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
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
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
4
Q
Acute Appendicitis - Complications
A
- Ischemia
- Gangrene
- Perforation
- Ruptured = Peritonitis
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
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
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
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
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
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
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
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
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
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
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
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
