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acute inflammation of the veriform appendix (the blind pouch attached to the cecum of the colon)
appendicitis
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what is the initial manifestation of appendicitis
abd pain in epigastric or periumbilical area
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is mcburney's point an early or late sign of appendicitis?
late
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what are s/s of perforation
- rebound tenderness
- increase pain with coughing
- relief of pain w/ fetal position
- wbc >20,000
*no perforation wbc 10-18000
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other s/s of appendicitis
nv, anorexia
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where is mcburney's point located?
RL quadrant
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causes of appendicitis
- obstruction of opening of appendix by fecaliths,
- malig tumors,
- worms,
- other infections,
- unknown
-
pathophysiology of appendicitis
- blocked lumen>
- infection (as bacterial invades pancreas walls)>
- increased internal pressure>
- decreased blood flow>
- PAIN
-
appendicitis w/ perforation has increased risk for what?
peritonitis
-
appendicitis:
nonsurgical interventions
- NPO
- iv fluids
- semi-fowler position
- analgesics
- no laxatives or enemas
- no heat
-
why would someone suspected of having an appendicitis be put in a semi-fowler's position
- decrease pain
- prevent infected fluids from going up
- keep abd fluid localized
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what is done to rule out appendicitis
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surgical management of appendicitis
appendectomy
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post op care of appendectomy
- vs
- deep breathe
- ambulation
- pain management
- bs
- lbm
- gas
- nv
- ABX!!!!!
-
this is a life-threataening acute inflammation of visceral/parietal peritoneum and endothelial lining of abd cavity or peritoneum
peritonitis
*contaminated by bacteria > walling off (a localized area)> inflamm reaction
-
peritonitis:
if walling off fails what happens???
massive inflammation and contamination
-
what are some causes of peritonitis
- bacteria
- chemicals
- perforating tumors
- leakage/contamination during surgery
- infected CAPD catheter
- perforation (appendicitis, diverticulitis, peptic ulcer disease)
- external penetrating wound
- gangrenous gall bladder
- bowel bostruciton
- peritoneal dialysis
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why might diffuse peritonitis occur?
if theres a delay in diagnosis or treatment
-
what can DIFFUSE PERISTALSIS do to the peristalsis
slows or stops it
*potential for septicemia
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DIFFUSE PERITONITIS may increase abd presure and distention. this increases the risk for what??
risk for resp problems
*bigger and bigger stomach pushes diaphragm up decreasing deep breathing
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what can third spacing into the peritoneal cavity result in?
loss of circulatory volume
*increase risk for hypovolemic shock and kidney failure
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how does third spacing happen in peritonitis?
infection continues therefore shunting extra blood to that area continues
fluid shifts from the extracellular fluid compartment into the peritoneal cavity, connective tissue, and GI tract
-
cardinal signs of of peritonitis
***start thinking peritonitis
-
other manifestations of peritonitis
- rigid, boardlike abd
- abd pain
- distended abd
- fever
- tachycardia
- dehydration
- low urine ouput
- hiccups
- compromised resp status
- nv
-
dx of peritonitis
- increased wbc
- blood cultures
- PD fluid
- xray - dilation, edema, and inflammation of small and large intestine
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nonsurgical management of peritonitis
- iv fluids
- broad spectrum ABX
- daily wt monitored
- fluid volume assessed
- ng suction - rid of fluid
- NPO status
- o2
- pain managment
*avoid resp issues by decompression of stomach
-
surgical management of peritonitis
exploratory laparotomy
-
peritonitis
post op care
- semi fowlers position
- wound care:
- care of incisions and drains
- peritoneal irrigation
- IV fluid replacement
-
inflammation of the gastrointestinal tract
gastroenteritis
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increase int he frequency and water content of stools or vomiting results form this condition
gastroenteritis - inflamm of mucous membranes of stomachand intestinal track
-
which part of the GI tract does gastroenteritis mainly affect
small bowel
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the gastroenteritis the same as food poisoning?
no!!
*differens from food poisoning with regard to transmission in the body, incubation time, and effect on immunity
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gastroenteritis:
bacterial form
- Campylobacter*
- Shigella
- Escherichia coli*
*2 forms of travellers diarrhea
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gastroenteritis:
viral form
norwalk virus
*cruise ship
-
gastroenteritis occurs in epidemic outbreaks where?
*most common cause of morbidity and morality
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manifestations of GASTROENTERITIS
- myalgia
- headache
- malaise
- dehydration
- abd cramps
- nv
- foul smelling stool
- bloody stool
*depends on causative organism; varies based on incubation time, trasmission, effects
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what's important to know about gastroenteritis
it's self limiting unless complications occur
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nursing interventions for gastroenteritis
- WASH HANDS!!!!
- stool culture
- fluid replacement
- nutrtion therapy
- skin care
- health teaching
- drug therapy:
- anticholinergics and antiemetics are not routinely given
- abx if bacterial
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dysenteries affect the ____ bowel while gastroenteritis affects the ____ bowel
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name the 3 round worms
- 1. enterobiasis "pinworms"
- 2. trichinosis
- 3. hook worms
-
pinworms are aka
enterobiasis
-
how is enterobiasis transmitted
oral intake contaminated food or drink
-
name some manifestation of pinworms or "enterobiasis"
- perianal itching esp at night
- vaginitis
- vague GI sx: abd pain, nvd
-
how is the enterobiasis dx
eggs from perianal
-
how is enterobiasis treated??
- handwashing!!
- hygiene
- drug therapy
-
what is the most common helminthic infection in the US
enterbiasis "pinworm"
-
the incidence of this type of roundworm infection is low in the US, but many mild or asymp cases go undx
Trichinosis
-
Trichinosis is caused by what?
Trichinella spiralis
-
where does Trichinella spiralis live?
intestine of humans, pigs, bears, rats
-
how is trichinosis transmitted?
eating undercooked pork or pork products
-
manifestations of trichinosis
*wk 1, 2, 3, recovery
- first week parasite invades gut:
- diarrhea
- abd pain
- nausea
- vomiting
- second week larvae invade muscle:
- hypersensitivity rxn w/ fever
- edema of face, around eyes
- subconjunctival hemorrhage
- 2-3 weeks after infection:
- myositis
- myalgia
- muscle wkness - low back pain neck, jaw , biceps
- recovery can last several months:
- fague muscle pain
- malaise
-
how is a trichimosis infection dx?
- hx
- wbc - elevated 2 wks after meat consumption
- muscle biopsy - shows larvae
*worms are rarely seen in feces
-
what meds are used to treat trichomosis
- vermox
- high dose corticosteroids
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what's different about hook worms in terms of how they enter the body?
they enter thru the SKIN
*infection occurs when larvae penetrate thru the skin
-
how long are hook worms infective outside the body?
1 wek in moist soil
-
how does the hook worm make its way around the body?
travels to lungs (alveoli) thru bloodstream
-
how does the hook worm make its way to the GI tract
when they enter the alveoli > cilia carry the organism up the resp treat > pharynx > mouth > swallowed > enters GI tract
-
what are early sx of hook worm disease
itchy, red, reaised, blister-like infalmmation of skin
-
infection of hookworm in the GI tract manifestations
- no sx
- anorexia
- diarrhea
- mild abd pain
- epigastric discomfort
- bleeding - when worms suck blood at sites in GI tract
- anemia - if blood loss is severe
-
this infection infects quarter of the world's population mainly in the tropics
hook worms
-
how is hookworm infection dx
- eggs in feces
- occult blood in stool
- anemia
-
what's the difference in dx between trichinosis and hookworms?
- trichinosis - larvae in muscle not feces
- hookworms - eggs in feces
-
how to treat a hookworm infection
- iron therapy for anemia
- high protein diet
- meds
-
how bad are tapeworm infections
- no sx
- gi upset:
- nd, abd pain
-
how is tapeworm infection dx
laboratory examination of eggs found in stool
-
what can cause a tapeworm infection
- consumption of undercooked:
- beef
- raw fish
- contaminated food or water
- accidental swallow of infecgted lice or fleas from dogs or COCKROACH
-
how is tapeworm infection treated
-
-
how to prevent tapeworm infection
- handwashing!!!!!!
- food prep
- food storage
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