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Med/Surg-Inflamm.
Inflammation
| Question | Answer |
|---|---|
| localized reaction intended to neutralize, control, or eliminate the offending agent to prepare the site for repair | inflammation |
| a nonspecific response (not dependent on a particular cause) meant to serve a protective function; ie-may be observed at site of a bee sting, in a sore throat, in a surgical incision, at a burn site; also occurs in cell injury events (ie-stroke, DVT, MI) | inflammation |
| sequence of events: vasodilation, increased vascular permeability, and leukocytic cellular infiltration | inflammatory response |
| the most common sign of a systemic response to injury, and it is most likely caused by endogenous pyrogens released from neutrophils and macrophages (specialized forms of leukocytes) | fever |
| local vascular and exudative changes; usually lasts <2 weeks; response is immediate and serves a protective function; after the causative agent is removed, Sx subside and healing takes place with return of normal/near-normal structure and function | acute inflammation |
| develops if injurious agent persists & acute response is perpetuated; Sx may be present for many months/years; may also begin insidiously and never have an acute phase; it is debilitating & can produce long-lasting effects | chronic inflammation |
| begins at approx same time as injury; healing proceeds after inflammatory debris has been removed; healing occurs by regeneration or replacement | reparative process |
| defect is gradually repaired by proliferation of the same type of cells as those destroyed | regeneration |
| cells of another type, usually connective tissue, fill in the tissue defect and result in scar formation | replacement |
| risk factors: family Hx, race (Caucasian, Ashkenazi Jewish), geography (northern climate, urban areas), age, smoking, sex | IBD |
| transmural ulcers (deepen/extend through layers), “cobblestone” appearance, “skip” lesions; fistulas, fissures, and abscesses form as inflammation extends into peritoneum; granulomas and intestinal lumen narrows in later disease | Crohn's |
| usually occurs in distal ileum, but can be anywhere throughout GI tract; less diarrhea and bleeding; common fistula formation | Crohn's |
| RLQ pain; usually no bleeding to mild bleeding; perianal involvement, fistulas, abd mass common; less severe diarrhea (steatorrhea) | Crohn's |
| barium study of upper GI tract (“string sign”)---CT and MRI now preferred; colonoscopy; labs: CBC (decreased H&H, elevated WBC), elevated ESR , albumin and protein levels decreased (malnutrition) | Crohn's |
| complications: intestinal obstruction, perianal disease, fluid/electrolyte imbalances, mal-absorption/nutrition, fistula/abscess, increased risk of colon CA, Rt-sided hydronephrosis, nephrolithiasis, cholelithiasis, arthritis, uveitis, erythema nodosum | Crohn's |
| most common small bowel fistula from Crohn’s? | enterocutaneous fistula |
| Tx: corticosteroids, immunomodulators or monoclonal antibodies (Remicade, Humira), ATBs, TPN, partial/complete colectomy (w/ileostomy or anastomosis), rectum can be preserved in some pts, recurrence common | Crohn's |
| unpredictable periods of remission and exacerbation w/bouts of abd cramps and bloody/purulent diarrhea; mucosal and submucosal ulcerations; usually in rectum and descending colon (limited to large intestine) in a continuous pattern | Ulcerative Colitis |
| superficial mucosa of colon has multiple ulcerations/diffuse inflammations/shedding of colonic epithelium; cont. ulcers; bleeding occurs from ulcers; mucosa becomes red/inflamed; bowel narrows/shortens/thickens b/c of muscular hypertrophy and fat deposits | Ulcerative Colitis |
| not common for abscesses, fistulas, fissures, abd mass, perianal involvement as only the superficial layer is affected | Ulcerative Colitis |
| diarrhea w/mucus/pus/blood; LLQ pain and int. tenesmus; bleeding may be mild or severe (pallor, anemia, fatigue); anorexia, weight loss, fever, vomiting, dehydration; passage of 6+ liquid stools/day; hypoalbuminemia, electrolyte imbalances; | Ulcerative Colitis |
| abd x-ray (to determine cause of Sx); colonoscopy (definitive test); CT, MRI, US can identify abscesses/perirectal involvement; labs: CBC (low H&H, elevated WBC), low albumin, BMP/CMP, CRP elevated; stool exam (blood; to rule out dysentery) | Ulcerative Colitis |
| Tx: corticosteroids; immunomodulators or monoclonal antibodies (Remicade, Humira); bulk hydrophilic agents; ATBs; proctocolectomy w/ileostomy; rectum can be preserved in only a few patients “cured” by colectomy | Ulcerative Colitis |
| complications: toxic megacolon; perforation; hemorrhage; colon cancer; pyelonephritis; nephrolithiasis; cholangiocarcinoma; arthritis; uveitis; erythema nodosum | Ulcerative Colitis |
| IBD diet | low-residue, low-fat, high-protein, high-calorie diet w/supplemental vitamin therapy and iron replacement; avoid cold foods; possible parenteral nutrition |
| What pain med do you NOT give for IBD? | NSAIDs (provokes IBD activity---can lead to hospitalizations) |
| Surgical Management for IBD: usually temporary but sometimes permanent; allows for drainage of fecal matter from ileum to outside of body | total colectomy with ileostomy |
| Surgical Mgmt for IBD: diverts portion of distal ileum to abd wall-->stoma; eliminates need for external fecal collection bag; GI effluent collects in pouch for several hours--removed by means of catheter inserted through nipple valve (often malfunctions) | continent ileostomy (rarely performed); Kock pouch |
| diseased colon/rectum removed, voluntary defecation maintained, anal continence preserved; procedure of choice (rectum preserved--eliminates need for perm. ileostomy); ileal reservoir is “new rectum”--decreased # BMs; anal sphincter control is retained | restorative proctocolectomy with ileal pouch anal anastomosis (IPAA) |
| normal H&H ranges for men and women? | Hgb 13.5-17.5 men and 12-15 women; Hct 45-52% men and 37-48% women |
| normal WBC range? | 4000-11000 |
| bowel sounds hyper- or hypo-active with IBD? | hyperactive |
| Nursing Process--IBD--Assessment | -health Hx (onset/duration/characteristics pain, urgency, tenesmus, N/V/D, anorexia, wt loss, bleeding, family Hx, smoking -discuss diet--ETOH, caffeine -assess BM patterns and stool (blood, pus, fat, mucus?) -allergies? food intolerance? -assess abd |
| Nursing Process--IBD--Diagnoses | -diarrhea -acute pain -deficient fluid -imbalanced nutrition -activity intolerance -anxiety -ineffective coping -risk for impaired skin integrity -risk for ineffective therapeutic regimen management -deficient knowledge |
| Nursing Process--IBD--Planning/Goals | -attainment of normal BM patterns -relief of abd pain/cramping -prevent fluid deficit -maintain optimal nutrition/wt -avoidance of fatigue -reduce anxiety -promotion of effective coping -absence of skin breakdown -avoidance of complications |
| occurs most commonly between 10-30 years of age; most frequent cause of acute abdomen in the US; most common reason for emergency abdominal surgery | appendicitis |
| area becomes inflamed/edematous as a result of becoming kinked or occluded by a fecalith (hardened mass of stool), lymphoid hyperplasia (secondary to inflammation or infection), or rarely, foreign bodies (ie-fruit seeds) or tumors | appendicitis |
| inflammatory process increases intraluminal pressure, causing edema and obstruction of the orifice; once obstructed, area becomes ischemic, bacterial overgrowth occurs, and eventually gangrene or perforation occurs | appendicitis |
| appendicitis S/Sx | vague periumbilical pain that progresses to RLQ; N/V; low-grade fever; local tenderness at McBurney point when pressure applied; rebound tenderness; Rovsing sign--palpate LLQ-->pain felt in RLQ |
| If pt w/appendicitis has constipation is it ok to give a laxative or cathartic? | no---laxative may result in perforation of inflamed appendix (don't give laxative/cathartic to pt's with fever, nausea, and abd pain) |
| diagnosing appendicitis | complete H&P; labs: CBC (elevated WBC), CRP (elevated); CT scan |
| complications of appendicitis | gangrene or perforation of appendix can lead to ***peritonitis, ***abscesses, portal pylephlebitis (septic thrombosis of portal vein caused by vegetative emboli that arise from septic intestines) |
| Medical Management: surgery (laparotomy or laparoscopy); sometimes delayed d/t abscess formation (drained percutaneously or surgically); IV fluids; ATBs | appendicitis |
| nursing management of appendicitis | pain; fluid volume deficit; anxiety; surgical site infection; atelectasis post-op (high Fowler, IS); skin integrity; nutrition (NPO until p BS present/passing flatus); ambulation (atelectasis, clots); no enemas; normal activity usually w/in 2-4 wks |
| five cardinal signs of inflammation | redness, warmth, swelling, pain, loss of function |
| calculi in the gallbladder; usually form from solid constituents of bile; vary greatly in size/shape/composition; two major types: those composed mostly of pigment and those composed mostly of cholesterol (most common) | cholelithiasis |
| Sx: none or minimal symptoms; acute or chronic; RUQ pain that radiates to back or Rt shoulder; biliary colic (usually w/N/V); jaundice; changes in urine (very dark color) or stool (grayish or clay colored); vitamin def (fat soluble vitamins A, D, E, K) | cholelithiasis |
| cholelithiasis diagnostic procedure of choice | ultrasound |
| not recommended for the evaluation of suspected common bile duct stones but can be used to treat confirmed choledocholithiasis before or during laparoscopic cholecystectomy | Endoscopic retrograde cholangiopancreatography (ERCP) |
| dietary management for cholelithiasis | NPO, NG suctioning then soft, low-fat, high-carb diet (potatoes, bread, plain pasta); avoid—eggs, cream, pork, fried foods, cheese, rich dressings, gas-forming veggies, alcohol |
| standard of therapy for symptomatic gallstones | laparoscopic cholecystectomy |
| Nursing Process: Cholelithiasis---Assessment | -Resp status and risk factors for resp complications post-op -Nutritional status -Monitor for potential bleeding -GI Sx: after surgery, assess for loss of appetite, vomiting, pain, distention, fever—potential infection or disruption of GI tract |
| Nursing Process: Cholelithiasis---Diagnosis | -Acute pain/discomfort -Impaired gas exchange -Impaired skin integrity -Imbalanced nutrition -Deficient knowledge |
| Nursing Process: Cholelithiasis---Planning | -Relief of pain -Adequate ventilation -Deep breathing and cough -IS -Early ambulation -Intact skin -Improved biliary drainage -Optimal nutritional intake -Absence of complications -Understands self-care routines |
| cholelithiasis potential complications | -Bleeding -GI Sx (may be r/t biliary leak or injury to bowel) -After laparoscopic cholecystectomy: poss. anorexia, vomiting, pain, abd distention, temp elevation -R/t surgery in general: atelectasis, thrombophlebitis |
| cholelithiasis: more frequent in men or women? | women |
| type of pancreatitis that is a medical emergency | acute pancreatitis |
| common causes of pancreatitis | gallstones or chronic alcohol abuse (80% of cases) |
| criteria for predicting severity of pancreatitis: criteria on admission to hospital | •Age >55 years •WBCs >16,000 •Serum glucose >200 mg/dL •Serum lactose dehydrogenase (LDH) >350 IU/L (>350 U/L) •AST >250 IU/L |
| criteria for predicting severity of pancreatitis: criteria within 48-hours of hospital admission | • Fall in HCT >10% (>0.10) • BUN increase >5 mg/dL (>1.7 mmol/L) • Serum calcium <8 mg/dL (<2 mmol/L) • Base deficit >4 mEq/L (>4 mmol/L) • Fluid retention or sequestration >6 L • PO2 <60 mmHg |
| Sx: severe abd/mid-epigastric pain & tenderness to back; abd distention; poorly defined, palpable abd mass; decreased peristalsis; N/V; rigid/boardlike abd (peritonitis); fever | acute pancreatitis |
| labs for pancreatitis | -amylase (rises within 2-12 hours and returns to normal in 48-72 hours) -lipase (elevates within 24 hours, but remains elevated longer than amylase) -CMP/BMP for electrolytes -CBC (elevated WBC; H&H to monitor for bleeding) |
| diagnostic (radiology) tests for pancreatitis | abd xray, US, CT scan, MRI |
| medical management for pancreatitis | -pain control (opioids; no meperidine/Demerol--toxic metabolites--seizures) -NPO -NG suction -resp care (hypoxemia common) -biliary drain -H2s, PPIs (decrease pancreatic activity by inhibiting secretion of gastric acid) -IV fluids -surgery |
| pancreatitis diet | low-fat, high-protein |
| progressive inflammatory disorder w/destruction of pancreas | chronic pancreatitis |
| common cause of chronic pancreatitis | ETOH |
| Sx: recurring attacks of severe abd & back pain, often w/emesis; opioid dependence (attacks so painful that opioids ineffective—even in large doses); wt loss; malabsorption/malnutrition; steatorrhea; calcium stones may form within duct | chronic pancreatitis |
| diagnostic procedures: ERCP (most useful), MRI, CT scan, US, glucose tolerance tests | chronic pancreatitis |
| Tx aimed at preventing/managing acute attacks, pain relief, managing exocrine/endocrine insufficiency | chronic pancreatitis |
| problems/complications are: fluid and electrolyte disturbances; necrosis of organ; shock; multiple organ dysfunction syndrome (MODS); bleeding/DIC | chronic pancreatitis |
| causes: bacterial or viral infection | glomerulonephritis |
| Sx: varies; renal insufficiency or failure, HTN, edema, red or cola-colored urine, proteinuria (foamy), hypoalbuminemia Chronic: can be asymptomatic for years as damage increases before S/Sx develop | chronic glomerulonephritis |
| diet for chronic glomerulonephritis | -proteins of high biologic value (dairy products, eggs, meats)---to promote good nutritional status -adequate calories---to spare protein for tissue growth and repair |
| a type of kidney disease characterized by increased glomerular permeability and is manifested by massive proteinuria | nephrotic syndrome |
| although liver is capable of increasing the production of albumin, it cannot keep up with the daily loss of albumin through the kidneys; thus, _______ results | hypoalbuminemia |
| causes include chronic glomerulonephritis, diabetes mellitus with intercapillary glomerulosclerosis, amyloidosis, lupus erythematosus, multiple myeloma, and renal vein thrombosis | nephrotic syndrome |
| Sx: ***edema, proteinuria, hypoalbuminema also: irritability, HA, malaise; high serum cholesterol, hyperlipidemia | nephrotic syndrome |
| assessment/diagnostic findings: proteinuria (hallmark), increased WBCs and granular & epithelial casts in urine, needle biopsy for histo exam---to confirm diagnosis | nephrotic syndrome |
| complications: infection (d/t deficient immune response), thromboembolism (esp. of renal vein), pulmonary embolism, AKI (d/t hypovolemia), accelerated atherosclerosis (d/t hyperlipidemia) | nephrotic syndrome |
| medical management: address underlying disease state causing proteinuria, slow progression of CKD, relieving Sx (diuretics for edema, ACE inhibitors to reduce proteinuria, lipid-lowering agents, steroids) | nephrotic syndrome |
| careful regulation of: proteins (allowed: dairy products, eggs, meats), fluids, sodium; some restriction of potassium; adequate caloric (carbs, fats) intake and vitamin supplements; fluids: ~500-600mL more than previous day’s 24-hour urine output | nephrotic syndrome |
| erosion of a circumscribed area of mucosa; occurs in esophagus, stomach, or (most likely in) duodenum | peptic ulcer disease |
| clinically different from peptic ulcers; most common in patients who are ventilator-dependent after trauma or surgery; when pt recovers, lesions are reversed | stress ulcers |
| may occur in esophagus, stomach, or duodenum; usually deeper and more penetrating than typical stress ulcers; frequently observed about 72-hrs after extensive burn injuries and often involves antrum of stomach or duodenum | Curling ulcer |
| type of ulcer? may occur in esophagus, stomach, or duodenum; usually deeper and more penetrating than typical stress ulcers; traumatic head injuries, stroke, brain tumor, or following intracranial surgery; thought to be caused by increased ICP | Cushing ulcer |
| cause: H. pylori infections (most common cause); NSAID use (esp. when combined with H. pylori); poss. smoking and ETOH; familial tendency, blood type O, associated w/some chronic diseases (COPD, cirrhosis of liver, CKD) | peptic ulcer disease |
| Sx: may last a few days, weeks, or months and may disappear only to reappear, often w/o an identifiable cause; many asymptomatic; dull, gnawing pain or burning sensation in mid-epigastrium or the back, pyrosis, N/V, constipation or diarrhea, GI bleeding | peptic ulcer disease |
| onset of pain with gastric ulcers and with duodenal ulcers | -gastric ulcers—pain immediately after eating -duodenal ulcers—2-3 hrs after meals |
| assessment/diagnostic findings: upper endoscopy (preferred); H. pylori (endo w/histo exam, rapid urease test of biopsy, serologic testing, stool antigen test, urea breath test); CBC (H&H---determine extent of blood loss); hemoccult | peptic ulcer disease |
| meds for Tx of peptic ulcer disease; meds to avoid | ATBs, PPIs, bismuth salts, H2 blockers (Ranitidine, Famotidine); most commonly used therapy is a combo of these meds; avoid ASA and other NSAIDs |
| why is smoking cessation important for peptic ulcer disease? | -decreases secretion of bicarb from pancreas into duodenum resulting in... -increased activity of duodenum (increased peristalsis) -smoking also delays healing of ulcers |
| dietary management of peptic ulcer disease | avoid extremes of food/drink temp, ETOH, coffee (including decaf), caffeinated beverages; eat three regular meals/day---small/frequent meals not necessary as long as antacid or H2 blocker is taken |
| intractable ulcers can lead to? | peritonitis |
| nursing assessment for peptic ulcer disease | -assess pain and methods used to relieve pain -recent h/o emesis? freq? characteristics? -dietary intake and 72-hr diet diary -cigarettes? ETOH? -meds? use of NSAIDs? -S/Sx of anemia or bleeding? -family Hx? -abd assessment |
| complications of peptic ulcer disease | -hemorrhage -penetration -perforation -gastric outlet obstruction |
| sac-like herniation of the lining of the bowel that extends through a defect in the muscle layer; may occur anywhere in the intestine but most common in the sigmoid colon | diverticulum |
| multiple diverticula without inflammation or symptoms | diverticulosis |
| increases with age and is associated with a low-fiber diet, obesity, h/o smoking, regular use of NSAIDs and APAP, and positive family hx | diverticular disease |
| diverticulum becomes inflamed, causing perforation, and potential complications such as obstruction, abscess, fistula (abnormal tract) formation, peritonitis, and hemorrhage | diverticulitis |
| Sx: chronic constipation sometimes precedes; most asymptomatic; some have mild S/Sx (bowel irregularity, nausea, anorexia, bloating or abd distention) | diverticulosis |
| Sx: mild to severe LLQ pain, change in bowel habits (usually constipation), nausea, fever, leukocytosis; acute--abscesses, hemorrhage, peritonitis; chronic--fistulas, colon narrows (cramps, narrow stools, increased constipation, intestinal obstruction) | diverticulitis |
| perforation can lead to? | peritonitis |
| diagnosis is usually by colonoscopy; labs: CBC (elevated WBC), H&H, UA/C&S if suspected colovesicular fistula (b/w colon and bladder); Abd CT scan | diverticular disease (Abd CT scan is diagnostic test of choice to confirm diverticulitis) |
| medical management: -depends on Sx -diet: clear liquid diet until inflammation subsides, then soft, high-fiber, low-fat diet -rest, oral fluids, analgesics, ATBs, steroids | diverticular disease |
| first three things you do when administering a blood transfusion | medical order, informed consent, pretransfusion meds |
| when should you administer pretransfusion med(s)? | ~30-mins before initiating blood transfusion |
| ask pt what before initiating blood transfusion? | previous experience(s) w/transfusion and any reactions |
| pt to report what during blood transfusion? | chills, itching, rash, unusual symptoms |
| what med runs with blood transfusion? | normal saline (NO dextrose---can coagulate blood!) |
| who (and how many) should compare and validate info at pt's bedside when initiating blood transfusions? | two RNs |
| Two RNs should compare and validate what at pt's bedside when administering blood products? | -order -informed consent -pt id # -pt name -blood group and type -expiration date -inspect blood product for clots, clumping, gas bubbles |
| blood product transfusion: obtain baseline vital signs when? | before beginning transfusion |
| blood product transfusion: obtain VS how often? | every 5-mins x 3 (at start of infusion), then every 15-mins for 1st hour, then every 30-mins after 1st hour until transfusion complete, once infusion is done, then every 30-mins after transfusion done |
| blood product transfusion: observe pt for what during transfusion? | infiltration, flushing, dyspnea, itching, hives, rash, any usual comments |
| blood product transfusion: max. time for transfusion | 4-hours |
| blood product transfusion: increase infusion rate when? | after observation period (first 15-mins of transfusion) |
| blood product transfusion: what do you do for transfusion reaction? | stop transfusion, quickly replace tubing with new set for normal saline (at 40-50mL/hr), obtain VS, notify ordering provider and blood bank |
| blood product transfusion: monitor and assess pt for what after transfusion? (you would also instruct pt on this) | delayed transfusion reaction |
| universal blood donor? | O- |
| universal blood recipient? | AB+ |
| antigen and antibody for blood type A | antigen-A antibody-B |
| antigen and antibody for blood type B | antigen-B antibody-A |
| antigen and antibody for blood type AB | antigen-AB antibody-none |
| antigen and antibody for blood type O | antigen-none antibody-A&B |
| blood: Rh factor matters when mom is Rh what and baby is Rh what? | mom Rh- baby Rh+ |
| Most common site for peptic ulcer formation? | duodenum |
| The use of NSAIDs such as ____ and ____ is a major risk factor for peptic ulcer disease. | ibuprofen, aspirin |
| The most common complication of peptic ulcer disease is ____. | hemorrhage |
| _____ is the preferred diagnostic procedure for peptic ulcers. | upper endoscopy |
| ____ is the bacillus commonly associated with the formation of gastric, and possibly duodenal, ulcers. | H. pylori |
| disease of the colon commonly associated with constipation | diverticular disease |
| The most common site for the presence of diverticulitis is the ____. | sigmoid colon |
| What four complications are associated with diverticulitis? | peritonitis, abscesses, fistulas, and bleeding |
Created by:
nurse savage
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