week 2 Flashcards
What are common signs and symptoms of acute abdominal pain?
- Pain
- Nausea
- Vomiting
- Diarrhoea
- Constipation
- Flatulence
- Fever
- Bloating
What is in the Right Upper Quadrant (RUQ)?
- Liver
- Gallbladder
- Duodenum
- Head of pancreas
- Right kidney and adrenal
- Hepatic flexure of colon
- Part of ascending and transverse colon
What is in the Left Upper Quadrant (LUQ)?
- Stomach
- Spleen
- Left lobe of liver
- Body of pancreas
- Left kidney and adrenal
- Splenic flexure of colon
- Part of transverse and descending colon
What is in the Right Lower Quadrant (RLQ)?
- Cecum
- Appendix
- Right ovary and tube
- Right ureter
- Right spermatic cord
What is in the Left Lower Quadrant (LLQ)
- Part of descending colon
- Sigmoid colon
- Left ovary and tube
- Left ureter
- Left spermatic cord
How do you assess abdominal pain?
Old Carts:
- Onset
- Location
- Duration
- Characteristics
- Aggravating factors
- Relieving factors
- Timing
- Severity
What is the aetiology (types ) of GI inflammation?
- Gastroenteritis
- Appendicitis
- Pancreatitis
- Diverticulitis
- Cholecystitis
What are life threatening effects of inflammation?
- Risk of perforation and peritonitis
- Fluid shifts to area of inflammation
- Unable to ingest fluid
What can the life threatening effects of inflammation cause?
- Septic shock
- Hypovolaemic shock
What is the aetiology of peritonitis?
Perforated peptic ulcers
- Ruptured diverticula
- Ruptured appendix
- Intestinal perforation
What are life threatening effects of peritonitis?
- Overwhelming infection
- Fluid shifts to area of inflammation
- Unable to ingest fluid
What can the life threatening effects of peritonitis cause?
- Septic shock
- Hypovolaemic shock
What are life threatening effects of obstruction?
- Strangulation risk
- Fluid trapped in bowel
- Fluid shifts to interstitial space
- Unable to ingest fluid
What can the life threatening effects of internal bleeding cause?
Hypovolaemic shock
Types of pain?
Nociceptive:
- Somatic
- Visceral
Neuropathic
What is the nursing assessment you would undertake of a patient who presents to the ED complaining of acute abdominal pain?
- Pain assessment
- Patient Hx/ Family Hx
- Diet
- Medications
- Constipation
- ABCD
- Vital signs
- Intake and output
- LOC
- Skin colour/temp
- Abdominal assessment
- Pregnancy test
What are diagnostic studies for abdo pain ?
- Complete history and physical examination
- FBC and Lytes
- ? X-match
- Urinalysis
- ? stool spec
- ECG
- AXR
- USS
- CT scan (+/- contrast)
- Pregnancy test
What is appendicitis?
- Inflammation of the appendix
- Most common cause is obstruction of the lumen by faeces, foreign body or tumour
What are signs and symptoms of appendicitis?
- Periumbilical pain
- Anorexia
- Nausea and vomiting
- Persistent pain , eventually shifting right lower quadrant and localising at McBurney’s point
- Localised tenderness, rebound tenderness and muscle guarding
- Patient may lie still often with the right leg flexed
What is peritonitis?
- Localised or generalised inflammatory process of peritoneum
- Results in massive fluid shifts and adhesions as body attempts to wall off infection
What are signs and symptoms of peritonitis?
- Abdominal pain
- Rebound tenderness
- Muscular rigidity
- Spasm
- Patient has shallow respirations
- Abdominal distension
- Fever
- Tachycardia, tachypnoea
- Nausea and vomiting
What is intestinal obstruction?
- Intestinal obstruction (partial or complete) occurs when intestinal contents cannot pass through the GI tract
- Requires urgent treatment
What are types of intestinal obstruction?
- Mechanical (90% of admissions)
- Non- mechanical
What are symptoms of a small intestinal obstruction?
- Onset - Rapid
- Vomiting - Frequent and copious
- Pain - Colicky, cramp like, intermittent pain
- Bowel movement - Faeces for a short time
- Abdominal distension - Greatly increased
What are symptoms of a large intestinal obstruction?
- Onset - Gradual
- Vomiting - Rare
- Pain - Low-grade, cramping abdominal pain
- Bowel movement - Absolute constipation
- Abdominal distension - Increased
What is the nursing assessment for intestinal obstruction?
- Hx
- Early recognition of deterioration
- Assessment of abdo
- Hydration/nutrition status- input/output
- Pain- coldspa
- Need for surgery
- Anxiety
What is cholelithiasis?
Stones in gallbladder
What is cholecystitis
Inflammation of the gall bladder
What is the care of cholelithiasis and acute cholecystitis?
- Pain control
- Antiemetic
- Antibiotics
- Maintain fluid and electrolytes
- Potentially NBM
What are symptoms of total obstruction?
- Jaundice
- Dark amber urine
- Clay-colored stools
- Pruritus
- Intolerance of fatty foods
- Bleeding tendencies
- Steatorrhoea
What are signs and symptoms of cholelithiasis and acute cholecystitis?
- Pain
- Indigestion
- Fever
- Jaundice
- Nausea and Vomiting
- Restlessness
- Diaphoresis
- Inflammation
What are (etiological) factors that cause acute pancreatitis?
- Alcohol
- Biliary tract disease
- Trauma
- Infection
- Drugs
- Postoperative GI Surgery
- Unknown
What complications can acute pancreatitis lead to?
- Activation of pancreatic enzymes
- Injury to pancreatic cells
What is nursing care for peritonitis?
- Analgesics
- NBM
- Respiratory assessment
- Oxygen therapy
- Antibiotic therapy
- Fluids and electrolytes
What are signs and symptoms of acute pancreatitis?
- Abdominal pain – LUQ radiating to the back
- Aggravated by eating, relieved by vomiting
- Abdominal tenderness with muscle guarding
- Paralytic ileus
- Greys Turners spots
- Cullen’s sign
- Signs of shock
- Watch for respiratory distress – ARF to ARDS
- D.I.C.
- Clots
- Tetany
What is treatment of pancreatitis?
- pain relief
- Prevention of or treating shock
- maintain Fluid and electrolyte
- potentially NBM w/ NG
- Antacids, PPI’s to neutralise gastric secretions and decrease hydrochloric acid stimulation
- Antibiotics and antispasmodics
- Removal of precipitating cause if possible
