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BEACON MedSurg/Peds > Test 4 Nutrition-Elimination > Flashcards

Test 4 Nutrition-Elimination Flashcards

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1
Q

Cleft Lip and Cleft Palate

A

Failure of maxillary and median nasal processes to fuse during embryonic development

Remember: psycho-social implications for these children and families

Early first trimester development.

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2
Q

Cleft lip and cleft palate assessment

A

various degrees.

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3
Q

Cleft lip concerns

A

scarring

teeth issues

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4
Q

cleft palate concerns

A

sucking - feeding

speech

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5
Q

cleft lip and palate issues

A

increased severity of scarring, teeth issues, sucking - feeding, speech.

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6
Q

Cleft lip/palate treatment

A
  • surgical repair between 3 and 6 months
  • multidisciplinary team - involving many specialists including plastic surgeons, nurses, ENT specialists, orthodontists, audiologists, and speech therapists
  • reconstruction begins in infancy and can continue through adulthood
  • homecare by the family prior to surgery.
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7
Q

Cleft lip/palate pre-op nursing care

TWO main goals

A
  1. prevention of aspiration

2. maintain nutrition

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8
Q

Cleft lip/palate

Pre-op nursing care

A
  • may breast feed if has small cleft lip
  • if bottle fed, use compressible bottle, longer nipple, larger hoe in nipple, any other special device for feeding this infant
  • feed slowly in upright position and burp frequently
  • keep bulb syringe and suction equipment at bedside
  • position on side after feeding
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9
Q

Cleft lip/palate

feeding problems

A

lack proper seal around nipple to create necessary suction

excessive air intake

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10
Q

cleft lip/palate

use of special feeding techniques

A

feeder with compressible sides

syringes with tubing

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11
Q

Cleft lip/palate

Prevent trauma to suture line

A
  • Logan’s bow to protect site (kind of brace that protects mouth/nose post-surgery)
  • do not allow to suck
  • maintain upper arm restraints
  • position supine
  • no hard objects in mouth - straws, pacifiers,spoons
  • do not take temperature orally
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12
Q

Cleft lip/palate

Reduce pain

A

mild analgesics and sedatives

parents to provide, holding, rocking, and parental voices

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13
Q

Cleft lip/palate

prevent infection

A

-cleanse suture line as ordered
rinse with water after each feeding
use cotton swab, use rolling motion vertically down suture line

  • apply anti-infective ointment as ordered
  • call doctor for any swelling or redness, bleeding, drainage, fever

Make early referrals to appropriate team members
daily weights, dietitian, speech therapy, audiologists

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14
Q

Cleft lip/palate

assess for complications

A

otitis media (cleft lip/palate increased risk)
hearing loss
speech difficulties
altered dentition

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15
Q

Esophageal atresia

A

Malformation from failure of esophagus to develop as a continuous tube.

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16
Q

Esophageal atresia

variations

A

esophagus not connected to anything
esophagus connected to trachea
trachea connected to stomach, esophagus connected to nothing
esophagus connected to trachea and stomach

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17
Q

Esophageal atresia

clinical manifestations

A
  • excessive amounts of salivation/mucus, frothy bubbles in the mouth and sometimes nose,
  • three C’s - coughing choking and syanosis when fed, overflow may be aspirated
  • food may be expelled through the nose immediately following the feeding
  • rattling respirations and frequent respiratory problems such as aspiration pneumonia
  • gastric distention, if fistula
  • history of polyhydramnios during pregnancy can suggest a high gastrointestinal obstruction.
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18
Q

Esophageal atresia

diagnosis and management

A

early diagnosis

- ultrasound
- radiopague catheter inserted in the esophagus to illuminate defect on x-ray

surgical repair
-thoracotomy and anastomosis

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19
Q

Esophageal atresia

pre-op nursing care

A
  • maintain airway
  • keep NPO administer iv fluids
  • place in warmer give humidified o2
  • elevate hob 30 degrees
  • suction PRN
  • give prophylactic antibiotics
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20
Q

Esophageal atresia

post op nursing care

A 
maintain airway
maintain thermoregulation
maintain nutrition
prevent trauma (can't see suture line)
monitor for potential complications...dehydration, internal bleeding, aspiration
monitor weight, growth and developmental achievements
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21
Q

Gastroesophageal Reflux Disease (GERD)

A

Backward flowing of gastric contents into esophagus

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22
Q

GERD causes

A

incompetence of lower esophageal sphincter
transient lower esophageal relaxation
increased intragastric pressure

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23
Q

GERD risk factors

A

obesity, pregnancy, hiatal hernia, chewing tobacco, smoking, caffeine, chocolate, drugs

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24
Q

GERD pathogenesis

A

Reflux of stomach contents

Gastric acid

esophageal mucosal injury

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25
GERD assessment: infant
- regurgitation almost immediately after each feeding when the infant is laid down - excessive crying, irritability - failure to thrive - life threatening risk/complications: - aspiration pneumonia - apnea
26
GERD assessment: child
- Heartburn - Abdominal pain - cough, recurrent pneumonia - dysphagia
27
GERD: clinical manifestations adult
``` heartburn after eating abdominal pain chestpain chronic cough asthma complications -strictures -> dysphagia -Barrett's esophagus (change in the normal cell structure of the esophagus) ```
28
GERD Diagnosis
Esophageal endoscopy | pH monitoring
29
GERD Nursing diagnosis
pain ineffective management of therapeutic regimen inadequate nutrition knowledge deficit
30
GERD Pediatric client | management and nursing care
small frequent feedings, of predigested formula or thicken the formula frequent burping positioning-keep upright for 30 minutes after feedings avoid excessive movement
31
GERD pediatric client management and nursing care
if history of apnea, brady, r/t GERD - needs continuous cardiac and apnea monitoring, arrange for CPR teaching for caregivers if infant does not respond to non-invasive therapy, then a nissen fundoplication may be done to increase competence of the cardiac sphincter.
32
GERD fundoplicatino post op nursing care
assess for pain, abdominal distention, and return of bowel sounds teach parents about gastrostomy tube feedings
33
GERD planning and implementation dietary management
limit or eliminate citrus juices, fatty and spicy foods, coffee, caffeine, alcohol, chocolate and peppermint eat smaller meals stay upright for 2 hr after meals refrain from eating for 3 hr before bedtime elevate HOB on 6-8 inch blocks weight reduction avoid restrictive clothing
34
GERD | Medications
Antacids(maalox, mylanta, gaviscon, gelusil, riopan, amphojel Histamine 2-receptor blockers (cimetidine, famotidine, rantidine, nazatidine) proton pump inhibitors (lansoprazole, omeprazole, pantoprazole, rabeprazole) prokinetic agent (metoclopramide)
35
Gastritis
inflammation of the stomach lining, results from irritation of the gastric mucosa
36
gastritis Acute
benign self-limiting related to ASA, ETOH, caffeine, or foods with bacteria stress ulcer - major stressor
37
Chronic gastritis
progressive and irreversible changes in gastric mucosa | gradually leads to atrophy of gastric tissues
38
chronic gastritis | type A
autoimmune
39
chronic gastritis | type B
chronic infection (Helicobacter pylori)
40
Gastritis assessment | acute
anorexia, n/v hematemesis malaise gi bleeding
41
gastritis assessment | chronic
may be asymptomatic anorexia, n/v belching heartburn after eating
42
Gastritis | nursing diagnosis
deficient fluid volume | imbalanced nutrition: < body requirements
43
Gastritis | planning and implementation
NPO status will help mucosa to heal then start back slowly with clear liquids, toast, bland fluids, slowly return to regular diet administer anti-emetics, antacids, H2 antagonists, antibiotics weigh daily monitor and maintain fluid and electrolyte balances, intake and output control nausea and vomiting
44
gastritis planning and implementation | medications
``` histamine 2-receptor blockers antacids PPI vitamin b12 antibiotics -biaxin, amoxicillin, flagyl, tetracylcine with bismuth(may not be appropriate if pt is on anti-coagulant therapy) or PPI ```
45
Pyloric Stenosis
Narrowing of the pyloric sphincter delayed emptying of the stomach symptoms develop 3-5 weeks after birth...NOT congential associate with infant receiving erythromycin, mother receiving erythromycin late in pregnancy, or mother taking erythromycin and baby breastfeeding.
46
pyloric stenosis | assessment
``` hypertrophied pylorus distended abdomen projectile vomiting constant hunger fussiness visible peristaltic waves ```
47
pyloric stenosis | treatment and nursing care
treatment - surgery (pyloromyotomy)
48
pyloric stenosis | postoperative care
``` STRICT I&O Feeding Position with head elevated assess surgical site to prevent infection patient teaching ```
49
Hirschprung's disease
congenital disorder of nerve cells in lower colon no innervation. occurs 5x more in males than females. usually associated with other conditions, esp Down's syndrome
50
hirschprung's disease | assessment
``` failure to pass meconium ribbon like stools vomiting reluctance to feed abdominal distention foul odor of breath ```
51
hirschprung's disease | diagnosis
history and physical barium enema (xray) rectal biopsy
52
hirschprung's disease | management
surgical intervention (series of surgeries colostomy resection
53
hirschprung's disease nursing care pre-op
cleanse bowel | patient/parent teaching
54
hirschprung's disease nursing care post-op
``` npo vital signs (rectal temperature is absolutely FORBIDDEN) gi assessment patient/parent teaching colostomy care skin care nutrition ```
55
Intussuception
most commonly seen in infants 3-12 months bowel "telescopes" within itself. don't know why happens, but usually seen after a rotovirus infection.
56
Volvulus
twisting of the bowel that leads to a bowel obstruction
57
Intussuception | assessment
``` pain vomiting stools- resemble currant jelly, bloody mucus sausage shape abdominal mass dehydration serious complications - shock and sepsis ```
58
volvulus | assessment
pain bilious vomiting abdominal distention tachycardia
59
therapeutic intervention | Intussuception
hydrostatic reduction inject barium or air to try to fix the telescoping surgery
60
therapeutic intervention | volvulus
surgery
61
nursing care | Intussuception/volvulus
following the hydrostatic reduction clear liquids and diet is advanced gradually observe for passage of barium and eventually passage of stool if reduction is not successful -> surgery
62
post op nursing care | Intussuception/volvulus
stabalize the child npo and start iv fluids ng tube to decompress the bowel pain medications provide information to the parents surgery usually completely fixes these issues.
63
Lactose Intolerance | manifestations
``` diarrhea that is frothy, but not fatty abdominal distention cramping abd pain excessive flatus ```
64
Lactose Intolerance
removal of lactose from the diet eliminate- milk, formulas that contain dairy products, ice cream, yogurt, hard cheeses breastfeeding moms- eliminate lactose from their diet. medications lactase preparations - lactaid, dairy ease, lac-dose obtain calcium from other sources
65
Celiac Disease | Clinical Manifestations
``` Failure to grow wasting of extremities large abdomen intestinal distention malnutrition complications hypocalcemia osteomalacia osteoporosis depression ```
66
Celiac Disease Treatment and Nursing Care Dietary Regulations
``` Gluten Free Diet NO Wheat Rye Barley Oats ```
67
Appendicitis | Assessment
``` Intensifying pain w/rebound tenderness RLQ or periumbilical area pain McBurney's point worse with mvt, coughing, sneezing anorexia, nausea, vomiting constipation or diarrhea rebound tenderness low-grade temperature elevated WBC ```
68
Appendicitis | Diagnosis
WBC w/differential | Abdominal Ultrasound
69
Appendicitis | pre-op
``` NPO IV Comfort measures - semifowlers or R side lying Antibiotics thermal therapy - ice, not heating pads elimination patient education **narcotic pain medications are used minimally so as not mask the signs of appendicitis. ```
70
Appendicitis | post-op nursing interventions
``` surgery - appendectomy NPO antibiotics analgesia patient teaching rupture -> drainage tube (penrose), antibiotics, NG tube, check for peritonitis ```
71
Peritonitis assessment
GI secretions and enteric bacteria enters peritoneal cavity from GI tract rupture ``` "acute abdomen" increased fever and chills, tachycardia, tachypnea abrupt onset of diffuse severe abdominal pain entire abdomen tender and board-like extreme guarding paralytic ileus distention anorexia, n/v ```
72
Irritable Bowel Syndrome (IBS)
Functional disorder of the bowel | chronic and recurrent intestinal symptoms
73
IBS | Etiology
Unclear | Anxiety and depression???
74
IBS | Pathogenesis
``` visceral hypersensitivity or "brain-gut axis" dysregulation abnormal GI motility and secretion intestinal infection overgrowth of intestinal flora food allergy or intolerance psychosocial ```
75
IBS | Clinical Manifestations
At least 2 or more than 3 months, w/onset occurring at least 6 months before recurrent abdominal pain or discomfort: abdominal pain or discomfort improved by defecation onset associated with a change in frequency of stool onset associated with a change in form (appearance) of stool
76
IBS Clinical Manifestations diagnosis
based on signs and symptoms | rule out other etiologies
77
Inflammatory Bowel Disease (IBD)
``` Term used to describe two similar but different forms of inflammation of the intestines Crohn's disease (no cure) Ulcerative Colitis (can be cured) ```
78
IBD Crohn's disease and Ulcerative Colitis Similarities
unclear etiology failure of immune regulation genetic predisposition environmental trigger
79
Crohn's Disease
Recurrent granulomatous lesions primarily involving the small and large intestines autoimmune disease exaggerated immune response against bacteria in the normal intestinal flora
80
Crohn's Disease | pathogenesis
inflammation begins in the intestinal submucosa extension to the mucosa and serosa activated neutrophils and macrophages promote inflammation and tissue injury sharply demarcated "skip" lesions
81
Crohn's Disease | Clinical manifestations
``` exacerbations and remissions **INTERMITTENT diarrhea, possible bloody abdominal tenderness weight loss malaise complications: fistulas malabsorption (anemia) ```
82
Ulcerative Colitis
chronic inflammatory disease that causes ulceration of the colonic mucosa rectum and sigmoid colon
83
Ulcerative Colitis | etiology
unknown familial tendency autoimmune activated macrophages, anticolon antibodies, and cytotoxic t-cells.
84
Ulcerative Colitis | pathogesis
inflammation of the crypts of lieberkuhn intestinal secretory glands inflammation of the crypts result in: pinpoint mucosal hemorrhages ->suppuration->crypt abscess->ulceration and necrosis
85
Ulcerative Colitis | Clinical manifestations
``` remission and exacerbation abdominal pain* diarrhea* rectal bleeding* anorexia weakness fatigue *cardinal signs ```
86
Ulcerative Colitis | diagnosis
sigmoid or colonoscopy
87
Ulcerative Colitis | complications
increased incidence of colon cancer fissures perirectal abcess
88
differences between crohn's and Ulcerative Colitis
Slide 74
89
Inflammatory bowel disease(IBD) | diagnosis
``` colonoscopy or sigmoidoscopy barium enema cbc w/ differential ESR (erythrocite sedimentation rate) electrolytes serum albumin ```
90
IBD medication | Aminosalicylates
sulfasalazine mesalamine olsalazine
91
IBD medication | corticosteroids
methylprednisolone prednisolone prednisone
92
IBD medication | immunosuppressives
azathioprine | cyclosporine
93
ibd medication | antidiarrheal agents
loperamide | diphenoxylate
94
IBD dietary management
NPO w/ TPN progressing diet bland, low fat, low residue increased calories, carbohydrates, proteins, vitamins free of milk products, caffeine, and gas-producting or raw fruits and vegetables
95
Total Parenteral Nutrition (TPN)
Given to patients intravenously (IV) when nutritionally deficient for several days in absence of normal GI functioning High dextrose concentration (>10%) Central line required of dextrose >15% contents guided by AM labs (Na+, K+, Mg+, Cl, Protein, albumin, etc) to meet specific caloric and protein needs of the client may also add vit K, insulin, heparin, pepcid, Vit C, B12, thiamine, lipids, folic acid.
96
IBD surgical management
``` Total colectomy segmental resection with reanastomosis ostomy ileostomy colostomy ```
97
Types of Ostomies
Ileostomy Cecostomy (output going to be very liquidy) ascending colostomy transverse colostomy descending colostomy sigmoid colostomy (output fairly formed...may require irrigation, can be regular elimination...don't necessarily need bag or appliance)
98
IBD | Nursing diagnosis
``` diarrhea disturbed body image imbalanced nutrition: less than body requirements fluid volume deficit electrolyte imbalance pain altered sexuality paterns ineffective individual coping knowledge deficit social isolation ```
99
IBD: Diarrhea | Therapeutic Nursing Interventions
Monitor appearance, frequency and amount of bowel movements monitor presence of blood in stools - occult and frank blood assess vital signs and weight assess skin turgor, weakness, lethargy monitor labs: cbc, lytes, albumin administer prescribed anti-inflammatory and anti-diarrheal medications
100
IBD: Diarrhea | Therapeutic Nursing Interventions
``` Maintain fluid intake provide good skin care assess perineal area for irritated skin, provide measures to protect perianal area nutritional consult post-op ostomy care ```
101
IBD: Ostomy Care
Assess the stoma - is it healthy? assess peristomal skin apply protective barriers to the peristomal skin apply ostomy pouch over stoma note characteristics of stool, record on I&O refer to enterostomal nurse therapist
102
Intestinal Obstruction
Interference with normal peristaltic movement of intestinal contents due to neurological or mechanical impairment most often occurs in small bowel may be partial or complete
103
Intestinal Obstruction | Causes
Mechanical (intussusception/volvulus/scar tissue) | or Functional
104
Intestinal Obstruction Assessment Paralytic Ileus
hypoactive or absent bowel sounds
105
Intestinal Obstruction Assessment Mechanical obstruction
very hyperactive bowel sounds at first then absent
106
Intestinal Obstruction Assessment General
Abdominal distention, cramping, mild to moderate abdominal pain, vomiting, constipation
107
Intestinal Obstruction | Diagnostic Tests
Abdominal XRays Barium Enema Colonoscopy
108
Intestinal Obstruction | Diagnostic Tests: Labs
``` WBC H/H Serum creatinine blood urea nitrogen electrolytes abg's ```
109
Intestinal obstruction | Therapeutic nursing interventions
``` restrict oral intake/NPO Decompression of GI tract - NG tube Fluid/electrolyte replacement measure abdominal girth q4 to 8 hrs assess bowel sounds q4 to 8 hrs surgical intervention ```
110
Colorectal cancer
3rd most common cancer diagnosis in the US Adenocarcinoma (glandular epithelium) of the large intestine begin as adenomatous polyps
111
Colorectal Cancer Location
Rectum Sigmoid Cecum Ascending Colon
112
Colorectal cancer Risk factors
``` age older than 50 years polyps of the colon and/or rectum family history of colon cancer inflammatory bowel disease exposure to radiation diet: high animal fat and kilocalorie intake ```
113
colorectal cancer clinical manifestations General
``` change in bowel habits rectal bleeding pain anemia weight loss ```
114
colorectal cancer clinical manifestations Cecum & ascending colon
guiac positive stools | anemia
115
colorectal cancer clinical manifestations rectum or sigmoid tumors
``` diarrhea and cramping bloody mucous stools distention anemia obstruction narrow, ribbon like stools ```
116
Colorectal cancer | metastasis
direct infiltration of the bladder lymphatic spread liver via the portal vein
117
Diverticular disease | Diverticulosis
mall outpouchings of the intestinal mucosa | most common in sigmoid colon
118
diverticular disease | diverticulitis
inflammation of one more diverticula | perforated diverticulum can progress to peritonitis
119
Diverticulosis Pathogenesis
roughage diet small hard fecal material increased pressure to propel fecal material through the colon increased intralumenal pressure herniation through weak areas where blood vessels enter
120
diverticulosis clinical manifestations
generally asymptomatic | may have : mild flatulence, diarrhea alternating with constipation
121
Diverticulitis
Inflammation of diverticula | generally undigested food or bacteria lodges in a diverticulum obstructing the opening into the bowel.
122
Diverticulitis | clinical manifestations
``` LLQ pain and tenderness n/v low-grade fever elevated WBC complications: minor bleeding, abscess formation (rupture of an abscess with perforation of the bowel wall would cause peritonitis) ```
123
Diverticular disease | diagnosis
``` CT Barium enema sigmoidoscopy/colonoscopy WBC H&H Hemoccult ```
124
diverticular disease | nursing diagnosis
impaired tissue integrity: GI Pain Anxiety Deficient knowledge
125
Diverticular disease dietary management Diverticulosis
High fiber, high residue
126
diverticular disease dietary management diverticulitis
NPO...need to rest the gut. Advance as tolerated. Low fiber, low residue until symptoms subside. Then go back on diverticulOsis diet. avoid foods with small seeds/nuts
126
Disorders of the Gallbladder | cholelithiasis
gallstones (acute or chronic)
127
Diverticular disease | Medication
``` Broad-spectrum antibiotics mild-flagyl, cipro, septra severe-mefoxin, zosyn, timentin pain medications talwin, demerol, morphine surgical intervention colon resection temporary colostomy ```
128
disorders of the gallbladder | cholangitis
Duct inflammation
129
Cholelithiasis
cholesterol, calcium salts, or mixed
130
cholelithiasis | etiology
bile composition abnormalities bile stasis inflammation
131
cholelithiasis | risk factors
pregnancy oral contraceptives obesity surgeries
132
Cholelithiasis | assessment
sudden, severe and steady RUQ pain - radiates to right scapula or shoulder occurs after high fat meal lasts up to 6 hours n/v/heatburn/flatuelnce jaundice (Check whites of eyes...possibly palms/soles) clay colored stools
133
Cholecystitis | assessment
all previous symptoms present plus Fever increased WBC abdominal guarding
134
Cholelithiasis/Cholecystitis
Abdominal x-rays ultrasonography nuclear med scan
135
Surgical Management
laparoscopic cholecystectomy Open cholecystectomy ERCP with endoscopic sphincterotomy (remove gallstones, enlarge sphincter).
136
Cholelithiasis/Cholecystitis | Nursing Diagnosis
Pain Imbalanced nutrition-less than body requirements Risk for Infection
137
Cholelithiasis/Cholecystitis | Goal: Control Pain
Discuss relationship between fat intake and pain. Teach about low fat diet. Withhold oral food and fluids during episodes of acute pain. Insert NG tube and connect to low suction. Administer demerol, morphine, ketorolac (toradol) or other analgesic. Place in fowler's position.
138
Cholelithiasis/Cholecystitis | Goal: Maintain adequate nutrition
Assess nutritional status Evaluate laboratory results, including serum bilirubin, albumin, glucose, and cholesterol levels. Refer to a dietician for diet counseling to promote healthy weight loss and reduce pain episodes. Administer vitamin supplements as ordered.
139
Cholelithiasis/cholecystitis
monitor vital signs q4 assess abdomen q4 assist with c/db or use IS q1-2 hrs. splint abdominal incision during coughing. Place in fowler's position and encourage ambulation as allowed. administer antibiotics as ordered maintain T-tube placement. report drainage >1000mL.
140
Hepatitis
Inflammation of the liver
141
Hepatitis | Etiologies
drugs toxins microorganisms autoimmune
142
Prodromal or preicterus manifestations
``` RUQ pain -malaise, fatigability, low grade fever, athralgia, n/v Anorexia and/or weight loss Fatique Elevated AST&ALT ``` **Infection highly transmissible during this phase.
143
Liver Enzymes
``` Aspartate aminotranserase (AST) Alanine asinotransferase (ALT) Alkaline Phosphatase(ALP) ```
144
``` Aspartate aminotransferase (AST) Normal Levels ```
5-35 units/mL
145
``` Alanine aminotransferase (ALT) Normal Levels ```
5-35 units/mL
146
``` Alkaline phosphatase (ALP) Normal Levels ```
30-120 IU/L
147
Icteric Phase
2nd phase. longer period of time. begins with onset of Jaundice. Jaundice (except HCV) concurrent with a rise in serum bilirubin Hepatic symptoms (dark urine, hepatosplenomegaly, severe pruritus, possibly tender lymphadenophathy) Elevated direct and indirect bilirubin Normal to moderately increased ALP (liver enzyme)
148
Serum Bilirubin | Conjugated Normal levels
direct bilirubin 0.1-0.3 mg/dl
149
Serum Bilirubin | Unconjugated normal levels
Indirect bilirubin | 0.2-0.7 mg/dl
150
Serum Bilirubin | Direct + Indirect = Total normal levels
Total Bilirubin | 0.3-1.0mg/dl
151
Convalescent or recovery
Increase sense of well-being Return of appetite Resolution of jaundice Clinical Recovery: 9 weeks HEP-A. 16 weeks uncomplicated HEP-B
152
Hepatitis Diagnosis
Hepatitis antigens/antibodies present increased alt, alp, ast increased bilirubin liver biopsy
153
Hepatitis Nursing diagnosis
Risk for infection (transmission) fatigue imbalanced nutrition: less than body requirements
154
Hepatitis therapeutic nursing interventions
``` Risk for infection (transmission) use universal precautions contact isolation (HAV, HEV) plan room assignments private bathroom hep A/ hep B vaccines ```
155
Hepatitis | client and family teaching
do not share bathroom unless strict personal hygiene maintaine no sharing of: bed linens, washcloths, towels, drinking and eating utensils, razors, nail clippers, toothbrushes, needles, body piercings. avoid sexual activity/safe sex avoid ETOH, OTC drugs, esp eacetaminophen/sedatives do not donate blood, organs, tissue small, frequent meals - Increase CHO, decrease fat, nutritional supplements.
156
Cirrhosis
Replacement of normal cells with fibrous tissue (scar tissue)
157
Cirrhosis | Macronodular
Hepatitis
158
Cirrhosis | Micronodular
alcoholism
159
Liver Dysfunction
Hepatocellular dysfunction portal hypertension ascites hepatic encephalopathy
160
Hepatocellular dysfunction
failure to inactive ADH and aldosterone retention of sodium and water....loss of K+ decreased synthesis of proteins (hypoalbuminemia) decreased production of urea from NH3 (increased serum ammonia NH3) decreased detoxification of potentially harmful substances (drug interactions and toxicities)
161
Cirrhosis | Assessment
``` Anorexia and weight loss dyspepsia n/v change in bowel habits/flatulence dull abdominal pain fatigue jaundice petechiae or ecchymosis peripheral edema ascites dilated abdominal veins hepatomegaly ```
162
Ascites
``` Accumulation of fluid in the peritoneal space increased hydrostatic pressure sodium and water retention decreased colloid osmotic pressure increased abdominal girth Fluid wave seen tenderness SOB ```
163
Cirrhosis | Diagnosis
``` liver biopsy - definitive diagnosis liver function - ast, alt, ldh elevated bilirubin (total, indirect) elevated protein, albumin - decreased PT/PTT (intrinsic measure) - elevated platelets - decreased CBC, H/H, WBS's (anemia and leukopenia) Serum ammonia - elevated creatinine- renal failure often develops ```
164
Cirrhosis - excess fluid volume | therapeutic nursing interventions
diet: decrease Na+, decrease protein, increase CHO, decrease fat fluid restriction with presence of ascites weigh daily - same time, same type clothes measure abdominal girth - to assess ascites diuretics - remove excess fluid
165
Cirrhosis - ineffective protection | therapeutic nursing interventions
Institute bleeding precautions - spontaneous bleeding an issue monitor signs of bleeding (vs, gums, nasal membranes, conjunctiva, stool for occult blood, emesis, neuro changes, abdomen. LABS: CBC platelets, PT/PTT avoid invasive procedures/devices apply pressure to puncture sites for 10 minutes blood transfusions and vit K beta-blockers - decrease portal hypertension lactulose/neomycin - decrease ammonia
166
Cholelithiasis
(gallstones) | Acute or chronic
167
Cholangitis
duct inflammation
168
``` Cholesterol, calcium salts, or mixed Etiology: -Bile composition abnormalities -Bile stasis -Inflammation Risk factors: Pregnancy, Oral Contraceptives Obesity surgeries ```
cholelithiasis
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``` Sudden, severe & steady RUQ pain – radiates to right scapula or shoulder Occurs after high fat meal Lasts up to 6 hours Nausea/vomiting/heartburn/flatulence Jaundice Clay colored stools ```
cholelithiasis assessment
170
inflammation and scar tissue destroy common bile ducts
cholangitis
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stones in the common bile duct itself
choledocholithiasis
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*key symptoms differentiating cholelithiasis from? Fever ↑ WBC Abdominal guarding
cholecystitis
173
Cholelithiasis / Cholecystitis patient teaching and management
- Discuss relationship between fat intake and pain. Teach about low fat diet. - Withhold oral food and fluids during episodes of acute pain. Insert NG tube and connect to low suction. - Administer Demerol, morphine, ketorolac (Toradol) or other analgesic. - Place in Fowler’s position.
174
risk factors associated with cholelithiasis/cholecystitis
- female, fat, fourties, still fertile | - seeing a blurring of that, and starting to see gallbladder problems in kids
175
labs to monitor in cholelithiasis/cholecystitis
serum bilirubin, albumin, glucose, and cholesterol levels
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T-tube
- report drainage greater than 1,000 - sits in common bile duct to keep it open post op and drain off excess bile - often pts go home with it in place for up to 6 weeks
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- inflammation of the liver | - etiologies: drugs, toxins, microorganisms, autoimmune
hepatitis
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- RUQ pain: malaise, fatigability, low grade fever, arthralgia, N/V - Anorexia and/or weight loss - Fatigue - Elevated AST & ALT * *Infection highly transmissible during this phase
-prodromal or preicterus manifestations
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``` Aspartate aminotransferase (AST) *normal values ```
Normal 5-35 units/ml
180
``` Alanine aminotransferase (ALT) *normal values ```
Normal 5-35 units/ml
181
``` Alkaline phosphatase (ALP) *normal values ```
Normal 30-120 IU/L
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-Jaundice (except HCV) concurrent with a rise in serum bilirubin -Hepatic symptoms: Dark urine, Hepatosplenomegaly, Severe pruritus Possibly tender lymphadenopathy -Elevated direct & indirect bilirubin -Normal to moderately elevated ALP (liver enzyme)
icteric phase
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Direct bilirubin: conjugated | *normal values
0.1-0.3 mg/dl
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Indirect bilirubin: unconjugated | *normal values
0.2-0.7 mg/dl
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Total bilirubin: Direct + Indirect = Total
0.3-1.0 mg/dl
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clinical recovery of Hep-A, Hep-B
Clinical Recovery: 9 weeks HEP-A 16 weeks uncomplicated HEP-B
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risk for infection nursing interventions for hepatitis
- Use universal precautions - Contact isolation (HAV, HEV) - Plan room assignments - Private bathroom - Hepatitis A / Hepatitis B vaccines
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- Do not share bathroom unless strict personal hygiene maintained - No sharing of: bed linens, washcloths, towels, drinking & eating utensils, razors, nail clippers, toothbrushes, needles, body piercings - Avoid sexual activity / Safe sex - Avoid ETOH, & OTC, esp acetaminophen, sedatives - Do not donate blood, organs, tissue - Small, frequent meals - ↑ CHO, ↓ fat, nutritional supplements * family teaching for?
hepatitis
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Replacement of normal cells with fibrous tissue
cirrhosis
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Macronodular Cirrhosis
Hepatitis
191
Micronodular CIrrhosis
alcoholism
192
Liver dysfunction causes
- Hepatocellular dysfunction - Portal hypertension - Ascites - Hepatic encephalopathy
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- Failure to inactivate ADH & Aldosterone - Retention of sodium & water - Loss of K+ - ↓ synthesis of proteins: hypoalbuminemia - ↓ production of urea from NH3: ↑ serum ammonia (NH3) - ↓ detoxification of potentially harmful substances: Drug interactions and toxicities
Hepatocellular dysfunction
194
- Anorexia & weight loss - Dyspepsia - Nausea/vomiting - Change in bowel habits / flatulence - Dull abdominal pain - Fatigue - Jaundice - Petechiae or ecchymosis - Peripheral edema - Ascites - Dilated abdominal veins - Hepatomegaly
Cirrhosis assessment
195
Accumulation of fluid in the peritoneal space: increased hydrostatic pressure, ↓colloid osmotic pressure, Sodium & water retention, increased abdominal girth, + fluid wave, tenderness, SOB
Ascites
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- Liver biopsy – definitive diagnosis - Liver function – AST, ALT, LDH elevated - Bilirubin (total, indirect) elevated - Protein, Albumin- decreased - PT/PTT (intrinsic measure)- elevated - Platelets- decreased - CBC, H/H, WBC’s (anemia & leukopenia) - Serum Ammonia- elevated - Creatinine- renal failure often develops
Cirrhosis diagnostics
197
Cirrhosis excess fluid volume nursing interventions
- Diet: ↓ Na+, ↓ protein, ↑ CHO, ↓ fat - Fluid restriction with presence of ascites - Weigh daily – same time, same type clothes - Measure abdominal girth – to assess ascites - Diuretics – remove excess fluid
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Why would you see a cirrhosis patient on Beta-Blockers | Lactulose / Neomycin
Beta blockers: decrease portal hypertension | Lactulose / Neomycin: decrease ammonia

BEACON MedSurg/Peds (21 decks)

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