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Med surg
Final notes from finnochiarro
84
Nursing
Undergraduate 4
03/14/2014

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Term
causes of peptic ulcers
Definition
- heliobacter pylori infection
- NSAID use --> decrease protective prostaglandins --> increase gastric acid secretion
- Severe stress
- hypersecretory states
- alcohol, caffeine, smoking
Term
diagnostic procedures to confirm peptic ulcers
Definition
Esophagogastroduodensocopy (EGD)
most definitive to confirm peptic ulcers
Term
Esophagogastroduodensocopy (EGD)
Definition
NPO
remove dentures
informed consent form
post procedure: food/fluid following return of gag reflex
Term
Gastric ulcer
Definition
pain 30-60 minutes after meal
rarely occurs at night
pain goes up with food ingestion
> women and older adults
Term
Duodenal ulcer
Definition
pain 90 mintes to 3 hours after meal
often occurs at night
pain relieved by food ingestion
80% of all PUD
H. pylori is found in 90-95% of pts with duodenal ulcer
Term
peptic ulcer dx
complications to watch for
Definition
Hemmorrhage (most common)
duodenal ulcer>gastric ulcer
perforation
GI outlet obstruction
Term
peptic ulcer dx
complications to watch for
Perforation:
Definition
sudden, severe epigastric pain spreading accors the abdomen and to the shoulder
- ulcer goes through stomach or duodenum --> stomach content enter periotneal cavity --> untreated --> bacterial peritonitis may occur (6-12 hours) --> rebound tenderness
Term
peptic ulcer dx
complications to watch for
GI outlet obstruction
Definition
c/o worsen pain at end of day d/t increase stomach content
belching or self-induced vomit (projectile vomit d/t obstruction)
Term
Nursing and collaborative management (conservative therapy)
Definition
nutritional therapy
stress reduction and rest
therapy related to complications
Term
Nursing and collaborative management (conservative therapy)
Nutritional therapy
Definition
eat 6 small meals or 3 regular meals
avoid irritating food -- spicy foods
eat as normally as possible
Term
Nursing and collaborative management (conservative therapy)
Therapy related to complications
ACute exacerbation/hemorrhage
Definition
goal: stop bleeding
Term
Nursing and collaborative management (conservative therapy)
Therapy related to complication
PErforation
Definition
Goal: stop spillage of gastric or duodenal content into peritoneal cavity
- NG tube, IV fluid replacement/PRBC, strict I/O, broad spectrum antibiotics, pain medicatio
Term
Billroth II
Definition
operation removes part of the stomach
remaining segment attached to jejunum
end of teh duodenum is sewn up
Term
Dumping syndrome
what is it?
Definition
rapid entry of ingested food into the jejunum without proper mixing and without the normal digestive process of the duodenum --
Term
Dumping syndrome
process...
Definition
the chyme are more hyperosmolar than the jejunal secreation --> cause fluid to be drawn from bloodstream into the jejunum because concentrated food and fluids move rapidly into the intestine --> decreasing blood volume --> hypotension --> diarrhea, feeling of fullness and discomfort
Term
dumping syndrome
when does it occur
Definition
5-30 minutes after meals
lasts 20-60 minutes
Term
dumping syndrome
complaints
Definition
weakness, faintness, tachycardia, diaphoresis, pallor, fullness, discomfort, nausea and diarrhea
Term
dumping syndrome
nursing interventions
most important
Definition
lying down after a meal slows movement of food within the intestines
Term
dumping syndrome medications
Definition
antispasmodic medications: dicyclomine
octreotide (sandostatin) subq
Term
dumping syndrome
other nursing interventions
Definition
monitor nutrition and electrolyte balance I&O, wt
wach for postprandial hypoglycemia
Term
dumping syndrome
nutritional education
Definition
limit amount of fluids at one time
eliminate fluids with meals and 1 hr before/after meals
6 small meals are best
avoid milk, bread, sweets and sugars
have a high protein high fat and low to moderate carbohydrate diet
Term
dumping syndrome
nutritional education
eliminate fluids with meals and 1 hr before/after meals
Definition
prevent distention/feeling of fullness
Term
dumping syndrome
nutritional education
6 small meals are best
Definition
avoid overloading intestines at mealtime
Term
dumping syndrome
nutritional education
avoid milk bread sweets and sugars
Definition
may cause dizziness, diarrhea, sense of fullness
Term
dumping syndrome
nutritional education
have a high protein, high fat and low to moderate carbohydrate diet
Definition
promote rebuilding body tissues and meet energy needs
Term
older adult GI changes
Definition
decreased taste and smell, sep sweet and sour
teeth enamel and dentin breakdown
periodontal disease
decreased motility of GI system
delayed gastric emptying
decreased acid production and intrinsic factor
Term
constipation
complications
Definition
fecal impaction/fecal incontinence
hemorrhoids
megacolon/megarectum
arterial HTN
Term
constipation
collaborative care
medications
Definition
Bulk formers: metamucil -- take with lots of fluid
stool softener: ducosate sodium (colace)
lubricants: mineral oil
hyperosmotic agents: colyte, golytely
saline laxative: milk of magnesia (MOM)
stimulat: dlucalox, castor oil
Term
constipation
nursing interventions
Definition
** adequate dietary fiber: apple sauce, prunes, prune jice, fruits and veggies
- fluid balance
- movement/ambulation/exercise
- bowel training program
- close commoed, use of bedpan, walking distance to restroom
- skin protection
- perianal pouching
- maintenance of skin integrity
Term
Appendicitis:
diagnostic studie
Definition
CBC, UA r/o GU concern
CT scan or US
Term
appendicitis
nursing management
Definition
keep npo until Dx is confirmed
before admit pain meds, confirm dx
no enema, no laxatives
Term
inflammatory bowel disease (IBD)
ulcerative colitis
Definition
edematous, inflamed mucosa with multiple abscesses begingin in the rectum and moving upward through the large intestine
can lead to cancer
Term
inflammatory bowel disease (IBD)
ulcerative colitis
s/s
Definition
constipation alternating with bloody diarrhea, cramping and abdominal pain
Term
inflammatory bowel disease (IBD)
chron's disease
Definition
intermittent involvement through the entire GI tract, most commonly in the small intestine and the terminal ileum. dz usually extends through all layers of the bowel over time
Term
inflammatory bowel disease (IBD)
chron's disease
s/s
Definition
non-bloody diarrhea, weight loss and pain
Term
inflammatory bowel disease (IBD)
treatment/intervention
Definition
possible surgery: collectomy and colostomy
dz often recurs: Chron's dz
dz is curable with colectomy
Term
IBD
diet
Definition
low fiber (low residue)
high calories, high protein and low fat
mashed potatoes, canned fruits, boiled chicken
Term
diverticulitis diet
Definition
high fiber
Term
IBD
diagnostic/lab tests
Definition
Colonoscopy -- definitive diagnosis
Term
colonoscopy procedure
Definition
clear liquids only for 24 hours prior
GoLYTELY or similar cathartic
NPO 8 hr prior due to conscious sedation
signed consent is necessary
vital signs and electrolyte monitored
Term
treatment for acute exacerbation of IBD
Definition
NPO
IV fluids with TPN
**BOWEL REST
Term
post operative care: total colection
Definition
** teach or emphasize that teh ostomy is permanent and teh ileum will be reconnected with the large bowel when it heals
** monitor ileostomy for high watery output-concern about the status of teh patient's fluid balance
ileostomy: stoma assessment and skin integrity-consider wound ostomy nurse
NG tube insertion and care
perineal skin care
Term
intestinal obstruction
types of obstruction
Definition
mechanical
nonmechanical
Term
intestinal obstruction
types of obstruction
mechanical
Definition
occlusion of teh tract
**adhesions are most common cause
hernia, neoplasms-- other causes
Term
intestinal obstruction
types of obstruction
nonmechanical
Definition
paralytic ileus -- lack of peristalsis
may occur post any abdominal surgery
Term
intestinal obstruction
etiology and pathophysiology
Definition
laction of obstruction determines extent of acid-base, fluid and electrolyte imbalance
High: (close to pylorus) metabolic alkalosis (loss of HCL acid from vomiting, NG suction
Low: (small intestine) dehydration occurs rapidly, reverse perstalsis may cause vomiting of fecal material
Term
colorectal cancer
clinical manifestations
Definition
** alternating constipation and diarrhea
mostly asymptomatic
rectal bleeding - most common
Term
colorectal cancer
diagnostic studies
Definition
**colonoscopy -- gold standard
digital rectal exam
Term
Stoma assessment
Definition
stoma should be pink moist, health looking
Term
stoma assessment
problems occur 3 ways
Definition
color
edema
bleeding
Term
stoma assessment
problems
**color
Definition
dusky red to blue or purple -- ischemia
brown to black -- necrosis
pale -- may inidcate anemia
Term
stoma assessment
problems
**edema
Definition
mild to mod - may be normal esp in immediate post op, may be trauma to stoma
mod to severe - obstruction of stoma, gastroenteritis, allergic reaction
Term
stoma assessment
problems
**bleeding
Definition
small: some oozing may be normal d/t high vascularity of stoma
mod to large: coagulation factor deficiency, stomal varices due to portal hypertension, low GI bleeding
Term
diverticula
Definition
outpouching of teh colon
occurs through circular smooth muscle of intestinal mucosa
Term
diverticulosis
Definition
** often asymptomatic
multiple noninflamed diverticula
Term
diverticulitis
Definition
inflamed diverticula
Term
complications of diverticulitis:
Definition
** peritonitis
perforation
hemorrhage
bowel obstruction
Term
nursing management of diverticula
Definition
high fiber diet, fiber supplements
stool softeners
anticholinergics ( decrease gI motility and spasms)
acute: antibiotics, NPO status, IV fluids, possible colon resection, NG suction
Term
hemorrhoids
nursing management
Definition
discharge teaching:
** sitz baths
preventative measures
pain control
prevent constipation
Term
Enteral feedings:
reducing the risk of aspiration
Definition
check ressidual: accumulation/back-ups
how much is too much (depends on the rate)
** return aspirate to the stomach and if high recheck the volume of aspirate in an hour
keep head of bed up as much as possible
Term
Parenteral nutrition
complications
Definition
** infection/sepsis (why PPNs have filters)
** hyperglycemia
** fluid overload
pneumothorax (from insertion of central line)
air embolism
clotted catheter line
catheter displacement
rebound hypoglycemia
Term
Parenteral nutrition
nursing intervention
Definition
** checking glucose levels
maintin optimal nutrition
prevent infection
maintain fluid and electrolytes balance
prevent metabolic imbalance
promte comfort
encourage activitiy
Term
Liver
Viral hepatitis:stages
Definition
early prodromal phase
preicteric phase
icteric phase
convalescent phase
Term
Liver
Viral hepatitis:stages
common features of Early Prodromal phase
Definition
flu like symptoms
occurs 2-3 weeks before jaundice
Term
Liver
Viral hepatitis:stages
common features of Preicteric phase
Definition
GI symptoms: N/V ab pain, anorexia
generalized malaise, myalgias, HA, fever
may last to several days to weeks; needs lots of rest
Term
Liver
Viral hepatitis:stages
common features of Icteric phase
Definition
** need adequate bedrest
s/s of jaundice, actual phase of illness
2-6 weeks
Term
Liver
Viral hepatitis:stages
common features of convalescent phase
Definition
full recovery usually within 6 months
Term
Diagnostic tests for liver disease
liver function tests
Definition
** serum enzyme activity (AST & ALT) which are elevated
bilirubin metabolism
serum protein study
ammonia level
blood clotting functions
activated (APTT)
fat metabolism (cholesterol, phospholipids)
Term
complications of hepatic dysfunction:
ascites: collaborative management
Definition
** paracentesis: watch for hypovolemia
Term
esophateal varices bleeding: collaborative management
goal for nursing
Definition
to maintain the pt's airway and prevent aspiration of blood
Term
hepatic encephalopathy
pathophysiology
Definition
build up of toxins which the liver fails to remove ammonia and metabolic wastes from the blood causing altered mental status
Term
hepatic encephalopathy
collaborative management
Definition
** reduction of blood ammonia levels
** reduce protein intake
** eliminate intestinal bacteria by using nemycin
Term
hepatic failure
collaborative management
Definition
** activity and rest: assess for fatigue, needs rest
nurition: oral hygiene, avoid alcohol, increase calories -- low fat, low protein, low Na
LOC: no opioids or sedatives
skin integrity: pruritus... give questran or atarax
Term
cirrhosis
Definition
**avoid alcohol intake
Term
types of gallstones
Definition
cholesterol stones
pigment stones (billirubin)
Term
cholelithiasis
Definition
presence of one or more gallstones
Term
cholelithiasis
pathophysiology and etiology
Definition
bile supersaturated with cholesterol --> bile stasis wihin the gallbladder --> decrease motility of gallbladder --> form crystal formation = microstones which aggregate more --> macrostones --> severe inflammation
Term
cholelithiasis
s/s
Definition
2ndary to severe inflammation = **abdominal pain, nausea (usually after eating high fat foods)
obstruction of common bile duct --> bile reflux into liver --> jaundice, pain --> hepatic damage, pancreatitis, sepsis
Term
management of cholelithiasis
laproscopic cholecystectomy
**procedure
Definition
abdominal incision
lighted scope attached to video camera into one incision near belly button
inserting surgical instruments into other incisions
removes gallbladder
4 small incisions, which will be covered with dressing
Term
Traditional cholecystectomy
Post-op care
Drainage catheters: penrose or Jackson-Pratt
Definition
**FT-tube: expect large amount of bloody to greenish brown drainage teh first 24 hours: 400-600 ml:
over 1000 ml contact physician
Term
pancreatitis
** Diagnostic studies
Definition
- serum amylase level is elevated early and remains high for 24-72 hrs (normal: 56-190 IU/L
- acute pancreatitis: 400-800 IU/L
- urine amylase remains high up to 2 weeks
- lipase: 3-5 x's above normal
- serum liver enzymes and bilirubin levels high with associated biliary dysfunction
- elevated WBC count
Term
pancreatitis
** Diagnostic studies
chronic pancreatitis
Definition
w/ pancreatic cell destruction. usually absence of high amylase level because less amylase is made within the pancreas
Term
pancreatitis
nursing interventions
rest the pancreas
Definition
** npo: no food until pain free
** NGT for gastric decompression
** TPN
once diet is resumed: bland, low fat
no stimulants, small frequent meals
no alcohol or smoking
limit stress
Term
pancreatitis
nursing interventions
**pain management
Definition
administer opioids prescribed (large doses of morphine IVP)
give antispasmodic:
- dicyclomine (Bentyl)
- propantheline bromide (Pro-banthine)
- (demerol given traditionally)
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