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181 terms

Test #3 Med-Surg

Fluid and Electrolytes, Renal, GI, Periop
STUDY
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pyelonephritis
inflammation of the renal parenchyma and collecting system
parenchyma
functional tissues of the organ
etiology of pyelonephritis
usually begins with colonization of lower UT, bacteria, fungi, protozia and virus
prexisting factors for pyelonephritis
vesicoureteral reflux, BPH, stricture or urinary stones
vesicoureteral reflux
a backflow of urine from the bladder into the ureter
S & S of pyelonephritis
mild fatigue, onset of chills, fever, vomiting, flank pain, bothersome symptoms of lower UTI (can subside even without treatment), pyuria (pus in urine) and bacteriuria (bacteria in urine) usually persist
diagnostic studies of pyelonephritis
urinalysis, urine C & D, ultrasound (abnormalities or stones)
pyridium
analgesic used to treat urinary tract infections and may turn urine orange
chronic pylonephritis
recurring acute pylonephritis, kidneys will appear shrunken and lose function due to scarring or fibrosis, usually progresses to end stage kidney disease if both kidneys are affected
causes of urinary incontinence
transient:confusion, depression, infection, drugs, restricted mobility, stool impaction
congenital: extrophy of the bladder (parts are outside body), epispadias (urethra is on upper tip), spina bifida
types of incontinence
stress (increased pressure), urge (few seconds warning), overflow (pressure is greater than sphincter), functional (unable to physically get there/mobility issue)
post void residual
diagnostic study, catheterization or bladder scan
incontinence
80% can be cured or significantly improved, take time, use voiding log, muscle training and prompting
urinary retention
Acute (total inability, medical emergency), chronic (not complete emptying), residual volume (what is left), more than 150 mL requires evaluation
treatment of urinary retention
acute- catheterization and treatment of cause,
chronic- schedule, alpha blockers, surgery
neurogenic bladder
dysfunction from lesion in the nervous system, types spastic (hyperactive), flaccid (overflow incontinence), complications are infection and stones, treatment is catheterization, encourage fluids and bladder retraining
urolithiasis
prescence of stones (calculi) in the urinary system
nephrolithiasis
the presence of kidney stones (calculi) in the kidney
S & S of kidney stones
deep intense pain,hematuria, pyuria, N/V, less than 1 cm are passed spontaneously, diagnosed by ultrasound, IVP (Intravenous Pyelography- exray with contrast), CT scan, blood chemistry, 24 hour urine collection,
treatment of kidney stones
Opioids and NSAIDs (anti-inflammatory properties), fluids, interventional procedures
cystoscopy
the visual examination of the urinary bladder using a cystoscope can also grab stones
lithotripsy
electromagnetically generated shock waves focused on stone to fragment stone
percutaneous nephrolithotomy
is performed by making a small incision in the back and inserting a nephroscope to crush and remove a kidney stone
patient teaching nephrolithiasis
fever, chills, flank pain, hemeturia, rine pH, fluid intake, dietary teaching, medication
urinary catheters
foley (double lumen), suprapubic (abdominal incision), straight cath (intermittent)
hypoxemia
decrease in partial pressure of oxygen in blood, mild 60-79, moderate 40-59, severe less than 40. p0rolonged or severe can lead to tissue hypoxia and anaerobic metabolism altering the acid-base balance, normal is 80-100 mm Hg
CO2
normal range is 35-45 high is acidic, low is alkalosis, ventilation is adjusted
respiratory alkalosis
caused by increased ventilations, anxiety, pain, PE
respiratory acidosis
caused by decreased ventilaitons, trauma, drowning, airway obstruction
HCO3
normal range is 22-26, low is acidosis, high is alkalosis, kedneys excrete bicarbonate ion as needed
acute symptoms indicting need for dialysis
encephalopathy (brain dysfunction), uncontrolled hyperkalemia, pericarditis, increrasing acidosis, medications or toxins
chronic need for dialysis when uremia develops
N/V, severe anorexia, increasing lethargy, confusion, fluid overload not responsive to diuretics or restrictions,
need for dialysis
GFR less than 15 mL/min
dialysis for acute pt
supportive care until kidneys heal
dialysis for chronic pt
allows them to live
dialysis limitation
does not take over kidney function of BP control, anemia (erythropoeitin), vitamin D, average life span on dialysis 5 years
hemodialysis (HD)
2-4 hours, 3 times a week, can be inpatient, outpatient or home, doc will write order for type and concetration, length of time and amount of fluid to be pulle doff
dialysate
fluid that pulls waste from blood
principlels of dialysis
urea, creatine, potassium, phosphate move from area of high concetration (blood) to area of low concetration (dialysate),
RBCs, WBCs, plasma protiens are too large to diffuse through membrane,
Na, Cl concetrations are isotonic,
glucose in the diasylate is hypertonic and pulls excess fluid from blood,
pressure gradient (hydrostatic) is created and forces extra fluid into dialysate
care of the pt on dialysis
removes lrg volumes- monitor for 1 hr HR, BP, orthostatic BP, dizziness, diaphoresis, nausea, watch for bleeding due to heparin, medications are dialyzed out, BP meds may need to be held- get directions from doc
vascular access for HD
needed for rapid and high volume blood flow
AV fistula
lasts longest and has least complication, allows for artertial flow through vein, veins become enlarged and tough, must mature for 2-3 months
AV graft
synthetic self sealing graft that connects artery and vein, used with pt with poor vessels,high rate of clotting, needs to heal for 2-3 weeks, easier for MD to put in
care of pt with AV graft or fistula
no BP or venipunctures in affected arm, palpate for thrill, auscultate for bruit, monitor circulation and aneurysm
IV catheters
for large volume high flow acute dialysis, if pt has lost AV graft or shunt, complications are infection, do not flush, heparin filled, only dialysis nurse accesses site
diabetes IV catheter site
do not access, only for diabetes nurse, heparin filled
peritoneal dialysis (PD)
peritoneum serves as the semipermeable membrane and supplies the blood, 10% of dialysis pts choose it, dialysate dwells for 4-6 hours and then is draned, 4-5 exchanges a day last one at bedtime for overnight dwell
automated PD
pt hooks up to a cycler at night, pt may need to do 1-2 exchanges during day to maintain
care of the pt on PD
need MD order for pt to do it, pt usually more expert than RN, peritonitis is major concern, assess effluent for clarity, abdominal pain, hyper BS, diarrhea, abnormal abd distension, notify MD and send specimen, monitor cath site for infection
advantages of PD
continuous process similar to kidney, no machine, slower avoid hemo unstable, more freedom with diet, can travel (no dialysis center needed), life expectancy not increased
kidney transplant
double life expectancy, live donor kidney better than cadaver kidney, after one year, cheaper than dialysis,
complications of transplant
rejection and failure (hyperacute-immediate, need to remove kidney), acute- days to months, not unusual, esp with cadaver, monitor increasing creatinine, decreased output, increased BP, chronic- months to years, usually irreversible
infections due to immunospuppression, CV disease- increased BP, lipids, cancer, corticosteroids and related symptoms
functions of the renal system
fluid and electrolyte balance, blood filtration, acid base balance, blood pressure regulation, erythropoietin production, vit D production
renal cortex
outer region that filters blood
renal medulla
middle region contains pyramids and empties into calyces
glomerulus
ball of capillaries that filters blood and retains protiens and RBCs
tubular reabsorption
water, glucose and amino acids
tubular secretion
potassium, hydrogen, and amonia are secreted from the capillaries into the urine
renal blood flow
1 liter/min, MAP- reflects hemodynamic perfusion pressure of the vital organs, over 65 adequate organ perfussion
renin
secreted by kidneys, regulates aldosterone to control BP
aldosterone
secreted by adrenal cortex and control retention of salt to control water and BP
ADH
secreted by posterior pituatary stimulating reabsorption of water in the distal tubules and collecting ducts
renal labs
BMP (BUN, creatinine, electrolytes), CBC (H&H, WBC), urinalysis (specific gravity, protien, blood), GFR
GFR
measurement of renal function, 125 ml/min
renal failure
decrease in the GFR so that the kidneys can no longer effectively filter water and waste from the blood
acute kidney injury (AKI) aka acute renal failure (ARF)
sudden onset, acute renal failure, frequently reversible with supportive care, 90% due to hypovolemia, frequently part of multi-organ failure
chronic renal failure (CRF)
gradual over months to years, progressive with loss of nephrons, symptoms occur when function is less that 20-25%,
end stage renal disease (ESRD)
condition in which kidney function is permanently lost
risk factors for renal failure
age, diabetes, severe ilness (especialy in septic and shock conditions), atherosclerotic disease, dehydration
prerenal ARF
most-common, due to conditions that affect renal blood flow, nephrons remain structurally intact, causes are hypovolemia, hypotension, sepsis, hemorrhage, renal stenosis
intrarenal ARF
direct injury to the kidneys with structural and functional damage to nephrons, ischemia, inflammation, infection, toxins, medications, IV contrast, rhabdomyolysis
rhabdomyolysis
muscle wasting disease that has been linked to statins
postrenal ARF
least common, due to obstruction of urine outflow, reversible with removal of obstruction unless it has been present long enough to cause kidney damage, causes are BPH, tumors, kidney stones, neurogenic bladder
ARF signs and symptoms
oligurina (less than 400 mL/24 hr), increased serum potassium, increased creatinine, decreased serum bicarb
ARF diagnosis
H & P, labs (BUN, ABGs, renal ultrasound, renal CT, renal agiogram,
ARF treatment
vary according to cause, rehydration, monitor fluid status for response and overload (foley, strict I/O, daily weights, orthostatic BP, assess lungs, monitor labs, treat hyperkalemia, oxygen, diuretics, dialysis
hyperkalemia treatment
kayexalate (binds with potassium for excretion in stool), IV insulin (moves K back into cells), IV glucose (to prevent hypoglycemia)
chronic renal insufficiency (CRI)
75% nephron loss,
cause- diabetes, hypertension, unsucessfully treated ARF, glomerulonephritis, autoimmune disorder, congenital defects,
early symptoms- maliase, fatigue, pruritis, headaches, weight loss, nausea, edema, hypertension, polyuria/nocturia
late symptoms- oliguria/anuria, CNS symptoms (drowsiness, confusion), numbness on hands or feet, easy bruising or bleeding, excessive thirst, breath odor of urine, uremic frost, N/V, constipation/diarrhea, stomatitis, gastritis
End stage renal disease (ESRD)
90% nephron loss
CRI complications/diagnosis
complications- decompensated heart failure, pulmonary edema, metabolic acidosis, pericarditis, pleural effusion, arrhythmias, anemia, malnutrition
diagnosis- same as acute renal failure: H & P, labs (BUN, ABGs, renal ultrasound, renal CT, renal agiogram,
CRI treatment
delay progression, prevent complications, plan for long term renal replacement, hemodialysis, peritonieal dialysis, kidney transplant
dietary and drug therapy for CRI
fluid restriction, dient restriction (low K, low Na, low protien, low phosphorus)
medications: antihypertensives, diuretics, meds to manage electrolytes, erythropoietin
pt teaching for CRI
dietary restrictions (low K, low Na, low protien, low phosphorus), fluid restriction (replace output plus 500 kL, avoid OTC meds NSAIDs, antacids and laxatives that contain Mg
PACU
post anesthesia care unit
PAT
preadmission testing, collect information regarding demographics, history consent forms, diagnositics and labs, teaching disharge planning, referrals to save time and money
elderly having special needs during surgery
comorbidities, less physiologic reserve, decreased renal and hepatic function, skin is fragile, malnutrition, decreased mobility
obese having special needs during surgery
fatty tissue especially suceptible to infection, increased risk for dihiscence, obstructive sleep apnea and need for CPAP in PACU
dihiscence
rupture separion of one or more layers of a wound
informed consent
legal mandate, surgeons responsibility to explain procedure, including benefits, alternatives, risks, complications, disfigurement, disabilities, removal of body parts, expectations
preoperative assessment (nutrtion and dentition)
nutritional and fluid status for optimal wound healing, dentition for infection control and choking on dentures or chipping compromised tooth during venting, drug hepatic and renal funtion, endocrine function (hypoglycemia from fasting before surgery, hyperglycemia from stress and will increase risk of surgical wound infection)
preoperative assessment (drug/alcohol and respiratory)
alcohol use for malnutrition and DT's (delirium tremens), CIWA scale, respiratory status, respiratory status (infection, quit smoking 4-8 weeks for optimal wound healing), teach C&DB, I/S
preoperative assessment (hepatic, renal, endocrine function)
hepatic and renal funtion (medications, anesthesia, endocrine function (hypoglycemia from fasting before surgery, hyperglycemia from stress and will increase risk of surgical wound infection)
preoperative assessment (immune, medication)
assess for allergies, ID sensitivities to meds, blood products, contrast agents, latex, food allergies and previous reactions, need to ID meds, OTC meds, herbal remedies the pt takes, corticosteriods sudden discontinuation can cause CV collapse, long term opioid use may alter response to analgesic agents, anticoagulants increase risk for bleeding
preoperative assessment (psychosical, spiritual, cultural)
anxiety, assessment of support network, readiness for teaching, assess spiritual and cultural beliefs and provide support
preoperative nursing interventions
Teaching (multiple strategies, repetitive) DB & C and I/S (prevent atelectisis and pneumonia), mobility and body movement (promotes circulation and prevents venous stasis), pain management (introduce pain rating scale, plan for analgensics, manage nutrtion and fluids (NPO after midnight), preparing the skin (special soap, hair removal-clippers)
preoperative checklist
H&P, labs, EKG, CXR, surgical consent, blood consent, medication recociliation, pt labels, pt ID, allergies, isolation, jewelry, VS, dentures, NPO status, current meds, current nursing assessment
surgical team
pt, circulating nurse (leadership role, coordinates), scrub nurse (set up, prep, count), surgeon, RN 1st asist (surgeon assistant), anethesiologist (assesses, selects and administers anesthesia, supervises condition througout the surgery)
surgical environment
surgical asepsis (absence of microorganisms, unrestricted, semi-restricted, restricted), OR ventilation exchange 15 times per hour, laminar air flow 400-500 exhanges per hour, room temp is 20-24 degrees C, humidity 30-60% less microbes in that environment
surgical classification
diagnostic (biopsy, laparotomy)
curative (appendectomy)
reparative (ORIP of hip)
cosmetic (facelift)
palliative (PEG tube)
categories of urgency
emergent- life threatening, without delay intestinal obstruction
urgent- requires prompt attention, gallbladder infection
required- needs surgery, thyroid disorder
elective- should have surgery, simple hernia
optional- decision rests on pt, cosmetic surgery
malignant hyperthermia
rare life threatening condiotion, inherited muscle disorder chemically induced by anesthetic agents, treatment is dantrolene sodium (Dantrium),
S&S: usually develop within one hour of exposure, respiratory acidosis, tachycardia >150, muscle rigidity (jaw), elevated body temp > 38.8, prognosis is poor if this condition is not aggresively treated
delirium tremens
an acute organic brain syndrome due to alcohol withdrawal that is characterized by sweating, tremor, restlessness, anxiety, mental confusion, and hallucinations, usually occurs within 72 hours
oropharynx
central portion of the pharynx between the roof of the mouth and the upper edge of the epiglottis
assessment of UGI system
history of symptoms, nutrition by mouth percentage, I&O, abilty to chew and swallow, pain, dyspepsia (indigestion), N&V, flatus (bloating), changes in appetite, bowel habits, weight gain or loss
diagnostic labs for the UGI
CBC (H&H, WBC), stool specimens, occult blood, clostridium difficile, ova and parasites
diagnostic UGI imaging studies
UGI series- oral contrast with multiple x-rays, can include swallowing and continue on to LGI tract, clear liquids and NPO after MN, push fluids after oral contrast
Chest XR or KUB (kidneys, ureter, bladder)- check placement of NGT, CXR preferred
CT/MRI
diagnostic UGI endoscopy
allows direct visualization of mucosa in esophagus, stomach and duodenum, cna do biopsies and therapeutic interventions, NPO for 8 hours prior,pt sedated, monitor for perforation, pain, and after return of gag, no PO until gag
dysphagia
difficulty swallowing, complicated by poor nutrtion, aspiration, poor dentition, oropharyngeal surgery, caused by stroke, parkinsons, alzheimers,
nursing implications- assess each time you give something PO, LOC, choking,minimize bacteria in mouth, upright position, do not rush, speech therapy consult for symptoms, hold po with altered LOC
N/V non GI causes
SE of meds, brain injuries (concussions, bleeds), brain infections (meningitis), migraines, brain tumors, vertigo, motion sickness, noxious stimuli, excess alcohol, pregnancy
N/V GI causes
obstruction, bleeding, infection or irritation
N/V assessment history
pain (OPQRST), blood coffee ground or bright red, dehydration, headache or head injury, generalized weakness, confusion, irregular HR, non-GI symptoms usually related to severe dehyration and electrolyte imbalance
N/V diagnostics
labs (H&H, WBC, electrolytes) UA- assess for dehydration, head CT, GI tests
N/V treatment
treat cause, rehydration, meds (phenergan, zophran, reglan, compazine)
Upper GI bleed
from esophagus, stmach, duodenum, causes- PUD, erosive esophagus or gastritis, gastric cancer, mucusal tears r/t forceful vomiting or injury, esophageal varices, NSAIDs, anticoagulants
UGI bleed risk factors
age > 60, severe comorbities, active bleeding, hypotension, RBC transfusion > 6 units, impatient or ICU, coagulopathy
UGIB assessment/history
hematemesis, melena, hematochezia, syncope, presyncope, dyspepsia, abdominal pain, weight loss, meds
melena
black tarry stool
dyspepsia
indigestion
hematochezia
passage of fresh, bright red blood from the rectum
UGIB physical exam
priority:assess for S/S of hemodynamic instability & shock, increased HR, decreased BP, orthostatic BP, decreased peripheral perfusion, syncope, vomiting bright red blood
UGI diagnostics
labs (CBC, H&H, platelets, troponin, APTT, PT/INR, type and crossmatch), NGT, endoscopy, CXR, CT
UGI treatment
stabilize hemodynamically, IVF (crystalloids, colloids), blood transfusions, NGT: relieves pressure in stomach, treat cause, may need to intubate if pt unable to maintain airway
GERD
backflow of contents into esophagus, incompetent sphincter, burning, can be confused with MI, symptoms greater than two weeks, diagnosed with endoscopy,
Barrett esophagus
cellular changes, squamous cells are replaced by columnar following chronic inflammation of acid reflux
GERD treatment
pt education: sit up after meals, avoid large meals, bland diet, limit caffeine, tobacco, alcohol, carbonated beverages,
meds: antacids, H2 blockers, PPI, pro-kinetic agents,
surgery: fundoplication
fundoplication
a surgical procedure for the treatment of reflux esophagitis in which the fundus of the stomach is wrapped around the lower end of the esophagus
hiatal hernia
part of stomach extrudes throug diaphram, symptoms similar to GERD, compllications are herniated portion of stomach obstruction, treatment: small meals, upright, raise HOB, fundiplication (15%)
esophageal surgery: nursing implications
do not manipulate NGT, no reinserting, or adjusting position, may damage anastomosis, call MD with any concerns re NGT
anastomosis
Surgical joining of two bowel segments to allow flow from one to another
esophageal varices
varicosed veins of esophagus, next in live for backflow if cirrhosis backs up blood
causes: portal hypertension
assessment: history, S/S liver disease, UGIB
treatment: beta blockers, endoscopic sclerotherapy, variceal ligation
PUD
gastric and duodenal ulcers, endoscopy to differentiate, S/S burning epigastric pain, non-specific GI symptoms, causes: NSAIDs, H pyori, stress, treatment: antibiotics, meds to decrease acidity, surgery for active bleed and perforation
perforated ulcer symptoms
(medical emergency) sudden onset of severe and sharp abd pain, vomiting frank blood, shock
gastric surgery
for gastric cancer and perforated ulcers, nursing managment is pain control, NGT for decompression and for feeding when BS returns, advance diet as tolerated, complications: dumping syndrome, vitamin and mineral deficiency
GI tubes purpose
decompress stomach, remove contents and keep fluid and gas from accumulating, lavage to remove toxins, diagnose GI disorder, administer meds and feedings, compress a bleeding site, aspirate contents for ananlysis
orogastric tube
(ICU only), tube inserted through the mouth into the stomach
nasogastric tube
large bore (salem sump), small bore (corpak)
what you need to know about the tube
purpose (decompression or feeding), insertion site, distal location, type of tube (salem sump, corpak, GT), amount of suction, date of insertion, initial placement confirmed by XR, bedside confirmation of placement
Large bore (salem sump)
diagnostic to evaluate gastric contents, therapeutic: lavage, decompress, prevent aspiration, provide rest for bowels, administer meds and feedings, confirm placement with XR, check placement before administering food or meds (aspirate to check for gastric contents), inserting air not accurate, I &O monitor every four hours
small bore (corpak)
replaces salem sump after ____ weeks. Only for feedings, cannot be used with suction, cannot measure residual, check placement before each feeding, notemlength at the nare, flush! clogs easily
GT/PEG & JT
end point chosen by radiology, long terms feedings, comatose patient, inserted in endoscopy lab, tract matures in 3-4 weeks, minimize movement of tube, feeding and med administration
enteral
within or by way of the intestines
parenteral
not through the intestinal tract
enteral and parenteral nutrtion
indicated if pt will be unable to eat for 7 + days, severe malnurishment or unable to meet nutrtional needs, monitor fluids balance and shifts, monitor for infections, monitor for evidence of better nutrtion
parenteral nutrition
pt is on bowel rest, cannot get sufficient nutrtion via enteral route, expensive, requires IV site, risk of infection, usually inpatient, change bag and tubing every 24 hours, excellent medium for bacteria growth, change central line dressing ever week using sterile technique
enteral nutrition
preferred when pt has funcitonal gut, maintains mucosal integrity, less complications, cheaper, easy procedure, done at home or LTC, many different formulas for pt populations (diabetic, renal,etc), needs extra hydration,
hemorrhoids
Swollen, painful rectal veins; often a result of constipation
valsalva maneuver
forceful exhalation against a closed glottis, which increases intrathoracic pressure and thus interferes with venous blood return to the heart
megacolon
an abnormal enlargement of the colon
diarrhea
acute < 14 days, chronic >2 weeks
cause- IBS, IBD, lactose, medication, tube feedings, infection, maladaptive disorder (celiac disease), aids, c-diff
celiac disease
Gluten-sensitive enteropathy or sprue; a chronic malabsorption syndrome in which one is unable to digest gluten, a protein found in wheat, barley, rye and oats
C diff
gram + bacteria, superinfection from antibiotic use, foul odor, 13% for pt with hospital stays over 2 weeks, treat with flagyl or vancomycin
fecal incontinence
involuntary passage, frequently from fecal impaction, preserve skin integrity, external devices, internal devices (flexi-seal fecal management, may be used for 29 days)
IBS (irritable bowel syndrome)
disorder of intestinal motility, spastic contraction, distension and mucus accumulation, diagnosis made after test to r/o other disorders, S&S constipation/diarrhea, both, pain (precipitated by eating and & ewliwcws by defecation, bloating and abdomnial distention, relieve abdominal pain, relieve stress
appendicitis
Inflammation of the appendix, usually due to obstruction or infection
S&S: abdominal pain RLQ, low grade fever, N/V, leukocytosis, complication is perforation usually within 24 hours, need immediate surgery, IV fluids and IV antibiotics, relieve pain, promote wound healing, teach would care, nutrtion and activity guidlines
diverticulitis
inflammation of a diverticulum, herniation of lining of colon (95% sigmoid), diverticulosis (multiple diverticulum without inflammation), retain food and bacteria that can lead to obstruction, perforation, pertonitis, and septicemia
S&S: pain in LLQ, N/V, fever, chills, leukocytosis, diagnosed by colonoscopy, CT, erythrocyte sedimentation rate
erythrocyte sedimentation rate
the rate at which red blood cells settle out in a tube of blood, indicates inflammation
diverticulitis medical managment
rest, analgesic, anti-spasmodics, clear liquid diet, antibiotics, acute: NPO, IV fluids, NGT to suction, antibiotics 7-10 days, if perforation, peritonitis, hemmorage, or obstructin occurs immediate surgery is required to remove diseased section of colon
diverticulitis nursing process
onset and duration of pain, dietary habits, hx of constipation/straining/abd distention, ascultate for bowel sounds, palpate for LLQ pain, inspect stool for pus/mucus/blood, dx is constipation and pain
diverticulitis goals and interventions
attain regular elimination, pain relief, absence of complications, educate re fluid intake, increase fiber, exercise program, assess pain, monitor for signs of perforation
peritonitis
inflamation of the peritonium usually from bacterial infection or ruptured organ, SS pain icreased with movement, abd rigidity, anorexia, low grade fever, tachycardia, leukocytosis,
peritonitis complications
paralytic ileus, bowel obstruction from adhesion, sepsis, septic shock, respiratory distress, medical managment fluid and electrolyte replacement, analgesic, antiemetics, antibiotics and oxygen therapy, surgical management: resection, repair and drainage
peritonitis nursing managment
assess and treat pain, assess that inflamation is subsiding (normal temps, pulse, soft abdomen, persitaltic sounds, flatus, bowel movement), monitor and record drainage fromsurgical drains, teach pt and family to care fro incision and drains at home
inflammatory bowel disease
crohns and ulcerative colitis
Crohn's disease
inflamation of GI tract wall that extends through all layers, begins with edema and thickening of the mucosa, ulcers begin to appear on the inflammed mucosa, ulcers are not continuous, granulomas occur in 50% of patients, bowel walls become thick and fibrotic and lumen narrows, S&S: RLQ pain (scar tissue and granulomas restrict digestion causing cramping pain), diarrhea unrelieved by defecation, steatorrhea
complications: intestinal obstruction or stricture formation, fluid or electrolyte imbalance, malnutrtion, fistula and abscess formation
steatorrhea
fat in the feces; frothy, foul-smelling fecal matter
crohns diagnostics
stool positive for occult blood and steatorrhea, barium study (show string sign indicating the constriction of the intestines), labs (H&H-L, WBC-H, ESR-H, albumin-L)
ulcerative colitis
ulcers and inflammation of colon and rectum, bleeding, begins at rectum and spreads proximally through entire colon, stool contains mucus and pus, LLQ pain, tenesmus, rectal bleeding, occult blood, colonscopy, CT scan, labs (H&H-L, WBC-H, ESR-H, albumin-L)
tenesmus
painful spasm of the anal sphincter along with an urgent desire to defecate without the significant production of feces,
complications of ulcerative colitis
toxic megacolon, perforation, bleeding, if pt doesnt respond to medical management of NG suction, IV fluids, corticosteroids, and antibiotics within 24-72 hours, a total colectomy is performed
management of IBD
nutrtion (low residual diet) and meds, total colectomy with ileostomy
ileostomy
surgical procedure that creates an opening from the ileum through the abdominal wall to function as an anus
nursing diagnoses for IBD
diarrhea, acute pain, deficient fluid, imbalanced nutrtion, activity intolerance, anxiety, ineffective coping, risk for impaired skin integrity, risk for ineffective therapeutic regimen management
nursing goals for IBD
attainment of normal bowel elimination patterns, relief of abdominal pain and cramping, prevention of fluid deficit, maintenance of optimal nutrtion and weight, avoidance of fatigue, reduction of anxiety, promotion of effective coping, absence of skin breakdowns, increased knowledge of disease process
nursing intervetions for IBD
maintain normal elimination patterns, relieve pain, maintain fluid intake, maintain obtimal nutrtion, promote rest, reduce anxiety, enhance coping measures, preventing skin breakdown
ostomy patients
pre-op teaching: what to expect (NG tube, perineal packing)
Post-op Care: assess stomoa, monitor for fecal drainage, monitor electrolytes, empting the appliance, change appliance, assess skin integrity frequntly,
bowel obstruction
usually caused by cancer or adhesions, usually occur in the small intestines, obstruction in large intestine due to cancer or IBD, usually in sigmoid colon
small bowel obstruction
abd pain, N/V, absence of stool or flatus, fecal vomiting occurs, XR, CT show abnormal amounts of air and or fluids int he intestines, decompress with NG tube, if unsuccessful then bowel resection
Large bowel obstruction
S&S: slow onset of symptoms, constipation, abd distension, eventually fecal vomiting, abd XR, CT reveal a distended colon
colorectal cancer
thirds most common cause of cancer deaths, importance of screening procedures, manifestations include change inbowel habits, blood in stools, tenesmus, pain, symptoms of obstruction, feeling incomplete evacuation, treatment depends on stage of the disease
nursing diagnosis r/t colon cancer
imbalanced nutrtion, risk for deficient fluid, anxiety, impaired skin integrity, disturbed body image, ineffective sexual patterns, pain
nursing interventions colon cancer
pre-op teaching, providing emotional support, post-op care, maintaining optimal nutrtion, providing wound care, monitor & manage complications, colostomy care, supporting positive body image