A nurse is monitoring a client who is 36 hr postoperative following gastric banding. Which of the following findings should the nurse expect?

A. Weigh the client before and after the procedure: Monitoring the client’s weight before and after paracentesis provides an objective measure of the volume of fluid removed. This helps evaluate the effectiveness of the procedure and assess for complications such as fluid shifts or hypotension.

B. Administer a low-volume hypertonic enema the night before the procedure: Bowel cleansing is not required for paracentesis, as the procedure targets the peritoneal cavity, not the gastrointestinal tract. Administering an enema could cause unnecessary discomfort without benefit.

C. Ensure the client has a full bladder just prior to the procedure: A full bladder increases the risk of puncture during paracentesis. Clients are typically advised to void before the procedure to minimize the risk of bladder injury.

D. Place the client in a side-lying position for the procedure: Paracentesis is usually performed with the client in a sitting position, leaning slightly forward, or in a supine position with the head of the bed elevated. Side-lying positioning does not provide optimal access to the fluid-filled peritoneal cavity.

Rationale:

• Hypoxia: Hypoxia occurs in both epiglottitis and RSV due to airway obstruction or lower respiratory involvement. In epiglottitis, airway swelling can limit oxygen intake, whereas in RSV, lower airway inflammation and bronchiolitis cause oxygen desaturation. Streptococcal pharyngitis typically does not impair oxygenation.

• Fever: Fever is a nonspecific finding seen in epiglottitis, RSV, and streptococcal pharyngitis. Infection-induced inflammation and immune response in all three conditions cause elevated temperatures. The degree and onset of fever can vary among the conditions.

• Tachypnea: Tachypnea is a compensatory response to hypoxia and airway compromise. It is commonly observed in epiglottitis due to upper airway obstruction and in RSV due to bronchiolar inflammation. It is usually absent in isolated streptococcal pharyngitis.

• Drooling: Drooling is a hallmark sign of epiglottitis due to painful swallowing and airway obstruction. It is not typical in RSV or streptococcal pharyngitis. Presence of drooling indicates urgent airway assessment.

• Exudate on pharynx: Exudative pharyngitis is characteristic of streptococcal infections. It is rarely seen in epiglottitis and RSV. White or yellow exudates on the tonsils help differentiate bacterial pharyngitis from viral or upper airway conditions.

• Wheezing upon auscultation: Wheezing is associated with lower airway involvement, commonly seen in RSV bronchiolitis. It is not typically present in epiglottitis or streptococcal pharyngitis. Wheezing reflects bronchospasm or airway inflammation.