PN132 Unit 1

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golfdiva
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151295
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PN132 Unit 1
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2012-05-08 21:52:18
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bowels constipation diarrhea hemerrhoids appendicitis
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Unit 1
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  1. Define diarrhea
    • frequent, loose stooles,
    • liquid stools
  2. What causes diarrhea?
    • medications
    • antibiotics
    • foods
    • tube feedings
    • cancer
    • stress
    • diverticulosis
    • infections
    • cdiff
  3. What are the clinical manifestation of diarrhea?
    • fever (from infections)
    • cramping
    • watery stools
    • pain
    • urgency
    • thirst
    • dehydration
    • muscle weakness
    • drowiness
    • urine more concentrated
  4. With diarrhea, what happens to specific urine gravity?
    • specific urine gravity is up
    • hemoglobin concentration is up
  5. elderly and diarrhea?
    eldery often get dehydrated because they lack thirst mechinism
  6. What things should a nurse assess r/t diarrhea?
    • diet
    • current meds
    • recent travel
    • frequency of stools
    • onset of diarrhea
    • dehydration
  7. What are some nursing dx r/t diarrhea?
    • Self Care Deficit
    • Skin Integrity
    • NutritionSelf Concept
    • Diarrhea
    • Anxiety
    • Pain, (cramping)
    • Fluid volume deficit
  8. What are some nursing interventionis r/t diarrhea?
    • Peri Care
    • Diet - Fluid & Electrolyte replacement
    • Intake and Output
    • Educationalways put assess for readiness on care plan
  9. What is constipation?
    • infrequent, hard, dry stools
    • difficult to pass
  10. What causes constipation?
    • decreased fluid intake
    • low fiber intake
    • meds
    • ignoring the urge
    • medical conditions
    • abdominal surgery
    • colon problems
    • brain and spinal cord conditions
  11. What are clinical manifestations of constipation?
    • abdominal distention
    • fatigue
    • decreased appitite
    • hard, dry stools
    • abdominal pain
    • incomplete emptying
    • headache
    • hemerrohiods
    • straining
  12. What is mega colon?
    colon is distended, fills w/ air above stool, pressure on diaphram,
  13. What is the valsalva manuever?
    • straining during bm
    • blood leaves head, causes dizziness, fainting, pressure in chest
    • then relax every thing goes back up
  14. What is obstipation?
    prolonged constipation
  15. What does a nurse assess r/t constipation?
    • diet
    • current meds
    • recent travel
    • normal bm schedule
    • onset and duration of constipation
    • stool color, consitancy
  16. What are some nursing dx r/t constipation?
    • constipation
    • knowledge defecit
    • anxiety
    • pain
  17. What are some nursing interventions r/t constipation?
    • Intake and Output
    • Encourage fluids
    • Ambulation
    • Education
    • Medications
    • good peri anal care
    • hemerrhoids
  18. Two types of insteinal obstructions:
    • mechanical
    • non mechanical
  19. What is a mechanical obstruction?
    inside the intestine
  20. What is vovulvus?
    instestine is twisted, spun around, need surgery
  21. What is intussception?
    telescoping of bowel
  22. What is stricture?
    • narrowing of bowel,
    • can be from radiation, crohn's,
  23. What are some causes of mechanical obstruction?
    • adhesions,
    • impactions
    • tumors
    • strangulation
    • hernias
    • foreign bodies
    • stricture
    • intussuception
    • volvolus
  24. What are some causes of non mechanical obstructions?
    • bowel surgery
    • sepsis
    • trauma
  25. What is non mechanical obstruction?
    The parastalsis stops
  26. What causes non mechanical obstruction?
    • paralytic ileus most common
    • obstruction after abdominal surgery
    • surgery
  27. What are some manifestations of bowel obstruction?
    • partial: high pitched bowel sounds
    • complete: no bowel sounds
    • vomiting
    • abdominal pain/tenderness
    • waves of cramping
    • constipation
    • blood and/or drainage may be passed
    • abdomin taunt, distended, shiny
    • might not pass
  28. Obstruction above the ilium:
    • profuse vomiting
    • bile
    • turns watery
  29. Obstruction below the ileum?
    vomit smells like stools
  30. What is singultus?
    • hiccups -
    • pressure on diaphram hits phrenetic nerve,
  31. Where are most obstructions? Why?
    small intesztine because the large bowel occur more slowly, bigger and can extend more, usually cancer, in sigmoid
  32. What are the clinical manifestations of a small bowel obstruction?
    • rapid onset
    • colicky, intermittent pain
    • frequent copious vomiting
    • abdomin greatly distended
    • some bm at first
  33. What are the clinical manifestations of a large bowel obstruction?
    • gradual onset
    • cramping pain
    • vomiting rare
    • abdomin distended
    • complete constipation
  34. What would a nurse assess r/t a bowel obstruction?
    • pain
    • nausea
    • last bm r/t pt's normal pattern
    • onset of symptoms
    • progression of symptoms
    • vital signs
    • abdominal distentioin
    • auscultate for high pitched sounds
  35. What nursing dxs are associated with bowel obstruction?
    • acute pain
    • fluid volume deficiet r/t vomiting
    • anxiety
    • risk for infection
    • ineffective breathing pattern r/t pressure on abdomin
    • altered tissue profusion r/t intestine obst.
  36. What are the usual treatments for bowel obstruction?
    • first do nothing, let bowel cool off
    • nasal gastric tube NG tube
    • suck contents out, relieves pressure of distention
  37. What are some nursing interventions for bowel obstructions?
    • monitor bowel sounds frequently
    • analgesics as ordered , monitor effectiveness
    • monitor vital signs
    • raise HOB
    • give explanation of care
    • maintain NG tube patency
  38. In general, what is the purpose of a NG tube?
    • Permits nutritional support
    • Gastric decompression
    • Relieves nausea
  39. Which of these statements about NG tubes do not pertain to a bowel obstructions:

    Permits nutritional support
    Gastric decompression
    Relieves nausea
    Permits nutritional support
  40. What are some nursing interventions r/t a NG tube?
    • Assess tube for patency q 2-4 hrs
    • Assess color, amt, & consistency of gastric drainage q shift
    • stool or bile? above or below ilieum?
    • Assess abdomen for distention
    • Assess patient for n/v, pain, cramping
    • nares
    • Provide mouth care q 2 hrs (bcs not swallowing)
    • brush teeth etc.
    • Monitor I/O q shift
    • chapped lips
  41. What is the definition of appendicitis?
    • inflammation of the appendix
    • (most common reason for emergency abdominal surgery in U.S.)
  42. What are some clinical manifestations of appendicitis?
    • begins with a dull, steady pain
    • pain in the epigastric region that shifts to the RLQ
    • pain at McBurney's Point (between belly button and iliac crest)
    • low grade fever
    • elevated WBC
  43. What would a nurse assess with suspects appendicitis?
    • pain:
    • location
    • severity
    • onset
    • past medications
    • HX of nausea and vomiting
    • abdominal clues:
    • pain
    • tenderness
    • distention
    • leg extension hurts
  44. What are some nursing dx's for appendicitis?
    • risk for infections
    • deficient fluid volume
    • acute pain
    • ineffective breathing pattern
    • fear
    • anxiety
  45. What are some pre operative nursing interventions for appendicitis?
    • Semi-fowler’s position
    • no analgesics
    • no ice
    • no heat (could cause ruture)
  46. What are some post operative nursing interventions for appendicitis?
    • Antibiotics
    • Naso-gastric tube (?) if preferation
    • turn, cough, deep breathing
    • intravenous fluids
    • gastrointestinal decompression
  47. Define peritonitis.
    inflammatioin of the peritoneum caused by bacterial or chemical contamination of the peritoneal cavity
  48. What are some causes of peritonitis?
    • trauma
    • ruptured appendix
    • perforated ulcer
    • severly inflammed gallbladder
  49. What are some clinical manifestations of peritonistis?
    • pain over the affected area
    • rebond tenderness
    • abdomeinal tenderness
    • abdominal rigidity/distention
    • fever
    • tachycardia
    • nausea and vomiting
  50. What should a nurse assess r/t peritonitis?
    • pain is predominent
    • inspect the abdomen
    • auscultate for bowel sounds
    • assess for dehydration
  51. What are some nursing dx's for peritonitis?
    • acute pain
    • decreased cardiac output
    • imbalanced nutrition
    • anxiety
  52. What are some nursing interventions for peritonitis?
    • administer opioid analgesics
    • monitor I & O
    • moniter vital signs
    • monitor patency of NB tube
    • adminster anti emetics if ordered
  53. What are some medical treatments for peritonitis?
    • NG tube
    • intravenous fluids
    • antibiotics
    • analgesics
    • surgical treatment care similar to any post-op abdominal surgery
  54. Define diverticulosis.
    a condition characterized by small pouches int eh intestinal wall called diverticula.
  55. Where are most diverticula located?
    sigmoid colon
  56. Define diverticulitis.
    inflammation of the diverticuli
  57. What causes diverticulosis?
    • cause is unknown
    • most prevalent in industrialized populations that consume diets low in fiber and high in refined carbs
  58. What are some clinical manifestations of diverticulitis?
    • changes in bowel habits
    • constipation
    • diarrhea
    • or both
    • rectal bleeding
    • pain in the LLQ
    • nausea and vomiting
  59. What are some nursing dx's r/t diverticulitis?
    • deficient fluid volume
    • acute pain
    • risk for infection
  60. How is diverticulitis treated/managed?
    • high residue diet
    • no spicy foods
    • stool softners
    • analgestics for pain
    • antibiotics for inflammation/infections
  61. How is diverticulitis treated/managed during an acute inflammation?
    • bed rest
    • NG tube
  62. symptoms of diverticulitis:
    pain
    • LLQ
    • cramping
  63. symptoms of diverticulitis:
    aggravating factors?
    onstipation and low fiber diet
  64. symptoms of diverticulitis:
    alieviating factors?
    tx of constipation
  65. symptoms of diverticulitis:
    timing?
    • graudual onset,
    • intermittent gradual increase in frequency of pain severity
    • usually 5-7 hours
  66. symptoms of diverticulitis:
    useful other data?
    • intermittent rectal bleeding
    • straining at stool
    • constipation alterating with diarrhea
    • elevated WBC
    • temp and pulse rate
    • pus muscus blood in stool
  67. Define hemorrhoids.
    Dilated veins in the rectum
  68. What are 3 kinds of hemorrhoids?
    • Internal:
    • Above the sphincter muscles of the anus
    • External:
    • Below the sphincter muscles of the anus Prolapsed/Thrombosed:
    • Blood clots form in the external type, inflamed and VERY painful
  69. What are some clinical manifestations of hemorrhoids?
    • rectal pain
    • itiching
    • bleeding that may occur with bm
  70. What are some risk factors r/t hemorrhoids?
    • increased pressure in the redtal blood vessels caused by constipation
    • pregnancy
    • prolonged sitting
    • prolonged standing
  71. What are some non surgical treatments for hemorrhoids?
    • heat
    • cold
    • creams
    • ointments
  72. What are some surgical treatments for hemorrhoids?
    • ligation
    • laser
    • sclerotherpay (injection of the same agent as used w/ vericose veins to shrink the veins)
    • rubber banding
    • cyro surgery: freezing tissue
    • thermocoagulation (heat)
    • hemorrhoidecomty (phasing out as it HURTS a lot) only if hemorrhoids are large and very painful, prolapsed, excessive bleeding
  73. What are some nursing interventions r/t hemorrhoids?
    • remember: the pain is sever
    • sitz baths
    • stool softners
  74. Define a hernia.
    weakness in the muscle wall through which a segment of the bowel or other structure protrudes
  75. What are 3 types of hernias?
    • reducible:
    • it can be pushed back through the muscle wall
    • irreducible or incarcerated:
    • it can't be pushed back through the muscle wall
    • strangulated:
    • gangarous, necrotic
  76. Where do hernias occur?
    • indirect inguinal
    • direct inguinal
    • femoral
    • umbilical
    • incisional
  77. What are some pre operative nursing dxs r/t hernias?
    • risk for injury r/t hernia strangulation
    • impaired skin integrity
  78. What are some nursing dxs r/t post operative hernia?
    • impaired urinary elemination
    • constipation
    • acute pain
    • risk for injury r/t wound dehiscence
    • I & O
  79. What are some nursing interventions related to hernias?
    • ice to site
    • monitor voiding
    • education: no lifting for 4-6 weeks
    • avoid coughing
    • do deep breathing
    • avoid straining
    • monitor for dehiscence and eviscerations
    • restrict activities 4 - 6 weeks
  80. What are some surgical treatments for hernias?
    • herniorrhaphy:
    • sew it shut
    • hernioplasty:
    • sew in a screen
  81. Name two types of UTI.
    • cystitis:
    •  bladder infection
    • pyelonephritis:
    • kidney infection
  82. What is the specific gravity of urine?
    specific gravity 1.010-1.030
  83. What is suggested by ketones in urine?
    • fat breaking down,
    • diabetes
    • starvation diet
  84. What is suggested by proteins in urine?
    • bladder stones
    • tumors
  85. What is suggested by rbc in urine?
    • might be caused by cath
    • period
  86. What is suggested by WBC in urine?
    > 5,000 = infection
  87. What is a KUB?
    xray of the kidney, ureters bladder
  88. What is an IVP?
    • dye into kidneys,
    • inverveinous. pyloragram
  89. What is a cystoscopy?
    bladder scope, no dye, usually under, urtheas bladder etc.
  90. What is a NPO?
    • urodynamic studies,
    • bladder capicity, tone, pressure, use of muscles to urinate
  91. What is lithiasis?
    stone formation
  92. What is urolithiasis?
    stones in the urinary system
  93. What 2 kinds of stone?
    • calcium stones:
    • most popular
    • uric stones:
    • gout
  94. What are risk factors for urolithiasis?
    • family history
    • personal history
    • dehydration
    • immobility
  95. What are the manifestations of urolithiasis?
    • varies w/ size and place,
    • renal
    • colic (spasms)
    • sever flank pain
    • pain rotates to groin
    • fever
    • other s/s of uti
  96. What tests are used to dx urolithiasis?
    • urinalysis
    • need to analysis stone
  97. What medications are used r/t urolithiasis
    • morphine
    • big time narcartics
  98. What is lithotripsy?
    • stone smasherunder
    • anesthesia
    • shock waves through water, ½ – 2 hours
  99. KIDNEY STONES
    • Often asymptomatic
    • Dull, aching flank pain
    • Microscopic hematuria
    • Manifestations of UTI
  100. URETERAL STONES
    • Renal colic
    • Acute, severe flank pain on affected side
    • Often radiates to suprapubic region, groin, and external genitals
    • Nausea,
    • vomiting,
    • pallor,
    • cool, clammy skin
  101. BLADDER STONES
    • May be asymptomatic
    • Dull suprapubic pain, possibly associated with exercise or voiding
    • Gross or microscopic hematuria
    • Manifestations of UTI
  102. pylonephritis
    • acute
    • usually comes from chronic bladder infections
    • dull ache in lower back
    • low grade fever
  103. Glomerulonephritis
    • inflammation of loops in the kidney where waste is filtered
    • usually in peds
    • usually follows strep infection
  104. S/S of Glomerulonephritis
    • concentrated, tea colored urine
    • decreased urine output
    • peripheral edema
    • mild to mod. hypertension
    • hypervolumia
  105. benign hyperplasia (bph)
    • can occur in men as early as 50
    • age related, gets worse as he gets older
    • idiopathis
    • enlargement of prostate gland
  106. benign hyperplasia S/S:
    • urgency
    • hesitancy to start stream
    • frequency
    • nocturia
    • dribbling
    • decreased force of stream
    • can't empty bladder
    • hemoturia
  107. TURP
    trans uretheal resection of prostate
    • surgical procedure
    • go up through penis and cut prostate gland off
    • eneral anesthesia or spinal
    • sometimes tissue regrows
  108. Nursing concern r/t TURP
    • first concern: assess for bleeding, hemauria
    • some bleeding is normal, starts out red after 24 hours should be pink
    • voiding after cath removed
    • pain
    • 36 cath w/ 30 ml balloon to put pressure on incision and get out clots
  109. hysterectemy
    • done for dysfunctional uterine bleeding (DUB)
    • heavy bleeding
    • fibroids
    • tumors
    • prolapsed uterus
  110. oophrectomy
    salmingectomy
    abh w/ b.s.o.
    • remove ovaries
    • remove fallopean tubes
    • abdominal hysterectemy w/ ovaries and tube
  111. c. diff.
    • lots of antibiotics can cause yeast infections and c. diff.
    • diarrhea
    • signs may take weeks or months to appear
    • watery diarrhea 3 or more times a day for 2 or more days
    • mild abdominal cramping/tenderness
    • bad odor
    • colon can become inflammed (colitis)
    • contact isolation until 3 stools w/o c. diff.
  112. TB
    • air born isolation
    • private room
  113. whooping cough, flu
    • droplet isolation
    • w/in 3 feet of pt need a mask
  114. protective isolation
    to protect autoimmun compromised pts
  115. MRSA
    • contact isolation
    • mostly in hospitals/nursing homes
    • spread by touching, sharing towels, et c
    • mainly on skin, in nose, blood, wound, urine
    • gets in thru a break in skin
    • even a past history needs isolation
    • antibiotics kill it but it can lie dormant

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