Chapter 34 Nursing Care of Patients with Lower Gastrointestinal Disorders

Answers CHAPTER 34 NURSING CARE OF PATIENTS WITH LOWER GASTROINTESTINAL DISORDERS AUDIO CASE STUDY Tara and Gastrointestinal Bleeding 1. Use of aspirin, two tablets four times a day. 2. Light-headed and seeing spots. 3. Intravenous (IV) fluids, laboratory work, and packed red blood cells. VOCABULARY 1. (12) 2. (10) 3. (2) 4. (11) 5. (1) 6. (4) 7. (8) 8. (9) 9. (3) 10. (5) 11. (7) 12. (6) OSTOMIES Corrections are in boldface. 1. Michelle Braun is a 16-year-old with ulcerative colitis. She is taking cortisone. She is on a low-residue diet. She has just been admitted to the hospital for a colectomy and permanent end ileostomy. The nurse monitors her intake and output, daily weights, and electrolytes. The nurse also monitors for signs of inflammation in her joints, skin, and other parts of her body. The nurse teaches her to increase fluids following surgery, but it is not possible to limit the number of stools she has daily. 2. James Key is a 46-year-old with a new sigmoid colostomy. Following surgery, the nurse monitors his stoma each shift to ensure that it remains pink and moist. The nurse explains that the stool will be formed and that irrigation is optional to establish regularity. The nurse contacts the dietitian to provide a list of the high-fiber foods that he should avoid. CRITICAL THINKING 1. Collect data on Mrs. Hendricks’s abdomen, including bowel sounds, distention, tenderness, and other signs of problems such as impaction as well as her diet, exercise, fluid intake, and other possible factors that may have caused constipation. 2. Because Mrs. Hendricks has arthritis, she may not be getting much exercise. Lack of teeth probably prevents her from eating many fresh fruits or vegetables. Poor fluid intake and certain medications may also be factors. 3. Mrs. Hendricks is only 1 day behind her normal bowel movement schedule. The nurse should intervene to prevent the problem from becoming worse. Unrelieved constipation can lead to fecal impaction, megacolon, and complications related to use of Valsalva maneuver. 4. Before giving Mrs. Hendricks more Milk of Magnesia, the nurse can try giving her some prune juice, have her ambulate in the halls if she is able, and have her sit on the toilet or bedside commode (avoid use of bedpan) to attempt to have a bowel movement. Placing her feet on a footstool while sitting on the toilet can be helpful. 5. Prevention is the best treatment for constipation. Place Mrs. Hendricks on a regimen of 2 g bran with her cereal each morning. Include pureed fresh fruits and vegetables as much as possible in her diet. Encourage fluids and assist her to walk in the halls several times each day. Establish a regular time each day (or two) for Mrs. Hendricks to have privacy in the bathroom for a bowel movement. Offer a warm drink such as a cup of coffee or tea or warm water before this time. If these measures do not work, add Metamucil to her daily regimen. Use Milk of Magnesia (magnesium hydroxide mixture), senna (Senokot), and enemas only as necessary. Continue use of footstool when using toilet. REVIEW QUESTIONS—CONTENT REVIEW The correct answers are in boldface. 1. (3, 4) are correct because diverticulitis involves infection and inflammation of the outpouchings and is usually symptomatic. (1, 2, 5) are incorrect. Diverticulosis and diverticulitis both have outpouchings of the bowel mucous membranes and weakness in the bowel wall and occur in the large intestine. 1 2 Chapter 34 Answers 2. (3) is correct. Inflammatory bowel syndrome is a disorder of altered intestinal mobility in which disorderly contractions of the colon lead to a pattern of alternating diarrhea and constipation. It is a functional problem, not a disease. (1, 2) are incorrect. Crohn disease and ulcerative colitis are both inflammatory bowel diseases often characterized by diarrhea that may lead to complications. (4) is incorrect. With a large-bowel obstruction, constipation usually occurs. 3. (3, 6) are correct. For some women with irritable bowel syndrome and constipation, fluoxetine (Prozac) or paroxetine hydrochloride (Paxil) is used because antidepressants block the brain’s perception of abdominal pain. (1, 2, 4, 5) are incorrect. The other drugs listed are used to treat irritable bowel syndrome with diarrhea. 4. (3, 5) is correct. People in the past with diverticulitis were advised to avoid nuts, seeds, and popcorn because of concern that they could lodge in outpouching and cause diverticulitis. (1, 2, 4, 6) do not exacerbate diverticulosis. REVIEW QUESTIONS—TEST PREPARATION The correct answers are in boldface. 5. (3) is correct. Parenteral nutrition is the only way to adequately feed a person for an extended period without using the gut. (1, 2) both require a functional bowel; (4) provides inadequate nutrition for an extended period. 6. (1) is correct. A low-fiber diet increases risk for diverticulosis. (2, 3, 4) do not increase risk for diverticulosis. 7. (3) is correct. A bowel obstruction can cause nausea and vomiting. (1, 2) would not apply to a bowel obstruction. There is no data given to support (4). 8. (4) is correct. The loop can be returned to the abdomen after the resected area of bowel has healed. (1) is correct. Transverse ostomies do not usually drain constant liquid stool. (2) is incorrect. There is no such thing as a looped bag. (3) is incorrect. The ostomy will drain stool. 9. (1) is correct. Fluids are needed to replace those lost in liquid stools. (2, 3, 4) can all increase liquid stools and fluid loss. 10. (2, 3) are correct. Pouches are made of odor-proof plastic and effluent does have an odor. (1) is incorrect. Nothing will absorb all odor. (4) is incorrect. Daily pouch changes are hard on skin and therefore not routinely recommended. (5) is incorrect. Ileostomies as well as colostomies can have odor. 11. (1, 3, 4) are correct. Treatment for anal fissures involves measures to ensure soft stools to allow fissures time to heal. Instructions to prevent constipation include 2 to 3 L of fluid a day to promote regular bowel movements. A side effect of opioid analgesics is constipation, which needs to be avoided; anesthetic suppositories and nonopioid analgesics may be ordered for comfort. (2) is incorrect. This would be the desired response for effective teaching as pain may be so severe that the patient delays defecation, leading to further constipation and worsening symptoms. (5) is incorrect. Sitz baths may be used to promote circulation to the area to aid in healing and comfort. (6) is incorrect. A high-fiber diet helps prevent constipation. 12. (5, 6, 4, 3, 7, 8, 2, 1) is the correct ranking. (5, 6) The patient is exhibiting signs of low blood pressure and potentially is going into shock. For safety, the patient should be quickly assisted back to bed with additional staff assistance and covered with warm blankets. (4) Intravenous fluids are essential to replace lost fluid, so after moving the patient, it is important to quickly verify that the intravenous site is patent and the normal saline is infusing while data is collected. (3, 7, 8, 2) Data must be collected to report to the health care provider immediately. Perform rapid head-to-toe assessment to identify signs and symptoms. (1) Notify the health care provider immediately with collected data. Ideally, if not already on-site, the health care provider is being contacted as data is being collected. 13. The area where the pain localizes in appendicitis. Chapter 34 14. The area where the nurse would view the surgical site for the repair of a right inguinal hernia. Answers 15. The area where the nurse would observe the stoma. 3