Sitty, a 66 y.o. patient underwent a colostomy for ruptured diverticulum. She did well during the surgery and returned to your med-surg floor in stable condition. You assess her colostomy 2 days after surgery. Which finding do you report to the doctor?

Correct Answer: A

Rationale: In this scenario, the correct answer is option A) Blanched stoma. A blanched stoma indicates poor blood supply to the area, which can be a sign of ischemia and compromised tissue viability. This finding is critical to report to the doctor promptly as it could lead to serious complications like necrosis if not addressed promptly. Option B) Edematous stoma can be a common finding postoperatively due to inflammation and fluid shifts, but it is not as concerning as a blanched stoma. It usually resolves on its own with proper care. Option C) Reddish-pink stoma is the ideal color indicating good blood supply and healthy tissue. This finding is normal and expected in the early postoperative period. Option D) Brownish-black stoma is indicative of necrotic tissue and requires immediate medical intervention. This finding suggests compromised blood flow and tissue death, which can be life-threatening if not addressed urgently. Educationally, understanding the assessment of a colostomy stoma is crucial for nurses caring for postoperative patients. Recognizing abnormal findings like a blanched stoma and knowing when to escalate concerns to the healthcare provider is essential in preventing complications and promoting positive patient outcomes.

Correct Answer: A

Rationale: The correct answer is A) Give tepid baths. In the context of pruritus (itching) due to hepatitis B, tepid baths can help alleviate discomfort by soothing the skin without causing further irritation. Tepid water helps to calm the skin and reduce itching sensations, providing relief to the patient. Avoiding lotions and creams (option B) is not the best intervention as these products can sometimes exacerbate itching or cause further skin irritation in individuals with pruritus, especially in the setting of hepatitis B. Using hot water to increase vasodilation (option C) may actually worsen pruritus by further irritating the skin and increasing blood flow, which can lead to more itching and discomfort. Using cold water to decrease itching (option D) is not recommended as it can cause vasoconstriction and may not provide the same soothing effect as tepid water. In the educational context, it is important for nurses to understand the underlying causes of pruritus and how different interventions can impact patient comfort. By choosing the appropriate intervention, such as giving tepid baths in this scenario, nurses can effectively manage symptoms and improve the overall well-being of patients with hepatitis B experiencing pruritus.

Correct Answer: D

Rationale: In the case of a patient like Rob, who is suspected to have Hepatitis B and presents with jaundice and weakness, the correct intervention is option D) Rest period after small, frequent meals. This choice is appropriate because patients with Hepatitis B often experience fatigue and weakness due to the strain on their liver. Providing rest periods after meals helps to conserve energy and aids in digestion, which can be compromised in liver disease. Option A) Regular exercise is incorrect in this scenario because excessive physical activity can exacerbate fatigue and put additional stress on the liver, which is already compromised in Hepatitis B. Option B) A low-protein diet is not the best choice as protein restriction is not typically recommended for Hepatitis B patients unless there are specific complications like hepatic encephalopathy. Protein is essential for tissue repair and maintaining muscle mass, important for overall recovery. Option C) Allowing the patient to select his meals may not be ideal in this case as a patient with Hepatitis B may have dietary restrictions that need to be followed to support liver function and promote healing. Providing guidance on a suitable diet is crucial in managing the condition effectively. In a medical-surgical nursing context, understanding the specific needs of patients with liver disease such as Hepatitis B is essential. Educating patients on appropriate dietary choices, rest periods, and energy conservation strategies is crucial in promoting optimal outcomes and supporting the patient's overall well-being during their hospital stay.

Correct Answer: D

Rationale: The correct answer is option D: "My family knows that if I get tired and start vomiting, I may be getting sick again." This statement indicates patient understanding because it shows awareness of the signs and symptoms of hepatitis B recurrence, emphasizing the importance of monitoring for early indications of illness. This reflects a proactive approach to managing the condition and seeking timely medical intervention if needed. Option A is incorrect because having had hepatitis B previously does not confer immunity from future infections or reinfections. Option B is incorrect as individuals with hepatitis B are typically deferred from donating blood due to the risk of transmitting the virus. Option C is also incorrect as ongoing liver damage can occur from alcohol consumption, especially in the context of hepatitis B. From an educational perspective, this question assesses the patient's understanding of hepatitis B management and self-care measures post-discharge. It highlights the importance of patient education in promoting self-awareness, early recognition of symptoms, and adherence to follow-up care to prevent disease progression and complications.

Correct Answer: A

Rationale: The correct answer is A) "You'll need to turn from side to side every 2 hours." This response is the best because it provides accurate postoperative care instructions for the patient undergoing a cholecystectomy. Turning from side to side every 2 hours helps prevent complications such as atelectasis, pneumonia, and pressure ulcers. This action also promotes circulation, aids in respiratory function, and reduces the risk of blood clots. Option B) "It's always a good idea to rest quietly after surgery," is incorrect as complete immobility can lead to complications and delays in recovery. Mobilization and turning are essential for postoperative patients to prevent complications and promote healing. Option C) "The doctor will probably order you to lie flat for 24 hours," is incorrect as prolonged immobility in the supine position can increase the risk of respiratory complications and venous thromboembolism. Option D) "Why don't you decide about activity after you return from the recovery room?" is incorrect because decisions regarding postoperative care should be based on evidence-based practices and healthcare provider recommendations rather than patient preferences, especially in terms of essential postoperative care activities like turning and mobilization. In a medical-surgical nursing context, it is crucial to educate patients on proper postoperative care to prevent complications and promote optimal recovery. Nurses play a vital role in ensuring that patients understand and adhere to these essential care instructions to enhance their outcomes and overall well-being.