Nursing acute abdomen/GDV patient Flashcards
What does acute abdomen mean?
any intra-abdominal disease process that leads to ana cute onset of clinical signs
What casues an acute abdomen?
either inflammation of an organ, leakage of fluid from a damamged organ or entrapment of an organ
What are the clinical signs of an acute abdomen?
- increased respiratory rate and effort
- increased heart rate, with thready or poor peripheral pulses
- pale, tachy mucous membranes and prolonged CRT or injected mucous membranes and rapid CRT
- hypotensive
- hypothermia
- collapsed or obtunded
- hypersalivation and nausea
- regurgitation, retching vomiting
- abdominal pain
- distended abdomen
- arryhthmias
What are injected mucous membranes a sign of?
SEPSIS
What is hypovolaemic shock?
decreased cirulating volume leading to decreased venous return, decreased stroke volume and decreased cardiac output
What is distributive shock?
vasodilation, leaky vessels and activation of coagulation leading to decreased venous return, decreased stroke volume and cardiac output, leading to sepsis
What is cardiogenic shock?
heart is unable to pump therefore decreased contractility and cardiac output
What is obstructive shock?
physical impediment to blood flow in vessels, causing decrease in venous return, stroke volume and cardiac output
What does insufficnet ocygen supply lead to?
necrosis of tissues
How do we stabilise the acute abdomen patient?
- oxygen therapy
- place IV catheter as big as possible and ideally 2
- analgesia
- IVFT
- blood sample
- potentially catecholamines e.g adrenaline
Why would you avoid NSAIDs in the acute abdomen patient?
reduced cardiac output so wouldn’t want to put them into acute kidney injury, risk of gastric ulceration
What diagnostics can we do?
POCUS - point of care ultrasound
thoracic x-ray
What is percutaneous decompression?
removes gas not fluid
What is oro-gastric decompression?
stomach tube is placed down oesophagus
How would you prepare the for surgery?
- crash kit
- stomach tubes
- suction unit
- IV fluids - warmed for abdominal lavage
- monitoring equipment
- large surgical kit and lap swabs
- sel-fretaining retractors
- elevated trough if can’t tilt table
- scrubbed assistant and float nurse if possible
- don’t use oesophageal stethoscope
What are the anaesthetic considerations for this patient?
- hypotension
- hypoxia
- hypoxaemia
- metabolic acidosis
- hypothermia
- arrythmias
- regurgitation
What arrythmias might you see?
VPCs
What is good for visceral organs and can help arrythmias?
benzodiazepines, methadone, fentanyl CRI, lidocaine
What can alpha-2s cause?
vasoconstriction
What is the anaesthetic protocol for these patients?
- pre-oxygenate
- pre-medication: methadone, midazolam
- ACP and medetomidine can cause too more CVS compromise
- induction: co-iniduction of midazolam with propofol or alfaxan
- maintenance: iso or sevo or TIVA
What might you not use aflaxan as part of you anaesthetic protocol?
it can cause tachycardia and more likely to have arrhythmias
What is most important to monitor in these patients?
blood pressure
What do anticholinergics help with?
bradycardia
What would you use glycopyrrolate for?
mild bradycardia 50-60bpm
What would you use atropine for?
bradycardia under 40bpm
What is vagally mediate bradycardia?
excessive pressure on the vagus nerve causing the brain to think it needs to beat slower
What is the post-op nursing care for these patients?
- monitoring HR, RR, MM, CRT, hydration status, blood database, ECG, blood pressure
- fluid therapy with constant re-evaluation
- analgesia, paracetamol good
- nutrition could consider feeding tube
- reduce stress
- monitor urine output
- monitor for signs of sepsis/SIRS/DIC
- monitor for oedema
- pain scoring
What is important to educate the owners on after their pet has had surgery for acute abdomen?
- reocurrence of GDV possible
- smaller portions of food multiple times a day
- avoid stress
What are the signs of sepsis in dogs?
- temperature below 37.2 or above 39.4
- heart rate above 120bpm
respiratory rate above 24 - white blood cell count less than 6 or more than 16 with 10% bands
What are the signs of sepsis in cats?
- temperature below 37.2 or above 39.4
- heart rate below 140 or above 220
- respiratory rate above 40
- white blood cell count below 6 or above 20
What is septic peritonitis?
the release of chemicals into the bloodstream to fight infection, which are innapropirate and unregulated response to these chemcials which triggers changes that can damage multiple organ systems
How do you treat septic peritonitis?
broad spectrum antibiotics which reduces the risk of endotoxaemia
What is a haemoabdomen?
an accumulation of blood within the peritoneal cavity
What can cause a haemoabdomen?
trauma or spontaneous organ rupture
How will the patient present if they have an acute bleed?
collapsed and hypovolaemic
How will the patient present if they have a chronic bleed?
general history of lethargy and anaemia
What is a uroabdomen?
associated with rupture or leak within the urinary tract associated iwith trauma to the bladder
How do patients with a uroabdomen present?
collapsed and hypovolaemic
What can be seen with a uroabdomen?
hypokalaemia and arrythmias (spiked t-waves)
What does electrolyte and acid base imbalances lead to?
hypokalaemia
What is treatment for hypokalaemia?
IVFT with calcium OR glucose +/- insulin CRI
What does glucose +/- insulin CRI do for hypokalaemia?
pushes potassium back into cells
What can uraemic acids cause?
metabolic acidosis
What is hypoxia?
low oxygen in the body tissues
What can acute kidney injury be associated with?
uroabdomen
What is hypoxaemia?
low oxygen in the blood
What are common differentials in these patients?
- GDV, foreign body, gastric ulceration or perforations, intussusception
- septic peritonitis, blunt/penetrating abdominal trauma, mesenteric volvulus
- acute hepatisis, biliary obstruction/rupture, neoplasia, pancreatitis, splenic mass/torsion
- AKI, pyelonephritis, urethral tear, uroabdomen
- pyometra, prostatitis
What breeds usually get GDV/acute abdomen?
deep chested, large breeds
