digging deeper urinalysis student information answers

#Digging deeper urinalysis student information answers series

This progresses rapidly to strangulation with risk of ischemia, gangrene, and subsequent perforation. Gas and fluid accumulate within this segment of bowel, and cannot escape.

A closed-loop obstruction is a particularly dangerous form of bowel obstruction in which a segment of intestine is obstructed both proximally and distally. Necrotic bowel generally does not occur in association with a SBO unless there is a closed-loop obstruction. This patient has a SBO with evidence of ischemic or gangrenous bowel most likely secondary to adhesions from past surgery (e.g., sigmoidectomy). Intravenous erythromycin acts as a prokinetic agent and has some utility for gastroparesis, but not for a SBO (D). Evidence of a complete SBO is a relative indication for surgery, but recent studies suggest that some of these patients resolve with nonoperative management as well. Operative management can be achieved either via open laparotomy or laparoscopy (B). Operative management (C) with laparotomy and lysis of adhesions should be considered in the following conditions: if the patient demonstrates evidence of clinical deterioration as manifest by increasing pain, tenderness, fever, leukocytosis, or acidosis. Most patients with SBO due to adhesions improve with these maneuvers, and do not require surgery. Once the patient has been adequately resuscitated, CT scan (E) with oral contrast is recommended as it is useful in confirming the diagnosis of SBO, determining if the SBO is partial or complete, and ruling out other diagnosis. Aside from the salutatory effect of NG decompression on the distended bowel, patients with SBO are at risk of aspiration. The initial management of SBO includes placing the patient NPO, aggressive intravenous fluid resuscitation (the patient is tachycardic and likely very dehydrated), and NG tube placement. SBO from adhesions can present many years after surgery. This patient has evidence (on history, physical, and radiologic imaging) of a small bowel obstruction (SBO) that is most likely secondary to adhesions from prior surgery (scar in RUQ). Amylase, lipase, and liver chemistries are normal.

#Digging deeper urinalysis student information answers series

Abdominal series demonstrates one loop of markedly distended small bowel in the right upper quadrant with an air fluid level. The rest of the abdominal exam is unremarkable. He has marked right upper quadrant tenderness to palpation with guarding. Bowel sounds are hyperactive with occasional rushes and tinkles. His abdomen has a well-healed midline scar and is distended. On physical exam, his temperature is 100.9 ☏, blood pressure is 110/80 mmHg, and heart rate is 110/min. Past history is significant for prior sigmoid colectomy for diverticulitis 10 years ago. If blood pressure medications are given prior to dialysis, the client can develop hypotension during the dialysis and then uncontrolled hypertension (decreased drug concentrations).A 65-year-old male presents to the ED with nausea, vomiting, and severe abdominal pain. Many medications that are taken once daily can be held until after the dialysis treatment to prevent their removal. In addition, medications are removed from the blood during hemodialysis, making them ineffective.

(Option B): During dialysis, excess fluid is removed, making the client prone to hypotension. Giving subcutaneous heparin prior to initiation is not necessary. (Option A): After the client is connected to the dialysis machine, IV heparin is added to the blood from the client to prevent clotting that can occur when blood contacts a foreign substance. Arteriovenous fistulas are created by anastomosing an artery to a vein a thrill can be felt when palpating the fistula, and a bruit can be heard during auscultation when the fistula is functioning properly (Option E). The amount of fluid removed (ultrafiltration) is determined by calculating the difference between the last post-dialysis weight and the client's current pre-dialysis weight (Option C). Answer: C, D, E Rationale: Prior to dialysis, the nurse should assess the client's fluid status, vascular access, and vital signs (Option D).