Adult I Final Part 3

=after partial gastrectomy due to hypertonic food pulling in water with increased peristalsis & motility

• Early symptoms occur within 5-30 min. of eating
• (N&V, cramps, diarrhea, borborygmi, hypovolemia)
• Late dumping syndrome 2 - 3 hours after eating (hyperinsulin with hypoglycemia)
• Managed by dietary measures:
• No liquids w/ meals (too filling)-separate out
• Low carb diet (digested too quickly)
• Moderate fat & proteins (slower digested)
• Small frequent feedings
• Recumbent 30 – 60 min. after meal

Diet – high fiber (fruits, veggies, bran) & 8 glasses water per day

Enemas – in acute situation (NS, soap suds, oil retention; tap water & phosphate/Fleets); can cause electrolyte imbalances & impaired bowel function

• Medications-
• Bulk-forming agents (Bran, Metamucil) with indigestible veg. fiber safe for use; draw in water
• Wetting agents (Colace, Surfak) reduce stool surface tension with emulsion of fat &water; don’t crush
• Osmotic & saline laxatives (Sorbitol, MOM,Lactulose) increase osmotic pressure & draw in water; short-term use as irritate bowel
• Irritant or stimulant laxatives (Ducolax,Senna, Caster oil) stimulate motility &secretion; don’t crush; less than 1 wk. useas suppresses bowel reflexes
• Lubricants (Mineral oil) forms oily coat on fecal mass preventing water absorption;interferes with fat soluble vitamin absorption (A, D, E & K); watch for aspiration

• Assess (Signs & Symptoms):
• + McBurney’s point
• Guarding, rebound tenderness RLQ
• N/V
• Low-grade fever (high if perforated)
• Elderly

• Diagnosis:
• Palpation, WBC, U/A to rule out other dx;Abd. X-ray, Ultrasound

• Surgery:
• Laparoscopic
• Laparotomy (open)

Celiac/Nontropical Sprue-sensitivity or immunity to gluten in wheat etc.

• TX: Corticosteroids
• Vitamin K supplements (IM/IV)
• Gluten-free diet (high cal., high protein, low fat

• Distention (fluid build-up proximal to /above obstruction)
• Mid-abdominal colicky pain or cramping
• Vomiting: clear/bile/fecal
• Constipation/diarrhea
• Borborygmi (hyperactive BS) early then silent due to paralytic ileus
• Obstruction high (pylorus) - metabolic alkalosis RT loss of HCL from stomach

• GI decompression/NG tube weighed if partial obstruction
• Fluid & electrolyte replacement
• Surgery for complete obstruction/strangulation/incarceration (laparotomy or laser photocoagulation if major surgery prohibited)
• Preventative= early ambulation postop to prevent ileus

High fiber diet with bran (avoid seeds, nuts, corn, berries, popcorn); progress from liquids to low roughage to high fiber

• Medications-
• Broad antibiotics (Flagyl, Cipro, Septra, Mefoxin)
• Pain meds (Talwin over Demerol or MSO4)
• Stool Softener (Colace)

Surgery if hemorrhage, abscess or peritonitis(Hartmann with temp. ostomy)

• Teeth wear down, periodontal disease, lose teeth (no appetite)
• Decrease in:
• Taste buds, smell, salivary secretions,GI motility, & HCL acid
• Delayed emptying of stomach
• Increase in gallstones
• Decrease in dietary fiber/fluid
• Increased constipation

Break in gastrointestinal mucosa with mucosal barrier unable to protect it from damage by hydrochloric acid and pepsin(gastric digestive juices)

• Duodenal ulcers (most common)
• 95% occur in first portion of duodenum
• Deep, sharply demarcated lesions
• Penetrate through mucosa and submucosa into muscle layer
• 95% to 100% due to H. pylori infection
• Esp. ages 30 –55 and males > females
• Intermittent pain 3 hrs. after eating

• IV fluids with electrolytes
• acute hemorrhage gets fresh, whole blood, which contains clotting factors
• less acute equals packed red cells to restore oxygen-carrying capacity
• bleeding vessel may be sclerosed using upper endoscopy

• Gastric lavage
• = remove or dilute gastric contents rapidly
• semi-filers position, or side laying to prevent risk of aspiration
• -insert NG tube and verify placement

• Closed system irrigation-connect normal saline irrigating solution to the NG tube using a y connector
• allow 50- 200 mL to flow into the stomach
• new section to remove

fatty, frothy, foul-smelling stools caused by decrease in pancreatic enzyme secretion that leads to malabsorption of fats

• Extreme thirst
• irritability and confusion in adults
• Very dry mouth, skin and mucous membranes
• Lack of sweating
• Little or no urination — any urine that is produced will be dark yellow or amber
• Sunken eyes
• Shriveled and dry skin that lacks elasticity and doesn't "bounce back" when pinched into a fold
• Low blood pressure
• Rapid heartbeat
• Rapid breathing
• Fever
• In the most serious cases, delirium or unconsciousness

• CYSTITIS(lower UTI)
• Inflammation of the bladder
• Frequency/urgency
• Dysuria (painful urination)
• Nocturia (void at night)
• Pyuria (cloudy/pus)
• Suprapubic pain
• Hematuria
• Foul smelling urine

• ELDERLY -
• nonspecific manifestations
• nocturia
• incontinence
• confusion
• behavior change
• lethargy
• anorexia
• just dont feel right

• PYELONEPHRITIS(upper UTI - kidney)Signs / Symptoms
• Fever/chills (rapid onset)
• Vomiting
• Flank pain (dull)
• Costoverebral tenderness
• Urine - cloudy, foul odor
• Bacteria and WBC’s in urine
• Dysuria and frequency
• Inflammation/scarring with HT, if chronic

• Elderly
• change in behavior
• acute confusion
• incontinence
• general deterioation in condition

• pH 4.5 - 8.0 (6 average)
• appearance clear
• color amber, yellow
• odor aromatic
• specific gravity 1.005 - 1.030
• protein 2 - 8 mg/dL (trace)
• glucose negative
• ketones negative
• blood RBC’s up to 2
• BUN 5-25 mg/dL(abnormal > 25-50 mg/dL or higher)
• Creatinine
• -Normal levels 0.5 - 1.5mg/dL(abnormal > 4 mg/dL)
• -Inversely proportional to GFR

• #1 cigarette smoking (2X nonsmokers)
• Age > 60 yrs.
• Gender: males 4 X > females
• Race: Caucasians 2 X > AfricanAmericans
• Environmental carcinogens
• -Dyes, rubber, plastics, paint, leather,ink
• Coffee, cola, caffeine (irritate bladder)
• Estrogen (diethylstilbestrol/DES)
• Chronic inflammation (UTI’s, calculi)

• Signs/Symptoms:
• mass or lump on one testicle (unilat.)-hard
• painless enlargement of the testis
• Heaviness (abd./pelvic/scrotal pain)
• backache
• weight loss
• gen. weakness
• cough/hemoptysis

• Risk Factors
• Cryptorchidism-undescended testicle5%; More common on right
• Genetic predisposition
• Kleinfelters syndrome(chromosomal irregularity XXY)
• Caucasian 5-10X > African American
• Maternal estrogen during pregnancy

Nonmalignant prostate enlargement due to aging esp. > 50 yrs.

• Signs/Symptoms:
• Urinary obstruction/retention or incontinence
• Feeling of incomplete emptying of bladder
• Nocturia/frequency esp. noc.
• Small urine stream
• Difficulty in voiding/dysuria
• Dribbling postvoid
• UTI’s
• Hyperplasia or prostate feels smooth, firm &rubbery (asymmetrical & enlarged)

• Perineal/Kegel exercises
• Psychological support
• Pain management
• Chemotherapy or radiation
• Altered sexual functioning (ED)
• Altered sexual image
• Post op-avoid rectal temp, enemas, perineal tubes