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Post-op for all procedures
- Vitals * need to establish baseline
- Watch for sighns of infection
- Use inspirative sparometer to get person backto baseline
- Mangage NG tube:
- bowel sounds must be present before tube is removed.
- small frequent meals
Sucralfate provides protective coating barrier over ulcer crater
Take only as directed, wait 30 min before taking other drug, monitor for constipation.
GERD - gastroesophageal reflux disease
- GERD: Syndrome, not a disease.
- 90% of people w/ GERD have a hiatal hernia.
- transient relaxation of the lower esophageal spincter allows fluids or food to reflux into the esophogus.
- Etiology: Certian food, medications, being overweight,.
- S/S: dyspepsia (heartburn), reflux, chest pain, coughing, dysphagia, belching, flatulence and bloating after eating. Symptoms aggervated by laying down.
- Treatment & Nursing managment:
- Diet therapy: exclude foods that cause sphincter relaxation - high-fat, spicy, garlic, eat 4-6 small meals, avoid straws and carbonated beverages, limit alcohol, tomato based products, caffeine, citrus juice, raw onions, chocolate, peppermint, spearmint.
- lifestyle changes:wait 2-3 hrs to lay down after eating
- no clothing that constricts middle of body
- loose weight if necessary 10% helps considerably
- sleep w/head of bed elivated 4-6 in.
- take meds as directed ie. meals/bedtime
- stop smoking
- stress reducing activities; exercise, meditation, deep breathing, laughter.
- Etiology: variety of illnesses, food poisoning, stress, inflammaiton of bowel
- Treatment:mild diarrhea is not treated
- persistant more than 24-48 hrs: antidiarrheal agents; Lomotil, Imodium Paregoric, Kaopectate
- Severe: npo, long-term parenteral nutrition.
- Lactobacillus acidophilus
- Management:monitor for electrolyte imbalances, dehydration, protect anus fro excoriation, sitz bath, hand hygeine
TPN - NG: total parental nutrition, nasogastric tube
- Monitor blood sugar, dyspnia/nausia
- check tube placement
- check & record residual volume Q4h or as ordered
- verify drip rate
- assess feeding pump
- change feeding bag & tubing Q24h
- keep head of bed elevated at least 30 degrees during feeding & 1hr after
- no die
- monitor labs: BUN,electrolytes, hematocrit, prealbumin, glucose
- monitor for diarrhea or excessive gas
- I/O, weekly weight
- flush tube w/30to60ml of water Q4h during continuous feeding, and before/after each intermittent feeding.
- 30 ml warm water before/after each individual med, do not mix meds w/feeding formula, use liquid med whenever possible
- flush tube if clogged w/ 30ml in a 50-ml piston syringe using gentle pressure
- oral care Q4h
- clean nares and around the tube in the naris ea. shift or 2x/day. inspect naris for pressure areas
- change tape on tubing if needed.
Hiatial Hernia, abdominal, inguinal
- Complications: strangulated, incarcerated - intestinal contents become blocked. emergent.
- Etiology: loss of muscle strength/tone, factors that cause intra-abdominal pressure (obesity, pregnancy), congenital defects.
- S/S: indigestion, belching, substernal or epigastric pain, feelings of pressure after eating worse when lying down.
- Treatment:weight reduction, avoidance of tight clothes antacids and histamine H2-receptor antagonsits, elevation of head othe the bed 6-8in. do not eat within several hrs of going to bed, limit, alcohol, chocolate, cafeine, fatty foods...quit smoking.
Peptic ulcers: gastric/duodenal
When would you expect pain to occur? Comes in waves last several minutes. Pattern of pain is associated w/secreation of gastric juices, in relation to food. Pain iminished in morening when secretion is low and after meals, is most sever before meals and & bedtime.
Constipation: what could happen w/ unresolved constipation?
Bowel obstruction, ruptures leading to sepsis, shock, death
Total gasteroctomy: what would the nurse monitor for?
vitamen B12 & folic acid
How many minutes listen for absent bowel sounds?
Listen to each of four quadrants for 5 min. Hypoactive bowel can be noted in the medical record when no sounds are heard after listening in each of the four quadrants for 30 seconds.
Peptic Ulcer: What would indicate peforation?
Sudden and severe pain in the upper abdomen that persists and increasesa in intesity and sometimes is referred to the shoulders.
a pouch that is created during an ileostomy which is looped back on itself an a nipple effect is created from the pressure of accumulating feces to prevent constant drainage. It is emptied with a catheter ever 3 to 4 hrs.
Where are the Colostomy and ileostomy located?
Colostomy: Large intestine (ascending, transverse, desending and sigmoid)
Ileostomy: small intestine
Expected stools for Colostomy & ileostomy
- Colostomy: formed
- ileostomy: liquid
What does a healthy stoma look like?
Pink, warm to touch, moist
- # 1st assess surgical site
- IV sites
- Urine Output
Diverticulitis - inflammation of the diverticuli (small, blind pouch)
Why do people get it? Occurs when herniated portions of thediverticula get food caught caught in the pouches and it mixes with bacteria. Herniation is called diverticulosis and is caused by straining due to constipation.
Colitis - inflammation of the bowels (ulcerative is inflammation with the presents of ulcers)
- Cause: unknown, genetics
- S/S: diarrhea, blooy stool, mucus, abdominal pain w/cramping, malaise, fever, weight loss.
Risk for colon cancer.
ileus -obstruction of the intestine
signs that it has resolved: flatulence, tolorence of oral intake, bowel movement.
IBS - irritable Bowel Syndrome
Pain, discomfort caused by altered bowel pattern and altered motility of the small and large intestine, bloating.
- alteration in bowel alemination - either constipation or diarrhea or both
- abdominal pain and bloating
- absence of detectable organic disease
- Best diet: low-fat, high-fiber, high-protien, high cal
- cramping abdominal pain that comes and goes
- inability to have bowl movement or pass gass
- abdominal distention
- bearing down, standing, pregancy
- pain, itching, bleeding
- heat/cold, sits bath, prep H surgical removal (scleropothy). rubber band ligation freezing
Post-op for Choleostecomy
- check incision
- check for bleeding
- check drains
- obsreve drainage
- cough and deep breath
- Position semi fowlers
- observe stool color: grey bowel duct obstruction
Pancreatitis - inflammation of the pancrease
- enzymes activate too early, in the pancrease
- acute or chronic
- very painful
- Primary focus of Intervention:
- Pain, IV fluid, NPO
- Test: blood test, stool test, CT scan, MRI
- Causes: alcohol, meds, smoking, familial, hypercalcemia, infection,
- Treatment (*TEST)
- Pain control
- IV fluids
- treat underlining cause
- change diet
- monitor blood sugar
- How are each contracted
- A - fecal to oral and contaminated food water and shellfish
- B - sexual contact, blood/fluid, mom/bb
- C- sexual contact, blood/fluid contaminated surgical equipment, tatooing, peircing
- D - blood and body fluid, close personal contact
- E - fecal to oral, contaminated food or water
Serum Billirubin level
- Total: 1.0 - 1.2 mg/dl
- Indirect: 0.2 - 0.8 mg/dl
- Direct: 0.1- 0.3 mg/dl
obsturction, peritonitis, wall ruptures
Signs and symptoms of cholecystitis may include:
- Severe, steady pain in the upper right part of your abdomen
- Pain that radiates from your abdomen to your right shoulder or back
- Tenderness over your abdomen when it's touched
- Abdominal bloating
keep still during the HIDA scan
- Flush the toilet twice after urinating
- Wash your hands thoroughly after you urinate
- Drink water throughout the day to help flush the radioactive tracer from your body
caused by increased levels of billiruben
Serface antigen HBsAg
Percausions: standard/universal percausions
- Diganosing: liver biopsy
- Yellowing of the skin (jaundice) due to the accumulation of bilirubin in the blood
- Loss of appetite
- Easy bruising from decreased production of blood clotting factors by the diseased liver.
Low-protien for cirrhosis
to lower ammonia levels while maintaining plasma osmotic balance