Upgrade to remove ads
Only $35.99/year

Med surg exam 3

Terms in this set (52)

normal hemoglobin 12-16
normal hematocrit 40-50%

AST and ALT are liver enzymes. they elevate with liver disease.

serum amylase and lipase elevate with pancreatic disorder.

elevated bilirubin indicated impaired secretion by the liver

liver detoxifies ammonia
...
GERD

-acute symptoms of inflammation
-gastric volume or intra-abdominal pressure is elevated
-caused by decreased or relaxed lower esophageal sphincter tone.

-dyspepsia- pain in chest
-regurgitation
-hypersalivation
-dysphagia- difficulty swallowing.
nonsurgical management
-diet, pt education
-elevate head 6in. for sleep.
-sleep in left lateral decubitus position
-reduce weight
-wear nonbinding clothing
-refrain from lifting heavy objects, straining, bent-over posture

drug therapy
-antacids- neutralize gastric acid
-histamine2 antagonist- decrease gastric acid secretions
-proton pump inhibitors-long acting inhibition of gastric acid secretion
-prokinetic (GI stimulants)- increased gastric emptying improve peristalsis.
HIATAL HERNIA-protrusion of stomach through esophageal hiatus of diaphragm into thorax.

-sliding hernia- most common.
-rolling hernia- quite rare. fundus rolls into thorax beside esophagus.

-sliding- heartburn, regurgitation, chest pain, dysphagia, belching.
-rolling- feeling of fullness, chest pain, worsening of symptoms in recumbent position.
nonsurgical management
-antacids, histamin receptor antagonists
-avoid eating in the late evening and avoid foods associated with reflux.
-elevate head
-remain upright after eating

surgical management
-Nissen fundoplication
GASTRITIS-inflammation of stomach lining
-acute and chronic gastritis
-etiology- H. pylori, E.coli, NSAIDS, alcohol, caffeine.
-chronic gastritis associated with risk of gastric cancer
-diagnosis- gold standard= endoscope w biopsy to detect h. pylori.

acute
-rapid onset of epigastric pain
-blood
-anorexia
-dyspepsia
-gastric hemorrhage

chronic
-pain relieved w food
-intolerance to fatty/spicy food
-pernicious anemia
-neurological problems d/t lack of b12
-h. pylori infection- most common
nonsurgical management
-histamine antagonist
-antacids
-mucosal barrier fortifiers
-proton pump inhibitors
-triple therapy for pylori infections. proton pump inhibitor w two antibiotics.
-limit intake of food and spices that cause distress (tea, coffee, cola, chocolate, mustard, paprika, cloves, pepper, and hot spices)
-limit alcohol and tobacco
-stress reduction

-once you're positive for pylori, you'll always be positive
PEPTIC ULCER DISEASE- mucosal lesion of the stomach or duodenum

-gastric mucosal defenses impaired- can't protect the epithelium against acid and pepsin
-acid, pepsin, and pylori play important role in development of gastric ulcers.

-epigastric tenderness located at the midline between umbilicus and xiphoid process
-dyspepsia
-sharp, burning, or gnawing pain. sensation of abdominal pressure, fullness, hunger.
duodenal ulcers- present as deep, sharply demarcated lesions that separate through the mucosa and submucosa into the muscularis propia.

stress ulcers- occur after acute medical crisis or trauma. associated w head injury, major surgery, burns, respiratory failure, shock, and sepsis.
-bleeding caused by gastric erosion.
peptic ulcer disease

drug therapy 4 goals
-provide pain relief
-eradicate pylori infection
-heal ulceration
-prevent recurrence
H2 receptor antagonist
-drugs that block histamine stimulated gastric secretion
-may be used for indigestion and heartburn
-block action of H2 receptors of parietal cells.

Antisecretory agents
-proton inhibitors

antacids
-buffer gastric acid and prevent formation of pepsin- effective in healing of duodenal ulcers.
-aluminum hydroxide-constipates and magnesium hydroxide- laxative

diet
-avoid bedtime snacks
-no alcohol or tobacco
Complications of ulcers

-hemorrhage- hematemesis
-perforation
-pyloric obstruction
-intractable disease- pt no longer responds to conservative management. interference with ADLs
...
Ulcerative Colitis- widespread inflammation of the rectum/ rectosigmoid colon

-remissions and exacerbations of mucosal lining of the colon or rectum is affected.
-loose stools containing blood and mucus
-poor absorption of vital nutrients
-etiology unknown
-colon
-continuous inflammation of the colon.
-10-20 liquid bloody stools daily
-anorexia
-only affects inner most lining of the colon.

diagnostic studies
-Hx
-CBC, ESR
-colonoscopy
-barium contrast studies
-endoscopy
drug therapy
-salicylate compounds- anti inflammatory effect.
-corticosteroids- given w/ exacerbations
-immunosuppresive drugs- after immune response
-antidiarrheal drug- symptomatic management.

surgical therapy
-total proctocolectomy w permanent ileostomy.

nutritional therapy
-NPO during acute phase.
-parental therapy
-supplemental iron
-post op nutrition critical
UPPER GI BLEED
-ppl on warfarin and liver disease have prolonged PT time
-hematemesis, melena starry black stool, occult bleeding
-emergency treatment required.

diagnosis
-CBC, BUN, PT, ABG's liver enzymes, blood glucose, type and cross, endoscopy.
...
IBS IRRITABLE BOWEL SYNDROME
-chronic or recurrent diarrhea, constipation, abdominal pain and bloating.
-criteria - abd pain relieved by defecation, abd distention, sense of incomplete evacuation of stool, presence of mucus in stool.
-more common in women
TREATMENT
-educate pt to avoid problem stimulants
-eliminate problem foods
-drugs- bulk forming laxatives, antidiarrheal agents, anticholinergic agents, tricyclic antidepressants
HERNIATION
-weakness in the abd muscle wall through which a segment of bowel or other abd structure protrudes

surgical management
-NPO day of surgery
-procedures- laparascopy, conventional open herniorrhapy.
-post op care- elevate scrotum to prevent and control swelling. address difficulties in voiding that may occur, observe for signs and symptoms of complications
...
INTESTINAL OBSTRUCTION
-mechanical- stool, tumors, adhesions, scarring, chron's.
-nonmechanical- obstruction, paralytic ileus, anesthesia.
-strangulated- obstruction resulting from tumors, hernias, fecal impactions, strictures.
mechanical obstruction
-pain and cramping
-vomiting
-obstipation
-diarrhea
-abd distension
-borborygmi (high pitched bowel sounds)


nonmechanical obstruction
-constant discomfort
-abd distension
-decreased to absent vowel sounds
-vomiting
-obstipation
APPENDICITIS
-acute inflammation of the vermiform appendix.
-abd pain in the epigastric area migrating to Mcburmey's point.
-N/V, rebound tenderness- palpate and it hurts when you let go.
-complications include peritonitis, sepsis, perforation, abscesses.
-elevated WBC
PERITONITIS
-life threatening
-acute inflammation of peritoneum and lining of abd cavity
-Rigid boardlike abdomen associated w/:
Abdominal pain
Distention
High fever
Tachycardia
Dehydration
Low urine output
Hiccups
Compromised respiratory status
N/V
GASTROENTERITIS(stomach flu)
-bacterial or viral disease of the intestine
-Increase in the frequency and water content of stools or vomiting as a result of inflammation of the mucous membranes of the stomach and intestinal tract

interventions
-fluid balance, electrolytes
-NPO/NG
-iv fluids
-pain control
-drug therapy
-control of N/V
chronic inflammatory bowel disease
-ulcerative colitis and chron's disease

-unknown etiology

ULCERATIVE COLITIS
-widespread inflammation of the rectum colon
-remissions and exacerbations of the mucosal lining of the colon or rectum is affected
-loose stools w blood and mucus
-poor absorption of nutrients
-10-20 liquid bloody stools per day
-anorexia
-perforation
-only in the colon
-only affects inner most lining of colon

surgery
-Total proctocolectomy w/ permanent ileostomy- removal colon, rectum, anus with anal closure
Total proctocolectomy w/ continent ileostomy
Total colectomy w/ rectal mucosal stripping and ileoanal reservoir

-NPO during acute phase
-parenteral therapy
-supplemental iron
-post op nutrition critical
CHRON'S DISEASE
-all layers of the bowel involved, mostly internal ileum.
-bowel fistulas- abnormal opening
-cancer of small bowel and colon can develop
-malabsorption of vitamins and nutrients
-discontinuous lesions, not continuous
-5-6 loose stools, rarely bloody
-weight loss
-can occur anywhere between mouth and anus

surgery
-conservative intestinal resection w anastamosis of healthy bowel. if disease spreads, ostomy.


DIAGNOSTIC STUDIES
-cbc, esr, colonoscopy, barium contrast studies, endoscopy.
CHRONS AND COLITIS DRUG THERAPY
-salicylate compounds- antiinflammatory
-corticosteroids- given w exacerbations
-immunosuppressive drugs- after immune response
-antidiarrheal drug

NUTRITION
-focus on providing nutrients that are deficient
-low fiber to minimize bowel stimulation
-protein and calories to facilitate healing
colostomy care
-check stoma
-skin protection
-volume, color, characteristic of drainage.
-irrigation

ileostomy care
-same as above
-increase fluid intake

adaptation
-self care
-sexual function
DIVERTICULAR DISEASE
-caused by increased pressure within intestinal lumen.
-usually asymptomatic
-diverticulitis occurs when diverticula become inflamed.

symptoms
-cramping
-period of diarrhea and constipation
-flatus
-abdominal distention
-fever
complications

Occult blood loss and acute rectal bleeding leading to iron-deficiency anemia
Abscesses and bowel perforation leading to peritonitis
Fistula formation causing bowel obstruction
Bacterial overgrowth (in small-bowel diverticula) that leads to malabsorption of fat and vitamin B12

nutrition
-high fiber intake may prevent and improve symptoms. and prevent diverticulitis
-avoid nuts, seeds, and popcorn

during acute diverticulitis
-Patients are NPO until bleeding and diarrhea subside
-Oral intake resumes with clear liquids and progresses to a low-fiber diet until inflammation and bleeding are no longer a risk
-A high-fiber diet is recommended unless symptoms of diverticulitis recur
GERD- common in middle aged adults. Relaxation of lower esophageal sphincters. Belching, pain, reflux, difficulty swallowing.
Hernias- sliding- hiatal. Rolling hernia.
Acute gastritis- bacterial, H. pylori. Chronic- autoimmune, but can be H. pylori
Appendicitis- low grade fever, rebound tenderness of right side, mcburney's sign
...
A-asymmetry of shape
B-border irregularity
C- color variation
D-diameter

look for signs of edema, moisture, vascular changes
-petechiaie- small circular red spots on skin due to internal bleeding.
-ecchymosis- bleeding under the skin due to bruising
-use palpation to confirm size of lesions and determine if they are raised or flat.
-hirsutism- excessive growth of body hair, which is a manifestation of hormonal imbalance.

nail clubbing- indicative of hypoxia
paronychia- inflammation of skin around nail

for pt's with dark skin, assess for
-pallor
-cyanosis- hypoxic
-inflammatioin
-jaundice
-skin bleeding

diagnostics
-Bacterial growths over 100,000= positive for infection
Less than 10,000= you're okay
-cultures for fungi, unroofing bacterial infections by puncturing outer surface and getting fluid, viruses by putting them on ice after they've been obtained.
XEROSIS- dryness
-older pts
-flaking of the stratum corneum
-pruritus
-scratching may results in secondary skin lesions, excoriations, lichenification, and infection

interventions
-rehydrate skin
-water softens outer skin layer. lotions seal the moisture.
PRURITUS(itching)
-scratching can cause more itchiness
-cool sleeping environment is helpful
-antihistamines
-topical steroids

SUNBURN
-cool baths
-antibiotic ointments for blistering and infected skin
-topical corticosteroids for pain
URTICARIA- hives
-presence of papules or plaque of varying sizes
-removal of triggering substances
-antihistamines helpful
-avoid alcohol, warm environment.
phases of wound healing
1.inflammatory phase
2. fibroblastic or connected tissue repair phase
3. maturation or remodeling phase
wound healing
-first intention resulting in a thin scar
-second intention(granulation) and contraction-a deeper tissue injury or wound
-third intention(delayed closure)- high risk for infection with a resultant scar
partial thickness wounds
-damage to epidermis and upper dermis
-heal by re-epithelialization within 5 to 7 days .
-skin injury followed by inflammation
full thickness wound
-damage extends to lower layers of dermis and subcutaneous tissue
-damaged tissue healed with granulation
-contraction develops in healing process
...
PRESSURE ULCER
-tissue damage caused when skin and soft tissue are compressed between a bony prominence and external surface for a long time.

-pressure, friction, shear

high risk pts
-mental status changes
-independent mobility
-nutritional status
-incontinence

relieving techniques
-pressure relief
-capillary closing pressure
-pressure relief products and devices
-positioning
Stage 1: non blanching, red
Stage 2: Open blister
Stage 3: Fat, subcutaneous tissue
Stage 4: Bone, tendon
-a wound that is exposed is always contaminated, but not always infected. contamination is the presence of organisms.
-infection is contamination with pathogenic organisms tot he degree that growth and spread cannot be controlled.

-high protein diet for wounds
-electrical stimulation increases perfusion
-hyperbaric oxygen therapy
-wound VAC
-topical growth factors-stimulate cell growth and movement
-skin substitutes
...
BACTERIAL INFECTIONS
-folliculitis- superficial infection involving only the upper portion of the follicle. Staph infection
-Furuncle (boil)—much deeper infection in the follicle. apply heat twice a day
-Cellulitis—generalized infection with either Staphylococcus or Streptococcus involving deeper connective tissue
HERPES SIMPLEX VIRUS
-Type 1 herpes simplex virus (HSV-1)—classic recurring cold sore. Contact precaution

-Type 2 herpes simplex virus (HSV-2)—genital herpes. Contact precaution

-Herpes zoster (shingles)
Airborne precaution

-Herpetic whitlow—a form of herpes simplex infection occurring on the fingertips of medical personnel who have come in contact with viral secretions
HERPES ZOSTER(shingles)

Caused by reactivation of the dormant varicella-zoster virus in patients who have previously had chickenpox.

Multiple lesions occur in a segmental distribution on the skin area innervated by the infected nerve.

Eruption lasts several weeks.

Postherpetic neuralgia occurs
after lesions have resolved.
FUNGAL INFECTIONS - dermatophyte

Tinea pedis- foot
Tinea manus- hand
Tinea cruris- groin
Tinea capitis- head
Tinea corporis- whole body
LAB ASSESSMENT

Tzanck smear- look for viral infection.
Swab culture- bacterial test
Potassium hydroxide (KOH) test- test for fungal infection. Look at sample under microscope.
...
PARASITIC DISORDERS

-pediculosis- human lice
-Head lice—pediculosis capitis
Body lice—pediculosis corporis
Pubic or crab lice—pediculosis pubis

-pruritus most common symptom
-launder clothing and linens
SCABIES- caused by mite infestation
-transmitted by close and prolonged contact or infested bedding.
-examine skin between fingers and palms.
-infestation confirmed by examination of a scraping of a lesion under a microscope.
PSORIASIS
-lifelong disorder w exacerbations and remissions
-Scaling disorder with underlying dermal inflammation; possibly an autoimmune reaction
-Exfoliative psoriasis—an explosively eruptive and inflammatory form of the disease

treatment
-Corticosteroids- suppress inflammation/ cell division
Tar preparations- reduce inflammation
Other topical therapies
Ultraviolet light therapy

Systemic therapy:
Biologic agents
Cytotoxic agents
Immunosuppressants
BENIGN TUMORS
Cysts
Seborrheic keratoses
Keloids-overgrowth of scar
Nevi (moles)


SKIN CANCER
-actinic keratoses- premalignant lesions. exposure to sun.
-squamous cell carcinoma.
-basal cell carcinoma
-melanomas- highly metastatic, survival depends on early diagnosis and treatment

surgery
Cryosurgery- liquid nitrogen on lesions
Curettage and electrodesiccation- cut lesion off and use electro to kill anything that's left
Excision
Mohs' surgery
Wide excision
TOTAL ENTERAL NUTRITION
-pts who can eat but cannot eat orally
-pts who have permanent neuromuscular impairment and cannot swallow.

-NG tube
-nasoduodenal tube
-gastrostomy (PEG)

Complications
-refeeding syndrome
-tube misplacement
-abd distention, N/V
-f/e imbalance
-start slow when you first feed someone
PARENTERAL NUTRITION
-Bring it to room temperature and leave it for 1 hour. Check electrolyte panel. Put it on a filter. Blood glucose check twice a day. Hang dextrose 10% if you run out of parenteral nutrition.

-partial parenteral- pt is also eating food.

Complications
-fluid/electrolyte imbalances
-infections
OBESITY

etiology
-diet high in fat and cholesterol
-physical inactivity
-drugs- hypertension drugs can make ppl sleepier
-familiar and genetic factors

nonsurgical management
Diet programs- low calorie diet
Nutrition therapy
Exercise program
Drug therapy—Xenical (BMI 27 w/comorbidities)
Behavioral management
Complementary and alternative therapies—acupuncture, acupressure, ayurvedic therapy hypnosis
BARIATRICS- deals w/ treating obesity

restrictive procedure- interferes w capacity of volume stomach.
malabsorption procedure- deals w absorption

OPERATIVE PROCEDURES

laparascopic adjustable gastric band- creates two compartments of the stomach. (restrictive)

laparascopic sleeve gastrectomy- excising part of the stomach. (restrictive)

gastric bypass- roux en Y- small pouch of stomach connected to small intestine. High success rate. Will maintain weight loss after 20 years.
Can have leakage or bleeding.
Malabsorptive procedure.
postoperative care
-airway
-pain management
-pt and staff safety
-assess for anastomic leaks


SPECIAL CONSIDERATIONS
-abd binder
-semi fowlers position
-compression hose
-assess skin
-absorbent padding
-remove urinary catheter within 24 hrs
-assist pt out of bed
-ambulate asap
-monitor abdo girth
-6 small feedings and prevent dehydration

-observe for signs of dumping syndrome- rapid gastric emptying. A feeling of fullness, even after eating just a small amount.
Abdominal cramping or pain.
Nausea or vomiting.
Severe diarrhea.
Sweating, flushing, or light-headedness.
Rapid heartbeat.
...
CIRRHOSIS
-scarring of the liver due to inflammation and necrosis
-nodular tissue can develop and block bile ducts and blood flow

types
-laennec's- alcoholic
-postnecrotic- viral hepatitis C or drugs
-biliary- caused by biliary obstruction GB

-Cirrhosis- blocks perfusion. Circulation is bad, loss of functionality. Then shrinks.
COMPLICATIONS
-portal hypertension
-ascites- fluid buildup in belly
-jaundice- liver can't remove bilirubin
-hepatic encephalopathy- loss of brain function when liver doesn't remove toxins from blood. elevated ammonia levels.
-hepatorenal syndrome- decreased urinary output. increased BUN and creatinine.
-spontaneous bacterial peritonitis
-increased ammonia levels
-esophageal varices- enlarged veins. Esophageal varices develop when normal blood flow to the liver is blocked by a clot or scar tissue in the liver.
liver disease early stages
-fatigue
-change in weight
-GI symptoms
-abd pain and liver tenderness
-pruritus

late stage
-jaundice
-dry skin
-petechiae
-edema
abd assessment
-massive ascitis
-umbilicus protrusion
-caput medusa
-hepatomegaly- enlarged liver
-tremors
-bruising
LABS

during hepatic inflammation
-ALT increased- specific to liver
-AST increased- cardiac, muscle, kidney, and brain
-LDH decreased
-alkaline phosphatase increased
-serum bilirubin and urobilinogen increased
-serum protein and albumin DECREASED
-PT time prolonged- low platelets
-hemoglobin and hematocrit are DECREASED
-ammonia increased
-creatinine increased
ASCITES
excess fluid volume
-low sodium diet
-paracentesis- insertion of catheter into abd to remove ascitic fluid from peritoneal cavity.

-for dyspnea, elevate head.
-supine position can aggravate dyspnea.

potential for hemorrhage
-gastric intubation
-blakemore tube to stop bleeding
HEPATIC ENCEPHALOPATHY
-reduce ammonia levels because they're too high
-small meals and protein packed
-drugs- lactulose, neomycin sulfate, metronidazole
...
HEPATITIS A
-fecal oral route by oral ingestion of fecal contaminants
-contaminated water, food, shellfish
-oral anal sexual activity
-incubation period 15-50days
-not life threatening unless older than 40
-symptoms don't rly show
HEPATITIS B
-unprotected sex w infected partner, sharing needles, transfusion, hemodialysis. healthcare workers needle stick
-symptoms occur 25-180 days after exposure.
-anorexia, nausea, fatigue, dark urine, joint pain, jaundice
HEPATITIS C
-spread by needles, blood, tattoo, cocaine use
-incubation period 21-140 days.
-asymptomatic. damage occurs over decades.
-hep c is the leading cause for liver transplants

hep b and c can infect others, even if they're without symptoms
HEP D
-transmitted primarily thru parenteral routes
-incubation 14-56 days

HEP E
-endemic in areas where waterborne epidemics occur.
-fecal oral route
-resembles hep A
-incubation 15-64 days
nonsurgical management
-high carbs and calories
-antiemetics, antiviral meds, immunomodulators
-use drugs sparingly because liver is damaged.
...
FATTY LIVER (steatosis)- accumulation of fats around hepatic cells
-caused by DM, obesity, elevated lipid profile, alcohol abuse.
-asymptomatic
HEPATIC ABSCESS
-liver invaded by bacteria
-treatment- drainage w ultrasound guidance. antibiotic therapy
LIVER TRANSPLANT
-used in treatment of end-stage liver disease
-transported in a cooled saline solution that preserves the organ for 8 hrs.

complications-
Acute, chronic graft rejection
Infection
Hemorrhage
Hepatic artery thrombosis
Fluid and electrolyte imbalances
Pulmonary atelectasis
Acute renal failure
...
ACUTE CHOLECYSTITIS
-inflammation of the GALLBLADDER
-cholethiasis(gallstones) usually accompanies cholecystitis

CHRONIC CHOLECYSTITIS
-repeated episodes of cystic duct obstruction result result in chronic inflammation, with calculi always present.

manifestations
Flatulence, dyspepsia, eructation, anorexia, nausea and vomiting, abdominal pain
Biliary colic- obstruction of bile duct.
MURPHY'S SIGN- right side pain increases when breathing.
Blumberg's sign (Rebound tenderness)
Steatorrhea- fatty stool
nonsurgical management
-low fat diet, bile salts
-opioid analgesics, anticholinergics, antiemetic
-shock wave lithotripsy
-percutaneous transhepatic biliary catheter insertion

surgical management
-laparascopic cholecystectomy- gold standard. removes the gallbladder. gall bladder stores bile, which breaks down fats, so limit fat intake.
-post op care- free air pain result of carbon dioxide retention in the abdomen. ambulation. return to activities in 1-3 weeks.
-traditional cholecystectomy- assess t tube after surgery
CANCER OF GALLBLADDER
-right upper quadrant pain
-poor prognosis
-surgery, radiation, chemotherapy
...
ACUTE PANCREATITIS
-life threatening inflammatory process of the pancreas caused by premature activation of excessive pancreatic enzymes that destroy pancreatic cells causing autodigestion and fibrosis of the pancreas.

-necrotizing hemorrhagic pancreatitis- diffusely bleeding pancreatic tissue w fibrosis and tissue death.
COMPLICATIONS
-HYPOVOLEMIA
-hemorrhage
-acute renal failure
-paralytic ileus- no perfusion so bowel mvmt slows down
-hypovolemic shock
-respiratory distress
-multisystem organ failure
-intravascular coagulation
-DM- destruction of islet cells
right sided- appendicitis and gallbladder
left sided- pancrease

-abd tenderness left side
-cullen's sign- edema and bruising around belly button
-turner's sign-bruising of the lower sides
-bowel sounds decreased
-pancreatic ascites
-vital sign changes
LABS
-amylase elevated- digests starch
-lipase elevated- digests fat
-Alkaline phosphatase- elevated if process accompanied by biliary involvement.
-calcium decreased w fat necrosis
acute pain
-relieve symptoms, decrease inflammation.
-fasting and drug therapy. give TPN and iv fluids

Interventions include:
-NPO in early stages
-Antiemetics for nausea and vomiting
-Total parenteral nutrition
-Small, frequent, moderate- to high-carbohydrate, high-protein, low-fat meals
-Avoidance of foods that cause GI stimulation
chronic pancreatitis- remissions and exacerbations
PANCREATIC ABSCESS
-most serious complication of necrotizing pancreatitis, fatal if untreated
-high fever up to 104
-blood cultures
-drainage
-antibiotic treatment alone does not resolve abscess

pancreatic pseudocyst
-hemorrhage from rupture
-bowel obstruction
-abscess
-pancreatic ascites
-may resolve on its own
-surgical intervention after 6 weeks.
pancreatic carcinoma
-one of the leading cause of cancer deaths
-metastasis spreads rapidly.
-radiation therapy to decrease size so they can eat better
-biliary stent insertion to help keep biliary duct open

surgical management
-TPN usually begins
-whipple procedure- remove the head of the pancreas, the first part of the small intestine (duodenum), the gallbladder and the bile duct. treats cancer

post op care
-observe for hemorrhage
-GI drain monitoring
-positioning
-f/e balance
-glucose monitoring

NEVER PUT ANYTHING ON HIGH SUCTION
...
increased eosinophils- asthmatic
hypercarbia- increased levels of CO2. pts with COPD
C02 narcosis- loss of sensitivity to increased levels of C02

oxygen toxicity- not good for tissue, it becomes damaged
apply humidifier for greater than 4L/min

when giving oxygen therapy, always start LOW
high oxygen delivery
-venturi- most accurate
-face tent
-aerosol mask
-tracheostomy collar
-T piece- pts with tracheostomy

POSITIVE AIRWAY PRESSURE TO KEEP ALVEOLI OPEN
BiPAP- inspiration and expiration are set at different setting by the machine
aPAP-automatic adjusting postivie airway pressure
cPAP- continuous positive airway pressure
tracheostomy problem
-reduced oxygenation
-inadequate communication
-inadequate nutrition
-potential for infection
-damaged oral mucosa

post op- assess every 2 hrs for airway patency, tube obstruction, dislodgment.
complications- pneumothorax, emphysema, bleeding, infection

Tracheostomy bypasses nose and mouth, which normally humidify. warm hair
-air must be humidified
-maintain proper temp
-ensure adequate hydration
complications of suctioning
-hypoxia
-tissue trauma
-infection
-bronchospasm
-cardiac dyysrhythmias from induced hypoxia
-do it only for 10-15 secs

tracheostomy
-turn/reposition every 2 hrs
-promote coughing and deep breathing
-avoid mouthwash that has alcohol
-elevate had of bed for at least 30 mins after eating to prevent aspiration
RHINITIS
-inflammation of nasal mucosa
-seasonal allergies
-direct or droplet

RHINOSINUSITIS
-inflammation of mucous membranes
-similar to cold

PHARYNGITIS
-sore throat, inflammation of pharyngeal mucous membranes
-strep throat can lead to serious medical complications

odynophagia- pain swallowing

RAT test- rapid antigen test
-screening for group A beta- hemolyric streptococcal antigen
-results available in 15 mins

when there's stridor, notify rapid response team
PNEUMONIA
-excess fluid in the lungs resulting from inflammatory process
-community acquired- easier to treat.
-healthcare associated- more resistant to antibiotics. difficult to treat.

BACTERIAL PNEUMONIA-streptococcal/ staph
VIRAL PNEUMONIA- most common
ATYPICAL PNEUMONIA- chlamidophila pneumoniae

bronchiolitis- inflammation of the lower, small end of brochioles. terminal ends

bronchitis- larger airways.

interstitial- viral
SEVERE ACUTE RESPIRATORY SYNDROME
-virus infection of respiratory cells, triggering inflammatory response.
-strick airborne
-new family of viruses- coronaviruses

PULMONARY TB
-highly communicable diseases
-most acquired virus
-aerosol
-persistent cough, night sweats, hemoptysis

-treatment for TB
-INH, rifampin
-therapy lasts 6 months if protocol followed.
-strict adherence
-airborne precautions
-3 consecutive negative sputums
thoracentesis- invasive procedure to remove fluid or air from the pleural space for diagnostic or therapeutic purposes.
Sets with similar terms