Question

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1. A client with ulcerative colitis has a total colectomy with formation of a terminal ileum stoma. What is an important nursing intervention for this patient postoperatively and why?

2. Upon assessment of the client to inspect the abdominal dressing, you find the original surgical dressing saturated with fresh bloody drainage. What do you do?

3. The client is receiving TPN at 85 mL/hr via a right subclavian central venous catheter. The nurse notices it was almost empty, but the night pharmacy does not prepare it during the night shift. What does the nurse need to do next?  (explain the rational for the right answer)

a. Notify the healthcare provider

b. Decrease the rate of the TPN to until the next TPN bag can be prepared

c. Hang a bag of D5W when the TPN is finished

d. Hang a bag of D10W when the TPN is finished

Answer 1

1.Check for drainage and output from ileostomy.Monitor intake and output of the patient to determine the fluid and electrolyte imbalance of the patient .Provide psychological support to patient and help him in ambulation.

2.Provide pressure and support the dressing, Notify the physician,Monitor vital signs and Elevate foot end to slow the bleeding, Send a coagulation profile along with complete blood count if adviced by physician.

3.Ans:Hang a bag of D10W when TPN is finished.

a. Notify the healthcare provider- Should notify healthcare provider but he also cannot do anythin if pharmacy does not prepare it during night.

b. Decrease the rate of the TPN to until the next TPN bag can be prepared-The TPN should be given at a prescribed regular rate, Decreasing the flow may lead to hypoglycemia

c. Hang a bag of D5W when the TPN is finished:D5W also can be given but D10W may decrease chances of hypoglycemia .

d. Hang a bag of D10W when the TPN is finished:Because abrupt discontinuation of TPN may lead to hypoglycemia