Adult I Final Part 3

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cswett
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151324
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Adult I Final Part 3
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2012-04-30 23:49:22
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Adult I Final Part 3
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  1. Dumping Syndrome
    =after partial gastrectomy due to hypertonic food pulling in water with increased peristalsis & motility

    • Early symptoms occur within 5-30 min. of eating
    • (N&V, cramps, diarrhea, borborygmi, hypovolemia)
    • Late dumping syndrome 2 - 3 hours after eating (hyperinsulin with hypoglycemia)
    • Managed by dietary measures:
    • No liquids w/ meals (too filling)-separate out
    • Low carb diet (digested too quickly)
    • Moderate fat & proteins (slower digested)
    • Small frequent feedings
    • Recumbent 30 – 60 min. after meal
  2. Constipation Treatments
    Diet – high fiber (fruits, veggies, bran) & 8 glasses water per day

    Enemas – in acute situation (NS, soap suds, oil retention; tap water & phosphate/Fleets); can cause electrolyte imbalances & impaired bowel function

    • Medications-
    • Bulk-forming agents (Bran, Metamucil) with indigestible veg. fiber safe for use; draw in water
    • Wetting agents (Colace, Surfak) reduce stool surface tension with emulsion of fat &water; don’t crush
    • Osmotic & saline laxatives (Sorbitol, MOM,Lactulose) increase osmotic pressure & draw in water; short-term use as irritate bowel
    • Irritant or stimulant laxatives (Ducolax,Senna, Caster oil) stimulate motility &secretion; don’t crush; less than 1 wk. useas suppresses bowel reflexes
    • Lubricants (Mineral oil) forms oily coat on fecal mass preventing water absorption;interferes with fat soluble vitamin absorption (A, D, E & K); watch for aspiration
  3. Acute Appendicitis:
    • Assess (Signs & Symptoms):
    • + McBurney’s point
    • Guarding, rebound tenderness RLQ
    • N/V
    • Low-grade fever (high if perforated)
    • Elderly

    • Diagnosis:
    • Palpation, WBC, U/A to rule out other dx;Abd. X-ray, Ultrasound

    • Surgery:
    • Laparoscopic
    • Laparotomy (open)
  4. Celiac Disease
    Celiac/Nontropical Sprue-sensitivity or immunity to gluten in wheat etc.

    • TX: Corticosteroids
    • Vitamin K supplements (IM/IV)
    • Gluten-free diet (high cal., high protein, low fat
  5. Intestinal Obstruction (small bowel)
    Signs & Symptoms
    • Distention (fluid build-up proximal to /above obstruction)
    • Mid-abdominal colicky pain or cramping
    • Vomiting: clear/bile/fecal
    • Constipation/diarrhea
    • Borborygmi (hyperactive BS) early then silent due to paralytic ileus
    • Obstruction high (pylorus) - metabolic alkalosis RT loss of HCL from stomach
  6. Intestinal Obstruction (small bowel)
    Treatments:
    • GI decompression/NG tube weighed if partial obstruction
    • Fluid & electrolyte replacement
    • Surgery for complete obstruction/strangulation/incarceration (laparotomy or laser photocoagulation if major surgery prohibited)
    • Preventative= early ambulation postop to prevent ileus
  7. Diverticular Disease Treatments:
    High fiber diet with bran (avoid seeds, nuts, corn, berries, popcorn); progress from liquids to low roughage to high fiber

    • Medications-
    • Broad antibiotics (Flagyl, Cipro, Septra, Mefoxin)
    • Pain meds (Talwin over Demerol or MSO4)
    • Stool Softener (Colace)

    Surgery if hemorrhage, abscess or peritonitis(Hartmann with temp. ostomy)
  8. GI GerontologicConsiderations:
    • Teeth wear down, periodontal disease, lose teeth (no appetite)
    • Decrease in:
    • Taste buds, smell, salivary secretions,GI motility, & HCL acid
    • Delayed emptying of stomach
    • Increase in gallstones
    • Decrease in dietary fiber/fluid
    • Increased constipation
  9. Peptic Ulcer Disease (PUD)
    Break in gastrointestinal mucosa with mucosal barrier unable to protect it from damage by hydrochloric acid and pepsin(gastric digestive juices)

    • Duodenal ulcers (most common)
    • 95% occur in first portion of duodenum
    • Deep, sharply demarcated lesions
    • Penetrate through mucosa and submucosa into muscle layer
    • 95% to 100% due to H. pylori infection
    • Esp. ages 30 –55 and males > females
    • Intermittent pain 3 hrs. after eating
  10. treatment interventions for G.I. bleed
    • IV fluids with electrolytes
    • acute hemorrhage gets fresh, whole blood, which contains clotting factors
    • less acute equals packed red cells to restore oxygen-carrying capacity
    • bleeding vessel may be sclerosed using upper endoscopy

    • Gastric lavage
    • = remove or dilute gastric contents rapidly
    • semi-filers position, or side laying to prevent risk of aspiration
    • -insert NG tube and verify placement

    • Closed system irrigation-connect normal saline irrigating solution to the NG tube using a y connector
    • allow 50- 200 mL to flow into the stomach
    • new section to remove
  11. steatorrhea
    fatty, frothy, foul-smelling stools caused by decrease in pancreatic enzyme secretion that leads to malabsorption of fats
  12. Dehydration S & S
    • Extreme thirst
    • irritability and confusion in adults
    • Very dry mouth, skin and mucous membranes
    • Lack of sweating
    • Little or no urination — any urine that is produced will be dark yellow or amber
    • Sunken eyes
    • Shriveled and dry skin that lacks elasticity and doesn't "bounce back" when pinched into a fold
    • Low blood pressure
    • Rapid heartbeat
    • Rapid breathing
    • Fever
    • In the most serious cases, delirium or unconsciousness
  13. S & S Cystitis Vs Pyelonephritis
    • CYSTITIS(lower UTI)
    • Inflammation of the bladder
    • Frequency/urgency
    • Dysuria (painful urination)
    • Nocturia (void at night)
    • Pyuria (cloudy/pus)
    • Suprapubic pain
    • Hematuria
    • Foul smelling urine

    • ELDERLY -
    • nonspecific manifestations
    • nocturia
    • incontinence
    • confusion
    • behavior change
    • lethargy
    • anorexia
    • just dont feel right

    • PYELONEPHRITIS(upper UTI - kidney)Signs / Symptoms
    • Fever/chills (rapid onset)
    • Vomiting
    • Flank pain (dull)
    • Costoverebral tenderness
    • Urine - cloudy, foul odor
    • Bacteria and WBC’s in urine
    • Dysuria and frequency
    • Inflammation/scarring with HT, if chronic

    • Elderly
    • change in behavior
    • acute confusion
    • incontinence
    • general deterioation in condition
  14. URINALYSIS
    • pH 4.5 - 8.0 (6 average)
    • appearance clear
    • color amber, yellow
    • odor aromatic
    • specific gravity 1.005 - 1.030
    • protein 2 - 8 mg/dL (trace)
    • glucose negative
    • ketones negative
    • blood RBC’s up to 2
    • BUN 5-25 mg/dL(abnormal > 25-50 mg/dL or higher)
    • Creatinine
    • -Normal levels 0.5 - 1.5mg/dL(abnormal > 4 mg/dL)
    • -Inversely proportional to GFR
  15. CANCER OF THE BLADDER
    RISK FACTORS
    • #1 cigarette smoking (2X nonsmokers)
    • Age > 60 yrs.
    • Gender: males 4 X > females
    • Race: Caucasians 2 X > AfricanAmericans
    • Environmental carcinogens
    • -Dyes, rubber, plastics, paint, leather,ink
    • Coffee, cola, caffeine (irritate bladder)
    • Estrogen (diethylstilbestrol/DES)
    • Chronic inflammation (UTI’s, calculi)
  16. Testicular Cancer Symptoms
    Risk Factors
    • Signs/Symptoms:
    • mass or lump on one testicle (unilat.)-hard
    • painless enlargement of the testis
    • Heaviness (abd./pelvic/scrotal pain)
    • backache
    • weight loss
    • gen. weakness
    • cough/hemoptysis

    • Risk Factors
    • Cryptorchidism-undescended testicle5%; More common on right
    • Genetic predisposition
    • Kleinfelters syndrome(chromosomal irregularity XXY)
    • Caucasian 5-10X > African American
    • Maternal estrogen during pregnancy
  17. BENIGN PROSTATIC HYPERPLASIA (“BPH”)
    Nonmalignant prostate enlargement due to aging esp. > 50 yrs.

    • Signs/Symptoms:
    • Urinary obstruction/retention or incontinence
    • Feeling of incomplete emptying of bladder
    • Nocturia/frequency esp. noc.
    • Small urine stream
    • Difficulty in voiding/dysuria
    • Dribbling postvoid
    • UTI’s
    • Hyperplasia or prostate feels smooth, firm &rubbery (asymmetrical & enlarged)
  18. Prostatectomy
    Postop nursing interventions
    • Perineal/Kegel exercises
    • Psychological support
    • Pain management
    • Chemotherapy or radiation
    • Altered sexual functioning (ED)
    • Altered sexual image
    • Post op-avoid rectal temp, enemas, perineal tubes

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