Chapter 51: Concepts Of Care For Patients With Noninflammatory Intestinal Disorders Flashcards
The community nurse is talking with a group of older clients about colorectal cancer (CRC) risk factors. Which of the following factors are considered to be CRC risk factors? Select all that apply.
A. High-fat diet
B. Crohn’s disease
C. Smoking
D. Alcoholism
E. Family history of cancer
F. Obesity
Answers: A, B, C, D, E, F
Rationales: All of the choices have been found to be risk factors for the development of colorectal cancer.
A client had an open partial colectomy and colostomy placement 6 hours ago. Which assessment would concern the nurse?
A. Purple, moist stoma
B. Stoma edema
C. Liquid stool collecting in the drainage bag
D. Serosanguineous fluid draining from the drain(s)
Answer: A
Rationales: The stoma in the immediate postoperative period is expected to be swollen (Choice B), but reddish-pink and moist, not purple, which may indicate lack of blood flow to the stoma (Choice A). The stool is expected to be liquid at first (Choice C) and serosanguinous drainage is expected from the wound drain(s) (Choice D).
A client who has colorectal cancer is scheduled for a colostomy. Which referral is initially the most important for this client?
A. Home health nursing agency
B. Social worker
C. Certified Wound, Ostomy, and Continence Nurse (CWOCN)
D. Hospital chaplain
CORRECT: C
Certified Wound, Ostomy, and Continence Nurse (CWOCN)
A CWOCN (or an enterostomal therapist) will be of greatest value to the client with colorectal cancer because the client is scheduled to receive a colostomy.
The client is newly diagnosed, so it is not yet known whether home health nursing will be needed. A referral to hospice may be helpful for a terminally ill client. Referral to a chaplain may be helpful later in the process of adjusting to the disease.
The home health nurse is teaching a client about the care of a new colostomy. Which statement by the client demonstrates a correct understanding of the health teaching?
A. “If the skin around the stoma is red or scratched, it will heal soon.”
B. “I need to strive for a very tight fit when applying the barrier around the stoma.”
C. “A dark or purplish-looking stoma is normal and would not concern me.”
D. “I need to check for leakage underneath my colostomy.”
CORRECT: D
“I need to check for leakage underneath my colostomy.”
The client’s statement, “I need to check for leakage underneath my colostomy” shows that the patient correctly understands the instructions about how to care for a new colostomy. The pouch system must be checked frequently for evidence of leakage to prevent excoriation.
A male client’s sister was recently diagnosed with colorectal cancer (CRC), and his brother died of CRC 5 years ago. The client asks whether he will inherit the disease. How would the nurse respond?
A. “Have you asked your primary health care provider about your chances ?”
B. “It is hard to know what can predispose a person to develop a certain disease.”
C. “The only way to know whether you are predisposed to CRC is by genetic testing.”
D. “No. Just because they both had CRC doesn’t mean that you will have it, too.”
CORRECT: C
“The only way to know whether you are predisposed to CRC is by genetic testing.”
The nurse’s best response to the client who asks if he will inherit CRC is “the only way to know whether you are predisposed to CRC is by genetic testing.” Genetic testing is the only definitive way to determine whether the patient has a predisposition to develop CRC.
The Certified Wound, Ostomy, and Continence Nurse (CWOCN) is teaching a client with colorectal cancer how to care for a newly created colostomy. Which statement by the client indicates a correct understanding of the necessary self-management skills?
A. “If I have any leakage, I’ll put a towel over it.”
B. “I can put aspirin tablets in the pouch in order to reduce odor”
C. “I will apply a nonalcoholic skin sealant and let it dry before applying the bag.”
D. “I will have my spouse change the bag for me.”
CORRECT: C
“I will apply a nonalcoholic skin sealant and let it dry before applying the bag.”
The nurse would teach the client and family to apply a skin sealant (preferably without alcohol) and allow it to dry before application of the appliance (colostomy bag) to facilitate less painful removal of the tape or adhesive. It is not realistic that the spouse will always change the patient’s bag and does not reflect correct understanding of self-management skills. A towel is not an acceptable or effective way to cope with leakage. Putting an aspirin in the pouch will not reduce odor and can lead to ulcers in the stoma.
A client with a family history of colorectal cancer (CRC) regularly sees a primary health care provider for early detection of any signs of cancer. Which laboratory result may be an indication of CRC in this client?
A. Decrease in liver function test results
B. Elevated carcinoembryonic antigen
C. Negative test for occult blood
D. Elevated hemoglobin levels
CORRECT: B
Elevated carcinoembryonic antigen
Carcinoembryonic antigen may be elevated in many patients diagnosed with CRC. Liver involvement may or may not occur in CRC. Hemoglobin will likely be decreased with CRC, not increased. An occult blood test is not reliable to affirm or rule out CRC.
The nurse is caring for a client who had an anterior-posterior surgical resection for colorectal cancer this morning. What will the nurse anticipate as the client’s priority problem at this time?
A. Intestinal obstruction
B. Nausea and vomiting
C. Severe pain
D. Constipation
Correct: C
Severe pain
The surgical incisions are in the perineal area and are very painful due to the number of nerves in that region of the body. Pain control is the biggest challenge for the nurse and health care team to promote client comfort.
The nurse is teaching a client with a newly created colostomy about foods to limit or avoid because of flatulence or odors. Which foods should be avoided? (Select all that apply.)
A. Mushrooms
B. Peas
C. Onions
D. Broccoli
E. Buttermilk
F. Yogurt
CORRECT: A, B, C, D
Mushrooms
Foods the patient with a newly created colostomy needs to limit or avoid because of flatulence or odors include: broccoli, mushrooms, onions, and peas. Buttermilk will help prevent odors. Yogurt can help prevent flatus.
Peas
Foods the patient with a newly created colostomy needs to limit or avoid because of flatulence or odors include: broccoli, mushrooms, onions, and peas. Buttermilk will help prevent odors. Yogurt can help prevent flatus.
Onions
Foods the patient with a newly created colostomy needs to limit or avoid because of flatulence or odors include: broccoli, mushrooms, onions, and peas. Buttermilk will help prevent odors. Yogurt can help prevent flatus.
Broccoli
Foods the patient with a newly created colostomy needs to limit or avoid because of flatulence or odors include: broccoli, mushrooms, onions, and peas. Buttermilk will help prevent odors. Yogurt can help prevent flatus.
The nurse is providing teaching on ways to promote bowel health and disease prevention. Which statement will the nurse include in this teaching?
A. “You should start colorectal cancer screening when you are over 70 years of age.”
B. “You only need to have regular colonoscopies if there is colorectal cancer in your family.’
C. “If you perform fecal occult blood tests every 5 years, you don’t need a colonoscopy.”
D. “You should have a colonoscopy every 10 years starting at 45 years of age.”
CORRECT: D
“You should have a colonoscopy every 10 years starting at 45 years of age.”
The American Cancer Society recommends that for individuals of average risk for colorectal cancer (CRC), a colonoscopy every 10 years or flexible sigmoidoscopy every 5 years is adequate. The screening should begin for adults of 45 years of age or older unless individuals are at high risk for CRC.
