A male client with a massive pulmonary embolus is tachycardic, hypotensive, and has audible bilateral pulmonary crackles. His arterial blood gas (ABG) results are: pH 7.0: PaCO, 66 mm Fig; HCO3- 24 mEq/L (24 mmol/L); PaO, 60 mm Hg. Based on these findings, this client is at greatest risk for which pathophysiological condition?

Reference Ranges:

pH [7.35 to 7.45] PaCO, [35 to 45 mm Hg]

HCO3- [21 to 28 mEq/L (21 to 28 mmol/L)]

PaO, [80 to 100 mm Hg]

A) Lipase:

Correct. Lipase is an enzyme produced by the pancreas that aids in the digestion of fats. Elevated levels of lipase in the blood can indicate pancreatic damage or inflammation, such as that which may occur due to trauma like a gunshot wound to the abdomen. Pancreatic injury can lead to leakage of enzymes into the bloodstream, resulting in elevated serum lipase levels. Monitoring lipase levels helps assess pancreatic function and detect injury or disease.

B) Myoglobinuria:

Myoglobinuria refers to the presence of myoglobin, a protein found in muscle cells, in the urine. It is often associated with muscle injury or breakdown, such as rhabdomyolysis. While abdominal trauma may result in muscle injury, myoglobinuria is not specific to pancreatic damage and is more indicative of muscle-related injury or conditions.

C) White blood count (WBC):

Elevated white blood cell count (WBC), or leukocytosis, is a non-specific marker of inflammation or infection. While it may occur in response to tissue injury, including pancreatic injury, it is not specific to pancreatic damage and can be elevated due to various other factors, such as surgical stress, infection, or inflammation.

D) Bilirubin:

Bilirubin is a pigment produced during the breakdown of red blood cells and is excreted by the liver. Elevated levels of bilirubin may indicate liver dysfunction or obstruction of the bile ducts, but they are not specific to pancreatic damage. While pancreatic injury can lead to obstruction of the bile ducts in some cases, monitoring bilirubin levels alone is not sufficient to diagnose pancreatic damage.

Benign prostatic hyperplasia (BPH) is a condition characterized by non-cancerous growth of the prostate gland, leading to its enlargement. This enlargement can contribute to urinary retention by obstructing the flow of urine through the urethra. Here's the breakdown of the explanation:

A) Abnormal growth results in loss of bladder muscle tone:

While BPH can lead to urinary symptoms such as urinary frequency, urgency, and nocturia, it does not directly cause loss of bladder muscle tone. Instead, the enlarged prostate gland obstructs the bladder outlet, making it difficult for urine to pass through the urethra.

B) Inflammation causes spasms of the gland:

Inflammation of the prostate gland, known as prostatitis, can cause symptoms such as pelvic pain, dysuria, and urinary frequency, but it is not typically associated with BPH. BPH is characterized by benign growth of the prostate tissue rather than inflammation and spasms.

C) The enlarged gland compresses the urethra:

Correct. The primary mechanism by which BPH causes urinary retention is by compressing the urethra, which obstructs the flow of urine from the bladder. As the prostate gland enlarges, it can constrict the urethra, leading to symptoms such as hesitancy, weak urinary stream, incomplete emptying, and urinary retention.

D) Nerve compression decreases the sensation that the bladder is full:

While compression of nerves in the pelvic region can contribute to urinary symptoms, such as decreased sensation of bladder fullness, it is not the primary mechanism by which BPH causes urinary retention. The compression of the urethra by the enlarged prostate gland is the main factor leading to urinary obstruction and retention.