Author Question: Which of the following expected outcomes or goals would be appropriate for a client with the nursing ... (Read 80 times)

nummyann · **on:** Jul 23, 2018

Which of the following expected outcomes or goals would be appropriate for a client with the nursing diagnosis Urinary Pattern Alteration related to an enlarged prostate?

1. The client will avoid bladder distention.
2. The client will maintain fluid imbalance.
3. The client will remain free of skin breakdown.
4. The client will voice increased discomfort.

Question 2

A client is rushed to the emergency department with what the physicians suspect to be necrosis of the urinary diversion stoma. What evidence presented by the client leads to this conclusion?

1. Black with sloughing
2. Moist stoma
3. Pink and shiny
4. Slight bleeding from stoma

tmlewis4706 · **Reply #1 on:** Jul 23, 2018

Answer to Question 1

Correct Answer: 1
Rationale 1: Avoiding bladder distention will help eliminate stasis of urine in the bladder which contributes to urinary tract infections, a possible complication of urine flow being obstructed from an enlarged prostate.
Rationale 2: One would want to maintain fluid balance, not imbalance, with a client with urinary obstruction and enlarged prostate. Keeping up with the client's intake and output would be a better goal.
Rationale 3: It is important to keep urine off the skin to prevent breakdown, but with an enlarged prostate the problem will be more of the client retaining urine instead of it being on the skin.
Rationale 4: One would hope if the retention subsides, the client would voice less discomfort, not more.

Answer to Question 2

Correct Answer: 1
Rationale: Black color to the stoma and sloughing are signs of necrosis to the stoma. A healthy stoma should appear pink to red and look moist and shiny. Slight bleeding might occur because the intestinal mucosa is very fragile.