While assessing the client with acute pancreatitis the nurse notes the following: skin warm and dry with inelastic turgor, hypoactive bowel sounds, nausea and vomiting for 24 hours, and amber-colored urine. Which action would the nurse take next?

Monitor I&O

Check blood pressure

Assess pain level

Measure oxygen saturation

Answer and Explanation

The Correct Answer is B

A)   Monitoring intake and output (I&O) is crucial for understanding the patient's fluid balance, especially after 24 hours of vomiting, which could lead to dehydration. However, it is important for fluid balance but not the immediate next step.
B)   Checking blood pressure can provide immediate information on the patient's hemodynamic status and potential hypovolemia due to fluid loss; thus, it should be assessed immediately.
C)   Assessing pain level is important for comfort, but stabilization of vital signs takes precedence.
D)   Measuring oxygen saturation is useful but less critical than assessing for potential hypotension due to dehydration.

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Correct Answer is A

Explanation

A) Chronic damage to the pancreas can lead to diabetes mellitus due to the destruction of insulin-producing cells.
B) Jaundice is typically associated with liver disease, not directly linked with chronic pancreatitis.
C) Ascites is a complication of liver disease, not typically a direct result of chronic pancreatitis.
D) While steatorrhea is a symptom of chronic pancreatitis due to malabsorption of fats, it is not a complication but rather a direct effect of the enzyme insufficiency.

A. WBC 10,000/mm3 (5,000-10,000 mm3) B. Serum potassium 3.5 mEq/L (3.5-5.0 mEq/L) C. Serum albumin 4.8 g/dL (3.5-5 g/dL) D. Lipase 900 u/L (20-180 u/L)

Correct Answer is D

Explanation

A) While an elevated WBC count may indicate infection, it is not unexpected in acute pancreatitis.
B) Serum potassium within normal range does not require immediate intervention.

C) Serum albumin within normal range does not require immediate intervention.

D) Lipase levels significantly elevated above the normal range indicate ongoing pancreatic inflammation and may require intervention or adjustment of treatment.

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While assessing the client with acute pancreatitis the nurse notes the following: skin warm and dry with inelastic turgor, hypoactive bowel sounds, nausea and vomiting for 24 hours, and amber-colored urine. Which action would the nurse take next?

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Explanation

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Explanation

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