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
What is in a “Banana Bag” and when is it used?
Hepatitis, Cirrhosis, & Gallbladder
- Thyamine
- Folic Acid
- Magnesium
- Multivitamins
Used for issues with the liver
What is checked for / associated with an imbalanced nutrition nursing intervention for patients with cirrhosis?
Hepatitis, Cirrhosis, & Gallbladder - KNOW THIS!!!
- I & Os
- Small frequent meals: high calorie diet, sodium restriction
- High calories, sodium restriction, high carbs, low protein (modified or restricted if patient is at risk for encephalopathy)
- Supplemental vitamins, minerals, B complex, provide water-soluble forms of fat-soluble vitamins for patients with steatorrhea
- Consider patient preferences
Why is lactulose given to patients with cirrhosis?
Hepatitis, Cirrhosis, & Gallbladder - KNOW THIS!!!
to reduce the amount of ammonia
Key Facts about Hepatitis A
Hepatitis, Cirrhosis, & Gallbladder - KNOW THIS!!!
- Acute only
- Fecal Oral transmission - contaminated food or water
- Most common form of hepatitis among daycares
- Vaccine for it
- Viral for 10 - 14 days
Key Facts about Hepatitis B
Hepatitis, Cirrhosis, & Gallbladder - KNOW THIS!!!
- Acute & Chronic
- Transmission via blood & bodily fluids
- 10% of cases become chronic
Key Facts about Hepatitis C
Hepatitis, Cirrhosis, & Gallbladder - KNOW THIS!!!
- Acute or Chronic
- Blood contact with skin or mucous membranes
- LEADING CAUSE OF CIRRHOSIS, LIVER CANCER, & TRANSPLANT
- No vaccine
Explain the following regarding Hepatitis A, B, & C:
- Acute, Chronic, Both
- Mode of Transmission
- Other Important Points
Hepatitis, Cirrhosis, & Gallbladder - KNOW THIS!!!
Hepatitis A
* Acute only
* *Transmission: *fecal oral (contaminated food or water)
* Most common form of hepatitis in daycares
Hepatitis B
* Acute & Chronic
* Transmission: blood & bodily fluids
Hepatitis C
* Acute & Chronic
* Transmission: blood or sexual contact with skin or mucous membranes
* Leading cause of cirrhosis, liver cancer, & liver transplant
Signs & Symptoms of Hepatitis A, B, & C
Hepatitis, Cirrhosis, & Gallbladder - KNOW THIS!!!
- Jaundice
- Strong aversion to strong odors
- asymptomatic
- anorexia
- flu-like symptoms
- indigestion, heartburn, nausea
What can cause non-viral hepatitis?
Hepatitis, Cirrhosis, & Gallbladder
Toxic & drug induced
- EtOH
- Acetaminophen
How is Hepatitis C transmitted?
Hepatitis, Cirrhosis, & Gallbladder - KNOW THIS!!!
Blood & sexual contact, including needle sticks & sharing needles
Where is the gallbladder located?
Hepatitis, Cirrhosis, & Gallbladder
Right Upper Quadrant (RUQ) - under the liver
What is cholelithiasis & what are clinical manifestations?
Hepatitis, Cirrhosis, & Gallbladder
gallstones
- asymptomatic
- pain
- biliary colic
- jaundice
- changes in urine or stool color
- vitamin deficiency (vitamins A, D, E, & K - fat soluble)
Would you want to get hit by a big bullet or a small bullet? Why?
HAYLEY
Big bullet because with a small bullet it moves around more and can cause multiple shock traumas
A 160 pound man is traveling in a car at 60 mph. He has LOC and the car strikes a pole at 50 mph How much force did he strike the pole with?.
Weight x Speed of car = Force
160 lbs x 50 mph = 8,000 lbs
How would you teach a male patient about a testicular exam?
Male Reproduction - KNOW THIS!!!
scrotum palpation for any abnormal growth, mass, or pain noted with testicles
How would you teach a patient to do a testucular self exam?
Male Reproduction - KNOW THIS!!!
- Roll testicles between thumb & fingers
- After a warm shower so testes are distended
How long does it take before sterility is complete after a vasectomy?
Male Reproduction
3 months
What is prostatitis?
Male Reproduction
Inflammation of the prostate caused by an infectious agent
What is benign prostatic hyperplasia (BPH) & what are signs / symptoms of it?
Male Reproduction
Enlarged prostate
S & S:
* urinary obstruction
* urinary retention
* urinary tract infections
* dysuria
* hesitancy
* sensation of incomplete bladder emptying
What is the most common procedure used in the treatment of BPH?
Male Reproduction
TURP
Transurethral Resection of the Prostate
Post-Op Care after a TURP
Male Reproduction - KNOW THIS!!!
- Assess for shock or hemorrhage (urine may be reddish pink initially)
- Monitor continuous bladder irrigation & vital signs
- Monitor I & Ox after catheter is removed
- Avoid long periods of sitting & strenuous activity until danger of bleeding is over
- Avoid consumption of large amounts of fluid at first post-op
- Avoid anticholinergics, antihistamines, & decongestants
Nursing Interventions after Radical Prostatectomy (for pt’s w/ prostate cancer)
Male Reproduction - KNOW THIS!!!
Reduction of anxiety
* be sensitive to potentially embarrasing & culturally charged issues
* establish a professional, trusting relationship
* provide privacy
* allow patient to verbalize concerns
* provide & reinforce information
Provide patient with education, including explanations of anatomy & function, diagnostic testing and surgery, and the surgical experience
After a prostatectomy, when should the urine be light pink?
a.) 1 day
b.) 2 days
c.) 1 week
d.) 2 weeks
Male Reproduction
a.) 1 day
What is testicular torsion?
Male Reproduction - KNOW THIS!!!
ischemia to blood vessels in testicle (twisting of blood vessels)
EMERGENCY
What risk factors, treatment, & patient education for Sexually Transmitted Infections (STIs)?
**Male Reproduction - KNOW THIS!!!
Risk Factor: MULTIPLE PARTNERS
Treatment: for both patient & partner
What is the organism & mode of transmission of AIDS.
Male Reproduction - KNOW THIS!!!
Acquired Immune Deficiency Syndrome (AIDS)
- Human immune deficiency virus (HIV)
- Transmission: sexual, percutaneous, perinatal
What should be included in education that nurses provide patients about STIs?
Male Reproduction - KNOW THIS!!!
- Causative organism
- Course of infection
- Possible complications
- Importance of following therapy
- Need to report side effects or symptom progression
- Methods used to contact partner about STI
- Risk of recurrent infections
What oral medication is used for the management of ED? What are common side effects? Caution should be used when giving this medicaiton to patients with what condition? What is it contraindicated with?
Male Reproduction - KNOW THIS!!!
sildenafil (Viagra)
Side Effects:
* headache
* flushing
* dyspepsia
- Cauthion with: Retinopathy
- Contraindicated: NITRATE Use
What injectable medications are used for the management of ED? What are complications associated with these medications?
Male Reproduction - KNOW THIS!!!
Vasoactive Agents:
* alprostadil
* papaverine
* phentolamine
Complications: Priaprism
What urethral supposetory medication is used for the management of ED?
Male Reproduction - KNOW THIS!!!
alprostadil
A nurse practitioner is assessing a 55-year-old male patient who reports perineal discomfort, burning, urgency, & frequency with urination. The patient states that he ahs had pain with ejaculation. THe nurse knows that the patient is exhibiting symptoms of what?
a.) Varicocele
b.) Epididymitis
c.) Prostatitis
d.) Hydrocele
Male Reproduction
c.) Prostatitis
A nursing student is learning how to perform sexual assessments using the PLISSIT model. According to this model, the student should begin the assessment by doing which of the following?
a.) Briefly teaching the patient about normal sexual physiology
b.) Asking the patient if the patient is willing to discuss sexual funcitoning
c.) Assuring the patient that what they say will be confidential
d.) Ensuring patient privacy
Male Reproduction
b.) Asking the patient if they are willing to discuss sexual funciton
A patient who is post-op day 12 & recovering at home after a laproscopic prostatectomy has reported that the patient is experiencing occasional “dribbling” of urine. How should the nurse best respond to the patient’s concern?
a.) Inform the patient that urinary control is likely to return gradually
b.) Arrange for the patient to be assessed by a urologist
c.) Facilitate the insertion of an indwelling urinary catheter by the home care nurse
d.) Teach the patient to perform intermittent self catheterization
Male Reproduction
a.) Inform the patient that urinary control is likely to return gradually
A 35-year-old father of 3 tells the nurse they want information about a vasectomy. What should the nurse tell the patient about ejaculation after a vasectomy?
a.) There will be no ejaculating after a vasectomy, though the patient’s potential for agsm is unaffected
b.) There is no noticeable decrease in the amount ejaculated after a vasectomy even though it contains no sperm
c.) There is a marked decrease in the amount ejaculated after a vasectomy, though it does not affect sexual satisfation
d.) There is no chang ein the quantity ejaculated after a vasectomy, but the viscosity is somewhat increased
Male Reproduction
b.) There is no noticeable decrease in the amount ejaculated after a vasectomy even though it contains no sperm
The nurse is assessing urinary output 24 hours after a prostatectomy for a patient with continuous bladder irrigation. What color output should the nurse expect to find in the drainage bag?
a.) Red wine colored
b.) Tea colored
c.) Amber
d.) Light pink
Male Reproduction
d.) Light pink
Testicular Cancer:
- Signs & Symptoms
- Preventative Measures
- Discharge Teachings
Male Reproduction
Signs & Symptoms: painless lump or mass in the testes
Preventative Measures:
* montly testicular self exams (TSE)
* annual testicular exam
Discharge Teachings:
* assessment of physical & psychological status
* support of coping
* address issues of body immage & sexuality
* encourage a positive attitude
* patient education
* TSE & follow-up care
What are symptoms associated wtih premenstral syndrome?
Female Reproduction
- hot flashes
- nausea
- vomiting
- headache
What is dysmennorhea?
Female Reproduction
painful menses
What is amenorrhea?
Female Reproduction
no menstrual cycle
What is menorrhagia?
Female Reproduction
prolonged bleeding at cycle
What is metrorrhagia?
Female Reproduction
prolonged bleeding between cycles
What patients receive RhoGAM?
Female Reproduction
Rh-negative patients
Nursing interventions & medical management of menopause
Female Reproduction
Medical Management: Hormone replacement therapy
Nursing Interventions: importance of taking calcium & vitamin D
What are contraindications for hormone replacement therapy with an estrogen patch? (select all that apply)
a.) Decreased bone density
b.) History of breast cancer
c.) Impaired liver function
d.) Sensitive skin
e.) Undiagnosed abnormal vaginal bleeding
f.) Weight gain
Female Reproduction
- b.) History of breast cancer
- c.) Impaired liver function
- e.) Undiagnosed abnormal vaginal bleeding
What is a hydrocele?
Male Reproduction
Collection of fluid in testes
What is epididymitis?
Male Reproduction
inflammation of the epididymis
usually from UTI
What is orchitis?
Male Reproduction
acute inflammatory reaction of the testes
Usually due to mumpts or STD exposure (can cause sterility, pain, swelling)
- common in kids
The nurse is caring for a patient in the clinic who complains of vaginal discharge that is thick with a white, cottage cheese-like appearance. The patient states that she has pruritus & irritation. The symptoms seem to be more severe just before menstruation. What should the nurse expect to be included in the plan of care for this patient?
a.) Clindamycin (Cleocin)
b.) Fluconazole (Diflucan)
c.) Metronidazole
d.) Tinidazole (Tindamax)
Women’s Health
b.) Fluconazole (Diflucan)
What is pelvic inflammatory disease?
Women’s Health
**inflammatory condition of the pelvic cavity **
may involve the uterus (endometriosis), fallopian tubes (salpingitis), ovaries (oophoritis), pelvic peritoneum, or pelvic vascular system
Usually caused by untreated STIs
What is the main symptom associated with pelvic inflammatory disease?
Women’s Health
dyspareunia (painful sexual intercourse)
anorexia, nausea, headache, fever, general malaise, possible vomiting; also lower abdominal pelvic pain & vaginal discharge
Which woman is at highest risk for cervical cancer?
a.) A 25-year-old who smokes & has multiple sexual partners
b.) A 40-year-old who had her first child at age 19 & has been exposed to HVP
c.) An 18-year-old who has just had her first sexual encounter
d.) An obese 30-year-old who has nutritional deficiencies & a family history of cervical cancer
Women’s Health
d.) An obese 30-year-old who has nutritional deficiencies & a family history of cervical cancer
What are potential complications of a hysterectomy?
Women’s Health - KNOW THIS!!!
- Hemorrhage
- DVT
- Bladder dysfunction
- Infection
What are signs & symptoms associated with complications of a hysterectomy?
**Women’s Health - KNOW THIS!!!*
- Restlessness
- Tachycardia (↑ HR)
- Hypotension (↓ BP)
- Increased respirations (↑ RR)
↑ HR
↑ RR
↓ BP
A nurse is caring for a patient after a hysterectomy. THe patient presents with increased HR, decreased BP, weak pedal pulses, & decreased urinary output. Which complication of a hysterectomy should the nurse be concerned about?
a.) Bladder dysfunction
b.) Hemorrhage
c.) Pain
d.) Venous thromboembolism
Women’s Health
b.) Hemorrhage
When should women start getting breast & pelvic exams?
Women’s Health
Any woman over age 21 or anyone who is sexually active
How are tumors staged?
Women’s Health
TMN
- Tumor
- Nodes
Metastasis
What are risk factors for breast cancer?
Women’s Health - KNOW THIS!!!
Combination of genetic, hormonal, & environmental factors
At what age should women start getting clinical breast exams twice per year?
Women’s Health
25
Signs & Symptoms of Breast Cancer
Women’s Health - KNOW THIS!!!
Lesions are NON-TENDER, FIXED, & HARD LESIONS WITH IRREGULAR BORDERS
- Can be found anywhere, but are usually in the UPPER OUTER QUADRANT
What should be included in the education plan for a patient after axillary lymph node dissection (ALND)? Select all that apply
a.) Avoid blood pressures, injections, & blood draws in affected extremity
b.) Wear gloves for gardening
c.) Maintain cuticles by cutting them
d.) Use disposable razors for shaving armpits
e.) Avoid lifting objects greater than 5-10 pounds
Women’s Health
a.) Avoid BP, injections, & blood draws in affected extremity
b.) Wear gloves for gardening
What condition can pre-menopause & menopause increase the risk of and why?
Women’s Health
Osteoporosis
Due to changes in calcium & vitamin D
