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ACVN - SURGICAL NURSING > Nursing acute abdomen/GDV patient > Flashcards

Nursing acute abdomen/GDV patient Flashcards

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1
Q

What does acute abdomen mean?

A

any intra-abdominal disease process that leads to ana cute onset of clinical signs

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2
Q

What casues an acute abdomen?

A

either inflammation of an organ, leakage of fluid from a damamged organ or entrapment of an organ

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3
Q

What are the clinical signs of an acute abdomen?

A
  • 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
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4
Q

What are injected mucous membranes a sign of?

A

SEPSIS

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5
Q

What is hypovolaemic shock?

A

decreased cirulating volume leading to decreased venous return, decreased stroke volume and decreased cardiac output

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6
Q

What is distributive shock?

A

vasodilation, leaky vessels and activation of coagulation leading to decreased venous return, decreased stroke volume and cardiac output, leading to sepsis

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7
Q

What is cardiogenic shock?

A

heart is unable to pump therefore decreased contractility and cardiac output

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8
Q

What is obstructive shock?

A

physical impediment to blood flow in vessels, causing decrease in venous return, stroke volume and cardiac output

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9
Q

What does insufficnet ocygen supply lead to?

A

necrosis of tissues

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10
Q

How do we stabilise the acute abdomen patient?

A
  • oxygen therapy
  • place IV catheter as big as possible and ideally 2
  • analgesia
  • IVFT
  • blood sample
  • potentially catecholamines e.g adrenaline
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11
Q

Why would you avoid NSAIDs in the acute abdomen patient?

A

reduced cardiac output so wouldn’t want to put them into acute kidney injury, risk of gastric ulceration

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12
Q

What diagnostics can we do?

A

POCUS - point of care ultrasound
thoracic x-ray

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13
Q

What is percutaneous decompression?

A

removes gas not fluid

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14
Q

What is oro-gastric decompression?

A

stomach tube is placed down oesophagus

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15
Q

How would you prepare the for surgery?

A
  • 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
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16
Q

What are the anaesthetic considerations for this patient?

A
  • hypotension
  • hypoxia
  • hypoxaemia
  • metabolic acidosis
  • hypothermia
  • arrythmias
  • regurgitation
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17
Q

What arrythmias might you see?

A

VPCs

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18
Q

What is good for visceral organs and can help arrythmias?

A

benzodiazepines, methadone, fentanyl CRI, lidocaine

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19
Q

What can alpha-2s cause?

A

vasoconstriction

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20
Q

What is the anaesthetic protocol for these patients?

A
  • 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
21
Q

What might you not use aflaxan as part of you anaesthetic protocol?

A

it can cause tachycardia and more likely to have arrhythmias

22
Q

What is most important to monitor in these patients?

A

blood pressure

23
Q

What do anticholinergics help with?

A

bradycardia

24
Q

What would you use glycopyrrolate for?

A

mild bradycardia 50-60bpm

25
Q

What would you use atropine for?

A

bradycardia under 40bpm

26
Q

What is vagally mediate bradycardia?

A

excessive pressure on the vagus nerve causing the brain to think it needs to beat slower

27
Q

What is the post-op nursing care for these patients?

A
  • 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
28
Q

What is important to educate the owners on after their pet has had surgery for acute abdomen?

A
  • reocurrence of GDV possible
  • smaller portions of food multiple times a day
  • avoid stress
29
Q

What are the signs of sepsis in dogs?

A
  • 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
30
Q

What are the signs of sepsis in cats?

A
  • 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
31
Q

What is septic peritonitis?

A

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

32
Q

How do you treat septic peritonitis?

A

broad spectrum antibiotics which reduces the risk of endotoxaemia

33
Q

What is a haemoabdomen?

A

an accumulation of blood within the peritoneal cavity

34
Q

What can cause a haemoabdomen?

A

trauma or spontaneous organ rupture

35
Q

How will the patient present if they have an acute bleed?

A

collapsed and hypovolaemic

36
Q

How will the patient present if they have a chronic bleed?

A

general history of lethargy and anaemia

37
Q

What is a uroabdomen?

A

associated with rupture or leak within the urinary tract associated iwith trauma to the bladder

38
Q

How do patients with a uroabdomen present?

A

collapsed and hypovolaemic

39
Q

What can be seen with a uroabdomen?

A

hypokalaemia and arrythmias (spiked t-waves)

40
Q

What does electrolyte and acid base imbalances lead to?

A

hypokalaemia

41
Q

What is treatment for hypokalaemia?

A

IVFT with calcium OR glucose +/- insulin CRI

42
Q

What does glucose +/- insulin CRI do for hypokalaemia?

A

pushes potassium back into cells

43
Q

What can uraemic acids cause?

A

metabolic acidosis

44
Q

What is hypoxia?

A

low oxygen in the body tissues

45
Q

What can acute kidney injury be associated with?

A

uroabdomen

46
Q

What is hypoxaemia?

A

low oxygen in the blood

47
Q

What are common differentials in these patients?

A
  • 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
48
Q

What breeds usually get GDV/acute abdomen?

A

deep chested, large breeds

ACVN - SURGICAL NURSING (17 decks)

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