After teaching a client who is recovering from a colon resection, ...

[kwoodring]

After teaching a client who is recovering from a colon resection, the nurse assesses the client's understanding. Which statements by the client indicate a correct understanding of the teaching? (Select all that apply.)
 
  a. I must change the ostomy appliance daily and as needed.
  b. I will use warm water and a soft washcloth to clean around the stoma.
  c. I might start bicycling and swimming again once my incision has healed.
  d. Cutting the flange will help it fit snugly around the stoma to avoid skin breakdown.
  e. I will check the stoma regularly to make sure that it stays a deep red color.
  f.
  I must avoid dairy products to reduce gas and odor in the pouch.

Question 2

A nurse inserts a nasogastric (NG) tube for an adult client who has a bowel obstruction. Which actions does the nurse perform correctly? (Select all that apply.)
 
  a. Performs hand hygiene and positions the client in high-Fowler's position, with pillows behind the head and shoulders
  b. Instructs the client to extend the neck against the pillow once the NG tube has reached the oropharynx
  c. Checks for correct placement by checking the pH of the fluid aspirated from the tube
  d. Secures the NG tube by taping it to the client's nose and pinning the end to the pillowcase
  e. Connects the NG tube to intermittent medium suction with an anti-reflux valve on the air vent

[momolu]

Answer to Question 1

ANS: B, C, D
The ostomy appliance should be changed as needed when the adhesive begins to decrease, placing the appliance at risk of leaking. Changing the appliance daily can cause skin breakdown as the adhesive will still be secured to the client's skin. The client should avoid using soap to clean around the stoma because it might prevent effective adhesion of the ostomy appliance. The client should use warm water and a soft washcloth instead. The tissue of the stoma is very fragile, and scant bleeding may occur when the stoma is cleaned. The flange should be cut to fit snugly around the stoma to reduce contact between excretions and the client's skin. Exercise (other than some contact sports) is important for clients with an ostomy. The stoma should remain a soft pink color. A deep red or purple hue indicates ischemia and should be reported to the surgeon right away. Yogurt and buttermilk can help reduce gas in the pouch, so the client need not avoid dairy products.

Answer to Question 2

ANS: A, C, E
The client's head should be flexed forward once the NG tube has reached the oropharynx. The NG tube should be secured to the client's gown, not to the pillowcase, because it could become dislodged easily. All the other actions are appropriate.