week 3 Flashcards
Anatomical considerations of abdomen
Newborn: two arteries & one vein, the liver is bigger, bladder located higher.
Early childhood: abdominal wall less muscular, urinary bladder higher.
older Adult: salvation decrees, liver size decreases, colon may be slower, sensation to open bowl reduced (causing constipation)
normal bowel function
passing a bowel motion as much as three times per day or as little as once every three days, pass without straining
constipation
difficulty passing stool or infrequent bowel movements
functional: normal transit constipation
mechanical: obstructive emptying (IBS)
Bowel obstruction
when the lumen of the bowel becomes either partially or completely blocked
common cause of constipation
Decreased physical activity
Inadequate intake of water
Low-fibre diet
Side effects of medications (e.g. opioids)
Irritable bowel syndrome
Bowel obstruction
Hypothyroidism
constipation signs and symptoms
Abdominal distension
Abdominal discomfort
Reduced appetiteTrouble passing stool
Change to usual bowel routine – more infrequent
Passing hard stools
Straining when trying to pass stool
constipation management
fire: men 30mg/day women 25
Fluid: men 2.6L/d women 2L/d
Increase physical activity
Documentation of bowl motions: bowel chart/bristol stool chart
constipation pharmacology
-faecal softening laxatives(decussate)
:MOA (mode of action) mixture of water and fatty substances 50-150 mg 1 or 2 day can cause diarrhoea, nausea, cramps
-osmotic laxatives(suppositories) increase volume of fluid in the intestinal lumen, 2.8 g daily can cause discomfort, cramps
stimulant laxatives( Senna) incease peristalsis in colon by irritating sensory nerve plexi endinging in the intestinal mucosa 7.5-30 nocte can cause cramps diarrhoea
bowel obstruction symptoms
Obstruction - Small intestine
Abdominal pain and/or cramping pain in upper abdomen
Inability to pass faeces
Vomiting
Diarrhoea/overflow – if the small intestine is partially obstructed.
Inability to pass flatus
Obstruction – Large Intestine
Constipation that becomes worse until stool cannot be passed.
Distended abdomen
Cramping pain – lower abdomen
Vomiting (uncommon but can occur alongside other symptoms e.g. pain)
Inability to pass flatus
people at risk of bowel obstruction
-have had abdominal or pelvic surgery
-have Crohn’s disease
-have abdominal or intestinal cancer
-have a paralytic ileus
-have twisting of the intestine (more common in children & teens),
bowel obstruction management
Primary survey – A-E assessment
Nil by mouth
IV fluids
Strict fluid balance chart
Pain relief
Promote comfort – positioning & a restful environment
If severe – nasogastric tube insertion to relieve abdominal distention and vomiting and to allow the bowel to rest and recover.
lactose intolerance
Lactase is a digestive enzyme necessary for absorption of carbohydrate lactose (milk sugar).
celiac disease is
Autoimmune disorder
Intolerance to gluten
bloating, abdominal pain
GI assessment subjective data
Appetite
Dysphagia
Food intolerance
Abdominal pain
Nausea and vomiting
Bowel habits
Past abdominal history
Medications
GI assessment objective data
vital signs
Abdominal assessment:
Inspection
Auscultation
Percussion
Palpation
Pain assessment
layer of the heart
Pericardium
Myocardium
Endocardium
Blood vessels arranged in two continuous loops what are they
Pulmonary circulation and systemic circulation
What is cardiac output
In resting adult, heart normally pumps between 4 and 6 L of blood per minute throughout body.
CO= HR x SV
Heart can alter its cardiac output to adapt to metabolic needs of body.
what is cardiac prelaod
venous return that builds during diastoleThis increased contractility results in an increased volume of blood ejected, increased stroke volume.
what is cardiac afterlaod
opposing pressure ventricle must generate to open aortic valve against higher aortic pressure.
Resistance against which ventricle must pump its blood
anatomical considerations of cardio
Infants & children
At birth - change in oxygenation of blood from being the placenta to via the lungs.
At 1year, - left ventricle’s mass reaches the adult ratio of 2:1.
Heart murmurs are very common throughout childhood (approx. 30%)
Older adult – haemodynamic changes
The ‘ageing process’ interrelated with lifestyle habits and underlying disease.
↑ systolic BP – caused by thickening & stiffening of large arteries (arteriosclerosis).
↑ left ventricular wall thickness.
Diastolic BP may ↓ - 60 + years of age.
↓ ability of the heart to augment cardiac output with exercise.
There is no change to resting heart rate or cardiac output with ageing.
Risk of dysrhythmias increases with age.
Ectopic beats are common in older adult but usually asymptomatic.
cardiovascular disease (cvd)
Most common = coronary heart disease, stroke and heart failure.
Incidence of CVD increases sharply with advancing age and accounts for approximately 89% of all deaths for adults aged 65 and over.
Underlying cause of 25% of all deaths in the Australian population in 2021.
Lifestyle habits play a significant role in the acquisition of cardiovascular disease.
hypertension is
(BP 140/90 or higher) - incidence increases with age – sustained hypertensive states (hypertensive disease) cause damage to the heart & other organs.
congestive cardiac failure
75 + at 10 times higher risk than younger adults.
