NRSG258 - part 5 Flashcards
Antipyretics
Non steroidal anti-inflammatory drugs NSAIDs
- many available in Australia
- Reduce fever
Paracetamol
- Reduces fever
- Not an NSAID
Nursing interventions:
- cooling techniques -fans
- tepid sponge
- remove clothing or blankets
- col drinks
Non-steroidal anti-inflammatory drugs (NSAIDs)
acetylsalicylic acid
- Aspirin
- Disprin
- Cardiprin
ibuprofen
- Nurofen
- Advil
diclofenac
* Voltaren
celecoxib
* Celebrex
naproxin
* Naprogesic
Bactericidal
kills bacteria
Bacteriostatic
slows the growth of bacteria
Broad spectrum
wide range of micro-organisms
Narrow spectrum
narrow range of micro-organisms
Therapeutic range
drug levels are maintained
Gram stain
positive or negative
Common infectious microorganisms
Gram Positive Gram Negative Spirochaetes Fungi Viruses
Gram Positive
Staphylococcus
Streptococcus
Gram Negative
Clostridium Enterobacter Escherichia coli Klebsiella Pseudomonas Haemophylusinfluenzae Mycobacterium Chlamydia
Spirochaetes
Syphilis
Fungi
Aspergillus
Candida
Tinea
Viruses
Cytomegalovirus
Herpes
Enterovirus
Antibiotics work by:
Disruption of cell membrane function
* Polyenes and polymixins
Cell wall
- Inhibit cell wall synthesis
- Penicillins and cephalosporins
- Results in cell death
Inhibit DNA and RNA synthesis
- Quinolenes
- Nalidixic acids
- Rifamycin
Protein synthesis by ribosides
- Chloramphenicol and erythromycin
- Tetracycline, streptomycin gentamycin
Inhibit folic acid metabolism
- Sulphonamides, trimotproprin
- Bacteriostatic
Antibiotics - Paediatric implications
- Proven effectiveness and adequate penetration
- Multiple drugs may be indicated
- Dosage calculated on weight
Drug plasma concentrations may need to be monitored
* Gentamicin, tobramycin, vancomycin
- Cultures taken prior to initiating therapy
- Continued until infection no longer present
Antibiotics - Prophylactic use in surgery
Joint replacement Bowel Head and neck Dental or oral Emergency Trauma Cardiac
Compromised immune systems
Diuretics
Modify kidney function Increase diuresis Increased formation and excretion of urine Natriuresis Increased excretion of NaCl
Diuretics - The main classes
osmotic diuretics
Loop diuretics
thiazide diuretics
potassium sparing diuretics
Diuretics - Nursing care considerations
Give medication in the morning
Monitor:
- fluid intake and output
- Blood pressure
- Serum electrolyte levels
- Blood glucose levels
- Patient education
- Access to toileting
- Assessment of catheter
- Assess for signs and symptoms of dehydration
Colonoscopy - What is it?
Study directly visualises entire colon up to ileocaecalvalve with flexible fibre-optic scope.
Test is used to diagnose inflammatory bowel disease, and to detect tumours, diverticulosis and dilate strictures.
Procedure allows for biopsy and removal of polyps without laparotomy.
Colonoscopy - Surgical Fasting Times
- Liquids and solids empty by different mechanisms at different times.
- Clear liquids up to two hours prior to surgery
- Clear liquids e.g. water, juice without pulp, coffee/ tea without milk & soft drinks usually out of the stomach in 12mins.
- Enhanced recovery (ERAS) protocols for surgery may include the administration of 300to 400 mL of a carbohydrate drink ±proteins ±lipids up to two hours prior to anaesthesia.
- Solids up to four hours prior to surgery
Indications for colectomy
- Malignant and premalignant lesions
- Metastatic tumour
- Crohn disease
- Colonic ischaemia
- Colon trauma
- Fulminant Clostridium difficilecolitis
- Diverticular disease
- volvulus
Transverse colectomy and formation of stoma
Transverse colectomy
Transverse colectomy removes the transverse colon.
Laparotomy
most common, incision just below the breastbone for a variable length down to the pelvis. Hospital stay 8-10 days.
If the cancer is larger, the doctor will perform a partial colectomy and an anastomosis
Usually lymph nodes are removed for biopsy. (test for metastases)
If an anastamosisis not possible, a stoma is made on the outside of the body for waste to pass through. This procedure is called a colostomy.
Sometimes the colostomy is needed only until the lower colon has healed, and then it can be reversed.
If the entire lower colon is removed, however, the colostomy may be permanent.
Congestive Cardiac Failure
occurs when the heart is unable to pump oxygenated, nutrient rich blood out at a rate that meets the metabolic demands of the body, causing a back-up of blood in the venous circuit and leading to oedema.
Results from any structural or functional cardiac disorder that impairs the ability of the ventricle to fill or eject blood.Diagnosed when LVEF < 40%
Congestive Cardiac Failure - Causes
Myocardial disease - (2/3 of all CHF –from fibrosis from IHD + AMI) Arrhythmias Valve disease Pericardial disease Congenital heart disease COPD (right sided HF)
Determinants of Cardiac function
Preload
Afterload
Contractility
Heart rate
Cardiac function - Preload
represent the stretch on the ventricles as a consequence of ventricular filling. (venous return relates directly to end diastolic volume) i.e intravascular blood volume
Cardiac function - Afterload
resistance downstream to the left ventricle which it has to overcome in order to eject blood from the heart. i.e arterial vasoconstriction increases resistance
Cardiac function - Contractility
the force of contraction to ensure the adequate stroke volume is ejected. The degree of myocardial fibre shortening
T2DM Pathophysiology
Chronic Progressive condition
Main problem is the body becomes resistant to the normal effects of insulin and/or the body loses the capacity to produce enough insulin in the pancreas to meet demand.
1.
There is a decreased intracellular reaction to insulin causing a decreased uptake of glucose by the tissue
2
Causing an unchecked regulation of glucose production/release by the liver (gluconesis& Gluconeogenesis)
3.
To overcome this there needs to be an increase in the amount of insulin secreted.
4.
However if the beta cells cannot keep up with the increased demand for insulin, glucose level rises above normal level and T2DM develops.
T2DM Risk factors - Modifiable
Weight Sedentary lifestyle diet HTN Apple shaped body
T2DM Risk factors - Non –modifiable
A family history of diabetes
ATSI background
Age
- Over 55 years of age - the risk increases as we age
- Are over 45 years of age and are overweight
- Are over 35 years of age and are from an Aboriginal or Torres Strait Islander background
Are a woman who has given birth to a child over 4.5 kgs, or had gestational diabetes when pregnant, or had a condition known as Polycystic Ovarian Syndrome.
Polyphagia
results from cell deprivation of nutrients as glucose is not entering the cells in sufficient amounts which stimulates increased food intake
Polyuria
the osmotic effect of glucose in the urine draws water from the bloodstream increasing production of urine
Polydipsia
the water being lost from the body in the urine leads to dehydration which triggers increased thirst in an attempt to rehydrate the cells
Surgical risk for obesity and diabetes
Obese patients have a higher risk of surgical and anaesthetic complications (BMI over 30) and post operative wound infections
Obesity stresses the cardiac and pulmonary systems and makes access to the surgical site and anaesthesia administration more difficult.
Some inhaled anaesthetic agents are absorbed and stored in adipose tissue, and therefore leave the body more slowly prolonging recovery/wakening times.
Diabetes mellitus is also associated with increased risk of perioperative infection and postoperative cardiovascular morbidity and mortality and longer hospital stays.
Persistent hyperglycemia is a risk factor for endothelial dysfunction, postoperative sepsis, impaired wound healing, and cerebral ischemia.
Surgery and general anaesthesia cause a increase in stress response which alters glucose metabolism.
Key aspect of the perioperative management is glycemic control through close monitoring, adequate fluid and caloric repletion, and judicious use of insulin
Fluid Overload
Pulmonary oedema is the accumulation of fluid within pulmonary interstitial spaces and ultimately within the alveoli.
The excess fluid occurs as a result of changes in pressure within the pulmonary vessels or from changes in vascular permeability
Pulmonary capillary pressure exceeds plasma oncotic pressure and forces fluid into the alveoli, interfering with gas exchange.
Cardiogenic pulmonary oedema is associated with heart failure
Stoma/ wound management
Patient adaptation-ADL’s in 6-8 weeks, no heavy lifting, psychological support, identify coping mechanism
Colostomy care
Assess stoma and surrounding skin:
- Pink stoma - healthy; pale - anaemic; dusky blue - necrotic
- Mild to moderate swelling - till 2-3 weeks is normal; moderate to severe swelling -obstruction of stoma * Small amount of oozing - normal; moderate to large bleeding -coagulation problem or GI bleed
Wash stoma with mild soap & water Use of skin barrier Use of pouch - leave ¼ of skin around the stoma Colostomy irrigations Regulate bowel function Treat constipation
