(60) An older adult has a perforated appendix and is scheduled for emergent surgery. What assessment findings will the nurse expect the client to have before surgery? Select all that apply.
A. Bradycardia
B. Dizziness
C. Distended abdomen
D. Fever
E. Diarrhea
F. Fistulas
G. Incontinence
B, C, D
Rationale: Perforation of the appendix also results in peritonitis with a temperature of greater than 101° F (38.3° C) and a rise in pulse rate.
When the lumen is blocked, the mucosa secretes fluid, increasing the internal pressure and causing abdominal distention.
Dizziness is a result of the infectious process.
Clients with a perforated appendix experience an increase in pulse rate as opposed to bradycardia.
Clients with appendicitis often have constipation.
Fistula formation and incontinence of stool or urine are not common occurrences with a perforated appendix.
(60) Bowel Surgery Prep
Data supports that w or w/o enema, etc. cleaning, infection rates are unaffected.
Antibiotic Prep with:
neomycin
Flagyl
Kanamycin (an aminoglycoside, which can affect nerve VIII, so monitor hearing)
(60) The nurse is caring for a client with an exacerbation of ulcerative colitis. Which laboratory finding for the client will the nurse expect?
C. Decreased serum potassium
Rationale:
Blood levels of sodium, potassium, and chloride may be low as a result of frequent diarrheal stools and malabsorption through the diseased bowel.
The ESR, WBC, and C-reactive protein will be elevatedin a client with ulcerative colititis as a result of the inflammatory process.
Platelet counts remain unchanged by the disease process of ulcerative colitis.
(60) The health care provider prescribes sulfasalazine (Azulfidine) for a client with ulcerative colitis. What nursing action is most important before the client begins the medication?
C. Ask the client if he has any allergies to sulfa-type drugs.
Sulfasalazine is in the same family as sulfonamide antibiotics. Therefore a client who has an allergy to sulfonamide or other drugs that contain sulfa should not take this drug. Determining whether the client’s insurance company will cover the medication should never be a priority when the client’s health is at stake. Consumption of alcohol and smoking should be discouraged in all clients with ulcerative colitis regardless of the drug therapy prescribed. Sulfasalazine does not suppress the immune system, so the client is not required to avoid large crowds.
(60) An older adult with a history of diverticulitis is admitted to the emergency department stating that she has severe abdominal pain and has not had a bowel movement in 6 days. What priority assessment will the nurse perform?
C. Auscultate the client’s bowel sounds.
(60) A 29-year-old woman who practices as a licensed practical nurse in a long-term care setting is admitted to the hospital with a draining enterocutaneous fistula as a result of long-term Crohn’s disease. She has been taking infliximab (Remicade) for about 10 months, but has noticed a return in her symptoms over the past week. The patient tells you that she is very upset about her condition and that she needs to go back to work as soon as she can. She is single but works extra shifts to help support her mother, who has advanced colon cancer.
What is your best response to the patient at this time?
Acknowledge the client’s concerns regarding her desire to return to work. Assure the client that the health care team will develop a plan to bring her symptoms under control so she can return to work and care for her mother. Offer to arrange for the social worker to talk to her about her concerns.
(60) A 29-year-old woman who practices as a licensed practical nurse in a long-term care setting is admitted to the hospital with a draining enterocutaneous fistula as a result of long-term Crohn’s disease. She has been taking infliximab (Remicade) for about 10 months, but has noticed a return in her symptoms over the past week. The patient tells you that she is very upset about her condition and that she needs to go back to work as soon as she can. She is single but works extra shifts to help support her mother, who has advanced colon cancer.
What patient assessments will you perform on admission and why?
A detailed history is needed to identify manifestations specific to the disease. Ask about recent unintentional weight loss, the frequency and consistency of stools, the presence of blood in the stool, fever, and abdominal pain. Perform a thorough abdominal examination to assess for inflammation or obstruction. Evaluate the patient’s nutritional and hydration status.
(60) A 29-year-old woman who practices as a licensed practical nurse in a long-term care setting is admitted to the hospital with a draining enterocutaneous fistula as a result of long-term Crohn’s disease. She has been taking infliximab (Remicade) for about 10 months, but has noticed a return in her symptoms over the past week. The patient tells you that she is very upset about her condition and that she needs to go back to work as soon as she can. She is single but works extra shifts to help support her mother, who has advanced colon cancer.
Based on the patient data provided, whatpriority problems do you identify?
Priority patient problems include the risk for lower GI bleeding and the resulting anemia, fever, abdominal pain, and diarrhea. Diarrhea, fever, impaired nutrient absorption, and decreased nutritional intake may result in weight loss and fluid and electrolyte imbalances. In addition, the patient’s physical symptoms and presence of a fistula will need to be addressed; fever is common with fistulas, abscesses, and severe inflammation. Finally, the patient’s employment situation and financial concerns will require a management plan.
(60) A 29-year-old woman who practices as a licensed practical nurse in a long-term care setting is admitted to the hospital with a draining enterocutaneous fistula as a result of long-term Crohn’s disease. She has been taking infliximab (Remicade) for about 10 months, but has noticed a return in her symptoms over the past week. The patient tells you that she is very upset about her condition and that she needs to go back to work as soon as she can. She is single but works extra shifts to help support her mother, who has advanced colon cancer.
Using best, current evidence, how will you plan care with other members of the health care team? What members of the health care team will be involved in this patient’s care and why?
Care should focus on the clinical presentation of Crohn’s disease, which varies greatly from person to person. In addition to the nurses and physicians involved in the patient’s care, a wound ostomy nurse may develop a plan for management of the patient’s fistula. The social worker and/or case manager may address the patient’s discharge and psychosocial needs. A registered dietitian can assist in developing a diet that is consistent with the diagnosis of Crohn’s disease and will help the patient maintain adequate nutritional intake. If the patient becomes deconditioned during the hospitalization, a physical therapist may be consulted.
(60) Nausea & vomiting before abdominal pains can indicate...
gastroenteritis
(60) Nausea & vomiting after abdominal pains can indicate...
apendicitis
(60) A client who had surgery for inflammatory bowel disease (IBD) is being discharged. The case manager will arrange for home health care follow-up. The client tells the nurse that family members will also be helping with care. What information is critically important for the nurse to provide to these collaborating members?
C. Written and oral instructions regarding symptoms to report to the health care provider
(60) A client 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 client's care does the nurse make certain to discuss with the health care provider before the client's discharge?
C. Having a home health consultation for wound care
Correct: Home health services are most appropriate for this client because wound care will be extensive and the client's mobility may be limited.
Incorrect: No indication suggests that the client is experiencing anxiety regarding postoperative care.
Incorrect: Pain medication may be needed for the client's osteoarthritis, but this is not the highest priority.
Incorrect: A skilled nursing facility is not necessary if the client can remain in his or her home with sufficient support services.
(60) A client has vague symptoms that indicate an acute inflammatory bowel disorder (IBD). Which symptom is most indicative of Crohn's disease (CD)?
D. Chronic diarrhea, abdominal pain, and fever
Incorrect: Abdominal pain that is relieved by bending the knees is indicative of peritonitis or pancreatitis.
Correct: Chronic diarrhea, abdominal pain, and fever are symptoms more indicative of Crohn's disease (CD) than of other acute inflammatory bowel disorders.
Incorrect: Epigastric cramping is a symptom more indicative of appendicitis.
Incorrect: Hypotension with vomiting is not characteristic of Crohn's disease (CD).
(60) A client demonstrates the manifestations of appendicitis with a suspected complication of peritonitis. What is the priority nursing intervention?
A. Preparing the client for emergency surgery
Incorrect: It is expected that the client will experience changes in vital signs as a result of the infectious process and accompanying pain. Although monitoring the client's vital signs is important, the client has an immediate need to go to surgery.
Incorrect: Although it is important to medicate the client for pain, it is not the highest priority.
Incorrect: Although it is important to determine whether the client is experiencing changes in mentation, it is not the highest priority.
Correct: The highest priority for this client is to prepare him or her for emergency surgery so that the source of the infection can be removed.
(60) A client has developed gastroenteritis while traveling outside the country. What is the likely cause of the client's symptoms?
C. Ingestion of parasites in water
Incorrect: Bacteria on the client's hands will not produce gastroenteritis unless food or water is contaminated with the bacteria.
Correct: A main cause of gastroenteritis when traveling outside the country is ingestion of water infested with parasites.
Incorrect: Insufficient vaccinations may cause other disease processes, but not gastroenteritis.
(60) Which is a correct statement differentiating Crohn's disease (CD) from ulcerative colitis (UC)?
D. Clients with UC may experience hemorrhage.
Incorrect: Five to six stools daily is common with CD.
Correct: Hemorrhage is commonly experienced in clients with UC.
Incorrect: The peak incidence of UC is between 15 to 25 and 55 to 65 years of age.
Incorrect: Fistulas commonly occur as a complication of CD.
(60) A nurse is teaching a client with Crohn's disease (CD) about managing the disease with the drug adalimumab (Humira). Which instruction does the nurse emphasize to the client?
B. "Avoid large crowds and anyone who is sick."
Correct: The client should avoid being around large crowds to avoid developing an infection. Immunomodulatorsdon't work well by themselves, but with a steroid yes. In addition to adalimumab (Humira) another immuomodulator is infliximab (Remicade).
Incorrect: The client should not take the medication if he or she is allergic to certain proteins.
Incorrect: Although immune suppression may occur to some degree, the client should not experience difficulty with wound healing while taking this particular medication.
Incorrect: The client should not experience a decrease in blood pressure from taking this drug.
(60) A client has a total colectomy, and a continent ileostomy is created. Which postoperative instruction does the nurse emphasize to this client?
A. A small dressing must be worn over the stoma at all times.
Correct: The client will need to wear a small dressing over the stoma to keep it moist.
Incorrect: The client will not require an external pouch system.
Incorrect: The client will need to drain the ileostomy several times a day.
Incorrect: The client will have a sensation of fullness when the ileostomy needs to be emptied.
(60) T/F: Consume a low-fiber diet while your diverticulitis is active. When inflammation resolves, consume a high-fiber diet.
True
(60) A client has an anal fissure. Which nursing intervention most effectively promotes perineal comfort for the client?
C. Using witch hazel wipes to relieve pain
Incorrect: Enemas should be avoided when an anal fissure is present.
Incorrect: Cold packs should be applied to acute inflammation to diminish discomfort.
Incorrect: Bulk-forming agents should be used to decrease pain associated with defecation.
Correct: Witch hazel wipes may be effective in relieving the pain associated with anal fissures.
(60) A client attending a summer camp develops an Escherichia coli infection. What does the camp nurse tell campers about how to prevent this infection?
C. "If you are swimming, avoid swallowing the water."
Incorrect: E. coli cannot be contracted by touching towels or bed linens.
Incorrect: E. coli cannot be contracted by using regular dishes or eating utensils.
Correct: Infection with E. coli can develop by swallowing water while swimming.
Incorrect: E. coli can be spread by drinking nonpasteurized dairy products.
(60) A nurse is teaching a client who recently began taking sulfasalazine (Azulfidine) about the drug. What does the nurse tell the client to report to the health care provider? Select all that apply.
A. Anorexia
B. Depression
C. Drowsiness
D. Frequent urination
E. Headache
F. Vomiting
A, E, F
(60) A client has newly diagnosed ulcerative colitis (UC). What does the nurse tell the client about diet and lifestyle choices?
B. "Lactose-containing foods should be reduced or eliminated from your diet."
Incorrect: Carbonated beverages are GI stimulants that can cause discomfort. They should be used rarely or should be eliminated from the diet of the client with UC.
Incorrect: Cigarette smoking is a stimulant that can cause GI distress symptoms. Nurses should not advise clients that any amount of cigarette smoking is "OK."
Correct: Lactose-containing foods are often poorly tolerated and should be reduced or eliminated from the diet of clients with UC.
Incorrect: Raw vegetables and high-fiber foods can cause GI symptoms in clients with UC.
(60) A client with ulcerative colitis (UC) has stage 1 of a restorative proctocolectomy with ileoanal anastomosis (RPC-IPAA) procedure performed. The client asks the nurse, "How long do people with this procedure usually have a temporary ileostomy?" How does the nurse respond?
D. "It is usually ready to be closed in about 1 to 2 months."
(60) A nurse is instructing a client with recently diagnosed diverticular disease about diet. What food does the nurse suggest the client include?
B. A slice of 5-grain bread
Correct: Whole-grain breads are recommended to be included in the diet of clients with diverticular disease. Cellulose and hemicellulose types of fiber are found in them.
Incorrect: Dietary fat should be reduced in clients with diverticular disease. If the client wants to eat beef, it should be of a leaner cut.
Incorrect: Foods containing seeds, such as strawberries, should be avoided.
Incorrect: Tomatoes should be avoided, unless the seeds are removed. The seeds may block diverticula in the client and present problems leading to diverticulitis.
(60)!!! Which client does the charge nurse assign to an experienced LPN/LVN?
C. 38-year-old with gastroenteritis who is receiving IV fluids at 250 mL/hr
Incorrect: Teaching about how to catheterize a Kock's ileostomy is a complex problem that requires assessment or intervention by an RN.
Correct: The LPN/LVN should be familiar with the purpose, adverse effects, and client teaching required for neomycin.
Incorrect: A client with UC who has a white blood cell count of 23,000/mm3 presents a complex problem that requires assessment or intervention by an RN.
Incorrect: The client with gastroenteritis who is receiving IV fluids at 250 mL/hr presents a complex problem that requires assessment or intervention by an RN.
(60) Situation: A 21-year-old woman has abdominal pain, cramping, and diarrhea. She reports having 10 to 12 liquid, bloody stools per day. A stool sample for ova and parasites is negative. A diagnosis of ulcerative colitis (UC) is made, and she is started on sulfasalazine (Azulfidine). What does the nurse tell her about why she is receiving this therapy?
C. "Your intestinal inflammation will be reduced."
Incorrect: Although it is hoped that reduction of inflammation will cause the diarrhea and bloody stools to stop, this is not the way that the drug works.
Incorrect: The drug's action as an anti-inflammatory will diminish the client's pain as the inflammation subsides. This is not the purpose of the drug-it is not an analgesic.
Incorrect: The drug's action as an anti-inflammatory will diminish the client's cramping as the inflammation subsides. This is not the purpose of the drug-it is not an analgesic.
Correct: Sulfasalazine (Azulfidine) is one of the primary treatments for UC. It is thought to inhibit prostaglandin synthesis and thereby to reduce inflammation.
(60) Situation: A 21-year-old woman has abdominal pain, cramping, and diarrhea. She reports having 10 to 12 liquid bloody stools per day. A stool sample for ova and parasites is negative. A diagnosis of ulcerative colitis (UC) is made, and she is prescribed sulfasalazine (Azulfidine) and corticosteroid therapy. As the disease improves, what change does the nurse expect in her medication regimen?
B. Taper the corticosteroid therapy.
Incorrect: Stopping corticosteroid therapy abruptly is unsafe. Steroids must be gradually decreased in clients. Usually the amount that they have been taking dictates how quickly or slowly they can be stopped.
Incorrect: Sulfasalazine (Azulfidine) therapy for the client will be given on a long-term basis. It may be increased or decreased, depending on the client's symptoms. These decisions are made over a long period of therapy.
Correct: Once clinical improvement has been established, corticosteroids are tapered over a 2- to 3-month period.
Incorrect: Sulfasalazine (Azulfidine) therapy for the client will be given on a long-term basis. It may be increased or decreased, depending on the client's symptoms. These decisions are made over a long period of therapy. This drug would not be decreased any time soon (if ever) for the client.
(60) Situation: A 21-year-old woman has abdominal pain, cramping, and diarrhea. She reports having 10 to 12 liquid bloody stools per day. A stool sample for ova and parasites is negative. A diagnosis of ulcerative colitis (UC) is made. She is to be discharged on loperamide (Imodium) for symptomatic management of diarrhea. What does a nurse include in the teaching about this medication?
C. "Be aware of the symptoms (as we discussed) of toxic megacolon."
Correct: Antidiarrheal drugs may precipitate colonic dilation and toxic megacolon. Toxic megacolon is characterized by an enlarged colon with fever, leukocytosis, and tachycardia.
Incorrect: Loperamide (Imodium) will decrease diarrhea rather than increase it. Constipation is sometimes a problem.
Incorrect: No contraindication for pregnancy is noted.
Incorrect: The administration of sulfasalazine (Azulfidine) continues. It is usually used on a long-term basis.
(60) Situation: A 38-year-old male is admitted with severe gastroenteritis. He states, "I've had watery diarrhea and frequent vomiting for the past couple of days; I am becoming very weak." A health care provider prescribes an IV for him. What fluid does the nurse expect to be administered?
B. 0.45% normal saline
Hypotonic fluids such as 0.45% normal saline, with or without potassium supplements, are usually infused, as prescribed.
(60) Situation: A 38-year-old male is admitted with severe gastroenteritis. He states, "I've had watery diarrhea and frequent vomiting for the past couple of days; I am becoming very weak." A health care provider prescribes an IV for him. The IV has been started, but the client continues with excessive diarrhea. Which medication does the nurse ask the health care provider about prescribing?
B. Loperamide (Imodium)
Incorrect: Balsalazide (Colazal) is not the best choice for control of diarrhea in this scenario.
Correct: If the health care provider determines that antiperistaltic agents are necessary, an initial dose of loperamide (Imodium) 4 mg can be administered orally, followed by 2 mg after each loose stool, up to 16 mg daily.
Incorrect: Mesalamine (Asacol) is used for clients with ulcerative colitis (UC)-over long-term therapy.
Incorrect: Milk of Magnesia (MOM) is a laxative.
(60) Gangrene (from peritonitis) can occur within AAA to BBB hours and is lifethreatening
24 to 36
(60) COMPLICATIONS OF ULCERATIVE COLITIS AND CROHN'S DISEASE
(60) GASTROENTEROLOGISTS CLASSIFICATION OF UC SEVERITY
(60) DIFFERENTIAL FEATURES OF ULCERATIVE COLITIS AND CROHN'S DISEASE
(60) Preventing Transmission of Gastroenteritis
Advise the patient to:
Wash hands well for at least 30 seconds with an antibacterial soap,especially after a bowel movement, and maintain good personal hygiene.
Restrict the use of glasses, dishes, eating utensils, and tubes of toothpaste for their own use. In severe cases, disposable utensils may be wise.
Maintain clean bathroom facilities to avoid exposure to stool.
Inform the health care provider if symptoms persist beyond 3 days.
Do not prepare or handle food that will be consumed by others. If the patient is employed as a food handler, the public health department should be consulted for recommendations about the return to work.
(60) diarrhea of unknown etiology supports Dx of:
HIV
(60) Primary intervention for gastroenteritis?
fluid replacement
(60) Abdomial pain that increases with cough or movement and is relieved by bending the right hip or knees suggests? A temperature above AAA and a BBB supports this Dx.
perforation (of the appendix) and peritonitis
A) 1000 F(38.30 C)
BV) rise in pulse rate
(60) McBurney's point?
Half way between umbilicus and anteriod illiac crest
(60) Situation: A 38-year-old male is admitted with severe gastroenteritis. He states, "I've had watery diarrhea and frequent vomiting for the past couple of days; I am becoming very weak." A health care provider prescribes an IV for him. The IV has been started, but the client continues with excessive diarrhea. He is given the maximum amount of an antispasmodic agent and yet continues to have diarrhea. What is additionally prescribed to decrease the watery volume of his stools?
B. Bismuth subsalicylate (Pepto-Bismol)
Correct: Bismuth subsalicylate (Pepto-Bismol) 30 mL or 2 tablets every 30 minutes for a maximum of eight doses can be given to reduce the watery volume of the stool.
Incorrect: Loperamide (Imodium) is used to control diarrhea-and this client has already had the maximum amount of an antispasmodic.
Incorrect: Olsalazine (Dipentum) is not the best choice for control of watery stools in this scenario.
Incorrect: Sulfasalazine (Azulfidine) is used for clients with ulcerative colitis (UC)-over long-term therapy.
Author
TomWruble
ID
213235
Card Set
NUR212CH60
Description
Care of Patients with Inflammatory Intestinal Disorders
