The nurse notices a sudden increase in central venous pressure (CVP) readings for a client who is being monitored for fluid status.
Which condition is the most likely cause of this change?

Pyloric obstruction involves a mechanical blockage at the stomach outlet, leading to the accumulation of gastric contents. Knowledge of gastrointestinal decompression and the therapeutic purpose of nasogastric tubes in managing increased intragastric pressure and preventing emesis is required here.

Choice A rationale

Pyloric obstruction causes gastric stasis and distension because contents cannot enter the duodenum. Nasogastric intubation provides decompression by removing accumulated secretions and gas, which relieves pressure, prevents vomiting, and reduces the risk of aspiration in the client.

Choice B rationale

Providing nutrition via tube feeding is contraindicated in pyloric obstruction. Because the outlet of the stomach is blocked, any enteral formula introduced would accumulate in the stomach, worsening distension and significantly increasing the risk of reflux or aspiration.

Choice C rationale

While gastric pH can be measured via a nasogastric tube, it is not the primary therapeutic rationale for tube placement in a client with a mechanical obstruction. Decompression is a critical intervention to ensure safety and comfort.

Choice D rationale

Administering oral medications through a nasogastric tube is ineffective during an obstruction. The medication cannot pass the pylorus to be absorbed in the small intestine, and it adds volume to an already overfilled and pressurized stomach.

Disseminated intravascular coagulation involves systemic activation of coagulation, leading to microthrombi formation. Assessing for organ dysfunction requires understanding how thrombotic microangiopathy causes ischemia in high-vascularity organs, specifically focusing on renal and hepatic biomarkers and physiological changes in perfusion.

Choice A rationale

Thrombotic microangiopathy in the lungs would typically cause increased respiratory rates and decreased oxygen saturation due to impaired gas exchange. Decreased rates and normal saturation do not indicate the ischemic damage associated with microvascular clotting.

Choice B rationale

The kidneys are highly susceptible to microthrombi. Elevated BUN (normal 10 to 20 mg/dL) and creatinine (normal 0.6 to 1.2 mg/dL) indicate acute kidney injury caused by fibrin deposition and subsequent ischemia in the glomerular capillaries.

Choice C rationale

While bilirubin might rise due to hemolysis, white blood cell counts are not a primary indicator of thrombotic organ dysfunction. Bilirubin increases are more common in hepatic failure or red blood cell fragmentation during DIC.

Choice D rationale

DIC typically presents with abnormal coagulation profiles, including prolonged PT and PTT and low fibrinogen. Normal profiles would contradict the diagnosis of DIC, even if transaminases were elevated due to localized hepatic microvascular occlusion.