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According to the lab values, the client has

related to or.
Answer and Explanation

The Correct Answer is {"dropdown-group-1":"E","dropdown-group-2":"E","dropdown-group-3":"D"}

Rationale for Correct Choices:

  • Anemia: The lab values indicate that the client’s hemoglobin and hematocrit are lower than normal, suggesting anemia. Anemia in this case is likely due to blood loss from the trauma, as the client has internal hemorrhaging, with blood noted in the peritoneum.
  • Blood loss: The client’s abdominal trauma, with liver and spleen lacerations and blood in the peritoneum, is a clear indicator of significant internal bleeding. This blood loss is directly responsible for the anemia seen in the lab results.
  • Hemodilution from intravenous fluids: The client is receiving IV fluids at a rate of 100 mL/hr, which can dilute the blood and artificially lower hematocrit and hemoglobin levels. This is a common effect when fluids are given in large amounts, as the fluid increases plasma volume without immediately increasing red blood cells.

Rationale for Incorrect Choices:

  • Acidosis: Acidosis typically presents with changes in blood pH and respiratory or renal compensation, which is not indicated by the client's lab results or current status. There are no signs of metabolic or respiratory acidosis in the current clinical picture.
  • Rh factor sensitization: Rh factor sensitization usually occurs during pregnancy when Rh-negative mothers develop antibodies against Rh-positive fetal blood cells. This is unrelated to the client’s trauma and lab findings, which focus on anemia.
  • Hypovolemia: Hypovolemia is more directly related to the blood loss and the hemodilution effect from intravenous fluid administration, making it a contributing but less specific factor in the anemia diagnosis.
  • Disseminated intravascular coagulation (DIC): DIC is characterized by widespread clotting followed by bleeding. There is no evidence of abnormal clotting or bleeding issues in the lab results or clinical presentation, such as abnormal coagulation studies.
  • Pregnancy: Pregnancy is not applicable in this case as the client's history does not mention any signs or symptoms of pregnancy. Anemia in this patient is related to trauma-induced blood loss and subsequent hemodilution, not pregnancy-related causes.
  • Clotting cascade: While it is relevant to conditions like DIC or bleeding disorders, it does not directly explain the client's low hemoglobin or hematocrit. The lab results are more consistent with blood loss and fluid resuscitation.
  • Blood administration: There is no mention of the client receiving blood products. While blood transfusion might be needed given the blood loss, there is no current indication from the lab results that blood administration has occurred or is required at this point.
  • Immune response: An immune response is typically seen in infections or allergic reactions. The client’s current clinical condition and lab results do not suggest an infection or immune response but rather trauma-related blood loss and fluid effects.
  • Hypoventilation: Hypoventilation typically leads to respiratory acidosis or elevated CO2 levels, but the client is intubated and on mechanical ventilation, with no indication of respiratory distress or acidosis.
  • Hypoxia: Although trauma patients may experience hypoxia, the client’s oxygen saturation is 100%, and there is no indication of respiratory distress or hypoxia in the lab results. The anemia is more related to blood loss rather than a lack of oxygen in the tissues.


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Related Questions

Correct Answer is []

Explanation

Rationale for Correct Choices:

  • Nephrotic Syndrome: The child’s symptoms, including edema, fatigue, increased weight despite decreased appetite, and proteinuria, point towards nephrotic syndrome. This condition involves the loss of protein (mainly albumin) in the urine, leading to edema. The laboratory result of 2+ protein in the urine and low albumin level of 2.8 g/dL are consistent with nephrotic syndrome.
  • Provide a low-salt diet: A low-salt diet is a key intervention in nephrotic syndrome to help manage fluid retention and edema. Sodium causes water retention, which worsens edema, and limiting salt intake can help reduce swelling and manage the symptoms effectively.
  • Administer albumin: Administering albumin is important in nephrotic syndrome because it helps replenish the albumin levels in the blood. Restoring the albumin levels can help reduce edema by improving osmotic pressure and preventing fluid from accumulating in the tissues.
  • Daily weight: Daily weight monitoring is essential to assess for changes in fluid retention. In nephrotic syndrome, fluid retention can fluctuate, and regular monitoring helps assess the effectiveness of the treatment plan and helps guide further interventions.
  • Abdominal girth: Monitoring abdominal girth is necessary to track the extent of fluid accumulation in the abdomen. Abdominal edema is common in nephrotic syndrome, and significant increases in girth could indicate worsening fluid retention.

Rationale for Incorrect Choices:

  • Type 1 diabetes: This presents with increased thirst, frequent urination, and weight loss due to elevated blood glucose levels. However, this child is experiencing weight gain despite decreased appetite and has symptoms of edema, which are not typical of diabetes.
  • Wilms' tumor: Wilms' tumor presents with an abdominal mass, hematuria, or pain, which is not mentioned in this case. While renal issues could cause edema, the lab results of proteinuria and low albumin suggest nephrotic syndrome rather than a malignancy like Wilms' tumor.
  • Hemolytic uremic syndrome: Hemolytic uremic syndrome is characterized by hemolytic anemia, thrombocytopenia, and acute kidney injury. The child does not show signs of anemia, low platelets, or kidney failure (such as elevated creatinine), which are key features of HUS.
  • Place the child on strict bed rest While it’s important to monitor the child closely, strict bed rest could lead to muscle weakness and decreased mobility. The focus should be on managing edema and ensuring proper fluid balance, not restricting movement.
  • Prepare the child for emergency surgery: Emergency surgery is not indicated for nephrotic syndrome, which is a non-surgical condition that can be managed with medications (like albumin) and lifestyle adjustments (such as a low-salt diet).
  • Prepare an insulin drip: An insulin drip would be appropriate for managing hyperglycemia, typically seen in diabetic emergencies. However, this child does not show any signs of diabetes or hyperglycemia. The focus is on managing nephrotic syndrome.
  • Lymph node size: Lymph node size is monitored in cases of infection or malignancy. In nephrotic syndrome, the primary concern is fluid retention and protein loss, not lymph node enlargement.
  • Bladder volume: Bladder volume monitoring is typically relevant in cases of urinary retention or other urinary tract disorders. This child’s primary concern is proteinuria and edema, which are linked to kidney function and fluid balance, rather than bladder volume.
  • Ketones: Monitoring ketones is generally relevant in cases of uncontrolled diabetes or prolonged fasting. However, this child is not presenting with symptoms of hyperglycemia or ketosis. Nephrotic syndrome does not typically involve ketones.

Correct Answer is {"A":{"answers":"A"},"B":{"answers":"A,B"},"C":{"answers":"A"},"D":{"answers":"A"},"E":{"answers":"A,B"}}

Explanation

Rationale:

  • 1+ strength in left upper extremity: Reduced strength in the affected arm could indicate a humeral fracture, which can impair muscle function and strength. A rotator cuff injury could cause pain, but it doesn’t necessarily lead to a reduction in strength to the extent seen with a humeral fracture.
  • Decreased range of motion: Decreased range of motion is common with humeral fractures as the bone is likely immobilized and painful to move. A rotator cuff injury can also lead to decreased range of motion due to pain and limited ability to lift or rotate the arm.
  • Coolness of skin: Coolness to the skin could indicate poor circulation, which can occur if there is vascular injury related to a humeral fracture or if there is significant swelling causing compression of blood vessels.Coolness is less commonly associated with rotator cuff injuries unless there is concurrent trauma affecting blood flow.
  • Reduced pulse distal to injury: Reduced pulses can suggest vascular injury, which is more likely with a humeral fracture, especially if the bone fragments are displacing or compressing blood vessels.This is unlikely with a rotator cuff injury, as it primarily affects the tendons and muscles without significant impact on vascular structures.
  • Pain with movement: Pain with movement is a classic symptom of a fracture, particularly when moving the arm or shoulder area. Pain with movement is also a hallmark of a rotator cuff injury, especially when the arm is raised or rotated.

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