A patient who has undergone an esophagectomy for esophageal cancer develops increasing pain, fever, and dyspnea when a full liquid diet is started postoperatively. The nurse recognizes that these symptoms are most indicative of:
An intolerance to the feedings
Esophageal perforation with fistula formation into the lung
Extension of the tumor into the aorta
Leakage of fluids into the mediastinum
The Correct Answer is B
A. An intolerance to the feedings might cause discomfort, but it would not typically cause increasing pain, fever, and dyspnea. These symptoms are more indicative of a serious complication.
B. Esophageal perforation with fistula formation into the lung is the most likely cause of these symptoms. A perforation can lead to leakage of gastric contents into the pleural space or mediastinum, causing fever, pain, and respiratory distress. The formation of a fistula between the esophagus and the lung would lead to dyspnea.
C. Extension of the tumor into the aorta is a rare complication that would typically manifest with symptoms related to cardiovascular issues, not gastrointestinal symptoms like fever and dyspnea.
D. Leakage of fluids into the mediastinum is a possible cause of the symptoms, but esophageal perforation with a fistula into the lung is more directly linked to these specific symptoms, especially dyspnea.
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Related Questions
Correct Answer is D
Explanation
A. Inflammation of the esophagus (esophagitis) may cause symptoms like heartburn or dysphagia, but it would not explain the sudden, sharp pain or rigid abdomen seen with a perforated ulcer.
B. An intestinal obstruction can cause abdominal pain and distension, but the rigid, board-like abdomen is more characteristic of peritonitis from a perforated ulcer, not an obstruction.
C. Additional ulcers could cause pain and bleeding, but they would not explain the sudden, sharp pain and rigid abdomen that typically result from perforation.
D. The sudden onset of sharp, severe pain in the mid epigastric area, along with a rigid, board-like abdomen, are hallmark signs of a perforated ulcer, which causes peritonitis. This is a medical emergency, as the perforation allows gastric contents to leak into the peritoneal cavity, leading to widespread infection.
Correct Answer is B
Explanation
A. Cytotec does not enhance the pain-relieving effects of NSAIDs. Instead, it works to protect the stomach lining from the harmful effects of NSAIDs, which can cause gastrointestinal ulcers and bleeding.
B. Misoprostol (Cytotec) is used to protect the stomach lining from damage caused by NSAIDs, which can increase the production of stomach acid and decrease the protective mucus lining. Cytotec helps prevent gastric ulcers and other GI complications associated with long-term NSAID use.
C. Cytotec does not directly decrease inflammation in the joints. NSAIDs are the primary medications for reducing joint inflammation in conditions like arthritis.
D. Cytotec does not reduce the risk of developing blood clots from NSAIDs. It is primarily used for its protective effect on the gastrointestinal system.
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