Which dietary intervention(s) should the nurse include in the plan of care for a client who had bariatric surgery? Select all that apply.

Rationale:

A. Respiratory Therapist: Although respiratory therapists are involved when respiratory compromise occurs, the client has normal oxygen saturation and stable respiratory function, so this role isn’t prioritized in current care.

B. Pharmacy Technician: Pharmacy technicians focus on medication dispensing and inventory, but do not participate in direct patient care or individualized therapy planning for stroke recovery.

C. Speech Therapist: A speech therapist is essential for evaluating and managing post-stroke speech and swallowing difficulties, such as dysarthria and dysphagia, which this client is exhibiting.

D. Medical Assistant: Medical assistants support clinic operations and perform basic administrative or procedural tasks, not advanced rehabilitative or discharge planning roles in acute stroke recovery.

E. Case Manager: The case manager facilitates discharge planning, ensures access to follow-up care and services, and coordinates rehabilitation or home care as needed for stroke recovery.

F. Physical Therapist: A physical therapist aids in improving mobility and strength, especially with the client’s observed diminished left-sided motor function, helping restore independence and prevent complications.

G. Chief Nursing Officer: The CNO is a high-level administrative leader not involved in direct bedside care or individual rehabilitation planning, making them unnecessary for the client’s interdisciplinary recovery team.

H. Occupational Therapist: Occupational therapists help the client regain skills needed for daily living, such as dressing or feeding, which may be impaired due to hemiparesis from the stroke.

Rationale:

• Auscultation of bruit: A bruit heard over the abdomen suggests turbulent blood flow, a key feature of aortic aneurysm. It results from abnormal dilation of the aortic vessel, which disrupts normal flow and produces an audible vibration on auscultation.
• Pulsatile mass: A pulsatile mass in the periumbilical area is highly suggestive of an abdominal aortic aneurysm. This occurs due to the expansion of the weakened aortic wall, making the pulse visible or palpable through the abdominal wall.
• Fatigue: Fatigue can appear in both conditions. In gastric cancer, it may be due to anemia or cancer-related systemic effects. In aortic aneurysm, it may be linked to poor circulation or cardiac workload from concurrent conditions like atrial fibrillation.
• Indigestion: Indigestion is more common in gastric cancer due to delayed gastric emptying, mucosal irritation, or tumor growth. It presents as bloating, discomfort, or heartburn and is not typically associated with aortic aneurysm.
• Feeling of fullness: Early satiety or a persistent sense of fullness can occur with gastric cancer as tumors restrict gastric expansion or interfere with digestion. This symptom is uncommon in aortic aneurysm unless the aneurysm is compressing nearby digestive organs, which is rare.
• Back pain: Back pain is a key warning sign of aortic aneurysm, especially if the aneurysm is enlarging or nearing rupture. It results from pressure on surrounding tissues or vertebrae and requires urgent follow-up to prevent life-threatening complications.