NUR336 Evolve: Chronic Inflammatory Bowel Disorder
A male patient with a long history of ulcerative colitis (UC) 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 does the nurse respond?
"A change in position may be what is needed for you to have intercourse with your wife."
A nurse is teaching a patient about dietary methods to help manage exacerbations ("flare-ups") of diverticulitis. What does the nurse advise the patient?
"Consume a low-fiber diet when your diverticulitis is active. When inflammation resolves, consume a high-fiber diet."
A patient has vague symptoms that indicate an inflammatory bowel disorder. Which symptom is most indicative of Crohn's disease (CD)?
Chronic diarrhea, abdominal pain, and fever.
Which complication is seen exclusively in patients with ulcerative colitis?
Colorectal cancer.
Which disorder is associated with inflammation of the small intestine?
Crohn's disease.
What term is used to describe a fistula which is present between the bowel and the bladder?
Enterovesical fistula.
A patient with a history of osteoarthritis has a 10-inch incision following a colon resection. The incision has become infected, and the wound requires extensive irrigation and packing. What aspect of the patient's care does the nurse make certain to discuss with the health care provider before the patient's discharge?
Having a home health consultation for wound care.
What physiological change is seen in a patient with ulcerative colitis?
Increase in white blood cell levels.
What measures should be taken by a patient who has gastroenteritis to prevent transmission of the infection?
Maintain clean bathroom facilities.
What surgical techniques are involved in the treatment of Crohn's disease?
Minimal invasive surgery (MIS) and stricturoplasty.
A patient has been diagnosed with ulcerative colitis (UC) and reports having between four and five bloody stools per day. How does the nurse classify the intensity of the patient's UC?
Moderate.
What interventions should the nurse provide to a patient with inflammatory bowel disease who complains of abdominal pain?
Observe for signs and symptoms of peritonitis.
Which clinical findings in a patient indicate ulcerative colitis?
Presence of blood and mucus in the stool.
What changes take place in a patient after a total proctocolectomy with a permanent ileostomy?
Stool volume decreases and becomes thick.
The registered nurse is supervising a student nurse providing preoperative care to a patient with ulcerative colitis who is scheduled for surgery. Which action of the student indicates effective learning?
The student nurse explains what an ileostomy is to the patient and family.
Which diagnostic test is preferred to differentiate between ulcerative colitis and Crohn's disease?
X-ray examination with barium enema.
A nurse is teaching a patient with Crohn's disease (CD) about managing the disease with the drug adalimumab. Which instruction does the nurse emphasize to the patient?
"Avoid large crowds and anyone who is sick."
The nurse is teaching a patient with ulcerative colitis (UC) about ileostomy care. Which information does the nurse include in the plan of care?
"Avoid taking enteric-coated medications."
The nurse is caring for a patient with ileo-anal pouch anastomosis who has undergone a restorative proctocolectomy. What pouch care advice given by the nurse will provide effective treatment?
"Change the entire pouch system every 3 to 7 days."
The primary health care provider prescribes natalizumab to a patient with Crohn's disease. Which health teaching is most important before beginning the medication?
"Cognitive, motor, and sensory changes have very lethal effects."
A patient with a new ileostomy is distressed because of the large amount of green liquid stool that must be emptied from the pouch several times each day. What does the nurse tell this patient?
"Eventually, the amount and consistency of the stool will change."
A parent of a patient suffering from chronic inflammatory bowel disease informs the nurse, "My son leaks stools while he is sleeping." The nurse teaches the parent necessary steps to manage the child's nocturnal stool leakage. Which statement made by the parent indicates a need for further teaching?
"I should encourage my son to drink more milk."
The nurse is teaching a patient about caring for an ileostomy at home. Which statement by the patient indicates a correct understanding of the teaching?
"I should use skin sealants and ostomy skin creams as needed to prevent irritation."
A patient with an exacerbation of ulcerative colitis (UC) has been prescribed Vivonex PLUS. The patient asks the nurse how this is helpful for improving symptoms. How does the nurse reply?
"It is absorbed quickly and allows the affected part of the GI tract to rest and heal."
A patient with ulcerative colitis (UC) has stage 1 of a restorative proctocolectomy with ileoanal anastomosis (RPC-IPAA) procedure performed. The patient asks the nurse, "How long do people with this procedure usually have a temporary ileostomy?" How does the nurse respond?
"It is usually ready to be closed in about 1-2 months."
A patient has been newly diagnosed with ulcerative colitis (UC). What does the nurse teach the patient about diet and lifestyle choices?
"Lactose-containing foods should be reduced or eliminated from your diet."
What instruction should the nurse give to a patient with inflammatory bowel disease regarding skin care?
"Tell the patient to apply a thin coat of A+D ointment or aloe cream."
The nurse is instructing a patient with recently diagnosed diverticular disease about diet. What food does the nurse suggest the patient include?
A slice of 5-grain bread.
What is a clinical manifestation of Crohn's disease?
Abdominal pain.
A patient is scheduled for discharge after surgery for inflammatory bowel disease (IBD). The patient's spouse will be assisting home health services with the patient's care. What is most important for the home health nurse to assess in the patient and the spouse with regard to the patient's home care?
Ability of the patient and spouse to perform incision care and dressing changes.
A patient with ulcerative colitis complains of severe diarrhea with exacerbations. What is the drug of choice in this condition?
Glucocorticoids.
A patient with a recent surgically created ileostomy refuses to look at the stoma and asks the nurse to perform all required stoma care. What does the nurse do next?
Has another patient with a stoma who performs self-care talk with the patient.
A patient has a low-grade fever and tenesmus. Which other clinical manifestations may indicate ulcerative colitis?
Inflammation of the joints.
Which is a correct statement differentiating Crohn's disease (CD) from ulcerative colitis (UC)?
Patients with ulcerative colitis may experience hemorrhage.
A patient is experiencing an exacerbation of ulcerative colitis (UC). What is an important nursing action to help minimize the patient's discomfort?
Restricting lactose-containing foods.
Which medication is used as the first line treatment for mild ulcerative colitis?
Sulfasalazine. Sulfasalazine is an aminosalicylate used to treat mild-to-moderate ulcerative colitis.
