pathophysiology
Why would a patient with cholelithiasis become jaundiced and have clay colored stools?
Bilirubin is a brownish yellow substance found in bile, it is produced when the liver breaks down old red blood cells. Bilirubin is then removed from the body through the stool (giving stool its normal color)If the flow of bile is impeded (gallstones in the bile ducts) bilirubin does not enter the intestine, as a result blood levels of bilirubin increase resulting in a yellowing of the skin and eyes (jaundice) a darkening of the urine (renal excretion of urobilirubin) and a lightening of the color of the stool
Patient presents with pain in the mid epigastric area occuring 24-48 hours after a meal or alcohol ingestion, abdominal distention, poorly defined palpable abdominal mass, decreased persitalsis, vomiting that fails to relieve the pain what would you suspect?
What do you expect to see if this condition worsens?
pancreatitis
Abdominal guarding, rigid, boardlike abdomen (usually indicates peritonitis)Cullen and Grey Turners sign (ecchymosis on flanks or around umbilicus,may indicate retroperitoneal hemorrhage) fever, jaundice,mental confusion, hypotension (represents hypovolemia and shock due to the large amount of protein rich fluid that is being lost into the tissues and peritoneal cavity), acute renal failure, resp distress, hypoxia, hyperglycemia, DIC
The nurse knows that this bacteria is usually the culprit for peptic ulcer disease______?
and would expect to administer what types of medications?
H. Pylori
Multiple antibiotics to prevent resistance, H2 receptor antagonists (ranitidine), PPI (protonix)
What type of diet is recommended after a gallbladder EPISODE? Give Examples
What type of diet is recommended after gallbladder REMOVAL?
EPISODE-low fat liquids, these can include powdered supplements high in protein and carbohydrate stirred into skim milk. Cooked fruits, rice or tapioca, lean meats, mashed potatoes, non gas forming vegetables, bread, coffee, or tea may be added as tolerated. The patient should avoid eggs, cream, pork, fried foods, cheese, rich dressings, gas forming vegetables and alcohol. *Fatty foods may induce an episode of cholecystitis.
REMOVAL-low in fats and high in carbohydrates and proteins immediately after surgery. Fat restriction is usually lifted after 4-6 weeks
signs of perforation/penetration in peptic ulcer disease
perforation is the erosion of the ulcer through the gastric serosa into the peritoneal cavity. symptoms include: sudden severe upper abdominal pain, pain may be referred to the shoulders especially the right one due to irritation of the phrenic nerve. vomiting, collapse,tender rigid abdomen, hypotension and tachycardia
penetration-is erosion of the ulcer through the gastric serosa into adjacent structures- back and epigastric pain not relieved by medications
Why is the urine foamy in nephrotic syndrome?
Why is there hypertension?
edema?
If a person has kidney damage or disease, proteins can leak from the kidneys into the urine. The result is known as proteinuria. Extra proteins reduce the urines surface tension, causing it to foam. Similar to the effect that soap has on water
Damage to the glomeruli and the resulting buildup of wastes in the bloodstream (uremia) can raise blood pressure
Because protein (albumin) is very useful at absorbing bodily fluid into the blood if it is being lost in the urine it is unable to do its job. Reduced albumin level in the blood causes fluid retention and swelling (edema)
what are important things to remember about amylase and lipase levels in pancreatitis?
Other important labs to monitor?
These levels are used in making the diagnosis of pancreatitis.Amylase and lipase levels are elevated within 24 hours of the onset of symptoms. Serum amylase usually returns to normal within 48-72 hours but serum lipase levels may remain elevated for a longer period.
Urine amylase
WBC-elevated
electrolytes- hypocalcemia may be present-have IV calcium gluconate available for tetany
glucose-hyperglycemia
H&H- increase in hematocrit may indicate hypovolemia(think bleeding), decrease-hypervolemia
Pt. is complaining of pain or discomfort in right shoulder or scapula after laparascopic cholecystectomy,what can you teach the patient to help alleviate pain?
Pain occurs due to the migration of carbon dioxide used to insufflate the abdominal cavity during the procedure. Sitting upright in a chair, ambulation or using a heating pad for 15-20 minutes hourly can help
What kind of diet would a nurse recommend for pancreatitis? 1.) In between acute attacks
2.) During acute attacks
1.)Consume a low fat, HIGH protein diet.
2.) LOW protein, low fat, high carbohydrate
**NPO may be recommended during acute exacerbations, TPN may be needed. For chronic pancreatitis, encourage high calorie snacks and taking enzyme preparations with meals to assist with absorption.
** serum glucose should be monitored every 4-6 hours by the nurse
complications of nephrotic syndrome
infection,thromboembolism, pulmonary embolism, AKI and accelerated atherosclerosis
how can gallstones cause pancreatitis?
gallstones block the common bile duct/pancreatic duct and cause a backup of pancreatic enzymes. The enzymes become activated inside the pancreas and begin to "digest" the pancreas
Signs and Symptoms of cholecystitis
What are some complications that can arise if the gallstone continues to obstruct the duct?
biliary colic(pain that occurs when a gallstone blocks the bile duct and the gallbladder is contracting and becomes distended) Distention causes the fundus (top) of the gallbladder to touch the abdominal wall and causes RUQ pain on inspiration that can radiate to the back or right shoulder- usually noticeable several hours after a large meal
fever, palpable abdominal mass, N/V, restless
*abscess, necrosis, and perforation with generalized peritonitis can occur
Before administering a blood product 2 RNS need to compare and validate which information?
After giving blood product how often are VS checked?
1.)Medical Order for transfusion of blood product
2.)Informed Consent
3) Patient identification number
4)patient name
5)Blood group and type
6)Expiration date
7)Inspection of blood product for clots, clumping, gas bubbles
*donor number if applicable
Q 5 minutes for 15 minutes, Q 15 minutes for 1 hour, Q 30 minutes until complete and for 1 hour after
What kind of diet would the nurse recommend for Diverticulitis?
NPO or clear liquid during exacerbations, then progress to low fiber,
Ongoing, eat high fiber diet. Avoid seeds, nuts, popcorn
complications of glomerular nephritis
hypertensive encephalopathy, heart failure, pulmonary edema
why do peptic ulcers occur in gastoduodenal mucosa?
this tissue cannot withstand the digestive action of gastric acid and pepsin. A damaged mucosa can not secrete enough mucous to act as a barrier against HCL
If a pt. has a drainage tube in after cholecystectomy how often should the nurse measure the bile and record the amount, color, and character of the drainage?
After several days of drainage the T-tube may be clamped (need an order for this) for ........?
24 hours
may be clamped for 1 hour before and after each meal to deliver bile to the duodenum to aid in digestion
Once blood has been received how long does the nurse have to start transfusion?
How long until transfusion must be complete?
If patient is having a reaction what should the nurse do?
30 minutes
4 hours
Stop transfusion immediately!!, run NS at an open rate, Obtain vitals, notify Dr. and blood bank and return blood and tubing to blood bank
what kind of diet would the nurse recommend for IBD?
NPO during exacerbations.
Ongoing, eat foods low in fiber, high in protein and calories. Avoid caffeine, alcohol
The most serious complication from a laparaoscopic cholecystectomy is a ..?
Because the hospital stay for this procedure is so short what should the the nurse should teach the patient about how to manage post op pain and the signs and symptoms of intra-abdominal complications.
bile duct injury
Teach to : splint the area, take shallow breaths to prevent pain (analgesics should be taken to decrease pain to avoid respiratory complications associated with shallow breaths), turn, cough and deep breathing is encouraged after pain relief provided and ambulate
pt should report loss of appetite, vomiting, pain, distention of abdomen and temperature elevation
patho of-auto digestion of the pancreas
pancreatic enzymes are normally inactive until pancreatic secretions reach the lumen of the duodenum. Activation of the enzymes can lead to vasodilation, increased vascular permeability, necrosis, erosion and hemorrhage
what is one of the major characteristics about urine in a patient with glomerulonephritis?
cola colored urine ( due to RBCs), proteinuria
the patient ask what type of medication will they be on for peptic ulcer disease
multiple antibiotics to prevent resistance, H2 receptor, PPI, antacids and mucosal protectors
what type of diet would the nurse recommend for peptic ulcer disease?
avoid oversecretion of acid. avoid extreme temperatures of food and beverages and overstimulation from the consumption of alcohol, coffee. 3 regular meals a day. Eat foods that the patient can toelrate. Also, take meds before meal or at bedtime
obstruction of bile flow interferes with absorption of the fat soluble vitamins ADEK, what complication can arise from the deficiency of vitamin K
bleeding caused by deficiency in vitamin K. The body needs vitamin k to produce prothrombin, a protein and clotting factor that is important in blood clotting and bone metabolism