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# See the table below. In the right column are words and phrases that link in some...

###### Question:

See the table below. In the right column are words and phrases that link in some way with each of the items numbered 1-XV on the left. In other words, this is a typical "matching exercise. Read the scenario and fill out the table FIRST, then use it to answer questions 11-20 below. THERE IS ONE ANSWER TO EACH LEFT-HAND TERM. DO NOT CHOOSE THE SAME ANSWER MORE THAN ONCE. CHOOSE THE BEST FIT Scenario: A 47 y/o female patient presents to the ER with the following complaints: "I'm short of breath and swollen all over." She reports a history of heavy ETOH (alcohol) use & has had worsening cirrhosis for many years. On examination she is noted to be confused and to have icteric sclera, various areas of bruising, infected skin sores, crackles in her lungs, & a distended abdomen. Labs are done. The following matching exercise describes various aspects of the patient's presentation and pathophysiology, and also some problems that might occur because of her cirrhosis. I. etiology of "swollen all over A. Increased destruction of WBCs due to hypersplenism II. direct bilirubin level B. AST 1000 (normal 10-40); ALT 1100 (normal 10-55) III. has caused fatigue, and also caused some of SOB IV. hyperaldosteronemia C causes retrograde venous flowesophageal varices may be present D. serum osmolality of 260 (normal - 280-295) ► fluid shifts into alveoli E. hypersplenism increased destruction of blood cells RBC count = 2.5 mill (norm = 4 to 6 mill) F. decreased metabolism of cortisol hypercortisolism intra-cellular enzymes V. damaged hepatocytes leak into blood VI. icteric sclera VII, portal HTN G. malfunctioning hepatocytes→ hypoproteinemia fluid shift from blood to tissue VIII. unconjugated bilirubin not being conjugated by cirrhotic liver IX. etiology of infected sores I. malfunctioning hepatocytes decreased breakdown of aldosterone 1. high indirect bilirubin in the blood. X. hypersplenism thrombocytopenia high XI. decreased ability to break down ammonia serum ammonia levels. K. assessment finding related to presence of pathologically high bilirubin in tissue cells XII. blood glucose of 37 XIII crackles in lungs L low because liver unable to conjugate unconjugated bilirubin M. decreased ability to institute glycogenolysis or gluconeogenesis as needed N. bruising & other S&S of easy bleeding XIV. development of Cushing's syndrome XV. hypoosmolality fluid shift into abdominal cavity O. etiology of asterixis
The patient has obvious generalized pitting edema. Etiology for "swollen all over (1): b. d. Understanding the many possible sequelae of cirrhosis, the patient's RN does a quick bedside glucose fingerstick. The blood glucose is 37 (XII). Which choice links best to this finding? C. d. K M 13. Labs on the patient come back with hardly a normal number. The serum ammonia level is especially high, and the RN knows to expect certain problems related to that. Choose the answer that best links to decreased ability to break down ammonia high serum ammonia levels" (xi). a. O b. K 14. The serum osmolality is 260 (norm-280-295). Which answer best links to "hypoosmolality abdominal cavity?" (XV). fluid shift into ь. Он C. d. B 15. Other lab results noted to be abnormal are the bilirubin levels. Which answer best goes with "unconjugated bilirubin not being conjugated by cirrhotic liver?" (VIII) d. 16. Another reason for the patient's complaint of being "puffy has to do with this problem: "development of Cushing's syndrome" (XIV). What's going on with that? a. B b. N d. F 17. The scenario mentions infected sores (and probably she has other infections, as well). Do you think someone with normal mechanisms of defense would have that many infections? Definitely not...so, what is it about cirrhosis that increases this propensity? Link the correct answer with "etiology of infected sores." (IX) a. A b. E d. M
18. In assessing this patient, the RN hears "crackles in the lungs." (XIII) What is the best link to that assessment finding? a. b. D C. K 19. "Has caused fatigue, and also caused some of SOB" (111)-this statement is partly explained by the issue in question 18. What other factor is involved? D dF The RN taking care of this patient knows to watch for many dangers related to "portal HTN" (VII). Several choices might be linked to this potentially severe cirrhosis-related problem, but out of the following, which choice is best?

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