Question

The unlicensed assistive personnel (UAP) is assisting the patient with Crohn's disease with perineal care. The UAP tells the nurse that the patient had feces coming from the vagina. What is the priority action by the nurse?

Notify the health care provider.
Document the fistula formation.
Assess the patient and vaginal drainage.
Have the UAP apply a dressing to the vagina.

Answer 1

The nurse should immediatly assess the patient with Crohn's disease who has feces coming from the vagina, as this may indicate a fistula. After assessing, the nurse should notify the healthcare provider and document the findings. Further intervention will be based on the healthcare provider’s orders.

Step-by-step explanation:

When unlicensed assistive personnel (UAP) report that a patient with Crohn's disease has feces coming from the vagina, the priority action by the nurse is to assess the patient and the vaginal drainage. This symptom may indicate the presence of a fistula between the digestive and reproductive tracts, which is a serious complication. After assessment, the nurse should promptly notify the healthcare provider so they can determine the appropriate course of action, which may include diagnostic imaging or surgical intervention. It is essential to document the suspected fistula formation in the patient's medical record after the initial assessment and notification of the healthcare provider. Applying a dressing to the vaginal area without assessment may delay necessary care.

It is crucial for all healthcare providers to recognize signs of fistula to manage and treat the condition effectively. If confirmed, the treatment can be complex, involving surgical procedures, nutritional support, and antibiotics to manage any associated infections.