1. Nursing Management: Lower Gastrointestinal Problems
Chapter 43
Nursing Management: Lower Gastrointestinal Problems

2. 1. On the second postoperative day, a patient who had an exploratory laparotomy complains of abdominal distention and gas pains. The patient asks the nurse if this indicates damage to the bowel during surgery. The nurse’s best response to the patient is,
1. “Abdominal distention occurs as a normal response to inflammation and healing of the bowel.”
2. “Gas pains occur when a nasogastric tube is not used during surgery to remove air from the stomach.”
3. “This is a common complication of abdominal surgery but usually can be relieved by having a bowel movement.”
4. “This occurs because of bowel immobility caused by anesthesia and manipulation of abdominal contents during surgery.”
Answer: 4
Rationale: Swallowed air and decreased peristalsis from decreased mobility, manipulation of abdominal organs during surgery, and anesthesia can lead to abdominal distention and gas pains. Early ambulation helps restore peristalsis and eliminate flatus and gas pain.

3. 1. “I should change the appliance daily to prevent odors.”
2. Which of the following comments made by the patient indicates that additional instruction about the care of a new ileostomy is needed?
1. “I should change the appliance daily to prevent odors.”
2. “When I change the appliance, I should check the skin for irritation.”
3. “I should clean around the stoma with mild soap and water and pat dry.”
4. “I’ll need to alter the appliance opening when the stoma becomes smaller as the area heals.”
Answer: 1
Rationale: The appliance is changed every 4 to 7 days unless leakage occurs. Flatus is expelled from the bag through a charcoal filter that helps control odor. Skin around the stoma should be washed with plain water or mild soap, rinsed with warm water, and dried thoroughly before the barrier is applied. When the appliance is changed, the skin should be assessed for irritation. Mild to moderate swelling of the stoma is expected the first 2 to 3 weeks after surgery. Therefore the size of the pouch opening that fits around the stoma needs to be adjusted to accommodate the stoma’s changing size.

4. 1. Baked cod, baked sweet potato, and canned pears
3. After teaching the patient with inflammatory bowel disease about dietary modifications, the nurse determines that teaching was effective when the patient chooses which of the following menus?
1. Baked cod, baked sweet potato, and canned pears
2. Barbecued brisket, coleslaw, baked beans, and angel food cake
3. Fried shrimp with cocktail sauce, corn on the cob, and a fruit roll-up
4. Turkey burger with cheese on a whole wheat bun, french fries, and an orange
Answer: 1
Rationale: Patients with inflammatory bowel disease require a high-calorie, high-vitamin, high-protein, low-residue, lactose-free (if lactase deficiency) diet. High-fat foods may trigger diarrhea. Cold foods and high-fiber foods may enhance gastrointestinal transit.