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The nurse is caring for a patient who has had a total proctocolectomy and permanent ileostomy who tells the nurse, 'I cannot bear to even look at the stoma. I do not think I can manage all these changes.' Which of the following actions is best?
- A. Develop a detailed written plan for ostomy care for the patient.
- B. Ask the patient more about the concerns with stoma management.
- C. Reassure the patient that care for the ileostomy will become easier.
- D. Postpone any patient teaching until the patient adjusts to the ileostomy.
Correct Answer: B
Rationale: Encouraging the patient to share concerns assists in helping the patient adjust to the body changes. Acknowledgement of the patient's feelings and concerns is important rather than offering false reassurance. Because the patient indicates that the feelings about the ostomy are the reason for the difficulty with the many changes, development of a detailed ostomy care plan will not improve the patient's ability to manage the ostomy. Although detailed ostomy teaching may be postponed, the nurse should offer teaching about some aspects of living with an ostomy.
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The nurse is caring for a patient with an acute exacerbation of ulcerative colitis having 14-16 bloody stools a day and crampy abdominal pain associated with the diarrhea. Which of the following actions should the nurse take?
- A. Place the patient on NPO status.
- B. Administer IV metoclopramide.
- C. Teach the patient about total colectomy surgery.
- D. Administer cobalamin injections.
Correct Answer: A
Rationale: An initial therapy for an acute exacerbation of inflammatory bowel disease (IBD) is to rest the bowel by making the patient NPO. Cobalamin (vitamin B12) is absorbed in the ileum, which is not affected by ulcerative colitis. Although total colectomy is needed for some patients, there is no indication that this patient is a candidate. Metoclopramide increases peristalsis and will worsen symptoms.
The nurse is obtaining a history for a female patient who is being evaluated for acute lower abdominal pain and vomiting. Which of the following questions is most useful in determining the cause of the patient's symptoms?
- A. Is it possible that you are pregnant?
- B. Can you tell me more about the pain?
- C. What type of foods do you usually eat?
- D. What is your usual elimination pattern?
Correct Answer: B
Rationale: A complete description of the pain provides clues about the cause of the problem. The usual diet and elimination patterns are less helpful in determining the reason for the patient's symptoms. Although the nurse should ask whether the patient is pregnant to determine whether the patient might have an ectopic pregnancy and before any radiology studies are done, this information is not the most useful in determining the cause of the pain.
The nurse is caring for a patient with an exacerbation of ulcerative colitis who is having 15-20 stools daily and has external hemorrhoids. Which of the following patient behaviours indicate that teaching regarding maintenance of skin integrity has been effective?
- A. The patient uses incontinence briefs to contain loose stools.
- B. The patient asks for antidiarrheal medication after each stool.
- C. The patient uses witch hazel compresses to decrease anal discomfort.
- D. The patient cleans the perianal area with soap and water after each stool.
Correct Answer: C
Rationale: Witch hazel compresses are suggested to reduce anal irritation and discomfort. Incontinence briefs may trap diarrhea and increase the incidence of skin breakdown. Antidiarrheal medications are not given 15-20 times a day. The perianal area should be washed with plain water after each stool.
The nurse is providing teaching to a patient with a new ileostomy. Which of the following daily drainage amounts should the nurse inform the patient is expected after the bowel adjusts to the ileostomy?
- A. 400 mL
- B. 600 mL
- C. 800 mL
- D. 1000 mL
Correct Answer: C
Rationale: After the proximal small bowel adapts to reabsorb more fluid, the average amount of ileostomy drainage is about 800 mL daily.
The nurse is caring for a patient who had an exploratory laparotomy with a resection of a short segment of small bowel two days previously. The patient has gas pains and abdominal distension. Which of the following nursing actions is best to take at this time?
- A. Give a return-flow enema.
- B. Assist the patient to ambulate.
- C. Administer the ordered IV morphine sulphate.
- D. Insert the ordered promethazine suppository.
Correct Answer: B
Rationale: Ambulation will improve peristalsis and help the patient eliminate flatus and reduce gas pain. Morphine will further reduce peristalsis. A return-flow enema may decrease the patient's symptoms, but ambulation is less invasive and should be tried first. Promethazine is used as an antiemetic rather than to decrease gas pains or distension.