med/surg1 E3

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med/surg1 E3
2010-02-14 20:19:06
GI and resp

GI, resp and elder
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  1. Appendicitis
    inflammation of the appendix R lower q of abdomen.
  2. Diverticulitis
    • small pouches that bulge outward through the colon/large intense
    • main cause is low fiber diet

    • Ss: pain usually L, constipation or inc frq of defecation
  3. 1. enteral nutrition
    2. parenteral nutrition
    • 1. ensure tube feeding
    • 2. TPN: nutrition deivered in the form of specialized intravenous fluids.
    • calories: glucose and lipids (dextose)
    • protein: amino acid (goal is to stop catbolism (bkdn))
    • usually pt that are: major surgery, trauma, seriously undernourised.
  4. GERD (upper GI)
    how do you developed?
    • acid reflux
    • developed:
    • lower esophageal sphincter does not work
    • dec esophageal motility
    • detay of acid emptying
    • inc pressure w/in stomach
  5. Hiatal Hernia
    sliding and rolling
    • stomach protrudes up through an opening in the diaphragm into the thoracic cavity
    • Sliding: most common. entire lower esophageal sphincter slides up
    • devep: weakening of themuscle of the diagram or inc intra-abdominal pressure (preg, obesity, heavy lifting)
  6. GERD/ Hital Hernia:
    • SS:
    • heartburn (frm morphine, chololate, alcohol, l meals, smoking)
    • diff of swallowing or a hump feeling
    • reguruation of gastric fluid up to mouth

    • Complications
    • chronic esophagitis w scarring
    • barretts esophagus
    • ulcer
    • micro aspiration
  7. GERD/ Hital Hernia:
    medical tx
    • Medical tx:
    • nexium, prevacid, prilosec, protanix

    • NR:
    • taking meds at the right time
    • shouldn't stop taking meds just bc they feel better
    • HOB >30
    • avoid high fat meals
    • avoid thight clothing
    • shouldn't eat so late
  8. Peptic Ulcer Disease
    medical m
    • open lesion on the mucosa of the esophagus, stomach or dudoenum (usually where there's gastric acid)
    • cause: h. pylori bacteria or use of NSAIDS (advil..)

    patho: disruption in mucosa barriers

    • SS: pain (buring, aching, gawing) **can be relieve by
    • eating, heart burncomplications: hemorrhage, scarring will cause
    • obsrution, perforation

    • Medical m: focus is to (relieve pain, treat infection, slow production of and neutralize
    • HCI acid, restore integrity of mucosa)
    • Diet: avoid caffine, high fat, alcohol
    • pharm: antibiotics, proton pump inhibitors, antiacids, h2 blockers

    • ND (NOT had surgery):
    • Pain: give meds on time
    • nutritional needs: monitor lab, meal planning
    • complication: focus on abd
  9. Types of gastric surgeries?
    1. Subtotal gastrectomy ( Billroth I n II)
    2. Total gastrectomy
    • 1. Billroth I (gastrodudoenostomy, 1/2 stomach removed and connected to duodenum)
    • Billroth II (gastrojejunostom, "" connected to jejunum)

    2. total removal of the stomach usually only if its cancer.
  10. Dumping syndrome (complication of gastric surgery)
    • complication to the billroth II surgery used in tx of peptic ulcer disease
    • patho: when pylrus has been resected, undigested food bolus rapidly enter the duo or jejunum
    • SS: (5-30mins after eating), nausea, vomiting, diarrhea, cramping, tachycarida
    • NC: low fat and no sugear! low carb, small freq meals, meals w/out fluid, lay down after eating.
  11. Ulcerative Colitis n Crohn's Disease (lower GI)
    ss, medical tx
    • inflammatory and ulceration of colon and rectum
    • ss:
    • diarrhea! (w bl and mucous), fatigue, anorexia, weakness

    • Medical tx:
    • Control/dec inflammation: *antidiarrheals: only use Mild colitis
    • Nuritional support: NPO to rest the bowel, food that does not stimulate the bowel, provide fluid/elec replacement
    • Surgical tx: total colectomy (surgical resection and removal of the colon), ileostomy is usually for colitis
  12. Intestinal Obstruction
    • Blockage of the flow of intestinal contents
    • Types:
    • Mechanical: physical (outside the intestine, ex: tumors or inflammatory bowel disease, high pitch sounds)
    • Functional: change in parastalsis
    • SS:
    • SBO: quicker onset of sx, abd pain, cramping distention, bowl sounds.
    • as the obstruction cont = dehydration, hypovolemia, electroyte imblances.
    • LBO: slower onset, deep cramping pian, constipation, vomitng (very late sign)

    • ND:
    • Deficient Fluid vol
    • Pain
    • other nursing care: focused abd ass, monitoring respiratory (distended abd cannot breath as well).
  13. Peritonitis
    Inflammatory of gastro fluids and bacteria into the abdominal cavity/peritoneal space

    Cause: anything that ruptures or proferiated in GI

    • SS: what happens if gastric and bacteria leaks somewhere it shouldn't be?
    • diminshed/absent bowel sounds, pain, anorexia, n&v, rigid abdomen, infections,pale

    • ND:
    • fluid vol deficit
    • risk for injury
    • pain
    • Alt in nutrition: less than body requirements (use TPN)
    • Anxiety
  14. What are the manifestations for DMI?
    result of a lack of insulin to transport glucose across the cell membrane

    • -Hyperglycemia
    • -polyuria (lots of peeing), polydipsia (thirst)
    • polyshagia (hungry), ketosis, weight loss
  15. what are the ss for DM2
    • hyperglycemia
    • slow wound healing
    • blurred version
    • fatigue
    • skin infections
  16. Rapid Acting insulin
    • onset (5-15mins
    • peak: 45-75mins
    • dur: 3-5hrs

    lispro, aspart, glulisine
  17. Short acting insulin
    • onset: 30-60 min
    • peak: 2-4 hr
    • dur: 6-8 h

    regular (R)
  18. Intermediate acting insulin
    • NPH: O: 2-4hr, P 6-10hr, D 12-18 hr
    • Lente: 3-4 hr, 8-12hr, 12-18hr
  19. DKA (diabetic ketoacidosis)
    • -occurs more in type 1
    • - severe lack of insulin which causes
    • hyperglycemia
    • dehydration
    • ketosis
    • acidosis
    • fruity oder to breath
    • renal failure

    • tx:
    • resp first! then fluid resuscitation, K replacment
  20. long acting insulin
    latus: 1-2hr, no peak, 24h

  21. insluin shock
    • -severe hypoglycemia
    • tachycardia, LOC, pale, cold skin, hunger, tremors

    "pale and cammy give me candy"
  22. GallBladder
    store and concentrate bile that was made in the liver --> release bile into the duodenum to digest fat.
  23. Cholecystits
    Inflammation of the gallbladder (commonly assoicated w/ tumor, obsrtution causes the bile remine in the gallbladder)
  24. Cholelithiasis
    gall stone
  25. Cholecystectomy
    removal of the gallbladder
  26. fn of the liver?
    • makes bile
    • makes proteins
    • detoxify bl
    • clotting factors
  27. Cirrhosis
    scarring of the liver
  28. what are the later symptoms of cirrhosis?
    • 1. Portal hypertension:
    • when bl can't get into the congested scarred liver--> venous inc pressure
    • (enlargement of the speen, dilation of veins in the gast tract of abd)

    • 2. Esophageal varices:
    • back up bl extends up to the small vessels/veins ---> inc pressure --> ruptures of the veins
    • (devlp of hemorrhoids, dilated, congested vessels in the esophageals)

    • 3. Hepatic Encephalopathy:
    • Liver is NOT detoxifying ammonia from teh intestines
    • (asterixis (flappy tamers due to inc ammonia), fetor hepaticus (bad breath))

    • 4. Ascities:
    • third spacing of fluid into the abdominal cavity.

  29. Bronchoscopy
    • Fiberoptic direct examination of airways
    • Indications for Bronchoscopy:
    • -direct visualization of tumors, inflammation or structures
    • - for aspiration of sputum
    • - removal of foreign bodies/object
    • NI:
    • remove dentures
    • keep pt NPO 8 to 12 hrs
  30. Pneumothorax
    • -acummulation of air in the pleural space
    • - ruptured bleb
    • - blunt force trauma
  31. Hemothorax
    • -bleeding in the pleural space
    • - piercing chest trauma (mwa, gun shot wounds, stabbing)
  32. Pleural effusion
    • -collection of excess fluid in the pleural space
    • -high protein fluid
    • -often r/t chf, cancer pheumonia, tb
  33. What are some Nconsiderations for chest tube?
    • -keep drainage system BELOW level of chest
    • -check suction q2hrs
    • - sterile irrigation fluid and vaseline gauze kept at beside at all times
    • - chest wall dressing at tube exit site must be airtight
    • - check thoracic wall for crepitus
    • - position pt for optimal lung expansion
  34. Thoracentesis
    • -invasive procedure in which fluid/air is removed from the pleural space w a needle.
    • - to obtain specimens, instill medications, remove fluid or air for relief of inc pleural pressures
    • **limit to 1L of fluid removal bc it causes pain, reduction in lung capacity and inc respiratory rate and effort
  35. 4 diff type of tracheotomy?
    • Emergent: acute closure of upper airways
    • scheduled: chronic supported needed
    • temporary: short term survival until
    • permanent: long term
  36. Emphysema (COPD)
    • -loss of elasticity and hyperinflation of lung. Destroys alveoli, dec surface area available for gas exchange.
    • *** 1st is getting airout first!!
  37. Chronic bronchitis (COPD)
    • inflammation of the bronchi and bronchioles due to chronic exposure to irritants
  38. diagnostic test for COPD
    • PFT
    • CXR (flattend diaphragm)
    • hgb and Hct (monitor for polycythemia)
    • alpha antitrypsin 1 level
  39. assessment/ss for COPD?
    • - chronic dyspnea
    • - rapid shallow respirations
    • - thin extremities, enlarged neck muscles
    • - hypoxemia
    • - hypercarbia
    • - resp acidosis and metabolic alkalosis
    • - r sided heart failure
  40. Atelectasis
    airway inflammation and edema leads to alveolar collapse w resultant inc risk for hypoxemia
  41. Three major injuries affecting older adults
    • Falls
    • •Fires
    • •Motor vehicle accidents
  42. Health Risks for Older Adults
    • Drug toxicities/ side effects
    • Due to changes in liver and kidney function
    • •Due to altered nutritional status
    • •Polypharmacy

    • •Longer exposure to environmental hazards
    • •Sun
    • •Smoking
    • •Pollutants
  43. Cardiovascular Changes in Elders
    • •Reduced cardiac output
    • •Reduced arterial elasticity
    • •Increase in systolic blood pressure; peripheral resistance•
    • Orthostatic hypertension
  44. Three Basic Components of chest tube
    • •Protection from atmospheric air by means of a “water seal” chamber
    • •Collection of drainage, either air or fluid
    • .•Suction chamber, to pull negative pressure and so facilitate lung reexpansion
  45. Chest Tubes—Complications
    • •Air leaks
    • –From pleural space to external chest around tube
    • –Into subcutaneous tissue

    • •Accidental disconnection
    • –For accidental removal
    • —Vaseline gauze @ bedside
    • –Sterile water
    • —if tube cut, submerge end

    • •Tension pneumothorax
    • —may occur if evacuation of air or fluid is not allowed