A nurse is caring for a critically ill client with autonomic dysreflexia. What clinical manifestations would the nurse expect in this client?

Reasoning:

Choice A reason: Iron deficiency anemia is a risk post-gastric bypass due to reduced stomach acid and bypassed duodenum, impairing iron absorption. Pantoprazole, a proton pump inhibitor, further reduces acid, exacerbating malabsorption. Fatigue results from low hemoglobin, as iron is essential for red blood cell production, matching the client’s profile.

Choice B reason: Aplastic anemia, caused by bone marrow failure, is not linked to gastric bypass or pantoprazole. It results from autoimmune, toxic, or idiopathic causes, leading to pancytopenia. The client’s surgical history and medication use point to malabsorption, not bone marrow suppression, ruling out this anemia.

Choice C reason: Sickle cell anemia is an inherited hemoglobinopathy, not related to gastric bypass or pantoprazole. It causes hemolytic anemia and vaso-occlusive crises, not malabsorption-related fatigue. The client’s surgical history suggests an acquired nutritional deficiency, making iron deficiency more likely than sickle cell disease.

Choice D reason: Pernicious anemia results from vitamin B12 deficiency, often due to lack of intrinsic factor, which may occur post-gastric bypass. However, pantoprazole primarily impairs iron absorption, and fatigue with this history points to iron deficiency, as B12 absorption is less affected in this scenario.

Reasoning:

Choice A reason: Teaching coughing and deep breathing techniques prevents respiratory infections but is not the primary intervention for immune thrombocytopenia (ITP). ITP involves autoimmune platelet destruction, increasing bleeding risk. While infection prevention is important, maintaining platelet counts through transfusion is more critical to prevent hemorrhage in ITP.

Choice B reason: Giving aspirin to control temperature is contraindicated in ITP, as aspirin inhibits platelet function, worsening bleeding risk in clients with low platelet counts. Fever management should use alternative antipyretics like acetaminophen, making aspirin administration inappropriate and potentially harmful in this condition.

Choice C reason: Administering platelets, as ordered, is a key intervention in immune thrombocytopenia when bleeding risk is high. ITP causes autoimmune destruction of platelets, leading to thrombocytopenia. Platelet transfusions restore counts, reducing the risk of spontaneous bleeding, such as intracranial or gastrointestinal hemorrhage, a critical concern in severe cases.

Choice D reason: Administering stool softeners prevents straining, which could cause bleeding in ITP due to low platelets. While useful, it is secondary to platelet transfusion, which directly addresses the primary issue of thrombocytopenia and bleeding risk, making it less urgent than restoring platelet counts.