What is a likely finding in the nurse's assessment of a patient who has a large bowel obstruction?

Rationale:
A. High fat content does not directly cause refeeding syndrome; fat is less likely to trigger the electrolyte shifts seen in this condition.

B. Rapid reintroduction of carbohydrates in malnourished patients stimulates insulin release, which drives phosphate, potassium, and magnesium into cells, leading to potentially life-threatening electrolyte imbalances—the hallmark of refeeding syndrome.

C. Excess protein intake can strain kidney function but is not the primary cause of refeeding syndrome.

D. Vitamin deficiencies, such as thiamine, can worsen complications, but the immediate trigger is the rapid carbohydrate load.

Rationale:

• Potential Condition: The client presents with jaundice, ascites, abdominal distention, confusion, and abnormal liver function tests (elevated AST, ALT, and bilirubin, with low albumin), consistent with cirrhosis and fluid volume excess.
• Actions to Take:
  • Administer diuretics (such as spironolactone or furosemide) to reduce fluid retention and help manage ascites.
  • Monitor fluid intake and output to evaluate fluid balance and effectiveness of diuretic therapy.
• Parameters to Monitor:
  • Blood pressure is important because hypotension is present and can worsen with fluid shifts and diuretic therapy.
  • Abdominal girth is monitored to track the progression or reduction of ascites.