A nurse is caring for a client who has an open abdominal wound with moderate drainage. Which of the following types of dressings should the nurse use to promote moist wound healing?

Choice A reason:

Increased hydrostatic pressure in the portal vein is one factor that causes ascites. The portal vein carries blood from the digestive organs to the liver for processing. However, when the liver is damaged by alcohol abuse, it becomes scarred and fibrotic, creating resistance to blood flow. This results in increased pressure in the portal vein and its branches, which forces fluid out of the capillaries into the abdominal cavity.

Choice B reason:

Decreased oncotic pressure in the plasma is another factor that causes ascites. Oncotic pressure is the force exerted by proteins in the plasma that attracts fluid into the capillaries from the interstitial space. However, when the liver is damaged by alcohol abuse, it cannot produce enough proteins, such as albumin and globulin, which are essential for maintaining oncotic pressure. This results in decreased oncotic pressure in the plasma and increased fluid movement into the interstitial space and the abdominal cavity.

Choice C reason:

Increased aldosterone secretion by the adrenal glands is another factor that causes ascites. Aldosterone is a hormone that regulates the balance of sodium and water in the body. It acts on the kidneys to increase the reabsorption of sodium and water from the urine into the blood. However, when the liver is damaged by alcohol abuse, it cannot metabolize aldosterone properly, leading to its accumulation in the blood. This results in increased sodium and water retention in the body and increased fluid movement into the interstitial space and the abdominal cavity.

Choice D reason:

Ascites is caused by a combination of factors that affect the fluid balance in the abdominal cavity.

Choice A reason:

Administering antiemetics as prescribed is an intervention that the nurse should implement for a client who has metabolic alkalosis due to prolonged vomiting. Antiemetics are medications that can prevent or treat nausea and vomiting, which are the main causes of metabolic alkalosis in this case. By stopping vomiting, antiemetics can help prevent further loss of gastric acid and bicarbonate retention, which can correct metabolic alkalosis.

Choice B reason:

Monitoring serum potassium levels is an intervention that the nurse should implement for a client who has metabolic alkalosis due to prolonged vomiting. Metabolic alkalosis can cause hypokalemia due to increased renal excretion of potassium and intracellular shift of potassium in exchange for hydrogen ions. Hypokalemia can worsen metabolic alkalosis by impairing renal acid excretion and increasing bicarbonate reabsorption. The nurse should monitor serum potassium levels regularly and report any abnormalities or signs of hypokalemia, such as muscle weakness, cramps, arrhythmias, or ECG changes.

Choice C reason:

Administering sodium bicarbonate IV as prescribed is not an intervention that the nurse should implement for a client who has metabolic alkalosis due to prolonged vomiting. Sodium bicarbonate is an alkalinizing agent that can increase serum bicarbonate levels and pH, which can worsen metabolic alkalosis. Sodium bicarbonate IV should be avoided or used with caution in clients who have metabolic alkalosis, unless they have severe acid-base imbalance or coexisting metabolic acidosis.

Choice D reason:

Encouraging intake of acidic foods and beverages is not an intervention that the nurse should implement for a client who has metabolic alkalosis due to prolonged vomiting. Acidic foods and beverages can lower the pH of the stomach, but they have little effect on the pH of the blood or urine, which are regulated by other mechanisms such as buffers, lungs, and kidneys. Acidic foods and beverages can also irritate the gastric mucosa and trigger more vomiting, which can aggravate metabolic alkalosis.

Choice E reason:

Providing supplemental oxygen as needed is an intervention that the nurse should implement for a client who has metabolic alkalosis due to prolonged vomiting. Metabolic alkalosis can cause respiratory compensation by decreasing the respiratory rate and depth, which can lead to hypoxemia and hypercapnia. Supplemental oxygen can help maintain adequate oxygenation and prevent tissue hypoxia and organ damage. The nurse should monitor the client's oxygen saturation and arterial blood gas levels and adjust the oxygen therapy accordingly.