Arthur has a family history of colon cancer and is scheduled to have a sigmoidoscopy. He is crying as he tells you, “I know that I have colon cancer, too.” Which response is most therapeutic?
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Solution
“You seem upset.”
Making observations about what you see or hear is a useful therapeutic technique. This way, you acknowledge that you are interested in what the patient is saying and feeling.
You’re preparing a teaching plan for a 27 y.o. named Jeff who underwent surgery to close a temporary ileostomy. Which nutritional guideline do you include in this plan?
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Solution
Eat six small meals a day
To avoid overloading the small intestine, encourage the patient to eat six small, regularly spaced meals.
You’re caring for Carin who has just had ileostomy surgery. During the first 24 hours post-op, how much drainage can you expect from the ileostomy?
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Solution
1500 ml
The large intestine absorbs large amounts of water so the initial output from the ileostomy may be as much as 1500 to 2000 ml/24 hours. Gradually, the small intestine absorbs more fluid and the output decreases.
You’re doing preoperative teaching with Gertrude who has ulcerative colitis who needs surgery to create an ileoanal reservoir. Which information do you include?
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Solution
The surgery occurs in two stages.
An ileoanal reservoir is created in two stages. The two surgeries are about 2 to 3 months apart. First, diseased intestines are removed and a temporary loop ileostomy is created. Second, the loop ileostomy is closed and stool goes to the reservoir and out through the anus.
You’re performing an abdominal assessment on Brent who is 52 y.o. In which order do you proceed?
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Solution
Observation, auscultation, percussion, palpation
Observation, auscultation, percussion, palpation
You have to teach ostomy self care to a patient with a colostomy. You tell the patient to measure and cut the wafer:
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Solution
About 1/16” larger than the stoma.
A proper fit protects the skin but doesn’t impair circulation. A 1/16” should be cut.
You’re advising a 21 y.o. with a colostomy who reports problems with flatus. What food should you recommend?
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Solution
Yogurt
High-fiber foods stimulate peristalsis, and a result, flatus. Yogurt reduces gas formation.
You’re caring for a patient with a sigmoid colostomy. The stool from this colostomy is:
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Solution
Formed
A colostomy in the sigmoid colon produces a solid, formed stool.
You’re assessing the stoma of a patient with a healthy, well-healed colostomy. You expect the stoma to appear:
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Solution
Red and moist
Good circulation causes tissues to be moist and red, so a healthy, well-healed stoma appears red and moist.
A patient with chronic alcohol abuse is admitted with liver failure. You closely monitor the patient’s blood pressure because of which change that is associated with the liver failure?
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Solution
Hypoalbuminemia
Blood pressure decreases as the body is unable to maintain normal oncotic pressure with liver failure, so patients with liver failure require close blood pressure monitoring. Increased capillary permeability, abnormal peripheral vasodilation, and excess rennin released from the kidney’s aren’t direct ramifications of liver failure.