Britney, a 20 y.o. student is admitted with acute pancreatitis. Which laboratory findings do you expect to be abnormal for this patient?
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Solution
Serum amylase and lipase
Pancreatitis involves activation of pancreatic enzymes, such as amylase and lipase. These levels are elevated in a patient with acute pancreatitis.
The student nurse is preparing a teaching care plan to help improve nutrition in a patient with achalasia. You include which of the following:
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Solution
Eat meals sitting upright.
Eating in the upright position aids in emptying the esophagus. Doing the opposite of the other three also may be helpful.
You have a patient with achalasia (incomplete muscle relaxtion of the GI tract, especially sphincter muscles). Which medications do you anticipate to administer?
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Solution
Isosorbide dinitrate (Isordil)
Achalasia is characterized by incomplete relaxation of the LES, dilation of the lower esophagus, and a lack of esophageal peristalsis. Because nitrates relax the lower esophageal sphincter, expect to give Isordil orally or sublingually.
You are developing a care plan on Sally, a 67 y.o. patient with hepatic encephalopathy. Which of the following do you include?
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Solution
Administering a lactulose enema as ordered.
You may administer the laxative lactulose to reduce ammonia levels in the colon.
You’re caring for Betty with liver cirrhosis. Which of the following assessment findings leads you to suspect hepatic encephalopathy in her?
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Solution
Asterixis
Asterixis is an early neurologic sign of hepatic encephalopathy elicited by asking the patient to hold her arms stretched out. Asterixis is present if the hands rapidly extend and flex.
After abdominal surgery, your patient has a severe coughing episode that causes wound evisceration. In addition to calling the doctor, which intervention is most appropriate?
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Solution
Cover the wound with a saline-soaked sterile dressing.
Cover the organs with a sterile, nonadherent dressing moistened with normal saline. Do this to prevent infection and to keep the organs from drying out.
You’re caring for Jane, a 57 y.o. patient with liver cirrhosis who developed ascites and requires paracentesis. Before her paracentesis, you instruct her to:
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Solution
Empty her bladder.
A full bladder can interfere with paracentesis and be punctured inadvertently.
You’re caring for Lewis, a 67 y.o. patient with liver cirrhosis who developed ascites and requires paracentesis. Relief of which symptom indicated that the paracentesis was effective?
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Solution
Dyspnea
Ascites puts pressure on the diaphragm. Paracentesis is done to remove fluid and reducing pressure on the diaphragm. The goal is to improve the patient’s breathing. The others are signs of cirrhosis that aren’t relieved by paracentesis.
You’re developing the plan of care for a patient experiencing dumping syndrome after a Billroth II procedure. Which dietary instructions do you include?
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Solution
Omit fluids with meals.
Gastric emptying time can be delayed by omitting fluids from your patient’s meal. A diet low in carbs and high in fat & protein is recommended to treat dumping syndrome.
You’re caring for Beth who underwent a Billroth II procedure (surgical removal of the pylorus and duodenum) for treatment of a peptic ulcer. Which findings suggest that the patient is developing dumping syndrome, a complication associated with this procedure?
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Solution
Dizziness and sweating.
After a Billroth II procedure, a large amount of hypertonic fluid enters the intestine. This causes extracellular fluid to move rapidly into the bowel, reducing circulating blood volume and producing vasomotor symptoms. Vasomotor symptoms produced by dumping syndrome include dizziness and sweating, tachycardia, syncope, pallor, and palpitations.