Normal Size Small Size show me how
Med Surg Final1
Acute & Chronic Pancreatitis, Cirrhosis, Acute Cholecystitis/Cholelithiasis/Chol
|What are S&S of ACUTE pancreatitis?
|Sudden onset of severe, deep, piercing, and continuous or steady pain of the abdomen in the left upper quadrant and may be in the midepigastrium.
|What are other manifestations/ S&S that are included with ACUTE pancreatitis?
|N/V, low-grade fever, leukocytosis, hypotension, tachycardia, jaundice, decreased or absent bowel sounds, crackles in lungs, greenish to yellow-brown discoloration of abd wall, Grey Turner's sign and Cullen's sign.
|What lab values would you look for with ACUTE pancreatitis?
|^ Serum amylase, ^ serum lipase, ^ blood glucose, decreased serum calcium, ^ serum triglycerides, ^ bilirubin...**Due to amylase drop after 24-48hrs, check amylase in urine to prove accurate dx of pancreatitis (stays up longer in urine)**
|What diagnostic tests are used to diagnose ACUTE pancreatitis?
|Abd ultrasound, x-ray, CT (best test), ERCP, EUS, MRCP, angiography
|What position should be used in pancreatitis?
|Knee chest position OR side-lying position with the HOB elevated at a 45 deg angle--this decreases tension on the abd and may help ease the pain
|A patient with pancreatitis should follow what type of diet?
|Initially pt should be NPO, but when food is allowed pt should eat small frequent meals that are high in carbs, low in fat, replacement enzymes, fat-soluble vit A,D,E,K, abstain from alcohol and caffeine beverages
|A pt comes in with CHRONIC pancreatitis, what S&S would you expect to see?
|Abd pain in left upper quadrant, unintentional weight loss, constipation, mild jaundice with dark urine, steatorrhea (fat in feces), DM, frothy urine, and abd tenderness, along with S&S of acute pancreatitis
|Lab values are drawn from the pt with CHRONIC pancreatitis, what labs are you looking for?
|Same labs as acute as well as: reduced bicarb, ^ alkaline phosphatase, mild leukocytosis and an ^ sedimentation rate
|What diagnostic tests are used to diagnose CHRONIC pancreatitis?
|Abd & trans abd ultrasound, x-ray, CT (best test), ERCP, EUS, MRCP, angiography, MRI, stool sample, secretin stimulation test
|What occurs from hemorrhagic pancreatitis?
|Cullen's sign and Grey Turner's sign...shock may occur from toxic enzymes or hypovolemia from fluid shift into the retroperitoneal space
|Cirrhosis can best be described as:
|A chronic progressive disease of the liver thats charaterized by extensive degeneration & destruction of the liver cells. Liver cells attempt to regenerate but are disorganized resulting in abnormal blood vessel & bile duct architecture & imped blood flow
|Cirrhosis pts should follow this type of diet:
|High in calories (3,000), high carb, moderate to low levels of fat, low sodium, protein may be restricted in some pts
|This type of varices is the most life-threatening complication of cirrhosis
|Bleeding esophageal varices
|Portal hypertension causes what?
|Tortuous veins at the lower end of the esophagus to become enlarged and swollen, known as esophageal varices
|How would you treat esophageal varices with tubing?
|Sengstaken-Blakmore tube and Linton-Nachlas tube: balloon tamponades
|Nursing assessment and care for esophageal varices include
|Keep scissors at bed side to cut balloon if choking, management of bleeding, keep pt in semi-fowlers, monitor for rupture or erosion, regurgitation, and aspiration, frequent oral and nasal care, treat symptoms and tend to pts needs
|Your pt for cirrhosis teaching should include:
|Patho of cirrhosis and importance of continuous care, symptoms of complications, when to seek medical attent., avoid hepatoxic OTC drugs, alcohol, ASA, NSAIDs, spicy and rough foods, straining (coughing, sneezing, retching, stool, and vomiting)
|A needle puncture of the abd cavity to remove ascitic fluid is known as
|paracentesis *make sure bladder is emptied*
|The definition of hepatic encephalopathy is
|A neuropsychiatric manifestation of the liver caused by high ammonia levels that cause confusion, abnormal neurotransmission, astrocyte swelling, and inflammatory cytokines. Daily weight is best indicator!!
|What causes hepatic encephalopathy?
|High ammonia levels due to the blood being shunted past the liver and the liver is unable to convert ammonia to urea
|What is cholecystitis?
|Inflammation of the gallbladder
|What is cholelithiasis?
|Gallstones- can be asymptomatic
|What is choledocholithiasis?
|Gallstone in the common bile duct
|Someone may be at risk for cholecystitis, cholelithiasis, and choledocholithiasis if they are
|Fat, Fertile, Female, Fair skinned, and Flatulant (pg. 1095)
|What symptoms would you look for in a pt with ACUTE cholecystitis?
|Indigestion to moderate to severe pain, fever, jaundice, pain and tenderness RUQ, towards right shoulder and scapula, N/V, restlessness, diaphoresis, leukocytosis
|What symptoms would you look for in a pt with CHRONIC cholecystitis?
|Same as acute as well as: hx of fat intolerance, dyspepsia, heartburn, and flatulence
|What symptoms would you look for in a pt with cholelithiasis?
|Gallbladder spasms (biliary colic), pain, tachycardia, diaphoresis, prostration
|You would run these types of diagnostic studies to dx cholecystitis and cholelithiasis:
|Ultrasound (best), ERCP, percutaneous transhepatic cholangiography, WBC, Serum enzymes: alkaline phosphate, AST, and ALT, serum amylase, direct and indirect bilirubin, hx and physical examination
|What is jaundice?
|Yellowish discoloration of body tissues from altered bilirubin or flow of bile into hepatic or biliary duct systems.
|Why would a pt have jaundice?
|Blood transfusion reactions, sickle cell crisis, hemolytic anemia, hepatitis, cirrhosis, hepatocellular carcinoma, stone, biliary strictures, sclerosing cholangitis, and pancreatic cancer
|Your pt has jaundice, you run labs, what would you look for?
|Unconjugated and conjugated bilirubin and urine bilirubin, hepatocytes, liver enzymes
|A pt with jaundice should follow what type of diet plan?
|A diet with small, frequent meals that is low in saturated fats, low fat, high in fiber, and high in calcium,
|Why would a T-tube be used?
|It would be inserted into the common bile duct during surgery when a common bile duct exploration is part of the surgical procedure so the bile can drain while the SI adjusts to receiving a continuous flow of bile