Chapter 42.4 Lower GI Problems

The nurse is reviewing the reports of different patients. Which patient is susceptible for an obstruction of the colon?

A

The nurse finds the presence of a pale stoma in a patient who has undergone ostomy surgery. What does the nurse suspect to have occurred?

Anemia

The nurse is assessing a patient who has undergone a total proctocolectomy with ileal pouch/anal anastomosis 6 months ago. Which finding indicates a positive outcome of surgery?

Decreased number of bowel movements

A patient is scheduled for surgery to have a permanent ostomy created. What does the nurse remember is the preferred site for the ostomy?

Descending colon

A patient has undergone sphincter-sparing surgery. For what common complication should the nurse closely assess?

Diarrhea

The nurse provides postoperative care one day after a patient undergoes colostomy surgery. The patient's stoma is moist and dark pink, with no obvious drainage. Which action should the nurse take?

Document the normal findings.

Help regulate the colon

Emptying an ostomy bag Placing the ostomy pouching system for an established ostomy

The student nurse is providing postoperative care to a patient who underwent ostomy surgery. Which action of the student nurse indicates the need for correction?

Emptying collecting bags when filled completely

The nurse observes altered skin integrity in a patient who has undergone an ileostomy. What does the nurse attribute as the reason for the skin breakdown?

Flat stoma

The nurse finds transient incontinence of mucus in a patient who has recently undergone ileostomy. What reason does the nurse suspect for this finding?

Intraoperative manipulation of the anal canal

Which ostomy surgery is indicated in the figure?

Loop colostomy

The nurse is reviewing the medical records of four patients. Which patient will the nurse prepare for an ileostomy surgery?

Patient A

The primary health care provider is reviewing the laboratory reports of four patients. Which patient does the nurse prepare for a wide resection and reanastomosis?

Patient B

For what complication should the nurse assess a patient after total proctocolectomy with an ileal pouch/anal anastomosis surgery?

Pouchitis

The nurse is caring for a patient after an abdominoperineal resection. For what complications should the nurse monitor the patient?

Sexual dysfunction

The nurse irrigates the stoma of a patient who has undergone ostomy surgery every 24 to 48 hours. Which ostomy surgery has the patient undergone?

Sigmoid colostomy

The wound, ostomy, and continence (WOC) nurse selects the site where the ostomy will be placed. What should be included in the consideration for the site?

The patient must be able to see the site.

The nurse is assigned to care for four patients who have had gastrointestinal surgery. Which patient would show a regular bowel pattern?

The patient who has undergone sigmoid colostomy.

The nurse is caring for a patient in the initial postoperative period after having an ileostomy. What is a priority nursing action for this patient?

Using transparent pouches for the patient

A patient has developed a complication after colostomy surgery. What statement made by the patient to the nurse indicates that further instruction is needed?

"I am including cooked split and black beans in my diet."

When evaluating the patient's understanding about the care of the ileostomy, what statement by the patient indicates the patient needs more teaching?

"I will be able to regulate when I have stools."

A patient is diagnosed with a rectovaginal fistula. For which surgery does the nurse prepare the patient?

#2

The nurse teaches self-care of a stoma to a patient who has undergone ostomy surgery. Which statement of the patient indicates the need of further teaching?

"I should limit my fluid intake."

The nurse is assessing a patient following a bowel resection with a permanent colostomy. The patient says, "How am I supposed to care for a colostomy? I can't look at my scars." What is the nurse's priority action?

Ask the patient to discuss fears or concerns about the colostomy.

The nurse is caring for a patient whose terminal ileum has been removed. What medication will the nurse administer to the patient?

Cobalamin supplement

The nurse is teaching the colostomy irrigation procedure to a patient. Which action by

Continuing the flow of solution if cramping occurs

The nurse collaborates with an enterostomal therapist to create a teaching plan for a patient with Crohn's disease who has a new ileostomy. Which lifestyle change would be appropriate for inclusion in the plan?

Increased fluid intake to 2 to 3 L/day

The nurse is assessing four patients. Which patient's fluid requirement would remain the same after surgery?

Patient D

The nurse finds that a patient who has undergone an ileostomy has a urinary output of 1800 mL/day. What should the nurse infer from this assessment finding?

This is a normal finding.

While reviewing laboratory reports of a patient, the nurse finds ulcerative colitis. Which surgery does the nurse expect to be beneficial for this patient?

Total proctocolectomy with ileal pouch/anal anastomosis

The nurse is teaching a caregiver about the measures to be taken while caring for a patient who has undergone ostomy surgery a week ago. Which statement indicates effective learning of the caregiver?

"I should observe the stoma color every 4 hours."

In a patient who has undergone a loop colostomy, the primary health care provider holds the loop in place by inserting a plastic rod for 7 to 10 days after the surgery. What reason would the nurse explain to the patient about this procedure?

"Plastic rods prevent the loop from slipping back into the abdominal cavity."

A patient has a newly formed ileostomy and asks the nurse, "When can I start training my ostomy to only produce stool at certain times?" What is the nurse's appropriate response?

"We will not be able to train your ileostomy because of the frequent drainage from the site."

Which figure indicates a single-barreled sigmoid colostomy?

#3

The nurse is caring for a group of patients in the acute care facility. What patient will the nurse prepare for ileostomy surgery?

A patient who has familial polyposis

The nurse is caring for a patient with colorectal cancer who had a polypectomy during a colonoscopy. Which finding indicates a positive outcome?

Absence of malignancy at the resected margin of the polyp

This is a normal finding.

Ask the patient to discuss fears or concerns about the colostomy.

The nurse is caring for a patient who has undergone an abdominoperineal resection; the nurse suspects infection. Which findings support the nurse's conclusion? Select all that apply.

Body temperature of 100.4° F Edematous and erythematous stoma White blood cell count of 15,000 cells/mL

The nurse is teaching the colostomy irrigation procedure to a patient. Which action by the patient indicates the need for further education?

Continuing the flow of solution if cramping occurs

The nurse is assessing a colostomy in a patient who had a colectomy 24 hours ago. Which of these assessment findings is considered normal for a new stoma?

Dark pink to red color

The nurse is caring for a patient whose small bowel has been shortened by an ileostomy. For what complication should the nurse assess this patient?

Excessive drainage

The nurse is caring for a patient after a sigmoid colostomy. What type of stool does the nurse anticipate when assessing the patient?

Formed

What does the arrow indicate in the following figure?

Hartmann's pouch

A patient's colostomy stoma is scheduled to be irrigated on the fifth postoperative day. What does the nurse understand to be the main purpose of the irrigation?

Help regulate the colon

The nurse is caring for a patient who has undergone an ileostomy. What is the appropriate nursing action for this patient?

Instructing the patient to wear a drainable collecting pouch constantly for 4 to 7 days before changing

Which statement is true regarding a double-barreled stoma?

It involves bringing both the proximal and distal ends through the abdominal wall as two separate stomas.

After reviewing a patient's medical record the nurse finds that the patient has a stage I tumor in the left colon. For which treatment does the nurse prepare the patient?

Laparoscopic surgery

The nurse is examining four patients. Which patient requires a permanent ostomy?

Patient C

The nurse is educating a patient about performing colostomy irrigation. What rationale does the nurse give the patient for the importance of doing the procedure?

To stimulate emptying of the colon