Exemplar 10.C - Inflammatory Bowel Disease
The nurse is caring for an adolescent client who has been nonadherent to the medical plan of care to treat Crohn disease. In order to increase adherent behavior, which complication associated with Crohn disease should the nurse include in the client's teaching plan? A) Vomiting B) Bowel perforation C) Intestinal obstruction D) Diarrhea
B) Bowel perforation Bowel perforation is rare but may be a consequence of noncompliance with the treatment plan, because the client's disease would continue to progress. Diarrhea, vomiting, and intestinal obstructions are common symptoms of Crohn disease and may occur even if the client is compliant with the medical plan of care.
The nurse provides teaching related to the diagnosis of Risk for Deficient Fluid Volume to a client with ulcerative colitis. Which statement on the part of the client indicates that this teaching has been effective? A) "I will drink at least 2 quarts of fluid each day." B) "I will continue to use a moisturizer on my skin." C) "I should report dry patches of skin immediately to my doctor." D) "If I have two liquid stools in any day, I will report this to my healthcare provider."
A) "I will drink at least 2 quarts of fluid each day." The client with irritable bowel syndrome should be taught to maintain a higher-than-normal fluid intake to maintain hydration. The client's dry patches could be due to a fluid volume deficit but would not necessitate immediate notification. Two liquid stools a day is not excessive for a client with ulcerative colitis, but the client must remember to take in enough fluid to account for these stools as well as the normal fluid needs of the body. Moisturizing the skin is a positive action for this client but does not indicate appropriate understanding of the teaching that is appropriate for this diagnosis.
A client is being scheduled for diagnostic tests to determine the presence of ulcerative colitis. For which diagnostic tests should the nurse plan to provide teaching? Select all that apply. A) Barium enema B) Intravenous pyelogram C) Colonoscopy D) Upper endoscopy E) Barium swallow
A) Barium enema C) Colonoscopy E) Barium swallow Tests to diagnose ulcerative colitis include upper and lower barium studies and colonoscopy. An intravenous pyelogram is used to diagnose kidney disorders. An upper endoscopy is used to diagnose disorders of the esophagus and stomach.
A nurse is receiving a client from the emergency department who was diagnosed with an acute exacerbation of ulcerative colitis. The nurse anticipates that the client may present with which clinical characteristics? Select all that apply. A) Between 5 and 30 diarrhea stools per day with blood and mucus B) Steady right lower quadrant or periumbilical pain C) Cramping in the left lower quadrant that is relieved by defecation D) Tenderness and a mass in the right lower quadrant E) Fever, malaise, and fatigue
A) Between 5 and 30 diarrhea stools per day with blood and mucus C) Cramping in the left lower quadrant that is relieved by defecation With both ulcerative colitis and Crohn disease, the client experiences periods of symptom-free remissions with sporadic periods of active disease (flares). However, each condition also has unique clinical characteristics. With ulcerative colitis, the client may have 5-30 diarrhea stools per day with blood and mucus. In addition, the pain associated with ulcerative colitis presents with cramping in the left lower quadrant which is relieved by defecation. All other clinical manifestations listed here are unique to Crohn disease.
Which of the following conditions is the leading indication for surgery in Crohn disease? A) Bowel obstruction B) Internal fistula C) Perianal complications D) Abscess
A) Bowel obstruction Bowel obstruction is the leading indication for surgery in Crohn disease. Other complications that less commonly require surgical intervention are perforation, internal or external fistula, abscess, and perianal complications.
A nurse caring for a pediatric client with inflammatory bowel disease (IBD) understands that there are variances in the presentation of IBD between children and adults. Which variances should the nurse anticipate for this pediatric client? Select all that apply. A) Children suffer from Crohn disease more frequently than ulcerative colitis. B) Pediatric clients often present with fistulizing or stricturing disease. C) Pediatric clients usually have colonic involvement. D) Pediatric clients more often present with left-sided colitis. E) In the pediatric population, IBD is more common in females than males.
A) Children suffer from Crohn disease more frequently than ulcerative colitis. C) Pediatric clients usually have colonic involvement. The pediatric etiology of IBD differs from that of adult-onset IBD. For example, IBD is more common in males than females in the pediatric population, whereas equal numbers of adult males and females have IBD. In addition, children suffer from Crohn disease more frequently than ulcerative colitis; the opposite is true of adults. Adults with Crohn disease usually present with terminal ileal disease without colonic involvement, whereas the majority of pediatric clients have ileocolonic or colonic disease. Children with Crohn disease usually present with inflammatory disease; adults often present with fistulizing or stricturing disease. Similarly, children with ulcerative colitis usually present with pancolitis, whereas adults more often present with left-sided colitis.
An adolescent client is experiencing abdominal pain with diarrhea and bloody stools. Based on this data, which specific type of inflammatory bowel disease does the nurse suspect the client is experiencing? A) Appendicitis B) Ulcerative colitis C) Crohn disease D) Necrotizing enterocolitis
B) Ulcerative colitis Diarrhea and bloody stools are typical symptoms of ulcerative colitis. Appendicitis is not associated with bloody stools, and usually not with diarrhea. A teen with Crohn disease might have abdominal pain and diarrhea, but stools usually do not have blood in them. Necrotizing enterocolitis is usually seen in premature infants and not generally in adolescent clients.
Which of the following statements is true with regard to ulcerative colitis and Crohn disease? A) Clients with ulcerative colitis experience periods of remission, whereas clients with Crohn disease do not. B) Ulcerative colitis is limited to the colon and rectum, whereas Crohn disease can affect any part of the GI tract. C) The inflammatory lesions associated with Crohn disease are continuous, whereas those associated with ulcerative colitis are not. D) Ulcerative colitis is more common in women, whereas Crohn disease is more common in men.
B) Ulcerative colitis is limited to the colon and rectum, whereas Crohn disease can affect any part of the GI tract. Ulcerative colitis and Crohn disease affect both genders equally, and both conditions are chronic diseases with periods of remission and active disease. Ulcerative colitis is limited to the colon and rectum, whereas Crohn disease can affect any part of the GI tract from mouth to anus. Furthermore, ulcerative colitis involves continuous lesions, whereas Crohn disease is marked by patchy or "skip" lesions.
A home health nurse is evaluating a client who had a colostomy placed 6 weeks ago for the treatment of ulcerative colitis. Which assessment would cause the nurse to conclude that teaching goals for this client have been met? A) The client's colostomy pouch is clean and dry. B) The client's vital signs reveal a normal temperature. C) The client's stoma is pink and intact. D) The client experiences pain with certain types of food.
C) The client's stoma is pink and intact. Stoma care is taught to the client after surgery, and the goal is for the stoma to be pink with intact skin. It is not as critical that the ostomy pouch be clean and dry, particularly if the client has passed a stool. A normal temperature would not be a particular goal for a client 6 weeks postoperatively. Patients with ulcerative colitis are going to have pain when they eat foods that irritate the bowel, but this is not a goal.
