The flashcards below were created by user
foxyt14
on FreezingBlue Flashcards.
-
When does a person usually get an appendicitis?
11-19
-
Complication of appendicitis
- Perforation
- Peritonitis
- Abscesses
-
Clinical Manifestations of Appendicitis
- Pain RLQ
- Anorexia
- N/V
- Rebound Tenderness
- Muscle Guarding
-
Common causes of Peritonitis
- ruptured appendix
- perforated gastric/duodenal ulcer
- severely inflamed gallbladder
- abdominal trauma-GSW/knife wound
-
Diseases that can cause peritonitis
- pancreatitis
- ascites
- peritoneal dialysis
-
Clinical Manifestations of peritonitis
- abdominal pain
- rebound tenderness
- muscular rigidity
- abdominal distention
- ascites
- fever
- tachycardia/tachypnea
- n/v
-
Why don't you give a person with an appendicitis laxatives or an enema?
increases peristalsis and can cause perforation
-
After a person has had surgery/been NPO when do you advance their diet?
Once you hear bowel sounds
-
How do you treat peritonitis?
- NPO
- fluid & electrolyte replacement
- antibiotics/antiemetics
- NG Tube with suction
- semi fowlers
- pain management
-
Name 2 inflammatory bowel diseases
Ulcerative Colitis and Crohn's
-
What's IBD?
chronic recurrent inflammation of the intestinal tract
-
Who's most likely to get IBD's?
Jewish white people....who have it in their family. Inherited
-
Where do Ulcerative Colitis usually occur?
starts in the rectum and sigmoid colon and spreads up the colon in a CONITNUOUS pattern of inflammation and ulceration of the mucosal layer
-
Why are F&E lost with ulcerative colitis?
cuz there is a decreased mucosal area for absorption of F&E
-
Clinical Manifestations of Ulcerative Colitis
- bloody diarrhea (4/5xday)
- abdominal pain
- fever
- malaise
- anorexia
-
Sever Ulcerative Colitis presents itself as....
- 10-20 stools per day
- mucous and blood in stools
- fever
- weight loss
- anemia
- tachy
- symptoms of dehydration
-
Complications of Ulcerative Colitis
- Toxic Megacolon
- Perforation
- Hemorrhage causing anemia
- Increased risk of colorectal cancer
-
Systemic complications from Ulcerative colitis
- arthritis
- eye inflammation
- skin lesions
- thromboembolism
- kidney stones
- sclerosing cholangitis
-
Lab studies for ulcerative colitis/Crohns and why you do those studies
- CBC-iron deficiency anemia
- WBC count-megacolon/perforation
- Serum Protein-hypoalbuminemia
- Stool testing-OB and C&S
-
Dx studies for ulcerative colitis and Crohns
- colonoscopy
- pillcam
- barium enema
-
Planning goals for a person with ulcerative colitis and Crohns
- decreased # of stools/day
- soft formed stools
- keep food in and maintain wt
- no anxiety
-
Interventions with ulcerative colitis/Crohns
- IV fluids and electrolytes
- monitor # stools and appearance
- meticulous peri care
-
Most effective exacerbation medications for ulcerative colitis/Crohns (2)...what does it do?
it's a retention enema that is an anti inflammatory
-
Severe anti inflammatory medications for ulcerative colitis/Crohns
- Prednisone PO
- Solumedrol IV
-
Maintenance medication for ulcerative colitis
Imuran
-
Surgical procedure for Ulcerative Colitis
total l colectomy with rectal mucosal stripping and ileal reservoir
CUREABLE
-
After colorectal surgery for ulcerative colitis...how much fluid may you see in the stoma bag?
1500-2000ml/24 hrs!!!
change bag frequently
-
Foods to encourage and discourage with Ulcerative Colitis
Encourage-high calorie, high protein low residue diet w/vitamins and iron supplements
Discourage-cold foods, high residue foods (wheat bread, cereal with bran, nuts, raw fruit) smoking
-
Describe Crohn's disease
- discontinuous inflammation involving all layers of the bowel
- most common in the terminal ileum and colon
-
Clinical Manifestations of Crohn's
- diarrhea
- abdominal pain
- fever
- fatigue
- wt loss/malnutrition
- dehydration
- anemia
- v. deficiency
- electrolyte imbalance
-
Ultimate problem with Crohns disease
- will need surgery, but it wont cure the problem
- due to multiple surgeries...they will ultimately have short bowel syndrome
-
short bowel syndrome causes
severe malabsorption
-
Oral diet for a person with Crohns
- high calorie
- high nitrogen (replace protein loss)
- fat free
- no residue
-
With Crohns if there is malabsorption at the terminal ileum what will my patient need?
v. B12 shots monthly
-
Gerontologic considerations for Crohns and Ulcerative colitis
- Second peak occurs at 70
- riskier to have surgery
- hard to control F&E issues
-
Mechanical Neurogenic bowel obstruction
caused by an occlusion of the lumen of the intestinal tract (usually small) from adhesions post op
-
Most common mechanical obstruction of the large intestine
cancer
-
Nom mechanical neurogenic bowel obstruction
- paralytic ileus (lack of peristalsis)
- vascular obstruction (emboli/atherosclerosis)
- Hernia
- Neoplasms
-
What is a neurogenic bowel obstruction
when the bowel cant tell that brain that it is full, and the brain cant tell the bowel to empty completely or at an appropriate time
-
Patho of neurogenic bowel obstructions
- obstruction causes distention and stimulates intestinal secretions
- increased pressure causes capillary permeability and fluids shift in to the peritoneal cavity
-
Systemic problems from neurogenic bowel obstructions
- hypotension
- hypovolemia
- F&E imbalances
-
Clinical Manifestations of neurogenic bowel obstructions
- N/V
- abdominal pain/distention
- NO FLATUS
- constipation
- Pain
- Fever
-
DX studies for neurogenic bowel obstructions
- CT
- Abdominal X ray (gas/fluids)
- CBC/Serum Chesistries
- Stool for OB
- Sigmoidoscopy/Colonoscopy with biopsy
-
High intestinal obstructions vs. low intestinal obstructions you will see.....Metabolic
- high-alkalosis
- low-acidosis
-
Nursing management for a person with a neurogenic bowel obstruction
- watch for fluid and electrolyte imbalances
- replace potassium?
- NPO
- Manage NG tube
-
What are diverticula
saccular dilations or outpouching of the mucosa thru the smooth muscle of the intestinal wall
-
Where do diverticula mainly occur?
sigmoid colon
-
What is thought to be the cause of diverticula?
Who gets it the most?
lack of fiber and high carb diet
US Americans get it the most
-
What is the result of diverticula?
transit time slows and more water is absorbed from the stool making it more difficult to pass thru the lumen
-
What causes diverticulitis?
retention of stool and bacteria in the diverticula causing inflammation, abscesses and small perforations
-
Common symptoms of diverticulitis
- LLQ abdominal pain
- fever
- leukocytosis
-
Compolications of diverticulitis
- Perforation with peritonitis
- abscess and fistula formation
- bowel and ureteral obstruction
- bleeding
-
What kind of a diet does a person with diverticulitis eat?
- High fiber...fruits and vegetables
- increased fluids
Avoid bending, heavy lifting and tight clothes
-
Reducible hernia
go back in to place by manipulation or when the patient lies down
-
Irreducible hernias
cant be placed back in to the abdominal cavity and may become strangulated.
-
Inguanal Hernia
Most common hernia and most common in men
Pushes through inguinal ring
-
Femoral Hernia
Occurs most in women
pushes thru the femoral ring in to the femoral canal
-
Umbillical Hernia
occur when the rectus muscle is weak or the umbilical opening fails to close after birth
-
Ventral/Incisional Hernia
occur due to a weakness in the abdominal wall at the site of a previous incision
-
Hernias are most common in people who are.....
- obese
- have had multiple surgeries in the same area
- inadequate wound healing
-
Clinical Manifestations of Hernias
- Protrusion
- Severe pain if strangulated
-
Herniorraphy
surgical repair of a hernia...done laparoscopically
-
Hernioplasty
reinforcement of a weakened area around a hernia
-
If strangulation of the intestines occur due to a hernia what will happen....
- necrosis/gangrene
- bowel resection with temporary colostomy
-
After Herniorraphy or Hernioplasty....tell the patient
- don't sneeze/cough
- don't lift heavy things for 6-8 weeks
-
Cirrhosis
chronic, progressive degeneration and destruction of liver cells
-
With cirrhosis destroyed liver cells are replaced by scar tissue....what's the result?
- inadequate blood flow
- poor cellular nutrition/hypoxia
further decreases fxn of liver
-
What causes cirrhosis
- Alcoholism
- Chronic Hepatitis
- Biliary cirrhosis
- Cardiac problems
-
Which Hepatitis cause Cirrhosis?
B&C
-
How does heart disease cause cirrhosis?
caused by long standing Rt. sided heart failure causing venous flow to back up in to the liver
-
Early symptoms of cirrhosis
- GI Distress
- Anorexia
- Dyspepsia
- Flatulence
- N/V
- Diarrhea/Constipation
-
Later symptoms of Cirrhosis
- Jaundice
- Peripheral Edema
- Ascites
- Skin lesions
- Endocrine disturbances
- Peripheral Neuropathies
-
Hematologic problems seen with cirrhosis
- Thrombocytopenia
- Leukopenia
- Anemia
-
Complications of Cirrhosis
- Portal HTN
- Esophageal Varices
- Ascites
- Peripheral Edema
- Hepatic Encephalopathy
- Hepatorenal Syndrome
-
What's esophageal Varices?
large torturous veins at the lower end of the esophagus as a result of portal hypertension causing high pressure and they are weak so they may hemorrhage.
Vericose veins of the esophagus
-
What causes Hepatic Encephalopathy?
the liver doesn't metabolize the ammonia in the body so it accumulates and crosses over the blood brain barrier causing neurologic changes
-
S/S of encephalopathy
lethargy to coma
-
Hepatorenal Syndrome
occurs with cirrhosis....renal failure with azotemia and is a result of portal hypertension
-
Persons with Cirrhosis are at risk for....
- Excess fluid volume
- Imbalanced nutrition
- impaired skin integrity
- bleeding
- acute confusion
-
Interventions for a person with cirrhosis
- reduce/eliminate risk factors for alcoholism
- rest to decrease metabolic demand on liver
- Banana Bag-B complex vitamins
- Assess for F&E imbalances
- Address skin
-
Nutritional therapy for a person with cirrhosis
- High calories/carbs
- Low fat/protein
-
Person with ascites is treated with....
- diuretics
- sodium restrictions
- paracentesis
- peritoneal shunt
-
How do you treat a patient with Esophageal Varices
- Goal is to reduce risk of bleeding....
- Give Beta Blockers to reduce BP
- TIPS-Transjugular Intrahepatic Portosystemic Shunt
- Vitamin K
-
Why is a person with Cirrhosis given V. K?
to correct clotting abnormalities
-
How is ammonia removed to prevent encephalopathy? (2)
- it is going to be removed via the intestines with Lactulose 3-4x/day
- Antibiotics impair bacterial action on protein in the feces to decrease ammonia production.
-
Clinical manifestation of pancreatitis
- LUQ abdominal pain
- N/V
- Leukocytosis
- Hypotension
- Tachycardia
- Jaundice
-
What aggravates pancreatitis
eating
-
Greys Turner's Sign
- seen in pt. with pancreatitis
- bluish discoloration of the blank areas
-
Cullen's Sign
- seen with Pancreatitis
- Bluish periumbilical discoloration resulting from seepage of blood stained exudates from the pancreas
-
Chronic pancreatitis will cause....
- weight loss
- constipation
- mild jaundice
- dark urine
- steatorrhea
- DM
-
-
Systemic complications of pancreatitis
- pleural effusion
- atelectasis
- pneumonia
- hypotension
- thrombi
- bleeding
-
Key management issues for a person with Pancreatitis
- NPO
- NGT with suction
- F&E balance
- PAIN MANAGEMENT (#1)
- Monitor infections
- Nutritional therapy
-
Cholelithiasis
gall stones
-
Cholecystitis
inflammation of the gallbladder
-
What causes cholelithiasis?
increased precipitation of cholesterol, bile salts and calcium. Infection and disturbances of cholesterol metabolism create an environment for gallstones to form
-
Gallstones are most commonly made from
cholesterol
-
How does cholelithiasis cause cholecystitis?
stones from the gallbladder migrate to the cystic/bile duct causing a blockage. There will be a blockage of bile from the gallbladder causing stasis and cholecystitis?
-
Clinical Manifestations of Cholecystitis
- RUQ pain
- N/V
- Fever
- Leukocytosis
- Jaundice
-
Patients with Cholecystitis will complain of....
- fat intolerance
- dyspepsia
- heartburn
- flatulence
-
How do you manage cholecystitis?
- pain management
- antibiotic for infections
- F&E balance per labs
- NGT tube with suction
-
How do you manage cholelithiasis?
ERCP-stone removal
-
After a cholecystectomy why may the person have should pain?
cuz carbon dioxide wasn't released or absorbed by the body
-
What is given to a person with cholecystitis to help with spasms?
Demoral
-
Fat soluable vitamins given to a person with cholecystitis
ADEK
-
What kind of diet should a person eat with cholecystitis?
low fat
-
What's toxic megacolon?
Symptoms?
- a condition seen in people with UC and Crohns. Inflammation and infection cause a widening of the colon:
- abdominal pain/distention/tenderness
- fever
- tachy
- SHOCK!!
|
|