Lewis Chapter 42 Study Guide

For the patient hospitalized with inflammatory bowel disease (IBD), which treatments would be used to rest the bowel (select all that apply)? a. NPO b. IV fluids c. Bed rest d. Sedatives e. Nasogastric suction f. Parenteral nutrition

A,B,E,F With an acute exacerbation of inflammatory bowel disease, to rest the bowel the patient will be NPO, receive IV fluids and parenteral nutrition, and have nasogastric suction. Sedatives may be used to alleviate stress. Enteral nutrition will be used as soon as possible.

A 20 year old patient with a history of Chron's disease comes to the clinic with persistent diarrhea. What are common characteristics of Chrons's disease (select all that apply)? A. Weight loss B. Rectal Bleeding C. Abdominal pain D. Toxic megacolon E. Has segmented distribution F. Involves the entire thickness of the bowel wall.

A,C,E,F Chron's disease may have severe wight loss, crampy abdominal pain, and segmented distribution through the entire wall of the bowel. Rectal bleeding and toxic megacolon are most often seen with ulcerative colitis.

When obtaining a nursing history from the patient with colorectal cancer, the nurse should specifically ask the patient about A. dietary intake B. sport involvement C. environmental exposure to carcinogens d. long-term use of NSAIDs

A. A diet high in red meat and low in fruit and vegetable intake is associated with development of colorectal cancer as are alcohol intake and smoking. Family and personal history of CRC are also increases the risk. Other environmental agents are not known to be related to colorectal cancer. Long term use of NSAIDs is associated with reduced CRC risk.

Priority Decision: A patient with ulcerative colitits has a total proctocolectomy with formation of a terminal ileum stoma. What is the most important nursing intervention for this patient postoperatively? A. Measure the ileostomy output to determine the status of the patient's fluid balance B. Change the ileostomy appliance every 3-4 hour to prevent leakage of drainage onto the skin C. Emphasize that the ostomy in temporary and the ileum will be reconnected when the large bowel heals D. Teach the patient about the high fiber-fiber, low carbohydrate diet required to maintain normal ileostomy drainage.

A. An initial output from newly formed ileostomy may be used as 1500 to 2000ml daily, and intake and output must be accurately monitored for fluid and electrolyte imbalance. Ileostomy bags may have to be emptied every 3 to 4 hours, but the appliance should not be changed for several days unless there is leakage onto the skin. A terminal ileum stoma is permanent, and the entire colon has been removed. A return to a normal, with restriction based only on the patient with an ileostomy, with restrictions based only on the patient individual tolerances.

The nurse plans teaching for the patient with a colostomy but the patient refuses to look at the nurse or the stoma, stating, "I just can't see myself with this thing." What is the best nursing intervention for this patient? a. Encourage the patient to share concerns and ask questions. b. Refer the patient to a chaplain to help cope with this situation. c. Explain that there is nothing the patient can do about it and must take care of it. d. Tell the patient that learning about it will prevent stool leaking and the sounds of flatus.

A. Encouraging the patient to share concerns and ask questions will help the patient to begin to adapt to living with the colostomy. The other options do not support the patient and do not portray the nurses focus on helping the patient or treating the patient as individual.

A patient with IBD has a nursing diagnosis of imbalanced nutrition: less than body requirements related to decreased nutritional intake and decreased intestinal absorption. Which assessment data support this nursing diagnosis? A. pallor and hair loss B. frequent diarrhea C. anorectal excoriation and pain D. hypotension and urine ouptut below 30ml/hr

A. Signs of malnutrition include pallor from anemia, hair loss, bleeding, cracked gingivae, and muscle weakness, which support a nursing diagnosis that identified impaired nutrition. Diarrhea may contribute to malnutrition but is not a defining characteristic for this patient. Anorectal excortiation and pain related to problem with skin integrity.

How is the most common form of malabsorption syndrome treated? a. Administration of antibiotics b. Avoidance of milk and milk products c. Supplementation with pancreatic enzymes d. Avoidance of gluten found in wheat, barley, oats, and rye

B The most common type of malabsorbtion syndrome is lacotse intolerance, and it is managed by restricting intake of milk and milk products. Antibiotics are used in case of bacterial infections that cause malabsorption, pancreatic enzyme supplementation is used for pancreatic insufficiency, and restriction of gluten is necessary for control of adult celiac disease (celiac sprue, gluten sensitive enteropathy.)

On examining a patient 8 hours after having surgery to create a colostomy, what should the nurse expect to find? A. Hyperactive, high pitched bowel sounds B. A brick red, puffy stoma oozes blood C. A purplish stoma, shiny, and moist with mucus D. A small amount of liquid fecal drainage from the stoma

B. A normal new colostomy stoma should appear rose to brick-red, have mild to moderate edema, and have a small amount of bleeding or oozing of blood when touched. A purplish stoma indicates inadequate blood supply and should be reported. Bowel spunds after extensive bowel surgery will be diminished or absent. the colostomy will not have any fecal drainage for 2 to 4 days, but there may be some earlier mucus or serosanguineous drainage.

Priority Decision: When caring for a patient with irritable bowel syndrome (IBS), what is the most important for the nurse to do? A. Recognize that IBS is a psychogenic illness that cannot be definitively diagnosed B. Develop a trusting relationship with the patient to provide support and symptomatic care. C. Teach the patient that a diet high in fiber will relieve the symptoms of both diarrhea and constipation D. Inform the patient that new medication are available and effective for treatment of IBS manifested by either diarrhea or constipation

B. Because there is no definitive treatment for irritable bowel syndrome (IBS), patients become frustrated and to develop a trusting relationship that will support the patient as different treatment and implemented and evaluated. Although IBS can be precipitated and aggravated by stress and emotions, it is nit a psychogenic illness. High-fiber diets may help, but they may also increase the bloating and gas pains of IBS. Medications are available, but use is individualized because of side effects.

A patient with ulcerative colitis undergoes the first phase of a total proctocolectomy with ileal pouch and anal anastomosis. On initial postoperative assessment of the patient , what should the nurse expect to find? A. A rectal tube set to low continuous suction B. A loop ileostomy with a plastic rod to hold it in place C. A colostomy stoma with an NG tube in place to provide pouch irrigation D. A permanent ileoostomy stoma in the right lower quadrant of the abdomen

B. Initial procedure for a total proctocolectomy with rectal mucousectomy, ileal reservoir construction, iloeoanal anastomosis, and temporary ileostomy. A loop ileostomy is the most common temporary ileostomy, and it may be held in place with a plastic rod for the first week. A rectal tube to suction is not indicated in any of the surgical procedures for ulcerative colitits. A colostomy is not used, and an NG tube would not be used to irrigate the pouch. A permanent ileostomy stoma would be expected following a total protocolectomy with a permanent ileostomy

Priority Decision: A patient with a gunshot wound to the abdomen complains of increasing abdominal pain several hours after surgery to reapir the bowel. What action should the nurse take first? A. Notify HCP B. Assess the patient's vital signs C. Position the patient with knees flexed D. Determine the patient IV intake since the end of surgery

B. It is likely that the patient could be developing peritonitis, which could be life threatening, and assessment of vital signs for hypovolemic shock should be done to report to the HCP. If an IV line is not in place, it should be inserted and pain may be eased by flexing the knees.

An important nursing intervention for a patient with a small obstruction who has an NG tube is to A. Offer ice chips to suck PRN B. Provide mouth care frequently C. Irrigate the tube with normal saline every 8 hours D. Keep the patient supine with the head of the bed elevated 30 degrees.

B. Mouth care should be done frequently for the patient will a small intestinal obstruction who has an NG tube position of the patient because of vomiting, fecal taste and odor, and mouth breathing. No ice chips are allowed when a patient is NPO because of a bowel obstruction. The NG tube should be checked for patency and irrigated only as ordered. The position of the patient should be one of comfort.

The patient has persistent and continuous pain at McBurney's point. the nurse assessment reveals rebound tenderness and muscle guarding with the patient preferring to lie still with the right leg flexed. What should the nursing intervention for the patient include? A. Laxatives to move the constipation bowel B. NPO status in preparation for possible appendectomy C. Parenteral Fluids and antibiotics therapy for 6 hours before surgery D. NG tube inserted to decompress the stomach and prevent aspiration.

B. The patient's manifestation are characteristics of appendicitis. After laboratory test and CT scan confirmation, the patient will have surgery. Laxatives are not used. The 6 hours of fluids and antibiotics preoperatviely would be used if the appendix was ruptured. The NG tube is more likely to be used with abdominal trauma.

A health care provider just told a patient that she has a volvus. When the patient asks the nurse what is, what is the best description for the nurse to giver her? A. Bowel folding in on itself B. Twisting of bowel on itself C. Emboli of arterial supply to the bowel D. Protrusion of bowel in weak or abnormal opening

B. Volvus is the bowel twisting on itself. The bowel folding in on itself is intussusception. Emboli of arterial blood supply to the bowel in vascular obstruction. Protrusion of bowel in a weak or abnormal opening is a hernia.

The patient asks the nurse to explain what the HCP meant when he said the patient had an anorectal abscess. Which description should the nurse use to explain this to the patient? A. Ulcer in anal wall B. Collection of perianal pus C. Sacrococcygeal hairy tract D. Tunnel leading from the anus or rectum

B. An anorectal abscess is a collection of perineal pus. An ulcer in the anal walls in an anal fissure. Sacrococcygeal hairy tract describes a pilonidal sinus. A tunnel leading from the anus or rectum is an anorectal fistula.

Which patient is most likely to be diagnosed with short bowel syndrome? A. History of ulcerative colitits B. Extensive resection of the ileum C. Diagnosed of irritable bowel syndrome D. Colectomy performed for cancer of the bowel

B. Short bowel syndrome results from extensive resection of portions of the small bowel and would occur if a patient had an extensive resection of the ileum. The other conditions primarily affect the large intestine and result in fewer and less sever symptoms.

A 60-yr-old African American patient is afraid she may have anal cancer. What assessment finding puts her at high risk for anal cancer? A. Alcohol use B. Only one sexual partner C. HPV (human papillomavirus) D. Use of a condom with intercourse

C. Human papillomavirus (HPV) is associated with about 80% of smoking, receptive anal sex, women with cervical or vulvar cancer or precancerous lesions, immunosuppression, and HIV infection. The other options are not considered risk factors for anal cancer.

The patient receiving the following medications. Which one is prescribed to relieve symptoms rather than treat a disease? A. Corticosteroid B. 6-Mercaptopurine C. Antidiarrheal agents D. Sulfasalazine (Azulfidine)

C. Antidiarrheal agents only relieve symptoms. Corticosteroids, 6-mercaptopurine, and sulfasalazine (Azulfidine) are used to treat and control inflammation with various disease and maintain IBD remission.

The medications prescribed for the patient with IBD include cobalamin and iron injections. What is the rationale for using these drugs? A. Alleviate stress B. Combat infection C. Correct malnutrition D. Improved quality of life

C. Colablamin and iron injections will help to correct malnutrition. Correcting malnutrition will also indirectly help to improve quality of life and fight infections.

What laboratory findings are expected in ulcerative colits as a result of diarrhea and vomiting? A. Increased albumin B. Elevated white blood cells (WBCs) C. Decreased serum (Na+, K+, Mg+, Cl-, and HC03) D. Decreased hemoglobin (Hgb) and hematocrit (Hct)

C. In the patient with ulcerative colitis, decreased serum Na, K, Mg, Cl, HCO3 are a result of diarrhea and vomiting. Hypoalbumemia may be present. Elevated WBC counts occur with toxic megacolon. Decreased hemoglobin and hematocrit occur with bloody diarrhea, leading to iron-deficiency anemia

A patient diagnosed with celiac disease following a workup for iron deficiency anemia and decreased bone density. The nurse identifies additional teaching about disease management is needed when the patient makes which statement? A. "I should ask my close relative to be screened for celiac disease." B. " If I don't follow the gluten-free diet, I might develop a lymphoma" C. I don't need to restrict gluten intake because I don't have diarrhea or bowel syndrome." D. " It is going to be difficult to follow a gluten-free diet because it is found in so many foods."

C. The autoimmune process associated with celiac disease continues as long as the body is exposed to gluten, regardless of the symptoms it produces, and a lifelong gluten-free diet is necessary. The other statements regarding celiac disease are all true.

During a routine screening colonoscopy on a 56-year old patient, a rectosigmoidal polyp was identified and removed. The patient ask the nurse if his risk for colon cancer is increased because of the polyp. What is the best response by the nurse? A. "It is very rare polyps to become malignant, but you should continue to have routine colonoscopies." B. " Individuals with polyps have a 100% lifetime risk of developing colorectal cancer and at an earlier age than those without polyps" C. "All polyps are abnormal and should be removed, but the risk for cancer depends on type and if malignant changes are present." D. " All polyps are premalignant and a source of most colon cancer. You will need to have colonoscopy every 6 months to check for new polyps."

C. Although all polyps are abnormal growths, the most common type of polyp (hyperplastic) is non-neoplasic, as are inflammatory, lipomas, juvenile polyps. However, adenomatous polyps are characterized by neoplastic changes in the epithelium, and about 85% of colorectal cancers arise from these polyps. Only patients with a family history of familial adenomatous polyposis (FAP) have close to a 100% lifetime risk of developing colorectal cancer and are a greater risk for other cancers.

Teamwork and Collaboration: The RN coordinating the care for a patient who is 2 days postoperative following an anterior-posterior resection (APR) with colostomy may delegate which interventions to the licensed practical nurse (LPN)(select all that apply)? A. Irrigate the colonostomy B. Teach ostomy and skin care C. Assess and document stoma appearance D. Monitor and record the volume, color, and odor of the drainage E. Empty the ostomy bag and measure and record the amount of drainage

D,E The licensed practical nurse can monitor and record observation related to the drainage and can measure and record the amount. The LPN could also monitor the skin around the stoma for breakdown. LPN's can irrigate a colostomy in a stable patient, but this patient is only 2 days postoperative. The other actions are responsibilities of the RN (teaching, assessing stoma, and developing a care plan.)

A male patient who is scheduled for an abdominal-perineal resection (APR) is worried about his sexuality. What is the best nursing intervention for this patient? A. Have the patient's sexual partner reassure the patient that he is still desirable B. Reassure the patient that sexual function will return when healing is complete C. Remind the patient that affection can be expressed in ways other through sexual intercourse D. Explain that physical and emotional factors can affect sexual function but not necessarily the patient's sexuality.

D. Sexual dysfunction may result from an APR, but the nurse should discuss with the patient that different nerve pathways affect erection, ejaculation, and orgasm and that a dysfunction of one does not mean total sexual dysfunction and also that an alteration in sexual activity does not have to alter sexuality. Referral to a wound, ostomy, continence (WOCN) nurse would also be helpful. Simple reassurance of desirability and ignoring concerns about sexual function does not help the patient to regain positive feelings of sexuality.

The patient with a new ileostomy needs discharge teaching. What should the nurse plan to include in this teaching? A. The pouch can be worn for up to 2 weeks before changing it B. Decrease the amount of fluid intake to decrease the amount of drainage C. The pouch can be removed when bowel movements have been regulated D. If leakage occurs, promptly remove the pouch, clean the skin, and apply a new pouch

D. The ileostomy drainage is extremely irritating to the skin, so the skin must be cleaned and a new solid skin barrier and pouch applied as soon as a leak occurs to prevent skin damage. The pouch is usually worn for 4-7 days unless there is a leak. Because the initial drainage from the ileosotmy is high, the fluid intake must be increased. The pouch must always be worn, as the liquid drainage, not formed bowel movements, is frequent.

In report, the nurse learns that the patient has a transverse colostomy. What should the nurse expect when providing care for this patient? a. Semiliquid stools with increased fluid requirements b. Liquid stools in a pouch and increased fluid requirements c. Formed stools with a pouch, needing irrigation, but no fluid needs d. Semiformed stools in a pouch with the need to monitor fluid balance

D. The patient with a transverse colostomy has semiliquid to semiformed stools needing a pouch and needs to have fluid balance monitored. The ascending colostomy has semiliquid stools needing a pouch and increased fluid. The ileosotmy has liquid to semiliquid stools need a pouch and increased fluid. Te sigmoid colostomy has formed stools, may or may not need a pouch but will need irrigation, and no changes in fluid needs.

What extraintestinal manifestations are seen in both ulcerative colitis and Crohn's disease? a. Celiac disease and gallstones b. Peptic ulcer disease and uveitis c. Conjunctivitis and colonic dilation d. Erythema nodosum and osteoporosis

D. Ulcerative colitis and Chron's disease haev many of the same extraintestinal symptoms, including erythema nodosum and osteoporosis, as well as gallstones, uveitis, and conjuctivits. Celiac disease, peptic ulcer disease, and colonic dilation are not extraintestinal.

The patient returns to the clinical until after an abdominal-perineal resection (APR), what should the nurse expect the patient to have? A. An abdominal dressing B. AN abdominal wound and drains C. A temporary colostomy and drains D. A perineal wound, drains, and a stoma

D. With abdominal perineal resection (APR), an abdominal incision is made, and the proximal sigmoid colon is brought through the abdominal wall and formed into a permanent colostomy. The patient is repositioned, a perineal incision is made, and the distal sigmoid colon, rectum, and anus are removed through the perineal incision, which may be closed or open and packed, and have drains.