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Adult Health 2 - Exam 1 > Inflammatory Disorders > Flashcards

Inflammatory Disorders Flashcards

1
Q

Acute Appendicitis - Pathophysiology

A
  • Appendix becomes inflamed, increases intraluminal (opening of the appendix) pressure, causes edema & obstruction of orifice
    > incrs internal pressure
    > restricts blood flow
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2
Q

Acute Appendicitis - Etiology

A
  • Result of becoming kinked or occluded with stool
  • Lymphoid hyperplasia (inrd lymphoid cells) secondary to inflammation or infection
  • Rarely, foreign bodies (seeds) or tumors
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3
Q

Acute Appendicits - CMs

A
  • Severe, steady pain in RLQ
    > McBurney Point: midway btwn anterior iliac crest & umbilicus in RLQ, area of tenderness during later stages of appendicitis
  • Rebound tenderness: pain after release
  • Low grade fever/nausea
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4
Q

Acute Appendicitis - Complications

A
  • Ischemia
  • Gangrene
  • Perforation
  • Ruptured = Peritonitis
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5
Q

Acute Appendicitis - Diagnostics

A
  • CBC
    > elevated WBC: 5000-10000mm3
    > elevated Neutrophils: 55-70%
  • Urinalysis: rule out UTI/stones
  • CT: RLQ density
    > appendix enlargement (6mm or >)
  • Pregnancy Test: rule out ectopic
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6
Q

Acute Appendicitis - Medical/Surgical Interventions

A
  • Appendectomy
    > laparoscopy: small incision near umbilicus, few postop complications
    > laparotomy: large abdominal incision
  • IV fluids
    > maintain fluid & electrolyte balance
  • Antibiotics
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7
Q

Acute Appendicitis - Nursing Diagnosis

A
  • Infection, risk for
  • Pain
  • Fluid volume deficit, risk for
  • Surgery, knowledge deficit
  • Anxiety
  • Risk for: atelectasis, DVT, ileus
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8
Q

Acute Appendicitis - Nursing Interventions

A
  • Educate pt on surgery
  • Admin pain med
  • Admin IV fluids/encourage PO fluids (after pass gas)
  • Provide postop care
  • Prevent post op comps:
    > educate pt on TCDB & IS
    > position: High Fowler’s
    > auscultate abd for bowel sounds
    > ambulate
  • Discharge instructions
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9
Q

Peritonitis - Pathophysiology

A
  • Inflammation of peritoneum usually a result of:
    > bacterial infection
    > external sources: abd surgery or trauma
    > peritoneal dialysis
    > inflamm of other organs
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10
Q

Peritonitis - CMs

A
  • Fever
  • Pain
    > begins as diffuse pain then constant, localized, more intense over site, incrs w/ movement
  • Rigid muscles/Distention of abd; board like
  • N/V; paralytic ileus
  • Hypovolemia: movement of fluid from extracellular fluid compartment into peritoneal cavity, connective tissues, & GI tract
  • Without Intervention = sepsis/shock
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11
Q

Peritonitis - Diagnostics

A
  • WBC elevated w/ Bands
    > bands = immature WBCs
  • Electrolytes
    > alt lvls of K, Na, Cl
  • C&S of aspirate
  • Abd X-Ray
    > air & fluid lvls; distended bowel loops
  • CT: abscess formation
  • MRI: intra-abd abscesses
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12
Q

Peritonitis - Medical/Surgical Interventions

A
  • Find infec source
  • Fluid/Electrolyte replacement
  • Pain meds
  • Antiemetics
  • Antibiotics
  • NG TUBE: relieve distention
  • Airway intubation & ventilator assist
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13
Q

Peritonitis - Nursing Diagnosis

A
  • Risk for infection
  • Deficient fluid vol
  • Acute pain
  • Risk for imbal nutrition: less than body requirements
  • Constipation
  • Nausea
  • Risk for dysfunc GI motility
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14
Q

Peritonitis - Nursing Interventions

A
  • May prep for surgery
  • Monitor, Assessment, VS
  • Focus on bowel sounds
  • Admin meds
  • Advance diet as tolerated
  • Intensive care for septic shock
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15
Q

Cholecystitis - Pathophysiology

A
  • Inflammation of gallbladder
  • Acute vs Chronic
  • Stones vs not
  • Women greater than men
    > age greater than 40, obese, fertile
    > 4 Fs: fat, fertile, female, forty
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16
Q

Cholecystitis - CMs

A
  • Biliary colic pain RU abd
    > radiates R shoulder & back
    > N/V
  • Obstruction causes jaundice
  • Urine/stool changes
    > urine dark; putty (pale) colored stool
  • Vit Deficiency
    > Fat soluble: A, D, E, K
  • Complications: stones
    > necrosis, peritonitis
17
Q

Cholecystitis - Diagnostics

A
  • Radiographic
    > abd x-ray
    > ultrasonography
    > endoscopic retrograde cholangiopancreatography (ERCP)
  • Procedural
  • Laboratory
    > incrd bilirubin (0.3-1mg/dL)
18
Q

Cholecystitis - Medical/Surgical Interventions

A
  • Diet/Supportive therapy
  • Pharmacologic therapy
    > dissolve small, gallstones
  • Nonsurgical removal gallstones
    > catheter inserted percutaneously
  • Surgical management
    > laparoscopic: less invasive
    > open (laparotomy): more invasive
19
Q

Cholecystectomy

A
  • Laparoscopic vs Traditional
    > lower comps
    > low death rates
    > rare bile duct injuries
    > quicker recovery
    > less postop pain
  • Preop, Intraop, Postop similarities & differences
20
Q

Cholecystitis - Nursing Diagnosis

A
  • Acute pain
  • Impaired gas exchange
  • Impaired skin integrity
  • Imbalanced nutrition; less than
  • Risk for infection at surgical site
21
Q

Cholecystitis - Nursing Interventions

A
  • Post Op Care
    > pain relief
    > improve resp status
    > maintain skin integrity
    > promote biliary drainage
    > low fat diet/high carb & protein
    > monitor & manage potential comps: bleeding, peritonitis, disruption of GI func
    > discharge care
22
Q

Cholecysitis - Pt Education: Home Care

A
  • Gas pain from surgery: sit up right/walk to ease; take pain meds as prescribed
  • Light exercise; may shower day 2, drive 3-4 days, avoid lifting >5lbs x 1 week
  • Check wounds daily, wash w/ soap & water, do not remove steri-strips
  • Add fat back into diet in small increments; Reg diet 4-6 weeks
  • Follow up appt 7 days; call if S/S on infec, fever, N/V, abd pain
23
Q

Acute Pancreatitis - Pathophysiology

A
  • Inflamm of pancreas
    > self-digestion of organ
  • Risk Factors
    > Gallstones: obstruction
    > ETOH
    > Autoimmune disease
24
Q

Acute Pancreatitis - CMs

A
  • Abd/back pain
  • Rigid abd/gaurding
    > peritonitis
  • N/V
  • Ecchymosis in flank or around umbilicus
  • Fever
  • Jaundice
  • Hypotension/hypovolemic shock
25
Q

Acute Pancreatitis - Diagnositics

A
  • Hx of abd pain
  • CBC
    > elevated WBC, H&H (bleeding)
  • Serum amylase/lipase
    > elevated w/in 24hrs of symps
  • Transient hyperglycemia & glycosuria & elevated serum bilirubin in some pts
  • Abd x-ray
  • US
26
Q

Acute Pancreatitis - Medical/Surgical Interventions

A
  • NPO
  • Parenteral feedings
    > hyperglycemia (TPN has D50W)
  • NG to suction
  • Pain management
  • Resp care
  • Biliary drainage
  • Surgical intervention
  • Intensive care
27
Q

Acute Pancreatitis - Nursing Diagnosis

A
  • Acute pain
  • Alt breathing pattern
  • Alt nutrition status: less than
  • Impaired skin integrity, risk for
  • Ineffective hlth maintenance
  • Nausea
28
Q

Acute Pancreatitis - Nursing Interventions

A
  • Admin analgesics
  • Positioning
    > improve breathing pattern
  • NPO/NG tube care/IV fluids
  • Parenteral nutrition
  • Monitor for comps
  • Educate
    > ETOH in pancreatitis
    > Alcoholics Anonymous
29
Q

Pancreatic Cancer - Pathophysiology

A
  • Adenocarcinoma
  • All parts of pancreas
  • Fast growing
  • Highly invasive
  • Primary
  • Secondary
  • Metastsis through venous & lymphatic systems
30
Q

Pancreatic Cancer - Risk Factors

A
  • Smoking
  • DM
  • Chronic pancreatitis
  • Cirrhosis
  • Male
  • Older age
  • Genetic (BRCA2)
31
Q

Pancreatic Cancer - CMs

A
  • Weakness & fatigue
  • Abd pain (dull/non-specific)
  • Jaundice
  • Clay-colored stools
  • Dark urine
  • Weight loss
  • Anorexia
  • N/V
32
Q

Pancreatic Cancer - Diagnosis

A
  • Assessment of CMs
  • Elevated amylase & lipase
  • Elevated alkaline phosphatase
  • Elevated total bilirubin
  • Ultrasound/CT
  • ERCP
  • Pancreatic washings
33
Q

Pancreatic Cancer - Medical/Surgical Interventions

A
  • Chemotherapy/Radiation
    > shrinks tumors
  • ERCP w/ Sphincterotomy & Stent
  • Pain control/opioids
  • Whipple procedure
    > open
    > minimally invasive
34
Q

Pancreatic Cancer - Nursing Diagnosis

A
  • Anxiety
  • Ineffective family coping
  • Fear
  • Grieving
  • Deficient knowledge
  • Spiritual distress
  • Risk for impaired liver func
35
Q

Pancreatic Cancer - Nursing Intervention

A
  • Admin analgesics
  • Positioning
    > improve breathing pattern
  • NPO/NG tube care/IV fluids
  • Blood glucose/TPN/Central line
  • Assess for bleeding, infection, abscess formation

Adult Health 2 - Exam 1 (7 decks)

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