Adult 1 Final

• Skin intact.
• Redness.
• Non-blanching.
• Possible blister.

• Partial thickness skin loss.
• Blistering.

• Full thickness skin loss.
• Necrotic tissue.

• Extensive full thickness skin loss.
• Possible bone/muscle visible.
• Drainage.

Nosocomial infections

Used to examine for bladder trauma and identify UT obstruction.

May be used to remove bladder tumors or enlarged prostate.

Can use general or local anesthesia.

A light evening meal may be eaten before.

NPO after midnight.

Bowel prep with laxatives or enemas the evening before the procedure.

Described by location.

Site of infection and bacteria present determine treatment.

90% are caused by E. Coli.

Acute pyelonephritis

Urethritis, Cystitis, Prostatitis

Inflammation of the bladder.

Caused by irritation or infection.

Reducing the use of indwelling catheters. If must be used, pay strict attention to sterile technique.

Remove catheter as early as possible.

Drink at least 3 L of water daily.

Urinate every 3-4 hours

Daily bathing.

Frequency

Urgency

Dysuria

Cloudy, foul smelling, blood tinged urine

treat bacteriuria and promote comfort

antibiotics, analgesics, antispasmodics, antiseptics.

Diet including all food groups.

More calories for the increased metabolism from infection.

Drink 50 mL of cranberry juice daily for 3-4 weeks.

to decrease the ability of bacteria to adhere to the epithelial cells lining the urinary tract.

Small tube placed in ureter.

Dilates the ureter and enlarges the passageway for the stone or stone fragments.

Prevents the passaging stone from coming in contact with the ureteral mucosa and so it reduces pain, bleeding and infection risk.

Foley catheter is places to facilitate passage of stone through urethra.

A loop of colon brought to the skin surface and sutured to the abdominal wall. Performed in the transverse colon and are temporary.

Split the bowel and bring the proximal and distal portions to the abdominal wall to have two stomas. The proximal stoma is functioning and eliminates stool. The distal stoma may secrete some mucus, but thats it.

Reddish/pink

Moist

protrude about 3/4 inch from the abdominal wall

Skin around stoma should be intact, smooth and without redness.

A catheter you can do yourself. Insert a a thin, hollow tube through the urethra into the bladder and allow the urine to drain out. Not permanent.

With aging. The prostrate gland enlarges and extends upward into the bladder and inward, causing bladder obstruction. The detrusor muscle thickens and cannot contract effectively.

Prostate will be enlarged, non tender.

Patient will have increased statis or acute or chronic retention.

Urinary Frequency, Nocturia, urinary hesitancy on initiation of voiding, hematuria

lowered force of stream, post-void dribbling from overflow incontinence, distention

evidence of renal insufficiency like edema, pallor and pruritis.

Urinalysis, Culture, CBC, BUN, PSA done before a DRE.

• 5-alpha reductase inhibitor:
• finasteride
• dutasteride

decreases testosterone levels to shrink the prostate and prevent further growth.

Side effects: decreased libido and ED

Transurethral resection of the prostate. Closed surgery (using the bodies openings)

enlarged portion of the prostate is removed endoscopically.

Disadvantage: since only a few pieces are removed, remaining tissue may continue to grow and cause urinary obstruction, requiring additional TURPs.

High risk for hemorrhage and severe bleeding

Most common type of cancer. Slow growing and metastasizes in nearby lymph nodes, bones, lungs and liver.

Prostate will be a stony hard nodule.

Most are androgen sensitive.

Most are adenocarcinomas that arise from epithelial cells in the posterior lobe or outer portion of the gland.

First symptoms are problems with starting urination, frequent bladder infections and retention.

Gross blood in the urine (most common)

Pain in pelvis, spine, hips and ribs

Swollen lymph nodes

Weight loss

PSA -glycoprotein protein produced by prostate

Normal level should be <4 ng/mL

most common intervention

Radical Prostatectomy -prostate removal

TURP- to promote urination for patients with advanced cancer. It is not curative.

Bilateral Orchiectomy- removal of both testicles.

Radiation therapy, hormonal therapy, chemotherapy, Cryotherapy (liquid nitrogen)

mood changes from changes in the levels of neurotransmitters serotonin.

hormonal or fluid shifts

depression, angry outbursts, anxiety, irritability, social withdrawal.

decreased libido.

breast tenderness, edema, headache, bloating, food craving, insomnia.

Short term memory problems, difficulty concentrating, unclear thinking.

Leiomyomas (fibroids) -slow growing tumors in the uterus.

Surgeon removes the uterus and cervix and sometimes the vagina in pieces.

Complications: hemorrhage, urinary retention, UTIs, wound infections.

Uterus and cervix are removed through a horizontal bikini incision or laprascopically.

Complications: intestinal obstruction, thromboembolism, atelectasis, pneumonia, wound dehiscence, urinary retention

The surgeon removes the uterus and the 5 supporting ligament and the reattaches the ligaments to the vaginal cuff so normal depth of the vagina is maintained.

All off the uterus except the cervix is removed. Rare

All of the uterus is removed abdominally. The lymph nodes, surrounding tissues and upper third of the vagina are also removed.

Should be less than 1 saturated perineal pad in 4 hours

small amount of abdominal bleeding at incision site

Intactness of incision

Catheter for 24 hours or less.

• Showers instead of baths
• No heavy lifting
• Avoid sitting for a long period of time
• Don't cross legs
• Avoid strenuous activity for 6 weeks
• No driving for 4 weeks.
• No sex for 4-6 weeks.
• Record temp BID for 2 weeks.

Painful menstrual flow. Occurs after ovulation begins

Painful uterine cramping with spasmodic lower abdominal. Pain often travels to lower back and thighs.

increased production and release of uterine prostaglandins which cause spasms in myometrium, which constrict uterine blood flow, resulting in ischemia and pain.

Bleeding in excessive amount- more than 21 mL or more than 21 days.

Occurs the the beginning or end of productive years.

a hormone imbalance because ovaries fail to ovulate. This decreases progesterone production which is needed to mature the uterine lining and prevent growth. Without progesterone, the estrogen stimulation causes the endometrium past its hormonal support, causing uterine bleeding.

• Estrogen therapy
• Hormonal contraceptives
• Progestin Pills
• IUD (nuvaring)

Endometrial Ablation-removal of a buildup of endometrial lining through a laser, roller ball or balloon.

Downward displacement of the uterus through the pelvic floor.

Caused by neuromuscular damage in childbirth, increased intra-abdominal pressure related to pregnancy, obesity or physical exertion or weakening of pelvic support due to decreased estrogen.

3 grades

protrusion of the bladder through the vaginal wall, which can lead to stress incontinence and urinary tract infections.

a protrusion of the rectum through a weakened vaginal wall.

feeling as if something is "falling out", dyspareunia (painful intercourse), backache and a feeling of heaviness in the pelvic region.

constipation, hemorrhoids, fecal impaction and feelings of rectal or vaginal fullness.

Difficulty in emptying the bladder, urinary frequency and urgency, UTIs, stres incontinence.

cystrography (to show bladder herniation)

measurement of residual urine by a bladder scan

urine culture and sensitivity testing.

Intravaginal estrogen to prevent atrophy and the weakening of the vaginal wall.

Kegel exercises to elevate uterine prolapse

Bladder training

High fiber diet/stool softeners/laxatives

Anterior colporrhaphy (anterior repair rightens the pelvic muscles for better bladder support)

Posterior colporrhaphy (posterior repair reduces rectal bulging)

A combination of estrogen and progestin.

used to "protect" against side effects of menopause.

Take at the lowest possible dose for the shortest amount of time.

white vaginal discharge used as a natural defense mechanism that the vagina uses to maintain its chemical balance and preserve the flexibility of the vaginal tissue.

May result from inflammation or congestion of the vaginal mucosa.

estrogen imbalance

vaginal infection or STD (more yellow and foul smelling)

yeast infection, bacterial vaginosis

inflammatory condition of vagina or cervix.

diagnoses anemia and infection.

Associated with cancer, peptic ulcer disease and inflammatory bowel disease.

GI bleeding

the rate at which prothrombin is converted to thrombin, a process that depends on Vitamin-K associated clotting factors.

Measures the presence of blood in the stool from GI bleeding from colorectal disease.

Done to evaluate function and integrity of GI tract.

May be collected to test for fecal fats when steatorrhea (fatty stools) or malabsorption is suspected.

an x-ray of the large intestine. Drink to contrast for xray then expect white, chalky feces.

Lower GI series

May be given a laxative to remove barium from GI tract.

a direct visualization of the GI tract using a flexible fiberoptic endoscope. Commonly requested to evaluate bleeding, ulceration, inflammation, tumors and cancer of the esophagus, stomach, biliary system or bowel.

visual examination of the esophagus, stomach and duodenum.

• NPO for 6-8 hours prior.
• Local anesthetic used to inactive the gag reflex and facilitate passage of the tube.

Check vitals every 30 minutes.

• an endoscopic examination of the entire large bowel.
• All men and woman should have one done every 10 years after the age of 50.

Evaluates the chronic diarrhea and locate the source of bleeding.

stay on a liquid diet for 12-24 hours.

NPO for 6-8 hours.

Drink an oral prep for cleaning the bowel the evening before an exam and repeat the procedure the morning before a study.

endoscopic examination of the rectum and sigmoid colon using a flexible scope.

Screen for colon cancer, investigate the source of GI bleeding, diagnose or monitor inflammatory bowel disease.

Clear liquid diet 24 hours prior. Cleansing enema the morning of the procedure.

measures the hydrochloric acid and pepsin content for evaluation of aggressive gastric and duodenal disorders.

a mucosal lesion of the stomach or duodenum. Results when mucosal defenses become impaired and can no longer protect the epithelium from effects of acid and pepsin.

Acid, pepsin and H. Pylori

When the pyloric sphincter dysfunctions, the bile backs up into the stomach. This reflux breaks the integrity of the mucosal barrier and produced hydrogen ion back-diffsion which results in mucosal inflammation. Toxic agents and bile destroy the membrane of gastric mucosa.

Most occur in upper part of abdomen.

Deep, sharply demarcated lesions that penetrate into the muscle layer.

pH levels are low.

Mucosal lesions that occur after an acute medical crisis or trauma, head injury or sepsis.

Bleeding caused by gastric erosion is the main manifestation of acute stress ulcers.

Epigastric tenderness located midline

hyperactive bowel sounds

most commonly reported symptom is dyspepsia (indigestion)

Gastric Ulcer Pain: upper epigastric area, left upper midline, aggravated by food, worsened by ingestion of food and occurs 30-60 minutes after a meal

Duodenal Ulcer Pain: right of epigastrum. Occurs 90 minutes to 3 hours after eating. Awakens patients at night. Made worse by certain food. Relieved by ingestion of food.

Bland diet

Avoid substances that stimulate gastric acid secretions-coffee, tea, cola. Avoid bedtime snacks.

Avoid alcohol and tobacco.

pouch like herniations of the mucosa through the muscular wall of any portion of the gut but most commonly the colon.

Diverticulosis is the presence of many diverticula in the wall of the intestine.

Diverticulitis is the inflammation of one or more of the diverticula.

Broad-spectrum antimicrobial drugs.

Opioid analgesic to alleviate pain.

Anticholinergenics to reduce intestinal hypermotility but should be avoided for older adults.

• Rest
• Avoid heavy lifting, straining, coughing and bending.
• Low fiber and clear fluids

• eat a high in cellulose diet found in wheat bran and cereals.
• Fresh fruits and vegetables high in fiber to add bulk to stool.
• Drink plenty of fluids to prevent bloating
• Avoid acohol.

Avoid all fiber because high fiber foods are irritation.

widespread inflammation of the rectum and rectosigmoid colon. Associated with remissions and flareups.

Mild- intestinal mucose is hyperemic (increased blood flow), edematous and reddened.

Severe- lining can bleed and small erosions, or ulcers occur. Abscesses can form and result in tissue necrosis (cell death).

Patient reports tenesmus (unpleasant and urgent sensation to defecate)

stool typically contains blood and mucus.

lower abdominal colicky pain relieved with defecation

Malaise, anorexia, weight loss

• record characteristics of stools
• eliminate gas producing and spicy foods and foods containing lactose.
• Low fiber, high protein, high calorie diet
• Caffeine, pepper, alcohol and smoking can cause discomfort
• Teach patient about correct use of antidiarrheal medications
• Monitor skin in perineal area for irritation and ulcerations from loose, frequent stool.
• Rest the bowel

Colonoscopy is the most definite to diagnose UC.

Total proctocolectomy with permanent ileostomy- loose,dark green liquid with some blood in stool, pouch worn at all times, skin care

Total Colectomy with Continent (Kock's) Ileostomy- internal ileal reservoir, intra-abdominal pouch, monitor drainage

Total Colectomy with Ileoanal Anastomosis (J-pouch) - J-pouch is an ileoanal reservoir that spares the renal sphincter and the need for an ostomy

• an inflammatory disease in the small intestine (most often), colon or both.
• Can affect GI tract from mouth to anus but usually the terminal ileum.

• causes a thickened bowel wall.
• Strictures and deep ulcerations (cobblestone) appearance which predispose the patient to fistulas. Result is severe diarrhea and malabsorption of nutrients.
• Cancer of the bowel may develop after the disease has been present for 15-20 years.

MIS via Laparoscopy

Small bowel resection and ileocecal resections

Stricturoplasty which increases the bowel diameter.

the bowel is physically blocked by problems outside the intestine (adhesions) in the bowel wall (crohn's disease), or in the intestinal lumen (tumors)

The intestinal contents accumulate at and above the area of obstruction. Distention results from the intestines inability to absorb the contents and move them down the intestinal tract. Peristalsis increases to try to move the contents forward. This increase stimulates more secretions which leads to additional distention.

also known as paralytic ileus. does not involve a physical obstruction in or outside the intestine. Peristalsis is decreased or absent as a result of neuromuscular disturbance, resulting in a slowing of the movement or a backup of intestinal contents.

most common cause is the handling of intestines during abdominal surgery.

• Reduced circulatory blood volume (hypovolemia)
• electrolyte imbalances

• Obstruction high in the small intestine
• causes a loss of gastric hydrochloride
• makes more basic

• Obstruction at the end of the small intestine and lower in the intestinal tract that causes a loss of alkaline fluids.
• makes more acidic

• bacteria that lies stagnant in the obstructed intestine.
• closed-loop obstruction (blockage in two areas).
• obstruction with compromised blood flow.

twisting of the intestine

telescoping of a segment of the intestine within itself

• NPO
• NG tube- to decompress the bowel by draining fluid and air.
• Question about passage of flatus.
• Flatus or stool means that peristalsis has returned.
• IV fluid replacement and management.

Exploratory laparotomy- a surgical opening of the abdominal cavity to investigate the cause of the obstruction. If adhesions are found, they are lysed (cut and released)

Rapid emptying of food contents into the small intestine, which shifts fluid into the gut causing abdominal distention. Symptoms include vertigo, tachycardia, syncope, sweating, pallor, palpitations, desire to lay down.

• nutrition changes that include decreasing the amount of food taken at one time, and eliminating liquids ingested with meals.
• Eat a high-protein, high-fat, low to moderate carb diet.

• are sacs resulting from herniation of esophageal mucosa. Patients report dysphagia, regurgitation, nocturnal cough, halitosis (bad breath).
• Diagnosed with EGD.
• Major interventions are nutrition therapy and positioning. Avoid vigorous exercise after meals. Elevate HOB. No restrictive clothing. NO frequent bending.

aimed at removing diverticula. NPO for several days to promote healing.

IV fluid for pain-relief measures

monitor for bleeding or perforation.

NG tube is placed during surgery for decompression and is not irrigated or repositioned unless requested by surgeon.

• occur when esophageal veins become distended from increased pressure.
• Potential to bleed depends on size
• Often occur in distal esophagus. can also be present in stomach and rectum.
• are a life-threatening medical emergency.

Greater than the normal amount of fat in the feces

Protrusion of the stomach through the esophageal hiatus into the diaphragm.

Sliding- most common. stomach slides upward through the esophageal hiatus into the chest, usually as a result of a weakened diaphragm. Major concern is the development of esophageal reflux.

Paraesophageal (rolling) reflux- fundus rolls into the thorax beside the esophagus. Reflux is not usually present. High risk for volvulus, obstruction and strangulation.

Laproscopic Nissen Fundoplication- surgeon wraps a portion of the stomach fundus around the distal esophagus to anchor and reinforce the LES

quit smoking

teach PT about chest tubes

inform NGT will remain for several days

clear liquids after parastalsis is reestablished

high incision makes breathing painful, teach about post op pain and incintive spirometer

primary focus of care is to prevent respiratory complication

elevate HOB

Promote lung expansion and lower diaphragm. Begin ambulating.

splint during coughing.

Have a NG tube to prevent the fundoplication wrap from becoming too tight around the esophagus.

Gas bloat syndrome, where the patients are unable to voluntarily burp. Avoid carbonated beverages and eating gas-producing foods, chewing gum and drinking through a straw.

Other complication is aerophagia (air swallowing) from attempting to reverse or clear acid reflux. Frequent position changes and ambulation.

Removal of colon, rectum and anus.

for patients undergoing a colectomy.

bring the ileum out through the abdominal wall and forms a stoma.

• After surgery, output is a lose, dark green liquid that may contain blood. Ileostomy adaptation will occur.
• Small intestine will begin to perform previous colon functions, like absorption of water and sodium.
• Effluent fluid material will have little or sweet odor. Any foul or unpleasant odor may be a sign of blockage or infection.

loop of the ilieum is placed through the abdominal wall for drainage of fecal material into a pouching system worn on the abdomen

care: empty when 1/3 to 1/2 full, change entire pouch every 3-7 days

protect skin from contact with ostomy contents

include adequate amounts of salt and water in the diet

teach pt to avoid foods that cause gas or make the stool thicker

specialized nutrition support in which nutrients are provided IV to PT's that are not receiving adequate nutrients or that cannot handle a regular diet.

PT receives 3-4 L per day

delivered through a PICC line, the subclavian or internal jugular vein.

administered with an infusion pump, controlled delivery is essential.

Sengstaken-blakmore tube

a balloon inflated to apply pressure to the bleeding variceal are.

Pt is usually placed on mechanical ventilator to protect the airway.

drains wound directly through a tube via gravity and vacuum. drain is sutured in place to create seal.

sterile technique is used to handle

Cirrhosis- hepatocellular disease (cannot excrete bilirubin) or intrahepatic obstruction (from edema or scarring of the bile ducts

-rxn to hepatic inflammation and necrosis

Hepatits- intrahepatic obstruction (edema of liver's bile channels)

Laennec's- alchohol

Postnecrotic- drugs or chemicals

biliary cirrhosis- biliary obstruction

cardiac cirrhosis- heart failure

liver is scarred but can still perform essential functions without causing major symptoms

the livers function is impaired with obvious manifestations of liver failure

portal hypertension

ascites

esophageal varices

coagulation problems

splenomegaly

jaundice

portal-systemic encephalopathy

increased in pressure within the portal vein from increased resistance or obstruction of blood flow. blood flows back to spleen, veins in esophagus, stomach, intestines, abdomen, and rectum become dilated.

free fluid in peritoneal cavity from increased hydrostatic pressure from portal hypertension.

results from fluid shift into abdomen.

esophageal veins become distended from increased pressure. Emergency!

production of bile in liver is decreased, preventing absorption of vitamin K

bleeding and easy bruising

enlargement of spleen from backflow of blood into the spleen

platelets are destroyed

high risk for bleeding

yellow coloration of skin. liver cells cannot effectively excrete bilirubin.

toxic substances are absorbed into the intestine and not broken down

affects function of the brain

• s/s: sleep, mood, mental, and speech problems
• can lead to neuromuscular problems

lactulose to cleanse the bowel of the toxins that can cause encephalopathy

nonabsorbable antibiotics for an intestinal for an intestinal antiseptic used to reduce or eliminate ammonia levels in the body

low sodium diet to control fluid accumulation in the abdomen

vitamin supplements because the liver cannot store vitamins

diuretics to reduce fluid accumulation with potassium to prevent potassium wasting

a trocar catheter is inserted into the abdomen to remove and drain ascitis fluid from the peritoneal cavity

may be used for temporary relief when diet and diuretics do not work

monitor 02 sat, apply oxygen if necessary

elevate HOB 30

encourage pt to sit in chair to relieve dyspea

BUN

protein

HCT

Electrolytes

used to control long term ascites and reduce variceal bleeding

auscultate lung sounds for crackles

monitor coagulation tests

weigh PT

measure abdominal girth

monitor I/O

Fecal/Oral

Food/water, shellfish

Blood transfusions

unprotected sex

needle sticks

sharing needles

maternal-fetal

Blood to Blood

organ transplant

sharing needles

needle sticks

Sex

Drugs

prenatal

Get if carrier has Hep B

waterbourne

fecal contamination of food and water

abdominal pain

changes in skin or sclera

joint pain

malaise

fever

lethargy

tenderness of RUQ

a-antibody in blood

b-antibody systems and detectable viral count in blood

c-antibodies have developed

confirms hepatitis

establish stage and grade of liver damage

percutaneous procedure with a local anesthetic

alternate rest/activity

slowly add self care and ambulation

high calorie and carb diet with fat and protein

b,c- antiviral and immunomodulating drugs are used

most common, hep c

end stage liver disease or acute liver failure not responding to other treatments

tachycardia, fever, RUQ or flank pain

decreased bile pigment and volume

increased jaundice, elevated bilirubin

increased pt-inr

early-pneumonia, wound infection, UTI

after 1 month- TB, herpes simplex

calculous cholecystitis-

when chemical irritation and inflammation results from gallstones that obstruct the cystic duct, gallbladder neck, or common bile duct

since the gallbladder is inflamed the bile is trapped and reabsorbed and is irritating to the gallbladder wall. causes ischemia and infection when combined with impaired circulation, edema, and gallbladder distention.

results in tissue sloughing with necrosis and gangrene

inflammation of gallbladder without gallstones, associated with biliary stasis caused by any condition that affects the regular filling or emptying or the gallbladder

results from repeated episodes of cystic duct obstruction that cause inflammation.

Calculi are common.

Gallbladder becomes fibrotic and contracted. Decreased motility and efficient absorption.

Patient will have clay colored stool and dark, foamy urine.

Jaundice and icterus (yellowing of the sclera) occur.

Extrahepatic- occurs from obstructed bile flow from edema of the ducts or gallstones.

Intrahepatic- results from inflammation of the livers bile channels or ducts.

In both, normal flow of bile is blocked and bile salt accumulates in the skin which causes pruritis.

Abdominal pain varies. Flatulence, dyspepsia, eructation, anorexia, nausea, vomiting or abdominal pains after fatty foods are eaten.

Pain may radiate to right shoulder or scapula.

Biliary Colic- severe pain that happens when a stone is moving through or lodged in a duct and tissue spasm occurs in order to mobilize the stone through the duct.

no tests that are specific.

Increased WBC count can mean inflammation.

Elevated serum levels.

Calcified gallstones can be viewed in x-rays.

Ultrasound in RUQ is the best diagnostic test.

• Avoid fatty foods to prevent biliary colic.
• Opioid analgesics for acute biliary pain.
• Anticholinergenic drugs used to relax smooth muscle and decrease ductal tone and spasm.
• Antiemetics- control nausea and vomiting.
• Lithotripsy- break up large stones into small ones.

• surgical removal of the gallbladder.
• Laprascopic- dissect gallbladder for liber bed and cystic artery and duct are closed. Gallbladder is removed through umbilical port. Discharged within a day.
• Traditional- chronic lung disease or heart failure. Large incision to remove gallbladder and locate stones. T-tube is inserted to prevent fluid accumulation (400+ mL qday) Teach pt that feces will pass much more quickly.

• main priority for care is to keep drain system below gallbladder.
• semi-fowler position
• Bloody drainage to green/brown bile.
• 400mL qday excreted
• assess for foul odor or purulent drainage.
• Inspect skin around T-tube and insertion site.
• Keep dressing dry.
• NEVER IRRIGATE, ASPIRATE OR CLAMP A T-TUBE. (unless given an order)
• Can clamp when pt is allowed to eat 1-2 hours before and after meals.
• stool will return brown after 7-10 days.

• serious. life-threatening.
• Pancreatic enzymes should be inactive until they reach the small intestine. There is an early activation of the enzymes which results in auto digestion and fibrosis of the pancreas.

Lipolysis- fatty acids are released and combined with calcium. Body cannot use this combination. Must have calcium by itself. Low calcium levels.

Proteolysis-splitting of proteins by hydrolysis by peptide bonds. May lead to thrombosis or gangrene.

Necrosis of blood vessels-results in bleeding. Can lead to hemorrhaging.

Inflammatory stage- leukocytes have clustered around the necrotic areas in the pancreas.

Jaundice, Intermittent hyperglycemia.

Cullens sign-turners sign

• Multisystem organ failure.
• atelactasis/pneumonia
• Coagulation defects.

Shock. Hypovolemia/ paralytic ileus.

• alcohol and biliary tract disease
• trauma from surgery

and pain when drinking alcohol or eating a fatty meal?

any abdominal surgery

any sudden onset of pain radiating to the back, left flank or shoulder.

Nausea and vomiting resulting in weight loss.

Serum amylase levels are increased and remain high for 3-4 days.

Trypsin is the most accurate indicator for pain.

Elevated WBC count, ESR and serum glucose levels.

Fasting and rest- NPO durring actue period. IV fluids to maintain hydration. NG tube . Assess for return of peristalsis.

Drug Therapy- PCA pump.

Comfort measures- side-lying position may decrease pain. oxygen for easy breathing. oral hygiene to keep membranes moist.

progressive, destructive disease. repeated episodes of acute pancreatitis or chronic obstruction of common bile duct.

• Major- abdominal pain. continuous, burning, gnawing.
• Respiratory complications. auscultate for adventitious sounds or decreased aeration.
• Obtain a stool sample
• assess for unintentional weight loss, muscle wasting, jaundice, dark urine, polyuria.

• based on manifestation, lab and imaging assessment
• CT, MRI, Ultrasounds are done.
• Slightly elevated serum bilirubin and alkaline phosphate levels.

• Opioid analgesics
• Pancreatic enzymes are given with meals or snacks to aid in digestion and absorption of fat and protein.
• Drugs to decrease gastric acid.

If the pancreatic duct sphincter is fibrotic, the surgeon performs a sphincterotomy (incision of the sphincter)

Laparoscopic cholecystectomy- done if biliary tract disease is the cause of pancreatitis.

Done to manage pain

• Whipple procedure
• removal of the head of the pancreas, duodenum, a portion of the jejunum, stomach and gallbladder.

Pre-op care- catheter into jejunum for feedings. TPN. No bowel prep. NPO 6-8 hours.

Post-op- NPO/ NG tube. Monitor NG drainage. It should be serosanguineous. Semi-fowlers position to reduce tension on suture line. Monitor H&H levels.

a opacity of the lens that distorts the image projected onto the retina. Maybe age related or caused by trauma or exposure to toxic agents.

• Blurred vision, decreased color perception
• lens cloudiness
• double vision that gets worse
• No pain or eye redness associated with age

• Surgery.
• Extracapsular removal- front capsule is opened with a small incision.
• Phacoemulsification- probe is inserted through the capsule and high-frequency sound waves break up the cataractous lens into small pieces and removed by suction.

After the lens will be replaced because without it, the eye has lost most of its refractive ability and has no accommodative power.

• Antibiotics immediately.
• Mild itching and bloodshot appearance are normal.
• Avoid aspirin.
• Pain early after surgery is not good. can indicate increase in IOP or hemorrhage.
• Creamy, white, dry, crusty drainage is normal.

most common. affects both eyes. outflow of aqueous humor through the chamber angle is reduced. IOP increases because fluid cannot leave the eye at the same rate as it is reduced.

S/S- foggy vision, reduced accommodation, mild aching in eyes, headaches.

late symptoms include halos around light, losing peripheral vision, decreased visual acuity. Not correctable with glasses.

• less common. sudden onset. emergency.
• Narrowed angle and forward displacement of the iris. Movement of the iris against the cornea narrows and closes the chamber angle, obstructing the flow of aqueous humor.

• Tonometry- shows elevated IOP. 10-21 mmHg. puff of air
• Perimetry- used to test visual fields
• Gonioscopy- when high IOP is found. Determines whether it is an open or closed angle.
• Optic Nerve Imaging- pts with ocular hypertension. assess nerve thickness and contours.

• Drug therapy that reduce IOP.
• Eyedrops to prevent an increase in IOP.

Laser trabeculoplasty- burns the meshwork, scarring it and causing the fibers to tighten which improves the outflow of aqueous humor and reduces IOP.

Filtering microsurgery- creates a drainage hole in the iris between the posterior and anterior chamber. If it wont stay open, a shunt can be put in place.

Choroidal hemorrhage. If IOP is too low, fluid may enter the suprachoroid space and cause a choroidal detachment. Extra fluid may break blood vessels located there.

S/S- acute pain deep in the eye, decreased vision and vital sign changes.

It ruptures and pus or blood drains from the ear.

Can heal ny themselves.

Tinnitus, one-sided sensoineural hearing loss and vertigo

an excess of endolymphatic fluid that distorts the entire canal system. Cause is known but it often occurs with infections, allergic reactions and fluid imbalances.

vertigo, headaches, increasing tinnitus, hearing loss, nausea, vomiting, feeling fullness in affected ear, rapid eye movements.

Teach patient to move slowly to prevent worsening of vertigo. Stop smoking. Avoid high salt foods and caffeine.

Meniett device- applies a low-pressure micropulse to the inner ear for 5 minutes three times daily. It displaces the fluid from the inner ear and this relieves manifestations.

aims to control the vertigo and vomiting and restore normal balance.

Mild diuretics to decrease endolymph volume.

Nicotonic acid to vasodilate.

Antihistamines to reduce the severity or stop an acute attack.

Last resort. Labyrinthectomy. involves resection of the vestibular nerve or total removal of the labyrinth. Endolymphatic sac is drained and a small tube is inserted to improve fluid damage.

• Use-laxative, decreases constipation, and blood ammonia level.
• Administration- orally. full glass of fruit juice, water or mild. Rectally with a retention enema
• Teaching- Do not take if you have abdominal pain, nausea, vomiting. Repot electrolyte imbalances. Do not take at bedtime.

• Use- useful in treating Meniere's disease because of its vasodilatory effects. Decreases cholesterol and LDL levels.
• Admin- orally. Dont break, crush, chew or give with meals or milk. IV, give after diluting.
• Teaching- side effects should discontinue after 2 weeks. No alcohol. No sunlight. Report clay colored stool, anorexia, jaundice, sclera.

• Target tissue: Kidney
• Actions: Promotes water reabsorption

• anticholinergenic
• given to relax smooth muscle and decrease ductal tone and spasm

inhibition of Hep C

ALT, AST, LDH, Alkaline Phosphatase

136-145

3.5-5

98-106

9-10.5

1.3-2.1

3-4.5

• Females - 12-16
• Males 14-18

• Females 37-47
• Males 42-52

• Females 4.2-5.4
• Males 4.6-6.1

5000-10000

150,000-400,000

10-20

• Female .5-1.1
• Male .6-1.2

70-110

6.4-8.3

3.5-5

Hypertension, esophageal varices, ascites and hepatic encephalopathy

Patients nails cut short to prevent excorciation due to pruritis. apply medicated creams and lotions to relieve itching. inspect skin for breakdown and provide support to edematous areas. turn every 2 hours. refrain from using alkaline soap on skin

Important to continue health care and seek medical attention if symptoms of complications occur. Discuss proper diet, rest and avoidance of hepatotoxic drugs like acetaminophen, and abstinence of alcohol.

Provide info regarding community support programs

Provide written info about diet, skin care, medications, avoid coughing to prevent hemorrhage

foods high in calories, high protein, low fat, low sodium

neurologic and mental unresponsiveness, sleep disturbances to lethargy and deep coma. Monitor function involving tremors called ASTERIXIS

Early- euphoria, depression, apathy, irritability, memory loss, confusion, yawning, drowsiness, insomnia, agitation

Later- slow slurred speech, emotional lability, impaired judgement, hiccups, slow and deep respirations, hyperactive reflexes. disorientation to time, place and person. As condition worsens, so does the patients mental status. Fetor Hepaticus- musty, sweet odor to breath.

Lactulose, Flagyl, Vancomycin, rifaximin. cathartics and enemas for constipation

• Avoid aspirin, alcohol and irritating foods. Upper respiratory infections should be treated promptly. Coughing should be controlled.
• Treated with Sondostatin, Vasopressin, Nitroglycerine, inderal, sclerotherapy, ligation of varices and shunt therapy.

ETOH (alcohol)

Early signs- anorexia, dyspepsia, flatulence, nausea, vomiting, diarrhea, constipation, fever, slight weight loss, enlarged liver and spleen.

Late signs- jaundice, skin lesions, palmar erythema, thrombocytopenia, leukopenia, anemia, coagulation disorders, gynecomastia, loss of axillary and pubic hair, testicular atrophy, impotence

abdominal pain, ankle edema, continuous mild fever, spiders and palmar erythema

splenomegaly, jaundice, clubbing of fingers, firm and enlarged abdomen, purpura and spontaneous bleeding, gonadal atrophy

One for each of the two balloons and one for gastric aspiration

Explain the use of the tube and how it will be inserted. Balloons are checked for patency, lumens should be labeled to prevent confusion. Nursing care includes monitoring for complications of rupture or erosion of the esophagus, regurgitation and aspiration of gastric contents and occlusion of the airway by the balloon. Nursing needs to encourage the patient to expectorate the saliva, frequent oral and nasal care provides relief from the taste of blood and irritation from mouth breathing.

Sandostatin. Other drugs are Vasopressin, Nirtoglycerin, B-adrenergic blockers (Inderal)

Wide spread malignant disease, severe pulmonary hypertension, morbid obesity, obstructed splanchnic blood flow.

• Cyclosporine-nephrotoxicity
• Interleukin- 2 receptor antagonists
• Corticosteroids

Fecal Oral transmission

Fecal Oral

Parenteral, sexual and prenatal contact

parenteral, sexual contact

Parenteral, high-risk sexual contact, prenatal contact

A & E

B, C, AND D

HCV RNA (RNA polymerase chain reaction assay)

arthralgia, myalgias, loss of strength (astheria), fatigue, headache, fever, nausea/anorexia, depression or irritability, hair thinning, insomnia, itching skin, diarrhea, weight loss, injection site reaction

• Terogenicity- interferes with normal fetal development
• Other side effects are anemia, anorexia, cough, insomnia, pruritis, rash

• Women- biliary tract disease
• Men-alcoholism

Serum amylase and lipase elevate. Amylase rises early and remains elevated for 24-72 hours. Serum lipase also elevates and is a helpful complementary test since there are other disorders that increase serum amylase.

Calcium is lost. Treat with calcium gluconate.

• Morphine for pain relief
• Nitroglycerine or papaverine for relaxation of smooth muscle and relief of pain

• Small frequent means, high carb content, low in fat, bland
• alcohol is totally avoided
• avoiding smoking and stressful situations
• avoid caffeine

Muscle wasting, weight loss, loss of energy, constipation, mild jaundice with dark urine, steatorrhea and DM