Chapter 23: Abdominal, Hematologic, Gynecologic, Genitourinary, and Renal Emergencies Flashcards
(92 cards)
1
Q
acute abdomen
A
acute abdominal pain, common condition that can be severe, can arise from cardiac, pulmonary, gastrointestinal, hematologic, genital, urinary, reproductive, or other body systems
2
Q
abdominal cavity
A
located below the diaphragm, extends to the top of the pelvis
3
Q
peritoneum
A
lines the abdominal cavity
4
Q
visceral peritoneum
A
the innermost layer, in contact with abdominal organs
5
Q
parietal peritoneum
A
the outermost layer
6
Q
intraperitoneal organs
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organs enclosed by the visceral peritoneum, such as the stomach, spleen, liver, gallbladder, pancreas, small intestine, part of the large intestine
7
Q
retroperitoneal space
A
behind the peritoneal space, some organs are here (the kidneys, ureters, pancreas, abdominal aorta)
8
Q
umbilicus
A
naval
9
Q
left upper quadrant (LUQ)
A
contains most of the stomach, spleen, pancreas, part of the large intestine, the left kidney is behind the abdominal lining
10
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right upper quadrant (RUQ)
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contains most of liver, gall bladder, part of large intestine, right kidney is behind abdominal lining
11
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right lower quadrant (RLQ)
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contains appendix, part of large intestine, female reproductive organs
12
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left lower quadrant (LLQ)
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contains parts of the large intestine and the female reproductive organs
13
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9 regions of abdominal cavity
A
from patients right to left and top to down:
- right hypochondriac, epigastric, left hypochondriac
- right lumbar, umbilical, left lumbar
- right iliac, hypogastric, left iliac
14
Q
hollow organs
A
contain some type of substance that might leak into the abdominal cavity if perforated or injured, can lead to bacterial/chemical peritonitis, do not have the same amount of blood supply as solid organs (bleed less)
15
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solid organs
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vascular (have many vessels and lots of blood), bleeds when ruptured
16
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vascular structures
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the large blood vessels found in the abdominal cavity, parts of the descending aorta and the inferior vena cava, rupture or injury can cause major bleeding
17
Q
abdominal pain mechanisms
A
1) mechanical forces (stretching)
2) inflammation
3) ischemia
18
Q
rapid distention of an organ causes…
A
…rapid onset of abdominal pain
19
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visceral pain
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occurs when an abdominal organ is involved, usually less severe, hard to localize, dull or aching or oppressive, also associated with nausea and vomiting…can still be a serious condition
20
Q
parietal pain, aka somatic pain
A
associated with irritation with parietal lining, more severe and localized, usually on one side or the other, intense, sharp, constant, patient lies with knees flexed up towards chest, breaths shallowly
21
Q
referred pain
A
visceral pain that is not felt in the organ itself but is felt elsewhere in the body, poorly localized but constant in the referred body part
22
Q
peritonitis
A
inflammation and irritation to the peritoneum, occurs when blood, pus, bacteria, or chemical substances leak into the peritoneal cavity, symptoms can vary depending on the substance
23
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common signs and symptoms of peritonitis
A
- abdominal pain or tenderness
- nausea, vomiting, or diarrhea
- fever and chills
- lack of appetite
- positive Markle test
24
Q
the Markle test
A
assesses for rebound tenderness in the abdomen (a sign of peritonitis), have patient stand on feet with knees straight, raise onto toes, and suddenly drop down onto heels
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appendicitis
inflammation of the appendix that commonly causes acute abdomen, usually caused by intestinal blockage, can lead to rupture, common in children
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common signs and symptoms of appendicitis
- abdominal pain or cramping, initially dull/diffuse but later on localizes to the iliac crest
- nausea and vomiting
- low-grade fever and chills
- lack of appetite
- abdominal guarding
- positive Markle test
27
pancreatitis
inflammation of the pancreas, can cause severe pain in the middle of the upper quadrants, can radiate to mid/lower back, can be triggered by alcohol consumption, gallstones, or infections
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common signs and symptoms of pancreatitis
- abdominal pain
- nausea and vomiting
- abdominal tenderness and distention
- mild jaundice
- severe abdominal pain with radiation from umbilicus to back and shoulders
- fever, rapid pulse, signs of shock
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cholecystitis
inflammation of the gallbladder, commonly associated with gallstones, more common in women, between the ages of 30-50
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common signs and symptoms of cholecystitis
- sudden onset of abdominal pain located from middle of the upper quadrants to the RUQ
- tenderness upon palpation of RUQ
- belching/heartburn
- nausea and vomiting (greenish contents)
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gastrointestinal bleeding
can occur anywhere in the gastrointestinal tract, from numerous causes, usually "upper" or "lower," upper: usually from peptic ulcer, gastric erosion, varices, more prevalent in adult males. lower: usually from diverticulitis, arteriovenous malformations, tumors, most common in women
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common signs and symptoms of gastrointestinal bleeding
- abdominal pain or tenderness
- hematemesis
- hematochezia
- melena
- altered mental status, weakness, syncope
- tachycardia
- signs of shock
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hematemesis
vomiting blood (bright red or looks like coffee grounds)
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hematochezia
bright red blood in stool, normally signifies rapid onset
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melena
dark tarry stools containing decomposing blood normally from upper gastrointestinal system
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esophageal varices
bulging, engorgement, or weakening of the blood vessels in the lining of the lower part of the esophagus, common to to heavy alcohol drinkers or those with liver disease
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common signs and symptoms of esophageal varices
- large amounts of bright red hematemesis
- absence of pain or tenderness in the abdomen
- rapid pulse
- breathing difficulty
- pale cool clammy skin
- other signs and symptoms of shock
- jaundice
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gastroenteritis
inflammation of the stomach and small intestines, commonly associated with presence of abdominopelvic pain, can be chronic or acute,
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common signs and symptoms of gastroenteritis
- abdominal pain or cramping
- nausea, vomiting, or diarrhea
- abdominal tenderness
- fever and dehydration
- signs and symptoms of shock/hemorrhage
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ulcers
about 4 million patients a year have ulcerative disease, open wounds or stores within the digestive tract usually in the stomach, usually from the breakdown of lining that protects the intestine from the digestive fluids, causes damage to stomach or intestine, pain depends on location and severity
41
common signs and symptoms of ulcers
- gradual onset of abdominal pain (normally in LUQ and epigastric area), usually burning or gnawing-type pain before meals or during stressful events
- nausea and vomiting
- hematemesis, hematochezia, or melena or coffee-ground emesis in some cases
- signs or symptoms of shock in cases of massive bleeding/perforation
- peritonitis with a rigid abdomen in cases of perforation
42
intestinal obstruction
a blockage that interrupts the normal flow of the intestinal contents within the intestines, either small or large intestine, can be partial or complete
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common signs and symptoms of intestinal obstruction
- abdominal pain (moderate to severe), depending on location of obstruction, crampy and colicky
- nausea and vomiting
- constipation
abdominal distention and tenderness
- abnormally prominent, high pitched bowel sounds with auscultation in early stages
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hernia
protrusion or thrusting forward of a portion of the intestine through an opening or weakness in the abdominal wall, most commonly associated with chronic pressure increases in abdominal cavity during heavy lifting/straining
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common signs and symptoms of hernia
- sudden onset of abdominal pain
- fever
- rapid pulse
- tender mass at point of hernia
- others similar to intestinal obstruction
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abdominal aortic aneurism (AAA)
weakened, ballooned, and enlarged area of the wall of the abdominal aorta, can eventually rupture and is one of the most lethal causes of abdominal pain
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common signs and symptoms of AAA
- gradual onset of lower lumbar, groin, and abdominal pain
- rupture associated with sudden onset of severe, constant abdominal pain, can radiate to lower back, flank, pelvis, can be described as "tearing" pain
- testicular pain in the male patient
- possible nausea and vomiting
- mottled or spotty abdominal skin
- pale, cool, clammy, and possible cyanotic skin in legs from decreased blood and perfusion
- absent or decreased femoral or pedal pulses
- if the abdomen is soft and thin, a pulsating abdominal mass will be felt. if the aneurism has burs, the abdomen will be rigid and tender
- if the aortic aneurysm is starting to rupture, the skin below the waistline can become cyanotic, cold, and mottled
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questions to ask pediatric patients with abdominal pain
1) has the child been more irritable than normal lately?
2) can you console the child when crying or upset?
3) has child had poor feeding habits recently?
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high priority abdominal pain signs
low blood pressure, syncope, pale cool clammy skin, pain lasting longer than 6 hours
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primary assessment for acute abdomen
typical primary assessment
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guarded position
knees drawn up, hands clenched over abdomen
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secondary assessment for acute abdomen
get OPQRST and SAMPLE. physical assessment: determine whether patient is restless or quiet, inspect abdomen, gently palpate abdomen, assess if abdomen feels soft or rigid, assess if abdomen is tender, note any masses, ask patient if there is pain in other locations, document the quadrant where the pain is located.
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involuntary guarding/rigidity
abdominal wall contraction that the patient cannot control resulting from peritoneum inflammation
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voluntary guarding
when the patient contracts the abdominal muscles usually in anticipation to pain or an unpleasant sensation
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emergency medical care for acute abdomen
1) keep airway clear
2) place patient in the position of comfort (e.g. lateral recumbet)
3) manage breathing
4) maintain oxygenation
5) never give anything by mouth
6) calm and reassure the patient
7) if signs and symptoms of hypoperfusion are present, treat for shock
8) initiate a quick and efficient transport
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anemia
a reduction of the number of red blood cells in the circulating blood volume
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sickle cell anemia
hereditary blood disorder that most often affects African Americans and black Africans, some red blood cells have abnormal hemoglobin that does not carry adequate oxygen
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sickle cell crisis
painful episodes of sickle cell disease.
- bone crisis
- acute chest syndrome
- abdominal crisis
- joint crisis
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common signs and symptoms of sickle cell crisis
- severe abdominal pain
- bone pain
- joint pain
- fever
- chest pain
- shortness of breath
- fatigue
- pale skin
- tachycardia
- jaundice
- ulcers on lower legs
- excessive thirst
- priapism
- frequent urination
- sudden blindness in 1 eye
60
hemophilia
blood disorder that affects clotting (they cannot form properly)
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thrombophilia
abnormal clotting condition, the opposite of hemophilia, blood clots inside vessels
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deep vein thrombosis
a blood clot forms in one or more of the deep veins in the body
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common signs and symptoms of DVT
- swelling and increased size of calf or entire leg
- pitting edema
- erythema (redness)
- increased warmth
- tenderness to palpation
- pain starting in calf (cramping, soreness)
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gynecology
the branch of medicine that studies the health of the female patient and her reproductive system
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menses
menstrual period
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sexual assault
an act of violence and a crime that is defined differently by each state, you are required to report cases
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effects of sexual assault
- traumatic injuries
- swelling, bleeding, pain around genital or rectal area
- STDs
- possible pregnancy
- severe anxiety, depression, fear
- inappropriate feelings of guilt
- flashbacks/nightmares
- emotional withdrawal, numbness, irritability
68
vaginal bleeding
can be caused by cancerous lesions, pelvic inflammatory disease, hormonal imbalances, spontaneous abortion, ectopic pregnancy, labor
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common signs and symptoms of spontaneous abortion (miscarriage)
- lower abdominal or pelvic pain
- abdominal tenderness
- vaginal bleeding
- rapid pulse
- signs and symptoms of shock
70
dysmenorrhea
severe pain during menstruation, caused by uterine cramps
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mittelschmerz
abdominopelvic pain in the middle of the menstrual cycle
72
ovarian cyst
fluid-filled sac that forms inside or on an ovary
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common signs and symptoms of ovarian cyst
- unilateral abdominopelvic pain that can radiate to the back
- abdominal tenderness
- vaginal bleeding
- pain during sexual intercourse or bowel movements
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endometritis
inflammation of the endometrium, most commonly caused by infection
75
common signs and symptoms of endometritis
- abdominopelvic pain or tenderness
- fever
- abdominal distention
- vaginal bleeding or discharge
- discomfort during a bowel movement
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endometriosis
a condition in which endometrial tissue grows outside the uterus
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common signs and symptoms of endometriosis
- abdominopelvic pain or tenderness that can be dull or cramping
- dysmenorrhea
- vaginal bleeding
- pain during sexual intercourse or bowel movement
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pelvic inflammatory disease (PID)
infection of the female reproductive tract
79
common signs and symptoms of PID
- abdominopelvic pain or tenderness
- vaginal discharge with an abnormal color, consistency, or odor
- fever and chills
- anorexia
- nausea/vomiting
- irregular vaginal bleeding/cramping
- pain during sexual intercourse
80
STDs
infectious diseases transmitted through sexual conduct, most common are chlamydia and gonorrhea
81
common signs and symptoms of STDs
- abdominopelvic pain or tenderness
- vaginal discharge with an abnormal odor, color, consistency
- fever and chills
- nausea/vomiting
- irregular vaginal bleeding/cramping
- pain during sexual intercourse or urination
- genital itching, redness, swelling
- leisions or ulcers
82
urology
the branch of medicine that studies the urinary system in females and the genitourinary system in males
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genitourinary system
male reproductive system and urinary system
84
urinary tract infections (UTIs)
can affect the urethra, bladder, ureters, kidneys, in men: prostate. most frequently caused by bacteria that enter via urethra
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common signs and symptoms of UTIs
- abdominopelvic pain or tenderness
- blood in urine
- urine with cloudiness or foul/strong odor
- pain or burning with urination or sexual intercourse
- frequent or urgent need to urinate
- genital or flank pain
- fever or chills
-nausea/vomiting
- altered mental status
86
hematuria
blood in urine
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renal calculi (kidney stones)
crystals of substances such as calcium, uric acid, struvite, cystine that are formed from metabolic abnormalities
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common signs and symptoms of kidney stones
- abdominopelvic pain or tenderness
- flank or back pain that is colicky and severe
- groin pain
- abnormal urine color
- pain with urination
- frequent or urgent need to urinate
- fever/chills
- nausea/vomiting
89
kidney failure/renal failure
occurs when kidneys fail to function adequately, either acute or chronic
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common signs and symptoms of kidney failure
- blood in urine/stools
- altered mental status
- edema of feet, ankles, legs
- decreased urine output or cessation of urine
- hypertension
- swelling or easy bruising
- anorexia
- tachycardia
91
dialysis
an artificial process used to remove water and waste substances from the blood when the kidneys fail to function properly, works through osmosis and filtration of fluid across a semipermeable membrane
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dialysate
special fluid used for dialysis
