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Nursing 2 - Chapters 50 & 53 From Contemporary Medical Surgical Textbook Daniels Exam #1 (Julieyang83)
From Contemporary Medical Surgical Textbook Daniels
Terms in this set (81)
The Concept of Elimination
all the body processes that get rid of waste products.
-Gastrointestinal or GI System
Through the skin or integumentary system.
Three Major Categories associated with Elimination
Exemplars of Control Issues
-Trauma to spine
Exemplars of Retention Issues
-Constipation possibly from dehydration, age, lack of fiber, medications, mobility, Ileus which is when peristalsis stops
Exemplars of Discomfort Issues
-Infection or UTI's
To have normal urinary and bowel elimination you need normal anatomical structure in the body
-Normal Kidney Function
-Normal Ureters and muscles
-Normal Bowel Function
Order of Assessment for GI
Diagnostics for Urinary and GI
-Urinalysis or UA
-Imaging Studies such as KUB, Flat Plate X-Ray of the abdomen
-Fecal Occult Blood Test
-Intravenous Pylergram or IVP
-CT's or MRI's
-Bladder Scan - post void residual
S&S for Appendicitis
-Beginning generalized periumbilical pain. -Local tenderness at McBurney's point which is between the navel and the right anterior iliac spine or crest is the point where most pain is elicited by pressure in acute appendicitis
-Low Grade Fever and bloating
-Rigidity of the rectus muscles in the region
-Rovsing's sign which is rebound tenderness
-Could have pain on urination or defecation depending on the location of the inflammation on the appendix.
-Elevated WBC 10,000/mm3 to 20,000/mm3.
Gold Standard for Diagnosis of Appendicitis
Nursing Care for Appendicitis
-Supporting the patient during acute pain and assessing their condition.
-Preparing the patient for surgery.
-Goals for patient care are:relieving pain, reducing anxiety and fears of the patient.
-Decreasing the chances of dehydration.
-Preventing postoperative complications.
Diagnostics for Appendicitis
X-Ray, CT Scan, CBC with differential, urinalysis to rule out UTI, pelvic examination if female if could be a gynecological disorder.
Diverticulitis refers to inflamed diverticula. Diverticula are sac like out pouches or hernias of mucosa through the muscular layer of the bowel and can be anywhere along the GI tract. 90-95 percent are found in the sigmoid colon. Someone has Diverticulosis if they have multiple Diverticula in the colon. Diverticulitis is when they are inflamed. 10-25 percent of people with Diverticulosis develop diverticulitis, which can lead to bleeding, abscess and fistulae formation, perforation and/or obstruction.
an inflammation of the appendix organ, which is a small finger-like appendage just below the ileocecal valve in the large intestine.
S&S for Diverticulitis
The most common symptom is left
lower quadrant pain LLQ (70%) that is often crampy and may be accompanied by nausea, vomiting, change in bowel habits,and bloating. Located in the Lower intestine.
Pain intensity may fluctuate.
If there are manifestations, they are likely constipation or diarrhea, abdominal pain in the left lower quadrant, irritable bowel syndrome (IBS) development, abdominal cramping, generalized fatigue, and low-grade fever.
Gold Standard for Diagnosing Diverticulitis
Gold Standard for Diagnosis is CT scan.
Nursing Care for Diverticulitis
Care strategies for patients with diverticulits vary depending on whether treatment is surgical or medical. Pain levels, anxiety, infections, and postoperative complications
are the areas of greatest concern for the nurse. Continued dietary management strategies are employed. Meds: Cipro, Flagyl or levoquin, cepholosporins, opiods for pain, stool softeners, antispasmodics.
Image for McBurney's Point
between the navel and the right anterior iliac spine or crest, is the point where most pain is elicited by pressure in acute appendicitis
This is the complication to Appendicitis. A description of peritonitis S&S is The triad of generalized pain, board-like abdominal rigidity, and rebound tenderness.
Clinical Manifestations for Peritonitis
Clinical manifestations for peritonitis are
elevated WBC, high fever, acute pain, drawing the
knees up to the chest, tachycardia, and diaphoresis
Classifications of Appendicitis
-Simple-Appendix is inflamed but still intact.
-Gangrenous-There is tissue necrosis and microscopic areas of perforation.
-Perforation-There is large perforation, which involves contents flowing into the peritoneal cavity.
1. The slim space between the parietal and visceral peritoneum. 2. This cavity is filled with peritoneal fluid (a serous fluid)
As appendicitis worsens
The pain is more intense and more acute even when the patient is completely still. The patient will often draw his/her knees upward towards the chest in an attempt to decrease pressure from the tension of the abdominal muscles.
Pharmacology for Appendicitis
-Patient will be put on antibiotics prophylactically (e.g., third generation cephalosporins) to prevent infection complications. Depending on category of appendicitis which is Simple, Gangrenous, or Perforation determines the length of antibiotic treatment.
-Patient will be started on IV fluids to maintain adequate vascular volume.
Surgery for Appendicitis
An appendectomy or surgical removal of the appendix is either performed laparoscopic approach or open appendectomy. Laparoscopic is less invasive and is made through a small incision through the naval.
Aftercare for surgical removal of the appendix
Involves postoperative care measures like ensuring good respiratory effort, taking frequent vital signs, maintaining IV fluids, assessing the wound, treating for pain, preventing infection. The patient is placed in a semi-fowler position to reduce the tension and pulling of the tissue on the wound area.
Patient Education for Appendectomy
-Will have to return for follow up visit to remove sutures.
-Monitor Activity level and rest as needed.
-signs and symptoms of infection and complications related to wound healing.
Cause of Diverticular disease
Diet plays the most important role in the cause of Diverticular Disease.Low fiber diets and those high in processed foods are associated with diverticular disease.
Other correlates with the disorder are decreased activity levels and constipation. The suggestion is that people with
decreased blood supply or nutrients in the bowel are more susceptible to diverticular disease.
Patho:when part of the stomach protrudes
through the esophageal hiatus. There are often no symp-
toms, but when it is evidenced the manifestations are similar
to those in GERD.
Types of Hiatal Hernia
There are two primary types of hiatal hernias: (a) sliding
hiatal hernia (type I) and (b) paraesophageal hiatal hernia
Non-Common Types of Hiatal Hernia
In addition, there are types III, IV, and V, and are less common. They are different by the amount of herniation.
-Sliding hiatal hernia: the upper stomach slides upward through the gastroesophageal junction.
This type of hiatal hernia is often asymptomatic.
-Paraesophageal hiatal hernia is when part of the stomach herniates through the esophageal hiatus. In this type the bloodflow can be constricted and patients can develop chronic or acute GI bleeding or gastritis.
S&S of Hiatal Hernia
Similar to GERD S&S, pyrosis which is heartburn, reflux, feeling of satiation, dysphagia which is difficulty swallowing, bleeding, substernal chest pain
Pain for Hiatal Hernia
Burning in the anterior Chest & possibly the shoulders, arms, neck and back
Diagnostics for Hiatal Hernia
Barium Swallow & upper endoscopy presentation
Nursing Assessment and Intervention for Hiatal Hernia
VS, health history, pain, nutritional assessment, meds including OTC and herbal. Stay upright after eating, administer meds and monitor for aspiration.
Treatment for Hiatal Hernia
Surgery and meds for GERD. Antacids, histamine H2-receptor agonists such as Zantac, tagament, Pepcid, Axid which block the excretion of histamine. Proton Pump Inhibitors are the most powerful meds for treating GERD. they work by blocking the final step in H+ ion secretion by the parietal cell. Few side effects and tolerated well but can hamper calcium absorption and may cause cardiac conduction defects.
Other meds for GERD
Prokinetic agents such as metoclopramide (Reglan)
improve the motility of the esophagus and stomach and
are moderately effective in treating GERD in patients with mild symptoms. Patients with more severe symptoms
typically require additional acid-suppressing medications,
such as PPIs. Long-term use of prokinetic agents may
have serious, or fatal, complications and
should be discouraged. Nursing management includes follow-up assessment and evaluation of the patient for potential complications related to taking these medications.
Surgery For GERD
If medications do not work surgery may be needed.Anti-
reflux surgeries change the ability of the LES to inhibit
gastric juices from reflux. There are laparoscopic surgeries, which can tighten the LES, and there is an open, more invasive surgery called Nissen fundoplication that may be performed.
Has the highest cancer mortality rate. Two types of esophageal Cancer: Adenicarcinoma and increased risks are Smoking, Chronic GERD, Barrett's esophagus. For Squamous Cell Carcinoma it is Obesity, Chronic Alcohol Use, Exposure to nitrosamines, Ingestion of lye, Fanconi's anemia, Achalasia, Plummer-Vincent webs, Tylosis.
Patho for ESOPHAGEAL CANCER
Caused by malignant advancement into the esophageal areas. Once it penetrated the submucosa the risk of it metastasis increases substantially.
Patient S&S for ESOPHAGEAL CANCER
Difficulty Swallowing because of cancer obstructing the esophagus. Other symptoms: anorexia, weight loss, hoarseness and voice change, aspiration, cough, and recurrent upper Respiratory infections. Patient may be anemic without overt GI bleeding.
Potential Complications of Hiatal Hernia
Potential complications of hiatal hernias are hemorrhaging, obstruction, and strangulation.
Patho of UTI
Infection of the urinary tract organs which are the urethra, bladder, ureters and kidneys. Microorganisms enter the urethra and travel to other parts of the urinary system.
S&S of a UTI
Dysuria which is painful urination, fever, flank pain, foul smelling odor to urine, urinary urgency, frequency of urination. Pain in the supra-pubic area. The elderly may have an altered mental status when they have an UTI.
Diagnostics for a UTI
Culture and Sensitivity for the strain and amount of bacteria present in the urine, Urinalysis will show protein, Urine Dipstick for nitrates, CBC for WBC count. Cystoscopy used which allows your doctor to look at the interior lining of the bladder and the urethra. looks for collection of urine or inflammation.
Antibiotics and meds for UTI
Cipro, Levoquin, Bactrim, IV fluids, Pyridium which turns your urine bright orange.
When stones form because concentrations of urine exceed solubility. Calcium is the mineral that composes the majority of renal calculi. Can be due to cystinuria or persistently acidic urine. Upper UTI or meds.
S&S of Renal Calculi
Sudden onset of unilateral flank pain accompanied by N&V. The pain can radiate and the pain location depends on the location of the stone. Urinary Frequency and Urgency. Gross Hematuria without pain is less common.
Diagnostics of Renal Calculi
Physical Exam, serum chemistries BUN and Creatinine, Helical CT scan is the gold standard for diagnosis so that doc can see stones. Ultrasound and Urinalysis.
Nursing Assessment / Interventions for Renal Calculi
Determine the location and quality of the pain and inspect the urine for blood. Monitor I&O and urine characteristics, strain the urine for the stones, palpate for distention, obtain urine for Culture and Sensitivity, pain management, increase fluid intake unless contraindicated.
Treatment for Renal Calculi
Increase fluid intake and give patient IV fluids if patient is extremely dehydrated. Measure allopurinol for uric acid stones. Give diuretics and Lithotripsy is used to break up stones or surgery is used for stones that are too large to pass and obstructing the ureters. Teach the patient to eat low calcium low purine and low oxalate diet.
Patho for Ulcerative Colitis
Chronic IBD affecting the mucosa and submucosa. It begins at the recto sigmoid located in the anal canal. This disorder causes ulcers, inflammation and abcesses which can become necrotic. IS idiopathic inflammation of the GI tract. Causes bleeding fluid and electrolyte loss
S&S of Ulcerative Colitis
Diarrhea, Abdominal Pain and rectal bleeding, severe symptoms include multiple bloody stools usually 10-20 a day.
Diagnostics for Ulcerative Colitis
CBC, ESRm Stool Cultures, tests for vitamin and mineral deficiencies.
Pain characteristics for UC
Rectal Pain, feeling of urgency, abdominal cramps, pain on the left side.
Nursing Assessment for UC
Assess for tachycardia, Hypotention, pallor, blood loss which could indicate severe complications such as excessive blood loss.
Treatment for UC
Proctocolectomey with ileostomy where the large intestine and rectum are removed and anus is sewed closed. Surgically created stoma and ostomy. and total colectomy with ileoanal anastomosis.
A surgical procedure to remove all or part of your colon / large intestine. Used for Colorectal cancer, Diverticulitis, Crohn's Disease, IBD or ulcerative colitis. Or cancer of the colon or rectum. Can be performed open or laparoscopically.
Patho Irritable Bowel Syndrome
Patho is unknown, hypothesis is that GI dysmotility or visceral hypersensitivity or hyper responsiveness, disordered immune responsiveness
S&S of IBS
Abdomincal Pain and discomfort at least 2-3 days in the last three months associated with 2 or more of the following: change in frequency of stool, change in formation of stool.
Diagnostics of IBS
No single test, usually other GI tract disorders are considered and eliminated. CBC, ESR, CRP, CT imaging, endoscopy.
Nursing assessment for IBS
Patient history, elimination and retention history, abdominal assessment and pain evaluation.
Nursing Interventions for IBS
Manage pain, avoid aggravating or triggering the IBS with diet and lifestyle modifications.
Treatment for IBS
Bulk forming laxatives, anti-diarrheals, anti-cholinergics, diet and exercise.
Patho for Colorectal Cancer
Transformation from normal gut lumen to polyp to carcinoma. Lesion begins in the mucosa and invades the bowel wall and grows. spreads through lymph nodes.
S&S for Colorectal Cancer
Fatigue, unintended weight loss, bloody stool, melena, change in bowel habits, persistent abdominal discomfort.
Diagnostic for Colorectal Cancer
digital rectal exam, fecal occult blood test, colonoscopy
Nursing Assessment for Colorectal Cancer
VS, changes in bowel history, medication history, pain history and location
Nursing Interventions for Colorectal Cancer
Provide comfort measures, monitor patient's bowel patterns.
Treatment for colorectal cancer
Radiation, cytotoxic agents, systemic therapy, surgical removal of tissue/ bowels
Patho for Peptic ulcer Disease
Hyper Secretion of hydrochloric acid and pepsin causing erosion of the mucosal lining.
S&S of PUD
Nausea, abdominal pain and distention, recurrent pain in the epigastric region, wt. loss, poor appetite, bloating, vomiting.
Pain characteristics of PUD
Burning sensation in the epigastric region.
Diagnostics for PUD
Radiographic and endoscopic study to look for a visual of the mucosal lining and duodenum. Culture for H. Pylori which is usually present in PUD. Esophogeal Gastroduodenoscopy is the gold standard for diagnosis of PUD.
Nursing Assessment for PUD
Health History, medication history, tobacco history and diet history, pain history and location of pain, appetite and weight history.
Interventions for PUD
Pt. Education non meds and nutrition, discontinuation of NSAIDs if the PUD was caused by NSAIDs. Pt. remain upright after eating.
Treatment for PUD
Antacids, Antibiotic to treat H. Pylori, omeprazole or Prilosec, vagotomy if severe.Vagotomy is the surgical cutting of the vagus nerve to reduce acid secretion in the stomach.
Types of Prostate Surgery
-TURP- Transurethral resection of the prostate (TURP), used for BPH inner portion of the prostate is removed.
-Open surgery prostatectomy - involves removal of the enlarged tissue of the prostate.
-Laser Surgery to shrink and destroy prostate tissue. Usually not effective on larger prostates.
-TUMP-transurethral microwave procedure. outpatient procedure the enlarged prostate tissue is heated to 111 degree through a tranurethral catheter while a water cooling system protects the urethra from damage. TUMP only reduces urinary flow symptoms and does not correct incomplete emptying of the bladder. -TUNA- Transurethral needle ablation- a low level radio frequency energy is emitted through twin needles to burn away the enlarged prostate tissue impinging on the urethra. TUNA improves urine flow and relieves urinary symptoms with fewer side effects than TURP.
Pharmacology for BPH
Non selective alpha blockers, such asas terazosin
(Hytrin), alfuzosin (Uroxatral), and doxazosin (Cardura).
These medications do not decrease the size of the hypertrophic cells but instead create smooth muscle relaxation of the bladder neck and prostate. Such
muscle relaxation leads to an almost immediate improve-
ment in urinary flow. The nonselective alpha blockers can cause orthostatic hypotension. Tamsulosin or Flomax is a
highly selective alpha blocker that maximizes urinary flow
with fewer side effects. Finasteride is an anti androgen agent that prevents conversion of testosterone to DHT, helping to shrink the hyperplastic cells. However, finasteride may cause
erectile dysfunction and gynecomastia (breast enlargement). Also, Proscar or Avodart can be prescribed to decrease prostate size.
Rectal prolapse occurs when part or all of the wall of the rectum slides out of place,sometimes sticking out of the anus.
Types of Rectal Prolapse
Partial Prolapse - mucosal lining of the rectum slides out of place and usually sticks out of the anus.
Complete Prolapse- the entire wall of the rectum slides out of place and usually sticks out of the anus.
Internal Prolapse - intussusception where a part of the wall of the large intestine or colon or rectum may slide into or over another part. Think of a toy telescope and how it expands and retracts.