A nurse is caring for a patient who has just been diagnosed with cancer of the colon.
The patient asks the nurse several Questions about what the provider might be planning to do. Which of the following nursing responses should the nurse make?

Choice A rationale

Gradually decreasing the dose of diphenhydramine once tolerance to sedation is reached is not a recommended strategy. Tolerance to the antihistamine effects, including sedation, may develop over time, but abruptly or gradually changing the dose without provider guidance is not advisable and could lead to a return of pruritus.

Choice B rationale

Taking diphenhydramine with meals may slightly delay its absorption but is unlikely to significantly reduce daytime sedation. While taking some medications with food can affect their pharmacokinetics, the primary cause of daytime sedation with diphenhydramine is its antihistaminic effect on the central nervous system, which is not directly mitigated by food intake.

Choice C rationale

Distributing the doses of diphenhydramine evenly throughout the day is likely to worsen daytime sedation. Diphenhydramine is a first-generation antihistamine known for its sedating properties due to its ability to cross the blood-brain barrier and block histamine receptors in the central nervous system. Evenly spaced doses would maintain a more consistent level of the drug in the system, leading to continued sedation.

Choice D rationale

Taking most of the daily dose of diphenhydramine at bedtime can help minimize daytime sedation. By concentrating the medication administration closer to the client's sleep period, the sedative effects are more likely to occur during sleep, and the residual sedation during the day may be reduced. This allows for symptom relief while minimizing interference with daytime activities. .

Choice A rationale

Obtaining a dietary history is important in managing ulcerative colitis, as certain foods can exacerbate symptoms. However, in an acute exacerbation, the immediate priority is to address physiological instability, which electrolyte imbalances can significantly contribute to.

Choice B rationale

During an acute exacerbation of ulcerative colitis, patients can experience significant fluid and electrolyte losses due to frequent and bloody diarrhea. Reviewing electrolyte values, such as potassium, sodium, and magnesium, is the priority to identify and promptly correct any imbalances that could lead to cardiac arrhythmias or other complications. Normal ranges for serum electrolytes are: Sodium: 135-145 mEq/L, Potassium: 3.5-5.0 mEq/L, Chloride: 98-106 mEq/L, Bicarbonate: 22-26 mEq/L, Calcium: 8.5-10.5 mg/dL, Magnesium: 1.5-2.5 mEq/L.

Choice C rationale

Checking perianal skin integrity is important because frequent diarrhea can lead to skin breakdown. However, this assessment is secondary to addressing potential life-threatening electrolyte imbalances that can occur during an acute flare-up.

Choice D rationale

Addressing the patient's emotional concerns is a crucial aspect of holistic care for patients with chronic conditions like ulcerative colitis. However, in the context of an acute exacerbation, the immediate physiological needs, such as identifying and correcting electrolyte imbalances, take precedence.