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73 Cards in this Set
- Front
- Back
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Diet prescribed is generally
High protein Low carbohydrates Low fats Low roughage 6 small feedings Fluids not to be ingested with meals <1000 ml/day |
post-op for bariatric surgery
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Diagnosed if an individual has three or more of the conditions listed
Waist circumference ≥40 inches (men) or ≥35 inches (women) Triglycerides >150 mg/dl or being treated High-density lipoprotein (HDL) cholesterol <40 men, <50 women or being treated Blood pressure ≥130 mm Hg systolic or ≥85 mm Hg diastolic or being treated Fasting glucose is ≥100 mg/dl or being treated |
metabolic syndrome diagnosis
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15 minutes after eating
weakness, dizziness, sweating, full, tachycardia, cramping small frequent meals ↑ fat, ↑protein, ↓ to moderate carbohydrates limit fluids with meals lie down for 30” after eating |
dumping syndrome
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rare in children less than 2. begins as dull steady pain in periumbilical area, progresses over 4-6 hours, localized to RLQ.
Low grade fever, nausea, anorexia. rebound pain, tenderness. sudden pain relief may indicate rupture of appendix and may lead to peritonitis. |
appendicitis
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Diagnosis
clinical s/s increased WBC, abdominal sonogram, exploratory lap |
diagnosis of appendicitis
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rapid onset
frequent vomiting,colicky cramplike, intermittnet feces for a short time, abd, distentention grealty increased. metabolic alkalosis |
small intestine obstruction s/s
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gradual onset, vomiting rare, low grade pain, constipated, increased abd distention.
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large int. obstruction s/s
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rising serum creatinine andBUN levels are indicators of acute renal failure.
urine output less than 0.5ml/kg/hr must be reported immediately. |
S/S of acute renal failure
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strict i&o;s comfort measures, iv fluids as ordered, keep visitors and distractions to minimum. NG tubes-mouth care and assess for breakdown around nose
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Int. obstruction nursing care
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Hepatitis A
Infectious Vaccine Transmission Fecal-oral route Flood waters |
Hep A
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Viral
Transmission Blood & blood products 75%-85% go on to develop chronic hepatitis Can only get HEP _ if Hep_ precedes common among drug users, needles |
HEP C&D
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Serum
Vaccine Transmission Blood, body secretions Needles, sex relations tatoos, piercing, parenteral, 4-6 months, in infected ppl last a lifetime. |
Hepatitis B
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before jaundice, malaise, anorexia, N&V, wt. loss
URI Icteric-Jaundice, bile-colored urine that foams when shaken Acholic [clay] stools recovery-fatigued easily |
HEP s/s
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Insidious, prolonged course
Liver cells attempt to regenerate Regenerative process is disorganized destruction of the liver parenchymal cells, hypoxia caused by inadequate blood flow. |
cirrhosis
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accumulation of fat in the liver cells, widespread scar formation occurs
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alcoholic cirrhosis
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viral, toxic, idipaothic(autoimmune) forms scar tissue
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postnecrotic cirrhosis
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chronic biliary obsctuction and infection. diffuse fibrosis with jaundice as the main feature.
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biliary cirrhosis
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long standing severe right sided heart failure in pts with cor pulmonale, tricuspid insufficiency.
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cardiac cirrosis
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Jaundice
Skin lesions Spider angiomas Palmar erythema Endocrine disorders Hematologic disorders Splenomegaly-enlargement of spleen Bleeding tendencies |
cirrhosis s/s
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alteration in blood flow and blood vessel tone in the circulation that supplies the intestines (the splanchnic circulation) and the circulation that supplies the kidney.[3] It is usually indicative of an end-stage of perfusion, or blood flow to the kidney, due to deteriorating liver function. Patients with hepatorenal syndrome are very ill, and, if untreated, the condition is usually fatal
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Hepatorenal syndrome-
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With severe liver impairment, toxic substances normally removed by the liver accumulate in the blood and impair the function of brain cells. If there is also portal hypertension, and subsequent bypassing of the liver filtration system of blood flowing in from the intestines, these toxic substances can travel directly to the brain, without being modified or purified. Signs can include impaired cognition, a flapping tremor (asterixis), and a decreased level of consciousness including coma (hepatic coma or coma hepaticum), cerebral edema, and, ultimately, death.
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hepatic encephalopahty
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Gastric varices are dilated submucosal veins in the stomach, which can be a life-threatening cause of upper gastrointestinal hemorrhage. They are most commonly found in patients with portal hypertension, or elevated pressure in the portal vein system, which may be a complication of cirrhosis
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Esophageal and gastric varices-
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portal htn
esopahgeal and gastric varices peripheral edema and ascites hepatic encephalopathy hepatorenal syndrome |
cirrhosis complications
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Rest
Administration of B-complex vitamins Avoidance of alcohol, aspirin, acetaminophen, and NSAIDs Management of ascites Prevention and management of esophageal variceal bleeding Management of encephalopathy |
cirrohis care
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high carbs. restrict sodium intake to 2g/day or even 250mg-500mg. Diuretics, fluid removal(parencentesis or peritovenous shunt)
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ascites reduction
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Diet for patient without complications
High in calories (3000 kcal/day) ↑ CHO Moderate to low fat Protein restriction rarely justified Protein supplements if protein-calorie malnutrition Low-sodium diet for patient with ascites and edema |
nutritional therapy for cirrhosis pts w/o severe complications
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Overall goals
Relief of discomfort Minimal to no complications Return to as normal a lifestyle as possible Health promotion Paracentesis care Varices care Encephalopathy care Home care |
cirrohis nursing management
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inflammation most often caused by obstruction
cholelithiasis bacteria adhesions control pain surgery: cholecytectomy (92% lap) |
cholecytitis gall bladde stones
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referred pain to the shoulder 2o the use of CO2 to inflate the abdomen for visualization
CO2 irritates the phrenic nerve and the diaphragm, → dyspnea Sim’s position, left side ambulation |
post-op lap surgery for cholescytitis
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inflammation and ulceration of the colon and rectum
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INFLAMM. bowel disease Ulcerative colitis:
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Overall goals
Relief of discomfort Minimal to no complications Return to as normal a lifestyle as possible Health promotion Paracentesis care Varices care Encephalopathy care Home care |
cirrohis nursing management
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inflammation most often caused by obstruction
cholelithiasis bacteria adhesions control pain surgery: cholecytectomy (92% lap) |
cholecytitis gall bladde stones
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referred pain to the shoulder 2o the use of CO2 to inflate the abdomen for visualization
CO2 irritates the phrenic nerve and the diaphragm, → dyspnea Sim’s position, left side ambulation |
post-op lap surgery for cholescytitis
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inflammation and ulceration of the colon and rectum
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INFLAMM. bowel disease Ulcerative colitis:Nonspecific complaints
Diarrhea Fatigue Abdominal pain Weight loss Fever Major symptoms Bloody diarrhea Abdominal pain Tenesmus- straining to urinate or defecate, without the ability to do so Rectal bleeding |
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Main manifestations
Diarrhea (nonbloody) : inflammation of segments of the GI tract Abscesses or fistula tracts that communicate with other loops of bowel, skin, bladder, rectum, or vagina may develop Colicky abdominal pain Malabsorption Nutritional deficiencies |
chrons disease ibd
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History and physical examination
Blood studies CBC Serum electrolyte levels Serum protein levels Stool cultures Sigmoidoscopy and colonoscopy Barium enema |
diagnostics for IBD
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Rest the bowel
Control inflammation Combat infection Correct malnutrition Alleviate stress Symptomatic relief Improve quality of life |
IBD goals of treatment
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Aminosalicylates
Sulfasalazine (Azulfidine) Antimicrobials Corticosteroids Immunosuppressants Biologic therapy |
drug therapy for IBD
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75% will require surgery
Surgery produces remission, but high recurrence rate |
surgical therapy for chrons disease
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Total colectomy with rectal mucosal stripping and ileoanal reservoir
Total protocolectomy with continent ileostomy (Kock pouch) Total protocolectomy with permanent ileostomy |
Procedures for chronic ulcerative colitis
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High-calorie
High-protein Low-residue diet Vitamin and iron supplements Parenteral nutrition |
nutritional therapy for IBD
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Observe for s/s of catheter sepsis
Monitor whole blood glucose Daily weight & accurate I&O Monitor electrolytes Change tubing & filters per agency policy Typically daily Change dressings per agency policy Typically q week Never stop unless ordered |
TPN care
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Usually short term
Percutaneous insertion via jugular, subclavian, femoral sites Multi-lumen may have 2,3, or 4 lumen Flush appropriately (as per agency policy) Dressing change after 1st 24 hours after insertion and then per agency policy CXR used to confirm placement & no pneumothorax Sterile technique for dressing changes Assess for s/s infection |
Single lumen or multilumen CVC
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0.5 ml'kg'hr
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urine output
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Evidence of wound infection usually not apparent until third to fifth postoperative day
May resume intake upon return of gag reflex NPO until return of bowel sounds for patient with abdominal surgery IV, NG for decompression |
post op care
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The anesthesia care provider (ACP) or surgeon should be notified if the following occur:
Systolic BP is less than 90 mm Hg or greater than 160 mm Hg.Pulse rate is less than 60 beats per minute or more than 120 beats per minute. |
post op care
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total 50-150 mcg/dl
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iron
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0.5-1.5 mg/dl
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creatinine
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less than Male 45 mg/dl
Female 55 mg/dl |
LDL
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less thna 130
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HDL
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140-200 mg/dl
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cholesterol
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95-105
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chloride
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4.5-5.5ionized
9-11 |
calcium
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7.35-7.45arterial
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ph
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0.2-1.3
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bilirubin
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3.5-5.0 g/dl
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albumin
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Women 4-5 X 106
Men 4.5-6 X 106 |
rbc
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4000-11000 / µl
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wbc
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Women 12-16 g/dl
Men 13.5-18 g/dl |
hemoglobin
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Women 38%-47%
Men 40%-54% |
hematocrit
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12-15 seconds
aPTT30-45 seconds(If anticoagulant regimen should 1.5-2 X normal) |
ptt and aptt
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150,000-400,000 / µl
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platelet
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0.7-1.8 (If on Coumadin, Therapeutic range 2.0-3.0)
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INR
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3.5-5.0 mEq/L
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potassium
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1.5-2.5 mEq/L
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MAG
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• Nociception is the physiologic process by which information about tissue damage is communicated to the central nervous system. Nociception involves transduction, transmission, perception, and modulation.
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nociception
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is the conversion of a mechanical, thermal, or chemical stimulus into a neuronal action potential.
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transduction
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stimuli cause the release of numerous chemicals into the area surrounding the peripheral Inflammation and the subsequent release of chemical mediators increase the likelihood of transduction.
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nociceptors
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The pain produced from activation of peripheral nociceptors is called ___ pain. Pain arising from abnormal processing of stimuli by the nervous system is called __ pain.
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nociceptive, neuropathic
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is the movement of pain impulses from the site of transduction to the brain.
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transmission
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are areas on the skin that are innervated primarily by a single spinal cord segment.
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dermatomes
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pain is characterized by deep aching or throbbing that is well localized and arises from bone, joint, muscle, skin, or connective tissue.
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somatic
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pain, which may result from stimuli such as tumor involvement or obstruction, arises from internal organs.
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visceral
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