A nurse is caring for a client with acute pancreatitis. What complications will the nurse need to consider when planning care for this client?

Choice A rationale Malnourishment occurs because the pancreas fails to secrete essential digestive enzymes like lipase and amylase into the duodenum. This leads to malabsorption of fats, proteins, and carbohydrates. Chronic inflammation or acute necrotizing processes damage acinar cells, preventing the breakdown of nutrients. Patients often lose weight rapidly due to this secondary nutritional deficiency. Serum albumin levels, normally 3.4 to 5.4 g/dL, may drop significantly as protein synthesis and absorption are impaired during the inflammatory response. Choice B rationale Acute pain is a primary complication resulting from the autodigestion of pancreatic tissue by prematurely activated enzymes like trypsin. This process causes severe mid-epigastric pain that often radiates to the back. The inflammation triggers the release of kinins and other inflammatory mediators that sensitize nociceptors. Distention of the pancreatic capsule and chemical peritonitis from leaked enzymes further intensify this sensation. Managing this pain is crucial to reduce the metabolic demand on the already stressed organ. Choice C rationale Peripheral edema is generally not a direct, immediate complication of acute pancreatitis compared to systemic issues like third-spacing or hypovolemia. While low albumin could eventually cause it, the more pressing concern is the shift of fluid into the peritoneal cavity or retroperitoneal space. Generalized swelling of the extremities is less common than localized inflammation or systemic shock. Therefore, it is not a prioritized complication that determines the immediate plan of care for most acute cases. Choice D rationale Nausea and vomiting are frequent complications caused by paralytic ileus or the intense pain associated with pancreatic inflammation. The inflammatory process can irritate the stomach and duodenum, leading to gastric stasis. This results in significant fluid and electrolyte imbalances. Frequent emesis can lead to metabolic alkalosis. It is vital to manage these symptoms with antiemetics and nasogastric suctioning to decompress the stomach and rest the pancreas by preventing further stimulation of digestive enzymes. Choice E rationale Dehydration is a critical complication resulting from massive fluid shifts, vomiting, and decreased oral intake. Inflammatory mediators increase capillary permeability, causing protein-rich fluid to leak into the interstitial and peritoneal spaces, known as third-spacing. This can lead to hypovolemic shock if not corrected with aggressive intravenous fluid resuscitation. Monitoring urine output, which should be at least 30 mL/hr, and hematocrit levels is essential to assess the client's hydration status and overall hemodynamic stability.