IBS questions and answers with complete solution.

Identify 6 priority problems for C.W. - answer Abdominal pain Weight loss Fatigue Frequent hospitalizations Nausea, vomiting, and diarrhea Dehydration Risk for ineffective relationship related to sex being difficult Considering C.W.'s weakness, chronic diarrhea, and lower-than-desired body weight, what nursing interventions need to be implemented to minimize skin breakdown? - answer Washing the skin with soap and water Keep genitals and buttocks clean and dry Proper nutrition to build strength and reduce diarrhea (low fiber, high protein and carb) Avoid prolonged sitting or laying in one position Apply barrier cream to help with chronic diarrhea Do not scrub hard, be gentle Do not soak skin in bath Use therapeutic surfaces such as a pressure relieving mattress Suggest therapy to build muscles and maintain proper support and flexibility What is the mechanism of action of the mesalamine (Asacol) in relation to the IBD? - answer It blocks prostaglandin production, thus diminishing inflammation in the colon. You begin a thorough postoperative assessment of C.W.'s abdomen. What does your assessment include? List the steps in the order in which the assessment should be completed. - answer Assess pain level Observe stoma for color and measure size Assess skin around pouch for breakdown or leakage Assess contents of ileostomy bag and measure Briefly turn off suction and auscultate for bowel sounds Lightly palpate abdomen being careful to avoid wound site Check under patient for bleeding or drainage A nursing student enters C.W.'s room and auscultates her abdomen. She looks at you and excitedly announces that she hears good bowel sounds. You take the opportunity to teach her the proper method of auscultating bowel sounds on a patient who has NGT to low-continuous wall suction. How would you correct her error? - answer Teach her that an NGT to low-continuous suction can mimic or mask bowel sounds. Teach her it is ok to turn it off briefly to do a proper assessment What else will you note about the drainage - answer Texture Color Smell Clear or cloudy Describe the proper method for reestablishing suction on the JP drain after you have emptied the bulb container. - answer Clean off plug with alcohol While maintaining compression of the bulb, recap it Document the time, quality and quantity of drainage C.W. asks you, "I know why I have the pouch. Why do I have to have this other little tube?" How will you explain the purpose of the JP drain? - answer A JP drain is a closed system of drainage that uses the suction of a bulb to decrease fluids pooling up at the wound site. Because it is a closed system, it has less risk of infection than an open system. It also allows for observation and measuring of drainage. How will you obtain a culture specimen from C.W.'s wound? - answer After reviewing the provider's order, I will gather supplies After performing hand hygiene and confirming patient's identity, I will assess the wound and surrounding tissues before setting up a sterile field Once the wound has been rinsed with normal saline, I will utilize a sterile technique to gently rotating a sterile swab in the wound (margin to margin) to express fluid from wound tissue Specimen will not be obtained from exudate or eschar (only healthy tissue) A cotton-tipped swab will not be used Levine technique will be used (ZIG-ZAG no longer recommended) The swab will be placed in a culture medium and labeled before being sent to lab What information do you need to send to the lab with the wound culture specimen? - answer The patient's name/MAR information on a sticker The date and time the culture specimen was obtained The location the culture was obtained from and type of specimen Often the person who collected it initials You obtain a wound culture specimen, complete the dressing change, obtain a full set of VS, note a temperature of 100.4° F (38° C), and assess increased tenderness in C.W.'s abdomen. What orders do you anticipate receiving once you notify the surgeon of C.W.'s condition? - answer Blood culture IV antibiotics: will be spectrum antibiotics until a specific organism is identified with the culture and sensitivity report. Urinalysis specimen CBC As you assess C.W.'s stoma and drainage, what would indicate that they are healthy? - answer a. The stoma will be level with the skin. b. The stoma will be in the shape of a donut. d. The skin around the stoma should be intact. f. The stoma will be light pink, and an occasional dark spot might appear. Will any aspect of C.W.'s history significantly affect the wound healing process? If so, how? - answer IBD causes nutrient loss through frequent diarrhea episodes (5-10/day) lactase deficiency also contributes to frequent diarrhea episodes when milk products are consumed. Thus, increasing nutrient loss. Anorexia which involves the patient not consuming adequate nutrients her body needs to heal and to replenish lost vitamins and minerals Chronic use of prednisone 40 mg/day for the past 5 years may also significantly her delay wound healing process (masks infection) Overall, poor fluid, nutritional intake and prednisone use will affect her wound healing process and lower her body's abi;ity to fight off infection. The surgeon tells you she will be there to examine C.W. As you tell C.W. that her doctor is coming to talk to her, C.W. says that she feels something wet running down her side. You find some leakage of intestinal drainage onto the skin. What should you do? - answer I will assess the pouch for proper attachment, fullness and measure the quantity of content then empty and document output I will clean the site to prevent skin breakdown and reduce the risk of infection. Apply a new skin barrier and attach a new pouch A few hours later, C.W. is still experiencing pain from the peritonitis as well as from the surgical incision. Which position may help to make her more comfortable? - answer Head of bed slightly elevated, with knees flexed C.W. has been on NPO status since the surgery. The surgeon orders total parenteral nutrition (TPN) at a rate of 50 mL/hr. What is the purpose of these orders? - answer TPN was ordered to provide nutrients to the body by IV route. This provides a fluid mixture rich in proteins, carbohydrates, fats, electrolytes, vitamins and minerals which helps to improve nutritional status, maintain/gain weight, establish a positive nitrogen balance and enhance the body's healing process. Purpose: This is to correct malnutrition and nutrition intolerance with enteral feeding Allows for accurate monitoring of I&O The pharmacy delivers C.W.'s first bag of TPN. You have an order to stop the maintenance IV infusion after starting the TPN. What is the purpose of this order? - answer To prevent fluid overload During the night shift the TPN solution bag becomes nearly empty, and the night nurse discovers that the next bag of TPN has not been prepared. The hospital pharmacy does not prepare TPN during the night shift. What does the nurse need to do next? - answer Hang a bag of D10W when the TPN is finished. You discuss with the RD what specific digestive difficulties C.W. is likely to face. What problems might C.W. be prone to develop after having so much of her bowel removed? - answer A leak between the joined sections of your colon Bleeding in your intestines Incision breaking open (dehiscence) Infection Injury to your bladder, ureters or blood vessels Intestines pushing through the incision into your belly (incisional hernia) Scar tissue that forms an intestinal blockage (stricture Frequent diarrhea Pus collecting in the small bowel (this may require drainage) Short bowel syndrome The RD talks with C.W. about her dietary needs. You attend the session so you will be able to reinforce the information. What basic information is the RD likely to discuss with C.W.? - answer Oral fluids and a low-residue, high-protein, high-calorie diet with supplemental vitamin therapy and iron replacement are prescribed to meet nutritional needs, Any foods that exacerbate diarrhea are avoided. Milk may contribute to diarrhea in those with lactose intolerance. Cold foods and smoking are avoided because both increase intestinal motility. Parenteral nutrition may be indicated (see Chapter 44).Page 1332 Med surg Parenteral nutrition is indicated in patients who have Crohn's disease with severe malnutrition and intolerance to enteral nutrition and who are expected to likely remain intolerant to enteral nutrition for more than 1 to 2 weeks Elemental feedings are high in protein and low in fat and residue. They are digested primarily in the jejunum, do not stimulate intestinal secretions, and allow the bowel to continue to rest. If oral foods are tolerated, small, frequent, low-residue feedings are given to avoid over distending the stomach and stimulating peristalsis. Page 1335 med surg Advise the patient to avoid food products with a cellulose or hemicellulose base (nuts, seeds). Due to the ostomy Pg 1338 med surg Recommend moderation in intake of certain irritating fruits such as prunes, grapes, and bananas due to the ostomy Avoid food that may cause gas due to the ostomy Asparagus, Alcohol, Broccoli, Brussels sprouts, Cabbage, Carbonated drinks (such as soda, Cauliflower, Corn, Dried beans and peas, Eggs