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Normal pH
7.35-7.45
Normal PCO2 (respiratory)
32-45 mm Hg
Normal (Metabolic)
20-26 mEq/L
What determines whether a fluid is an acid or a base?
amount of hydrogen
An acid is a substance that:
releases a hydrogen ion
A common acid in the body is:
hydrochloric acid, found in the stomach
A base is a substance that:
binds oxygen
A common base in the body is:
bicarbonate
another word for base
alkali
fixed acids are formed as end products of:
glucose, fat and protein metabolism
bicarbonate begins as:
carbonic acid, a weak acid
Maintains a delecate balance between acids and bases in the body
ECF
Measures the strength of acids and bases
pH
pH range of a solution
0 to 14
Neutral pH
7
Acidic range of pH
0 - 6.99
Alkaline range of pH
7.01 - 14
A pH of lower than ________ or higher than _______ is usually fatal.
6.9 / 7.8
Name the three major mechanisms used to compensate for changes in serum pH:
cellular buffers, lungs, kidneys
First line of defense against pH changes
cellular buffers
The lungs respond with shallow respirations if the blood pH is too:
high/alkaline
The lungs respond with rapid deep breathing if the blood pH is:
too low/acidic
Slowest mechanism to respond to changes in the blood pH, taking 24 to 48 hours to respond:
kidneys
Acidosis or alkalosis that is corrected for by the body is referred to as:
compensated
The laboratory tests that are used to evaluate acid base balance are called:
arterial blood gases (ABGs)
Most often used to obtain ABG samples:
femoral, brachial and radial arteries
When the serum pH falls below: _________ the blood becomes too: _________
7.35 , acidic
When the serum pH increases above: _____________ the blood becomes: __________
7.45, alkaline
When carbon dioxide is not adequately "blown off" during expiration, the blood becomes:
acidic
Acid base imbalance caused by hypoventilation:
acute respiratory acidosis
Acid base imbalance usually caused by chronic respiratory disease, drugs, or neurological problems that depress breathing
Respiratory Acidosis
As carbon dioxide increases, mental status is altered, progressing from confusion and lethargy to stupor and coma if not treated. Respirations become more depressed and shallow as muscle weakness worsens in this acid base imbalance:
Respiratory Acidosis
Uncontrolled diabetes mellitus and end stage renal failure are the two most common causes of this acid base imbalance:
Metabolic Acidosis
The GI tract is rich in:
bicarbonate
Patients experiencing severe diarrhea or prolonged nasointestinal suction are at high risk for this acid base imbalance:
Metabolic Acidosis
Serum potassium tends to increase in the presence of this acid base imbalance
Metabolic Acidosis
The signs and symptoms of Metabolic Acidosis are similar to Respiratory Acidosis with the exception of:
the respiratory pattern
To help compensate for the acidotic state, during Metabolic Acidosis, the lungs get rid of excess carbon dioxide through
Kussmaul's respirations
Deep and rapid breathing that can only occur in patients with healthy lungs
Kussmaul's respirations
Acid base imbalance that is a result of hyperventilation
Respiratory Alkalosis
Patients may hyperventilate when they are:
severely anxious or fearful
Mechanical ventilation, being in high altitudes, or deep breathing during a pulmonary examination can cause this acid base imbalance
Respiratory Alkalosis
Respiratory Alkalosis is treated by having patients do this, in addition to treating the underlying cause
hold their breath or rebreathe their own carbon dioxide with a paper bag or a rebreathing mask
Results from excessive ingestion of bicarbonate or other bases into the body or loss of acids from the body
Metabolic Alkalosis
Overuse or abuse of antacids or baking soda (sodium bicarbonate) can lead to:
Metabolic Alkalosis
Prolonged vomiting or nasogastric suction can cause
Metabolic Alkalosis
The serum potassium decreases in this acid base imbalance (and hypocalcemia may also accompany it)
Metabolic Alkalosis
Signs and symptoms of this acid base imbalance relate to hypokalemia and hypocalcemia rather than the state itself
Metabolic Alkalosis
If the stoma is an Ileostomy the effluent is
liquid to mushy
If the stoma is a cecostomy, ascending colostomy the effluent is
liquid to mushy, foul odor
If the stoma is a right transverse colostomy the effluent is
mushy to semiformed
If the stoma is a left transverse colostomy the effluent is
semiformed, soft
If the stoma is a descending or sigmoid colostomy the effluent is
soft to hard formed
Fluids located inside the cells
intracellular fluid (ICF)
Fluids located outside cells
extracellular fluid (ECF)
Three types of ECF
interstitial, intravascular, transcellular
Fluids that is the water that surrounds the body's cells and includes lympth
interstitial
Fluids and electrolytes move between the interstitial fluid and the:
intravascular fluid
Fluid that is the plasma of the blood
intravascular fluid
Fluids that are those in specific compartments of the body, such as cerebrospinal fluid, digestive juices, and synovial fluids in joints
transcellular fluids
The primary control of water in the body is through pressure sensors in the vascular system, which stimulate or inhibit the release of:
ADH (antidiuretic hormone)
ADH is released from this gland:
pituitary gland
If fluid pressures within the vascular system decrease, more of this is released
ADH - and fluid is retained
If fluid pressures within the vascular system increase, less of this is released
ADH - and fluid is released
Active transport depends on the presence of adequate:
cellular ATP
The most common examples of active transport:
sodium potassium pumps
No energy is expended specifically to move substances:
passive transport
The three types of passive transport systems
diffusion, filtration and osmosis
A process in which the substance moves from an area of higher concentration to an area of lower concentration
diffusion
If you pour cream into a cup of coffee, this is an example of:
diffusion
The movement of both water and smaller molecules through a semipermeable membrane
filtration
the force that water exerts, sometimes called water pushing pressure
hydrostatic pressure
serve as semipermeable membranes allowing water and smaller substances to move from the vascular system to the interestitial fluid, but large molecules and red blood cells remain inside the capillary walls
capillaries
the movement of water from an area of lower substance concentration to an area of higher concentration
osmosis
Refers to the concentration of the substances in body fluids
osmolarity
The normal osmolarity of the blood
between 270 and 300 milliosmoles per liter (mOsm/L)
A fluid that has the same osmolarity as the blood is called
isotonic
A solution that has a lower osmolarity than blood is called
hypotonic
When a hypotonic solution is given to a patient
water leaves the blood and other ECF areas and enters the cells
When a hypertonic solution is given to a patient
water leaves the cells and enters the blood stream
This is very important to the body for cellular metabolism, blood volume, body temperature regulation, and solute transport
water
How often is water gained and lost from the body?
every day
Why are older adults more prone to fluid deficits
b/c they have a diminished thirst reflex and their kidneys do not function as effectively
An adult loses as much as __________ of sensible and insensible fluid each day
2500 ml
Losses of which the person is aware
sensible
What type of loss is urination?
sensible
Perspiration is an example of what type of loss?
insensible
Feces is an example of what type of loss?
insensible
At the highest risk for life threatening complications that can result from either fluid deficit or fluid excess
elderly people
Take in and excrete a large proportion of their body water each day
infants
occurs when there is not enough fluid in the body, especially in the blood (intravascular area)
dehydration
decreased blood volume
hypovolemia
Occurs when the patient is hemorrhaging or when fluids from other parts of the body are lost
hypovolemia
Severe vomiting and diarrhea, severely draining wounds, and profuse diaphoresis (sweating) can cause
dehydration
Hypovolemia may occur when fluid from the intravascular space moves into the interstitial fluid space. This is called:
third spacing
common in conditions such as burns, liver cirrhosis, and extensive trauma
3rd spacing
Common causes of this are: long term NPO, hemorrhage, profuse sweating (diaphoresis, diuretic therapy, diarrhea, vomiting, gastrointestinal suction, draining fistulas, draining abcesses, severely draining wounds, systemic infection, fever, frequent enemas, ileostomy, cecostomy, diabetes insipidus
dehydration
The initial symptom of dehydration in an otherwise healthy adult
thirst
Dehydration signs and symptoms include:
rapid, weak pulse, low bp, poor skin turgor, increased temp (may not be visable in elderly), decreased and more concentrated urine, constipation and weight loss
Dehydration should be considered in any adult with a urine output of less than:
30 ml per hour
A pint of water weighs approximately
1 pound
Manifestations of dehydration in an older adult
altered mental status, light headedness, and syncope due to inadequate circulatory volume and inadequate oxygen supply to the brain
If dehydration is not treated, lack of sufficient blood volume causes:
organ function to decrease and eventually fail
Which diagnostic tests would suggest dehydration?
elevated BUN, elevated hematocrit, increased specific gravity
What therapeutic interventions are commonly used for moderate to severe dehydration?
IV therapy using isotonic fluids
Where do you check for skin turgor
forehead or sternum
What is the impact of Ramadan on the medical needs of a Muslim?
though the ill are not required to participate, it is a practice of not taking fluids or meals between sunup and sundown, including medications so special precautions must be taken to avoid dehydration
Too much fluid in the bloodstream or from dilution of electrolytes and red blood cells causes
fluid excess
excess fluid in the intravascular space is:
hypervolemia
Poorly controlled IV therapy, excessive irrigation of wounds or body cavities and excessive ingestion of water can cause
hypervolemia
renal failure, heart failure and the syndrome of inappropriate antidiuretic hormone can cause
hypervolemia
How would you address IV therapy in at risk patients?
electronic infusion pump or quantity limiting devies such as a burette
Pitting edema, pale and cool skin, increased and diluted urine output, rapid weight gain, boudning pulse, elevated bp, increased shallow respirations, distended neck veins, and in severe cases crackles in the lungs, dyspnea, and ascites
hypervolemia
Result of acute fluid excess is typically
congestive heart failure
What test results would you expect in a patient w/ fluid excess?
decreased BUN and hematocrit levels, diminished specific gravity
How could you position the hypovolemic patient to facilitate ease of breathing?
semi fowlers or high fowlers
Typically used to ensure adequate perfusion of major organs and to minimize dyspnea
oxygen therapy
A patient with COPD such as emphysema or chronic bronchitis needs what special consideration in regards to oxygen therapy
no more than 2 L per minute of oxygen, or they may lose the stimulus to breathe and may suffer respiratory arrest
Frequently administered to rapidly rid the body of excess water
diuretic
The drug of choice for fluid excess when the patient has adequately functioning kidneys
Lasix (furosemide)
Loop diuretics cause the kidneys to excrete
sodium and water
IV furosemide should be administered by:
RN or physician
In viewing I&O, how can you tell if the patient is retaining fluid?
drinking 1500 mL p/day or more and voiding small amts
Where would you check a bedbound patient for edema?
sacrum
A weight gain of what would indicate fluid retentions?
1-2 lbs or more per day - even if other signs and symptoms may not be present
what are two types of diuretics?
loop and thiazide
mEq/L means
milliequivalents per liter
mg/dL means
milligrams per deciliter
postive electrically charged electrolytes
cations
negatively electrically charged electrolytes
anions
The most important electrolytes
sodium, potassium, calcium and magnesium
Norm: serum sodium
135 to 145 mEq/L
Norm: potassium
3.5 to 5 mEq/L
Norm: calcium
9 to 11 mg/dL or 4.5 to 5.5 mEq/L
Potassium losing diuretics
Lasix, digitalis preparations, Lanoxin, rednisone, corticosteroids
Sodium imbalances are related to
fluid imbalances
Potassium is especially important for:
cardiac, skeletal and smooth muscle
Potassium is a potentially dangerous drug, especially when administered intravenously. In too high a concentration, it causes:
cardiac arrest
A potassium sparing diuretic
Aldactone
A therapeutic intervention for Hyperkalemia, a cation exchange resin is:
Kayexalate
Person most at risk for hypocalcemia and osteoporosis
postmenopausal thin petite caucasion woman
Patients with hyperphosphatemia often experience
hypocalcemia
Adequate intake of calcium for ages 19 to 50:
1000 mg
An inexpensive source of calcium for patients who do not require vitamin D supplementation
calcium carbonate (Tums)
What is the Trousseau's sign test?
inflate the bp cuff around the patient's upper arm for 1 to 4 minutes, in a patient w/ hypocalcemia the hand and fingers become spastic and go into palmar flexion
What is the Chvostek's sign?
tests for calcium deficit: tap the face just below and in front of the ear: facial twitching on that side of the face indicates a positive test
A thiazide diuretic that, in prolonged or overuse can cause Hypercalcemia, is:
HydroDiuril
Norm: Magnesium
1.5 to 2.5 mEq/L
Type of diarrhea caused by an increase in peristalsis w/out an increase in fecal volume
small volume diarrhea
Type of diarrhea caused by increased volume of feces
large volume diarrhea
The most common cause of acute diarrhea
bacterial or viral infection / e-coli, Campylobacter jejuni, Shigella, C-diff, Giardia and Salmonella
Poor tolerance or allergies to certain foods may cause
diarrhea
Foods that most commonly cause diarrhea are:
additives (such as nutmeg or sorbitol), caffeine, milk products, meats, wheat and potatoes
Acute diarrhea usually resolves in how many days:
7 to 14
Chronic diarrhea may result from
inflammatory disease, osmotic agents, excessive secretion of electrolytes, or increased intestinal motility
Inflammatory diseases such as Crohn's disease or ulcerative colitis may result in:
frequent watery stools
results from ingestion of laxatives or other agents that prevent absorption of water or nutrients in the intestine
osmotic diarrhea
Radiation therapy for cancer may induce
malabsorption syndrome
Enteral tube feedings commonly result in this, especially when malnutrition has caused edema in the gut wall, which decreases absorption
diarrhea
What is the best way to start enteral feedings?
slowly with full strength formula and gradually incrase the rate rather than dilute the formula
Diarrhea resulting from food poisoning has the following signs and symptoms:
explosive onset, nausea, vomiting, abdominal cramping, distention, anorexia, intestinal rumbling and thirst
What is the first priority in caring for a patient with diarrhea?
replacing fluids and electrolytes
If the patient has three or more watery stools per day, motility of the intestines can be decreased with the use of drugs such as:
Lomotil, Motofen, Imodium
If diarrhea is thought to be caused by antibiotics that change the normal flora of the bowel, this dietary supplement may be used to restore the normal flora
Lactinex
Occurs with the rapid entry of food into the jejunum without proper mixing of the food with digestive juices
dumping syndrome
Causes a rapid shift of fluids and as a result decreases circulating blood volume
dumping syndrome
Symptoms of Dumping Syndrome
dizziness, tachycardia, fainting, sweating, nausea, diarrhea, feeling of fullness and abdominal cramping, also rising blood sugar and possible symptoms of hypoglycemia
The treatment of dumping syndrome
teaching patient to eat small frequent meals high in protein and fat and low in carbs and refined sugars, avoid fluids for 1 hr before, during, and 2 hrs after meals to prevent rapid gastric emptying
Symptoms of Dumping Syndrome may last for how long?
up to 6 months after gastric surgery and may subside slowly over time
Bowel sounds are categorized as:
hyperactive, hypoactive, or absent
Norm: bowel sounds
5 to 30 times per minute
Also known as a barium swallow
Upper Gastrointestinal Series
an x-ray examination of the esophagus, stomach, duodenum, and jejunum using an oral liquid radiopaque contrast medium and a fluoroscope to outline the contours of the organs
Upper Gastrointestinal Series
Used to dectect strictures, ulcers, tumors, polyps, hiatal hernias and motility problems
Upper Gastrointestinal Series
Preparation for an Upper GI includes:
NPO 6-8 hrs prior, no smoking the morning of the procedure
Why is smoking discouraged prior to an Upper GI?
smoking can stimulate gastric motility
During this procedure a patient drinks thick chalky substance while standing in front of a fluoroscopic tube while x-rays are taken
Upper Gastrointestinal Series
What color is a patient's stool initially, after an Upper GI?
white, but should return to normal color within 3 days
A patient who has an Upper GI or Lower GI is at risk for what complication after procedure?
constipation or a barium impaction
Also known as a barium enema
Lower Gastrointestinal Series
performed to visualized the position, movements, and filling of the colon
Lower Gastrointestinal Series
Tumors, diverticular, stenosis, obstructions, inflammation, ulcerative colitis and polyps can be detected by this test:
Lower Gastrointestinal Series
Preparation for a Lower Gi includes:
Low residue or clear liquid diet for 2 days prior, laxatives, bowel cleansing solutions (such as GoLYTELY) and enemas may be administered the evening prior
Why is the bowel cleared prior to a Lower GI?
for adequate visualization during the procedure, inadequate prep may result in poor test results or test cancellation
During this procedure barium is instilled rectally and xray films are taken with or without fluoroscopy, patient may experience some abdominal cramping and an urge to have a bowel movement during the procedure
Lower Gastrointestinal Series
Normal pH
7.35-7.45
Normal PCO2 (respiratory)
32-45 mm Hg
Normal (Metabolic)
20-26 mEq/L
What determines whether a fluid is an acid or a base?
amount of hydrogen
An acid is a substance that:
releases a hydrogen ion
A common acid in the body is:
hydrochloric acid, found in the stomach
A base is a substance that:
binds oxygen
A common base in the body is:
bicarbonate
another word for base
alkali
fixed acids are formed as end products of:
glucose, fat and protein metabolism
bicarbonate begins as:
carbonic acid, a weak acid
Maintains a delecate balance between acids and bases in the body
ECF
Measures the strength of acids and bases
pH
pH range of a solution
0 to 14
Neutral pH
7
Acidic range of pH
0 - 6.99
Alkaline range of pH
7.01 - 14
A pH of lower than ________ or higher than _______ is usually fatal.
6.9 / 7.8
Name the three major mechanisms used to compensate for changes in serum pH:
cellular buffers, lungs, kidneys
First line of defense against pH changes
cellular buffers
The lungs respond with shallow respirations if the blood pH is too:
high/alkaline
The lungs respond with rapid deep breathing if the blood pH is:
too low/acidic
Slowest mechanism to respond to changes in the blood pH, taking 24 to 48 hours to respond:
kidneys
Acidosis or alkalosis that is corrected for by the body is referred to as:
compensated
The laboratory tests that are used to evaluate acid base banalce are called:
arterial blood gases (ABGs)
Most often used to obtain ABG samples:
femoral, brachial and radial arteries
When the serum pH falls below: _________ the blood becomes too: _________
7.35 , acidic
When the serum pH increases above: _____________ the blood becomes: __________
7.45, alkaline
When carbon dioxide is not adequately "blown off" during expiration, the blood becomes:
acidic
Acid base imbalance caused by hypoventilation:
acute respiratory acidosis
Acid base imbalance usually caused by chronic respiratory disease, drugs, or neurological problems that depress breathing
Respiratory Acidosis
As carbon dioxide increases, mental status is altered, progressing from confusion and lethargy to stupor and coma if not treated. Respirations become more depressed and shallow as muscle weakness worsens in this acid base imbalance:
Respiratory Acidosis
Uncontrolled diabetes mellitus and end stage renal failure are the two most common causes of this acid base imbalance:
Metabolic Acidosis
The GI tract is rich in:
bicarbonate
Patients experiencing severe diarrhea or prolonged nasointestinal suction are at high risk for this acid base imbalance:
Metabolic Acidosis
Serum potassium tends to increase in the presence of this acid base imbalance
Metabolic Acidosis
The signs and symptoms of Metabolic Acidosis are similar to Respiratory Acidosis with the exception of:
the respiratory pattern
To help compensate for the acidotic state, during Metabolic Acidosis, the lungs get rid of excess carbon dioxide through
Kussmaul's respirations
Deep and rapid breathing that can only occur in patients with healthy lungs
Kussmaul's respirations
Acid base imbalance that is a result of hyperventilation
Respiratory Alkalosis
Patients may hyperventilate when they are:
severely anxious or fearful
Mechanical ventilation, being in high altitudes, or deep breathing during a pulmonary examination can cause this acid base imbalance
Respiratory Alkalosis
Respiratory Alkalosis is treated by having patients do this, in addition to treating the underlying cause
hold their breath or rebreathe their own carbon dioxide with a paper bag or a rebreathing mask
Results from excessive ingestion of bicarbonate or other bases into the body or loss of acids from the body
Metabolic Alkalosis
Overuse or abuse of antacids or baking soda (sodium bicarbonate) can lead to:
Metabolic Alkalosis
Prolonged vomiting or nasogastric suction can cause
Metabolic Alkalosis
The serum potassium decreases in this acid base imbalance (and hypocalcemia may also accompany it)
Metabolic Alkalosis
Signs and symptoms of this acid base imbalance relate to hypokalemia and hypocalcemia rather than the state itself
Metabolic Alkalosis
If the stoma is an Ileostomy the effluent is
liquid to mushy
If the stoma is a cecostomy, ascending colostomy the effluent is
liquid to mushy, foul odor
If the stoma is a right transverse colostomy the effluent is
mushy to semiformed
If the stoma is a left transverse colostomy the effluent is
semiformed, soft
If the stoma is a descending or sigmoid colostomy the effluent is
soft to hard formed
Fluids located inside the cells
intracellular fluid (ICF)
Fluids located outside cells
extracellular fluid (ECF)
Three types of ECF
interstitial, intravascular, transcellular
Fluids that is the water that surrounds the body's cells and includes lympth
interstitial
Fluids and electrolytes move between the interstitial fluid and the:
intravascular fluid
Fluid that is the plasma of the blood
intravascular fluid
Fluids that are those in specific compartments of the body, such as cerebrospinal fluid, digestive juices, and synovial fluids in joints
transcellular fluids
The primary control of water in the body is through pressure sensors in the vascular system, which stimulate or inhibit the release of:
ADH (antidiuretic hormone)
ADH is released from this gland:
pituitary gland
If fluid pressures within the vascular system decrease, more of this is released
ADH - and fluid is retained
If fluid pressures within the vascular system increase, less of this is released
ADH - and fluid is released
Active transport depends on the presence of adequate:
cellular ATP
The most common examples of active transport:
sodium potassium pumps
No energy is expended specifically to move substances:
passive transport
The three types of passive transport systems
diffusion, filtration and osmosis
A process in which the substance moves from an area of higher concentration to an area of lower concentration
diffusion
If you pour cream into a cup of coffee, this is an example of:
diffusion
The movement of both water and smaller molecules through a semipermeable membrane
filtration
the force that water exerts, sometimes called water pushing pressure
hydrostatic pressure
serve as semipermeable membranes allowing water and smaller substances to move from the vascular system to the interestitial fluid, but large molecules and red blood cells remain inside the capillary walls
capillaries
the movement of water from an area of lower substance concentration to an area of higher concentration
osmosis
Refers to the concentration of the substances in body fluids
osmolarity
The normal osmolarity of the blood
between 270 and 300 milliosmoles per liter (mOsm/L)
A fluid that has the same osmolarity as the blood is called
isotonic
A solution that has a lower osmolarity than blood is called
hypotonic
When a hypotonic solution is given to a patient
water leaves the blood and other ECF areas and enters the cells
When a hypertonic solution is given to a patient
water leaves the cells and enters the blood stream
This is very important to the body for cellular metabolism, blood volume, body temperature regulation, and solute transport
water
How often is water gained and lost from the body?
every day
Why are older adults more prone to fluid deficits
b/c they have a diminished thirst reflex and their kidneys do not function as effectively
An adult loses as much as __________ of sensible and insensible fluid each day
2500 ml
Losses of which the person is aware
sensible
What type of loss is urination?
sensible
Perspiration is an example of what type of loss?
insensible
Feces is an example of what type of loss?
insensible
At the highest risk for life threatening complications that can result from either fluid deficit or fluid excess
elderly people
Take in and excrete a large proportion of their body water each day
infants
occurs when there is not enough fluid in the body, especially in the blood (intravascular area)
dehydration
decreased blood volume
hypovolemia
Occurs when the patient is hemorrhaging or when fluids from other parts of the body are lost
hypovolemia
Severe vomiting and diarrhea, severely draining wounds, and profuse diaphoresis (sweating) can cause
dehydration
Hypovolemia may occur when fluid from the intravascular space moves into the interstitial fluid space. This is called:
third spacing
common in conditions such as burns, liver cirrhosis, and extensive trauma
3rd spacing
Common causes of this are: long term NPO, hemorrhage, profuse sweating (diaphoresis, diuretic therapy, diarrhea, vomiting, gastrointestinal suction, draining fistulas, draining abcesses, severely draining wounds, systemic infection, fever, frequent enemas, ileostomy, cecostomy, diabetes insipidus
dehydration
The initial symptom of dehydration in an otherwise healthy adult
thirst
Dehydration signs and symptoms include:
rapid, weak pulse, low bp, poor skin turgor, increased temp (may not be visable in elderly), decreased and more concentrated urine, constipation and weight loss
Dehydration should be considered in any adult with a urine output of less than:
30 ml per hour
A pint of water weighs approximately
1 pound
Manifestations of dehydration in an older adult
altered mental status, light headedness, and syncope due to inadequate circulatory volume and inadequate oxygen supply to the brain
If dehydration is not treated, lack of sufficient blood volume causes:
organ function to decrease and eventually fail
Which diagnostic tests would suggest dehydration?
elevated BUN, elevated hematocrit, increased specific gravity
What therapeutic interventions are commonly used for moderate to severe dehydration?
IV therapy using isotonic fluids
Where do you check for skin turgor
forehead or sternum
What is the impact of Ramadan on the medical needs of a Muslim?
though the ill are not required to participate, it is a practice of not taking fluids or meals between sunup and sundown, including medications so special precautions must be taken to avoid dehydration
Too much fluid in the bloodstream or from dilution of electrolytes and red blood cells causes
fluid excess
excess fluid in the intravascular space is:
hypervolemia
Poorly controlled IV therapy, excessive irrigation of wounds or body cavities and excessive ingestion of water can cause
hypervolemia
renal failure, heart failure and the syndrome of inappropriate antidiuretic hormone can cause
hypervolemia
How would you address IV therapy in at risk patients?
electronic infusion pump or quantity limiting devies such as a burette
Pitting edema, pale and cool skin, increased and diluted urine output, rapid weight gain, bounding pulse, elevated bp, increased shallow respirations, distended neck veins, and in severe cases crackles in the lungs, dyspnea, and ascites
hypervolemia
Result of acute fluid excess is typically
congestive heart failure
What test results would you expect in a patient w/ fluid excess?
decreased BUN and hematocrit levels, diminished specific gravity
How could you position the hypovolemic patient to facilitate ease of breathing?
semi fowlers or high fowlers
Typically used to ensure adequate perfusion of major organs and to minimize dyspnea
oxygen therapy
A patient with COPD such as emphysema or chronic bronchitis needs what special consideration in regards to oxygen therapy
no more than 2 L per minute of oxygen, or they may lose the stimulus to breathe and may suffer respiratory arrest
Frequently administered to rapidly rid the body of excess water
diuretic
The drug of choice for fluid excess when the patient has adequately functioning kidneys
Lasix (furosemide)
Loop diuretics cause the kidneys to excrete
sodium and water
IV furosemide should be administered by:
RN or physician
In viewing I&O, how can you tell if the patient is retaining fluid?
drinking 1500 mL p/day or more and voiding small amts
Where would you check a bedbound patient for edema?
sacrum
A weight gain of what would indicate fluid retentions?
1-2 lbs or more per day - even if other signs and symptoms may not be present
what are two types of diuretics?
loop and thiazide
mEq/L means
milliequivalents per liter
mg/dL means
milligrams per deciliter
postive electrically charged electrolytes
cations
negatively electrically charged electrolytes
anions
The most important electrolytes
sodium, potassium, calcium and magnesium
Norm: serum sodium
135 to 145 mEq/L
Norm: potassium
3.5 to 5 mEq/L
Norm: calcium
9 to 11 mg/dL or 4.5 to 5.5 mEq/L
Potassium losing diuretics
Lasix, digitalis preparations, Lanoxin, rednisone, corticosteroids
Sodium imbalances are related to
fluid imbalances
Potassium is especially important for:
cardiac, skeletal and smooth muscle
Potassium is a potentially dangerous drug, especially when administered intravenously. In too high a concentration, it causes:
cardiac arrest
A potassium sparing diuretic
Aldactone
A therapeutic intervention for Hyperkalemia, a cation exchange resin is:
Kayexalate
Person most at risk for hypocalcemia and osteoporosis
postmenopausal thin petite caucasion woman
Patients with hyperphosphatemia often experience
hypocalcemia
Adequate intake of calcium for ages 19 to 50:
1000 mg
An inexpensive source of calcium for patients who do not require vitamin D supplementation
calcium carbonate (Tums)
What is the Trousseau's sign test?
inflate the bp cuff around the patient's upper arm for 1 to 4 minutes, in a patient w/ hypocalcemia the hand and fingers become spastic and go into palmar flexion
What is the Chvostek's sign?
tests for calcium deficit: tap the face just below and in front of the ear: facial twitching on that side of the face indicates a positive test
A thiazide diuretic that, in prolonged or overuse can cause Hypercalcemia, is:
HydroDiuril
Norm: Magnesium
1.5 to 2.5 mEq/L
Type of diarrhea caused by an increase in peristalsis w/out an increase in fecal volume
small volume diarrhea
Type of diarrhea caused by increased volume of feces
large volume diarrhea
The most common cause of acute diarrhea
bacterial or viral infection / e-coli, Campylobacter jejuni, Shigella, C-diff, Giardia and Salmonella
Poor tolerance or allergies to certain foods may cause
diarrhea
Foods that most commonly cause diarrhea are:
additives (such as nutmeg or sorbitol), caffeine, milk products, meats, wheat and potatoes
Acute diarrhea usually resolves in how many days:
7 to 14
Chronic diarrhea may result from
inflammatory disease, osmotic agents, excessive secretion of electrolytes, or increased intestinal motility
Inflammatory diseases such as Crohn's disease or ulcerative colitis may result in:
frequent watery stools
results from ingestion of laxatives or other agents that prevent absorption of water or nutrients in the intestine
osmotic diarrhea
Radiation therapy for cancer may induce
malabsorption syndrome
Enteral tube feedings commonly result in this, especially when malnutrition has caused edema in the gut wall, which decreases absorption
diarrhea
What is the best way to start enteral feedings?
slowly with full strength formula and gradually incrase the rate rather than dilute the formula
Diarrhea resulting from food poisoning has the following signs and symptoms:
explosive onset, nausea, vomiting, abdominal cramping, distention, anorexia, intestinal rumbling and thirst
What is the first priority in caring for a patient with diarrhea?
replacing fluids and electrolytes
If the patient has three or more watery stools per day, motility of the intestines can be decreased with the use of drugs such as:
Lomotil, Motofen, Imodium
If diarrhea is thought to be caused by antibiotics that change the normal flora of the bowel, this dietary supplement may be used to restore the normal flora
Lactinex
Occurs with the rapid entry of food into the jejunum without proper mixing of the food with digestive juices
dumping syndrome
Causes a rapid shift of fluids and as a result decreases circulating blood volume
dumping syndrome
Symptoms of Dumping Syndrome
dizziness, tachycardia, fainting, sweating, nausea, diarrhea, feeling of fullness and abdominal cramping, also rising blood sugar and possible symptoms of hypoglycemia
The treatment of dumping syndrome
teaching patient to eat small frequent meals high in protein and fat and low in carbs and refined sugars, avoid fluids for 1 hr before, during, and 2 hrs after meals to prevent rapid gastric emptying
Symptoms of Dumping Syndrome may last for how long?
up to 6 months after gastric surgery and may subside slowly over time
Bowel sounds are categorized as:
hyperactive, hypoactive, or absent
Norm: bowel sounds
5 to 30 times per minute
Also known as a barium swallow
Upper Gastrointestinal Series
an x-ray examination of the esophagus, stomach, duodenum, and jejunum using an oral liquid radiopaque contrast medium and a fluoroscope to outline the contours of the organs
Upper Gastrointestinal Series
Used to dectect strictures, ulcers, tumors, polyps, hiatal hernias and motility problems
Upper Gastrointestinal Series
Preparation for an Upper GI includes:
NPO 6-8 hrs prior, no smoking the morning of the procedure
Why is smoking discouraged prior to an Upper GI?
smoking can stimulate gastric motility
During this procedure a patient drinks thick chalky substance while standing in front of a fluoroscopic tube while x-rays are taken
Upper Gastrointestinal Series
What color is a patient's stool initially, after an Upper GI?
white, but should return to normal color within 3 days
A patient who has an Upper GI or Lower GI is at risk for what complication after procedure?
constipation or a barium impaction
Also known as a barium enema
Lower Gastrointestinal Series
performed to visualized the position, movements, and filling of the colon
Lower Gastrointestinal Series
Tumors, diverticular, stenosis, obstructions, inflammation, ulcerative colitis and polyps can be detected by this test:
Lower Gastrointestinal Series
Preparation for a Lower Gi includes:
Low residue or clear liquid diet for 2 days prior, laxatives, bowel cleansing solutions (such as GoLYTELY) and enemas may be administered the evening prior
Why is the bowel cleared prior to a Lower GI?
for adequate visualization during the procedure, inadequate prep may result in poor test results or test cancellation
During this procedure barium is instilled rectally and xray films are taken with or without fluoroscopy, patient may experience some abdominal crapming and an urge to have a bowel movement during the procedure
Lower Gastrointestinal Series
GI bleed may be caused by:
ulcer perforation, tumors, gastric surgery or other conditions
The most common cause of blood loss into the stomach or intestine
bleeding peptic ulcers
vomited observable blood
hematemesis
When you observe coffee grounds in emesis, what would you expect?
bleeding in the stomach due to blood mixing w/ hydrochloric acid and enzymes
occurs from slow bleeding in an upper GI area
melena
Signs and symptoms of a mild GI bleed
slight weakness or diaphoresis
What constitutes severe blood loss
more than 1 L in 24 hours
Severe GI bleed may result in:
hypovolemic shock, hypotension, weak thready pulse, chills, palpitations, diaphoresis
The goal for treating a massive GI bleed
prevent or treat hypovolemic shock, prevent dehydration, electrolyte imbalance
How would you treat a severe GI bleed?
NPO, IV to replace lost fluids, administer blood if necessary, CBC, cath, NG tube to assess rate of bleeding decompress stomach monitor pH of gastric secretions and administer saline lavage if odered, possible oxygen therapy, elevate head of bed
Why would a physician perform an endoscopy after a GI bleed?
control the bleeding
Why would Zantac be given in a GI bleed patient?
decrease secretion of gastric acid
Chronic excessive alcohol indigestion combined with a lack of dietary protein can cause
cirrhosis
may result from massive exposure to hepatoxins, viral hepatitis, or infection
cirrhosis / postnecrotic liver failure
caused by chronic inflammation and obstruction of the gallbladder and bile ducts
cirrhosis / biliary liver failure
caused by chronic severe congestion of the liver from heart failure, liver congestion causes death of liver cells from lack of nutrients and oxygen
cirrhosis / cardiac liver failure
Chronic liver failure is a progressive disease. Healthy liver cells respond to toxins such as alcohol by becoming:
inflamed
In Chronic liver failure, liver cells are infiltrated w/ fat and whilte blood cells and then replaced with:
fibrotic tissue
Chronic liver failure may be prevented by:
abstinence from alcohol, eating a balanced diet w/ adequate amts of protein, avoiding exposure to infections or hepatotoxic chemicals
This is a common finding with hepatitis
jaundice
Signs and symptoms of impaired liver function include:
malaise, anorexia, indigestion, nausea, weight loss, diarrhea or constipation, and dull aching RUQ pain
Hepatorenal syndrome, blood clotting defects, ascites, portal hypertension and hepatic encephalopathy are complications of:
chronic liver failure
Symptoms include oliguria w/out detectable kidney damage, reduced GFR w/ essentially no urine output or less than 200 mL p/day, nearly total sodium retention, and is considered an ominous sign
Hepatorenal syndrome
May develop because of impaired prothrombin and fibrinogen production in the liver, as well as the absence of bile salts preventing the absorption of fat soluable vitamin K. Patients w/ chronic liver failure have a tendency to bruise easily and may progress to disseminated intravascular coagulation (DIC) or hemorrhage
clotting defects
The most serious result of portal hypertension is:
bleeding esophageal varices
Hepatic encephalopathy represents end stage liver failure and has a mortality rate as high as ______ once coma begins
90%
Serum levels that are elevated in chronic liver failure
enzymes, bilirubin, ammonia, prothrombin times
Tests done to determine liver failure
abdominal radiograph (may show ascites and enlargement of the liver), upper GI (may reveal esophageal varices or evidence of gastric inflammation or ulcers), liver scan (may be done to show abnormal liver masses or thickening), EGD (to detect bleeding and directly observe the esophagus stomach and duodenum), liver biopsy (determine the extent and nature of the liver damage)
Procedure in which a patient may get to wear a football helmet
tamponade - a temporary measure to treat bleeding varices
Inflation pressure of the esophageal balloon should be maintained at:
between 20 and 25 mm Hg
What emergency tool would you always keep at the bedside when performing Tamponade?
scissors - to cut the inflation ports in the event the balloon dislodges
Recurrence of bleeding occurs how often in patients after successful tamponade
20% to 60%
A procedure usually done as part of an EGD, in which the varices are injected to cause thickening and closing of dilated vessels, and after which the patient may complain of chest pain for up to 72 hours
sclerotherapy
An uncommon but gravely serious complication of liver disease that has a mortality rate as high as 50%
Acute (Fulminant) Liver Failure
Acute liver failure results from:
sudden massive loss of liver tissue or necrosis
The cause of acute/fulminant liver failure is usually:
drug toxicity or HBV in the presence of HDV
The outcome of Acute Liver Failure may be decided within how many hours of diagnosis?
48 to 72 hours
Possible outcomes of Acute Liver Failure
reversal, need for transplant, or death
Acute liver failure may be avoided by:
eliminating exposure to hep B or hepatotoxic liver damaging substances
Patient may suddenly lapse into exteremely serious illness starting with confusion and progressing to coma, show rapid reduction in liver size, elevation of liver enzymes and bilirubin, and encephalopathy
Acute (Fulminant) Liver Failure
Why is early diagnosis of acute liver failure essential?
to begin the process of organ procurement
Why would the patient with acute (fulminant) liver failure have metabolic alkalosis
related to disruption of the urea production cycle and resulting accumulation of bicarbonate
Why would a patient with acute (fulminant) liver failure be at risk for sepsis?
due to poor white blood cell migration and other responses to infection
Type of Hepatitis transmitted by contaminated water:
Hepatitis E
Type of hepatitis transmitted by oral-fecal contamination of water, shellfish, eating utensils, or equipment
Hepatitis A
Type of Hepatitis transmitted by blood or body fluids such as saliva, semen, breast mlk, or equipment contaminated by blood
Hepatitis B
Type of Hepatitis strongly linked with HBV
Hepatitis D
Type of Hepatitis linked to blood transusions, IV drug use, or unprotected sex
Hepatitis C
Type of Hepatitis that has no antigen test
Hepatitis E
Sometimes called "infectious hepatitis"
Hepatitis A
Sometimes called "serum hepatitis"
Hepatitis B
Sometimes called "non A Non B hepatitis"
Hepatitis C
Types of Hepatitis that have a vaccine
A, B, D
What group of people are most at risk for Hepatitis A?
military or daycare
What group of people are most at risk for Hepatitis B?
IV drug abusers, homosexuals, healthcare workers, transplant and hemo patients
What group of people are most at risk for Hepatitis C?
same as HepB
What group of people are most at risk for Hepatitis D?
same as HepB
What group of people are most at risk for Hepatitis E?
Travelers to endemic areas
How many estimated new hep A, B, and C infections are there in the US each year?
164,000
HBV has a mortality rate of:
5%
How do you destroy Hep viruses?
30 min in boiling water
How is full recovery from Hepatitis measured?
when all liver function tests have returned to normal and may take as long as 1 year
5% of hepatitis patients progress to:
acute liver failure / fulminant liver failure
HBV infected carrier patients have a greater risk of developing:
cancer of the liver
What is the primary therapeutic intervention for a patient with Hepatitis?
rest
Name the 13 most common hepatotoxic substances:
ethyl alcohol, acetaminophen (tylenol), acetylsalicylic acis (asprin), antesthetic agents like fluothane, valium (diazepam), Ilosone (erythromycin), INH (Isoniazid), Aldomet (Methyldopa), Oral contraceptives, Luminal (phenobarbital), Dilantin (Phenytoin), tranquilizers like thorazine (chlorpromazine) and industrial chemicals like carbon tetrachloride, trichloroethylene and toluene
A herniation or outpouching of the bowel mucous membrane caused by increased pressure within the colon and weakness in the bowel wall
diverticulum
a condition in which multiple diverticula are present without evidence of inflammation
diverticulosis
When food and bacteria are trapped in a diverticulum and inflammation and infection develop
diverticulitis
The development of diverticulosis is usually preceeded by this for many years
chronic constipation
Diverticulitis - Where is the pain?
usually in the lower left quadrant
Diverticulitis - How does it feel? (quality)
tender, crampy
Diverticulitis - what aggrevates and alleves it?
constipation and low fiber diets aggrevate; treatment of constipation may alleviate
Diverticulitis (onset, duration, frequencey)
gradual onset, intermittent, gradual increase in frequency of pain events
Diverticulitis - severeity of pain
usually 5-7
Diverticulitis - associated symptoms
intermittent rectal bleeding; straining at stool; constipation alternating w/ diarrhea; elevated white blood cells and sedimentation rate; elevated temperature and pulse rate; pus, mucus and blood in stool;
Diverticulitis - patient's perception
fear of diagnosis of cancer
When a patient is chronically constipated, pressure w/in the bowel is increased, leading to the development of:
diverticula
A major cause of diverticula is
decreased intake of dietary fiber
Diverticulosis is most common in the:
sigmoid colon
The most common group to experience diverticula:
people older than age 60
Diverticulitis can be prevented by:
increasing dietary fiber
The patient with diverticulosis is generally:
asymptomatic
The patient with diverticulitis generally presents:
bowel changes possibly alternating between constipation and diarrhea, steady or cramping pain in lwer left quadrant, and as it worsens, bleeding, weakness, fever, fatigue and anemia may occur
If an abscess forms within a diverticulum, it may rupture, causing:
peritonitis
What tests are used to diagnose diverticulosis:
sigmoidoscopy, colonoscopy, or barium enema
If an abscess is suspected within a diverticulum these tests can be done:
CT scan, stool specimen for occult blood, barium enema to show irregular narrowing of the colon and thickened muscle walls, or an abdominal xray examination may be done to identify a perforated diverticulum
Dietary considerations for a patient with diverticulosis (w/out evidence of inflammation) includes:
foods high in fiber ut soft (i.e. prunes, raisins, and peas)
Fiber should be increased in the diet slowly to prevent:
excess gas and cramping
A method of supplying nutrients to the patient by an IV route that is not a central vein
PPN (Peripheral Parenteral Nutrition)
What is the maximum amount of dextrose that can be administered via PPN?
12%
What are some restrictions on PPN use?
less than 10 days, no more than 2000 calories, less than 12% dextrose
TPN is also known as:
total parenteral nutrition, intravenous hyperalimentation
Method of supplying nutrients to the patient via IV route
TPN/PPN
TPN solutions are designed to:
improve nutritional status, achieve weight gain, enhance healing process
Patients with burns, trauma, cancer, AIDS, malnutrition, anorexia nervosa, fever or undergoing major surgery may need:
TPN
Who generally administers TPN
RNs
Must be used with TPN solutions but not with lipid solutions, which are given as a separate infusion along with TPN therapy
filter
Why is TPN started slowly?
to give the pancreas time to adjust to increasing insulin production for the high amounts of glucose in the TPN
What process is used when discontinuing TPN?
gradual weaning to allow the pancreas to adjust to the decreasing glucose levels, and patient is generally fed before the TPN is stopped
What is it important to monitor in a patient receiving TPN?
hyperglyxemia
What lab values are usually ordered during TPN:
CBX, albumin, glucose, electrolytes, plately count, prothrombin time
How would TPN dextrose over 12% be administered and why?
via central venous catheter into a large vein such as the subclavian or internal jugular to minimize irritation
chemicals that can conduct electricity when dissolved in water
electrolytes
fluids located inside cells
intracellular
fluids located outside cells
extracellular
fluid that is the water that surrounds the body's cells and includes lymph
interstitial
fluids in specific compartments of the body such as cerebrospinal fluid, digestive juices, and synovial fluids in joints
transcellular
plasma of the blood
intravascular
causes the kidneys to decrease fluid excretion
antidiuretic
process in which the substance moves from an area of higher concentration to an area of lower concentration
diffusion
the movement of both water and smaller molecules through a semipermeable membrane
filtration
the movement of water from an area of lower substance concentration to an area of higher concentration
osmosis
works like a screen that keeps the larger substances on one side and permits only the smaller molecules to filter to the other side
semipermeable
the force that water exerts, sometimes called water pushing pressure
hydrostatic pressure
a fluid that has the same osmolarity as the blood
isotonic
a solution that has a lower osmolarity than blood
hypotonic
exerts greater osmotic pressure than blood
hypertonic
occurs when there is not enough fluid in the body, especially in the blood (intravascular area)
dehydration
decreased blood volume
hypovolemia
excess fluid in the intravascular space
hypervolemia
edema
electrolytes that carry a positive electrical charge
cations
electrolytes that carry a negative electrical charge
anions
sodium deficit
hyponatremia
sodium excess
hypernatremia
serum pH of the blood increases so that the blood is more alkaline than usual
alkalosis (> 7.45)
serum pH of the blood deceeases, an acidic condition
acidosis (< 7.35)
when serum calcium falls below 9 mg/dL or 4.5 mEq/L
hypocalcemia
when serum calcium increases above 11mg/dL or 5.5 mEq/L
hypercalcemia
when bones become porous and brittle and fracture easily
osteoporosis
when the serum magnesium level falls below 1.5 mEq/L
hypomagnesemia
when the serum magnesium level increases above 2.5 mEq/L
hypermagnesemia
rapid shallow respirations, causing light headedness and confusion at times caused by anxiety or fear
hyperventilation
rhythmic contraction of muscles
peristalsis
stretch marks, light silver colored or thin red lines on the abdomen
striae
bluish purple swollen vein pattern extending out from the naval
caput medusae
thin reddish purple vein lines close to the skin surface
spider angiomas
yellowing of the skin and the sclerae of the eyes
icterus or jaundice
marker used to monitor GI cancer treatment effectiveness and dectects recurrence
carcinoembryonic antigen (CEA)
blood not seen with the naked eye
occult blood
excessive secretion of fecal fats
steatorrhea
an x-ray examination of the esophagus, stomach, duodenum, and jejunum using an oral liquid radiopaque contrast medium and a fluoroscope
upper gastrointestinal series (upper GI)
used to outline the contours of organs
fluoroscope
may result when the fecal mass is so dry it cannot be passed
impaction
performed to visualize the position, movements, and filling of the colon
lower gastrointestinal series (lower GI)
visualizes the esophagus
esophagoscopy
visualizes the stomach
gastroscopy
visualizes the esophagus AND the stomach
EGD (esophagogastroduodenoscopy)
Test in which abnormalities such as inflammation, cancer, bleeding, injury or infection to the esophagus, stomach or duodenum can be seen
EGD (esophagogastroduodenoscopy)
Why are patients asked to sign an operative consent and preoperative checklist made prior to an EGD
invasive procedure
What preparations are done for a patient scheduled for an EGD?
NPO 8-12 hrs, possibly sedatives given (valium or versed), atropine sulfate to dry secretions, and local anesthetic in spray or gargle form to inhibit the gag reflex
In this test, a patient is placed on the left side, flexible endoscope tube is passed orally down the GI tract and photographs or videotapes of the procedure as well as biopsy or cytology specimens can be obtained
EGD (esophagogastroduodenoscopy)
How long is a patient to remain NPO after an EGD?
until the gag reflex returns, generally within 4 hours
What is the major postoperative complication from an EGD?
perforation and bleeding
permits the physician to visualize the liver, gallbladder, and pancreas
ERCP (retrograde cholangiopancreatography)
the examination of the distal sigmoid colon, rectum, and anal canal using a rigid or flexible endoscope
proctosigmoidoscopy
provides visualization of the lining of the large intestine to identify abnormalities through a flexible endoscope which is inserted rectally
colonoscopy
a NG tube is inserted and the contents of the stomach are suctioned out through the tube using a syringe and the tube is connected to wall suction, and stomach contents are collected every 15 minutes for 1 hour
basal cell secretion test
measures the amount of gastric acid for 1 hour after subcutaneous injection of a histamine drug
gastric acid stimulation test
gavage
lavage
surgical creation of gastric fistula through the abdominal wall
gastrostomy
A method of supplying nutrients to the patient by an IV route that is not a central vein
Peripheral Parenteral Nutrition (PPN)
lack of appetite, a common symptom of many diseases
anorexia
an eating disorder where patients may have a phobia of weight gain, are afraid of a loss of control, and are mistrusting
anorexia nervosa
compulsive eating with self induced vomiting
bulemia nervosa
20% or more above ideal body weight
obesity
the most commonly used restrictive surgery for weight reduction and control
gastroplasty
a common gastric bypass surgery of two steps, in which a small pouch the size of a thumb is created with staples and a Y shaped section of the small intestine is attached to the pouch to allow food to bypass the lower stomach and duodenum
Roux-en-Y
canker sores
aphthous stomatitis
general term for inflammation of the oral cavity
stomatitis
a condition in which the lower part of the esophagus and stomach slides up through the hiatus of the diaphragm into the thorax
hiatal hernia
group of drugs that cause constipation and diarrhea
opoid analgesics
inflammation of the stomach mucosa and can be acute or chronic
gastritis
primarily caused by infection with the gram negative bacterium Helicobacter pylori (H pylori)
peptic ulcer disease (PUD)
Helicobacter pylori
used to treat cancer in the lower two thirds of the stomach
gastrectomy
procedure also known as Billroth I procedure, in which the surgeon removes the distal 75% of the stomach
gastroduodenostomy
involves removal of the distal 50% of the stomach and reanastomosis of the proximal remnant of the stomach to the proximal jejunum
Billroth II procedure, also known as gastrojejunostomy
procedure in which the surgeon removes the distal portion of the stomach and the remainder of the stomach is anastomosed
Billroth I procedure/Gastroduodenostomy
procedure used to treat gastric problems
Billroth I procedure/Gastroduodenostomy
Because it results in bypassing of the duodenum, the Billroth II procedure is used to treat:
duodenal ulcers
fat in the stool
steatorrhea
occurs when the fecal mass is held in the rectal cavity for a period that is not usual for the patient
constipation
prolonged constipation
obstipation
hemorrhoids
fissures
grossly dialated loops of the colon
megacolon
excision of the colon or a portion of it
colectomy
occurs when fecal matter passes through the intestines rapidly, resulting in decreased absorption of water, electrolytes, and nutrients and causing frequent, watery stools
diarrhea
inflammation of the colon
colitis
inflammation of the appendix, the small fingerlike appendage attached to the cecum of the large intestine
appendicitis
because of the small size of the appendix, obstruction may occur, making it susceptible to:
infection
signs and symptoms of appendicitis include:
fever, increased WBC, generalized pain in the upper abdomen, localized pain in the RLQ, nausea, vomiting and anorexia
One of the classic symptoms of appendicitis
pain at McBurney's point, midway between the umbilicus and the right iliac crest
Physical exam of the patient with appendicitis would reveal:
guarding (slight abdominal muscular rigidity), normal bowel sounds, local rebound tenderness, sometimes pain in the RLQ when the LLQ is palpated (Rovsing's sign)
If there is no evidence of perforation or peritonitis, the correct intervention for appendicitis would be:
NPO and immediate surgery, w/ ice to the site and maintaining semi fowlers to reduce pain
Why is a heating pad to the abdomen avoided in a patient w/ appendicitis?
b/c the warmth may increase inflammation and risk of rupture
Why is pain controlled post-op for a patient w/ appendicitis?
to promote early ambulation, coughing, deep breathing, and turning to prevent respiratory complications
What are the major complications of appendicitis?
perforation, abscess of the appendix, and peritonitis
How would you identify a perforated appendix?
severe pain and temp 100 or higher
a localized collection of pus seperated from the peritoneal cavity by the omentum or small bowel related to appendicitis is usually treated by:
parenteral antibiotics, surgical drainage, and appendectomy 6 wks later
inflammation of the peritoneum that occurs from a variety of causes and can be life threatening
peritonitis
hernia
a condition in which multiple diverticula are present without evidence of inflammation
diverticulosis
When food and bacteria are trapped in a diverticulum and inflammation and infection develop
diverticulitis
may be done to allow inflammation of diverticulum to subside and diseased portion of colon to rest
colostomy
an inflammatory bowel disease that can involve any part of the intestine but most commonly affects the terminal portion of the ileum, extending through the intestinal mucosa
Crohn's disease aka enteritis
fistulas
ileostomy
occurs when the bowel twists, occluding the lumen of the intestine
volvus
occurs when peristalsis causes the intestine to telescope into itself
intussusception
black and tarry stools
melena
bleeding from the colon or rectum, usually bright red
hemotochezia
the portion of bowel that is sutured onto the abdomen
stoma
an inflammation of the cells of the liver, resulting from infection by viral agents or exposure to drugs toxic to the liver or occasionally from bacterial infection
hepatitis
central nervous system dysfunction
encephalopathy
chronic liver failure, 10th leading cause of death among the total population and more common among men than women
cirrhosis
a secondary kidney failure that occurs in about one third of liver failure patients
hepatorenal syndrome
an accumulation of serous fluid in the abdominal cavity
ascites
persistent blood pressure elevation in the portal circulation of the abdomen
portal hypertension
flapping tremors in the hands caused by toxins at the peripheral nerves
aterixis
foul odor caused by metabolic endproducts related to sulfur
fetor hepaticus
a nonsurgically placed shunt between the portal and systemic venous systems that may be used to treat ascites
transjugular intrahepatic portosystemic shunt (TIPS)
T-tube
gallstones, which may trigger pancreatitis
cholelithiasis
inflammation of the bile ducts, which may trigger pancreatitis
cholangitis
removal of all or part of the pancreas
pancreatectomy
characterized by the formation of gallstones in the gallbladder that are usually composed primarily of cholesterol
cholethiasis
an acute or chronic inflammation of the gallbladder
cholecystitis
refers to gallstones in the common bile ducts
choledocholithiasis
colic
laparascopy
procedure involves the use of a n endoscope to explore the common bile duct and possibly snare and remove stones found
choledochoscopy
uses shock waves as a noninvasive method to destroy stones in the gallbladder or biliary ducts
ESWL (extracorporeal shock wave lithotripsy)
most common type of hiatal hernai in which the stomach slides up into the thoracic cavity when a patient is supine and then usually goes back into the abdominal cavity when the patient stands upright
sliding hiatal hernia
People with hiatal hernia often have this other disease as well
GERD (gastrointestinal reflux disease)
Most common people to be diagnosed with a hiatal hernia
women, people over 60, obese, or pregnant
Symptoms and signs of a large hernia can include:
pain, heartburn, feeling of fullness, or reflex
This can injure the esophagus with possible ulceration and bleeding
hiatal hernia
A hiatal hernia is diagnosed by:
x-ray studies and fluoroscopy
Medical treatment for a symptomatic hiatal hernia:
antacids, eating small meals, not reclining for 1 hour after eating, elevating head of the bed 6 to 12 inches, avoiding bedtime snacks, spicy foods, alcohol, caffeine, and smoking
Procedure in which the stomach fundus is wrapped around the lower part of the esophagus, the most common surgical procedure performed for hiatal hernias
fundoplication
Why would the physician be notified if a patient appeared to have dysphagia following a fundoplication?
b/c the repair might be too tight causing obstruction to passage of food
Peptic ulcer disease (PUD) is primarly caused by:
gram-negative bacterium Helicobacter pylori
responsible for 80% of gastric ulcers and more than 90% of duodenal ulcers
H. pylori
Two thirds of all people are infected with:
H. pylori
Risk factors that contribute to PUD include:
smoking, chewing tobacco, stress, caffeine, or medications such as steriods, aspirin, and NSAIDS
Increases the harmful effects of H. pylori, alters protective mechanisms and decreases gastric blood flow
smoking
H. pylori can be cured by:
antibiotics
a condition in which the lining of the stomach, pyloruys, duodenum or esophagus is eroded
peptic ulcer disease (PUD)
Peptic ulcers occur in the portions of the gastrointestinal tract that are exposed to:
hydrochloric acid and pepsin
Ulcers are named by:
their location
Two noninvasive tests for H. pylori
urea breath test and IgG antibody detection test
The most conclusive test for H. pylori
CLO - campylobacter-like organism biopsy
Peptic ulcers are diagnosed on the basis of:
symptoms, upper GI, endoscopy, and EGD
what is "triple therapy"? As a medication regimen for H. pylori.
three antibiotics (Amoxil, Biaxin, Prilosec) or two antibiotics (amoxil & biaxin) and a proton pump inhibitor (Prevacid)
What is "dual therapy"? As a medication regimen for H. pylori.
Antibiotic and proton pump inhibitor (Biaxin and Prilosec or Amoxil and Prevacid), or an antibiotic and H2 antagonist (Biaxin & Tritec)
Treatment for PUD lasting ______ days has better eradication rates than a ______ day treatment
14 / 10
may be used in PUD treatment for its antibacterial effects
Pepto Bismol (Bismuth subsalicylate)
Powerful agents that stop the final step of gastric acid secretion to reduce mucosa erosion and aid in healing ulcers
proton pump inhibitor
block K2 receptors to decrease acid secretions, although not as powerfully as gastric acid pump inhibitors
H2 antagonists
Major complications that can result from PUD include:
bleeding, perforation, and obstruction
A medication used to stop bleeding:
vasopressin
A perforated ulcer usually requires:
surgical intervention (medical emergency)
Used to correct an obstruction from peptic ulcer disease
pyloroplasty
may develop for a small number of patients who are critically ill
gastric or small intestinal stress ulcers
The stress response to illness causes reduced blood flow to the stomach and small intestine, resulting in:
ischema and damage to the mucosa
Why do stress ulcers have a high mortality rate?
b/c they have multiple bleeding ulcer sites