The nurse is monitoring a patient recovering from an emergency appendectomy.
Which finding is most concerning?

• Increase fiber intake: This is nonessential at this time. While a high-fiber diet can help prevent future episodes of diverticulitis, it won’t help in the acute phase, especially when the client is unable to eat or drink without vomiting.
• CT of the abdomen with contrast: This is an anticipated action. A CT scan can help confirm the diagnosis of diverticulitis and assess the severity of the condition.
• Flexible sigmoidoscopy: This is an anticipated action. A flexible sigmoidoscopy can help visualize the diverticula and assess the extent of the inflammation.

• Change IV fluids to 0.9% sodium chloride with KCl: This is an anticipated action. The client is likely dehydrated due to vomiting and unable to take oral fluids, so IV hydration is necessary. The client’s potassium level is at the lower end of the normal range, so adding KCl to the IV fluids can help prevent hypokalemia.
• Type and crossmatch blood: This is an anticipated action. The client has a positive stool occult blood test and a lower than normal hemoglobin and hematocrit, suggesting that he may be experiencing bleeding. It’s important to have blood ready for a transfusion if necessary.
• Administer IV piperacillin-tazobactam: This is contraindicated. Piperacillin-tazobactam is a penicillin-based antibiotic, and the client has a known allergy to penicillin. Another class of antibiotics should be used. Please note that these are potential actions and the healthcare provider should be informed immediately for further evaluation and management. It’s important to continue following the provider’s prescriptions and closely monitor the client’s condition.

Choice A rationale
While it’s true that dentures and other oral appliances should be removed before an EGD to prevent damage or loss during the procedure, this information is not the most crucial for the patient to understand.
Choice B rationale
Although a sore throat can occur after an EGD due to the passage of the endoscope, it’s not the most important information. The patient should be aware that the sore throat is temporary and can be relieved with warm gargles or ice.
Choice C rationale

This choice is accurate. An EGD allows the doctor to directly visualize the esophagus, stomach, and part of the small intestine. However, this information, while important, is not the most critical aspect for the patient to understand about the post-procedure period.
Choice D rationale
This is the correct answer. After an EGD, it’s crucial for the patient to understand that they should not eat or drink until their gag reflex has returned. This is to prevent aspiration, which can occur if the patient tries to swallow food or liquid before the gag reflex is functioning properly.