A patient, being treated for multiple injuries in the intensive care unit, had been NPO for several days. While attempting to provide oral nourishment, the patient complains of early satiety, has a large emesis, and develops a fever
These assessment findings could indicate which of the following to the nurse? 1. fluid intolerance
2. electrolyte imbalance
3. gastric ulcer
4. gut failure
4
Rationale: During periods of high stress, the body will shunt blood to the organs to maintain maximum functioning. When this occurs, the gastrointestinal tract could develop ischemia and atrophy. The introduction of food or fluids at this time could cause the patient to vomit and have complaints of early satiety. With an ischemic gut, the patient is prone to developing bacterial translocation which means bacteria enter the general circulation from the gastrointestinal tract. This is a major cause of sepsis with the body response as an increase in temperature. The patient's inability to tolerate fluids after being NPO would not indicate fluid intolerance, electrolyte imbalance, or a gastric ulcer.
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