During a Whipple procedure the head of the pancreas, which is a part of the stomach, the jejunum, and a portion of the stomach is removed and anastomosed. It is the most often used surgery to treat pancreatic cancer that’s confined to the head of the pancreas. After performing the Whipple procedure, the surgeon reconnects the remaining organs to allow the client to digest food normally after surgery.

Option B: Small bowel resection is surgery to remove a part of the small bowel. It is done when part of the small bowel is blocked or diseased.
Option C: A gastrectomy is the surgical removal of all or part of the stomach. The stomach is a J-shaped organ in the upper abdomen. It is part of the digestive system, which processes nutrients ( vitamins, minerals, carbohydrates, fats, proteins, and water) in foods that are eaten and help pass waste material out of the body. A partial gastrectomy is the removal of only part of the stomach. The remaining portion then continues with its digestive role. If the entire stomach is removed, the esophagus is connected directly to the small intestine, where digestion now begins. Patients must make significant dietary changes when a gastrectomy is performed.
Option D: Jejunal interposition is a procedure in which surgeons replace the missing section of a child’s esophagus with a section of the jejunum (the middle part of the small intestine). It is used to treat children who have already undergone failed repair of long-gap esophageal atresia and for whom the Foker process isn’t an option.

Fresh raw or whole pepper is not allowed unless thoroughly cooked in food. A low-bacteria diet is designed to reduce exposure to bacteria and other pathogens that can make one sick. It’s often prescribed for people who are at a greater risk of infection because they’re currently not making enough white blood cells due to certain illnesses or medical treatments.

Option A: Canned fruits are allowed since they are processed and pasteurized. Fresh fruits and vegetables are fine as long as they are washed first or cooked thoroughly. Meat, fish, and eggs should also be fully cooked. Commercially prepared and packaged foods are acceptable but avoid buying foods indented and swollen cans or damaged packaging.
Option B: Salt is allowed. The keys to a low-bacteria diet are choosing foods that are less likely to carry bacteria while avoiding the foods that do. Frequent hand washing and paying particular attention to food safety practices are also essential.
Option D: Ketchup is also allowed. Bread, ready-to-eat cereals, pancakes, waffles, and crackers are safe to eat. Bottled beverages, hot beverages, and pasteurized fruit and vegetable juices are good as well. Cream cheese, sour cream, mayonnaise, margarine, commercial peanut butter, and chocolate are okay, too.

Coumadin is an anticoagulant. One of the tests for bleeding time is a Protime. This test should be done monthly. The client will need to have his blood tested to tell how well the medication is working. The blood test, called prothrombin time (PT or protime), is used to calculate the International Normalized Ratio (INR). INR helps the healthcare provider determine how well warfarin is working to prevent blood clots and if the dose needs to be adjusted.

Option B: Eating more fruits and vegetables is not necessary, and dark-green vegetables contain vitamin K, which increases clotting. Vitamin K is needed for normal blood clotting. However, large changes in the amount of vitamin K in the diet can change the way warfarin works. If the client eats foods high in vitamin K, it’s important to keep a weekly intake of vitamin K-containing foods consistent.
Option C: Drinking more liquids could boost the platelet count and increase the body’s immunity. Do not start consuming the following herbal teas and supplements because they may affect the INR, causing it to be too high or too low. If the client drinks tea, black tea (such as orange pekoe tea) is acceptable because it is not high in Vitamin K.
Option D: Avoiding crowds is important for patients with decreased WBC. Stay away from people who are ill. Avoid contact with anyone who has recently been vaccinated, including infants and children. Avoid crowds as much as possible. When going to places where there are often a lot of people (i.e., church, shopping), try going at off-peak times, when they are not as crowded.

The client who is having a central venous catheter removed should be told to hold his breath and bear down. This prevents air from entering the line.

Option B: Although there are many steps in the process of CVC removal, essential elements of the procedure include (for internal jugular and subclavian CVCs), positioning of the patient in the head down (Trendelenburg) position, having the patient perform a Valsalva maneuver as the catheter is being withdrawn, application of pressure to the catheter-entry site as the catheter is being withdrawn, placement of an air-occlusive dressing over the site after removal, and a period of post-procedure monitoring.
Option C: The patient is asked to take a deep breath, hold it, and bear down during the removal to avoid introduction of an air embolism. Breath-holding or Valsalva maneuver will increase intracardiac pressures. Immediate occlusion is required to prevent air embolism.
Option D: The patient’s head should be placed in a supine position with the head of the bed flat to reduce the risk of air embolism. Risk for air embolism increases when the catheter insertion site is above heart level (e.g., in a sitting position), if the patient is hypovolemic or during spontaneous inspiration.

Clients with a history of streptococcal infections could have antibodies that render the streptokinase ineffective. Due to streptokinase’s thrombolytic mechanisms of action, patients need monitoring for bleeding. The patient’s thrombin time, prothrombin time, partial thromboplastin time, complete blood count, and any signs of bleeding demand careful surveillance. Patients also need monitoring for signs and symptoms of reinfarction or vessel occlusion.

Option B: There is no reason to assess the client for allergies to pineapples or bananas. Streptokinase can precipitate an allergic reaction. Symptoms include fever, shivering, and rash. Patients in rare instances have developed nonfatal anaphylactic reactions. In cases of anaphylaxis, patients should be administered epinephrine immediately and discontinue streptokinase therapy. The toxicity of streptokinase is believed to be because it is a polypeptide derivative of beta-hemolytic streptococci bacteria.
Option C: There is no correlation to the use of phenytoin and streptokinase. The thrombolytic nature of streptokinase makes it contraindicated in patients with active internal bleeding, as it can worsen bleeding in some patients. It is also contraindicated in patients with severe uncontrolled hypertension, intracranial neoplasms, surgery within two months, recent stroke, and intraspinal surgery.
Option D: A history of alcohol abuse is also not a factor in the order for streptokinase. Streptokinase administered with extreme caution to those who have experienced recent trauma, coagulopathies or hematologic diseases, gastrointestinal bleeding, infective endocarditis, obstetric deliveries, diabetic hemorrhagic retinopathy, organ biopsies, or previous puncture of a non-compressible vessel. Streptokinase is a pregnancy Category C medication. The effects of streptokinase on a fetus are unknown, and patients who are pregnant should only receive streptokinase to prevent life-threatening injury.