An 82-year-old patient with a history of chronic heart and ...

[Brittanyd9008]

An 82-year-old patient with a history of chronic heart and respiratory problems asks the nurse, What can I do to keep my hemorrhoids from acting up? Which of the following responses made by the nurse are appropriate? (Select all that apply.)
 
  a. Ask if he experiences constipation with any regularity.
  b. Encourage him to increase his fluid intake to 2000 mL daily.
  c. Suggest he eat more whole grains and fresh fruits.
  d. Discuss how he should include a walk into his daily routine.
  e. Ask if he has a history of rectal bleeding.

Question 2

An older adult patient has an open, draining wound on the lower medial aspect of the right leg. The skin surrounding the wound is reddish brown with surrounding erythema and edem
 
  a. Based on this information, the nurse edits the patient's care plan to include impaired skin integrity:
  a. related to altered venous circulation.
  b. peripheral related to arterial insufficiency.
  c. related to diabetic neuropathy.
  d. open wound related to pressure ulcer.

[bhavsar]

Answer to Question 1

A, C, D, E
Nursing management of an older patient with hemorrhoids includes the prevention and elimina-tion of constipation. This includes a review of high-fiber, high-roughage foods, including indi-gestible fiber like whole grains, legumes, and fresh fruits and vegetables. An adequate intake of fluids is also important. Older patients should be encouraged to consume up to 2000 mL of fluids each day unless contraindicated. This patient has heart disease and possibly should not take in that much fluid. The nurse should encourage light exercise on a regular basis and review the im-portance of a regular toileting routine. Rectal bleeding should be investigated.

Answer to Question 2

A
Venous ulcers are usually on the medial aspect of the lower leg, with flat or shallow craters and irregular borders, accompanied by varicosities, liposclerosis (brown ruddy color and thickened skin), and itching. Venous ulcers generate a large amount of exudate and are usually surrounded by erythema and edema. Arterial insufficiency would produce shiny, taut, hairless skin. There is no indication the patient is a diabetic. There is no indication the patient has risks for pressure ulcers.