Week 3 (GI Trauma, Hepatitis, Cirrhosis, Male Reproductive, & Female Reproductive (Part 1)) Flashcards
Abdominal Assessments: which organs are associated with pain in each abdominal quadrant
GI - KNOW THIS!!!
RUQ = Liver
LUQ = spleen
RLQ = appendix
LLQ = UC & diverticulitis
When the following traumas occur, what areas are usually injured?
1.) Trauma to the lower rib cage
2.) Chest trauma
3.) Pelvic trauma
GI Trauma - KNOW THIS!!!
1.) Lower Rib Cage = spleen
2.)Chest Trauma = esophageal & gastric
3.)Pelvic Trauma = bladder & uterus
Signs & Symptoms / Patho of Abdominal Trauma
GI Trauma
- blood loss
- pain
- decreased peristalsis
What are Esophageal Varicies? What is the cause?
GI Trauma
Abnormal veins in the esophagus
Cause: portal hypertension or blockage of liver
What is the cause of esophageal varicies & what are common symptoms?
GI Trauma - KNOW THIS!!!
Cause: portal Hypertension (blockage of the liver)
Signs & Symptoms:
* Jaundice
* Hematemesis (vomiting blood)
* Melena
* Altered LOC (decreased consciousness)
* Shock
* Vomiting
* Bleeding
* Lightheadedness
Risk factors for esophageal varicies
GI Trauma
- Portal Hypertension
- Red marks on the varicies (seen on the EGD)
- Severe cirrhosis
- Liver failure
- Continued EtOH use
Signs & Symptoms of esophageal varicies
GI Trauma - KNOW THIS!!
- Hematemesis
- Melena
- Altered Consciousness
- Shock
- Jaundice
- bleeding
- lightheadedness
Treatment for Bleeding Varicies
GI Trauma - KNOW THIS!!!
- Treat for shock (administer O2)
- IV fluids, electrolytes, blood & blood products
- Vasopressin, somatostatin, octreotide to decrease bleeding
- Nitroglycerin + vasopressin to reduce coronary vasoconstriction
- Propranolol & nadolol (beta blockers) to reduce portal pressure
- Balloon tamponade
- TIPS (Trans jugular Intrahepatic Portosystemic Shunt)
What 2 medications are used to treat esophageal varicies & why are they used?
GI Trauma - KNOW THIS!!!
Propranolol & Nadolol
- beta-blockers; they decrease portal HTN
What is a balloon tamponade & when is it used?
GI Trauma - KNOW THIS!!!
Inflating a balloon inside the esophagus which puts pressure on varicies to stop the bleeding
- Used for esophageal varicies
Nursing Management of Esophageal Varicies
GI Trauma
- Safe environment (prevent injury, bleeding, & infection)
- Administer treatments
- Monitor for potential complications
- Encourage deep breathing & position changes
- Education & support
What are signs & symptoms of hepatic injury?
GI Trauma - KNOW THIS!!!
- RUQ pain
- Rebound tenderness
- Hypoactive / absent bowel sounds
- SIGNSN OF HEMORRHAGE OR SHOCK
- abdominal wall muscle rigidity, spasm, or involuntary guarding
Key Symptoms of Hepatic Injuries
GI Trauma - KNOW THIS!!!
- RUQ Pain
- Rigidity
- Guarding
- Signs of Shock or Hemorrhage
What type of abdominal trauma is associated with underlying damage to the spleen?
GI Trauma - KNOW THIS!!!
fractures of the 10th or 12th ribs
Signs & Symptoms of Splenic Injury
GI Trauma
- Signs of hemorrhage or shock
- Abdominal wall muscle rigidity, spasm, or involuntary guarding
- LUQ Tenderness
- Pain in the L Shoulder (KEHR’S SIGN)
Key Signs & Symptoms of Splenic Injury
GI Trauma - KNOW THIS!!!
- Kehr’s Sign (Radiating L shoulder pain)
- LUQ Pain
- S&S of shock or hemorrhage
Signs & Symptoms of Hollow Organ Injuries
GI Trauma - KNOW THIS!!!
- Peritoneal irritation
- Evisceration of small bowel or stomach
- Diagnostic peritoneal lavage may show presence of bile, feces, or food fibers
- Bruising
- Rigidity
What organs should you think of when you hear pelvic fracture?
GI Trauma - KNOW THIS!!!
Bladder & Urethra
If there is blood at the meatus or scrotum, what should you do?
GI Trauma - KNOW THIS!!!
Do NOT insert a catheter
Key Signs & Symptoms of Bladder Injury
GI Trauma - KNOW THIS!!!
- Blood at meatus and/or scrotum
- Urge to urinate but unable to urinate
Signs & Symptoms of Bladder & Urethral Injuries
GI Trauma - KNOW THIS!!!
- Suprapubic pain
- Urge, but unable to urinate
- Blood at meatus & in scrotum
- Rebound tenderness
- Displacement of prostate
- Abdominal wall muscle rigidity, spasm, or involuntary guarding
What is Cullen’s Sign & what does it indicate?
GI Trauma - KNOW THIS!!!!
Bluish / purplish bruising (ecchymosis) at or around the umbilicus (bellybutton)
Indicates: internal bleeding into the peritoneum
What is Kehr’s Sign & what does it indicate?
GI Trauma - KNOW THIS!!!
Radiating L shoulder pain
- Indicates splenic injury
What is Grey Turner’s Sign & what does it indicate?
GI Trauma - KNOW THIS!!!!
ecchymosis on the flank; one or both sides
Indicates: renal injury
Why do patients receive lactated ringers after GI trauma?
GI Trauma - KNOW THIS!!!
Lactated ringers most closely resemble plasma commposition
**What are key interventions nurses must do / implement during an abdominal / GI trauma? **
GI Trauma - KNOW THIS!!!!
- 2 Wide Bore IVs
- Provide lactated ringers (fluid resuscitation) and blood products
What are the 3 concurrent injuries associated with GI / abdominal trauma?
GI Trauma - KNOW THIS!!!!
1.) Lower Rib Cage Injury = Spleen
2.) Chest = Esophageal & Gastric
3.) Pelvis = Bladder & Uterus
What are signs & symptoms / pathophysiolgoy of abdominal trauma?
GI Trauma
- Blood loss
- Pain
- Decreased peristalsis
Where is the liver located?
Hepatitis, Cirrhosis, & Gallbladder
Right Upper Quadrant (RUQ)
What are basic functions of the liver?
Hepatitis, Cirrhosis, & Gallbladder
- Metabolize: glucose, lipids, proteins
- Storage: vitamins B12, A, C, , D, E, & K
- Digestion: hepatocytes produce bile to help with aborption of fats
- Production of albumin
- Detoxifies: makes drugs less harmful to the body
What is Jaundice and when does it occur?
Hepatitis, Cirrhosis, & Gallbladder
yellow or greenish-yellow sclera & skin due to increased bilirubin levels
- Occurs when bilirubin is greater than 2 mg/dL
What is portal hypertension?
Hepatitis, Cirrhosis, & Gallbladder
**Obstructed blood flow through the liver **resulting in increased pressure in the portal venous system
Causes: acites & esophageal varicies
What does portal hypertension lead to?
Hepatitis, Cirrhosis, & Gallbladder
- Ascites
- Esophageal varicies
What is cirrhosis of the liver? What are common causes?
Hepatitis, Cirrhosis, & Gallbladder
Scarring
- healthy liver cells are replaced by scar tissue
Common Causes: Hepatitis C, heavy EtOH consumption
Caused by:
* Viral Infection: hepatitis C & heptatitis B
* EtOH consumption (heavy amounts)
* Too much fat (non-alcoholic): obesity, hyperlipidemia, diabetes
* Problems with bile duct: bile stays in liver & damages cells
* Autoimmune disorders
What is cirrhosis of the liver? What are common causes?
Hepatitis, Cirrhosis, & Gallbladder
Scarring
- healthy liver cells are replaced by scar tissue
Common Causes: Hepatitis C, heavy EtOH consumption
Caused by:
* Viral Infection: hepatitis C & heptatitis B
* EtOH consumption (heavy amounts)
* Too much fat (non-alcoholic): obesity, hyperlipidemia, diabetes
* Problems with bile duct: bile stays in liver & damages cells
* Autoimmune disorders
What are Signs & Symptoms of Cirrhosis?
Hepatitis, Cirrhosis, & Gallbladder - KNOW THIS!!!
The Liver Is Scarred
- Tremors of hands
- Hepatic foetor (musty breath)
- Eye & skin yellowing (jaundice)
- Loss of appetite
- Increased bilirubin & ammonia (HIGH Bilirubin & ammonia)
- Varices (esophageal varices)
- Edema in the legs
- Reduced platelets & WBCs (low platelets & WBCs)
- Itchy skin
- Spider angiomas
- Splenomegaly
- Confusion or coma
- Ascites
- Redness on the palms of the hands
- Renal failure
- Enlarged breast in men (gynecomastia)
- Deficient on vitamins
How is ascites assessed?
Hepatitis, Cirrhosis, & Gallbladder
- Abdominal Girth & Weight recorded daily
- Presence of striae, distended veins, & umbilical hernia
- Assess for fluid in abdominal cavity by percussion for shifting dullness
- Monitor potential fluid & electrolyte imbalance
What procedure can be used for the treatment of ascites & what happens in this procedure?
Hepatitis, Cirrhosis, & Gallbladder
Transjugular Intrahepatic Portosystemic Shunt (TIPS)
- Shunt is placed in the liver to connect the portal & hepatic veins which decreases portal hypertension
What assessments should be done by nurses when caring for patients with cirrhosis?
Hepatitis, Cirrhosis, & Gallbladder - KNOW THIS!!!
- Focus: symptoms & history of precipitating factors
- EtOH use or abuse
- Dietary intake & nutritional status
- Exposure to toxic agents & drugs
- Assess changes in mental status, ADL & IADLs, job & social relationships
- Monitor signs & symptoms related to bleeding; changes in fluid volume & lab data)
- Dull abdominal ache
- Poor tissue turgor
- Bruising
- Musty Breath (Hepatic foetor)
What are nursing interventions when caring for patients with cirrhosis?
Hepatitis, Cirrhosis, & Gallbladder - KNOW THIS!!!
- Monitor for bleeding
- Check reflexes
- Mental Status
- Diet
- Glucose levels
- Monitor for signs of jaundice of skin, urine, & sclera
- I & Os; Daily weight
- Administer medications Lactulose