A nurse is monitoring a client who is 36 hrs postoperative following gastric banding. Which of the following findings should the nurse expect?

A. Emphasize vowel sounds when speaking. Consonants are typically more difficult to hear than vowels, and overemphasizing vowels can distort speech and make it harder to understand. Clear, natural enunciation is more effective.
B. Sit next to the client when speaking to them. Sitting in front of the client is more effective, as it allows the client to read lips and observe facial expressions, both of which are important in supporting communication for individuals with hearing loss.
C. Lower the tone of voice at the end of each sentence. Lowering pitch or volume at the end of sentences can make speech harder to follow. A steady, moderate tone throughout conversation is more helpful and easier to understand.
D. Decrease background noise when talking with the client. Reducing environmental noise helps the client focus on the speaker’s voice, improving their ability to hear and comprehend the message. It’s one of the most effective strategies in communication with hearing-impaired individuals.

• Pain rating: Severe, intermittent abdominal pain where the child draws their knees to the chest and then returns to normal behavior is a classic symptom of intussusception. Neither Crohn’s disease nor appendicitis typically presents with this pattern, appendicitis pain is usually constant and worsening, while Crohn’s pain is chronic and non-episodic.
• Vomiting: Vomiting in intussusception is common and often non-bilious in early stages, aligning with the child's light-colored emesis. Vomiting also occurs in appendicitis, especially in the early stages. However, it is not a prominent or early symptom of Crohn’s disease unless obstruction is present.
• Stool: The presence of blood and mucus in the stool ("currant jelly stool") is strongly associated with intussusception and may also occur in Crohn’s disease during flares due to colonic inflammation. Appendicitis does not typically cause bloody or mucoid stools, making this finding inconsistent with that diagnosis.
• Temperature: A temperature of 37.4°C is within normal limits, appendicitis however may present with low grade fever. The absence of fever at this time limits its diagnostic value in this case.
• Abdominal findings: A distended abdomen with hypoactive bowel sounds and a palpable sausage-shaped mass in the right upper quadrant is highly indicative of intussusception. These findings are not characteristic of appendicitis, which usually involves RLQ pain, or Crohn’s, which rarely presents with a discrete palpable mass.