When evaluating a health care team member's ability to digitally remove feces, the nurse determined that further teaching is required in which of the following situations?
a. Staff member provides perianal skin care.
b. Staff member continues the procedure if bleeding starts.
c. Staff member follows the procedure by offering the patient the bedpan.
d. Staff member discontinues the procedure in the presence of bradycardia.
B
If the patient experiences bleeding from the rectum, the anal and perianal regions should be assessed to locate the source of the bleeding. Observe for the presence of perianal skin irritation. The presence of such indicates the need for postprocedure skin care to the perianal region to reduce pain during subsequent bowel elimination. After the procedure, assist the patient to the toilet or onto a clean bedpan. Removal of impaction stimulates the defecation reflex. The sacral branch of the vagus nerve is stimulated during digital stimulation; this may result in reflex slowing of the heart rate. Stop the procedure and retake vital signs.
You might also like to view...
The child in early adolescence experiences developmental issues with his or her identity as evidenced by:
a. Feeling stable with his or her self-esteem b. Conforming to group norms c. Being very self-centered d. Being idealistic
Which types of drugs are used to treat inflammatory bowel disease (IBD)? (Select all that apply.)
a. Aminosalicylates b. Glucocorticoids c. Immunomodulators d. Opioid antidiarrheals e. Sulfonamide antibiotics
A client is to receive an implantable contraceptive. The nurse describes this contraceptive as containing:
A) Synthetic progestin B) Combined estrogen and progestin C) Concentrated spermicide D) Concentrated estrogen
A pocket mask can be turned upside down for infant resuscitation.
Answer the following statement true (T) or false (F)