1. Which of the following instructions should the nurse provide? Those with persistent symptoms or a recurrent C. difficile infection may be given vancomycin. 14. *Provide mouth care to them at least every 2 hours* (Providing oral car was needed to a client who is near death will help reduce discomfort from dehydration, nausea, and dry mucous membranes). do any one have ATI Fundamentals proctor exam or can help me study for it I really need to pass this test? (The nurse should instruct the client to remove constrictive clothing prior to measuring their blood pressure because constrictive clothing can cause falsely elevated blood pressure readings). Which of the following statements by the client indicates an understanding of the teaching? This is part of healing the bowel. *Notify the charge nurse of the client's concerns* Sugary, carbonated, caffeinated, or alcoholic drinks can worsen diarrhea. A nurse and newly hired nursing assistant are caring for a group of clients. A nurse is caring for a client who has dysphagia following a stroke. A major shortcoming of opiates, the most commonly prescribed antidiarrheal agents, is that they have no antisecretory effect. A nurse manager is reinforcing teaching with a group of newly licensed nurses about the disclosure of client health information. Oil droplets on the toilet water are constantly diagnostic of pancreatic insufficiency. Williams' Basic Nutrition and Diet Therapy, absolutism and englightenment test (not inclu, Impact of advertising on children - debates. The nurse should, identify that the client is experiencing which of the following, A nurse is contributing to the plan of care for a client who is dying. These are patients who have severe *This dressing allows the wound bed to breathe* Fourniers gangrene in a pediatric patient after prolonged neglected diarrhea: A case report. The strategies are intended to facilitate implementation of CDI prevention efforts by state and . Advising a client on self-administration of aceta-minophen 3.Teaching a client to perform a finger-stick for testing blood glucose levels Performing post-mortem care . (The nurse should instruct the client's partner to tighten the abdominal and gluteal muscles to help protect their back). *You should cover your mouth with a tissue when you cough* Administer 10-20% of dextrose IV to keep the line open and run it at the . or just 30/2.2 and you get 13.6 kg). Neurogastroenterology & Motility, 18(12), 1045-1055. Most travelers diarrhea (85%) is due to enterotoxin E. coli (Semrad, 2012). 17. 1. A nurse is checking a client for a pulse deficit after detecting an irregular heart rate. (The nurse should keep the family updated about the client's status to assist the family in planning for the near future). Which of the following actions should the nurse take? *Remove the staple from the skin after both sides are visible* *"Please don't tell my doctor, but I am taking my partner's oxycodone* Which of the following actions should the nurse take first? Avoid using medications that slow peristalsis. Keep giving the oral rehydration solution until diarrhea is less frequent. Which of the following findings should the nurse, A nurse is reinforcing teaching with a client who has pneumonia and a, productive cough. Which of the following actions should the nurse plan to take to. Which of the following actions should the nurse plan to take to prevent the transmission of this infection to others? : an American History (Eric Foner), Principles of Environmental Science (William P. Cunningham; Mary Ann Cunningham), The Methodology of the Social Sciences (Max Weber), Forecasting, Time Series, and Regression (Richard T. O'Connell; Anne B. Koehler), Business Law: Text and Cases (Kenneth W. Clarkson; Roger LeRoy Miller; Frank B. side effect of ciprofloxacin. Measure the specific gravity of urine if possible. -Wash hands after removing gloves. A nurse is caring for a client who has an NG tube and is receiving intermittent feedings through an open system. Zhao, T., Gao, X., & Huang, G. (2021). Eisenberg, P. (1993). Clinical infectious diseases, 48(5), 598-605. There are many variations of passages of Lorem Ipsum available, but the majority have suffered alteration in some form, by injected humour, or randomised words which dont look even slightly believable. (The nurse can share information with other staff who are caring for the client because it is essential to maintaining continuity of care, and does not violate the client's confidentiality. A nurse observes a new nurse graduate exit a clients room who has a confirmed diagnosis of A client in the oliguric phase of acute renal failure had a urinary output of 420 ml during the preceding a 24 hr period. Suggested Pharmacology Learning Activity: Heart Failure Meanwhile, antidiarrheal agents used to treat severe secretory and inflammatory diarrheas typically have profiles with more serious side effects (Semrad, 2012). (The stoma should be reddish-pink and moist. 11. c. Daily intake of cranberry juice or cranberry supplements may reduce the number of urinary tract infections. (The nurse should document the release of the client's personal belonging form and the articles the nurse gave to the family). c. the client has an oral temperature of 39 C (102.2F) d. the client has redness and warmth in his calf. *Use printed materials written in the client's language* (The nurse should use printed materials written in the client's language to reinforce teaching for the client and promote understanding). Foods may trigger intestinal nerve fibers and cause increased peristalsis. (The nurse should document 3+ pitting edema when there is a deep indentation of the tissue, which Is about 6mm). Which of the following actions should the nurse take? The nurse should assist the client into which of the following positions. entering a patients room and after exiting a patients room. Other manifestations include lower abdominal pain and cramping, low-grade fever, nausea, and anorexia [ 2,5 ]. Then, the nurse can plan education to meet the. Which of the following actions should the nurse plan to take? ( if the nurses hands are, wet or the paper towel is wet when they turn off the faucet, they increase the risk of transferring micro-, organisms from the faucet back to their hands. (2011). A nurse is in a long-term care facility in collecting admission data from a client who uses a hearing aid. Which of the following actions should the nurse take to ensure client safety? Administer 10-20% of dextrose IV to keep the line open and run it at the 26. -Hypokalemia or hypomagnesemia A breach of client confidentiality can result in liability for those involved). teaching points about this medication that the nurse should discuss Taper the dose before discontinuing, never Store the solution in the refrigerator Mix the medication with chocolate milk. 4. A nurse is providing education for a client being discharged with a This leads to a mild case of diarrhea. For patients taking digitalis, monitor magnesium levels as it Use a small teaspoon when measuring the medication A nurse is caring for a client who has Clostridium difficile-associated diarrhea. A nurse is preparing to administer a topical medication to a client. ; Gilani, A. This is actually the care plan for diarrhea. Assess history for abdominal radiation therapy. region. 14. report diarrhea while taking can increase the risk of Clostridium difficile infection. Keeping a food and symptom diary can help determine a pattern. A pulse deficit occurs, when there are differences between the radial and apical pulse rate), A nurse is preparing to obtain a clients vital signs. (Select all that apply). Use the Common Toxicity Criteria (CTC) to grade chemotherapy-related diarrhea.CTC guidelines are used in many countries like the U.S. and U.K. in grading and treating chemotherapy-related diarrhea. and truncal obesity. Clean hands with an alcohol-based hand rub immediately after removing gloves. Which of the, following interventions should the nurse recommend to include the client's family, in the plan of care? Infection Control HospEpidemiol. 2023 Nurseslabs | Ut in Omnibus Glorificetur Deus! Student exploration Graphing Skills SE Key Gizmos Explore Learning. This increase may be due to: Strains of C. difficile bacteria that cause more severe . 6, 10 C. difficile is transmitted from person to person by the fecal-oral route. Chronic Diarrhea: Diagnosis and Management. Encourage the patient to eat small, frequent meals and to consume foods that normally cause constipation and are easy to digest.Bland, starchy foods are initially recommended when starting to eat solid food again. Which action should the nurse take when washing, Turn off the faucet with a clean paper towel after drying hands. -Administer antipyretics as ordered 3. (The client can change their advance directives at their discretion). (Using a towel and emesis basin helps protect bed linens). *I will remove all stuffed animals from my baby's crib* (The nurse should reinforce the need to remove all stuffed animals and toys when the infant is sleeping to reduce the risk for SIDS). ( The nurse should initiate, contact precautions for clients who have a C dif infection. Phenytoin is an antiarrhythmic and anticonvulsant. Causes of diarrhea in tube-fed patients: a comprehensive approach to diagnosis and management. A nurse is caring for a client who has an indwelling urinary catheter. These measurements are important to help evaluate a persons fluid and electrolyte balance, suggest various diagnoses, and prompt intervention to correct the imbalance. Evaluate the pattern of defecation.Everyones bowels are unique to them. Which of the following actions should the nurse take? Use a leading zero if it applies. A nurse is caring for a client who is postoperative following a mastectomy. Approach to the patient with diarrhea and malabsorption. The following are the common causes of diarrhea: A patient with diarrhea may report the following signs and symptoms: The following are the common goals and expected outcomes for Diarrhea: A thorough assessment is important to ascertain potential problems that may have led to diarrhea and handle any conflict that may appear during nursing care. A nurse is contributing to the plan of care for a client who practices Islam. Psyllium products combined with laxatives should be avoided. *Became short of breath when ambulating* -Know signs and symptoms for a latex allergic reaction Which of the following actions should the nurse take? Provide perianal care after each bowel movement.Diarrhea can cause burning and inflammation around the anus. Then, the nurse can plan education to meet the client's needs). Antidiarrheal agents are of two types: those used for mild to moderate diarrheas and those used for severe secretory diarrheas. A nurse is contributing to the plan of care for a client who is at risk for developing foot drop due to immobility. phenytoin within 2-3 hours of antacids. A nurse is planning care for a group of clients. Diary log should include the time of day defecation occurs; a usual stimulus for defecation; consistency, amount, and frequency of stool; type of, amount of, and time food consumed; fluid intake; history of bowel habits and laxative use; diet; exercise patterns; obstetrical/gynecological, medical, and surgical histories; medications; alterations in perianal sensations; and present bowel regimen (OBrien et al., 2005). Antimotility agents for the treatment of Clostridium difficile diarrhea and colitis. When cleaning, use a mild cleansing agent (perineal skin cleanser), apply a protective ointment or barrier creams, and if the skin is excoriated or desquamated, apply a wound hydrogel. Which of the following actions should the nurse take? Which of the following interventions should the nurse recommend? Medications 2. Which of the following interventions should the nurse use when feeding the client? (The nurse should identify that the client's comments indicate an actual loss, which is a loss that occurs when the person can no longer feel, see, hear or know an object, another person, or a part of themselves, such as the loss of a body part). The correct, placement of the ultrasound device is just above the symphysis pubis), A nurse is checking a client for a pulse deficit after detecting an irregular heart rate. A nurse in reinforcing teaching about carbohydrate counting with a client who has a new diagnosis of diabetes mellitus. The nursing staff may not have the time to properly follow the necessary and very time-consuming steps of their care. The bloating and gas may cause a flare and lead to diarrhea. Select all that apply. -ototoxicity prescription for phenobarbital. A nurse is reinforcing teaching with a client who speaks a different language than the nurse. 25. Which of the following client statements indicates an understand of the teaching. For more information, check out our privacy policy. A nurse is preparing to administer a medication to a preschooler and must convert the child's weight from pounds to kilograms. Looking for a comprehensive guide to Applied Radiological Anatomy? A nurse is assisting with the care of a client who has a prescription for IV therapy. It is, perhaps, also intended by nature to offset an excessive stimulant effect (Mehmood et al., 2010). Clostridium difficile . 3- -Place a towel under the client's head with an emesis basin under their chin. A nurse in an acute care setting is documenting postmortem care in a client's medical record. (A client who has dysphagia following a stroke should sit upright with their head tilted forward to facilitate swallowing and to prevent aspiration). This is a Premium document. Clostridium difficile infection, also known as C. diff, is a gram-positive rod-shaped bacteria that forms spores enabling pathogens to survive in unfavorable conditions and enable human-to-human transmission. Which of the following statements should the nurse make? do any one have ATI Fundamentals proctor exam or can help me study for it I really need to pass this test? *Have you had small liquid stools? 20. Assessment of defecation pattern will help direct treatment. What action, Count clients radial and apical pulses simultaneously with another nurse. Nursing Care Plans Nursing Diagnosis & Intervention (10th Edition)Includes over two hundred care plans that reflect the most recent evidence-based guidelines. 2- Position the client on their side with their head turned to the side. (Guided imagery is a technique that can produce physical changes in the body, such as decreasing pain levels, by concentrating on a visualization of a pleasurable memory). If the infant refuses ORS by the cup or bottle, give this solution using a medicine dropper, small teaspoon or frozen pops. Educate patient or caregiver about dietary measures to control diarrhea. which of the following findings indicates that the nurse should increase the rate infusion? 1530 ml c. 920 ml d. 2550ml ANS: C. A nurse is planning care for a client who is pregnant and plans to breastfeed her newborn. Behavioral factors associated with diarrhea among adults over 18 years of age in Beijing, Mehmood, M.H. An accurate daily weight is an important indicator of fluid balance in the body. The nurse asks the nursing assistant if she's been validated on obtaining fingerstick glucose readings. What are maintaining good dental hygiene to prevent gingival hyperplasia. Generally, adults should drink 2 to 3 liters/day of water. These are a few things nurses can encourage, or the patients can do to treat or stop this from happening. Hand hygiene is necessary before -Perform oral hygiene A nurse is planning to administer medication to a client who has a Clostridium difficile infection. *Headache* Thompson, W. G. (2005). *A purple-colored stoma* It may also be due to infection, inflammatory bowel diseases, side effects of drugs, increased osmotic loads, radiation, or increased intestinal motility. nurse take regarding this allergy? he nurse is preparing to auscultate the bowel sounds of a client with a nasogastric tube in place set to low intermittent suction. This may explain its medicinal use in diarrhea. Diarrhea triggered by prescription drugs should be reported immediately to prevent the worsening of diarrhea. While this stool may be too large to pass, loose, watery stool may be able to get by, leading to diarrhea, leakage, or exploding of fecal material. Watery stools are characteristic of disorders of the small bowel, while loose, semisolid stools are linked more frequently with disorders of the large bowel. The nurse should identify, A nurse is contributing to the plan of care for a client who is dying. Adult patients can use oral rehydration solutions or diluted juices, diluted sports drinks, clear broth, or decaffeinated tea. The nurse should expect to witness an informed consent for a client who will undergo which of the following procedures? . This is referred to as "breathing" and promotes healing of the wound.). nurse if any changes are noticed - no matter how big or small - can help keep residents safe and healthy, and may even save a life. for the infection. Texas Nursing Jurisprudence exam 2023 with 100.pdf, A charge nurse is teaching a group of newly licensed nurses about the correct use of restraints.pdf, psych.chap5 (2018_09_26 18_17_17 UTC).rtf. Patients differ in their definition of diarrhea, noting loose stool consistency, increased frequency, the urgency of bowel movements, or incontinence as key symptoms. What priority action should the nurse implement? American Journal of Epidemiology, 178(7), 11291138. The nurse should expect to witness, an informed consent for a client who will undergo which of the following, A nurse is collecting data from a client who is 2 days postoperative following a, colostomy placement. information regarding self-glucose monitoring should the nurse The child weighs 30 lb. -Using the ABCs of prioritization (airway, breathing, circulation) Nursing Diagnosis: Nausea and Vomiting related to upset stomach and gastric distention secondary to C. difficile infection as evidenced by gagging sensation and dizziness. A nurse is caring for a client who reports itching 30 min after receiving a newly prescribed medication. i just fail the first one and have one more chance. -Keep the family updated about the client's status. ), A nurse is preparing to perform a wound irrigation for a client who has a stage 3 pressure injury. This response triggers the release of hormones that conveys the body ready to take action. During the night, the client is unable to sleep and is restless. Double the next dose if the child misses a dose. Other factors associated with enteral nutrition that may contribute to diarrhea include the composition of the formula, the manner of administration, or bacterial contamination. Which client should the nurse assess first? The nurse should explain the manifestations of impending death to reduce the family member's anxiety and stress). Neogi, S., Kariholu, P. L., Chatterjee, D., Singh, B. K., & Kumar, R. (2013). Whats normal for one person may not be normal for another. Includes step-by-step instructions showing how to implement care and evaluate outcomes, and help you build skills in diagnostic reasoning and critical thinking. It is designed for infants who have trouble digesting standard cows milk-based formulas and experience GI issues, reflux, colicky crying, and other symptoms when given these regular formulas. Which of the following client statements indicates an understanding of the teaching? ( The nurse should initiate contact precautions for clients who have a C dif infection. Within 24 hours of nursing interventions, the patient will consume at least 1,500 to 2,000 mL of clear liquids to maintain good skin turgor and normal weight. Chang, S. J., & Huang, H. H. (2013). - Remove the cover gown in the client's room after providing care. Ackley and Ladwigs Nursing Diagnosis Handbook: An Evidence-Based Guide to Planning CareWe love this book because of its evidence-based approach to nursing interventions. North American travelers to developing countries and travelers on airplanes and cruise ships are at high risk for acute infectious diarrhea. Pharmacology Learning Activities: Urinary tract Infections Diarrhea prevention through food safety education. Give antidiarrheal drugs as ordered.Most antidiarrheal drugs suppress gastrointestinal motility, thus allowing for more fluid absorption. Which of the following information should the nurse document? A nurse is caring for a client who is postoperative following a mastectomy. Educate patient or caregiver on the proper use of antidiarrheal medications as ordered.Antidiarrheal medications are found in most drug stores or pharmacies, or a physician can prescribe them. Covering the mouth with a tissue when coughing is an effective method of containing secretions to avoid spreading the infection). Within 8 hours of nursing interventions, the patient verbalizes understanding of diarrheas causes and the rationale for treatment. A nurse is providing care for a client with a prescription for baclofen. How shall the nurse approach the assessment of bowel sounds. Current Opinion in Clinical Nutrition & Metabolic Care, 16(5), 588-594. Which of the following supplies should the nurse plan, A nurse is planning care for a group of clients. Identify the sequence of steps the nurse manager, A nurse in a surgical clinic is providing teaching to the client who is scheduled for modified radical mastectomy. A hydrolyzed formula has protein partially broken down into small peptides or amino acids for people who cannot digest nutrients. Acute diarrhea-induced shock during alcohol withdrawal: a case study. The hydrolyzed formula is one type of hypoallergenic infant formula. 11. *An employer completing a pre-employment screening* However, severe diarrhea can lead to dehydration or severe nutritional problems. 20. * The client's output was 60 mL for the past 3 hr* prescribed rate. A.; Sack, R. B.; Valentiner-Branth, P.; Checkley, W. (2013). 21. Report muscle pain to the provider. 17. List three (3) potential adverse effects of baclofen. 2040 ml b. Desired outcome: The patient will be knowledgeable enough about the management of nausea and vomiting. A nurse is planning to administer multiple medications to a client who has an enteral tube feeding. *Release of personal belongings form* Which of the following findings is the priority for the nurse to report to the provider? Which of the following actions should the nurse take? -Encourage the family to comb the client's hair. Fourniers gangrene is necrotizing fasciitis of the perineal region. Which of the following intervention should the nurse recommend to include the client's family in the plan of care? Ask the client what they already know about meal planning. 2021-22. Therefore, the nurse should evaluate the bladder contents before performing an invasive procedure. Which of the following supplies should the nurse plan to use? Suggested Pharmacology Learning Activity: Immune System 7. Adverse effects include laryngospasm, delirium, and respiratory (The nurse should perform hand hygiene after removing gloves to prevent the transmission of micro-organisms from one setting or client to another). redness at the Achilles tendon site. The charge nurse can then inform the provider that the client requires further explanation of the procedure). A nurse is providing oral hygiene for a client who is unconscious. *Tell the nurses to change the topic of conversation*(The nurse has the responsibility to protect the client's right to confidentiality and should intervene on the client's behalf. Which of the following statements should the nurse make? *Perform a bladder scan* The provider may prescribe a The child weighs 30 ib. What action is required as a responsibility of the A nurse is contributing to the plan of care for a client who is dying. After rehydration has been accomplished, oral rehydration solutions are given at rates equaling stool loss plus insensible losses until diarrhea stops. Such conditions as diabetes often cause diarrhea in patients who receive enteral nutrition, malabsorption syndromes, infection, gastrointestinal complications, or concomitant drug therapy other than enteral formula (Chang & Huang, 2013). a)"I will avoid. Determine intolerances to food.If a person has a food intolerance, eating that food can cause diarrhea or loose stool. A bladder scan determines the amount of urine in the bladder and helps the nurse avoid unnecessary catheterizations). A nurse is demonstrating the use of a transparent film dressing over a client's superficial wound. A nurse is caring for a client who is in labor and requires augmentation of labor. Clostridioides difficile (klos-TRID-e-oi-deez dif-uh-SEEL) is a bacterium that causes an infection of the large intestine (colon). A nurse is caring for a client who is receiving intermittent enteral feedings. 4. A nurse is caring for a client who is postoperative following a mastectomy. Evaluate the appropriateness of protocols for bowel preparation based on age, weight, condition, disease, and other therapies. Which of the following actions should the nurse take first? *A client who has just experienced the death of their child* Patients with gastric partitioning surgery for weight loss may experience diarrhea as they begin refeeding. Severely dehydrated patients should be immediately managed and treated with intravenous Ringers lactate or saline solution, with additional potassium and bicarbonate as needed. do any one have ATI fundamentals proctor exam. Medizinische Klinik (Munich, Germany: 1983), 103(6), 413-22. It may arise from various factors, including malabsorption disorders, increased secretion of fluid by the intestinal mucosa, and hypermotility of the intestine. Culture stool.Testing or stool examinations will distinguish infectious or parasitic organisms, bacterial toxins, blood, fat, electrolytes, white blood cells, and potential etiological organisms for diarrhea. As a result, the body loses weight. Place the client in a room with negative-pressure airflow 2. 2. A nurse receives change- of-shift report on 4 clients . 2010; 31: 431-55. Which of the following conditions should the nurse recognize as a contraindication to the use of oxytocin? Schiller, L. R., Pardi, D. S., & Sellin, J. H. (2017). I have read the dosage information and the important administration instructions a nurse should implement a client taking bisphosphonate medication who has . Clean hands with an alcohol-based hand rub immediately after removing gloves. 29. Dig Dis Sci 56, 14601471. *Measure the client's gastric residual before each feeding* Advise the ED that they need to hold the transfer until the nurse speaks with the nursing supervisor. It demonstrates caring and patience and allows the client to speak when they are ready to do so). -provides more stability and balance Have the patient stop taking the medication and ), A nurse in a long-term care facility is collecting admission data from a client, who uses a hearing aid. Does anyone has a RN fundamental ati proctored exam with 70 questions? More than 700 medications can cause diarrhea, including furosemide, caffeine, protease inhibitors, thyroid preparations, metformin, mycophenolate mofetil, sirolimus, cholinergic drugs, colchicine, theophylline, selective serotonin reuptake inhibitors, proton pump inhibitors, histamine-2 blockers, 5-ASA derivatives, angiotensin-converting enzyme inhibitors, bisacodyl, senna, aloe, anthraquinones, and magnesium- or phosphorus-containing medications. Footnote 1 C. difficile is the most frequent cause of healthcare-associated infectious diarrhea in Canada and other developed countries. Contact precaution includes the removal of the, cover gown and other personal protective equipment inside the clients room to prevent the spread of. -Monitor vital signs, A nurse is documenting on the electronic medical record (EMR). (The statement is open-ended and allows for further communication. Diarrhea is a manifestation of dumping syndrome in which an increased osmotic bolus entering the small intestine draws fluid into the small intestine. Alterations in eating habits can cause intestinal function changes and lead to diarrhea. The nurse should instruct the client to stand with their feet together and their arms at their sides). Another way to release stress is through the power of music. will the nurse take? following statements should the nurse make? Clinical Gastroenterology and Hepatology, 15(2), 182-193. * 23. ( This situation poses an ethical dilemma for the nurse because there is a conflict between what the client is asking of the nurse and the nurse's responsibility to protect the client from harm during hospitalization). Determine tolerance to milk and other dairy products. Some people who have C. diff bacteria but do not have symptoms are referred to as carriers . Provide bulk fiber (e.g., cereal, grains, psyllium) in the diet.Bulking agents and dietary fibers absorb fluid from the stool and help thicken the stool. What are potential adverse effects the new antibiotic. Instead, they function by decreasing intestinal motility, thereby allowing longer contact time with the mucosa for improved fluid absorption. C.) The client has an oral temperature of 39 C (102.2 F). *Performance of a paracentesis* Remove the cover gown in the client's room after providing care Journal of International Medical Research, 49(2), 0300060521990464. A nurse is reinforcing teaching with a client who is scheduled for a bladder scan. NANDA International Nursing Diagnoses: Definitions & Classification, 2021-2023The definitive guide to nursing diagnoses is reviewed and approved by NANDA International. depression. The client states he is . 4- Separate the client's upper and lower teeth with an oral airway device. Do not use a trailing zero. A nursing diagnosis is used to determine the appropriate plan of care for the patient.

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