4068_Ch35_779-808 15/11/14 1:47 PM Page 806
806 UNIT EIGHT Understanding the Gastrointestinal, Hepatic, and Pancreatic Systems
SUGGESTED ANSWERS TO
CRITICAL THINKING
■ Carl Young
1. Foreign travel within the past 2 months, eating raw
oysters, fatigue, nausea, and irritability suggest hepati-
tis A virus infection. Recent possible exposure to mate-
rials contaminated with blood or body fluids and
fatigue, headache, and nausea suggest hepatitis B
virus infection.
2. Careful hand hygiene and standard precautions when
handling any body fluids or feces should be instituted.
3. Infectious disease HCP, dietician for nutritional needs,
social worker for financial information during recovery
period.
4. The nurse should plan to give an antiemetic if Carl is
nauseated. Larger meals should be given early in the
day, with Carl in an upright or sitting position. The
nurse should also ensure that the environment is free
of noxious stimulants such as unpleasant odors. The
diet should be high calorie, high protein, high carbohy-
drate, and low fat.
5. Any medication that is known to be hepatotoxic, such
as acetaminophen, aspirin, and diazepam (Valium),
should be avoided.
6. Carl should be taught that cleanliness, especially with
food preparation, is essential; that he should avoid eat-
ing raw oysters or raw or undercooked shellfish; that
frequent hand washing is crucial; and that alcohol and
other liver-toxic substances should be avoided.
■ Mrs. Conner
1. Mrs. Conner has a history of poor nutrition that puts
her at risk, as does her age.
2. Mrs. Conner may report that she has malaise, nausea,
weight loss, a change in bowel habits, and dull, aching
RUQ pain.
3. Serum albumin level may be less than 3.2 g/dL. Her pro-
thrombin time will probably be greater than 25 seconds.
4. Esophageal varices and ascites are the two greatest
concerns for the patient with portal hypertension.
5. The physician will usually order diuretics, a sodium-
restricted diet, and possibly IV albumin infusions.
■ Mrs. Samuels
1. The most common cause of acute pancreatitis is heavy
alcohol intake. Mrs. Samuels reports no alcohol
consumption, but she does have the risk factor of
having had a recent ERCP, which may have dislodged
a gallstone or irritated the pancreatic duct.
2. Respiratory distress may result from excess fluid ac-
cumulation in the retroperitoneal space and from shal-
low respirations that seek to decrease pressure from
the diaphragm on the inflamed pancreas and surround-
ing tissues.
3. Pancreatitis is similar to a chemical burn and may
cause erosion of major blood vessels in surrounding
tissue.
4. Serum amylase rises quickly and then returns to nor-
mal in 3 to 5 days. Serum lipase is thought to be more
specific for acute pancreatitis and elevates and stays
elevated for a longer period of time.
5. Opioids are ordered because pain is intense, and pain
with anxiety stimulates the autonomic nervous system,
which may stimulate greater production of pancreatic
enzymes.
6. Stomach acid stimulates the production of pancreatic
enzymes. Histamine antagonists decrease stomach
acidity.
7. Enteral nutrition until symptoms (pain) are resolved,
then oral nutrition.
■ Donna Stewart
1. Some low-fat diets have been linked to the develop-
ment of cholesterol gallstones, which then irritate the
gallbladder and cause inflammation.
2. Donna’s physician might order a white blood cell
count, which will be elevated if she has cholecystitis.
In addition, the physician may order an ultrasound or
radionuclide scan to visualize the gallbladder and its
contents and the common bile duct.
3. Donna is 4 months pregnant. Radionuclide scans
should be cleared with her obstetrical care provider
before being scheduled.
4. You can anticipate that the HCP will order an antibi-
otic and an analgesic.
5. Donna will need to eat a low-fat diet after discharge.
Eventually she may be able to add more fats to her diet
as her body adjusts.
6. If the diagnosis is confirmed, Donna will probably
have a laparoscopic cholecystectomy unless her HCP
decides that she needs a traditional cholecystectomy.