Abdominal + oncology Flashcards
Acute pancreatitis
s/s
a) about pain
b) other findings
c) what sing will be positive?
d) watch out for?
a) Severe LUQ Pain(radiate to the back)
-pain after large meal or alcohol
Pain not relieved by vomiting
b)Dec bowel sounds
Low-grade fever
Jandice
c) Grey-Turner sign
Cullen sign(umbilicus)
d) Hypovolemia(possible shock)
Lab
a) Amylase
how long it remins?
b) Lipase
how long it remins?
a) inc with in 12-24hr
remains 2-3days
b) inc slowely
remains in 2 weeks
c) Glucose
d) calcium
e) LDH,AST
f) WBC, sed rate
g) platelets
a) inc
b) dec
e) inc
f) inc
g) dec
A nurse is completing the admission assessment on a pt who has acute pancreatitis. Which of the following findings is the priority to be reported to the provider?
History of cholelithiasis
Serum amylase levels three times greater than the expected value.
Pt report of severe pain radiating to the back that is rated at an “8”
Hand spasms present when blood pressure is checked
Hand spasms present when blood pressure is checked
bacuse of low calcium
Complication
Pseudocyst
Accumulated pancreatic enzymes
Resolve spontaneously or rupture → peritonitis
Complication
Abscess
Infectoion leads to necrosis and that also leads perforation into adjacent organs
Surgery drainage immediately
When assessing a patient with acute pancreatitis the nurse would expect to find:
a) Pain in the right upper quadrant radiating to the right shoulder
b) Reporting of pain being worse when sitting upright
c) Severe mid-epigastric or left upper quadrant pain
d) Pain relieved with defecation
c
Pancreatitis
nursing care
a) pain
b) diet
a) pt upright w/knee flexed to chest, fetal position
DO NOT lay flat,inc pain
b) NPO
or small frequent meals with high protein and carb with low fat
Nursing management of the patient with acute pancreatitis includes:SATA
Check for S/S of hypocalemia
Monitor of infection
Provide diet high in protein and fat
Restrict fluid administration
a.b
Acute abdomen
common causes?
onset with in 24hr
Inflamamation
Perforated
Obstraction
Internal bleeding
How to assess to pain?
O– onset
L – location
D – duration
C – character
A – aggravating factors
R– relieving factors
T– treatments
S – Symptoms (N,V,D or fevers, etc)
Pain location
a) RUQ
b) LUQ
c) RLQ
d) LLQ
e) what order to assess abdominal?
a) Gallbladder
ascending colon
b) Pancreatitis
desending colon
spleen
stomach
c) Appendicitis
d) constipation
e) inspection
Ausculation
percussion
Palpation
Murphy’s Sign?
Place hand firmly at right costal margin (RUQ)
Ask patient to breathe deeply
Pain=Positive Cholecystitis
McBurney’s Point?
Deep tenderness in RLQ
Acute appendicitis
Psoas & Obturator Sign?
Appendicitis
Psoas-pain passive extention on the right thigh
Obtirator-pain on passive internal rotation of the hip
Acute liver failure
a) liver produce?
b) detoxifies?
c) store?
a) clotting factors,bile,albumin
b) alcohol,meds
c) iron, vitamins, minerals,fat,glucose
it receives 25% of cardiac output!
Lab Analysis
a) Blirubin
b) Liver Enzymes AST, ALT; LDH
c) albumin
d) Ammonia
e) INR
f) GGT
g) Platlet
a) inc
b) inc
c) dec protein
d) inc
e) prolonged
f) inc
g) dec
Dx
ERCP/MRCP
PTC
US,CT
Manifestations of Cirrhosis
jaundice
Spider angioma
erythema
Anemia, leukopenia
Overt bleeding, bruising
Infections
Weight loss
Dysrhythmias, tachycardia
Portal Hypertension
a) Elevated portal pressure d/t?
b) causes?
a) obstructed blood flow into cirrhotic liver
b) Splenomegaly
Destroys RBC, WBC, platelets → hematologic disorders
Esophageal/gastric varices
Ascites
Esophageal/gastric varices
a) s/s?
b) waht kind of stool?
medical emergence
a) sudden onset bright red or coffee ground emesis
b) Melena(dark sticky bloody feces)
Increased ammonia levels
Compromises airway
Care for esophagal varices
a) avoid?
b) monitor for?
c) if it ruptured?
a) alcohol,asprin,NSAIDS
b) hypovolimic shock
c) HOB
O2
IV w/fluid,blood
NPO
Ascites
Result of?
Portal hypertension
Failure to produce albumin
Fluid leaks from liver capsule
Increased hydrostatic pressure
Increase aldosterone & ADH
Can develop spontaneous bacterial peritonitis (SBP)
Hepatic Encephalopathy
a) cause?
b) s/s?
a) Liver cannot pee pit ammonia–toxic to brain
b) Changes in LOC
Inc ammonia level
Sleep disturbances
Asterixis
Lethargy
musty,sweet breath
Hepatorenal Syndrome (HRS)
a) what is it?
b) what to do?
a) Sudden renal failure with hepatic failure
b) Give adequate fluids, vasopressors, dialysis,
consider liver transplant
Paracentesis
a) Pre
b) during
c) post
a) informed consent, void, be sure foley draining. Why??
because we don’t want to puncture the bladder by accident
Check INR
b) supine with HOB elevated
c) monitor for hypovolemia (may give Albumin post procedure)
hepatic encephalopathy
Decrease Ammonia levels
a) meds?
b) diet?
a) Rifazimin, Flagyl, Vancomycin
Lactulose
b) high protein
The client is diagnosed with esophageal bleeding. Which of the following assessment findings warrant immediate intervention by the nurse?
H/H 11.4/32
Abdomen soft to touch, non tender
T99, BP 88/60, HR 119
NGT has coffee ground emesis
Old blood, slow bleed
T99, BP 88/60, HR 119
Watch for S/S hypovolemic shock
Fulminant Hepatic Failure
a) what is it?
b) causes?
c) s/s
a) Rapidly develop liver failure with no prior history of liver dysfunction
b) Drug overdose
Viral hepatitis (HBV)
c) Hypoglycemia
Cerebral edema
MODS
oncology
spinal cord compression
a) s/s
b) tratment
a) back pain(d/t pressure)
bowel, bladder dysfunction
paralysis
b) Radiation rapidly!!
Neuro check q1
Limit activity(further harm to spinal)
Oncology
SIADH
a) patho
a) s/s
b) treatment
a) body retains urine S=stop pee
more fluid in the blood, less in urine
a) Weight gain
personality change
Seizure
b) Restric fluid
Weight 2time/day
Inc diately Na
Oncology
Hypercalcemia
a) Normal range and medical emergency
b) s/s
c) treatment
a) normal 8.5-10.5
emergency greater than 12
b) seizures
bone pain
dysrhythmias
real insufficiency
c) bisphosphonate
hydration
mobilize(ca will leave blood to bone)
Oncology
tumor lysis syndrome
a) s/s
b) treatment
a) hyperuricemia=itchiyng
hyperkalemia
hypocalcemia
b) diuresis
restrict dietary potassium
insulin(move to potassium)
Oncology
Superior vena cava syndrome
a) s/s
b) tratment
a) neck vein distention
facial edema,redness
SOB,dyspnea
chest pain,cough
Think about what fluid buildup in the upper body
b) O2
diuretics
Semi-fowelers position
avoid straining
