A nurse is assisting in the care of a client who has tuberculosis. Which of the following personal protective equipment should the nurse wear during routine care for this client?

Teaching for a client with a new ascending colostomy focuses on stoma care, expected stool characteristics, and early identification of complications such as impaired blood flow or ischemia. An ascending colostomy typically produces semi-liquid to liquid stool because it is located in the proximal large intestine where minimal water absorption occurs. Proper education also includes recognizing normal stoma appearance and identifying warning signs that indicate compromised perfusion. Client understanding is demonstrated by correctly identifying urgent changes requiring medical attention.

Rationale:
A. Avoiding nuts is unnecessary because there is no universal restriction of nuts for clients with a colostomy. Dietary tolerance varies, and clients are usually encouraged to gradually reintroduce foods while monitoring for gas or blockage. Complete elimination of specific foods is not typically required unless individual intolerance is identified.

B. A purple or dusky-colored stoma indicates impaired blood flow and possible ischemia or necrosis, which is a medical emergency. A healthy stoma should appear pink to red and moist, reflecting adequate perfusion. Reporting color changes promptly is critical to prevent tissue loss and complications related to Colostomy.

C. Expecting formed stool is incorrect for an ascending colostomy because stool at this level is typically liquid or semi-liquid due to limited water absorption in the proximal colon. Formed stool is more characteristic of distal colostomies such as descending or sigmoid colostomies. This statement indicates misunderstanding of normal postoperative expectations.

D. Routine irrigation is not indicated for an ascending colostomy because stool is liquid and continuous. Irrigation is typically used for descending or sigmoid colostomies to establish regular bowel emptying. Performing irrigation in this case would be inappropriate and ineffective.

Nutritional intake during pregnancy is essential for fetal growth, organ development, and maternal health maintenance. During the first trimester, folic acid is particularly important because neural tube development occurs early in gestation. Prenatal dietary teaching focuses on appropriate caloric intake, balanced nutrition, vitamin supplementation, and avoidance of substances that may harm fetal development. Nurses play a key role in reinforcing evidence-based nutritional recommendations during pregnancy.

Rationale:
A. Limiting caffeine intake to 700 mg/day is incorrect because this amount is excessively high during pregnancy. Excessive caffeine intake has been associated with miscarriage, low birth weight, and fetal growth restriction. Current recommendations generally advise limiting caffeine to less than 200 mg/day during pregnancy.

B. Increasing dietary intake by 500 calories per day is incorrect for a client at 12 weeks of gestation because caloric needs do not substantially increase during the first trimester. Most pregnant clients require only a small increase in calories early in pregnancy, with larger increases occurring later in gestation. Excessive caloric intake may contribute to unnecessary weight gain.

C. Eating 40 mg of protein-rich foods per day is incorrect because protein requirements are measured in grams, not milligrams. Pregnant clients generally require approximately 71 g of protein daily to support fetal tissue growth, placental development, and maternal physiologic changes. This statement reflects inaccurate nutritional guidance.

D. Consuming 600 micrograms of folic acid daily is correct because folic acid is essential for prevention of neural tube defects such as spina bifida and anencephaly. Adequate intake during early pregnancy supports normal fetal neurologic development and is a standard prenatal recommendation in conditions involving fetal neural tube formation, including Spina bifida.