Exam 3: Biliary system and pancreas and Malnutrition and obesity Flashcards
cholecystitis risk factors
- over 60 years old
- women
- type 1 diabetes
- obesity
- high fat diet
- low calorie, liquid protein diets
- high cholesterol
- rapid weight loss
Cholecystectomy post op care
- Opioids via PCA pump
- T-tube (and care of)
- Antiemetics
- Wound care
- NPO until peristalsis returns
- Nutrition therapy
Post-cholecystectomy syndrome
Acute pancreatitis Ranson’s critieria: At admission
- Age > 55 years
- Leukocytosis
(> 16,000) - Hyperglycemia
(>200 mg/dl) - LDH > 350 units/L
- AST > 250 units/L
Pancreatic cancer/carcinoma nonsurgical management
- Drug therapy
- Radiation therapy
- Biliary stent insertion
Pancreatic cancer/carcinoma risk factors
- Older age
- Tobacco use
- Chronic pancreatitis, DM, cirrhosis, obesity
Decreased Hematocrit (HCT) means
- anemia, hemorrhage, excessive fluid, renal disease, cirrhosis
Increased Hematocrit (HCT) means
dehydration
Increased albumin means
dehydration
Decreased albumin means
fluid excess
Prealbumin normal range
15-36 mg/dL
- best indicator of nutritional status
Cholesterol < 160 means
malnutrition
Total lymphocytic count < 1500
Can be an indicator of malnourishment
NGT care
- Confirm with x-ray
- Continuously stay in high fowlers
- Use irrigation set no more than 24 hours
- Discard any unused open cans after 24 hours
- Flush with 20-30 mL of fluid
- Every 4 hours during cont. tube feeding
- Before and after intermittent feeding and drug administration
- After checking residual
Total parental nutrition care
- Dextrose 10% if solution is unavailable
- Daily weights
- Change IV tubing every 24 hours
- Accuchecks
Total parental nutrition complications
- Fluid imbalance, hyperglycemia
- hyponatremia/hypokalemia
- osmotic diuresis
Gastric bypass teaching and care
- Airway management: positioning (semi-fowlers)
- Abdominal binder to prevent anastomotic
- SCDs/heparin
- 6 small feedings, prevent dehydration
- monitor for dumping syndrome
Dumping syndrome
Caused by food entering the small intestine instead of the stomach after gastric bypass
tachycardia, nausea, diarrhea, abdominal cramping
