Week 10 TUES Flashcards
GI inflammation
hematemsis
bloody vomit
occult blood
blood in stool via lab test
melena
dark, coffee ground , tarry stools
hematochezia
bright red stools
Upper GI bleeds are most likey caused by
- peptic ulcer
- tumors
- stress ulcers
- erosive gastritis
manifestations of upper gi bleed
melena and hematemsis
- depending on if blood was digested or not
Upper GI bleed diagnosis
hx and visualization w/ fiber optic endoscopy
treatment for upper gi bleed
- ppis
- sucralfate
- antacid
- eliminating foods that cause distress
prevention for upper gi bleeds
- reduced or prevented if gastric pH level maintained above 4
- ppi, sucralfate used for both treatment and prophylaxis
Acute lower GI bleeds are most common in what population?
Older adult population
causes of lower gi bleeds
- diverticulosis
- inflammatory bowel disease
- neoplasms
- ischemic bowel disease
- rectal ulcers
- ischemic colitis
Ischemic bowel disease is?
ischemia of the colon
- caused by interruption of colonic blood supply
Management of acute GI bleeding
- 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
GI bleed assessment
- hgl and hct levels
- increase BUN?
- stool color and characteristics
- abdominal assessment
- where is bleed coming from
diagnosis for upper and lower gi bleed
- upper; gastroenterologist> endoscopy
-Lower; general surgeon/colorectal> colonoscopy
What is the primary goal of early management in hemodynamically unstable pt
resuscitation
- oxygen maintenance can provide tissues with oxygen
- think ABC’s
Interventions for a severe GI hemorrhage
- vasopressin
- somatostatin
- octreotide drip
- mechanical tamponade
management of shock
- maintain adequate tissue perfusion and oxygenation
- prevention of fluid volume deficit related to blood loss
optimization of hemodynamic status in a pt w/ a GI bleed
- 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
What can cause a bowel obstruction?
- mechanical issues
- tumor
- surgical issue
- incarcerated hernia
- paralytic ileus
Acute small bowel obstruction
etiologies
- 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
Large bowel obstruction etiologies
- neoplasms are most common
- diverticulitis, stricture formation, and fecal impaction
- paralytic ileus
Clinical findings in intestinal obstruction
- 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
treatment for acute intestinal obstruction
- fluid resuscitation and stabilization of pt> intial therapy
- board spectrum antibiotics
- early surgical consult advised in high-risk pts
- monitor for complications> sepsis
what is pancreatitis
inflammation of the pancreas
- results in injury to the pancreas
what is acute pancreatitis
sudden onset of pancreatic inflammation
Mild acute pancreatitis
- short term
- pancreatic edema and swelling
- localized inflammation
- no organ failure
- no local or systemic complications
- reversible
- good prognosis
Moderate acute pancreatitis
- organ failure that resolves in 48 hrs (transient) and/ or
- local or systemic complications w/out persistent organ failure
Severe acute pancreatitis
- longer duration
- persistant single or multi organ failure
- poor prognosis> associated with sepsis and multiple organ dysfunction
etiologies of acute pancreatitis
- gallstones
- chronic alcohol abuse
- medications
- metabolic causes
- idiopathic
- complications of AIDs
- genetic factors
Nursing assessment for a pt with acute pancreatitis
- pain assessment
- focused hx
- GI assessment
- s/s of inflammation
- skin assess> cullen/ grey sign
- cardiovascular assess
- watch electrolyte imbalances
diagnosing acute pancreatitis
- 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
Supportive treatment for pancreatitis
- stabilze hemodynamic status
- monitor BP
- control pain
- minimize pancreatic stimulation
- provide psychosocial support
- curative therapies> correct underlying problems and prevent/ treat complications
pancreatitis; whole body system complications
- 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
Defining acute Liver failure
- 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
Causes of liver failure
- drug induced ALF> acetaminophen
- Viral infections> hepatitis’, herpes
- vasuclar> loss of blood supply
- metabolic> hellp syndrome, reyes syndrome
Diagnosis for acute liver failure
labs; routine chemistry values, LFT, serum amylase and lipase, CBC, PT/INR, hepatitis serologies, autoimmune markers
testing; CT scan or ultrasound
N-acetylcysteine therapy is for what diagnosis of ALF
acetaminophen toxicity
Acyclovir is for what diagnosis of ALF
HERPES SIMPLEX VIRUS
Complications of ALF
- hepatic encephalopathy
- cerebral edema
- coagulation abnormalities
- hypoglycemia
- metabolic abnormalities
- infection
- cardiopulmonary abnormalities
- AKI
Asterixis
bilateral flapping tremor most often seen w/ dorsiflexion
What grade of hepatic encephalopathy can be reversible
grade 1
Treatment for severe hepatic encephalopathy
Lactulose
Ammonia levels are _____ with HE
High; toxic
What is cerebral edema
- life-threating complication of ALF
- greatest concern is development of IICP and brain herniation
- severity coorelates to severity of HE
coagulopathy w/ ALF
- INR greater than 1.5 due to livers inability to produce clotting factors
- treatment; it k, rrp, plts
other complications related to ALF
- hypoglycemia and electrolyte imbalnces
- infection
- cardiopulmonary abnormalities
- AKI
Factors that contribute to hepatic encephalopathy in chronic liver failure
- infections> throws balance off
- high protein diet> excess protein is hard on the liver
- worsening hepatic function
- constipation
- Azotemia> HIGH BUN
- GI bleeds
- Hypovolemia
Azotemia
high BUN
Ascites w/ liver failure
- abnormal collection of fluid in abdominal cavity
- volume of ascites can be so large pt may develop abdominal compartment syndrome
Treatment for ascites
- albumin
- paracentesis
- pleurX drain
Nursing goals for liver failure
- 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
Nursing assessment with liver failure
- Full HTT
- neurologic; cognitive, muscular, neurosensory
Frequently occurring nursing interventions for Liver failure
- 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
nursing considerations/ management for liver failure
- administration of oral, entral, or parenteral nutrtion to meet metabolic demand
- administer pharm and nonpharm measures to optimize comfort
- monitor and prevent for infections
what organ absorbs food
small intestine
Upper GI bleed stool characteristic
black and tarry stools
what s/s would indicate a peptic ulcer rupture
severe abdominal pain
what electrolyte often is low after having spouts of diarrhea
potassium
