In preparing a pediatric client for an appendectomy the nurse would question which doctors orders

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Long-term impairment of venous return leads to chronic venous insufficiency that is characterized by leathery, brawny appearance from erythrocyte extravasation to the extremity, persistent edema,
stasis dermatitis, and pruritus. Venous leg (stasis) ulcers characteristically form near the ankle on the medial aspect, with wound margins that are irregularly shaped with tissue that is a ruddy color.
Gangrenous wounds and diminished peripheral pulses are associated with arterial occlusive disease. (Lewis et al., 10th ed., pp. 826-828)

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Symptoms of heart failure include weight gain, orthopnea, fatigue, edema, and nocturia. Additionally the client can experience tachycardia,
skin changes, behavioral changes, and chest pain. (Lewis et al., 10 ed., pp. 742-743)

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A focused cardiac assessment is directed toward assessing physiologic symptoms (cardiac pain, JVD distention, heart sounds and rate, presence of diaphoresis) that provide immediate information regarding the client's condition, which is appropriate for the nurse to do at the beginning of each shift. After the physiologic parameters have been evaluated, the nurse can determine any history of difficulty breathing and a list of medications the client was taking before admission. (Lewis et al., 10 ed., p. 663)

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In end-stage liver disease, the liver cannot break down ammonia byproducts of protein metabolism. The increased ammonia levels in the serum cross the blood-brain barrier, causing uncontrolled
drowsiness and confusion. Hyperglycemia is characterized by polyphagia, polydipsia, and polyuria, along with fatigue, weight loss, excessive thirst, and abdominal pain. Hypocalcemia is characterized by tetany symptoms. Increased bile production does not cause neurologic symptoms; it is related more to digestion. (Lewis et al., 10 ed., p. 990)

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A low-fat diet is appropriate for the client with cholecystitis. Eggs, bacon, cheese, and avocados are high in fat and should be avoided. Other foods to avoid include whole milk, cream, butter, ice cream, fried foods, rich pastries, gravies, and nuts. (Lewis et al., 10 ed., p. 1008)

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Dumping syndrome is not uncommon after a combination bariatric surgery. Common symptoms include nausea, vomiting, abdominal cramping, weakness, palpitations, diaphoresis, and dizziness.
Precautions such as limiting the amount of fluids taken with a meal should be implemented. The intake of foods high in iron, calcium, and B12 may not prevent the vitamin or mineral deficiencies,
because the problem is with the absorption of these elements; supplements may be necessary. The client should plan to eat six small meals a day to decrease distention of the remaining stomach
and limit the ingestion of carbohydrates, which may cause hyperglycemia. Rest after a meal, rather than activity, is helpful because it may prevent gastric contents from emptying too rapidly into the
small intestine, thus generating the symptoms. (Lewis et al., 10 ed., pp. 917-918)

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Colicky, cramping abdominal pain located around the umbilicus often noted as "referred pain" for its vague periumbilical localization is characteristic of appendicitis. The most common point of tenderness is over the area known as McBurney's point. Typically, nausea, vomiting, and anorexia follow onset of pain. Diarrhea, poor feeding, lethargy, and irritability may accompany peritonitis. Tenderness in the right lower quadrant (not the left) that occurs during palpation or percussion is called Rovsing's sign. Gastric distention and gnawing radiating pain are not common signs of appendicitis; gnawing pain is more characteristic
of ulcers. Hemoptysis is not seen in appendicitis but in pulmonary edema. Remember, all the items in an option have to be correct if it is the correct answer. (Hockenberry & Wilson, 10 ed., p. 1079)

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The child with celiac disease will need a gluten-free diet, eliminating foods such as pastas and breads that are made from wheat or dessert foods made from malt whey. Remember BROW—barley,
rye, oats, and wheat. Foods that would be appropriate include rice and corn cereals, milk, corn and potato breads, tapioca, peanut butter, and honey. (Lewis et al., 10 ed., p. 967)

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Guillain-Barré is an acute and rapidly progressing condition affecting the peripheral nervous system characterized by an ascending level of paralysis leading to a serious complication of respiratory failure. This necessitates constant monitoring of the respiratory system. Although other autonomic dysfunctions can occur (requiring the other assessments), such as orthostatic hypotension, hypertension, heart block, bowel and bladder dysfunction, facial flushing, diaphoresis, and lower brainstem involvement (cranial nerves), respiratory problems are the priority. (Lewis et al., 9 ed., p. 1467)