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HESI MED SURG
#4
| Question | Answer |
|---|---|
| Crohn's Disease | Inflammation involving all layers of the bowel wall. Can occur anywhere in the GI tract. Strictures form at areas of inflammation and may cause bowel obstruction or peritonitis. Consists of skip lesions (cobblestone appearance of alternating areas of healthy and diseased tissue) the ulcerations are deep. |
| Crohn's Disease Symptoms | Weight loss, malnutrition, anemia, cramping after meals, diarrhea, steatorrhea, abdominal pain that is NOT relieved by defecation, and abdominal pain is in the RLQ. |
| Crohn's Disease Menu | Oral fluids, low-residue, high-protein, high-calorie diet with supplemental vitamin therapy and iron replacement. |
| Ulcerative Colitis | Disease of the mucosal layer of the colon and rectum. Typically begins in the rectum and moves inward. Best viewed by colonoscopy |
| Ulcerative Colitis Symptoms | Marked fluid loss, damage to mucosa, breakdown of cells, possible formation of pseudo polyps. Bloody diarrhea, mucous and pus may be present too. LLQ abdominal pain, and pain is often relieved by defecation |
| Bariatric Surgery - Post-op Checklist | Assess abdominal pain, medications, wound assessments, and provide education. Eat slowly, stop when full, NO liquids with solid food. Assess for psychological issues (guilt for needing surgery, left with a lot of skin leading to disturbed body image). DUMPING syndrome and vitamin/mineral imbalances are possible, as well as ulcers and bleeding |
| Constipation | The nurse should first assess bowel habits, as many believe they should have a bowel movement every day (not true, they should not have less than 3 per week). Encourage a high fiber/residue diet, establish healthy bowel habits, avoid holding stool, possible bulk forming laxative OTC. |
| Small Bowel Obstruction | Occurs 75% of the time. Symptoms include NAUSEA/VOMITING, abdominal distention, and decreased bowel sounds. Typically caused by ADHESIONS, hernias, cancers, strictures. Treatment includes IV FLUIDS, NPO, NG decompression, and surgery (less than 50% of the time) |
| Large Bowel Obstruction | Occurs 25% of the time. Symptoms include ABDOMINAL DISTENTION, nausea and vomiting, and decreased bowel movements. Causes are typically from CANCER, VOLVULUS, strictures, adhesions. Treatment includes IV fluids, NPO, NO DECOMPRESSION (except in sigmoid volvulus), and surgery is needed more than 50% of the time. |
| Appendicitis- pre-op preparation | IV infusion to replace loss fluids, promote adequate renal function, antibiotic therapy to prevent infection, and administration of analgesics for pain. NO ENEMA |
| Diverticulosis- S&S | Acute left lower quadrant pain, changes in bowel movements are the main characteristics. |
| Diverticulitis- WBC | Increased ESR and WBC. |
| Septic shock- peritonitis | Delay of surgical therapy until the acute septic process has subsided. Surgical treatment is directed at excision (appendix), resection with or without anastomosis (intestine), repair (perforation), and drainage (abscess). Intensive care is needed for a patient with septic shock |
| Signs of Septic Shock Improvement | decrease in temp, pulse rate, softening of abdomen, return of peristaltic sounds, passing gas, and bowel movements. The nurse should increase fluid and food intake gradually and reduce parental fluids as prescribed. |
| Signs of Septic Shock Worsening | may indicate complication and the nurse should prepare the patient for emergency surgery |
| Urine retention- incontinence-male | Can be caused by the enlarged prostate obstructing the bladder neck or urethra, causing incomplete emptying of the bladder and urinary retention. Urinary retention may result in UTIs |
| BPH- pathology | Common > 60 years old, in men. Prostate enlarges over time and can impede urine flow. Not cancerous or painful. Chronic retention can lead to lower UTIs. |
| BPH Symptoms | Weak urine stream, frequent urination, dribbling after urinate, urge to urinate, leakage of urine (overflow incontinence), nocturia |
| TURP- discharge plan | Irrigation stops when urine is clear, and blood clots and blood is no longer present. Procedure relieves symptoms rather quickly, and men have a stronger urine stream soon after procedure. Possible side effects include incontinence, and dribbling for the first year. Monitor for drainage color, or obstruction in catheter bag, monitor lower abdomen for swelling or distention, monitor BP, pulse, respirations, restlessness, diaphoresis, and pallor |
| Tamsulosin | Used in patients with BPH. Is an Alpha I - Adrenergic Antagonist. Used mostly for relatively smaller prostates (dynamic obstructions). Relaxes smooth muscle of the bladder neck and prostate, which improves urine flow and relieves symptoms. Side effects include dizziness, headache, asthenia/fatigue, postural hypotension, rhinitis, and sexual dysfunction |
| Sildenafil Side Effects | Headaches, visual changes, dizziness, flushing, muscle pains, and a stuffy nose. |
| Stress Incontinence | IN MEN, often experiences after a radical prostatectomy for prostate cancer because of the loss of urethral compression that the prostate had supplied before the surgery and possibly bladder wall irritability |
| Urolithiasis | Stones (Calculi) in the urinary tract |
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