Nursing acute abdomen/GDV patient Flashcards
(48 cards)
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
