A nurse is preparing to discharge a client from a surgical unit.

Exhibits

Which 3 dietary strategies should the nurse recommend to prevent post- operative complications for this client?

Rationale:
A. Family history increases risk for heart disease and arthritis but is not a direct risk factor for peptic ulcer disease.
B. Smoking increases gastric acid secretion, reduces mucosal healing, and significantly raises PUD risk.
C. Alcohol use is denied by the client and therefore is not a contributing factor in this case.
D. Adalimumab use (an immunosuppressant for rheumatoid arthritis/psoriasis) does not directly increase PUD risk.
E. NSAIDs inhibit prostaglandin synthesis, reducing the gastric mucosal barrier and predisposing to ulcer formation.
F. H. pylori infection is a primary cause of peptic ulcers due to its damaging effect on gastric mucosa.

Rationale:
A. Tap water enemas are hypotonic, and repeated or large-volume use can lead to hyponatremia or other electrolyte disturbances, particularly in infants, elderly clients, or those with renal or cardiac issues.

B. Administering a tap water enema in a client with suspected appendicitis can increase intra-abdominal pressure, potentially causing perforation or worsening the condition.

C. Tap water enemas can further disrupt fluid and electrolyte balance in clients who are already dehydrated, exacerbating their condition.

D. Regular use of laxatives is not a strict contraindication for a tap water enema but may reduce its effectiveness over time due to bowel adaptation.

E. Clients with recent bowel surgery or structural abnormalities are at higher risk for perforation or injury when receiving an enema.

F. Tap water enemas are not indicated for clients with normal bowel function because they are unnecessary and can cause discomfort or dependence.

G. While maintaining hydration is important, it does not contraindicate the use of a tap water enema; it may actually support bowel function.