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Complex Care > Week 10 TUES > Flashcards

Week 10 TUES Flashcards

GI inflammation

1
Q

hematemsis

A

bloody vomit

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2
Q

occult blood

A

blood in stool via lab test

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3
Q

melena

A

dark, coffee ground , tarry stools

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4
Q

hematochezia

A

bright red stools

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5
Q

Upper GI bleeds are most likey caused by

A
  • peptic ulcer
  • tumors
  • stress ulcers
  • erosive gastritis
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6
Q

manifestations of upper gi bleed

A

melena and hematemsis
- depending on if blood was digested or not

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7
Q

Upper GI bleed diagnosis

A

hx and visualization w/ fiber optic endoscopy

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8
Q

treatment for upper gi bleed

A
  • ppis
  • sucralfate
  • antacid
  • eliminating foods that cause distress
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9
Q

prevention for upper gi bleeds

A
  • reduced or prevented if gastric pH level maintained above 4
  • ppi, sucralfate used for both treatment and prophylaxis
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10
Q

Acute lower GI bleeds are most common in what population?

A

Older adult population

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11
Q

causes of lower gi bleeds

A
  • diverticulosis
  • inflammatory bowel disease
  • neoplasms
  • ischemic bowel disease
  • rectal ulcers
  • ischemic colitis
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12
Q

Ischemic bowel disease is?

A

ischemia of the colon
- caused by interruption of colonic blood supply

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13
Q

Management of acute GI bleeding

A
  • assess the severity of blood loss
  • assist in determining cause of bleed
  • plan and implement treatment
  • provide supportive care
  • provide fluid replacement
  • monitor on going care and progression
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14
Q

GI bleed assessment

A
  • hgl and hct levels
  • increase BUN?
  • stool color and characteristics
  • abdominal assessment
  • where is bleed coming from
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15
Q

diagnosis for upper and lower gi bleed

A
  • upper; gastroenterologist> endoscopy
    -Lower; general surgeon/colorectal> colonoscopy
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16
Q

What is the primary goal of early management in hemodynamically unstable pt

A

resuscitation
- oxygen maintenance can provide tissues with oxygen
- think ABC’s

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17
Q

Interventions for a severe GI hemorrhage

A
  • vasopressin
  • somatostatin
  • octreotide drip
  • mechanical tamponade
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18
Q

management of shock

A
  • maintain adequate tissue perfusion and oxygenation
  • prevention of fluid volume deficit related to blood loss
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19
Q

optimization of hemodynamic status in a pt w/ a GI bleed

A
  • ensure open airway and administer supplemental oxygen
  • initiate continuous monitoring for cardia dysrhythmias
  • prepare for insertion of central venous or pulmonary artery catheter
  • prepare pt for emergent surgical intervention
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20
Q

What can cause a bowel obstruction?

A
  • mechanical issues
  • tumor
  • surgical issue
  • incarcerated hernia
  • paralytic ileus
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21
Q

Acute small bowel obstruction
etiologies

A
  • swallowed air major cause of distention
  • strangulation can progress to bowel ischemia, necrosis, perforation, and peritonitis
  • intestinal strangulation occurs when intestine becomes so twisted circulation is interrupted
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22
Q

Large bowel obstruction etiologies

A
  • neoplasms are most common
  • diverticulitis, stricture formation, and fecal impaction
  • paralytic ileus
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23
Q

Clinical findings in intestinal obstruction

A
  • abdominal dissention
  • cramping and periumbilicus pain that occurs in waves, with periods of comfort in between
  • vomiting, possibly profuse, soon follows onset of pain and is usually bilious
  • electrolyte imbalance and intraluminal loss(sweating) of fluids occur
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24
Q

treatment for acute intestinal obstruction

A
  • fluid resuscitation and stabilization of pt> intial therapy
  • board spectrum antibiotics
  • early surgical consult advised in high-risk pts
  • monitor for complications> sepsis
25
Q

what is pancreatitis

A

inflammation of the pancreas
- results in injury to the pancreas

26
Q

what is acute pancreatitis

A

sudden onset of pancreatic inflammation

27
Q

Mild acute pancreatitis

A
  • short term
  • pancreatic edema and swelling
  • localized inflammation
  • no organ failure
  • no local or systemic complications
  • reversible
  • good prognosis
28
Q

Moderate acute pancreatitis

A
  • organ failure that resolves in 48 hrs (transient) and/ or
  • local or systemic complications w/out persistent organ failure
29
Q

Severe acute pancreatitis

A
  • longer duration
  • persistant single or multi organ failure
  • poor prognosis> associated with sepsis and multiple organ dysfunction
30
Q

etiologies of acute pancreatitis

A
  • gallstones
  • chronic alcohol abuse
  • medications
  • metabolic causes
  • idiopathic
  • complications of AIDs
  • genetic factors
31
Q

Nursing assessment for a pt with acute pancreatitis

A
  • pain assessment
  • focused hx
  • GI assessment
  • s/s of inflammation
  • skin assess> cullen/ grey sign
  • cardiovascular assess
  • watch electrolyte imbalances
32
Q

diagnosing acute pancreatitis

A
  • abdominal pain characteristics
  • serum amylase and or lipase more than 3 times the upper limit of normal
  • characteristic findings of acute pancreatitis on abdominal imaging
  • abdominal and chest x-ray
    -ct scan, ultrasound, MRI, image-guided aspiration biopsy
33
Q

Supportive treatment for pancreatitis

A
  • stabilze hemodynamic status
  • monitor BP
  • control pain
  • minimize pancreatic stimulation
  • provide psychosocial support
  • curative therapies> correct underlying problems and prevent/ treat complications
34
Q

pancreatitis; whole body system complications

A
  • cardiac output decreased
  • hypovolemia
  • oxygenation and gas exchange
  • acute epigastric or abdominal pain
  • n/v
  • impaired nutritional intake
  • increased risk for infection
  • anxiety> d/t pain
  • pt at increased risk for injury
  • electrolyte imbalance
35
Q

Defining acute Liver failure

A
  • life-threatening condition
  • coag abnormalities
  • INR greater than 1.5
  • onset of encephalopathy in someone who has no previously known hepatic cirrhosis
  • duration less than 26 wks
36
Q

Causes of liver failure

A
  • drug induced ALF> acetaminophen
  • Viral infections> hepatitis’, herpes
  • vasuclar> loss of blood supply
  • metabolic> hellp syndrome, reyes syndrome
37
Q

Diagnosis for acute liver failure

A

labs; routine chemistry values, LFT, serum amylase and lipase, CBC, PT/INR, hepatitis serologies, autoimmune markers
testing; CT scan or ultrasound

38
Q

N-acetylcysteine therapy is for what diagnosis of ALF

A

acetaminophen toxicity

39
Q

Acyclovir is for what diagnosis of ALF

A

HERPES SIMPLEX VIRUS

40
Q

Complications of ALF

A
  • hepatic encephalopathy
  • cerebral edema
  • coagulation abnormalities
  • hypoglycemia
  • metabolic abnormalities
  • infection
  • cardiopulmonary abnormalities
  • AKI
41
Q

Asterixis

A

bilateral flapping tremor most often seen w/ dorsiflexion

42
Q

What grade of hepatic encephalopathy can be reversible

A

grade 1

43
Q

Treatment for severe hepatic encephalopathy

A

Lactulose

44
Q

Ammonia levels are _____ with HE

A

High; toxic

45
Q

What is cerebral edema

A
  • life-threating complication of ALF
  • greatest concern is development of IICP and brain herniation
  • severity coorelates to severity of HE
46
Q

coagulopathy w/ ALF

A
  • INR greater than 1.5 due to livers inability to produce clotting factors
  • treatment; it k, rrp, plts
47
Q

other complications related to ALF

A
  • hypoglycemia and electrolyte imbalnces
  • infection
  • cardiopulmonary abnormalities
  • AKI
48
Q

Factors that contribute to hepatic encephalopathy in chronic liver failure

A
  • infections> throws balance off
  • high protein diet> excess protein is hard on the liver
  • worsening hepatic function
  • constipation
  • Azotemia> HIGH BUN
  • GI bleeds
  • Hypovolemia
49
Q

Azotemia

A

high BUN

50
Q

Ascites w/ liver failure

A
  • abnormal collection of fluid in abdominal cavity
  • volume of ascites can be so large pt may develop abdominal compartment syndrome
51
Q

Treatment for ascites

A
  • albumin
  • paracentesis
  • pleurX drain
52
Q

Nursing goals for liver failure

A
  • determine and correct underlying cause of ALF
  • Prevent worsening of liver function
  • Support organ function until pt recovers or receives liver transplant
  • Promote stable hemodynamic and ventilatory status
  • Prevent or minimize secondary complication
53
Q

Nursing assessment with liver failure

A
  • Full HTT
  • neurologic; cognitive, muscular, neurosensory
54
Q

Frequently occurring nursing interventions for Liver failure

A
  • interventions to optimize airway, breathing, and oxygentation/ gas exchange
  • administer fluid resuscitation
  • initiation of mobility protocols to prevent complications of immobility
  • initiation of mobility protocols to prevent complication of immobility
55
Q

nursing considerations/ management for liver failure

A
  • administration of oral, entral, or parenteral nutrtion to meet metabolic demand
  • administer pharm and nonpharm measures to optimize comfort
  • monitor and prevent for infections
56
Q

what organ absorbs food

A

small intestine

57
Q

Upper GI bleed stool characteristic

A

black and tarry stools

58
Q

what s/s would indicate a peptic ulcer rupture

A

severe abdominal pain

59
Q

what electrolyte often is low after having spouts of diarrhea

A

potassium

Complex Care (26 decks)

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