Chapter 47: Management of Patients With Intestinal and Rectal Disorders

usual pattern of elimination. Constipation has many possible reasons; assessing the client's usual pattern of elimination is the first step in identifying the cause.

The nurse is assessing a client for constipation. To identify the cause of constipation, the nurse should begin by reviewing the client's:

Assist client to increase dietary fiber.

A client with anorexia complains of constipation. Which of the following nursing measures would be most effective in helping the client reduce constipation?

metabolic acidosis

In a client with enteritis and frequent diarrhea, the nurse should anticipate:

Peritonitis Peritonitis is inflammation of the peritoneum, the serous membrane lining the abdominal cavity and covering the viscera. Peritonitis is typically a life-threatening emergency that requires prompt surgical intervention, and typically involves postoperative critical care monitoring due to the risk of sepsis, organ failure, and subsequent infections.

Post appendectomy, a nurse should assess the patient for abdominal rigidity and tenderness, fever, loss of bowel sounds, and tachycardia, all clinical signs of:

hypokalemia. The older client taking digoxin must be aware of how quickly dehydration and hypokalemia can occur with diarrhea. The nurse teaches the client to recognize the symptoms of hypokalemia because low levels of potassium intensify the action of digitalis, leading to digitalis toxicity.

The nurse caring for an older adult client diagnosed with diarrhea is administering and monitoring the client's medications. Because one of the client's medications is digitalis (digoxin), the nurse monitors the client closely for:

high-fiber diet. A high-fiber diet is prescribed to help control diarrhea and constipation. Foods that are possible irritants, such as caffeine, spicy foods, lactose, beans, fried foods, corn, wheat, and alcohol, should be avoided. Fluids should not be taken with meals because they cause abdominal distention.

Diet therapy for clients diagnosed with irritable bowel syndrome (IBS) includes:

Third degree

A patient is being seen in the clinic for complaints of painful hemorrhoids. The nurse assesses the patient and observes the hemorrhoids are prolapsed but able to be placed back in the rectum manually. The nurse documents the hemorrhoids as what degree?

0.9% NS The administration of several liters of an isotonic solution is immediately prescribed. Hypovolemia occurs because massive amounts of fluid and electrolytes move from the intestinal lumen into the peritoneal cavity and deplete the fluid in the vascular space.

Medical management of a patient with peritonitis includes fluid, electrolyte, and colloid replacement. The nurse knows to prepare the initial, most appropriate intravenous solution. Which of the following is the correct solution?

Adding fiber-rich foods to the diet gradually The nurse instructs the client to add fiber-rich foods to the diet gradually to avoid bloating, gas, and diarrhea. It is essential for a client to include bran cereals and beans in the diet because they ease defecation. The nurse also instructs the client to increase fluids to 6 to 8 glasses per day to prevent hard, dry stools. The client should also develop a regular exercise program to increase peristalsis and promote bowel elimination.

In addition to teaching a client with constipation to increase dietary fiber intake to 25 g/day, which of the following would the nurse include as important?

Familial polyposis Family history of colon cancer or familial polyposis is a risk factor for colorectal cancer. Age older than 40 years andd a high-fat, high-protein, low-fiber diet are risk factors for colorectal cancer. A history of skin cancer is not a recognized risk factor for colorectal cancer.

The nurse is performing a community screening for colorectal cancer. Which characteristic should the nurse include in the screening?

severe abdominal pain with direct palpation or rebound tenderness. Peritonitis decreases intestinal motility and causes intestinal distention. A classic sign of peritonitis is a sudden, diffuse, severe abdominal pain that intensifies in the area of the underlying causative disorder (such as appendicitis, diverticulitis, ulcerative colitis, or a strangulated obstruction). The client may also have rebound tenderness. Tenderness and pain in the right upper abdominal quadrant suggest cholecystitis. Jaundice and vomiting are signs of cirrhosis of the liver. Rectal bleeding or a change in bowel habits may indicate colorectal cancer.

Nursing assessment of a client with peritonitis reveals hypotension, tachycardia, and signs and symptoms of dehydration. The nurse also expects to find:

increasing fluid intake to prevent dehydration. Because stool forms in the large intestine, an ileostomy typically drains liquid waste. To avoid fluid loss through ileostomy drainage, the nurse should instruct the client to increase fluid intake. The nurse should teach the client to wear a collection appliance at all times because ileostomy drainage is incontinent, to avoid high-fiber foods because they may irritate the intestines, and to avoid enteric-coated medications because the body can't absorb them after an ileostomy.

A client is recovering from an ileostomy that was performed to treat inflammatory bowel disease. During discharge teaching, the nurse should stress the importance of:

Borborygmus Borborygmus is the intestinal rumbling caused by the movement of gas through the intestines that accompanies diarrhea. Tenesmus refers to ineffectual straining at stool. Azotorrhea refers to excess of nitrogenous matter in the feces or urine. Diverticulitis refers to inflammation of a diverticulum from obstruction (by fecal matter) resulting in abscess formation.

The nurse is performing and documenting the findings of an abdominal assessment. When the nurse hears intestinal rumbling and the client then experiences diarrhea, the nurse documents the presence of which condition?

Dry skin thoroughly after washing The nurse should teach the client without peristomal skin irritation to dry the skin thoroughly after washing. Barrier powder, triamcinolone acetonide spray, and nystatin powder are used when the client has peristomal skin irritation and/or fungal infection.

The nurse is teaching a client with an ostomy how to change the pouching system. Which information should the nurse include when teaching a client with no peristomal skin irritation?

paralytic ileus Bowel sounds are hypoactive or absent in a client with a paralytic ileus. Clients with Crohn's disease and gastroenteritis have hyperactive bowel sounds because of increased intestinal motility. A complete bowel obstruction causes absent bowel sounds below the obstruction and hyperactive sounds above the obstruction.

A nurse is performing focused assessment on her clients. She expects to hear hypoactive bowel sounds in a client with:

The client's natural bowel function may become sluggish. Explanation: It is essential for the nurse to caution the client against the prolonged use of laxatives because it decreases muscle tone in the large intestine. Prolonged use of laxatives may cause the client's natural bowel function to become sluggish. Laxatives do not increase the risk of developing inflammatory bowel disease, arthritis, or arthralgia, nor do they cause a loss in appetite.

A client realizes that regular use of laxatives has greatly improved his bowel pattern. However, the nurse cautions this client against the prolonged use of laxatives for which reason?

White blood cell (WBC) count 22.8/mm3 The nurse should report the elevated WBC count. This finding, which is a sign of infection, indicates that the client's appendix might have ruptured. Hematocrit of 42%, serum potassium of 4.2 mEq/L, and serum sodium of 135 mEq/L are within normal limits. Alterations in these levels don't indicate appendicitis.

A client with complaints of right lower quadrant pain is admitted to the emergency department. Blood specimens are drawn and sent to the laboratory. Which laboratory finding should be reported to the physician immediately?

Hypotension Clinical manifestations include hypotension, increased temperature, tachycardia, and elevated ESR.

The nurse is caring for a patient diagnosed with abdominal perforation. Which of the following is a clinical manifestation of this disease process?

Internal hemorrhoids cause bleeding but are less likely to cause pain, unless they protrude through the anus. External hemorrhoids may cause few symptoms, or they can produce pain, itching, and soreness of the anal area.

When interviewing a client with internal hemorrhoids, which of the following would the nurse expect the client to report?

"I didn't eat anything I shouldn't have; I just ate roast beef on rye bread." The client stating that he ate roast beef on rye bread indicates the need for a dietary consult because rye bread contains gluten, which must be eliminated from the client's diet. The client stating that he's followed the ordered medication regimen and diet doesn't suggest that the client needs a dietary consult; a treatment regimen consisting of medications to improve symptoms and dietary modification is necessary to treat celiac disease. The client stating that he hasn't traveled outside of the country doesn't suggest that dietary concerns exist. The client saying that he can't have oatmeal shows an understanding of the dietary restrictions necessary with celiac disease.

A client is readmitted with an exacerbation of celiac disease 2 weeks after discharge. Which statement by the client indicates the need for a dietary consult?

Rovsing's sign; acute appendicitis When an examiner deeply palpates the left lower abdominal quadrant and the client feels pain in the RLQ, this is referred to as a positive Rovsing's sign and suggests acute appendicitis.

A client presents to the ED with acute abdominal pain, fever, nausea, and vomiting. During the client's examination, the lower left abdominal quadrant is palpated, causing the client to report pain in the RLQ. This positive sign is referred to as ________ and suggests the client may be experiencing ________.

fissure. An anal fissure (fissure in ano) is a linear tear in the anal canal tissue. An anal fistula (fistula in ano) is a tract that forms in the anal canal. Hemorrhoids are dilated veins outside or inside the anal sphincter. A pilonidal sinus is an infection in the hair follicles in the sacrococcygeal area above the anus.

A client reports severe pain and bleeding while having a bowel movement. Upon inspection, the health care provider notes a linear tear in the anal canal tissue. The client is diagnosed with a:

Peritonitis Lack of bowel motility typically accompanies peritonitis. The abdomen feels rigid and boardlike as it distends with gas and intestinal contents. Bowel sounds typically are absent. The diagnosis of acute appendicitis correlates with the symptoms of rupture of the appendix and peritonitis. A paralytic ileus and gas alone do not produce these symptoms.

A client with a diagnosis of acute appendicitis is awaiting surgical intervention. The nurse listens to bowel sounds and hears none and observes that the abdomen is rigid and boardlike. What complication does the nurse determine may be occurring at this time?

The client exhibits signs of adequate GI perfusion. Adequate GI perfusion can be maintained only if Crohn's disease is controlled. If the client experiences acute, uncontrolled episodes of Crohn's disease, impaired GI perfusion may lead to a bowel infarction. Positive self-image, a manageable level of discomfort, and intact skin integrity are expected client outcomes, but aren't related to control of the disease.

A nurse is caring for a client who has experienced an acute exacerbation of Crohn's disease. Which statement best indicates that the disease process is under control?

enterostomal nurse The surgeon should collaborate with the enterostomal nurse who can address the client's concerns. The enterostomal nurse may schedule a visit with a client who has a colostomy to offer support to the client

A surgeon is discussing surgery with a client diagnosed with colon cancer. The client is visibly shaken over the possibility of a colostomy. Based on the client's response, the surgeon should collaborate with which health team member?

Absent. Since lack of bowel motility typically accompanies peritonitis, bowel sounds are absent. Therefore, the nurse will not observe mild, high-pitched, or hyperactive bowel sounds.

After assessing a client with peritonitis, the nurse most likely would document the client's bowel sounds as:

Loperamide (Imodium) Loperamide and diphenoxylate with atropine sulfate are examples of opiate-related antidiarrheal agents. Bismuth subsalicylate and kaolin and pectin are examples of absorbent antidiarrheal agents. Bisacodyl is a chemical stimulant laxative.

After teaching a group of students about irritable bowel syndrome and antidiarrheal agents, the instructor determines that the teaching was effective when the students identify which of the following as an example of an opiate-related antidiarrheal agent?

stool consistency and client comfort Normal bowel patterns range from three bowel movements per day to three bowel movements per week. In differentiating normal from abnormal, the consistency of stools and the comfort with which a person passes them are more reliable indicators than is the frequency of bowel elimination.

An older adult client in a long term care facility is concerned about bowel regularity. During a client education session, the nurse reinforces the medically acceptable definition of "regularity." What is the actual measurement of "regular"?

Ulcerative colitis The presence of mucus and pus in the stool suggests ulcerative colitis. Watery stools are characteristic of small-bowel disease. Loose, semisolid stools are associated more often with disorders of the colon. Voluminous, greasy stools suggest intestinal malabsorption.

The nurse is conducting a gastrointestinal assessment. When the client reports the presence of mucus and pus in the stool, the nurse assesses for additional signs/symptoms of which disease/condition?

Nausea Nausea, with or without vomiting, is typically associated with appendicitis. Pain is generally felt in the right lower quadrant. Rebound tenderness, or pain felt upon the release of pressure applied to the abdomen, may be present with appendicitis. Low-grade fever is associated with appendicitis.

The nurse working in the ED is evaluating a client for signs and symptoms of appendicitis. Which of the client's signs/symptoms should the nurse report to the physician?

presents with a rigid, board-like abdomen. A rigid, board-like abdomen is a sign of peritonitis, a possibly life-threatening condition. Epigastric pain occurring 90 minutes to 3 hours after eating indicates a duodenal ulcer. Anorexia and peri-umbilical pain are characteristic of appendicitis. Risk of rupture is minimal within the first 24 hours, but increases significantly after 48 hours. A client with a large-bowel obstruction may have ribbon-like stools.

Which client requires immediate nursing intervention? The client who:

Board-like abdomen The client with peritonitis would typically exhibit a rigid, board-like abdomen, with absent bowel sounds, elevated pulse rate, and rapid, shallow respirations.

Which of the following would a nurse expect to assess in a client with peritonitis?

It is the third most common cancer in the United States. Colorectal cancer is the third most common type of cancer in the United States. The lifetime risk of developing colorectal cancer is 1 in 20. The incidence increases with age (the incidence is highest in people older than 85). Colorectal cancer occurrence is higher in people with a family history of colon cancer.

The nurse is conducting a community education program on colorectal cancer. Which statement should the nurse include in the program?

Right lower quadrant The pain of acute appendicitis localizes in the right lower quadrant (RLQ) at McBurney's point, an area midway between the umbilicus and the right iliac crest. Often, the pain is worse when manual pressure near the region is suddenly released, a condition called rebound tenderness.

A client is admitted with a diagnosis of acute appendicitis. When assessing the abdomen, the nurse would expect to find rebound tenderness at which location?

Mucosal disorders causing generalized malabsorption In addition to celiac sprue, regional enteritis and radiation enteritis are examples of mucosal disorders. Examples of infectious diseases causing generalized malabsorption include small-bowel bacterial overgrowth, tropical sprue, and Whipple disease. Examples of luminal problems causing malabsorption include bile acid deficiency, Zollinger-Ellison syndrome, and pancreatic insufficiency. Postoperative gastric or intestinal resection can result in development of malabsorption syndromes.

Celiac sprue is an example of which category of malabsorption?

Small bowel obstruction Small bowel obstruction is a serious systemic complication of regional enteritis. The other clinical signs are associated with ulcerative colitis. Refer to Table 24-4 in the text.

A nurse caring for a patient with regional enteritis knows to assess for this most serious systemic complication. What is that complication?

high-fiber diet A high-fiber diet is prescribed to control diarrhea and constipation and is recommended for patients with IBS.

A patient diagnosed with IBS is advised to eat a diet that is:

Bowel perforation Megacolon is a dilated and atonic colon caused by a fecal mass that obstructs the passage of colon contents. Symptoms include constipation, liquid fecal incontinence, and abdominal distention. Megacolon can lead to perforation of the bowel.

A patient is admitted to the hospital after not having had a bowel movement in several days. The nurse observes the patient is having small liquid stools, a grossly distended abdomen, and abdominal cramping. What complication can this patient develop related to this problem?

Steatorrhea Hyperacidity in the duodenum inactivates pancreatic enzymes causing steatorrhea and ulcer diathesis. Refer to Table 24-2 in the text.

A patient is diagnosed with Zollinger-Ellison syndrome, a malabsorption disorder. The nurse knows to assess the patient for the characteristic clinical feature of:

Broiled chicken with low-fiber pasta A low-residue, high-protein, and high-calorie diet is recommended to reduce the size and number of stools. Foods to avoid include yogurt, fruit, salami, and peanut butter.

A patient with IBD would be encouraged to increase fluids, use vitamins and iron supplements, and follow a diet designed to reduce inflammation. Select the meal choice that would be recommended for a low-residue diet.

Breast In women, only incidences of breast cancer exceed that of colorectal cancer. In men, only incidences of prostate cancer and lung cancer exceed that of colorectal cancer.

In women, which of the following types of cancer exceeds colorectal cancer?

solid. With a sigmoid colostomy, the feces are solid. With a descending colostomy, the feces are semimushy. With a transverse colostomy, the feces are mushy. With an ascending colostomy, the feces are fluid.

The nurse teaches the client whose surgery will result in a sigmoid colostomy that the feces expelled through the colostomy will be

Drink at least 8 to 10 large glasses of fluid every day The nurse should instruct a client with diverticulosis to drink at least 8 to 10 large glasses of fluid every day. The client should include unprocessed bran in the diet because it adds bulk, and should avoid the use of laxatives or enemas except when recommended by the physician. In addition, regular exercise should be encouraged if the client's current lifestyle is somewhat inactive.

What information should the nurse include in the teaching plan for a client being treated for diverticulosis?

Mineral Oil Mineral oil should never be taken with meals because it can impair the absorption of fat-soluble vitamins and delay gastric emptying. Refer to Table 24-1 in the text.

When a nurse recommends the following laxative, she emphasizes that it should not be taken with meals. Choose the laxative.

The clusters of ulcers take on a cobblestone appearance. The clusters of ulcers take on a cobblestone appearance. It is characterized by remissions and exacerbations. The pain is located in the lower right quadrant. The lesions are not in continuous contact with one another and are separated by normal tissue.

Which is a true statement regarding regional enteritis (Crohn's disease)?

constipation, diarrhea, or a combination of both

Which is one of the primary symptoms of irritable bowel syndrome (IBS)?

Borborygmus Borborygmus is a rumbling noise caused by the movement of gas through the intestines, often associated with diarrhea.

The nurse is performing an abdominal assessment for a patient with diarrhea and auscultates a loud rumbling sound in the left lower quadrant. What will the nurse document this sound as on the nurse's notes?

Flexible sigmoidoscopy The treatment of fecal incontinence depends on the cause. A rectal examination and other endoscopic examinations, such as a flexible sigmoidoscopy, are performed to rule out tumors, inflammation, or fissures. X-ray studies such as barium enema, computed tomography (CT), anorectal manometry, and transit studies may be helpful in identifying alterations in intestinal mucosa and muscle tone or in detecting other structural or functional problems.

The nurse in an extended-care facility reports that a resident has clinical manifestations of fecal incontinence. The health care provider orders a diagnostic study to rule out inflammation. The nurse would prepare the patient for which of the following?

Defecography In defecography, a thick barium paste is inserted into the rectum. Radiographs are taken as the client expels the barium to determine whether there are any anatomic abnormalities or problems with the muscles surrounding the anal sphincter. A KUB will not determine this. Colonic transit studies are used to determine how long it takes for food to travel through the intestines. Abdominal radiography will show the structure but does not determine the muscle ability surrounding the anal sphincter.

The nurse is preparing a client for a test that involves inserting a thick barium paste into the rectum with radiographs taken as the client expels the barium. What test will the nurse prepare the client for?

The clusters of ulcers take on a cobblestone appearance.

Which is a true statement regarding regional enteritis (Crohn's disease)?

Diarrhea The primary symptoms of IBS include constipation, diarrhea, or a combination of both. Pain, bloating, and abdominal distention often accompany changes in bowel pattern.

Which is one of the primary symptoms of irritable bowel syndrome (IBS)?

Metamucil Metamucil is a bulk-forming laxative. Milk of Magnesia is classified as a saline agent. Mineral oil is a lubricant. Dulcolax is a stimulant.

Which of the following is considered a bulk-forming laxative?

Computed tomography scan A computed tomography scan is the diagnostic of choice if the suspected diagnosis is diverticulitis; it can also reveal one or more abscesses. A barium enema or colonoscopy may be used to diagnosis diverticulosis. Magnetic resonance imaging would not be used to diagnose diverticulitis.

Which of the following is the diagnostic of choice if the suspected diagnosis is diverticulitis?

• Do not suppress the urge to defecate. • Drink at least 8 to 10 large glasses of fluid every day. Avoid constipation. Do not suppress the urge to defecate. Consume at least 2 L/day (within limits of the client's cardiac and renal reserve) and include foods that are soft but have increased fiber, such as prepared cereals or soft-cooked vegetables, to increase the bulk of the stool and facilitate peristalsis, thereby promoting defecation. Avoid the use of laxatives or enemas except when recommended by the physician. Exercise regularly if the current lifestyle is somewhat inactive.

A client is being treated for diverticulosis. Which points should the nurse include in this client's teaching plan? Select all that apply.

Every 4 to 6 hours The length of time between drainage periods is gradually increased until the reservoir needs to be drained only every 4 to 6 hours and irrigated once each day. This prevents the accumulating effluent from spilling or causing infection.

A client underwent a continent ileostomy. Within which time frame should the client expect to empty the reservoir?

Colonoscopy Diverticulosis is typically diagnosed by colonoscopy, which permits visualization of the extent of diverticular disease and biopsy of tissue to rule out other diseases. In the past, barium enema was the preferred diagnostic test, but it is now used less frequently than colonoscopy. CT with contrast agent is the diagnostic test of choice if the suspected diagnosis is diverticulitis; it can also reveal abscesses.

A patient is suspected to have diverticulosis without symptoms of diverticulitis. What diagnostic test does the nurse anticipate educating the patient about prior to scheduling?

Lack of free water intake

A resident at a long-term care facility lost the ability to swallow following a stroke 4 years ago. The client receives nutrition via a PEG tube, has adapted well to the tube feedings, and remains physically and socially active. Occasionally, the client develops constipation that requires administration of a laxative to restore regular bowel function. What is the most likely cause of this client's constipation?

Fecal incontinence The nurse should anticipate fecal incontinence as one of the assessment findings. Other possible assessment findings include constipation and abdominal distention.

The nurse is caring for a client with a suspected megacolon. The nurse anticipates that one of the findings of assessment will be

Endoscopy with mucosal biopsy Endoscopy with biopsy of the mucosa is the best diagnostic tool for malabsorption syndrome.

The nurse is caring for a patient who has malabsorption syndrome with an undetermined cause. What procedure will the nurse assist with that is the best diagnostic test for this illness?

Clamp the tubing and allow client to rest. The nurse should clamp the tubing and allow the client to rest when the client begins to report cramping during colostomy irrigation. Once the cramping has stopped, the nurse can resume the irrigation.

The nurse is irrigating a client's colostomy when the client begins to report cramping. What is the appropriate action by the nurse?

Clamp the tubing and give the patient a rest period. When irrigating a colostomy, the nurse should allow tepid fluid to enter the colon slowly. If cramping occurs, the nurse should clamp off the tubing and allow the patient to rest before progressing. Water should flow in over a 5- to 10-minute period.

The nurse is irrigating a colostomy when the patient says, "You will have to stop, I am cramping so badly." What is the priority action by the nurse?

Sudden, sustained abdominal pain Sudden, sustained pain, abdominal distention, and fever are symptoms of perforation in a client with intestinal obstruction. A decrease in blood pressure and decrease in urine output are symptoms of shock. Purulent drainage from the gluteal fold is not a symptom of perforation; it only indicates that the client has developed a condition of anorectal abscess.

Which of the following will the nurse observe as symptoms of perforation in a patient with intestinal obstruction?

Review the client's usual pattern of elimination. Constipation has many possible reasons; assessing the client's usual pattern of elimination is the first step in identifying the cause.

The nurse is assessing a client for constipation. Which review should the nurse conduct first to identify the cause of constipation?

Bisacodyl Bisacodyl is a stimulant laxative. Magnesium hydroxide is a saline agent. Mineral oil is a lubricant. Psyllium hydrophilic mucilloid is a bulk-forming agent.

Which drug is considered a stimulant laxative?

Encourage the client to avoid exercise. Activity promotes healing and normal stool patterns. Proper cleansing prevents infection and irritation. Sitz baths promote healing, decrease skin irritation, and relieve rectal spasms. Encouragement promotes compliance with therapeutic regimen and prevents complications.

A client has been recently diagnosed with an anorectal condition. The nurse is reviewing interventions that will assist the client with managing the therapeutic regimen. What would not be included?

Insufficient fiber Emotional stress Inactivity

A client reports having increased incidence of constipation. What can cause constipation?

Assist client to increase dietary fiber. The nurse should assist the client to increase the dietary fiber in her food because it helps reduce constipation. Providing an adequate quantity of food is necessary in maintaining sufficient nutrition and in sustaining normal body weight. Obtaining medical, allergy, and food history would provide valuable information, however, it would not help reduce constipation.

A client with anorexia complains of constipation. Which of the following nursing measures would be most effective in helping the client reduce constipation?

Ask the client to remain inactive for 5 minutes. Explanation: After applying the ostomy appliance, the nurse should ask the client to remain inactive for 5 minutes to allow body heat to strengthen the adhesive bond. The adhesive faceplate should be pressed from the stomal edge outward to prevent the formation of wrinkles. A small amount of air should also be allowed to be trapped in the pouch; liquid feces will then drain to the bottom of the pouch, placing less tension on it.

A nurse applies an ostomy appliance to a client who is recovering from ileostomy surgery. Which intervention should the nurse utilize to prevent leakage from the appliance?

inflammatory bowel disease (IBD)

A nurse is assessing a client and obtains the following findings: abdominal discomfort, mild diarrhea, blood pressure of 100/80 mm Hg, pulse rate of 88 beats/minute, respiratory rate of 20 breaths/minute, temperature 100° F (37.8° C). The nurse suspects the client will be diagnosed with:

Low residue Oral fluids and a low-residue, high-protein, high-calorie diet with supplemental vitamin therapy and iron replacement are prescribed to meet the nutritional needs, reduce inflammation, and control pain and diarrhea.

Diet modifications for patient diagnosed with chronic inflammatory bowel disease include which of the following?

Notify the physician. Abdominal pain, a rigid board-like abdomen, loss of bowel sounds, and signs and symptoms of shock occur with peritonitis. Peritonitis is typically a life-threatening emergency that requires prompt surgical intervention, and typically involves postoperative critical care monitoring due to the risk of sepsis, organ failure, and subsequent infections; thus, the nurse should notify the physician.

The nurse is admitting a patient with a diagnosis of diverticulitis and assesses that the patient has a boardlike abdomen, no bowel sounds, and complains of severe abdominal pain. What is the nurse's first action?

Usual pattern of elimination Constipation has many possible reasons and assessing the client's usual pattern of elimination is the first step in identifying the cause. The nurse should obtain a description of the bowel elimination pattern, asking about the frequency, overall appearance and consistency of stool, blood in the stool, pain, and effort necessary to pass stool. It is also essential for the nurse to review the client's current medications, diet, and activity levels.

The nurse is assessing a client for constipation. Which factor should the nurse review first to identify the cause of constipation?

One part of the intestine telescopes into another portion of the intestine. In intussusception of the bowel, one part of the intestine telescopes into another portion of the intestine. When the bowel twists and turns itself and obstructs the intestinal lumen, this is known as a volvulus. A hernia is when the bowel protrudes through a weakened area in the abdominal wall. An adhesion is a loop of intestine that adheres to an area that is healing slowly after surgery.

The nurse is caring for a client with intussusception of the bowel. What does the nurse understand occurs with this disorder?

Peritonitis The nurse should report to the physician that the client has signs/symptoms of peritonitis. Signs/symptoms of a pelvic abscess include anorexia, chills, fever, diaphoresis, and diarrhea. Signs/symptoms of an ileus include absent bowel sounds, nausea, and abdominal distention. Signs/symptoms of hemorrhage include tachycardia, hypotension, anxiety, and bleeding.

The nurse is monitoring a client's postoperative course after an appendectomy. The nurse's assessment reveals that the client has vomited, has abdominal tenderness and rigidity, and has tachycardia. The nurse reports to the physician that the client has signs/symptoms of which complication?

Rectal bleeding

Which of the following is the most common symptom of a polyp?

Suggest fluid intake of at least 2 L/day The nurse should suggest a fluid intake of at least 2 L/day to help the client avoid constipation. The nurse should also offer prune or apple juice because they promote elimination. The nurse should encourage the client to eat regular meals. Dieting or fasting can decrease stool volume and slow elimination. The nurse should instruct the client to keep a record of food intake in case of diarrhea, because this helps identify specific foods that irritate the gastrointestinal tract.

A client who has undergone colostomy surgery is experiencing constipation. Which intervention should a nurse consider for such a client?

Red, sensitive skin around the stoma site Red, sensitive skin around the stoma site may indicate an ill-fitting appliance beefy redness at a stoma site that isn't sensitive to touch is a normal assessment finding. Urine mixed with mucus is also a normal finding.

A nurse is caring for a client who had an ileo conduit 3 days earlier. The nurse examines the stoma site and determines that she should consult with the ostomy nurse. Which assessment finding indicates the need for further consultation?

A change in bowel habits Although abdominal distention and blood in the stool (frank or occult) may be present, the chief characteristic of cancer of the colon is a change in bowel habits, such as alternating constipation and diarrhea. Abdominal pain is a late sign.

A nurse is preparing a presentation for a local community group of older adults about colon cancer. Which of the following would the nurse include as the primary characteristic associated with this disorder?

Hypokalemia The older person taking digitalis must be aware of how quickly dehydration and hypokalemia can occur with diarrhea. The nurse teaches the patient to recognize the symptoms of hypokalemia because low levels of potassium intensify the action of digitalis, leading to digitalis toxicity.

An elderly client diagnosed with diarrhea is taking digoxin. Which electrolyte imbalance should the nurse be alert to?

Colace Colace can be used safely by patients who should avoid straining such as cardiac patients and those with anorectal disorders. Milk of Magnesia is a saline agent. Dulcolax is a stimulant. Mineral oil is a lubricant.

Which of the following laxatives should be used by a cardiac patient who should avoid straining?