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EXAM 2 - MED SURG
OBSTRUCTIONS, DISORDERS OF GI TRACT, TUBE FEEDINGS
| Question | Answer |
|---|---|
| Assessment and clinical manifestations of SBO | Excessive Increased Nausea & Vomiting, Increased Distention, Decreased BM - Symptoms: Increased bowel sounds, colicky abdominal pain, marked distension early on - Leading Cause: Adhesion - Other Causes: Hernia, cancer, stricture, other (rare) - treatment is supportive (IVF, NPO, NG Decompression), and then if needed surgery (<50%) |
| Assessment and clinical manifestations of LBO | Increased Nausea, Vomiting, Excessive Increased Distention, Decreased BM - Symptoms: Decreased/Absent bowel sounds, may complain of constipation for weeks in advance, marked distension occurs later, bowel may be visible or palpated through abdominal wall - Leading Cause: Cancer - Other Causes: Volvulus, Stricture, Adhesive, Other (rare) - Treatment is surgery (<50%), and then supportive (IVF, NPO), Decompression is contradicted except in sigmoid volvulus |
| Intussusception complications & (population most affected?) | intestinal obstruction, dehydration, lack of blood flow to the part of the intestine, peritonitis, sepsis, shock. Babies and young children are more likely than adults to get it. Most common in babies younger than 1 |
| peritonitis complications | Two complications may develop if intervention is delayed. When inflammation persists, nerve conduction is impaired and peristalsis decreases, leading to obstruction of the intestines (paralytic ileus). The inflamed membranes permit intestinal bacteria and toxic materials to migrate into the blood and then into the general circulation, which may lead to septicemia. |
| umbilical hernia complications | Obstruction, when the section of the bowel becomes stuck outside the abdomen, causing nausea, vomiting and pain. Strangulations where a section of the bowel becomes trapped and its blood supply is cut off. Requires emergency surgery within hours to release trapped tissue so it does not die |
| complications of untreated infection of the appendix | May burst, cause peritonitis, infect other organs, and can sometimes lead to death. |
| Peritonitis | Inflammation of the peritoneum which is the serous membrane lining the abdominal cavity and covering the viscera. Inflammation, infection, trauma, or tumor perforation. Turbid fluid in peritoneal cavity, increasing amounts of protein, WBC, cellular debris, and blood. Immediate response is hypermotility soon followed by paralytic ileus with accumulation of air and fluid in the bowel |
| Primary Peritonitis | Spontaneous Bacterial Peritonitis (SBP) occurs as a result of spontaneous bacterial infection of ascetic fluid. Occurs most commonly in adult patients with liver failure |
| Secondary Peritonitis | occurs secondary to perforation of abdominal organs with spillage that infects the serous peritoneum. Most common is perforated appendix, perforated peptic ulcer, perforated sigmoid colon by severe diverticulitis, volvulus of the colon, and strangulation of small intestine |
| Tertiary Peritonitis | occurs as a result of a superinfection in a patient who is immunocompromised. Tuberculous peritonitis in patients with AIDS is an example. These are rare |
| Signs and Symptoms of Peritonitis | Early signs are manifestations the same as infections, pain is diffuse, but becomes constant, localized, and more intense of the site . Area may be extremely tender and distended. Muscles become rigid. Rebound tenderness may be present. Usually accompanied by anorexia, nausea, and vomiting. |
| Most common causes of Peritonitis | E. Coli, Klebisella, Proteus, Pseudomonas, and Streptococcus |
| Diverticulum | Saclike herniation of the lining of the bowel that extends through a defect in the muscle layer True Diverticula are herniations of all layers of the GI wall (mucosa, muscularis proproa, and adventitia). Pseudo-diverticula only involve the mucosa and sub-mucosa. Can occur anywhere in the GI tract |
| Diverticulosis | Presence of multiple diverticula without inflammation or symptoms |
| Diverticulitis | Inflammation of one or more diverticula and is common reason for elective colectomy |
| Diverticulitis Symptoms | Acute onset of mild to severe cramping in the LLQ . Change in bowel habits, constipation or obstipation (severe). Bloating, nausea, fever, and leukocytosis. Complications can include abscess formation, bleeding, and peritonitis. |
| Treatment Plan for Appendicitis | Immediate surgery may be needed. Fluids to correct or prevent fluid and electrolyte imbalance, dehydration, and sepsis, antibiotics and IV fluids are given until surgery is performed. |
| Treatment Plan for Peritonitis | Fluid, Colloid, and electrolyte replacement is the major focus of management. |
| Treatment Plan for Diverticulitis | Rest, oral fluids, and analgesic meds. Initially a clear liquid diet until inflammation subsides. Sometimes antibiotics. For Acute Diverticulitis with significant symptoms. Hospitalization is required |
| Assessment & Signs and Symptoms of A patient with Cholelithiasis | Silent, epigastric distress, such as fullness, abdominal distention, and vague pain in upper right abdomen. Jaundice, Changes in urine and stool color, feces are grayish or white like putty when it is no longer covered with bile pigments. |
| Plan of Care for Patient with Cholelithiasis | May need pharmacologic therapy, endoscopic procedures, or surgical interventions. Otherwise, Rest, IV fluids, Nasogastric suction, analgesia, and antibiotic agents. Usually low-fat liquids such as powdered supplements high in protein and carbs |
| Nonsurgical Removal of Gallstones | Stone removal by instrument, intracorporal lithotripsy, extracorporeal shock wave therapy, dissolving |
| What should be avoided in patients with cholelithiasis | Eggs, cream, port, fried foods, cheese, rich dressing, gas-forming veggies, alcohol, and fatty foods (may induce episode of cholecystitis) |
| Morphine should be avoided in patients with cholecystectomy because | it can cause spasm of the sphincter of Oddi |
| Open Cholecystectomy Patient Education | Need to avoid aspirin, NSAIDs, and other OTC and herbal remedies that effect coagulation. Splint affected side, avoid turning/moving. Gradually increase activity. Deep breathe, ambulate. Incentive spirometry use. Patients are told to avoid smoking, to enhance pulmonary recovery post op, and avoid respiratory complications |
| T-TUBE | Bile must be measured every 24 hours. Record amount, color, characteristics of drainage. After several day may be clamped for 1 hour before and 1 hour after each meal to deliver bile to duodenum to aid in digestion. Within 1-3 weeks it is removed |
| Laparoscopic Cholecystectomy | Standard management . Dissolution therapies are used for those patients who may not be candidates for procedure due to safety concerns. Performed through a small incision or puncture in the abdominal wall at the umbilicus. Abdominal cavity is insufflated with CO2 (pneumoperitoneum) to assist in inserting scope and to visualize structures |
| Priority Pre Assessment for Open Cholecystectomy | Chest x-ray, ECG, and LFTs may be ordered in addition to imaging studies of gallbladder. Vitamin K may be given if the prothrombin level is low. Nutritional requirements are considered, Respiratory status and history, diet history |
| Acute issues to assess for post operative cholecystectomy patients | Monitor LFTs. Respiratory is top post op risk. Others include Pain interventions. . Fasten drain to patient's gown with enough leeway for them to move without damaging. Monitor for infection, leakage of bile into peritoneal cavity, obstruction of bile drainage. Assess for jaundice, RUQ pain, nausea, vomiting, bile drainage around tube, clay-colored stools, change in VS. |
| Cholecystitis Clinical Manifestations | Inflammation of the gallbladder, pain tenderness, and rigidity of the upper right abdomen that may radiate to midsternal area or right shoulder. Is associated with nausea, vomiting, and usual signs of infection. |
| Calculous Cholecystitis | most common cause of cholecystitis (gallbladder stone obstructs bile flow) |
| Acalculous Cholecystitis | is acute gallbladder inflammation in the absence of obstruction by gallstones, Often occurs after major surgical procedures |
| NG tube assessment & nursing interventions | Ensure suction is set at prescribed pressure, Drainage should be assessed and noted as consistent with gastric drainage, Sterile Saline or water can be used as irrigates, if prescribed. Nurse records the amount, color, and type of drainage. Must ensure oral and nasal hygiene is maintained, prevent discomfort, prevent skin breakdown, and infection. |
| Dobhoff Tube | Enteric Feeding Tube. Used for tube feedings, fluids, and meds. Made for gastric decompression and drainage. Used in patients who have the ability to receive and process nutrition, fluids, and meds adequately by the gastric route. |
| Medication Administration through NG Tube | For tube feedings, the nurse adheres to guidelines for safe administration. Tablets or powders may stick in the tube lumen, which may mean the full dose of medication does not reach the stomach. Also, the obstruction of the tube is likely. It is important not to mix medications with tube feeding formula |
| Enteric Tube for Short-Term Use | Orally or nasally placed tubes |
| Enteric Tube for Long Term Use | Gastrostomy (longer than 4-6 weeks)Jejune ostomy (lasts 6-9months) |
| Orogastric Tube Placement | Inserted through the mouth into the stomach and contains a wide outlet for removal of gastric contents |
| Nasogastric Tube Placement | Inserted through the nose into the stomach. Often before or during surgery, or at the bedside to remove fluid and gas from the upper GI tract by the process known as decompression |
| Nasoenteric Tube Placement | Inserted through the nose into the stomach, and beyond the pylorus into the small intestine for feedings |
| Oroenteric Tube Placement | Inserted in the mouth to the small intesting for feedings |
| Nasojejunal Tube placement | Through the nose into the small intestine distal to the duodenum (in the jejunum) |
| Administration route of parenteral feeding | intravenous (IV) administration of nutrients |
| Considerations while patient is receiving Paternal Feedings | The nurse assists in identifying patients unable to tolerate oral or enteral feedings who may be candidates for PN. Indicators include significant weight loss (10% or more of usual weight), a decrease in oral food intake for more than one week, muscle wasting, decreased tissue healing, abnormal urea nitrogen excretion, and persistent vomiting and diarrhea The nurse carefully monitors the patient's hydration status, electrolyte levels, and calorie intake. |
| Plan of care to prevent hypoglycemia in TPN patients | Run Dextrose.--- solution is discontinued gradually to allow the patient to adjust to decreased levels of glucose. If the PN solution is abruptly terminated, isotonic dextrose can be given at the same rate the PN solution was infused for 1 to 2 hours to prevent rebound hypoglycemia. Symptoms of rebound hypoglycemia include weakness, faintness, sweating, shakiness, feeling cold, confusion, and increased heart rate. |
| Assessments necessary for patients receiving TPN | Monitor for signs of infection, abnormal glucose, electrolyte levels, mineral levels, hepatic or gallbladder effects, reactions to lipid emulsions, and volume overload and dehydration |
| Signs of adverse reactions | With commercial nutritional formulas the nurse observes for tachycardia, hypotension, dehydration, nausea, vomiting, diarrhea, and increased urine output. |
| Education for patient receiving fat emulsion with TPN as a supplement | Can cause thrombosis of peripheral veins so a central venous catheter is required. Prepared using sterile techniques. --- Central line should not be used for any other purpose. --- External tubing should be changed every 24 hours with the first bag of the day. ---- Dressing should be kept sterile and are usually changed every 48 hours using strict sterile techniques. |
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