Med-Surg: GI, Hepatic, Pancreatic/4 Flashcards
bariatric surgery indications
3
- BMI >40
- BMI > 35 with other diseases
- repeated failure of nonsurgical weight reduction
bari surgery - diet post op
liquids and pureed foods for first 6 weeks
bari surgery post op care
6
- # 1 airway
- ensure abd binder in place
- place in semi fowlers
- ambulate asap, day of surgery
- measure and compare abd girth
- listen for bowel sounds
bari surgery - feedings post op should be
2
- six small feedings per day
2. begin with 1 oz cups of clear liquids
dumping syndrome s/s
6
- tachycardia
- nausea
- diarrhea
- abd cramping
- diaphoresis
- anastomotic leak
colostomy - avoid what foods
5
- nuts
- popcorn
- celery
- seeds
- coconut
colostomy - foods that can cause odor and gas
6
- cruciferous veggies
- asparagus
- fish
- eggs
- garlic
- beans
cirrhosis contributing factors
4
- alcoholism
- postnecrotic
- biliary disease
- severe right sided HF
cirrhosis mani. early
4
- enlarged liver
- jaundice
- GI disturbances
- weight loss
cirrhosis mani. late
8
- liver becomes smaller and nodular
- splenomegaly
- ascites
- bleeding tendencies, decreased vit K and PT time, anemia
- esophageal varices
- pruritis of skin
- clay colored stools; no bile in them
- tea colored urine; bile in urine
cirrhosis diet
high calorie, low protein (10-20 g/day), low fat, low sodium diet
cirrhosis - sodium and fluid
limit
lactulose
decreases ammonia levels in cirrhosis
hep a route
fecal oral
hep B route
blood
hep C route
blood
hep A mani.
2
- mild
2. flu like
hep B mani.
9
- may be asymptomatic
- RUQ pain
- anorexia
- NV
- fatigue
- febrile
- dark urine
- light colored stool
- jaundice
hep C mani.
3
- most are asymp.
- dx with blood testing
- chronic inflammation progresses to cirrhosis
hep A prevention
2
- hand washing
2. vaccine ages 2+ (two doses 6-18 months apart)
hep B prevention
2
- vaccine infants and high risk populations
2. 3 doses over 6-month time
hep C prevention
avoid high risk behaviors
hep B and C tx
3
- antiviral drugs
- peginterferon alfa-2B
- monitor kidney function
cholecystitis
inflammation of gallbladder
cholelithiasis
presence of stones in the gallbladder
gallbladder disease CF
5
- more common in females
- obesity
- high fat diet
- older adults
- DM type 2
gallbladder manif.
7
- sharp right upper quadrant, epigastric, or shoulder pain
- NV after ingestion of high fat food
- murphy’s sign
- flatulence
- dyspepsia
- dark urine
- clay colored stool
cholecystectomy post op
4
- may have T tube 1-2 weeks
- monitor drainage, keep below level of GB
- report drainage greater than 1000ml/day
- never irrigate without order
GB disease client education
3
- resume regular low fat diet
- prevent dumping syndrome
- care of T tube
chronic pancreatitis CFs
6
- alcohol
- gallstones
- illegal drug use
- infection
- blunt abd trauma
- operative manipulation and trauma
pancreatitis manif.
9
- severe mid-epigastric or LUQ pain
- pain intensifies after meals and when lying down
- NV
- weight loss
- abd tenderness
- ascites
- elevated amylase and lipase
- steatorrhea
- Turner and Cullen’s sign
pancreatitis position of comfort
upright leaning forward
pancreatitis - monitor for what electo
hypocalcemia and hypomag
pancreatitis rx for pain that is contraindicated
meperidine
client education for chronic pancreatitis
3
- take enzymes before meals and snacks
- nutrition: high caloric needs, low fat
- no alcohol
pancreatic cancer dx procedures
5
- carcinoembryonic antigen (CEA) levels - normal is <2.5 nonsmokers, <5 smokers
- elevated serum amylase and lipase
- elevated alkaline phosphate and bilirubin
- ERCP
- US, CT scan
