A nurse is gathering medical history from a client admitted for pyelonephritis. Which of the following should the nurse expect the client to report when asked about their medical history?

Choice A reason: A new ileal conduit is a permanent life change that requires the client to learn complex self-care skills. The uncertainty regarding stoma management, fear of appliance leakage in public, and the lifestyle adjustments required often lead to significant anxiety. The nurse must address these psychological stressors during the initial postoperative period to promote successful adaptation.

Choice B reason: The continuous drainage of urine from the stoma creates a high risk for peristomal skin breakdown. Urine is caustic to the skin, and moisture trapped under the skin barrier can lead to maceration, dermatitis, or fungal infections. Maintaining a secure, well-fitted appliance and assessing the skin frequently are essential nursing interventions for this risk.

Choice C reason: Surgical creation of an ileal conduit involves bowel resection and ureteral implantation, increasing the risk for peritonitis or wound infection. Furthermore, since the conduit is a direct pathway to the kidneys without a sphincter, the client is at lifelong risk for ascending urinary tract infections or pyelonephritis requiring vigilant monitoring.

Choice D reason: While postoperative patients require fluid monitoring, an ileal conduit does not typically cause a chronic fluid volume deficit. Unlike an ileostomy, where significant water and electrolytes are lost through liquid stool, the ileal conduit simply transports urine. Unless there is excessive surgical bleeding or unrelated dehydration, this is not a primary risk.

Choice E reason: The permanent diversion of urine to an external pouch on the abdomen significantly alters the client's physical appearance and "normal" elimination process. Concerns regarding sexual function, clothing choices, and the presence of a stoma frequently lead to a disturbed body image, necessitating supportive counseling and referral to an ostomy nurse.

Choice A rationale
Monitoring fluid and electrolytes is essential in managing ascites to prevent complications such as fluid overload or electrolyte imbalances, which can exacerbate the condition.

Choice B rationale
Providing a high-sodium diet is not recommended for patients with ascites. Sodium restriction is typically advised to help manage fluid retention.

Choice C rationale
Anticipating paracentesis is appropriate as it is a procedure used to remove excess fluid from the abdominal cavity, providing relief from discomfort and respiratory difficulty.

Choice D rationale
Encouraging high-fluid intake is not recommended for ascites management. Fluid restriction may be necessary to prevent further accumulation of fluid in the abdominal cavity.

Choice E rationale
Administering an albumin infusion can be part of the treatment for ascites, especially following paracentesis, to help maintain blood volume and pressure.