The nurse is caring for a primigravida client at 34 4/7 weeks gestation, who has come in for a prenatal appointment.
Which of the findings would alert the nurse that this patient may be developing preeclampsia?

Choice A rationale

Malnourishment occurs because the pancreas fails to secrete essential digestive enzymes like lipase and amylase into the duodenum. This leads to malabsorption of fats, proteins, and carbohydrates. Chronic inflammation or acute necrotizing processes damage acinar cells, preventing the breakdown of nutrients. Patients often lose weight rapidly due to this secondary nutritional deficiency. Serum albumin levels, normally 3.4 to 5.4 g/dL, may drop significantly as protein synthesis and absorption are impaired during the inflammatory response.

Choice B rationale

Acute pain is a primary complication resulting from the autodigestion of pancreatic tissue by prematurely activated enzymes like trypsin. This process causes severe mid-epigastric pain that often radiates to the back. The inflammation triggers the release of kinins and other inflammatory mediators that sensitize nociceptors. Distention of the pancreatic capsule and chemical peritonitis from leaked enzymes further intensify this sensation. Managing this pain is crucial to reduce the metabolic demand on the already stressed organ.

Choice C rationale

Peripheral edema is generally not a direct, immediate complication of acute pancreatitis compared to systemic issues like third-spacing or hypovolemia. While low albumin could eventually cause it, the more pressing concern is the shift of fluid into the peritoneal cavity or retroperitoneal space. Generalized swelling of the extremities is less common than localized inflammation or systemic shock. Therefore, it is not a prioritized complication that determines the immediate plan of care for most acute cases.

Choice D rationale

Nausea and vomiting are frequent complications caused by paralytic ileus or the intense pain associated with pancreatic inflammation. The inflammatory process can irritate the stomach and duodenum, leading to gastric stasis. This results in significant fluid and electrolyte imbalances. Frequent emesis can lead to metabolic alkalosis. It is vital to manage these symptoms with antiemetics and nasogastric suctioning to decompress the stomach and rest the pancreas by preventing further stimulation of digestive enzymes.

Choice E rationale

Dehydration is a critical complication resulting from massive fluid shifts, vomiting, and decreased oral intake. Inflammatory mediators increase capillary permeability, causing protein-rich fluid to leak into the interstitial and peritoneal spaces, known as third-spacing. This can lead to hypovolemic shock if not corrected with aggressive intravenous fluid resuscitation. Monitoring urine output, which should be at least 30 mL/hr, and hematocrit levels is essential to assess the client's hydration status and overall hemodynamic stability.

Choice A rationale

Pancreatitis requires a slow reintroduction of nutrients starting with clear liquids that are low in fat and protein to avoid stimulating pancreatic enzyme secretion. Beef broth, gelatin, and apple juice provide hydration and simple carbohydrates without taxing the inflamed pancreas. Keeping fat intake near zero initially prevents the exacerbation of autodigestion and pain. Serum amylase levels (normal 30 to 110 U/L) and lipase (normal 0 to 160 U/L) should be monitored closely during this transition.

Choice B rationale

This meal is far too heavy in fats and complex proteins for a client recovering from acute pancreatitis. A hamburger patty, even if broiled, contains significant lipids that trigger cholecystokinin release, stimulating the pancreas to produce digestive enzymes. This could lead to a recurrence of severe epigastric pain and elevated serum lipase. High-fiber foods like peas and carrots may also be difficult to digest immediately after a 48 hour period of bowel rest and NPO status.

Choice C rationale

While gelatin and tea are appropriate clear liquids, oatmeal is a solid food containing fiber and complex carbohydrates. Introducing solids too early can lead to nausea and increased pancreatic workload. The goal of the first meal is to ensure the client can tolerate liquids before advancing to a full liquid or low-fat soft diet. Oatmeal requires more digestive effort than the pancreas may be ready to handle after a significant inflammatory event and prolonged fasting period.

Choice D rationale

This choice contains several items that are contraindicated for the initial post-NPO meal. Plain yogurt and vanilla ice cream contain dairy fats and proteins that strongly stimulate pancreatic activity. Vegetable soup may contain fats or large chunks of fiber that are inappropriate for the first stage of diet advancement. After 48 hours of NPO, the focus must remain on clear, non-fatty liquids to ensure the inflammation has subsided sufficiently to prevent a clinical relapse.