med/surg1 E3

inflammation of the appendix R lower q of abdomen.

• small pouches that bulge outward through the colon/large intense
• main cause is low fiber diet

• Ss: pain usually L, constipation or inc frq of defecation
• 

• 1. ensure tube feeding
• 2. TPN: nutrition deivered in the form of specialized intravenous fluids.
• _calories: glucose and lipids (dextose)
• protein: amino acid (goal is to stop catbolism (bkdn))
• usually pt that are: major surgery, trauma, seriously undernourised.

• acid reflux
• developed:
• _{lower esophageal sphincter does not work}
• dec esophageal motility
• detay of acid emptying
• inc pressure w/in stomach

• stomach protrudes up through an opening in the diaphragm into the thoracic cavity
• Sliding: most common. entire lower esophageal sphincter slides up
• devep: weakening of themuscle of the diagram or inc intra-abdominal pressure (preg, obesity, heavy lifting)
• 

• SS:
• _{heartburn (frm morphine, chololate, alcohol, l meals, smoking)}
• diff of swallowing or a hump feeling
• reguruation of gastric fluid up to mouth

• Complications
• _{chronic esophagitis w scarring}
• barretts esophagus
• ulcer
• micro aspiration

• Medical tx:
• _{nexium, prevacid, prilosec, protanix}

• NR:
• _{taking meds at the right time}
• shouldn't stop taking meds just bc they feel better
• HOB >30
• avoid high fat meals
• avoid thight clothing
• shouldn't eat so late

• open lesion on the mucosa of the esophagus, stomach or dudoenum (usually where there's gastric acid)
• cause: _{h. pylori bacteria or use of NSAIDS (advil..)}

patho: disruption in mucosa barriers

• SS: pain (buring, aching, gawing) **can be relieve by
• eating, heart burncomplications: hemorrhage, scarring will cause
• obsrution, perforation

• Medical m: focus is to (relieve pain, treat infection, slow production of and neutralize
• HCI acid, restore integrity of mucosa)
• Diet: avoid caffine, high fat, alcohol
• pharm: antibiotics, proton pump inhibitors, antiacids, h2 blockers

• ND (NOT had surgery):
• Pain: give meds on time
• nutritional needs: monitor lab, meal planning
• complication: focus on abd
• 

• 1. Billroth I (gastrodudoenostomy, 1/2 stomach removed and connected to duodenum)
• Billroth II (gastrojejunostom, "" connected to jejunum)

2. total removal of the stomach usually only if its cancer.

• complication to the billroth II surgery used in tx of peptic ulcer disease
• patho: _{when pylrus has been resected, undigested food bolus rapidly enter the duo or jejunum}
• SS: _{(5-30mins after eating), nausea, vomiting, diarrhea, cramping, tachycarida}
• NC: _{low fat and no sugear! low carb, small freq meals, meals w/out fluid, lay down after eating.}

• inflammatory and ulceration of colon and rectum
• ss:
• _{diarrhea! (w bl and mucous), fatigue, anorexia, weakness}

• Medical tx:
• _{Control/dec inflammation}: *antidiarrheals: only use Mild colitis
• Nuritional support: NPO to rest the bowel, food that does not stimulate the bowel, provide fluid/elec replacement
• Surgical tx: total colectomy (surgical resection and removal of the colon), ileostomy is usually for colitis
• 

• Blockage of the flow of intestinal contents
• Types:
• _Mechanical: physical (outside the intestine, ex: tumors or inflammatory bowel disease, high pitch sounds)
• Functional: change in parastalsis
• SS:
• _SBO: quicker onset of sx, abd pain, cramping distention, bowl sounds.
• as the obstruction cont = dehydration, hypovolemia, electroyte imblances.
• LBO: slower onset, deep cramping pian, constipation, vomitng (very late sign)

• ND:
• _{Deficient Fluid vol}
• Pain
• other nursing care: focused abd ass, monitoring respiratory (distended abd cannot breath as well).

Inflammatory of gastro fluids and bacteria into the abdominal cavity/peritoneal space

Cause: _{anything that ruptures or proferiated in GI}

• SS: _{what happens if gastric and bacteria leaks somewhere it shouldn't be?}
• diminshed/absent bowel sounds, pain, anorexia, n&v, rigid abdomen, infections,pale

• ND:
• fluid vol deficit
• risk for injury
• pain
• Alt in nutrition: less than body requirements (use TPN)
• Anxiety

result of a lack of insulin to transport glucose across the cell membrane

• -Hyperglycemia
• -polyuria (lots of peeing), polydipsia (thirst)
• polyshagia (hungry), ketosis, weight loss

• hyperglycemia
• slow wound healing
• blurred version
• fatigue
• skin infections

• onset (5-15mins
• peak: 45-75mins
• dur: 3-5hrs

lispro, aspart, glulisine

• onset: 30-60 min
• peak: 2-4 hr
• dur: 6-8 h

regular (R)

• NPH: O: 2-4hr, P 6-10hr, D 12-18 hr
• Lente: 3-4 hr, 8-12hr, 12-18hr

• -occurs more in type 1
• - severe lack of insulin which causes
• _{hyperglycemia}
• _dehydration
• _ketosis
• _acidosis
• _{fruity oder to breath}
• _{renal failure}

• tx:
• resp first! then fluid resuscitation, K replacment

latus: 1-2hr, no peak, 24h

....more

• -severe hypoglycemia
• tachycardia, LOC, pale, cold skin, hunger, tremors

"pale and cammy give me candy"

store and concentrate bile that was made in the liver --> release bile into the duodenum to digest fat.

Inflammation of the gallbladder (commonly assoicated w/ tumor, obsrtution causes the bile remine in the gallbladder)

gall stone

removal of the gallbladder

• makes bile
• makes proteins
• detoxify bl
• clotting factors

scarring of the liver

• 1. Portal hypertension:
• when bl can't get into the congested scarred liver--> venous inc pressure
• (enlargement of the speen, dilation of veins in the gast tract of abd)

• 2. Esophageal varices:
• back up bl extends up to the small vessels/veins ---> inc pressure --> ruptures of the veins
• (devlp of hemorrhoids, dilated, congested vessels in the esophageals)

• 3. Hepatic Encephalopathy:
• Liver is NOT detoxifying ammonia from teh intestines
• (asterixis (flappy tamers due to inc ammonia), fetor hepaticus (bad breath))

• 4. Ascities:
• third spacing of fluid into the abdominal cavity.

.....

• Fiberoptic direct examination of airways
• Indications for Bronchoscopy:
• -direct visualization of tumors, inflammation or structures
• - for aspiration of sputum
• - removal of foreign bodies/object
• NI:
• remove dentures
• keep pt NPO 8 to 12 hrs

• -acummulation of air in the pleural space
• - ruptured bleb
• - blunt force trauma

• -bleeding in the pleural space
• - piercing chest trauma (mwa, gun shot wounds, stabbing)

• -collection of excess fluid in the pleural space
• -high protein fluid
• -often r/t chf, cancer pheumonia, tb

• -keep drainage system BELOW level of chest
• -check suction q2hrs
• - sterile irrigation fluid and vaseline gauze kept at beside at all times
• - chest wall dressing at tube exit site must be airtight
• - check thoracic wall for crepitus
• - position pt for optimal lung expansion

• -invasive procedure in which fluid/air is removed from the pleural space w a needle.
• - to obtain specimens, instill medications, remove fluid or air for relief of inc pleural pressures
• **limit to 1L of fluid removal bc it causes pain, reduction in lung capacity and inc respiratory rate and effort
• 

• Emergent: acute closure of upper airways
• scheduled: chronic supported needed
• temporary: short term survival until
• permanent: long term

• -loss of elasticity and hyperinflation of lung. Destroys alveoli, dec surface area available for gas exchange.
• *** 1st is getting airout first!!
• 

• inflammation of the bronchi and bronchioles due to chronic exposure to irritants
• 

• PFT
• CXR (flattend diaphragm)
• hgb and Hct (monitor for polycythemia)
• alpha antitrypsin 1 level

• - chronic dyspnea
• - rapid shallow respirations
• - thin extremities, enlarged neck muscles
• - hypoxemia
• - hypercarbia
• - resp acidosis and metabolic alkalosis
• - r sided heart failure

airway inflammation and edema leads to alveolar collapse w resultant inc risk for hypoxemia

• Falls
• •Fires
• •Motor vehicle accidents

• Drug toxicities/ side effects
• Due to changes in liver and kidney function
• •Due to altered nutritional status
• •Polypharmacy

• •Longer exposure to environmental hazards
• •Sun
• •Smoking
• •Pollutants

• •Reduced cardiac output
• •Reduced arterial elasticity
• •Increase in systolic blood pressure; peripheral resistance•
• Orthostatic hypertension

• •Protection from atmospheric air by means of a “water seal” chamber
• •Collection of drainage, either air or fluid
• .•Suction chamber, to pull negative pressure and so facilitate lung reexpansion

• •Air leaks
• –From pleural space to external chest around tube
• –Into subcutaneous tissue

• •Accidental disconnection
• –For accidental removal
• —Vaseline gauze @ bedside
• –Sterile water
• —if tube cut, submerge end

• •Tension pneumothorax
• —may occur if evacuation of air or fluid is not allowed