If the client experiences hypotension after an injection of epidural anesthetic, the nurse should turn her to the left side, apply oxygen by mask, and speed the IV infusion. If the blood pressure does not return to normal, the physician should be contacted. Epinephrine should be kept for emergency administration.

Option A: Placing the client in Trendelenburg position (head down) will allow the anesthesia to move up above the respiratory center, thereby decreasing the diaphragm’s ability to move up and down and ventilate the client.
Option B: The IV rate should be increased, not decreased. Monitoring the patient hemodynamic status during the procedure is very important. The minimum monitors required are pulse oximeter for pulse and oxygen saturation as well as blood pressure cuff and continuous EKG to assess cardiovascular status.
Option C: The oxygen should be applied by mask, not cannula. Epidural anesthesia is achievable using either the classic epidural, the combined spinal-epidural (CSE) technique, or dural puncture epidural (DPE). CSE and DPE include an additional step consisting of delivering a spinal dose of LA and co adjuvants (CSE) or only puncturing the dura mater (DPE) using a spinal needle.

Cancer of the pancreas frequently leads to severe nausea and vomiting and altered nutrition. Weight loss occurs in about 90% of patients. Abdominal pain occurs in about 75% of patients. Weakness, pruritus from bile salts in the skin, anorexia, palpable, non-tender, distended gallbladder, acholic stools, and dark urine.

Option B: Patients with adenocarcinoma of pancreas typically present with painless jaundice (70%) usually due to obstruction of the common bile duct from the pancreatic head tumor. Lab findings will include elevation in liver function tests, direct and total bilirubin levels, elevated amylase and lipase, and elevated pancreatic tumor markers (CA 19-9 and CEA).
Option C: Neoadjuvant first approach in resectable pancreatic adenocarcinoma is implemented more and more frequently at high-volume centers nationwide and internationally. The rational behind neoadjuvant first approach is that the patient is in their best shape to receive chemotherapy and at best odds of completing chemotherapy for 4-6 months. In addition, tissue is thought to be still well-oxygenated having not gone through a large procedure such as the Whipple.
Option D: For patients with metastatic, stage IV, pancreatic cancer, discussions with the patient regarding treatment are essential. One can receive chemotherapy. However, the life prolongation will be at best months, yet affect the toxicity and effects of the chemotherapy. It is important to keep nutrition on the forefront of the patient’s care as nutrition can affect wound healing.

Measuring with a paper tape measure and marking the area that is measured is the most objective method of estimating ascites. Ascites is the pathologic accumulation of fluid within the peritoneal cavity. It is the most common complication of cirrhosis and occurs in about 50% of the patient with decompensated cirrhosis in 10 years. The development of ascites denotes the transition from compensated to decompensated cirrhosis.

Option A: The initial tests that should be performed on the ascitic fluid include a blood cell count, with both a total nucleated cell count and polymorphonuclear neutrophils (PMN) count, and a bacterial culture by bedside inoculation of blood culture bottles. Ascitic fluid protein and albumin are measured simultaneously with the serum albumin level to calculate the serum-ascites albumin gradient (SAAG).
Option B: Palpation of the liver will not determine the amount of ascites. The first abnormality that develops is portal hypertension in the case of cirrhosis. Portal pressure increases above a critical threshold and circulating nitric oxide levels increase, leading to vasodilation. As the state of vasodilatation becomes worse, the plasma levels of vasoconstrictor sodium-retentive hormones elevate, renal function declines, and ascitic fluid forms, resulting in hepatic decompensation.
Option D: Inspecting and checking for fluid waves are more subjective. Patients typically report progressive abdominal distension that may be painless or associated with abdominal discomfort, weight gain, early satiety, shortness of breath, and dyspnea resulting from fluid accumulation and increased abdominal pressure. Symptoms such as fever, abdominal tenderness, and confusion can be seen in spontaneous bacterial peritonitis.

The vital signs indicate hypovolemic shock. Monitor and document vital signs especially BP and HR. Decrease in circulating blood volume can cause hypotension and tachycardia. Alteration in HR is a compensatory mechanism to maintain cardiac output. Usually, the pulse is weak and may be irregular if electrolyte imbalance also occurs. Hypotension is evident in hypovolemia.

Option A: The oxygen and nutrients subsequently diffuse from the blood into the interstitial fluid and then into the body cells. Insufficient arterial blood flow causes decreased nutrition and oxygenation at the cellular level. Decreased tissue perfusion can be temporary, with few or minimal consequences to the health of the patient, or it can be more acute or protracted, with potentially destructive effects on the patient.
Option C: Ineffective airway clearance is the inability to clear secretions or obstructions from the respiratory tract to maintain a clear airway. Appropriate management is vital to prevent potentially life-threatening hypovolemic shock. Older patients are more likely to develop fluid imbalances. The goals of management are to treat the underlying disorder and return the extracellular fluid compartment to normal, to restore fluid volume, and to correct any electrolyte imbalances.
Option D: Alterations sensory / perceptual (visual, auditory, kinesthetic, gustatory, tactile, olfactory) State in which an individual experiences a change in the amount or type of stimuli received, accompanied decrease towards exaggeration or disorder of the response to such stimuli.

The client with osteogenesis imperfecta is at risk for pathological fractures and is likely to experience these fractures if he participates in contact sports. The client might experience symptoms of hypoxia if he becomes dehydrated or deoxygenated; extreme exercise, especially in warm weather, can exacerbate the condition.

Option B: Osteogenesis imperfecta (OI) is a genetic disorder of connective tissues caused by an abnormality in the synthesis or processing of type I collagen. It is also called brittle bone disease. It is characterized by an increased susceptibility to bone fractures and decreased bone density. Other manifestations include blue sclerae, dentinogenesis imperfecta, short stature, as well as deafness in adulthood. There are also reports of valvular insufficiencies and aortic root dilation.
Option C: Osteogenesis imperfecta is a rare genetic disease. In the majority of cases, it occurs secondary to mutations in the COL1A1 and COL1A2 genes. More recently, there has been the identification of diverse mutations related to OI.
Option D: Milder manifestations include generalized laxity, easy bruising, hernias, and excess sweating. Clinical manifestations range from mild with a nearly asymptomatic form to most severe forms (involving infants presenting with crumpled ribs, fragile cranium, and long bone fractures incompatible with life) resulting in perinatal mortality.