AH1 exam 4

ulcerative colitis

• inflammatory disease of large intestine

• edema and inflammation primarily in rectum, thickened bowel mucosa can cause obstruction

• can lead to colon cancer

manifestations of ulcerative colitis

• LLQ pain and cramping

• 15-20 watery stools per day, may contain mucous, blood, or pus

• high pitched bowel sounds indicate obstruction

labs for ulcerative colitis

• H&H and albumin decreased

• WBC, ESR, C reactive protein increased

crohn’s disease

• inflammation and ulceration of GI tract (mouth to anus) often at distal ileum

• lesions are sporadic and fistulas are common

• malabsorption and malnutrition occur when jejunum and ileum involved

manifestations of crohn’s disease

• RLQ pain and cramping

• 5 loose stools a day with mucous or pus

• high pitched bowel sounds

• steatorrhea

labs for crohn’s

• H&H, electrolytes, albumin, folic acid/b12 decreased

• ESR, WBC, C reactive protein increased

• stool occult positive, urinalysis will show WBC

nursing care for crohn’s and UC

• monitor electrolyte imbalances and I&O

• diet: high protein/calorie, low fiber

• long term: NPO with TPN for bowel rest

• avoid caffeine and alcohol, iron supplements

• small frequent meals reduce exacerbations

medications for crohn’s and UC

• 5-aminosalicylic acid (anti-inflammatory)

• corticosteroids (reduce pain and inflammation)

• immunosuppressants and immunomodulators

• antidiarrheals

surgical interventions for crohn’s and UC

• UC: colectomy w/wo ileostomy

• crohn’s: laparoscopic strictureplasty and surgical repair of fissures or perforation of bowel

post-op care for crohn’s and UC

• NPO, NGT to los intermittent suction

• oral hydration introduced 1-2 days post-op

complications for crohn’s/UC: peritonitis

life threatening inflammation of the peritoneum and lining of abdominal cavity, caused by bacteria in the peritoneal cavity

peritonitis manifestations

• rigid, board like abdomen, N/V

• rebound tenderness, tachycardia, fever

• older clients: decreased mental status and confusion

complications for crohn’s/UC: abscess/fistula

occurs to destruction or the bowel wall leading to infection

manifestations of abscess/fistula

• s/s of dehydration

• fluid and electrolyte imbalances

• s/s of infection (indicates sepsis)

complications of crohn’s/UC: toxic megacolon

occurs due to inactivity of the colon, massive dilation of the colon increases risk for perforation

manifestations of toxic megacolon

• abdominal pain/distension

• N/V/D

• dehydration, fever, fatigue

cholecystitis

inflammation caused by a bacterial pathogen, reduced blood flow to the bladder, tumors of liver/pancreas

cholelithiasis

• gallstones, most are cholesterol based

• women are 2-3 times more likely to have them

risk factors for cholecystitis

the four f’s:

• fatty, female, fertile, forty/fifty

• blocked bile duct can cause cholelithiasis

• obesity, DM, family history/genetics

manifestations of cholecystitis

• mild GI symptoms, bloating

• epigastric pain after fatty meals

• pain is sudden and sharp in the RUQ (radiates to right shoulder)

labs for cholecystitis/cholelithiasis

• WBC, direct, indirect, and total serum bilirubin all elevated

• liver function test: elevated amylase and lipase with pancreatic involvement

• elevated aspartate aminotransferase and alkaline phosphatase with blockage of common bile duct

medical management for cholecystitis/cholelithiasis

pharm:

• analgesics: opioids and NSAIDs

• bile acid: helps breakdown cholesterol-based gallstones

surgical:

• extracorporeal shock wave lithotripsy

• cholecystectomy

post-op edu for cholecystitis/cholelithiasis

• open: avoid lifting for 4-6 wks, shower while drains are in place

• both: monitor for bile leakage and signs of infections

risks for GERD

• obesity, old age

• sleep apnea, NG tube

contributing factors for GERD

• excessive ingestion of foods that relax LES

• prolonged frequent abdominal distension from overeating

• increased abdominal pressure, hiatal hernia, lying flat

• gastritis from H. pylori, meds that relax LES

manifestations of GERD

• dyspepsia, pyrosis, odynophagia

• radiating pain, feeling of having heart attack

• pain that occurs after eating and lasts 20 min-2 hr

• throat irritation, dental caries, increased flatus and eructation

• chest congestion and wheezing

medical management for GERD

• PPI for 8 wks once daily (intermittent symptoms), 30 mins before breakfast

• PPI for 8 wks twice daily (moderate symptoms)

• EGD/upper endoscopy, possible surgery

peptic ulcer disease

• erosion of mucous membrane in the stomach, pylorus, duodenum, or esophagus

• main cause if H. pylori

risks for PUD

• H. pylori infection, blood type O

• excessive alcohol use, excessive secretion of stomach acid

• chronic use of NSAIDs or corticosteroids

• rare: zollinger-ellison syndrome and gastrin secreting tumor

manifestations of PUD

• dull aching pain

• burning in mid-epigastric area or back

• heartburn, vomiting, and bleeding possible

medical management of PUD

pharm:

• H2 receptor anatagonists

• PPis, antacids

• H. pylori antibiotics

surgical:

• only used for ulcers that do not heal in 12-16 wks or become life threatening

• gastrectomy, vagotomy, pyloroplasty

nursing management post op for PUD

• monitor incision for infection

• semi-fowlers position for lung expansion

• NGT: monitor output

• monitor bowel sounds

complications of PUD: hemorrhage

• monitor for bleeding and shock

• treatment includes IVF, NG, saline/water lavage

• endoscopic or surgical intervention

complications of PUD: pyloric obstruction

• N/V/C, epigastric fullness, anorexia

• NG tube to decompress the stomach

• provide IVF and electrolytes

• balloon dilation or surgery may be required

complications of PUD: perforation or penetration

• severe upper abdominal pain that may move to shoulder

• vomiting and collapse, immediate surgery

• tender/board like abdomen

• symptoms of shock or impending shock

functions of renal system

• maintain fluid volume, remove waste

• regulate BP, maintain acid-base balance

• produce erythropoietin, activate vitamin d

lab tests kidneys

BUN:

• urea is a waste product of protein that is filtered out through kidneys

• 7-18, 8-20 for over 60 yrs

Creatinine levels

• waste product of muscles that is excreted by kidneys

• 0.6-1.2

ratio:

• elevated indicates hypovolemia

• about 10:1

UTI

• bacterial invasion of urinary tract

• cystitis, urethritis, prostatitis

• most common cause E. coli

• complications include pyelonephritis and urosepsis

assessment for older adults: UTI

• confusion

• incontinence, loss of appetite

• nocturia, dysuria

• hypotension, tachycardia, tachypnea, fever

medications for UTI

antibiotics:

• treat UTI by directly killing bacteria and inhibiting bacterial reproduction

• educate client to complete prescription, take with food, monitor and report watery diarrhea

phenazopyridine:

• bladder analgesic: will not treat UTI but relieves discomfort

• medication will turn urine orange

urinary retention

• inability to void or empty bladder due to obstruction, infection, or comorbidities

• PVR <50 is good, >200 is inadequate bladder emptying

clinical presentation of urinary retention

• urgency, bladder fullness after voiding

• hematuria or foul smelling urine

• lower abdominal pain/discomfort

• may be asymptomatic or reduced urge to void

lab tests for urinary retention

• urine culture, bladder scan

• cystoscopy, BUN/Cr

renal calculi

presence of stones in urinary tract or kidney

risk factors for renal calculi

• urine flow that is decreased, concentrated, and contains particles

• urinary stasis, urinary retention, immobilization, dehydration

• decreased fluid intake or increased incidence of dehydration

manifestations of renal calculi

• severe flank pain, fever, N/V

• urinary frequency or dysuria, diaphoresis, pallor

• hematuria (smoky or rusty)

• oliguria/anuria (calculi obstruct urinary flow which is medical emergency)

extracorporeal shock wave lithotripsy (ESWL)

• uses sound, laser, or shockwave energies to break calculi into fragments

• requires moderate sedation and ECG monitoring

benign prostatic hyperplasia (BPH)

• enlargement of the prostate through which the urethra passes

• risks: obesity, >50 yrs, metabolic syndrome

manifestations of BPH

• difficulty initiating urine stream

• dysuria, nocturia

• frequency, urgency

• urine retention, weak stream

• diagnosis: digital rectal exam, PSA

medications for BPH

alpha blockers:

• dilate arteries and veins, relaxes smooth muscle in prostate and bladder neck

5-alpha reductase inhibitors

• inhibit hormones that increase prostate enlargement

transurethral resection of the prostate (TURO)

• resectoscope is guided into the tip of the penis and down through the urethra

• allows for vision of the prostate and ability to cut away excess tissue

• complication: heavy bleeding

clinical manifestation of osteoporosis

• reduced height (2-3 in, 5-7.5 cm)

• acute back pain after lifting or bending

• restriction in movement and spinal deformity

• history of fractures

• kyphosis of dorsal spine

• pain upon palpation over affected area

manifestations of osteoarthritis

OSTEO

• outgrowths on hands: nodes on finger, bone spurs

• stiffness and joint pain

• tenderness when touching the joint with bony outgrowth

• experience grating (crepitus) of the bone

• only the joint: asymmetrical/uneven

rheumatoid arthritis manifestations

seven S’s

• sunrise stiffness (severe pain) greater than 30 mins

• soft, tender, warm joint

• swelling in the joint

• symmetrical

• synovial (affected and inflamed)

• systemic (affects the joint, aches, tired, lungs, heart, anemia)

• stages (synovitis, pannus, ankylosis)