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BEACON MedSurg/Peds > Test 4 Nutrition-Elimination > Flashcards

Test 4 Nutrition-Elimination Flashcards

1
Q

Cleft Lip and Cleft Palate

A

Failure of maxillary and median nasal processes to fuse during embryonic development

Remember: psycho-social implications for these children and families

Early first trimester development.

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2
Q

Cleft lip and cleft palate assessment

A

various degrees.

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3
Q

Cleft lip concerns

A

scarring

teeth issues

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4
Q

cleft palate concerns

A

sucking - feeding

speech

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5
Q

cleft lip and palate issues

A

increased severity of scarring, teeth issues, sucking - feeding, speech.

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6
Q

Cleft lip/palate treatment

A
  • surgical repair between 3 and 6 months
  • multidisciplinary team - involving many specialists including plastic surgeons, nurses, ENT specialists, orthodontists, audiologists, and speech therapists
  • reconstruction begins in infancy and can continue through adulthood
  • homecare by the family prior to surgery.
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7
Q

Cleft lip/palate pre-op nursing care

TWO main goals

A
  1. prevention of aspiration

2. maintain nutrition

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8
Q

Cleft lip/palate

Pre-op nursing care

A
  • may breast feed if has small cleft lip
  • if bottle fed, use compressible bottle, longer nipple, larger hoe in nipple, any other special device for feeding this infant
  • feed slowly in upright position and burp frequently
  • keep bulb syringe and suction equipment at bedside
  • position on side after feeding
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9
Q

Cleft lip/palate

feeding problems

A

lack proper seal around nipple to create necessary suction

excessive air intake

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10
Q

cleft lip/palate

use of special feeding techniques

A

feeder with compressible sides

syringes with tubing

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11
Q

Cleft lip/palate

Prevent trauma to suture line

A
  • Logan’s bow to protect site (kind of brace that protects mouth/nose post-surgery)
  • do not allow to suck
  • maintain upper arm restraints
  • position supine
  • no hard objects in mouth - straws, pacifiers,spoons
  • do not take temperature orally
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12
Q

Cleft lip/palate

Reduce pain

A

mild analgesics and sedatives

parents to provide, holding, rocking, and parental voices

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13
Q

Cleft lip/palate

prevent infection

A

-cleanse suture line as ordered
rinse with water after each feeding
use cotton swab, use rolling motion vertically down suture line

  • apply anti-infective ointment as ordered
  • call doctor for any swelling or redness, bleeding, drainage, fever

Make early referrals to appropriate team members
daily weights, dietitian, speech therapy, audiologists

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14
Q

Cleft lip/palate

assess for complications

A

otitis media (cleft lip/palate increased risk)
hearing loss
speech difficulties
altered dentition

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15
Q

Esophageal atresia

A

Malformation from failure of esophagus to develop as a continuous tube.

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16
Q

Esophageal atresia

variations

A

esophagus not connected to anything
esophagus connected to trachea
trachea connected to stomach, esophagus connected to nothing
esophagus connected to trachea and stomach

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17
Q

Esophageal atresia

clinical manifestations

A
  • excessive amounts of salivation/mucus, frothy bubbles in the mouth and sometimes nose,
  • three C’s - coughing choking and syanosis when fed, overflow may be aspirated
  • food may be expelled through the nose immediately following the feeding
  • rattling respirations and frequent respiratory problems such as aspiration pneumonia
  • gastric distention, if fistula
  • history of polyhydramnios during pregnancy can suggest a high gastrointestinal obstruction.
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18
Q

Esophageal atresia

diagnosis and management

A

early diagnosis

- ultrasound
- radiopague catheter inserted in the esophagus to illuminate defect on x-ray

surgical repair
-thoracotomy and anastomosis

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19
Q

Esophageal atresia

pre-op nursing care

A
  • maintain airway
  • keep NPO administer iv fluids
  • place in warmer give humidified o2
  • elevate hob 30 degrees
  • suction PRN
  • give prophylactic antibiotics
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20
Q

Esophageal atresia

post op nursing care

A 
maintain airway
maintain thermoregulation
maintain nutrition
prevent trauma (can't see suture line)
monitor for potential complications...dehydration, internal bleeding, aspiration
monitor weight, growth and developmental achievements
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21
Q

Gastroesophageal Reflux Disease (GERD)

A

Backward flowing of gastric contents into esophagus

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22
Q

GERD causes

A

incompetence of lower esophageal sphincter
transient lower esophageal relaxation
increased intragastric pressure

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23
Q

GERD risk factors

A

obesity, pregnancy, hiatal hernia, chewing tobacco, smoking, caffeine, chocolate, drugs

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24
Q

GERD pathogenesis

A

Reflux of stomach contents

Gastric acid

esophageal mucosal injury

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25
Q

GERD assessment: infant

A
  • regurgitation almost immediately after each feeding when the infant is laid down
  • excessive crying, irritability
  • failure to thrive
  • life threatening risk/complications:
    • aspiration pneumonia
    • apnea
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26
Q

GERD assessment: child

A
  • Heartburn
  • Abdominal pain
  • cough, recurrent pneumonia
  • dysphagia
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27
Q

GERD: clinical manifestations adult

A 
heartburn after eating
abdominal pain
chestpain
chronic cough
asthma
complications
	-strictures -> dysphagia
	-Barrett's esophagus (change in the normal cell structure of the esophagus)
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28
Q

GERD Diagnosis

A

Esophageal endoscopy

pH monitoring

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29
Q

GERD Nursing diagnosis

A

pain
ineffective management of therapeutic regimen
inadequate nutrition
knowledge deficit

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30
Q

GERD Pediatric client

management and nursing care

A

small frequent feedings, of predigested formula or thicken the formula
frequent burping
positioning-keep upright for 30 minutes after feedings
avoid excessive movement

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31
Q

GERD pediatric client management and nursing care

A

if history of apnea, brady, r/t GERD - needs continuous cardiac and apnea monitoring, arrange for CPR teaching for caregivers
if infant does not respond to non-invasive therapy, then a nissen fundoplication may be done to increase competence of the cardiac sphincter.

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32
Q

GERD fundoplicatino post op nursing care

A

assess for pain, abdominal distention, and return of bowel sounds
teach parents about gastrostomy tube feedings

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33
Q

GERD planning and implementation

dietary management

A

limit or eliminate citrus juices, fatty and spicy foods, coffee, caffeine, alcohol, chocolate and peppermint
eat smaller meals
stay upright for 2 hr after meals
refrain from eating for 3 hr before bedtime
elevate HOB on 6-8 inch blocks
weight reduction
avoid restrictive clothing

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34
Q

GERD

Medications

A

Antacids(maalox, mylanta, gaviscon, gelusil, riopan, amphojel
Histamine 2-receptor blockers (cimetidine, famotidine, rantidine, nazatidine)
proton pump inhibitors (lansoprazole, omeprazole, pantoprazole, rabeprazole)
prokinetic agent (metoclopramide)

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35
Q

Gastritis

A

inflammation of the stomach lining, results from irritation of the gastric mucosa

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36
Q

gastritis

Acute

A

benign self-limiting related to ASA, ETOH, caffeine, or foods with bacteria
stress ulcer - major stressor

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37
Q

Chronic gastritis

A

progressive and irreversible changes in gastric mucosa

gradually leads to atrophy of gastric tissues

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38
Q

chronic gastritis

type A

A

autoimmune

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39
Q

chronic gastritis

type B

A

chronic infection (Helicobacter pylori)

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40
Q

Gastritis assessment

acute

A

anorexia, n/v
hematemesis
malaise
gi bleeding

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41
Q

gastritis assessment

chronic

A

may be asymptomatic
anorexia, n/v
belching
heartburn after eating

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42
Q

Gastritis

nursing diagnosis

A

deficient fluid volume

imbalanced nutrition: < body requirements

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43
Q

Gastritis

planning and implementation

A

NPO status will help mucosa to heal then start back slowly with clear liquids, toast, bland fluids, slowly return to regular diet
administer anti-emetics, antacids, H2 antagonists, antibiotics
weigh daily
monitor and maintain fluid and electrolyte balances, intake and output
control nausea and vomiting

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44
Q

gastritis planning and implementation

medications

A 
histamine 2-receptor blockers
antacids
PPI
vitamin b12
antibiotics -biaxin, amoxicillin, flagyl, tetracylcine with bismuth(may not be appropriate if pt is on anti-coagulant therapy) or PPI
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45
Q

Pyloric Stenosis

A

Narrowing of the pyloric sphincter
delayed emptying of the stomach
symptoms develop 3-5 weeks after birth…NOT congential
associate with infant receiving erythromycin, mother receiving erythromycin late in pregnancy, or mother taking erythromycin and baby breastfeeding.

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46
Q

pyloric stenosis

assessment

A 
hypertrophied pylorus
distended abdomen
projectile vomiting
constant hunger
fussiness
visible peristaltic waves
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47
Q

pyloric stenosis

treatment and nursing care

A

treatment - surgery (pyloromyotomy)

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48
Q

pyloric stenosis

postoperative care

A 
STRICT I&O
Feeding
Position with head elevated
assess surgical site to prevent infection
patient teaching
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49
Q

Hirschprung’s disease

A

congenital disorder of nerve cells in lower colon
no innervation.
occurs 5x more in males than females. usually associated with other conditions, esp Down’s syndrome

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50
Q

hirschprung’s disease

assessment

A 
failure to pass meconium
ribbon like stools
vomiting
reluctance to feed
abdominal distention
foul odor of breath
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51
Q

hirschprung’s disease

diagnosis

A

history and physical
barium enema (xray)
rectal biopsy

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52
Q

hirschprung’s disease

management

A

surgical intervention (series of surgeries
colostomy
resection

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53
Q

hirschprung’s disease
nursing care
pre-op

A

cleanse bowel

patient/parent teaching

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54
Q

hirschprung’s disease
nursing care
post-op

A 
npo
vital signs (rectal temperature is absolutely FORBIDDEN) 
gi assessment 
patient/parent teaching 
	colostomy care
	skin care
	nutrition
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55
Q

Intussuception

A

most commonly seen in infants 3-12 months
bowel “telescopes” within itself.
don’t know why happens, but usually seen after a rotovirus infection.

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56
Q

Volvulus

A

twisting of the bowel that leads to a bowel obstruction

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57
Q

Intussuception

assessment

A 
pain
vomiting
stools- resemble currant jelly, bloody mucus
sausage shape abdominal mass
dehydration
serious complications - shock and sepsis
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58
Q

volvulus

assessment

A

pain
bilious vomiting
abdominal distention
tachycardia

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59
Q

therapeutic intervention

Intussuception

A

hydrostatic reduction inject barium or air to try to fix the telescoping

surgery

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60
Q

therapeutic intervention

volvulus

A

surgery

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61
Q

nursing care

Intussuception/volvulus

A

following the hydrostatic reduction
clear liquids and diet is advanced gradually
observe for passage of barium and eventually passage of stool

if reduction is not successful -> surgery

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62
Q

post op nursing care

Intussuception/volvulus

A

stabalize the child
npo and start iv fluids
ng tube to decompress the bowel
pain medications

provide information to the parents

surgery usually completely fixes these issues.

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63
Q

Lactose Intolerance

manifestations

A 
diarrhea that is frothy, but not fatty
abdominal distention
cramping
abd pain
excessive flatus
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64
Q

Lactose Intolerance

A

removal of lactose from the diet
eliminate- milk, formulas that contain dairy products, ice cream, yogurt, hard cheeses

breastfeeding moms- eliminate lactose from their diet.

medications
lactase preparations - lactaid, dairy ease, lac-dose

obtain calcium from other sources

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65
Q

Celiac Disease

Clinical Manifestations

A 
Failure to grow
wasting of extremities
large abdomen
	intestinal distention
	malnutrition
complications
	hypocalcemia
	osteomalacia
	osteoporosis
	depression
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66
Q

Celiac Disease
Treatment and Nursing Care
Dietary Regulations

A 
Gluten Free Diet
NO
Wheat
Rye
Barley
Oats
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67
Q

Appendicitis

Assessment

A 
Intensifying pain w/rebound tenderness
	RLQ or periumbilical area pain
	McBurney's point
	worse with mvt, coughing, sneezing
anorexia, nausea, vomiting
constipation or diarrhea
rebound tenderness
low-grade temperature
elevated WBC
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68
Q

Appendicitis

Diagnosis

A

WBC w/differential

Abdominal Ultrasound

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69
Q

Appendicitis

pre-op

A 
NPO
IV
Comfort measures - semifowlers or R side lying
Antibiotics
thermal therapy - ice, not heating pads
elimination
patient education
**narcotic pain medications are used minimally so as not mask the signs of appendicitis.
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70
Q

Appendicitis

post-op nursing interventions

A 
surgery - appendectomy
NPO 
antibiotics
analgesia
patient teaching
rupture -> drainage tube (penrose), antibiotics, NG tube, check for peritonitis
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71
Q

Peritonitis assessment

A

GI secretions and enteric bacteria enters peritoneal cavity from GI tract rupture

"acute abdomen"
increased fever and chills, tachycardia, tachypnea
abrupt onset of diffuse severe abdominal pain
entire abdomen tender and board-like
extreme guarding
paralytic ileus
distention
anorexia, n/v
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72
Q

Irritable Bowel Syndrome (IBS)

A

Functional disorder of the bowel

chronic and recurrent intestinal symptoms

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73
Q

IBS

Etiology

A

Unclear

Anxiety and depression???

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74
Q

IBS

Pathogenesis

A 
visceral hypersensitivity or "brain-gut axis" dysregulation
abnormal GI motility and secretion
intestinal infection
overgrowth of intestinal flora
food allergy or intolerance
psychosocial
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75
Q

IBS

Clinical Manifestations

A

At least 2 or more than 3 months, w/onset occurring at least 6 months before recurrent abdominal pain or discomfort:
abdominal pain or discomfort improved by defecation
onset associated with a change in frequency of stool
onset associated with a change in form (appearance) of stool

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76
Q

IBS
Clinical Manifestations
diagnosis

A

based on signs and symptoms

rule out other etiologies

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77
Q

Inflammatory Bowel Disease (IBD)

A 
Term used to describe two similar but different forms of inflammation of the intestines
	Crohn's disease (no cure)
	Ulcerative Colitis (can be cured)
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78
Q

IBD
Crohn’s disease and Ulcerative Colitis
Similarities

A

unclear etiology
failure of immune regulation
genetic predisposition
environmental trigger

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79
Q

Crohn’s Disease

A

Recurrent granulomatous lesions primarily involving the small and large intestines

autoimmune disease
exaggerated immune response against bacteria in the normal intestinal flora

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80
Q

Crohn’s Disease

pathogenesis

A

inflammation begins in the intestinal submucosa
extension to the mucosa and serosa
activated neutrophils and macrophages promote inflammation and tissue injury
sharply demarcated “skip” lesions

81
Q

Crohn’s Disease

Clinical manifestations

A 
exacerbations and remissions
**INTERMITTENT diarrhea, possible bloody
abdominal tenderness
weight loss
malaise
complications:
	fistulas	
	malabsorption (anemia)
82
Q

Ulcerative Colitis

A

chronic inflammatory disease that causes ulceration of the colonic mucosa
rectum and sigmoid colon

83
Q

Ulcerative Colitis

etiology

A

unknown
familial tendency
autoimmune
activated macrophages, anticolon antibodies, and cytotoxic t-cells.

84
Q

Ulcerative Colitis

pathogesis

A

inflammation of the crypts of lieberkuhn
intestinal secretory glands
inflammation of the crypts result in:
pinpoint mucosal hemorrhages ->suppuration->crypt abscess->ulceration and necrosis

85
Q

Ulcerative Colitis

Clinical manifestations

A 
remission and exacerbation
	abdominal pain*
	diarrhea*
	rectal bleeding*
	anorexia
	weakness
	fatigue
	*cardinal signs
86
Q

Ulcerative Colitis

diagnosis

A

sigmoid or colonoscopy

87
Q

Ulcerative Colitis

complications

A

increased incidence of colon cancer
fissures
perirectal abcess

88
Q

differences between crohn’s and Ulcerative Colitis

A

Slide 74

89
Q

Inflammatory bowel disease(IBD)

diagnosis

A 
colonoscopy or sigmoidoscopy
barium enema
cbc w/ differential
ESR (erythrocite sedimentation rate)
electrolytes
serum albumin
90
Q

IBD medication

Aminosalicylates

A

sulfasalazine
mesalamine
olsalazine

91
Q

IBD medication

corticosteroids

A

methylprednisolone
prednisolone
prednisone

92
Q

IBD medication

immunosuppressives

A

azathioprine

cyclosporine

93
Q

ibd medication

antidiarrheal agents

A

loperamide

diphenoxylate

94
Q

IBD dietary management

A

NPO w/ TPN progressing diet
bland, low fat, low residue
increased calories, carbohydrates, proteins, vitamins

free of milk products, caffeine, and gas-producting or raw fruits and vegetables

95
Q

Total Parenteral Nutrition (TPN)

A

Given to patients intravenously (IV) when nutritionally deficient for several days in absence of normal GI functioning
High dextrose concentration (>10%)
Central line required of dextrose >15%
contents guided by AM labs (Na+, K+, Mg+, Cl, Protein, albumin, etc) to meet specific caloric and protein needs of the client
may also add vit K, insulin, heparin, pepcid, Vit C, B12, thiamine, lipids, folic acid.

96
Q

IBD surgical management

A 
Total colectomy
segmental resection with reanastomosis
ostomy 
	ileostomy
	colostomy
97
Q

Types of Ostomies

A

Ileostomy
Cecostomy (output going to be very liquidy)
ascending colostomy
transverse colostomy
descending colostomy
sigmoid colostomy (output fairly formed…may require irrigation, can be regular elimination…don’t necessarily need bag or appliance)

98
Q

IBD

Nursing diagnosis

A 
diarrhea
disturbed body image
imbalanced nutrition: less than body requirements
fluid volume deficit
electrolyte imbalance
pain
altered sexuality paterns
ineffective individual coping
knowledge deficit
social isolation
99
Q

IBD: Diarrhea

Therapeutic Nursing Interventions

A

Monitor appearance, frequency and amount of bowel movements
monitor presence of blood in stools - occult and frank blood
assess vital signs and weight
assess skin turgor, weakness, lethargy
monitor labs: cbc, lytes, albumin
administer prescribed anti-inflammatory and anti-diarrheal medications

100
Q

IBD: Diarrhea

Therapeutic Nursing Interventions

A 
Maintain fluid intake
provide good skin care
assess perineal area for irritated skin, provide measures to protect perianal area
nutritional consult
post-op ostomy care
101
Q

IBD: Ostomy Care

A

Assess the stoma - is it healthy?
assess peristomal skin
apply protective barriers to the peristomal skin
apply ostomy pouch over stoma
note characteristics of stool, record on I&O
refer to enterostomal nurse therapist

102
Q

Intestinal Obstruction

A

Interference with normal peristaltic movement of intestinal contents due to neurological or mechanical impairment
most often occurs in small bowel
may be partial or complete

103
Q

Intestinal Obstruction

Causes

A

Mechanical (intussusception/volvulus/scar tissue)

or Functional

104
Q

Intestinal Obstruction
Assessment
Paralytic Ileus

A

hypoactive or absent bowel sounds

105
Q

Intestinal Obstruction
Assessment
Mechanical obstruction

A

very hyperactive bowel sounds at first then absent

106
Q

Intestinal Obstruction
Assessment
General

A

Abdominal distention, cramping, mild to moderate abdominal pain, vomiting, constipation

107
Q

Intestinal Obstruction

Diagnostic Tests

A

Abdominal XRays
Barium Enema
Colonoscopy

108
Q

Intestinal Obstruction

Diagnostic Tests: Labs

A 
WBC
H/H
Serum creatinine
blood urea nitrogen
electrolytes
abg's
109
Q

Intestinal obstruction

Therapeutic nursing interventions

A 
restrict oral intake/NPO
Decompression of GI tract - NG tube
Fluid/electrolyte replacement
measure abdominal girth q4 to 8 hrs
assess bowel sounds q4 to 8 hrs
surgical intervention
110
Q

Colorectal cancer

A

3rd most common cancer diagnosis in the US
Adenocarcinoma (glandular epithelium) of the large intestine
begin as adenomatous polyps

111
Q

Colorectal Cancer Location

A

Rectum
Sigmoid
Cecum
Ascending Colon

112
Q

Colorectal cancer Risk factors

A 
age older than 50 years
polyps of the colon and/or rectum
family history of colon cancer
inflammatory bowel disease
exposure to radiation
diet: high animal fat and kilocalorie intake
113
Q

colorectal cancer
clinical manifestations
General

A 
change in bowel habits
rectal bleeding
pain
anemia
weight loss
114
Q

colorectal cancer
clinical manifestations
Cecum & ascending colon

A

guiac positive stools

anemia

115
Q

colorectal cancer
clinical manifestations
rectum or sigmoid tumors

A 
diarrhea and cramping
bloody mucous stools
distention
anemia
obstruction
narrow, ribbon like stools
116
Q

Colorectal cancer

metastasis

A

direct infiltration of the bladder
lymphatic spread
liver via the portal vein

117
Q

Diverticular disease

Diverticulosis

A

mall outpouchings of the intestinal mucosa

most common in sigmoid colon

118
Q

diverticular disease

diverticulitis

A

inflammation of one more diverticula

perforated diverticulum can progress to peritonitis

119
Q

Diverticulosis Pathogenesis

A

roughage diet
small hard fecal material
increased pressure to propel fecal material through the colon
increased intralumenal pressure
herniation through weak areas where blood vessels enter

120
Q

diverticulosis clinical manifestations

A

generally asymptomatic

may have : mild flatulence, diarrhea alternating with constipation

121
Q

Diverticulitis

A

Inflammation of diverticula

generally undigested food or bacteria lodges in a diverticulum obstructing the opening into the bowel.

122
Q

Diverticulitis

clinical manifestations

A 
LLQ pain and tenderness
n/v
low-grade fever
elevated WBC
complications: minor bleeding, abscess formation (rupture of an abscess with perforation of the bowel wall would cause peritonitis)
123
Q

Diverticular disease

diagnosis

A 
CT 
Barium enema
sigmoidoscopy/colonoscopy
WBC
H&H
Hemoccult
124
Q

diverticular disease

nursing diagnosis

A

impaired tissue integrity: GI
Pain
Anxiety
Deficient knowledge

125
Q

Diverticular disease
dietary management
Diverticulosis

A

High fiber, high residue

126
Q

diverticular disease
dietary management
diverticulitis

A

NPO…need to rest the gut. Advance as tolerated.
Low fiber, low residue until symptoms subside. Then go back on diverticulOsis diet.
avoid foods with small seeds/nuts

126
Q

Disorders of the Gallbladder

cholelithiasis

A

gallstones (acute or chronic)

127
Q

Diverticular disease

Medication

A 
Broad-spectrum antibiotics 
	mild-flagyl, cipro, septra
	severe-mefoxin, zosyn, timentin
pain medications
	talwin, demerol, morphine
surgical intervention
	colon resection
	temporary colostomy
128
Q

disorders of the gallbladder

cholangitis

A

Duct inflammation

129
Q

Cholelithiasis

A

cholesterol, calcium salts, or mixed

130
Q

cholelithiasis

etiology

A

bile composition abnormalities
bile stasis
inflammation

131
Q

cholelithiasis

risk factors

A

pregnancy
oral contraceptives
obesity surgeries

132
Q

Cholelithiasis

assessment

A

sudden, severe and steady RUQ pain - radiates to right scapula or shoulder
occurs after high fat meal
lasts up to 6 hours
n/v/heatburn/flatuelnce
jaundice (Check whites of eyes…possibly palms/soles)
clay colored stools

133
Q

Cholecystitis

assessment

A

all previous symptoms present plus
Fever
increased WBC
abdominal guarding

134
Q

Cholelithiasis/Cholecystitis

A

Abdominal x-rays
ultrasonography
nuclear med scan

135
Q

Surgical Management

A

laparoscopic cholecystectomy
Open cholecystectomy
ERCP with endoscopic sphincterotomy (remove gallstones, enlarge sphincter).

136
Q

Cholelithiasis/Cholecystitis

Nursing Diagnosis

A

Pain
Imbalanced nutrition-less than body requirements
Risk for Infection

137
Q

Cholelithiasis/Cholecystitis

Goal: Control Pain

A

Discuss relationship between fat intake and pain. Teach about low fat diet.
Withhold oral food and fluids during episodes of acute pain. Insert NG tube and connect to low suction.
Administer demerol, morphine, ketorolac (toradol) or other analgesic.
Place in fowler’s position.

138
Q

Cholelithiasis/Cholecystitis

Goal: Maintain adequate nutrition

A

Assess nutritional status
Evaluate laboratory results, including serum bilirubin, albumin, glucose, and cholesterol levels.
Refer to a dietician for diet counseling to promote healthy weight loss and reduce pain episodes.
Administer vitamin supplements as ordered.

139
Q

Cholelithiasis/cholecystitis

A

monitor vital signs q4
assess abdomen q4
assist with c/db or use IS q1-2 hrs. splint abdominal incision during coughing.
Place in fowler’s position and encourage ambulation as allowed.
administer antibiotics as ordered
maintain T-tube placement. report drainage >1000mL.

140
Q

Hepatitis

A

Inflammation of the liver

141
Q

Hepatitis

Etiologies

A

drugs
toxins
microorganisms
autoimmune

142
Q

Prodromal or preicterus manifestations

A 
RUQ pain
      -malaise, fatigability, low grade fever, athralgia, n/v
Anorexia and/or weight loss
Fatique
Elevated AST&ALT

**Infection highly transmissible during this phase.

143
Q

Liver Enzymes

A 
Aspartate aminotranserase (AST)
Alanine asinotransferase (ALT)
Alkaline Phosphatase(ALP)
144
Q 
Aspartate aminotransferase (AST)
Normal Levels
A

5-35 units/mL

145
Q 
Alanine aminotransferase (ALT)
Normal Levels
A

5-35 units/mL

146
Q 
Alkaline phosphatase (ALP)
Normal Levels
A

30-120 IU/L

147
Q

Icteric Phase

A

2nd phase. longer period of time.
begins with onset of Jaundice.
Jaundice (except HCV) concurrent with a rise in serum bilirubin
Hepatic symptoms (dark urine, hepatosplenomegaly, severe pruritus, possibly tender lymphadenophathy)
Elevated direct and indirect bilirubin
Normal to moderately increased ALP (liver enzyme)

148
Q

Serum Bilirubin

Conjugated Normal levels

A

direct bilirubin 0.1-0.3 mg/dl

149
Q

Serum Bilirubin

Unconjugated normal levels

A

Indirect bilirubin

0.2-0.7 mg/dl

150
Q

Serum Bilirubin

Direct + Indirect = Total normal levels

A

Total Bilirubin

0.3-1.0mg/dl

151
Q

Convalescent or recovery

A

Increase sense of well-being
Return of appetite
Resolution of jaundice
Clinical Recovery: 9 weeks HEP-A. 16 weeks uncomplicated HEP-B

152
Q

Hepatitis Diagnosis

A

Hepatitis antigens/antibodies present
increased alt, alp, ast
increased bilirubin
liver biopsy

153
Q

Hepatitis Nursing diagnosis

A

Risk for infection (transmission)
fatigue
imbalanced nutrition: less than body requirements

154
Q

Hepatitis therapeutic nursing interventions

A 
Risk for infection (transmission)
use universal precautions
contact isolation (HAV, HEV)
plan room assignments
private bathroom
hep A/ hep B vaccines
155
Q

Hepatitis

client and family teaching

A

do not share bathroom unless strict personal hygiene maintaine
no sharing of: bed linens, washcloths, towels, drinking and eating utensils, razors, nail clippers, toothbrushes, needles, body piercings.
avoid sexual activity/safe sex
avoid ETOH, OTC drugs, esp eacetaminophen/sedatives
do not donate blood, organs, tissue
small, frequent meals - Increase CHO, decrease fat, nutritional supplements.

156
Q

Cirrhosis

A

Replacement of normal cells with fibrous tissue (scar tissue)

157
Q

Cirrhosis

Macronodular

A

Hepatitis

158
Q

Cirrhosis

Micronodular

A

alcoholism

159
Q

Liver Dysfunction

A

Hepatocellular dysfunction
portal hypertension
ascites
hepatic encephalopathy

160
Q

Hepatocellular dysfunction

A

failure to inactive ADH and aldosterone
retention of sodium and water….loss of K+
decreased synthesis of proteins (hypoalbuminemia)
decreased production of urea from NH3 (increased serum ammonia NH3)
decreased detoxification of potentially harmful substances (drug interactions and toxicities)

161
Q

Cirrhosis

Assessment

A 
Anorexia and weight loss
dyspepsia
n/v
change in bowel habits/flatulence
dull abdominal pain
fatigue
jaundice
petechiae or ecchymosis
peripheral edema
ascites
dilated abdominal veins
hepatomegaly
162
Q

Ascites

A 
Accumulation of fluid in the peritoneal space
increased hydrostatic pressure
sodium and water retention
decreased colloid osmotic pressure
increased abdominal girth 
Fluid wave seen
tenderness
SOB
163
Q

Cirrhosis

Diagnosis

A 
liver biopsy - definitive diagnosis
liver function - ast, alt, ldh elevated
bilirubin (total, indirect) elevated
protein, albumin - decreased
PT/PTT (intrinsic measure) - elevated
platelets - decreased
CBC, H/H, WBS's (anemia and leukopenia) 
Serum ammonia - elevated
creatinine- renal failure often develops
164
Q

Cirrhosis - excess fluid volume

therapeutic nursing interventions

A

diet: decrease Na+, decrease protein, increase CHO, decrease fat
fluid restriction with presence of ascites
weigh daily - same time, same type clothes
measure abdominal girth - to assess ascites
diuretics - remove excess fluid

165
Q

Cirrhosis - ineffective protection

therapeutic nursing interventions

A

Institute bleeding precautions - spontaneous bleeding an issue
monitor signs of bleeding (vs, gums, nasal membranes, conjunctiva, stool for occult blood, emesis, neuro changes, abdomen.
LABS: CBC platelets, PT/PTT
avoid invasive procedures/devices
apply pressure to puncture sites for 10 minutes
blood transfusions and vit K
beta-blockers - decrease portal hypertension
lactulose/neomycin - decrease ammonia

166
Q

Cholelithiasis

A

(gallstones)

Acute or chronic

167
Q

Cholangitis

A

duct inflammation

168
Q 
Cholesterol, calcium salts, or mixed
Etiology:
-Bile composition abnormalities
-Bile stasis
-Inflammation
Risk factors: Pregnancy, Oral Contraceptives
Obesity surgeries
A

cholelithiasis

169
Q 
Sudden, severe &amp; steady RUQ pain – radiates to right scapula or shoulder
Occurs after high fat meal 
Lasts up to 6 hours
Nausea/vomiting/heartburn/flatulence
Jaundice
Clay colored stools
A

cholelithiasis assessment

170
Q

inflammation and scar tissue destroy common bile ducts

A

cholangitis

171
Q

stones in the common bile duct itself

A

choledocholithiasis

172
Q

*key symptoms differentiating cholelithiasis from?
Fever
↑ WBC
Abdominal guarding

A

cholecystitis

173
Q

Cholelithiasis / Cholecystitis patient teaching and management

A
  • Discuss relationship between fat intake and pain. Teach about low fat diet.
  • Withhold oral food and fluids during episodes of acute pain. Insert NG tube and connect to low suction.
  • Administer Demerol, morphine, ketorolac (Toradol) or other analgesic.
  • Place in Fowler’s position.
174
Q

risk factors associated with cholelithiasis/cholecystitis

A
  • female, fat, fourties, still fertile

- seeing a blurring of that, and starting to see gallbladder problems in kids

175
Q

labs to monitor in cholelithiasis/cholecystitis

A

serum bilirubin, albumin, glucose, and cholesterol levels

176
Q

T-tube

A
  • report drainage greater than 1,000
  • sits in common bile duct to keep it open post op and drain off excess bile
  • often pts go home with it in place for up to 6 weeks
177
Q
  • inflammation of the liver

- etiologies: drugs, toxins, microorganisms, autoimmune

A

hepatitis

178
Q
  • RUQ pain: malaise, fatigability, low grade fever, arthralgia, N/V
  • Anorexia and/or weight loss
  • Fatigue
  • Elevated AST & ALT
  • *Infection highly transmissible during this phase
A

-prodromal or preicterus manifestations

179
Q 
Aspartate aminotransferase (AST)
*normal values
A

Normal 5-35 units/ml

180
Q 
Alanine aminotransferase (ALT)
*normal values
A

Normal 5-35 units/ml

181
Q 
Alkaline phosphatase (ALP)
*normal values
A

Normal 30-120 IU/L

182
Q

-Jaundice (except HCV) concurrent with a rise in serum bilirubin
-Hepatic symptoms: Dark urine, Hepatosplenomegaly, Severe pruritus
Possibly tender lymphadenopathy
-Elevated direct & indirect bilirubin
-Normal to moderately elevated ALP (liver enzyme)

A

icteric phase

183
Q

Direct bilirubin: conjugated

*normal values

A

0.1-0.3 mg/dl

184
Q

Indirect bilirubin: unconjugated

*normal values

A

0.2-0.7 mg/dl

185
Q

Total bilirubin: Direct + Indirect = Total

A

0.3-1.0 mg/dl

186
Q

clinical recovery of Hep-A, Hep-B

A

Clinical Recovery:
9 weeks HEP-A
16 weeks uncomplicated HEP-B

187
Q

risk for infection nursing interventions for hepatitis

A
  • Use universal precautions
  • Contact isolation (HAV, HEV)
  • Plan room assignments
  • Private bathroom
  • Hepatitis A / Hepatitis B vaccines
188
Q
  • Do not share bathroom unless strict personal hygiene maintained
  • No sharing of: bed linens, washcloths, towels, drinking & eating utensils, razors, nail clippers, toothbrushes, needles, body piercings
  • Avoid sexual activity / Safe sex
  • Avoid ETOH, & OTC, esp acetaminophen, sedatives
  • Do not donate blood, organs, tissue
  • Small, frequent meals - ↑ CHO, ↓ fat, nutritional supplements
  • family teaching for?
A

hepatitis

189
Q

Replacement of normal cells with fibrous tissue

A

cirrhosis

190
Q

Macronodular Cirrhosis

A

Hepatitis

191
Q

Micronodular CIrrhosis

A

alcoholism

192
Q

Liver dysfunction causes

A
  • Hepatocellular dysfunction
  • Portal hypertension
  • Ascites
  • Hepatic encephalopathy
193
Q
  • Failure to inactivate ADH & Aldosterone
    • Retention of sodium & water
      - Loss of K+
  • ↓ synthesis of proteins: hypoalbuminemia
  • ↓ production of urea from NH3: ↑ serum ammonia (NH3)
  • ↓ detoxification of potentially harmful substances: Drug interactions and toxicities
A

Hepatocellular dysfunction

194
Q
  • Anorexia & weight loss
  • Dyspepsia
  • Nausea/vomiting
  • Change in bowel habits / flatulence
  • Dull abdominal pain
  • Fatigue
  • Jaundice
  • Petechiae or ecchymosis
  • Peripheral edema
  • Ascites
  • Dilated abdominal veins
  • Hepatomegaly
A

Cirrhosis assessment

195
Q

Accumulation of fluid in the peritoneal space: increased hydrostatic pressure, ↓colloid osmotic pressure, Sodium & water retention, increased abdominal girth, + fluid wave, tenderness, SOB

A

Ascites

196
Q
  • Liver biopsy – definitive diagnosis
  • Liver function – AST, ALT, LDH elevated
  • Bilirubin (total, indirect) elevated
  • Protein, Albumin- decreased
  • PT/PTT (intrinsic measure)- elevated
  • Platelets- decreased
  • CBC, H/H, WBC’s (anemia & leukopenia)
  • Serum Ammonia- elevated
  • Creatinine- renal failure often develops
A

Cirrhosis diagnostics

197
Q

Cirrhosis excess fluid volume nursing interventions

A
  • Diet: ↓ Na+, ↓ protein, ↑ CHO, ↓ fat
  • Fluid restriction with presence of ascites
  • Weigh daily – same time, same type clothes
  • Measure abdominal girth – to assess ascites
  • Diuretics – remove excess fluid
198
Q

Why would you see a cirrhosis patient on Beta-Blockers

Lactulose / Neomycin

A

Beta blockers: decrease portal hypertension

Lactulose / Neomycin: decrease ammonia

BEACON MedSurg/Peds (21 decks)

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