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Which of the following nursing actions should be included in the plan of care for a male patient with bowel irregularity and a new diagnosis of irritable bowel syndrome (IBS)?
- A. Encourage the patient to express feelings and ask questions about IBS.
- B. Suggest that the patient increase the intake of milk and other dairy products.
- C. Educate the patient about the use of metronidazole to reduce symptoms.
- D. Teach the patient to avoid using nonsteroidal anti-inflammatory drugs (NSAIDs).
Correct Answer: A
Rationale: Because psychological and emotional factors can affect the symptoms for IBS, encouraging the patient to discuss emotions and ask questions is an important intervention. Metronidazole is an antimicrobial used for infections, not IBS, at the present time. Although yogurt may be beneficial, milk is avoided because lactose intolerance can contribute to symptoms in some patients. NSAIDs can be used by patients with IBS.
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The nurse is teaching a patient who has persistent constipation, about the use of psyllium. Which of the following information should the nurse include?
- A. Absorption of fat-soluble vitamins may be reduced by fibre-containing laxatives.
- B. Dietary sources of fibre should be eliminated to prevent excessive gas formation.
- C. Use of this type of laxative to prevent constipation does not cause adverse effects.
- D. Large amounts of fluid should be taken to prevent impaction or bowel obstruction.
Correct Answer: D
Rationale: A high fluid intake is needed when patients are using bulk-forming laxatives to avoid worsening constipation. Although bulk-forming laxatives are generally safe, the nurse should emphasize the possibility of constipation or obstipation if inadequate fluid intake occurs. Although increased gas formation is likely to occur with increased dietary fibre, the patient should gradually increase dietary fibre and eventually may not need the psyllium. Fat-soluble vitamin absorption is blocked by stool softeners and lubricants, not by bulk-forming laxatives.
The nurse is caring for a patient with ulcerative colitis who underwent a proctocolectomy with an ileostomy. Which of the following information should the nurse include in patient teaching?
- A. Restrict fluid intake to prevent constant liquid drainage from the stoma.
- B. Use care when eating high-fibre foods to avoid obstruction of the ileum.
- C. Irrigate the ileostomy daily.
- D. Change the pouch every day to prevent leakage of contents onto the skin.
Correct Answer: B
Rationale: High-fibre foods are introduced gradually and should be well chewed to avoid obstruction of the ileostomy. Patients with ileostomies lose the absorption of water in the colon and need to take in increased amounts of fluid. The pouch should be drained frequently but is changed every 5-7 days. The drainage from an ileostomy does not require daily irrigation.
Which of the following nursing actions is most important to include in the plan of care for a patient who had an abdominal-perineal resection the previous day?
- A. Teach about a low-residue diet.
- B. Monitor output from the stoma.
- C. Assess the perineal drainage and incision.
- D. Encourage acceptance of the colostomy stoma.
Correct Answer: C
Rationale: Because the perineal wound is at high risk for infection, the initial care is focused on assessment and care of this wound. Teaching about diet is best done closer to discharge from the hospital. There will be very little drainage into the colostomy until peristalsis returns. The patient will be encouraged to assist with the colostomy, but this is not the highest priority in the immediate postoperative period.
The nurse is conducting preoperative preparation for a patient scheduled for an abdominal-perineal resection. Which of the following actions should the nurse implement?
- A. Give IV antibiotics starting 24 hours before surgery to reduce the number of bowel bacteria.
- B. Teach the patient that activities such as sitting at the bedside will be started the first postoperative day.
- C. Instruct the patient that another surgery in 8-12 weeks will be used to create an ileal-anal reservoir.
- D. Administer polyethylene glycol lavage solution (GOLYTELY) to ensure that the bowel is empty before the surgery.
Correct Answer: D
Rationale: A bowel-cleansing agent is used to empty the bowel before surgery to reduce the risk for infection. Oral antibiotics (rather than IV antibiotics) are given to reduce colonic and rectal bacteria. Sitting is contraindicated after an abdominal-perineal resection. A permanent colostomy is created with this surgery.
The nurse is caring for a patient who has blunt abdominal trauma after an automobile accident and severe pain. A peritoneal lavage returns brown drainage with fecal material. Which of the following actions should the nurse plan to take next?
- A. Auscultate the bowel sounds.
- B. Prepare the patient for surgery.
- C. Check the patient's oral temperature.
- D. Obtain information about the accident.
Correct Answer: B
Rationale: Return of brown drainage and fecal material suggests perforation of the bowel and the need for immediate surgery. Auscultation of bowel sounds, checking the temperature, and obtaining information about the accident are appropriate actions, but the priority is to prepare to send the patient for emergency surgery.