The nurse has finished providing a tube feeding to a client. What should the nurse document about this procedure? (SELECT ALL THAT APPLY)

A. A healthy stoma should appear moist and shiny, indicating adequate blood supply and hydration of the tissue. Dryness or dullness of the stoma may indicate poor blood flow or dehydration and should be further evaluated.
B. A healthy stoma typically appears deep pink to red in color, indicating good tissue perfusion. Pallor or cyanosis of the stoma may indicate inadequate blood supply and should be assessed promptly.
C. The skin around the stoma, known as the peristomal skin, should be intact, without signs of irritation, redness, or tenderness. Irritation or breakdown of the peristomal skin can occur due to leakage of stool or irritation from ostomy appliances and should be addressed promptly to prevent skin complications.
D. A flat abdomen suggests normal abdominal contour without distention or bulging. Distention or bulging of the abdomen may indicate underlying issues such as bowel obstruction, gas accumulation, or fluid retention and should be assessed further.

E. Bowel sounds are indicative of gastrointestinal motility and function. Normal bowel sounds are present and audible in healthy individuals and are characterized by 8 to 10 clicks or gurgles per minute. Absence or abnormal bowel sounds may indicate bowel obstruction, ileus, or other gastrointestinal disorders and should be assessed further.

B. Adapting to a stressor involves adjusting one's thoughts, feelings, or behaviors in response to the stressor. The nursing instructor's advice to the student to think of each clinical day as an opportunity to learn new things is an example of adapting to the stressor of clinical anxiety. By reframing the clinical experience as an opportunity for growth and learning, the student can change their perspective and better cope with their anxiety.
A. Eliminating a stressor involves completely removing the source of stress from the situation. In this scenario, the nursing instructor is not removing the clinical experience itself, which may be causing the student's anxiety, but rather providing a coping strategy to help the student manage their anxiety and view the clinical day in a more positive light.
C. Altering a stressor involves making changes to the stressor itself to reduce its impact or eliminate it altogether. In this scenario, the nursing instructor is not directly altering the clinical experience but rather providing a cognitive coping strategy to help the student manage their anxiety. While altering the clinical experience itself may not be feasible, altering one's perception of the experience can be an effective way to cope with stress.
D. Avoiding a stressor involves deliberately avoiding or withdrawing from the situation or activity that is causing stress. In this scenario, the nursing instructor is not advising the student to avoid clinical altogether but rather providing guidance on how to approach and cope with the clinical experience in a more positive and constructive manner.