FINALE Flashcards
Causes of GI bleed?
-Upper: peptic ulcers, esophageal varices, esophagitis.
-Lower: diverticulitis and inflammation of small and bulging pouches in GI tract
Other: -UC and Crohns disease
-tumors
-hemorrhoids
-anal fissures
-colon polyp
Interventions for GI bleeds?
- Assess vital signs particularly blood pressure- Hypovolemia due to GI bleeding may lower blood pressure levels and put the patient at risk for hypotensive episodes that lead to shock.
- Start a fluid balance chart, monitoring the input and output of the patient.
- Start intravenous therapy as prescribed. Electrolytes may need to be replaced intravenously.
- Administer blood as prescribe
- Meds: PPI, H2 receptors, antacids
What is the universal blood type?
O-
What are interventions for ascites/liver failure?
paracentesis, watch for sudden shift in fluid volume (hypovolemic shock)
- ABC’s
- Low sodium diet: reduces fluid retention and decreases the accumulation
- Diuretics: Helps increases sodium and water excretion, promoting diuresis and reducing ascitic fluid accumulation
- Fluid and electrolyte monitoring
What is normal pH?
7.35-7.45
What is normal PaC02?
35-45
What is normal HCO3?
22-26
What is fully comp?
normal pH +2 abnormal
What is partially comp?
abnormal pH +2 abnormal
What is uncompensated?
abnormal pH +1 abnormal
What does a low pressure alarm mean and what would you do?
Pressure is leaving the system (aka air leak)
Nursing action: Assess! (CHECK TUBES & ETT), Reconnect, repair.
What does a high pressure alarm mean and what would you do?
Blockage (biting, secretions, kinks, mucus plug, coughing)
Nursing action: Assess and identify problem: Tell pt to relax (meds?), fix kinks, suction.
What does a cervical injury affect?
C1-C8
-effects all four limps (quad and tetraplegia)
-resp, impaired bleeding, life threatening
What does thoracic injury effect?
T1-T-12
-effects lower limbs paraplegia
-legs, bladder, bowel
What does a lumbar injury effect?
L1-L5
-legs and bladder
