains may be used to remove the pus from the tissues. A nasogastric tube may be placed to decompress the stomach and prevent abdominal distention. IV antibiotics are used to reduce infections. Analgesics should be administered to reduce pain and inflammation. The patient should be encouraged to ambulate in the evening of the day of surgery to help prevent respiratory complications.
The nurse is performing discharge teaching with a patient who has been diagnosed with a parasitic infection. Which instructions does the nurse include in the teaching plan? Select all that apply.
keep toilet areas clean All household members should be tested for parasites. Wash hands with antimicrobial soap after bowel movements. For those infected with a parasite, they should be educated to keep toilet areas clean, wash hands with antimicrobial soap after bowel movements, and have all household members tested for parasites. Avoidance of feces of dogs and beavers is recommended. Drinking water has not been shown to have an impact on parasitic infections.
What are the less-common causes for peritonitis? Select all that apply.
perforating tumors leakage during surgery contamination during surgery Peritonitis is an acute inflammation of the visceral or parietal peritoneum and endothelial lining of the abdominal cavity. Perforating tumors, leakage during surgery, and contamination during surgery are less-common causes for peritonitis. Bacteria and chemicals are the most-common causes for peritonitis.
What disorders does the nurse identify as acute inflammatory bowel disorders? Select all that apply.
peritonitis appendicitis gastroenteritis Appendicitis, gastroenteritis, and peritonitis are classified as acute inflammatory bowel disorders. Appendicitis is an acute inflammation of the vermiform appendix. Gastroenteritis is an acute inflammation of the mucous membranes of the stomach and intestinal tract. Peritonitis is an acute inflammation of the visceral or parietal peritoneum and endothelial lining of the abdominal cavity. Ulcerative colitis and Crohn's disease are classified as chronic inflammatory bowel diseases.
Which information is important to collect from a patient who is admitted to the hospital with diarrhea to determine the risk for gastroenteritis? Select all that apply.
recent travel recent restaurant meals food items purchased recently Diarrhea in a patient may indicate gastroenteritis. Therefore, the nurse should check all the risk factors of gastroenteritis. Recent travel to the tropical regions of Asia, Africa, or South America may increase the risk of tropical disease-induced gastroenteritis. Recent restaurant meals may also increase the risk of gastroenteritis. Food items purchased from a grocery store may also be infected. Information such as age and family should be collected; however, these may not indicate a risk for gastroenteritis.
What drug has a complication of hemolytic anemia in a patient with ulcerative colitis if taken in higher doses?
sulfasalazine Sulfasalazine is an aminosalicylate drug that causes hemolytic anemia if taken in high doses. Oslalazine, balsalazide, mesalamine are drugs used for ulcerative colitis that do not necessarily cause hemolytic anemia.
Which patient does the charge nurse assign to an experienced LPN/LVN?
30-year-old who must receive neomycin sulfate before a colectomy The LPN/LVN should be familiar with the purpose, adverse effects, and patient teaching required for neomycin. Teaching about how to catheterize a Kock ileostomy, assessing the patient with UC with a high white blood cell count, and monitoring the patient with gastroenteritis receiving IV fluids present complex problems that require assessment or intervention by an RN.
A patient was admitted to the hospital for evaluation of abdominal pain. The patient is unable to pass flatus and the abdomen has become firm and distended. The nurse is unable to hear bowel sounds. The patient has a heart rate of 90 beats/min and a temperature of 39° C. Which nursing action is correct?
Notify the provider immediately of this potentially life-threatening situation. The patient is showing signs of peritonitis, which is a life-threatening condition, and should be reported immediately. Administering oral medications is contraindicated. Ambulation will not increase peristalsis in this case. X-rays and blood tests may be ordered by the provider.
The nurse is caring for a patient admitted for gastroenteritis. What symptoms does the nurse expect to see in the patient? Select all that apply.
fever acute confusion poor skin turgor The patient with gastroenteritis loses a considerable amount of fluid through diarrhea and vomiting. This may lead to dehydration manifested by fever, acute confusion, and poor skin turgor. Therefore, the patient has oliguria or a decreased urine output. Hypotension, rather than hypertension, is present in patients with gastroenteritis.
Which medication is used as the first line treatment for mild ulcerative colitis?
sulfasalazine Sulfasalazine is an aminosalicylate used to treat mild-moderate ulcerative colitis. Infliximab alone is not effective in treating ulcerative colitis. Glucocorticoids such as prednisone are prescribed during exacerbations of the disease. Antidiarrheal drugs such as loperamide provide symptomatic management of the disease.
A nurse is caring for a patient with a new diagnosis of moderate ulcerative colitis (UC). The nurse anticipates an order for which medication?
sulfasalazine Several drugs can be prescribed to treat UC, including two aminosalicylates, one of which is sulfasalazine. Sulfamethoxazole is an antibiotic that can be used to treat gastroenteritis caused by shigellosis. Both azathioprine and mercaptopurine are prescribed to manage the symptoms of Crohn disease.
What instructions should the nurse give to a patient with Crohn's disease to manage his or her condition? Select all that apply
Instruct the patient to take monthly vitamin B 12 injections. Teach the patient about drug therapy and the side effects. Teach the patient about the usual course of the disease and symptoms. The nurse should instruct the patient to take monthly injections of vitamin B 12 because it gets easily absorbed during inflammation. The nurse should teach the patient about the drug therapy and the side effects for his of her information. Teaching the patient about the usual course of the disease and the symptoms helps him or her to be aware of any abnormalities. The patient should be instructed to avoid milk and stimulants such as caffeine because they cause discomfort. The patient should follow a low-residue and high-calorie diet to avoid any digestion problems that can lead to inflammation.
What surgical techniques are involved in the treatment of Crohn's disease?
Minimal invasive surgery (MIS) and stricturoplasty MiIS is performed for treating Crohn's disease which involves one or more small incisions, less pain, and quicker surgical recovery. Stricturoplasty is performed for bowel strictures related to Crohn's disease.Ileostomy and NOTES are the surgical techniques performed for treating ulcerative colitis.
Which clinical findings in a patient indicate ulcerative colitis?
Presence of blood and mucus in the stool Presence of blood and mucus in the stool is caused by bleeding in the intestinal mucosa. This symptom is indicative of ulcerative colitis. Strictures and deep ulcerations occur in Crohn's disease, which put the patient at risk for developing bowel fistulas. Thickened bowel walls and inflammation of ileum and colon are seen in Crohn's disease.
A patient with Crohn's disease has been admitted to the hospital with the development of a fistula between the bowel and bladder. What is the nursing priority for this patient?
Providing adequate nutrition and fluid and electrolytes Adequate nutrition and fluids and electrolytes are priorities for a patient with a fistula. Improving bowel and bladder elimination, increasing perfusion and circulation, and maintaining skin integrity are all important but are not the highest priority.
What is the most common cause of right lower quadrant pain?
appendicitis Appendicitis is an acute inflammation of the vermiform appendix that occurs most often in young adults and is the most common cause of right lower quadrant pain. Peritonitis may lead to respiratory problems. Sepsis occurs due to peritonitis and may have systemic manifestations. Gastroenteritis leads to abdominal cramping and diarrhea.
Which immediate order should the nurse expect from the primary health care provider who, while assessing a patient with gastroenteritis, observes increased peristaltic movements?
Administer oral dose of 4 mg loperamide. Peristaltic movements can be reduced by antiperistaltic agents. An initial dose of 4 mg of loperamide can be administered orally followed by 2 mg after each loose stool, up to 16 mg daily. Loperamide 10 mg and 16 mg are not initial doses.
A nurse is teaching a patient with Crohn's disease about managing the disease with the drug adalimumab. Which instruction does the nurse emphasize to the patient?
"Avoid large crowds and anyone who is sick." The patient should avoid being around large crowds to prevent developing an infection. The patient should not take the medication if he or she is allergic to certain proteins. Although immune suppression may occur to some degree, the patient should not experience difficulty with wound healing while taking adalimumab. The patient should not experience a decrease in blood pressure from taking this drug.
The nurse is teaching a patient with ulcerative colitis about ileostomy care. Which information does the nurse include in the plan of care?
"Avoid taking enteric-coated medications." For a patient with an ileostomy, the nurse should teach the patient to avoid taking enteric-coated medications; enteric-coated drugs are released in the terminal ileum and right side of the colon. Patients with ileostomies should also be taught to empty the pouch when it is one-third to one-half full and to change the entire pouch system every 3 to 7 days. High-fiber foods cause gas and make the stool thicker, so patients with ileostomies should avoid them if possible.
A patient with an exacerbation of ulcerative colitis (UC) has been prescribed Vivonex PLUS. The patient 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." For less severe exacerbations of UC, an elemental or semi-elemental product such as Vivonex PLUS may be prescribed to induce remission. These products are absorbed in the jejunum and therefore permit the distal small intestine and colon to rest. GI stimulants such as caffeinated beverages and alcohol should be avoided, but this is not the reason for using Vivonex PLUS. The objective of Vivonex is not to reduce gastric acid secretions. Nutritional supplements such as Ensure or Sustacal are added to provide nutrients and more calories.
A patient has been newly diagnosed with ulcerative colitis (UC). What does the nurse teach the patient about diet and lifestyle choices?
"Lactose-containing foods should be reduced or eliminated from your diet." Lactose-containing foods are often poorly tolerated and should be reduced or eliminated from the diet of patients with UC. Carbonated beverages are GI stimulants that can cause discomfort and should be used rarely or completely eliminated from the diet. Cigarette smoking is a stimulant that can cause GI distress symptoms; nurses should never advise patients that any amount of cigarette smoking is "OK." Raw vegetables and high-fiber foods can cause GI symptoms in patients with UC.
The nurse is teaching a nursing student about care of the patient with gastroenteritis. Which statement by the student indicates a need for further instruction?
"Patients with gastroenteritis will present with hypoactive bowel sounds." Gastroenteritis causes hyperactive, not hypoactive, bowel sounds with nausea, vomiting, and diarrhea. The other statements are correct. The loss of fluid through vomiting and diarrhea makes fluid replacement a priority. Most bacterial and viral causes of gastroenteritis are transmitted through the fecal-oral route, making handwashing an effective prevention method to decrease transmission.
An intensive care unit (ICU) RN is floated to the medical-surgical unit. Which patient does the charge nurse assign to the float nurse?
36-year-old with peritonitis who just returned from surgery with multiple drains in place The ICU nurse is familiar with the care of a patient with peritonitis, including monitoring for complications such as sepsis and kidney failure. The patient with CD who has a draining enterocutaneous fistula, the patient with UC who needs discharge teaching, and the patient with questions about an ileoanal reservoir are best assigned to a medical-surgical nurse who is more familiar with the care and teaching needed for patients with their respective disorders.
A patient with ulcerative colitis is scheduled to undergo restorative proctocolectomy with ileo pouch-anal anastomosis (RPC-IPAA). What statements about the procedure are accurate? Select all that apply.
A temporary loop ileostomy is created. Parenteral antibiotics are given within 1 hour before the surgery. An internal pouch is created with the distal part of the small intestine. During an RPC-IPAA, the surgeon creates an internal pouch, or reservoir, using the distal part of the small intestine. The loop of the ileum is placed through the abdominal wall or stoma to facilitate the drainage of fecal material into a pouch worn on the abdomen. It helps to heal the internal pouch and increases its capacity. Parenteral antibiotics are given within 1 hour before surgery to reduce the risk of infection. The surgery removes only the colon and most of the rectum. The anus and anal sphincter remain intact and the internal pouch is connected to the anus. Metronidazole is usually prescribed if the internal pouch is inflamed.
An older patient is being evaluated for abdominal pain. After 2 days of pain, the patient began vomiting and now reports increased pain with coughing. The patient prefers to lie in a fetal position with the right hip and knee bent. The patient's white blood cell count is 25,000/mm 3. What does the nurse suspect in this patient?
Perforation of the appendix Older patients are at increased risk for perforation with appendicitis. Symptoms of perforation include relief from pain by flexing the right knee or hip and increased pain with coughing along with a white blood cell count of > 20,000/mm 3. A fecalith may be present with prolonged, less severe symptoms of appendicitis. Ulcerative colitis involves bloody stools. Gastroenteritis is characterized by nausea and vomiting that precede pain.
What postoperative measure must the patient take after undergoing abdominal surgery for peritonitis?
Report a temperature higher than 38°C. The patient must report to a temperature higher than 38°C (101°F) to the provider immediately. Drugs such as docusate sodium are used to soften the stool. Foul-smelling drainage is a sign of infection and must be reported. Antibiotics should be taken as prescribed until they are finished. Lifting is usually not allowed for at least 6 weeks.
A patient is experiencing an exacerbation of ulcerative colitis (UC). What is an important nursing action to help minimize the patient's discomfort?
Restricting lactose-containing foods Patients with UC often have decreased lactose tolerance; lactose-containing foods should therefore be restricted. Discontinuing all oral intake is only done with a provider order and if total parenteral nutrition is to be used (in severe cases). Since ambulation increases intestinal activity, patients with UC should be limited in activity. Carbonated beverages will increase bloating, so they should be limited.
A certified Wound, Ostomy, and Continence Nurse is teaching a patient about caring for a new ileostomy. What information is most important to include?
"Call the health care provider if your stoma has a bluish or pale look." If the stoma has a bluish, pale, or dark look, its blood supply may be compromised and the health care provider must be notified immediately. It is true that output from the stoma after surgery may be a loose, greenish-colored liquid that may contain some blood, but this information is not the highest priority for instruction. It is normal for output from the stoma to have very little odor or a sweetish smell. Although it is true that the patient will be required to wear a pouch system at all times, this is not the highest priority for instruction.
The primary health care provider prescribes natalizumab to a patient with Crohn's disease. Which health teaching is most important before beginning the medication?
"Cognitive, motor, and sensory changes have very lethal effects." Natalizumab causes progressive multifocal leukoencephalopathy (PML), a deadly infection that affects the brain. Cognitive, motor, and sensory changes indicate PML and should be immediately reported. Glucocorticoids mask the symptoms of infection; natalizumab is a monoclonal antibody drug. Cold, sore throat infections, headache, and abdominal pain are common side effects of infliximab and certolizumab.
A nurse is teaching a patient about dietary methods to help manage exacerbations ("flare-ups") of diverticulitis. What does the nurse advise the patient?
"Consume a low-fiber diet while your diverticulitis is active. When inflammation resolves, consume a high-fiber diet." The most effective way to manage diverticulitis is with a low-fiber diet while inflammation is present, followed by a high-fiber diet once the inflammation has subsided. Neither an exclusively low-fiber diet nor an exclusively high-fiber diet will effectively manage diverticulitis. A high-fiber diet while diverticulitis is active will only worsen the disease and its symptoms.
A patient who develops viral gastroenteritis with vomiting and diarrhea is scheduled to be seen in the clinic the following day. What will the nurse teach the patient to do in the meantime?
"Consume extra fluids to replace fluid losses." Patients should be taught to drink extra fluids to replace fluid lost through vomiting and diarrhea. It is not necessary to stop all solid food intake. Antidiarrheal medications are used if diarrhea is severe. Antibiotics are used if the infection is bacterial.
The nurse is teaching a patient about caring for an ileostomy at home. Which statement by the patient indicates a correct understanding of the teaching?
"I should use skin sealants and ostomy skin creams as needed to prevent irritation." Skin care is essential with an ileostomy and patients must use products to protect skin from ostomy contents. Patients who have not had a stool for 6 to 12 hours should notify the provider; laxatives are not recommended. The ostomy pouch should be emptied when it is one-third to one-half full. The pouch should be emptied during periods of lower activity, including 2 to 4 hours after eating.
A patient with ulcerative colitis (UC) has stage 1 of a restorative proctocolectomy with ileo-anal anastomosis (RPC-IPAA) procedure performed. The patient 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." The RPC-IPAA has become the most effective method of creating an alternate method for UC patients who have surgery to remove diseased portions of intestines.Stage 1 creates an ileostomy while the internally created pouch is healing. Stage 2 closes the ileostomy, and the patient begins to use the pouch for storage of stool. The time between the surgeries is generally 1 to2 months. Telling the patient that he or she will have to discuss it with the health care provider evades the question; the nurse can give generalities to the patient based on past practice and available data. The time that the patient has the ileostomy is not "indefinite." The intent of this procedure is to eliminate the need to have a permanent ileostomy. The pouch should heal in 1 to 2 months, not 6 months; this estimate is not based on the expected outcome.
The RN receives a change-of-shift report about four patients. Which patient does the nurse assess first?
25-year-old who has just been admitted with possible appendicitis and has a temperature of 102°F This patient with possible appendicitis may have developed a perforation and may be at risk for peritonitis. Rapid assessment and possible surgical intervention are needed. The patient with UC who had six liquid stools, the patient whose colostomy bag does not have any stool in it, and the patient who was admitted with acute gastroenteritis all need assessment and intervention by an RN, but they are not at immediate risk for life-threatening complications. The patient with possible appendicitis has a life-threatening emergency.
What interventions should the nurse follow to manage the patient with peritonitis who is prescribed hypertonic intravenous (IV) fluids and broad-spectrum antibiotics? Select all that apply.
Administer analgesics. Monitor daily weight, intake, and output. Monitor all pain assessments and interventions. Analgesics are used to relieve the inflammation and pain of peritonitis. Monitoring daily weight and intake and output is necessary for assessing the condition of the patient. Monitoring pain assessments and interventions may help in the patient's early recovery. Antidiarrheal agents are not indicated in the treatment of peritonitis. The patient will be NPO and a nasogastric tube will be used to decompress the stomach and intestine.
A patient who has undergone a restorative proctocolectomy with ileo pouch-anal anastomosis complains of severe bowel irritation and leakage of stool at night. What interventions should the nurse perform to help the patient manage the condition? Select all that apply.
Administer antidiarrheal drugs. Instruct the patient to take flax seeds and vitamin C. Prepare the patient for a total proctocolectomy with a permanent ileostomy. Antidiarrheal drugs can help decrease the number of bowel movements and prevent leakage of stool. Flax seeds and food rich in vitamin C are used to manage chronic inflammatory bowel disease. A total proctocolectomy with a permanent ileostomy is performed on patients who do not want an ileo-anal pouch. Food items such as cabbage and broccoli should be avoided because they cause odor and gas. The patient should have adequate salt and water intake because an ileostomy causes a loss of both substances.
Which drug is often used to treat gastroenteritis caused by Shigella?
Ciprofloxacin Ciprofloxacin is used to treat gastroenteritis caused by Shigella. Loperamide is a drug that reduces peristaltic movement and is not commonly given for Shigella because it prevents elimination of the infecting organism. Diloxanide furoate is used to treat amebiasis caused by Entamoeba histolytica. Tinidazole is used to treat giardiasis caused by Giardia lamblia.
A patient presents to the emergency department with elevated temperature and severe diarrhea. When obtaining the history, the nurse learns the patient has recently eaten fast food and traveled to South America. Which medication would be prescribed to the patient
Ciprofloxacin In tropical regions and fast-food restaurants, lettuce and spinach are foods most commonly contaminated with bacteria. Ciprofloxacin is prescribed in cases of bacterial gastroenteritis with severe illness. Oxycodone is used to decrease inflammation in case of peritonitis. Loperamide is an antiperistaltic agent. Sulfamethoxazole is used to treat infections caused by Shigella.
A patient with ulcerative colitis (UC) is prescribed sulfasalazine and corticosteroid therapy. As the disease improves, what change does the nurse expect in the patient's medication regimen?
Corticosteroid therapy will be tapered. Once clinical improvement has been established, corticosteroids are tapered over a 2- to 3-month period. Stopping corticosteroid therapy abruptly is unsafe—steroids must be gradually decreased in patients. Usually the amount that they have been taking dictates how quickly or slowly they can be stopped. Sulfasalazine therapy will be taken on a long-term basis. It may be increased or decreased, depending on the patient's symptoms, but will likely never be stopped. These decisions are made over a long period of therapy.
Which disorder is associated with inflammation of the small intestine?
Crohn's disease Crohn's disease is an inflammatory disorder of the small intestine, sometimes the colon, or both. Peritonitis is inflammation of the peritoneum. Gastroenteritis is inflammation of the gastrointestinal tract. Ulcerative colitis is inflammation of the rectum and rectosigmoid colon and can extend to the entire colon.
A patient 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 patient's care does the nurse make certain to discuss with the health care provider before the patient's discharge?
Having a home health consultation for wound care Home health services are most appropriate for this patient because wound care will be extensive and the patient's mobility may be limited. No indication suggests that the patient is experiencing anxiety regarding postoperative care. Pain medication may be needed for the patient's osteoarthritis, but this is not the highest priority. A skilled nursing facility is not necessary if the patient can remain in his or her home with sufficient support services.
Which statements about shigellosis are accurate? Select all that apply.
Humans are possible carriers for months. Cipro may be used for treatment of gastroenteritis Shigellosis is transmitted by direct fecal-oral routes. Shigellosis is transmitted by direct and indirect fecal-oral routes and carries an incubation period of 1 to 7 days. It is communicable during the acute illness to 4 weeks after the illness. Humans are possible carriers for months. If gastroenteritis is due to shigellosis, anti-infective agents such as trimethoprim/sulfamethoxazole or ciprofloxacin are prescribed.
A patient has developed gastroenteritis while traveling outside the country. What is the likely cause of the patient's symptoms?
Ingestion of parasites in the water A main cause of gastroenteritis when traveling outside the country is ingestion of water that is infested with parasites. Bacteria on the patient's hands will not produce gastroenteritis unless food or water is contaminated with the bacteria. Insufficient vaccinations may cause other disease processes, but not gastroenteritis. Undercooked, not overcooked, food may produce gastroenteritis.
Which pathophysiological finding is least likely to occur in ulcerative colitis?
Intestinal mucosa becomes bluish. In ulcerative colitis, the intestinal mucosa becomes hyperemic, edematous, and reddened due to increased blood flow. The mucosa is unlikely to turn blue in case of ulcerative colitis. In more severe inflammation, continuous edema and mucosal thickening lead to a narrowed colon and partial bowel obstruction. Due to bleeding in the intestinal lining, ulcers and small erosions are formed
Which nursing interventions are appropriate for the patient with appendicitis?
Keeping the patient in a semi-Fowler's position Maintaining the patient with appendicitis in a semi-Fowler's position helps to contain any abdominal drainage in the lower abdomen. Opioid analgesics can be administered to reduce the pain. Laxatives are not administered, as they can cause perforation of the appendix. Warm compresses are not applied on the abdomen, as they increase circulation to the appendix, which further increases inflammation and perforation.
Which organism causes gastroenteritis and is possibly transmitted through the respiratory route?
Norovirus Norovirus, also known as Norwalk-like viruses, causes gastroenteritis and is transmitted through the fecal-oral route and possibly the respiratory route. Shigella transmits through direct and indirect fecal-oral routes . Escherichia coli transmit through fecal contamination of food, water, or fomites. Campylobacter enteritis causes gastroenteritis through the fecal-oral route or by contact with infected animals or infants.
After reviewing the case sheet of a patient experiencing severe abdominal pain and diarrhea, the nurse suspects ulcerative colitis. Which findings support the nurse's conclusion? Select all that apply.
Presence of blood in stools Intolerance to milk and milk products Use of non-steroidal anti-inflammatory drugs for pain Hemorrhage is a complication of ulcerative colitis; thus, a patient with ulcerative colitis may have melena (blood in stools). Consumption of milk and milk products in patients with lactose intolerance may trigger an inflammatory response increasing the likelihood of ulcerative colitis. Recent use of non-steroidal anti-inflammatory drugs can cause a flare-up of ulcerative colitis. The presence of bowel fistulas is indicative of Crohn's disease. Multiple fractures may occur because of decreased bone density due to osteoporosis. Osteoporosis is typically associated in patients with Crohn's disease.
An 80-year-old patient with a 2-day history of myalgia, nausea, vomiting, and diarrhea is admitted to the medical-surgical unit with a diagnosis of gastroenteritis. Which health care provider request does the nurse implement first?
Start an IV solution of 5% dextrose in 0.45 normal saline at 125 mL/hr. Fluid therapy is the focus of treatment for patients with gastroenteritis. Older patients are at increased risk for the complications of dehydration such as hypovolemia and acute kidney failure. Acetaminophen 650 mg should be rapidly administered rectally, and blood draws and stool specimen collection should be implemented rapidly, but prevention and treatment of dehydration are the priorities for this patient.
An obese patient is discharged 10 days after being hospitalized for peritonitis, which resulted in an exploratory laparotomy. Which assessment finding by the patient's home health nurse requires immediate action?
States, "I feel like the incision is splitting open" The patient feeling like the incision is splitting open is at risk for poor wound healing and possible wound dehiscence; the nurse should immediately assess the wound and notify the health care provider. Reports of pain when coughing, being too tired to ambulate, and a temperature of 100.8°F (38.2°C) all require further assessment or intervention but are not as great a concern as the possibility of wound dehiscence for this patient.
Which instructions should the nurse provide to the patient with appendicitis that is scheduled for surgery? Select all that apply.
Take antibiotics as prescribed. Take opioid analgesics as prescribed. Antibiotics are prescribed to reduce infections. Opioid analgesics are prescribed for patients with appendicitis to reduce inflammation and pain. Laxatives may cause perforation of the appendix and should be avoided. Heat should not be applied because it may increase circulation to the appendix and result in increased inflammation and perforation. Enemas may also cause perforation of the appendix and should be avoided.
What should the nurse teach a patient with gastroenteritis? Select all that apply.
To use medicated cleansing wipes To apply a protective barrier cream to the skin To take sitz baths for 10 minutes two or three times daily The nurse should teach the patient to use medicated wipes to avoid skin irritation and infections. Applying protective barrier cream on the skin helps protection. Taking sitz baths for 10 minutes two or three times daily helps relieve pain and itching in the genital area. Use of toilet paper and harsh soaps should be avoided. The genital area should be cleaned with warm water for relief from pain.
A patient admitted with severe diarrhea is experiencing skin breakdown from frequent stools. What is an important comfort measure for this patient?
Using sitz baths three times daily Patients with skin breakdown may use sitz baths for comfort two or three times daily. Barrier creams, not hydrocortisone creams, may be used. The skin should be cleaned gently with soap and warm water. Absorbent cotton underwear helps keep the skin dry but is not a comfort measure.
Which examination is used first to identify an enlarged appendix in a patient?
abdominal ultrasound An abdominal ultrasound study may show the presence of an enlarged appendix. An x-ray is used in identification of free air or abdominal fluid. A computed tomography scan may be used after an ultrasound to confirm the diagnosis. Palpation of the abdomen may reveal muscle rigidity and guarding.
Which findings are likely in a patient with peritonitis?
abdominal wall rigidity In patients with peritonitis, abdominal wall rigidity is a cardinal sign of peritonitis and is referred to as a "boardlike" abdomen. Tachycardia may occur due to high fever and decreased circulating blood volume. Severe diarrhea may be observed in gastroenteritis. Hematuria is not typically associated with peritonitis.
The nurse is caring for a patient with peritonitis. What assessment findings will the nurse observe? Select all that apply.
anorexia distended abdomen Peritonitis is an acute inflammation of the visceral and the parietal peritoneum and the endothelial lining of the abdominal cavity. A patient with peritonitis presents with a distended abdomen and anorexia. The patient has a high fever rather than a low-grade fever. Urine output is decreased because fluid shifts from the vascular compartment to the peritoneal cavity. There is no diarrhea; rather, the patient is unable to pass flatus because peristalsis slows or stops due to severe peritoneal inflammation.
A patient is admitted to the hospital with appendicitis. What signs/symptoms are consistent with this diagnosis? Select all that apply.
anorexia nausea and vomiting rebound tenderness Symptoms consistent with appendicitis include abdominal pain that is aggravated by coughing, nausea and vomiting, anorexia, rebound tenderness, and an increased white blood cell count.
A patient presents to the emergency department with complaints of severe abdominal pain near the right anterior iliac crest that later led to nausea and vomiting. Which acute inflammatory bowel disorder does the nurse suspect is the most likely cause?
appendicitis Appendicitis is the most likely cause since it presents as lower right quadrant abdominal pain in the region of the anterior iliac crest to the umbilicus followed by nausea and vomiting. Peritonitis has a hallmark sign of a rigid, boardlike abdomen. Viral and bacterial gastroenteritis present with nausea and vomiting before the onset of abdominal pain.
Which sign of peritonitis appears first in an older adult?
confusion The first sign of peritonitis in older adults may be a sudden change in mental status (e.g., acute confusion). For those who have dementia, the confusion worsens. Fever and chills may not be present because of normal physiologic changes associated with aging. Abdominal pain will be present but will not be the first sign.
Which findings support the nurse's conclusion that a patient has gastroenteritis and may require hospitalization? Select all that apply.
dehydration hypovolemia cardiac dysrhythmias Dehydration and hypovolemia may occur as a result of vomiting and diarrhea associated with gastroenteritis. Patients with gastroenteritis also may have imbalance of fluid and electrolytes, increasing the risk for cardiac dysrhythmias. Hypokalemia, not hyperkalemia, occurs as a result of diarrhea. Septicemia may occur in peritonitis but is not typically associated with gastroenteritis.
What term is used to describe a fistula that is present between the bowel and the bladder?
enterovesical fistula A fistula that is present between the bowel and bladder is referred to as an enterovesical fistula. A fistula that is present between two segments of bowel is called an enteroenteric fistula. A fistula that is present between the skin and bowel is an enterocutaneous fistula. A fistula that is present between the bowel and vagina is called an enterovaginal fistula.
Which findings in a patient indicate dehydration? Select all that apply.
fever oliguria poor skin turgor Loss of fluids and electrolytes from the body can cause dehydration. The patient may develop fever due to dehydration. Oliguria, or low urine output, may be a consequence of low renal perfusion due to dehydration. Less fluid in extracellular spaces may cause poor skin turgor. Dehydration may cause low intravascular volume, resulting in hypotension. Pain in the right lower quadrant or abdominal pain due to cough is not consistent with dehydration.
What is a common complication of Crohn's disease?
fistulas Crohn's disease is an inflammatory disease that usually affects the small intestine and the colon. The patient with Crohn's disease is at risk for fistulas due to the presence of strictures and deep ulcerations in the bowel wall. Patients with ulcerative colitis have bloody and liquid stools and report tenesmus, an unpleasant and urgent sensation to defecate. The lower abdominal colicky pain reduces with defecation.
What are potential complications of Crohn's disease? Select all that apply.
fistulas, osteoporosis, malabsorption, abscess formation The complications of Crohn's disease include abscess formation, colon cancer, malabsorption, fistulas, and osteoporosis. Stomach cancer is not a complication of Crohn's disease; colorectal cancer, however, is a possible complication of ulcerative colitis.
A patient reports pain and a boardlike abdomen. What other findings would indicate peritonitis? Select all that apply.
high fever dehydration inability to pass feces High fever may result due to infections and inflammation in a case of peritonitis. Dehydration may occur due to nausea and vomiting. Feces may not be easily passed due to pain at the site of inflammation. Diarrhea is usually not seen since there is a problem in passing feces. Decreased urine output is seen in peritonitis.
The patient requires a large amount of calories daily to promote the healing of a fistula. Which kind of diet should the nurse provide to the patient?
high-protein food A high-protein diet is beneficial for wound healing. High-fiber foods cause discomfort and indigestion problems. High-vitamin foods are suggested to speed up the wound cure. Low-calorie meals do not increase caloric intake.
A patient has a low-grade fever and tenesmus. Which other clinical manifestations may indicate ulcerative colitis?
inflammation of the joints Ulcerative colitis may have extraintestinal complications such as inflammation of the joints. Appetite would be decreased because mealtimes may be unpleasant since eating is associated with pain. Patients with ulcerative colitis have an increased frequency of stools rather than difficulty passing stools. Patients with ulcerative colitis may have lesions or ulcers inside the mouth involving the tongue, palate, and pharynx rather than outside the mouth.
A patient complains of severe diarrhea and abdominal pain. Which information collected from the patient would indicate an increased risk for inflammatory bowel disease? Select all that apply.
intolerance to milk exposure to antibiotics travel to a tropical area Intolerance to milk and milk products can cause intestinal distress and bloating. Exposure to antibiotics potentially causes flaring-up of inflammatory bowel disorder. Tropical areas are more prone to bacterial contamination; people who travel to these areas are at a higher risk of stomach infections. In a healthy person, the bowel color is yellow to brown and the pattern of bowel elimination is two to three times a day.
Which clinical investigations may be performed to diagnose septicemia?
white blood cell count An elevated white blood cell count is consistent with infection or septicemia. An abdominal x-ray and abdominal ultrasound tests are useful in identifying edema and inflammation of small and large intestines. Serum creatinine is performed to determine kidney function. Blood urea nitrogen indicates renal function.