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73 Cards in this Set
- Front
- Back
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Causes of pancreatitis |
acute cause: alcohol & gallbladder disease chronic cause: alcohol |
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S&S of pancreatitis |
pain increases when eating; rigid board-like abdomen; fever; n/v; abdominal mass; ascites; hypotension |
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Dx of pancreatitis |
increased serum lipase and amylase; increased WBC; high blood sugar; ALT AST liver enzymes increase bilirubin increase; |
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Normal lab value H&H |
hemoglobin male: 14-18 female: 12-16 hematocrit male: 42-52 female: 37-47 |
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Normal lab value for amylase |
30-220 |
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Normal lab value for lipase |
0-110 |
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Tx for pancreatitis |
1. control pain by - decreasing gastric secretions (NPO, NGT) which keeps stomach dry and empty - morphine, fentanyl patches 2. give steroids (decrease inflammation) 3. anticholinergics (dries up) - benztropine, atropine, diphenoxylate 4. GI protectants |
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GI protectants |
pantoprazole, ranitidine, famotidine, antacids |
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Why do you want to give insulin to someone with pancreatitis? |
- steroids make BG go up - pancreas are sick so might not produce it - may be getting TPN |
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4 major function of the liver |
- makes clotting factors - synthesizes albumin - breaks down drugs - detoxifies body |
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What is the antidote for Tylenol overdose? |
Mucomyst |
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What is the cause of portal HTN? |
scar liver tissue that alters circulation |
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S&S of cirrhosis |
firm, nodular liver abdominal pain GI upset change in bowel habits ascites splenomegaly decrease in serum albumin increase in ALT & AST anemia can progress to hepatic encephalopathy/coma |
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NH4 acts like? |
sedative |
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Dx of cirrhosis |
liver biopsy - clotting studies pre-procedure: PT, INR, aPTT |
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how do you position liver biopsy pt? |
supine; right arm behind head exhale and hold breath to get diaphragm out of the way |
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post-liver biopsy procedure |
lie on the right side; worry about bleeding |
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Tx of cirrhosis |
antacids, vitamins, diuretics; prevent bleeding; measure abdominal girth; paracentesis; good skin care for jaundice; avoid narcotics because liver cannot metabolize; decrease protein (increases NH4); low Na diet |
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what are you worried about for paracentesis? |
throwing them into shock |
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Protein breaks down into |
ammonia |
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What converts ammonia (NH4) into urea? |
liver |
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What excretes urea? |
kidneys |
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S&S of hepatic coma |
decreased LOC; difficult to awake; asterixis; decreased reflexes; breath smells like acetone; GI bleeders |
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Tx of hepatic coma |
lactulose (decrease NH4) cleansing enemas (removes old blood) decreases protein in the diet monitor serum NH4 |
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explain bleeding esophageal varices |
portal HTN causes collateral circulation to form in the esophagus |
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When does bleeding esophageal varices become a problem? |
ruptures |
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Tx of bleeding esophageal varices |
replace blood; vital signs; CVP; oxygen (anemic); balloon tamponade; cleansing enema; lactulose saline lavage |
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what is the common cause of GI bleeding? |
peptic ulcers |
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where can you find peptic ulcers? |
esophagus, stomach, duodenum |
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S&S of peptic ulcers |
burning pain in mid-epigastric area heartburn |
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Dx of peptic ulcers |
gastroscopy - EGD or endoscopy upper GI |
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pre-procedure gastroscopy? |
NPO; sedated |
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post-procedure gastroscopy? |
NPO until gag reflex returns; watch for perforation by watching for PAIN or bleeding |
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Tx of bleeding esophageal varies - meds & - teaching |
liquid antacids (coats stomach); proton pump inhibitors H2 antagonist antibiotics for H. Pylori decrease stress stop smoking follow up for a year avoid extra spicy food or caffeine or extremes |
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when do you take antacids? |
when stomach is empty and at bedtime so antacid can get on the ulcer |
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proton pump inhibitors |
omeprazole, lansoprazole, pantoprazole, esomeprazole |
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H2 antagonist |
ranitidine; famotidine |
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explain hiatal hernia & cause |
hole in diaphragm so large hat stomach moves up into the thoracic cavity; large abdomen is cause |
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S&S of hiatal hernia |
heartburn; fullness after eating; regurgitation; dysphagia (difficulty swallowing) |
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Tx of hiatal hernia |
KEEP STOMACH DOWN: small frequent meals; sit up 1 hour after eating; elevate HOB surgery |
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explain dumping syndrome |
stomach empties too quickly after eating secondary to gastric bypass, gastrectomy |
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S&S of dumping syndrome |
fullness; cramping; faintness; diarrhea; weakness; palpitations |
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Tx of dumping syndrome |
semi-recumbent with meals; LIE DOWN after meals; no fluids with meals; small and frequent meal; avoid high carbs and high electrolytes because they empty fast |
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which side of stomach do you lay on to keep food in? |
left side |
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which side of stomach do you lay on to release food? |
right side |
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explain ulcerative colitis |
large intestine inflammatory bowel disease |
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crohn's disease |
inflammation and erosion of the ileum but can be found anywhere in the small or large intestines |
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S&S of crohn's or ulcerative colitis |
diarrhea; rectal bleeding; weight loss; vomiting; fever; cramping; dehydration; rebound tenderness |
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what does rebound tenderness indicate? |
peritoneal inflammation |
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dx of ulcerative colitis or CRohn's |
colonscopy; CT; barium enema |
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pre-procedure colonoscopy |
clear liquid diet for 12-24 hours; NPO 6-8 hours pre-procedure; avoid NSAIDs; laxatives or enemas until clear polyethylene glycol drink; sedation; |
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post-op colonoscopy WARNING SIGN |
pain or discomfort - PERFORATION! |
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Tx of ulcerative colitis or CRohn's - diet & meds |
DIET: low fiber to limit GI motility to save fluids; avoid extreme foods and smoking because they can all increase motility MEDS: antidiarrheals; antibiotics; steroids |
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Surgery for ulcerative colitis |
J pouch or Koch's |
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Surgery for CrohnS |
may remove only affected area; ileostomy or colostomy |
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ileostomy care |
drain liquids so don't have to irrigate; avoid hard to digest foods; gatorade; stay hydrated |
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colostomy care |
you irrigate for descending and sigmoid for regularity |
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what type of stool will ascending and transverse colon have? |
semi liquid stools |
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what position do you lie when you are irrigating an ostomy? or doing an enema? |
lying on the left side |
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if the pt gets a cramp while giving an enema, what do you do? |
stop the fluids and lower the bag OR check temperature of the fluid |
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after intermittent bolus feeding, which side do you lie pt on? |
right side because it empties well |
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cause of appendicitis |
low fibers diet |
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S&S of appendicitis |
localized RLQ pain (McBurney's point) rebound tenderness nv anorexia |
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if appendix ruptures, the pt can go into |
sepsis |
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if appendix ruptures, place pt in |
right side bc bowel contents will stay confined |
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what do you NOT give to appendicitis Pts? |
enema or laxatives because you don't want to cause perforation |
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Tx of appendicitis |
laparoscope surgery |
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after appendectomy, what position? |
elevate HOB; decrease pressure on abdomen |
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what is needed for TPN? |
central line; filter; dedicated line; 24 hour hung; tubing change with new bag; blood sugar check q6; taking insulin |
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when assisting physician to insert a central line, what position does the pt need to be in? |
trendelenberg to distend veins |
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if air gets into the line, what position is pt in? |
left side trendelenberg |
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how do you avoid getting air in the central line? |
clamp it off; valsalva; deep breath and hum |
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what do we check for in X-ray of central line? |
placement; no pneumothorax |
