GI Disorders and PeriOperative Care Flashcards
What is delegation?
Transfer of authority, responsibility to a competent individual. The nurse remains ACCOUNTABLE
Benefits of Delegation
- nurse can perform more complex tasks
- delegate builds new skills, develops trust
- more time for undelegable tasks
- less overtime, more productivity
What are the 6 elements of delegation?
1, No judgement based on nursing knowledge needed
- Results predictable
- safely performed with no alterations
- no complex observation/clinical decision needed
- does not require repeat nursing assessment
- consequence of improper performance non life-threatening
What are the principles for delegation?
- nurse must assess patient before delegating
- task must be routine
- nurse must know delegation policies
- nurse must know variations in ability/training
- nurse must foster communication, teaching, learning
4 Steps of Delegation
- Assessment/planning
- is this the right task to delegate? - Communication
- communicate expectations - surveillance/supervision
- is task being done correctly? - evaluation/feedback
- any problems? job well done!
5 Rights of Delegation
- Right task
- Right circumstance
- Right person
- Right direction/communication
- Right supervision/evaluation
What is civil law?
rights and duties of private persons, they usually want compensation
Tort
A civil wrong against an individual or individuals property
Unintentional Tort Types
Negligence: deviates from what a normal person would do in a similar situation
Malpractice: professional negligence
What must you prove for malpractice?
- Duty: relationship between patient and provider existed
- Breach of Duty: act or omission that violates standard of care
- foreseeability: could you see it would cause harm?
- causation: did act cause harm?
- injury
What are types of Intentional tort?
- Assault: creating apprehension
- Battery: touching w/o permission
- false imprisonment
Some things to remember about law
- NPA is state law
- document!
- obtain liability insurance
What is pancreatitis?
inflammation of pancreas - located LUQ behind stomach
autodigestion of pancreas, trypsin released too early
Can be acute (interstitial edamatous) or chronic (necrotizing, permanent)
What are the possible causes of pancreatitis?
Gallstone - most common - blocks bile duct
Alcoholism
Risk factors for pancreatitis
T: toxic - metabolic (alcohol) I: idiopathic (unknown) G: genetic A: autoimmune R: recurrent/sever acute pancreatitis
O: obstructive: gallstone, fat, tumor, duct scars
Symptoms of acute pancreatitis
- mid epigastric pain to upper back
- abdominal distention
- hypoactive bowel sounds D/T ileus
- tachycardia D/T hypovolemia
- hypotension D/T hypovolemia
- jaundice
Symptoms of chronic pancreatitis
- pain localized in LUQ
- anorexia D/T nausea/pain
- N/V D/T distention
- steatorrhea D/T lack of enzymes
- grey turners and cullens sign D/T blood seepage
complications of pancreatitis
- cysts and absesses
- SIRS: inflammation through whole body! tachycardia, hypotension, low or high temp, low or high WBC, monitor vitals
- Respiratory complications: ARDS - monitor SPO2
- renal/hepatic failure
- pancreatic infection
- malabsorption/diabetes
- hypovolemia
Laboratory Tests for Pancreatitis
- increased WBC
- increased amylase
- increased lipase
- increased bilirubin
- increased AST
- increased ALT
- increased triglycerides
Diagnostic Tests for Pancreatitis
- U/S: to see if gallstones and size
- CT: gallstone, infection
- ERCP: down bile duct through throat
- MRCP: type of MRI, detailed image
Pharmacotherapy Pancreatitis
- NSAID
- first line
Pharmacotherapy Pancreatitis
NSAID (1st line), opioid analgesic, H2 Blockers, Proton Pump Inhibitor, Antibiotic (preventative), Pancreatic Enzymes
Diclofenac NA
NSAID for pancreatitis
Morphine, Hydromorphine
Opioid analgesic, morphine given first than dilauded
H2 Blockers
- Reduce the production of gastric acid
- treat ulcers, GERD, esophogitis
- administer according to recommended time difference between meals
- separate drug and antacid therapy by 1 hour
- maitenance drug therapy given at bedtime
- famotidine ( pepcid)
- cimetidine ( tagemet)
Proton Pump Inhibitors
- blocks final step in acid production w/o blocking histamine 2 . decreases hydrogen (acid) production
- administer before meals
- omeprazole (prilosec)
- esomeprazole ( nexium)
- iansoprazole ( prevacid)
- pantoprazole (protonix)
impenem (primaxin)
antibiotic
Pancreatic Enzymes
- creon (pancreas)
- pancreatin (cotazym)
- pancrelipase (viokase)
Nursing Management Pancreatitis
- Rest pancreas NPO
- NG tube, prevent intraabdominal pressure
- TPN
- high carb, high protein, low fat diet
- IV access
- Prevent hypovolemia (watch for fluid overload)
- assess I/O, skin turgor
- CIWA protocol
Goals of patient care with pancreatitis
- decrease pain
- adequate fluid/nutrition
- increase respiratory function
- behavior modification (diet)
What is cholecystitis?
inflammation of the gallbladder
located RUQ, under liver
gallbladder full of bile will empty after meal
Cholelithiasis
gallstones
Choledocholithiasis
bile duct stones
choleangitis
duct inflammation
cholecystits
gallbladder inflammation
Risk factors for cholecystitis
Female Forty Fertile Fat Family
Prevention of cholecystitis
weight loss
diet low fat low cholesterol
certain meds cause GBD like estrogen, clofibrate
Cholecystitis signs and symptoms
RUQ pain, cramping Fat intolerance N/V Jaundice Clay colored stool
Cholecystitis Complications
Empyema (puss) Gangrene Peritonitis Pancreatitis Sepsis
What is murphys sign?
take a deep breth while palpating RUQ and if pain murphys sign is positive
Cholecystitis Lab Values
Increased WBC
increased serum bilirubin
increased amylase
increased lipase
What is the normal value for bilirubin?
1.2
Cholecystitis Diagnostic Tests
U/S: gallstone?
Cholecystogram: pic of gb with contrast tablet
HIDA Scan: cystic duct obstruction, cholcystitis
GBD Pharmacology
NSAID (1ST LINE), Opioids, antiemetic, antibiotic (preventative), gallstone solubizing agents
Celecoxib (celebrex), Ketorlac (toradol)
NSAID to treat GBD
Antiemetic
Prevent and treat N/V
- promethazine (phenergan) - push slowly or dilute
- ondansetron (zofan)
- metocolopramide (reglan)
- scopolamine ( transderm-scop)
- dimethydrinate (dramamine)
- diphenhydromine ( benadryl)
- granisetron (kytril)
Gallstone Solubilizing Agents
- ursodiol (actigal)
- chenodiol (chenix)
- dissolve gallstone
Nursing Management GBD
- Diet
NPO or SFF
low saturated fat, high fiber, high calcium
- IV access
- NG tube for gastric decompressionSurgery for GBD
- laparoscopic cholecystectomy
treatment of choice
removal of GB
- cholecystectomy, T-TUBE
when stones lodged
drainage bag post op
- ERCP
small stones
captures stonesGoals for GBD
- decrease pain
- adequate fluid and nutrition
- improve respiratory function
- behavior/mood
Types of TPN
Central: more easily tolerated
Peripheral: Short term, nutritional needs less, used as a supplement
Indications for TPN
catabolic state, can’t eat enough to maintain positive nitrogen balance
needs cannot be met with oral/tube feeding or other IV nutrition
Carbs TPN
dextrose
energy & calories
3000-4000 cal/24 hr
Amino Acid TPN
for protein
Fat Emulsion TPN
prevent or reverse a fatty acid deficiency and provide calories
use non PVC bag or glass/piggyback
electrolytes, vitamins, trace elements, medications TPN
- electrolytes: Na, K, Ca, Cl Ph
- Vitamines ADEK, C, B
- trace: zinc, copper, chromium, magnese, selenium
- meds: insulin, heparin, histamine receptor agonist
Complications of TPN
- hyperglycemia: dry mouth, HA, nausea, flush skin, thirst, increased urine
- increase rate over several hours
- check sugar every 4-6 hours
- hypoglycemia: cold, clammy skin, weakness, hunger, tachycardia, dizziness
- keep rate accurate, taper rate when D/C, if next bag is not available run D5W or D10W
- infection
- strict asepsis
- redness, swelling, tenderness, drainage, fever, chills
- air embolism
- trendelenburg during cather insertion
- use clamps or valsava maneuver during tube change
- fluid overlad/electroyte imbalance
- refeeding syndrome
- cardiac arrest
- physco aspect
- hallucination with taste/smell
Peptic Ulcer Disease Patho
Disruption of the mucosal barrier of the stomach due to H Pylori or ulcer of the lining of the stomach, duodenum, lower esophagus
mucosal injury D/T increaed gastric acid HCL and Pepsin
etiology of PUD
- NSAID use (most common cause)
- alcohol, smoking, stress, antbiotic (docucycline, clindomycin)
- zollinger-ellison (tumor in pancrease which incrase hormone that stimulates stomach acid
Avoid with PUD
- chocolate
- coffee
- brined/fermented
- fatty
- spicy
- acidic
S&S of PUD
bloating, belching D/T distention N/V weight loss anemia D/T bleeding guaic positive ( check H&H)
gastric ulcer characteristics
superficial "gas" pain pressure in LUQ pain 1-2 hours after meal common in low social status relieved by eating
duodenal ulcer characteristics
penetrating cramping pain pressure in midepigastric and upper abdomen pain 2-4 hours after meal stress and disease
Diagnostic Tests for PUD
CBC - check H&H Fecal Analysis (blood, H. Pylori) barium swallow C-Urea (breath in bag, if Co2 increased you have H. Pylori) EGD
Pharmacotherapy for PUD
antacids, H2 receptor agonist, PPI, cytoprotective agents, antibiotics
Antacids
-Neutralize gastric acid t bring the pH above 3-3.5
-Most not absorbed and excreted through feces
- can cause diarrhea, constipation, effect absorption of other drugs, electrolyte alteration
- take medication 1-2 hours before or after taking antacid
- monitor electrolytes
-
Antacid Contraindications
- Amphojel high in sodium, do not use in pt. wih HTN, CHF, renal disease D/T fluid retention
- those containing aluminum must be used cautiously in pt with gastric disease b/c they cn cause constipation and phosphate depetion
- those with magnesium can cause hypermagnesmia
- those containing sodium bicarb can cause metabolic alkalosis
- those with calcium can cause rebound hyperacidity, metabolic alkalosis, and constipation
Common antacids
- aluminum carbonate (Basalgel)
- aluminum hydroxide gel ( Alternagel, Amphojel)
- calcium carbonate (turns)
- aluminum/ magnesium compounds (Maalox, Riopan plus)
- sodium bicarbonate
Surgery for PUD
- vagotomy (removal of vagus nerve)
- pyloroplasty ( repair pyloric sphincter)
Complications of PUD
Pyloric Obstruction
- anorexia, N/V
Hemmorhage
- anemia
Perforation/Peritonitis (lethal!!!)
- rigid, board like abdomen
- rebound tenderness
- no bowel sounds
- hypotension, tachycardia, shallow respirationsNursing Management of PUD
- V/S and I/O
- assess repirations and gastric status
- maintain NG tube
- observe for distention
- small, frequent meals
- minimize stress
Goals for PUD
- minimize pain
- gastric drainage
- nutrition
- monitor I/O
- observe for hemm/infection
IBD Patho
chronic inflammation of GI tract (autoimmune!!). Chrons or Ulcerative Colitis
Chrons
usually affects the terminal Ileum and ascending colon, can effect any portion of GI tract
Ulcerative Colitis
More common! Affects colon, frequent stool
Ulcerative Colitis S&S
Diarrhea, mucousy, bloody LLQ pain bloody stools fever (rare) anemia weight loss dehydration
UC Complications
- chronic anemia
- arthritis
- skin, eye, liver, renal disease
- hemmorage, perforated bowel
- colon cancer
Chron’s S&S
- always diarrhea
- abdominal pain (RUQ)
- steatorrhea
- fever
- anemia
- weight loss
Chron’s Complications
- fistula, abcess
- SBO
- colorectal cancer
Nursing Management IBD
Diet
- NPO w/ IVF during flare up
- small, frequent meals low residue, lactose free, elemental
- high protein, high vitamin, high carlorie
IV access for antibiotics, transfusion
monitor V/S, I/O, daily weight, stool for occult blood, lab values
Educate: NO alcohol, NO smoking, LOW stress
Pharmacotherapy for IBD
5-amino acids, antimicrobials, coricosteroids, immunosuppresents, antidiarrheal
5-Amino Acids
- decrease inflammation
- sulfasalazine ( Azufinide)
Antimicrobials
most common
metronidazole ( flagyl)
corticosteroids
metylpredisalone
immunosupressents
azathioprine (imuran)
methotrexate
Antidiarrheal
- diphenoxylate HCL (lomotil)
- record number and consistency of stools
- can cause constipation
- bismuth subsalicylate (kaopectate), diphenoxylate-atropine (lomotil), Ioperamide (imodium), amphorated tincuture of opium ( paragoric)
Surgery for UC
- total protolectomy
- total colectomy with ileal pouch
Surgery for Chrons
intestinal resection with anastomosis
Ileostomy Vs Colostomy
Ileostomy stools more liquid
colostomy stools more formed
Goals of IBD
- less pain
- no diarrhea, fever
- adequet nutrition and fluid
- stress managed
Bowel Obstruction
Partial or complete blockage of intestinal lumen
Small (more common) or large bowel
Needs prompt treatment
Intestine contents, gas, fluid, digested substances, accumulate proximal to obstructuion
Etiology of bowel obstruction
- increased pressure, distention
- increased pressure obstructs arterial blood flow
- fluid leaks into peritoneal cavity, hypovelmic shock, bowel necrosis, dehydration
Risk Factors for Bowel Obstruction
- adehesions (fibrous tissue after sx.)
- volvulus (twisted bowel)
- hernia
- tumor
- fecal impaction
- paralytic ileus D/T sx., infection, opioids
S&S of bowel obstruction
- distention
- pain, cramping
- diarrhea/constipation
- obstipation (severe constipation, no gas)
- S/O dehydration (tachycardia, fever)
- peritoneal signs (if perforated)
- bowel dounds borborygmi above obstruction, absent below
Diagnostic Tests for Bowel Obstruction
CBC (low H&H, increased WBC) BMP (electrolytes) urinalysis (UTI D/T pressure?) abdominal X-RAY, CT (string of perles) EGD, colonoscopy barium enema
Nursing Management for BO
NPO
IV access
GI decompression (NG tube)
monitor V/S I/O, bowel function, labs
Surgery for Bowel Obstruction
bowel resection - 30-45 day recovery
bowel resection w/ colostomy - temporary a few months
- lysis of adhesion - scar tissue from abdominal SX.
Goals of Bowel Obstruction
decrease pain, maintain nutrtion, prev. respiratory complications, relieve obstruction
Cytoprotective Agents
- sucralafate
- treatment of PUD
- forms an ulcer adherent paste that protects ulcer from further damage
- constipation side effect
- instruct pt, to take med 30 min to 1 hour before meals or 2 hours after meals and at bedtime
- do not give antacids within 30 mins of sucralfate admin
- misoprotsol (cytotec)
- prostaglandin analogue
- contraindicated in pregnancy
- PUD
Gastric Stimulants
- improves gastric emptying
- relief of GERD sypmtoms
- prevention of nausea by chemo or sx.
- facilitation of small bowel intubation
- metoclopramite (Reglan)
anticholinergics
decrease gastric secretions
side effect is drowsiness, dry mouth, urniary retention
- encourage increaed fluid intake
- avoid driving until effects are known
- belladonna alkaloids (atropine, scopolamine), propatheline (pro-bathine)
What is perioperative care?
Care provided before, during, and after sx.
What is preoperative care?
- 2-3 weeks before sx.
- preadmission testing PAT (not always done by nurse)
- bring list of medications including supplements
Nurses Role Intraoperative
promote safety and privacy
prevent wound infection
promote healing
nurses role post operative
prompt pain control assessment of surgical site assessment of drainage tubes monitor rate and patency of IV assess patients level of senstaion, circulation, and safety
Classifications of Surgical Intervention
Emergent: must be done now
Urgent: must be done soon w/i 24-48 hours
Elective: preplanned
Preoperative: Pre Admission Testing
Initiates teaching appropriate to patient
- who will drive patient home?
- does patient understand surgery?
- medication/food restriction
Informed Consent - Preoperative
Required! Nurse must be sure it’s ON FILE, prior to pre-medication, nurse is the patient’s advocate
Nurse can serve as witness
- pt must understand before signing, be able to make decisions
Preoperative Nursing Assessment
A. Nursing History
B. Physical Assessment (objective data)
C. Assess patient’s needs
Nursing History
- nutrition, diet, normal elimination pattern, normal sleep pattern, sexulatity, reproductive, etc.
Physical Assessment
Head to Toe - Focus on the system that needs surgery
Pyschological Needs
- medical decisions
- emotional support - who will take care of patient? how are they feeling?
- cultural considerations - do they want priest? blood transfusion?
PreOp Nutrition/Hydration
NPO 8-12 hours
Check institiution Policy
Medication Reconciliation
Stop Taking: anticoagulants, NSAIDS, diuretics, eye drops/inhalers, herbal supplements
Preoperative Medications
- Benzodiapines
- midazolam (versed)
- diazepam ( valium)
- relax pateitn, amnesic effect
- Barbiturates
- phenobarbital
- sedation
- anticholinergics
- atropine So4
- opiod analgesic
- fentanyl
- Histamine 2 receptor antagonist
- antiemetics
- metoclopramide hydrochloride (Reglan)
- odansetron hydrochloride ( Zofran)
- promethazine (phenergan)
- scopolamine (transdermal patch)
- phenothazine derivitives
- antibiotics
Preop Teachings
- deep breathing
- incentive spirometer
- turning and positioning
- VTE prophalylaxis
Patients With High Risk
- old
- diabetes/ chronic disease
- obesity
Intraoperative Care
When the patient is placed on the OR table and ends when the patient is transferred to the PACU
Role of RN
- Remains sterile
- safe and optimal outcome is goal
Role of Circulating Nurse
- Not sterile, inform family, maintain privacy
What are SCIP procedures?
Actions that are required to be completed within the standard perioperative time frame
Universal Protocol
Call time out to ensure
- Correct patient
- Correct procedure
- Correct surgical site
Nursing Management Intraoperative
- maintain asepsis
- assist with transfer
- provide for privacy/modesty
- provide patient safety
- position patient
Types of Anesthesia
I General : completely unconscious
II Local: just the area is numb
III. regiona: ex. epidrual
IV: MAC: twilight zone
General Anesthesia: Pre Induction
- pre-op assessment
- check and confirm consent form
- call “time-out”
- time when pt. could have problems, maximum attention on patient.
- attach patient to monitoring machines
General Anesthesia: Induction
- initiation of medication
- airway secured
- monitor the devices
General Anesthesia: Maitenence
maintain patient safety, positioning of patient
General Anesthesia: Emergence
- assist in placement of dressing
- safety of patient
- prepare for pacu
General Anesthesia: IV induction agents
- most common
- Barbiturate Hypnotics
- Nonbarbiturate Hypnotics
Barbiturate Hypnotics
- thiopental ( pentothol)
- methohexital (brevitol)
- rapid induction w/i 20-60 seconds
- sedation and hypnosis
- NOT analgesia
- may have post op nausea
Nonbarbiturate Hypnotics
etomidate (amidate)
- little change in cardiovascular status
- useful in unstable patients
- minor resp depression
propofol (diprivan)
- rapid onset
- new
- can maintain anesthesia
- rapid elimination
- less N/V
BOTH:
- observe for abormal skeletal movement, N/V, hypotension, hypoglycemia, bradycardia
General Anesthesia: Inhalation Agents
through tube or mask
trauma to teeth, lips, vocal cords, or trachea may occur
laryngospasm or bronchospasm
volatile liquid: liquid at room temp. , mixed with O2
gasses: gas at room temp
- depress neurotransmitter in CNS
Nitrous Oxide
- Gas
- adjunct to IV drugs
- commmon induction agent
- avoid in pt with bone marrow depression
- give with O2 to prevent hypoexmia
- smells like perment marker
Volatile Liquids
Exhibit respiratory depression, hypotension, and myocardial depression, muscle relaxation!
Isoflurane (Forane)
- can cause airway irritation
- no increase in ventricular irritability
- no nephro or hapto toxicity
- use with caution in cardiac patients
Desflurane (Suprane)
- fastest onset and emergence
- ambulatory settings
- use with caution in cardiac patients
Sevoflurane (Ultane)
- rapid acting
- non irritating to airway
- may be associated with emergence delirium
Halothane (fluothane)
- bronchodilation
- may cause hepatotoxicity
Local Anesthesia
Interrupts nerve impulses
Blocks motor (movement) and sensory (feeling) impulses
Topical most common, can be local infiltration, nebulized, or opthalmic
Regional Anesthesia
Injection of local anesthesia around or near nerve groups
Regional (peripheral nerve block
IV reginal block (Bier’s block)- short term
Spinal Block (dural sac)
epidural
Side effects of local/reginal anesthesia
Regional:
Spinal Headache - result of CSF leaking. r/t needle gauge. Blood patch treatment
Local:
palpatations, tachycardia, temor, pallor, diaphoresis - similar to hyperglycemia
MAC anesthesia
- benzodiazepines
- opioids
- maintain own airway
Nurse role during/after procedure
- monitor v/s
- document
- LOC
- maintain airway - #1 priority
- discharge criteria (v/s stable, pt breath on own?)
Malignant Hyperthermia
rare, metbolic disease, dominant, inherited
- caused by depressed hypothalmus
- rise in body temp of 6 degrees C/hour
- often fatal
- succinylcholine
- tachycardia, tachypnea, hypercarbia, ventricular ectopy, hyperthermia
- treat w/ cooling blanket, cool IV fluid
Anaphylactic Reaction
- if shows sypmtoms of anaphylaxis stop infusing
- hypotension
- tachycardia
- bronchospasm
What is a sentinel awareness?
patient aware during sx. Report to JCAHO
PACU
Immediately after surgery until patient is discharged to regular nursing floor
What does the intake nurse need to know on admission to the PACU
Full report from anesthesia, why did they do the procedure? Medication received? complications? Fluid status - how much blood lost? IV fluids?
What is the aldrete score?
When patient can be safely discharged from PACU - need 7/8.
if less ask doctor why and document!
Primary Focus in PACU
- maintain airway #1
- prevent aspiration
- maintain tissue perfusion
- prevent injury
complications in PACU
- airway obstruction D/T tongue falling back is most common
- hemmorhage (check V/S, BP, output, HR)
Assessment Requirements in PACU
- every 5-15 minutes until stable
- then every 30 minutes for 1-2 hours
make sure V/S completed by surgen before accepting patient
Respiratory Status - PACU
1 priority
Assess for airway devices (ETT, OPA, Tracheostomy)
- O2 sat
- respiratory rate, quality, chest expansion, breath sounds, oxygen
- Complication is hypoxemia PaO2 < 60
- hypoventilation ( hypoexmia, hypercapnia) - shallow rapid breathing
- prevent airway obstruction
- prevent complications by side lying position, HOB elevated
Circulation - pacu
- ekg, BP, temp./skin color, cap refill, peripheral pulse
- Hypotension most common compliation D/T fluid loss
- Cardiac Arrythmia (hypovolemia, hypoxia/hypercapnia)
- Hypertension D/T pain, anxiety, bladder distention
Neurovascular - PACU
Check pulse below sx. site. Especially for regional anesthesia
Neurological - PACU
Ability to follow commands
PERLA
Emergent delerium (restlessness, agitiation, disoreiented, thrashing, yelling)
Delayed Emergence - too long to wake up
Body Fluid/Genitourinary
I/O, I/V fluids, if urine <30 mL/hr notify HCP!
Nursing Interventions For PACU
- Safety
- positioning for airway compliance, turn frequently, stay with patient if restless and find cause
- Pain Relief
- PRN medications before pain, elderly need pain meds even if they don’t feel pain because they have delayed response D/T anesthesia,
- N/V
- Comfort measures, anti-emetics
- Thermoregulation
- hypothermia (less than 35 C 95 F), increase infection, bleeding, cardiac problems
- give blankets, bair hugger, meperidine (demerol)
- Psychological Support
- orient while coming out of anesthesia, reassure them
Criteria for discharge from PACU
- stable V/S
- acceptable aldrete score
- adequent respiration/circulation
- awake
- complications under control
- SPO2 > 90
- report given
- if pt going home, must have responsible adult
Postoperative Phase
When patient is admitted to PACU and ends when patient no longer needs sx. related nursing care
Initial Assessment in post op care
Any pre op orders dont apply
Temperature may increase 1st 48 hours, if temp increase for greater than 2 days may be another problem
Plan of Care for Respiratory function post op
No pneumonia, no atelectasis, promote gas exchange, RR 12 - 20 SPO2 >95 room air
Plan Of Care for Urinary Function Post Op
SCIP - remove foley within 24-48 hours (MD order)
- must void within 8 hours of sx. or removal of foley
- palpate bladder for retention
- bladder scan
- provide measures to help trigger spontaneous voiding
Plan of Care GI function Post Op
- enforce dietary orders (NPO to ADAT)
- note for signs/symptoms of ileus (bloated, N/V, constipation, cramps, watery stool)
- antiemetics PRN
- NGT patency
Pharmacologic Management Post Op
- Nonopioid
- 1st choice
- for mild to moderate pain
- NSAID (prevent prostaglandin synthesis)
- tylenol (can cause liver damage)
- Opioid
- moderate to severe pain
- monitor for sedation/resp depression
- Adjuvant Analgesic
- local anesthetics (blacks Na channels prev. induction of nerve impulses)
- antivonvulsants ( stabilize nerve membranes)
- antidepressents ( increase level of neurotrans in spinal cord that blocks nerve transmission)
Wound Maintainence Post Op
- superficial wound infection most common
- assess for pain/discharge
- aseptic technique
- HCP changes first post op dressing
- incisional cellulitis/ deep tissue absess
- with bowel SX.
- wound will require vacuum, packing, or frequent dressing changes
- deep abscesses may need re-exploration
- Gangrene
- rare, life threatening
- painful, rapid swelling, bloody discharge
- crepitius
- emergency surgery
Discharge Criteria
comfort control activity tolerance knows when to notify HCP measures to promote healing health promoion/agency support restoring wellness
Cystitis
inflammation/infection of the bladder - urethra to bladder
Pyelonephritis
inflammation/infection of kidney - uretrha to kidney
Bacteriuria
Bacteria in the urine
Bacteremia
bacteria in the blood
urosepsis
infection starts in UT and spreads into blood stream
Most common cause of UTI
CAUTI
Lab Work UTI
- CBC
- leukocyte esterase
- nitrates (normally in urine) to nitrities (when infected)
- WBCs
- Urine Culture
Risk Factors UTI
- female
- sexual activity
- use of birth control
- menopause
- catheter
- supressed immune system
- ut abnormailites
- bloackage in UT
- recent urinary procedure (cystoscopy)
Escherichia Coli
caused by wiping back to front
Kiebsiella
common with CAUTI
Enterococcus
From caregiver or pt. to pt.
Proteus
pseudomonas
enterobacter
canidida
CAUTI common
Obtaining Urine Specimens
Clean catch
sterile urine bag
urethral cath
suprapubic aspiration
Treatment UTI
- antibiotic
- fluids
- phenazopyridine (pyridium)
- can cause orange/red fluids
