A nurse is caring for a client.

Nurses' Notes 0900:

Client reports a 3-month history of intermittent diarrhea and abdominal pain. Reports unintentional weight loss of 5.5 kg (12 lb) in 3 months.

0930:

Stool sample obtained for fecal occult blood test. Fatty appearance and foul odor noted.

For each assessment finding, click to specify if the finding is consistent with ulcerative colitis, diverticulitis, or Crohn's disease. Each finding may support more than 1 disease process.

Client reports lower back pain and pinkish vaginal discharge.

• Explanation: Lower back pain and pinkish discharge can indicate preterm labor, especially given the client’s history of a previous preterm birth.

Uterine contractions every 8 minutes, palpate strong, duration 30 seconds.

• Explanation: Frequent and strong contractions suggest that labor may be progressing, which is concerning at 33 weeks gestation and needs close monitoring.

FHR baseline 145, minimal variability.

• Explanation: Minimal variability in the fetal heart rate (FHR) can be a sign of fetal distress or a lack of fetal well-being, warranting further evaluation.

Cervical exam indicates 2 cm, 50% effaced, 0 station.

• Explanation: Cervical dilation and effacement at 33 weeks gestation indicate that labor is progressing. Given the client's history of preterm birth, this finding is concerning and requires intervention to try to prevent another preterm delivery.

Choice C rationale:

Avoiding consuming foods containing chocolate is important for individuals with gastroesophageal reflux disease (GERD) Chocolate contains substances that can relax the lower esophageal sphincter, allowing stomach acid to flow back into the esophagus, worsening GERD symptoms. Therefore, the nurse should include this information in the discharge teaching to help the client manage GERD effectively.

Choice A rationale:

Taking antacids that contain mint for heartburn is not recommended. Mint can relax the lower esophageal sphincter, similar to chocolate, potentially worsening GERD symptoms. Therefore, clients with GERD should avoid mint-containing products.

Choice B rationale:

Increasing dietary intake of citrus fruits is not advisable for individuals with GERD. Citrus fruits are acidic and can irritate the esophagus, leading to increased reflux symptoms. Clients with GERD should limit or avoid citrus fruits in their diet.

Choice D rationale:

Lying down for 30 minutes after eating a meal is not a recommended practice for individuals with GERD. Instead, clients with GERD should remain upright for at least 2-3 hours after eating to reduce the risk of reflux. Lying down shortly after a meal can worsen symptoms by allowing stomach acid to flow back into the esophagus more easily.