Week 6 - Abdominal Flashcards
what are the 5 factors that effect nausea
Anxiety Increased Intracranial Pressure (ICP) Movement Gastric changes (stasis, constipation, obstruction) Biochemical Changes (e.g. drugs)
what are the The Emetic Pathway
Vomiting Centre
- Cerebral Cortex
- Pressure Receptors
- Vestibular Nucleus
- Gastrointestinal Tract
- Chemoreceptor Trigger Zone
what medication can induce nausea
Histamine Antagonists
Acetylcholine (muscarinic) Antagonists
Serotonin Antagonists
Dopamine Antagonists
WHY DO WE NEED a Digestive System?
All organisms must obtain nutrients from their environment to survive
Single-cell organisms – no need for GIT
More complex organisms – more cells
need organisation and coordination
what is the Gastrointestinal tract (GIT)
A hollow muscular tube starting from the oral cavity
Passes through the pharynx, esophagus, stomach & intestines to the rectum and anus
Accessory organs assist by secreting enzymes to help break down food into its component nutrients
The salivary glands, liver, pancreas & gall bladder have important functions
Food is propelled along the length of the GIT by peristaltic movements of the muscular walls.
what are the primary Functions of the GIT
Ingestion
Digestion
Absorption
Elimination
what function does the mouth serve
Oral cavity – teeth and tongue: mechanical processing, moistening, chemical digestion starts
Salivary glands – enzymes and lubrication
Pharynx – muscular propulsion of materials into oesophagus
what are the common disorders of the mouth
Stomatitis
Primary or secondary
Can affect any or all parts of the mouth
Symptoms of pain, halitosis, swelling, bleeding, ulceration
Other common disorders of the mouth?
Oral Cancer
what are the common disorders of the oesophagus
Gastro –Oesophageal Reflux Disease (GORD)
Definition – the backward flowing of gastric contents into the oesophagus
Pathophysiology
Contributing factors e.g. Increased gastric volume; positioning & increased gastric pressure
Manifestations
Complications
what is the HIATAL HERNIA
this is when part of the stomach pokes through the diaphragm
name of stomach areas
refer to image on power point Topic 5 abdominal bowel considerations slide 15
what are the disorders of the stomach
Gastritis Definition – inflammation of the stomach lining as a result of irritation of the gastric mucosa. Two types – acute and chronic Manifestations Nursing management
key points of stomach cancer
Incidence increases with age
Risk factors – H. Pylori infection –35%-89%
Most common type – Adenocarcimona
Metastatic spread to liver lungs, ovaries and peritoneum
Manifestations – few – similar to gastritis
Treatment – medical / oncology; gastrostomy tube
Nursing intervention
Disorder of the Bowel
Bowel Obstruction Intestinal obstruction is failure of intestinal contents to move through the bowel lumen. Can be in the small or large intestine. Mechanical or functional Manifestations
Disorders of the Liver
Hepatitis Inflammatory condition of the liver Generally caused by one of 5 virus’s Mode of Transmission Manifestations: Acute hepatitis Manifestations: Chronic hepatitis Can be brief, severe & life threatening Liver can regenerate tissue - but can lead to cirrhosis & chronic liver dysfunction and cancer
Disorders of the Pancreas
Pancreatitis Inflammation of the pancreas Acute : Manifestations Chronic : Manifestations Causes – alcohol main cause but not the only one Nursing interventions
Pancreatic Cancer
Accounts for 1/6 of all cancer deaths 5 year survival rate of less than 6 % Often advanced on diagnosis – only 30% offered curative treatment Risk Factors Manifestations Nursing Management
what is the GALL BLADDER
Site of bile storage
Bile is released into the duodenum in response to the hormone cholecystokinin (CCK)
CCK is produced in the duodenum
Cholecystitis
Cholecystitis
- Commonly caused by gall stones lodged in the common bile duct
- May produce jaundice
- Extremely painful; often mistaken by sufferers for a heart attack
- Episodic in nature; acute episodes often brought on by an influx of high-fat food
- Typical patient fits the ‘three Fs’: ‘fair’, ‘fat’ and ‘forty’
- Affects 20% of people over 40 years; more in women
- Treated surgically
how can Common Disorders of the GIT occur
Results from food intolerance, psychological distress or increased gastric juices
Signs &symptoms - constipation & diarrhoea, abdominal distention & pain, mucous in stools
Gastroenteritis
Inflammation of the stomach and intestines
Causes
Manifestations
Can be dangerous due to loss of fluids and electrolytes
Nursing Management
Appendicitis
Inflammation of the appendix
Manifestations
Complications
Nursing Management
Inflammatory Bowel Disease
Ulcerative colitis and Crohn’s disease are caused by abnormal activation of the immune system in the intestines
Ulcerative colitis : Manifestations
Crohn’s disease : Manifestations
About 25 to 40 % of ulcerative colitis patients must eventually have their colons removed because of massive bleeding, severe illness, rupture of the colon or risk of cancer.
Nursing Management
what is a STOMAS
Stoma is the Latin term for
Opening, and it is artificially made by a surgeon
There are 3 types of “ostomy” Colostomy Ileostomy Urostomy Name usually depends on the site it is situated.
why are stomas necessary
Approximately 36,000 Australians receiving ostomy support.
Newborns may require a stoma due to congenital deformities.
They may be necessary due to trauma or disease
They may be permanent; or temporary
what are the clinical observations a nurse should observe
Observe for signs of nutritional alteration.
General appearance- alert/responsive or listless/confusion
Muscles- tone, development, presence of fat
CNS- reflexes, attention span, sensation
CVS- HR, BP, rhythm
GI – appetite, digestion
Hair – lustre, scalp
Skin/nails – colour, dry, scaly
Eyes – lustre, membranes
Oral cavity – mucous membranes, teeth, lips
what are the relevant health information
Past medical/ health history chronic and acute
Surgical procedures
Medications & Allergies
Developmental problems – growth, birth history, milestones, functional abilities if applicable
Obstetric and reproductive history
Genito-urinary problems
Substance use- Alcohol and cigarettes
what is the importance of the renal system
Prevent build up of waste • Prevent build up of fluid • Maintain electrolyte balance • Produce hormones for BP regulation • Stimulate production of red blood cells • Maintain strength of bones
GLOMERULAR FILTRATION
RATE (GFR)
Glomerular Filtration Rate (GFR) - the rate at
which fluid filters from the glomerulus into
the Bowman’s capsule
• GFR provides a measure to assess renal
function
• Creatinine clearance is used in clinical
practice to estimate GFR
• Normal GFR 90-140 ml/min (men), 80-125
ml/min (women)
Renal system - Terminology
Renal • Nephrology • Urology • Glomerular filtration rate • Diuretic • Diuresis
what considered RENAL FAILURE (RF)
Severe decrease in GFR.( Glomerular Filtration Rate) • Kidneys fail to remove metabolic end nitrogenous products from the blood (azotemia). • Failure to regulate electrolyte & acid – base balance of the ECF. • Two types of renal failure – Acute renal failure (ARF) – Chronic renal failure (CRF)
what is considered ACUTE RENAL FAILURE
School of Nursing
& Midwifery
• Sudden decline in renal function sufficient to
increase plasma levels of nitrogen waste products
(azotaemia) and impair water-electrolyte balance
• Sudden decline in renal function with a Decrease in
urinary output to less than 400ml / day
what are the 3 classifications of acute renal failure
– 1. Pre-renal
- Marked decrease in renal blood flow
– 2. Intra-renal
- Damage of kidney structures
– 3. Post-renal obstructionwhat causes Pre-renal failure
– Hypovolemia • Massive haemorrhage • Dehydration • Excessive fluid loss due to burns – Heart failure (myocardial infarction) – Decreased vascular filling • Anaphylactic shock – Drugs and toxins • E.g. NSAIDs, endotoxins
what causes INTRA-RENAL FAILURE
– Glomerulonephritis (common)
– Pyelonephritis
– Acute tubular necrosis
– Transfusion reactions
– Nephrotoxic agents (methanol, lead, arsenic)
– Antibiotics (Gentamycin and other aminoglycosides)
what is Glomerulonephritis
There is active proliferation of glomerular cells &
an extensive inflammatory process.
• The inflammation leads to a decrease in GFR,
it may be transient or progress to renal failure
• Manifestations: haematuria, proteinuria, salt
and water retention
what is PYELONEPHRITIS
Refers to inflammation of the renal pelvis
Mainly caused by bacterial infection
Ascending infection from the bladder is the most common cause
what are the symptoms of ACUTE PYELONEPHRITIS
Fever, chills Leukocytosis, pyuria common Haematuria may be present May follow cystitis May subside w/o treatment (organisms may present in the urine for wks/mths)
ACUTE TUBULAR NECROSIS
- Extensive necrosis of tubular epithelial cells
- Most common cause of acute renal failure
what causes ACUTE TUBULAR NECROSIS
• Causes – Ischaemia •Due to massive haemorrhage shock – Nephrotoxins •Antibiotics, heavy metals
what are the 3 phases of ACUTE TUBULAR NECROSIS
• Initiating phase
– First 24-48 hours
– Clinical causing event (e.g. haemorrhage, poisoning)
– Abrupt decrease in urinary output oliguria anuria
• Maintenance phase
– Few days – tubular epithelium needs time to regrow
– Requires supportive care ± dialysis
• Recovery phase
– Urinary output increases may be excessive initially
(polyuria) as new epithelium cannot yet fully reabsorb
components of filtrate normal urine output
what are the causes of POSTRENAL FAILURE
– Obstructive disorders – Calculi and strictures in the ureters – Bladder tumours, neurogenic bladder – Prostatic hyperplasia urethral obstruction
what are the obstructive disorders
- Pelvis
>Calculi
>Tumors
>Ureteropelvic
- Ureter-intrinsic >Calculi >Tumors >Clots >Sloughed papillae
- Ureter-extrinsic
>Pregnancy
>Tumors
>retrioeritoneal fibrosis - Vesicoreteral reflux
- Bladder
>Calculi
>Tumors
>Functional - Urethra
>Tumors
>Posterior valve structure - Prostate
>Hyperplasia
>Carcinoma
>Prostatitis
what are the 4 types of RENAL CALCULI
- Calcium Stones
- Struvite Stones
- Uric acid stones
- Cystine stones
key points of calcium stones
- Calcium stones : 70 – 80 %
• Calcium oxalate, calcium phosphate or combination of the two. • Associated with concentrated calcium in the blood & urine. • Risk factors • Management
key points of struvite stones
- Struvite stones : magnesium ammonium
phosphate stones formed in alkaline urine.
• These stones are always associated with urinary
tract infections.
• They are often called staghorn stones due to
their shape
• Risk factors & Managemen
key points of Utic acid stones
- Uric acid stones: due to increase in uric acid in the
urine
• Risk factors – Gout and genetics
- Not visible on x-ray films.
- Management
what are the key points of Cystine stones
- Cystine stones : are rare.
- Genetic defect in renal transport of cystine
- can be Managed
what are the CLINICAL MANIFESTATIONS
OF ACUTE RENAL FAILURE
• Oliguria and anuria > diuresis > recovery
• ↓GFR > azotaemia (↑plasma creatinine, ↑ BUN
(blood urea nitrogen) and ↑ urea)
• Outcomes
– Complete recovery
– Progress to chronic renal failure
– Death
Treatment Goals
Treatment goals are:
1.Identify the correct underlying cause
2.Prevent additional kidney damage
3.Restore urine output and kidney function
4.Compensate for renal impairment until kidney
function is restored
