A nurse on a postpartum unit is caring for a client.

Exhibits

The nurse should anticipate a provider's prescription for a(n)

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Rationale:

A. "I prefer to leave the lights off when I am changing my clothes.": This statement suggests discomfort with the appearance of the body after surgery and a desire to hide it, which reflects an altered body image. Avoiding visual exposure is a common coping mechanism for those struggling with physical changes.

B. "I am ready to join a breast cancer support group.": Willingness to participate in a support group indicates acceptance and proactive coping. It reflects psychological adaptation rather than body image disturbance.

C. "I want to have reconstructive surgery as soon as I can.": Expressing a desire for reconstruction shows future-oriented thinking and a readiness to restore body image, not necessarily an inability to accept the current state.

D. "I understand that my scars will eventually fade.": This statement demonstrates acceptance and understanding of the healing process, indicating a realistic and healthy perception of body changes.

Rationale:

• Temperature: The child’s temperature is 37.4°C (99.3°F), which is mildly elevated. Crohn’s disease typically causes intermittent fever during flare-ups. Appendicitis often presents with a higher fever in later stages. Intussusception can cause low-grade fever due to bowel inflammation, making it the most consistent with this finding.
• Vomiting: Vomiting is uncommon in Crohn’s disease unless there’s obstruction or severe disease. In appendicitis, vomiting usually follows the onset of pain and is related to peritoneal irritation. Intussusception often involves vomiting early due to intermittent bowel obstruction, making it consistent with this client’s symptoms.
• Pain rating: A FLACC score of 5 indicates moderate pain. Crohn’s pain tends to be chronic and crampy rather than episodic. Appendicitis pain worsens over time and becomes localized, typically in the right lower quadrant. Intussusception causes intermittent, severe abdominal pain with sudden relief, matching the child’s pain episodes and behavior.
• Abdominal findings: Crohn’s disease rarely produces a palpable abdominal mass or sudden distension. Appendicitis can cause right-sided tenderness and decreased bowel sounds but does not typically involve a mass. Intussusception often presents with a distended abdomen, hypoactive bowel sounds, and a sausage-shaped mass in the right upper quadrant, as described.
• Stool: Crohn’s disease can lead to bloody, mucus-filled stools due to ulceration in the intestinal lining. Appendicitis does not typically alter stool characteristics unless perforation occurs. Intussusception is well known for producing “currant jelly” stools, composed of blood and mucus, aligning with this child’s bowel movement description.