Final part 5

Question 1

S/S of peritonitis

Answer 1

Increased HR, BP, temp, stiff plap belly,

Question 2

Labs for pancreatitis acute

Answer 2

Panc enzymes, hypoca+,

Liver, triglycerides, glucose, bilirubin,

Question 3

Chronic pancreatitis and about the two types

Answer 3

Irreversible structural damage to the pancreas. This includes fibrotic tissue, strictures, and calcification, Scaring, dilation, stones pass.
Obstructive- Gallstones that cause inflam of sphincter or odi-cancer of amp, duodenum, pancreas, or cystic fibrosis,
Non-obstructive- Inflam and sclerosis in head of pancreases and duct, alcohol abuse

Question 4

manifestations of chronic pancreatitis

Answer 4

Swelling, mass, chronic ab pain, or no pain, mal absorption, weight loss, constipation, DM!, increase in cholesterol, heavy burning not relieves by food or antacids, mild jaundice, dark urine-from bile, Steatorrhea

Question 5

Gallbladder disease two types and risks

Answer 5

Cholelith-Stones
Cholecys- Inflam of gallbladder usually from cholelith
Balance of chole, bile salts, ca+, and Na+=precipitation
Infections or alterations in metab or chole or stasis
immobility, pregnancy, inflam or obstruction, lesions-all cause obstruction

Question 6

Manifestatons of choelith

Answer 6

Pain is severe-none, more pain when stone is moving or obstructing, may be in shoulder or scap, tachy, diaphoresis, tender RUQ pain,- 3-6 hours after meal or when laying down

Question 7

Manifestations of chole sis

Answer 7

fat intol, dyspepsia, heart burn, flatulence, inflam with leuko and fever, ab regidity

Question 8

Total gal stone obstruction symptoms

Answer 8

Jaundice, dark urine, clay stools, pruritus, intol of fat, bleeding tendencies, steatorrhea

Question 9

Complications of gal bladder disease

Answer 9

Cholesis, gangrenous, subphrenic abcess, pancreatitis, cholangitis, billiary ducts, fistulas, bil cirrhosis, perionitis, choledocholithiasis.

Question 10

Tx for cholecycsitis

Answer 10

Pain control, NSAIDS, anticholenergics, antibiotics, choleystestomy, Fluids and electrolytes, NG tube in severe N/V,

Question 11

Surgical tx for choleitis

Answer 11

Laperascopic cholecystectomy- Removal through holes, minimal post pain, normal activity in 1 week, few complications, clear lq, same day discharge
or open- removal through right subcostal incision
t-tube-Inserted into the common bile duct,
ESWL

Question 12

esophageal cancer patho history and risks

Answer 12

Usually advanced disease by the time of diagnosis, it narrows the esophagus, Risks-Increase with age, BE, smoking, alcohol, Obestiy, abestos, cement dust, achalasia-delayed emtying, gerd, barrets

Question 13

Manifestatons of Esoph cancer

Answer 13

Progressive dysphagia-meat, soft food, lq
Pain is latep substernal epigastric, back that increases with swallowing-even spit, 
Weight loss
Sore throat, choacking 
hoarseness\regur with blood tinged
Hemmorrhage-if trach
May cause obstruction
common metastasis to lungs and liver

Question 14

Diagnosis for esoph cancer

Answer 14

Endoscope biops
ultrasound
CT/MRI
Bronchoscopy

Question 15

Tx for Esoph cancer

Answer 15

Surg-esophagectomy-removal
esophagastromy -resection to stomach
esophagoenterostomy-resection to colon- lap or open
Photodynamic lasor therapy- no sun 3-6 weeks
Chemo and radiation

Question 16

Post of esoph cancer

Answer 16

Watch respiratory, pain control, Chest tube, TPN, Swallow study, HOB 30 and for 2hr after meal

Question 17

Surg risk for esoph cancer

Answer 17

DysR, anastomatic leaks, fistulas, edema, respiratory distres, dysruption of medial sternal lymph nodes

Question 18

Care for E cancer

Answer 18

Airway, respiratory, swallow B4 oral fluids, high fowlers, tube feeding tol, pain

Question 19

Lower GI obstruction types

Answer 19

Mechanical- Detectable, commonly found in sm intestine, surgical adhesion-small intest and colorectal cancer-Large intest
non mechanical- Paralytic illeus, pseudo- acting like theres an obstruction- critically ill, trauma, burns. vascular- no blood to intestines- a fib, art obstruction, clots, heart valve issues, heart attack, congestive fail

Question 20

Types of lower gi obstruction

Answer 20

Adhesions, intessuseption, hernwas, tumors, volvus,

Question 21

Steps of lower obs

Answer 21

1.obstruction- build up fluid, gas, intestial contents-prox
Collapse- distal
2. Increase in bowel distension- reabsorption of fluids
3. increase pressure- cap perm, fluids into 3rd space
4. loss of blood volume
5, ischemic bowel no blood supply

Question 22

Sm in lower GI

Answer 22

Rapid onset

Early- Colckly, intermit ab pain, NV in large ammounts, projectile vom with bile, if long standing smells like poop

Question 23

Lg in obstruction s/s

Answer 23

Gradual onset, vom it rare, ab pain present but low grade, ab distention increased new onset of constipation and no flatulus

Question 24

diagnosis of bowel obstruction

Labs

Answer 24

x ray-ct scan
Sigmoidoscopy/colonoscopy
Increase in WBC, H and H, BUN and creatinine

Question 25

Tx for lower GI obstruction

When do you need surgery

Answer 25

conservative, NPO, rest, NG tube, IV fluids-NS or lac ringers, Pain control
if strangulated or tx not effective, May need colonosctomy or illiostomy

Question 26

What are the biggest concerns with Lrg bowel obstructions

Answer 26

Ischemia, peritinitous, sepsis

Question 27

CFS contents

Answer 27

Question 28

Stroke: 1 (make sure you know the screening indicators for tPA use

Answer 28

d to produce localized fibrinolysis by binding to the fibrin in the thrombi
● Given IV to prevent cell death with ischemic stroke
● Tissue plasminogen activator (tPA)- Reestablish blood flow, given within 3 to 4.5 hours of onset of clinical signs of ischemic stroke –pts screened carefully
● Patient screening includes: noncontrast CT scan or MRI to rule out hemorrhagic stroke, blood tests for coagulation disorders, GI bleeding, storke, head trauma within the past 3 months, major surgery within 14 days, internal bleeding within 22 days
● Monitor patients VS and neuro status, control BP SBP <185

Question 29

Spinal Shock: 30-60 min after injury

Answer 29

Spinal Shock: 30-60 min after injury
● Loss of sensation, decreased reflexes, absent thermoreg, or flaccid paralysis below injury level
● Days to weeks after injury

Question 30

Neurogen shock

Answer 30

Neurogenic Shock (injury above T-6)
● Loss of SNS innervation/tone (cervical or high thoracic injury)
● Peripheral vasodilation = venous pooling, low CO
● Give fluids, vasopressors
● Respiratory: hypoventilation, C4= loss of resp fctn
● Cardiovascular: bradycardia
● hypotension- (Neurogenic shock)
● Urinary: neurogenic bladder-atonic bladder initially
● Gastrointestinal: hypomotility
● Temperature: unable to regulate-lack of SNS/nerve disruption to hypothalamus
● Integumentary: pressure ulcers/skin breakdown

Question 31

Autonomic Hyperreflexia (Injury T6 or higher)

Answer 31

● Uncompensated cardiovascular response from SNS
● Triggered by stimuli at or below T6-
● Blood vessels constrict
● S/S= HTN, HA, bradycardia, diaphoresis-above level of injury
● piloerection- below level of injury
● PNS responds to B/P- reduces HR but can’t dilate peripheral vessels below level of injury
● Causes: most common-bladder distention, bowel impaction, tight clothes, pressure ulcers, pain

Question 32

Treatment of Autonomic Hyperreflexia

Answer 32

● Sit patient upright or elevate HOB 45 degrees
● Identify the cause of stimuli
o Insert catheter/look for kink
o Resolve bowel impaction
o Remove restrictive clothing
● Notify healthcare provider
● Monitor B/P & give B/P meds (vasodilators) if s/s continue
● If left untreated= possible stroke, MI, status epilepticus

Question 33

c4, c6, t6, L1

Answer 33

c4-Tetra and paralysis of respiratory, C6-tetra with pa in hands and arms, T6 para below chest, L1-Para below waist