Iggy:Chapter 52 - Concepts of Care for Patients With Inflammatory Intestinal Disorders

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

a. "A change in position may be what is needed for you to have intercourse with your wife." The nurse tells the client who had an emergency ileostomy that a simple change in positioning during intercourse may alleviate apprehension and facilitate sexual relations with his wife. Suggesting marriage counseling may address the client's concerns, but it focuses on the wrong issue. The client has not stated that he has relationship problems. Asking the client what his wife has said about the pouch may address some of the client's concerns, but it similarly focuses on the wrong issue.

The nurse is teaching a family how to prevent the client's transmission of gastroenteritis at home. Which instructions will the nurse include in the health teaching? (Select all that apply.) Select all that apply. a. "Clean and disinfect all bathrooms often to avoid stool exposure." b. "Everyone in the home should wash their hands for at least 30 seconds with an antibacterial soap using friction." c. "Contact the primary health care provider if GI symptoms last more than 3 days." d. "Wear a mask at home to prevent transmission of the disease." e. "Do not share dishes, glasses, and silverware among members of the family."

a. "Clean and disinfect all bathrooms often to avoid stool exposure." b. "Everyone in the home should wash their hands for at least 30 seconds with an antibacterial soap using friction." c. "Contact the primary health care provider if GI symptoms last more than 3 days." e. "Do not share dishes, glasses, and silverware among members of the family." All of these interventions are important to prevent the spread of gastroenteritis except there is no need to wear a mask because the disease is spread via the fecal-oral route rather than by droplets.

The nurse is instructing a client with recently diagnosed diverticular disease about diet. What food does the nurse suggest the client include? a. A slice of 5-grain bread b. Strawberries (1 cup [160 g]) c. Tomato (1 medium) d. Chuck steak patty (6 ounces [170 g])

a. A slice of 5-grain bread The nurse suggests to the client with recently diagnosed diverticular disease to include a slice of 5-grain bread in the diet. Whole-grain breads are recommended to be included in the diet of clients with diverticular disease because cellulose and hemicellulose types of fiber are found in them. Dietary fat would be reduced in clients with diverticular disease.If the client wants to eat beef, it must be of a leaner cut. Foods containing seeds, such as strawberries, must be avoided. Tomatoes would also be avoided unless the seeds are removed. The seeds may block diverticula in the patient and present problems leading to diverticulitis.

A client returns to the unit after having an exploratory abdominal laparotomy. How does the nurse position this client after being situated in bed? a. Semi-Fowler b. Lateral Sims' (side-lying) c. High Fowler d. Supine

a. Semi-Fowler The nurse places the postoperative abdominal laparotomy client in the semi-Fowler position in bed. The client is maintained in this position to facilitate the drainage of peritoneal contents into the lower region of the abdominal cavity after an abdominal laparotomy. This position also helps increase lung expansion.High-Fowler position would be too high for the client postoperatively. It would place strain on the abdominal incision(s), and, if the client was still drowsy from anesthesia, this position would not enhance the client's ability to rest. Sims' position does not promote drainage to the lower abdomen. The supine position does not facilitate drainage to the abdomen or increased lung expansion. The client would be more likely to develop complications (wound drainage stasis and atelectasis) in the supine position.

The nurse is caring for a client who has an enterocutaneous fistula. For what complications will the nurse monitor? (Select all that apply.) Select all that apply. a. Skin breakdown b. Hyperkalemia c. Malnutrition d. Hypernatremia e. Dehydration f. Bowel obstruction

a. Skin breakdown c. Malnutrition e. Dehydration f. Bowel obstruction The client has an abnormal tunneling between the small intestines and the skin causing spillage of the GI contents onto the skin. Enzymes in the intestines can break down skin and underlying tissues. The intestinal contents are also rich in fluids and electrolytes, especially potassium, such that the client would likely develop hypokalemia rather than hyperkalemia. Loss of fluids could lead to dehydration if the client is not carefully monitored and managed.

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

b. "Avoid large crowds and anyone who is sick." The nurse emphasizes that the client taking adalimumab for Crohn disease needs to avoid being around large crowds to prevent developing an infection. Adalimumab (Humira), a biological response modifier (BRM), also known as a monoclonal antibody drug, has been approved for use in Crohn disease when other drugs have been ineffective. BRMs are approved for refractory (not responsive to other therapies) cases. These drugs cause immunosuppression and should be used with caution. Clients must be taught to report any signs of a beginning infection, including a cold, and to also avoid others who are sick.The client would not take the medication if he or she is allergic to certain proteins. Although immune suppression may occur to some degree, the client would not experience difficulty with wound healing while taking adalimumab. Also, the client would not experience a decrease in blood pressure from taking this drug.

The nurse is teaching a client about dietary methods to help manage exacerbations (flare-ups) of diverticulitis. What does the nurse advise the client? a. "Maintain a high-fiber diet to prevent the development of hemorrhoids that frequently accompany this condition." b. "Consume a low-fiber diet while your diverticulitis is active. When inflammation resolves, consume a high-fiber diet." c. "Make sure you consume a high-fiber diet while diverticulitis is active. When inflammation resolves, consume a low-fiber diet." d. "Be sure to maintain an exclusively low-fiber diet to prevent pain on defecation."

b. "Consume a low-fiber diet while your diverticulitis is active. When inflammation resolves, consume a high-fiber diet." The nurse teaches the client that the most effective way to manage diverticulitis is to consume 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 client has been newly diagnosed with ulcerative colitis (UC). What does the nurse teach the client about diet and lifestyle choices? a. "Raw vegetables and high-fiber foods may help to diminish your symptoms." b. "Lactose-containing foods should be reduced or eliminated from your diet." c. "Drinking carbonated beverages will help with your abdominal distress." d. "It's OK to smoke cigarettes, but you should limit them to ½ pack per day."

b. "Lactose-containing foods should be reduced or eliminated from your diet." The nurse teaches the newly diagnosed client with ulcerative colitis that lactose-containing foods are often poorly tolerated and need to be reduced or eliminated from the diet.Carbonated beverages are GI stimulants that can cause discomfort and must be used rarely or completely eliminated from the diet. Cigarette smoking is a stimulant that can cause GI distress symptoms. Nurses would 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 preparing to administer natalizumab for a client who has Crohn disease (CD). What is the most important client assessment for the nurse to perform before giving this drug? a. Skin integrity b. Body temperature c. Peripheral pulses d. Breath sounds

b. Body temperature Because this drug may cause a deadly infection that affects the brain (progressive multifocal leukencephalopathy [PML]), the nurse would want to ensure that the client does not have any type of infection. Assessing body temperature is one way to determine the presence of infection.

The nurse is reinforcing teaching provided by the registered dietitian nutritionist about dietary restrictions needed for a client who has a new ileostomy. Although each client can tolerate different foods, what food would the nurse suggest that the client avoid? a. Potatoes b. Corn c. Bread d. Green beans

b. Corn The client should avoid gas-forming foods like cabbage and foods that contain indigestible fiber such as nuts and corn.

The nurse is assessing an older client who has had frequent vomiting and diarrhea for the last 24 hours. Which vital sign change would be of mostconcern to the nurse? a. Increased oxygen saturation b. Decreased blood pressure c. Increased temperature d. Decreased pulse rate

b. Decreased blood pressure Older clients are most at risk for dehydration from loss of fluids. Older clients who have dehydration usually have an increased pulse and decreased blood pressure (BP). When BP decreases, the client is at risk for orthostatic hypotension which can cause dizziness and subsequent falls. The client may also experience an elevated temperature, but this change is less common in older adults when compared to their younger counterparts.

The nurse is teaching a group of senior citizens in a residential facility about how to prevent gastrointestinal (GI) infectious outbreaks, such as norovirus. What information will the nurse include as a priority intervention for the group? a. Keeping at least 6 feet apart b. Handwashing and hand sanitizing c. Avoiding group dining d. Cooking all food and boiling water

b. Handwashing and hand sanitizing GI infections like norovirus are typically transmitted via the fecal-oral route. Therefore, handwashing and using hand sanitizers frequently is the best method to promote health and prevent infection.

A client developed gastroenteritis while traveling outside the country. What is the most likely cause of the client's symptoms? a. Overcooked food b. Ingestion of parasites in the water c. Insufficient vaccinations d. Bacteria on the patient's hands

b. Ingestion of parasites in the water The likely cause of gastroenteritis when a client travels outside the country is ingestion of water that is infested with parasites. Bacteria on the client'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.

The nurse is caring for a client admitted with a long-term diagnosis of ulcerative colitis (UC). For what potentially life-threatening complication would the nurse monitor? a. Chronic kidney disease b. Lower gastrointestinal (GI) bleeding c. Metabolic acidosis d. Hyperkalemia

b. Lower gastrointestinal (GI) bleeding The client who has UC is at most risk for lower GI bleeding due to inflammation and diarrhea. The client with UC is also at risk for hypokalemia and metabolic alkalosis as a result of losing intestinal contents through diarrhea.

An older client with a 2-day history of myalgia, nausea, vomiting, and diarrhea is admitted to the medical-surgical unit with a diagnosis of gastroenteritis. Which primary health care provider request does the nurse implement first? a. Obtain a stool specimen for culture and sensitivity. b. Start an IV solution of 5% dextrose in 0.45 normal saline. c. Draw blood for a complete blood count and serum electrolytes d. Administer acetaminophen 650 mg rectally.

b. Start an IV solution of 5% dextrose in 0.45 normal saline. The request the nurse implements first is to start an IV solution of 5% dextrose in 0.45 normal saline at 125 mL/hr. Although the dextrose 5% in 0.45% sodium chloride is hypertonic in the IV bag, once it is infused, the glucose is rapidly metabolized and the fluid is really hypotonic. Fluid therapy is the focus of treatment for clients with gastroenteritis. Older clients are at increased risk for the complications of dehydration such as hypovolemia and acute kidney failure.Acetaminophen 650 mg should be administered rectally soon, and blood draws and stool specimen collection would also be implemented soon, but prevention and treatment of dehydration are the priorities for this client.

An older client with a 2-day history of myalgia, nausea, vomiting, and diarrhea is admitted to the medical-surgical unit with a diagnosis of gastroenteritis. Which primary health care provider request does the nurse implement first? a. Obtain a stool specimen for culture and sensitivity. b. Start an IV solution of 5% dextrose in 0.45 normal saline. c. Draw blood for a complete blood count and serum electrolytes. d. Administer acetaminophen 650 mg rectally.

b. Start an IV solution of 5% dextrose in 0.45 normal saline. The request the nurse implements first is to start an IV solution of 5% dextrose in 0.45 normal saline at 125 mL/hr. Although the dextrose 5% in 0.45% sodium chloride is hypertonic in the IV bag, once it is infused, the glucose is rapidly metabolized and the fluid is really hypotonic. Fluid therapy is the focus of treatment for clients with gastroenteritis. Older clients are at increased risk for the complications of dehydration such as hypovolemia and acute kidney failure.Acetaminophen 650 mg should be administered rectally soon, and blood draws and stool specimen collection would also be implemented soon, but prevention and treatment of dehydration are the priorities for this client.

The nurse is teaching a client about caring for a new ileostomy. What information is most important to include? a. "After surgery, output from your ileostomy may be a loose, dark-green liquid with some blood present." b. "Remember that you must wear a pouch system at all times." c. "Notify the primary health care provider if output from your stoma has a sweetish odor." d. "Call your primary health care provider if your stoma has a bluish or pale look."

d. "Call your primary health care provider if your stoma has a bluish or pale look." It is most important for the nurse to tell the client with a new ileostomy to call the primary health care provider if the 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 primary health care provider must be notified immediately.

A client who developed viral gastroenteritis with vomiting and diarrhea is scheduled to be seen in the clinic the following day. What intervention would the nurse recommend for the client to do? a. "Avoid all solid foods to allow complete bowel rest." b. "Take an over-the-counter antidiarrheal medication." c. "Contact your primary health care provider for an antibiotic medication." d. "Consume extra fluids to replace fluid losses."

d. "Consume extra fluids to replace fluid losses." The nurse tells the client 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 preparing to provide health teaching for a client who is starting sulfasalazine. Which statement by the client indicates a need for further teaching? a. "I'll let my primary health care provider know if the drug upsets my stomach." b. "I will be sure to take a folic acid supplement while on this drug." c. "I will follow up with getting labs done to check my blood counts." d. "This drug can make me dehydrated because I'm already on a diuretic."

d. "This drug can make me dehydrated because I'm already on a diuretic." Sulfasalazine can cause nausea and vomiting, and can interfere with folic acid absorption. In high doses, it can also cause anemia and agranulocytosis, so blood work would be important for ongoing monitoring. However, the drug does not cause dehydration.

A client is admitted to the hospital with right lower quadrant abdominal pain, nausea, and vomiting. What assessment would the nurse monitor to identify a potentially life-threatening complication based on the client's condition? a. Intake and output b. Electrolyte values c. Abdominal assessment d. Vital signs

d. Vital signs The client most likely has appendicitis which can result in perforation of the appendix and peritonitis. If this complication occurs, the client would develop tachycardia and a fever. Therefore, the nurse would monitor for changes in vital signs.