RN101
Home of the Registered Nurses (RN) and
Licensed Practical Nurses (LPN)

SITUATION I

 

Question 1:

1. Change the appliance q 5 days or as needed if it leaks or if it smells

2. Empty the bag when it is 1/3 full

3. Put a drop of oil in the bag when it is new to make it easier to empty

4. Use a bag with filter

5. Avoid foods that are likely to produce a foul smell or gas as they decompose

6. Take care of the ostomy bag before breakfast

7. Add a product to the bag that will reduce odors (e.g. M9)

8. Take bismuth subcarbonate tablets (3-4x) daily to reduce odors

 

Question 2:

Do not interrupt the treatment, it must be discontinued gradually with decreasing dose to prevent adrenal failure/adrenal crisis/Addisonian crisis.

 

Question 3:

Obstruction 

 

Question 4:

Notify the physician 

 

SITUATION II

 

Question 1:

"Having an ileostomy does not necessarily mean that you can't bear children. Let's talk about your concerns."

 

(The fact that the client has an ileostomy does not necessarily mean that she cannot get pregnant and bear children. It may be recommended, however, that the number of pregnancies be limited. Women of childbearing age should be encouraged to discuss their concerns with their physician. Discussing their concerns about sexual functioning and pregnancy will help decrease fears and anxiety. Empathizing or telling the woman that she can adopt does not address her concerns. Her current fears may be based on erroneous understanding. Telling the client that she will adjust to the situation ignores her concerns.)

 

Question 2:

1. No heavy lifting

2. No contact sports

 

Question 3:

Swimming tips for patient:

(The patient can swim with their pouching system in place. Teaching for this patient:

1. If you use a support ostomy belt, you can leave it on if you want to.

2. You may want to protect the barrier by taping the edges with waterproof tape.

3. Before swimming, empty your pouch and remember to eat lightly. Choosing a swimsuit, the patient may want to choose a swimsuit that has a lining for a smoother profile.

4. Dark colors or busy patterns can also help hide the pouching system.

For women: 1. Consider a suit with a well-placed skirt or ruffle. 2. You may also wear stretch panties made especially for swimsuits.

For men: 1. Try a suit with a higher waistband or longer leg. 2. You may also wear bike shorts or a support garment sold in men’s underwear departments or athletic wear departments under your bathing suit. 3. Some men may prefer to wear a tank top and trunks, if the stoma is above the belt line.)

 

SITUATION III

 

Question 1:

1. Alcohol intake

2. High fats/cholesterol in the diet (eating fast foods/Chinese cuisine regularly)

 

SITUATION IV

 

Question 1:

Percussion

 

SITUATION V

 

Question 1:

Peritonitis, notify the physician immediately.

 

SITUATION VI

 

Question 1:

1. Position patient in low fowlers to lessen tension on the abdomen

2. Cover the wound with sterile, nonadherent dressing moistened with sterile normal saline solution

3. Monitor patient’s condition (i.e. V/S, sign and symptoms of shock)

4. Document the incident

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SITUATION VII

 

Question 1:

Ammonia level

 

Question 2:

1. Low protein diet

2. Limit activity

3. Enema as prescribed

 

Question 3:

1. Use smallest gauge needle possible when giving injections or drawing blood. 
2. Teach patient to avoid straining at stool, vigorous blowing of nose and coughing. 
3. Advise patient to use a soft-bristle toothbrush and avoid ingestion of irritating food. 
4. Instruct patient to avoid aspirin and NSAIDs to prevent hemorrhage when varices are present. 

Using the smallest gauge needle for injections will minimize the risk of bleeding into the tissues. Avoiding straining, nose blowing, and coughing will reduce the risk of hemorrhage at these sites. The use of a soft-bristle toothbrush and avoidance of irritating food will reduce injury to highly vascular mucous membranes. The nurse should apply gentle but prolonged pressure to venipuncture sites to minimize the risk of bleeding. Aspirin and NSAIDs should not be used in patients with liver disease because they interfere with platelet aggregation, thus increasing the risk for bleeding.

 

SITUATION VIII

 

Question 1:

Alcohol abuse

 

SITUATION IX

 

Question 1:

Duodenal ulcer

 

Question 2:

Dumping syndrome

 

Question 3:

1. Rest after meals

2. Small frequent meals

3. No fluids after meals (only between meals)

 

SITUATION X

 

Question 1:

Encourage the patient to use codom

 

SITUATION XI

 

Question 1:

Plantar, palmar, and hard palate

 

Question 2:

"An injection of immunoglobulin will need to be given to prevent or minimize the effects of this exposure." 

 

SITUATION XII

 

Question 1:

Insert a nasogastric tube and maintain NPO status to allow pancreas to rest

Initial treatment with acute pancreatitis will include an NG tube if there is vomiting and being NPO to decrease pancreatic enzyme stimulation and allow the pancreas to rest and heal. Fluid will be administered to treat or prevent shock. The pain will be treated with IV morphine because of the NPO status. Enteral feedings will only be used for the patient with severe acute pancreatitis in whom oral intake is not resumed. Antibiotic therapy is only needed with acute necrotizing pancreatitis and signs of infection.

 

SITUATION XIII

 

Question 1:

Shoulder pain is a common complaint following laparoscopic surgery due to the effects of carbon dioxide gas. 

 

Question 2:

1. Apply warm compress on the patient shoulder

2. Position patient in sim's to facilitate removal of CO2

3. Encourage ambulation

 

SITUATION XIV

 

Question 1:

Banana

Rice

Applesauce

Tea

Toast

Yogurt

 

SITUATION XV

 

Question 1:

Pain after meal

 

SITUATION XVI

 

Question 1:

Corticosteroids