Synthesis Exam 1

Small Intestine

completes majority of digestion and absorption, has duodenum, jejunum, and illeum

Duodenum

breaks down partially digested food with enzymes released from the pancreas and gall bladder, iron is absorbed the most here

Jejunum

smooth muscles which cause peristalsis to push through digestive tract, absorbs most of the glucose fatty acid and amino acids

Large Intestine

converts food to feces, makes chyme*, peristalsis over several hours; releases vitamin K, B’s and biotin

GERD

reflux of chyme from the stomach into the esophagus; salts, pancreatic or intestinal enzymes cause injury

Barretts esophagus

long term consequence of GERD, changes the cells and lining in the esophagus; s/s= heartburn, cough, acid reflux, upper abd pain within 1 hour of eating

Interventions for GERD

stop smoking, sit up for 1 hour after eating, stop eating 3 hours before bed

Peptic Ulcer Disease

upper gi tract issue from HCL and pepsin; causes injury to esophagus, stomach, and duodenum; caused by H. Pylori*; s/s= pain on empty stomach or soon after meal or duodenum ulcer has pain 2-3 hours after meal

Patient teaching for PUD

avoid meds that increase risk, stop smoking, mx for complications including perforation(blood emesis), obstruction(board abdomen), and a bleed(coffee ground emesis)

Medications for PUD

antacids= increase pH of gastric acids, H2 antagonists(Famotidine)= decrease gastric secretions, Mucosal Barrier Fortifiers(Sucralfate)= coats the stomach for 1 hr before and 2 hr after meal; PPI’s= activated by food and do not crush

Gastric Cancer

H pylori infection is the largest risk factor, alkaline environment allows for bacteria to multiply; s/s=dyspepsia and abd pain→ advanced s/s= occult blood in stool, decreased iron and vit B12 absorption

Gastric Cancer Management

Diagnose with EGD biopsy, tx with chemo and radiation or surgery

Dumping Syndrome

rapid emptying of food contents into small intestine, occurs within 30 minutes of eating or 90min-3 hours after food

Vit b12 deficiency

shiny smooth “beefy” looking tongue

Education for Dumping Syndrome

small frequent meals, avoid liquid with meals, eliminate caffeine and alc, B12 injections

Intestinal Obsruction

prevents flow of chyme through intestine, caused by surgery, hernia or crohns w/ previous surgery scars

Nonmechanical Obstruction

paralytic illeus, Hypokalemia causes slow movements

Colon Cancer

polyps need atleast 5 years of growth to reach clinical significance

Colon Cancer prevention

45 or older without family history should get CRC screening, family history should have scopes earlier

Peritonitis

acute inflammation and infection of visceral/parietal peritoneum and endothelial lining of abd cavity, rigid, board-like abdomen; s/s=F&E imbalance, third spacing, peristalsis slows or stops, abd pain with tenderness and distension, WBC >20000

Ulcerative Colitis

widespread chronic inflammation of rectum and rectosigmoid colon, can be is remission or exacerbation; unknown cause

UC Manifestiations

bloody diarrhea, abd pain, decreased water and sodium absorption, Toxic Megacolon

UC Medication Therapy

amino salicylates, prednisone #1 tx, immunomodulatorsC

Crohns disease

chronic inflammation of small intestine, colon or both; slow to progress and unpredictable, skipped lesions, cobblestone like apperance

Crohn’s manifestations

diarrhea, bowel not absorbing, b12 anemia, folic acid and vit d not absorbed, fistulas and skipped lesions

Crohn's meds

Methotrexate to suppress immune system, prednisone, monoclonal antibody drugs to inhibit tumor necrosis factor

Patient care w/ Crohn’s

balanced diet, bowel rest with TPN, supplement vitamins, avoid smoking and alcohol

Diverticulitis

presence of pouch-like herniations in intestines, undigested food traps and can create abscess; no fiber diet; s/s= fever, abd pain, psyllium is allowed as it is bulk forming

Diverticulosis

, bulging pockets in gi tract, increase fiber when in losis

Cholecystitis

cholesterol stone formed in the gallbladder, supersaturation of bile with cholesterol, decreased reabsorption of bile salts; if not treated can lead to rupture and perotinitis

Acute Pancreatitis

caused by excessive pancreatic enzymes that destroy ductal tissue; increase in serum lipase and amylase; s/s= jaundice and grey-blue umbilical area

Treatment for Acute Pancreatitis

NPO, NG to suction w/ TPN, side lying w/ legs to chest

Chronic pancreatitis

progressive destruction of pancreas, alcoholism is #1 risk factor, decreased pancreatic sec. and bicarb steatorrhea d/t decreased pancreatic enzymes, dark urine

Chronic Pancreatitis education

avoid etoh and nicotine, eat bland low fat and high protein diet

Pneumothorax

caused by air entering the pleural cavity, as air volume increased, lung volumes decreases

Clinical manifestations of Pneumothorax

small= mild tachycardia, and dyspnea

large= resp. distress, high respirations and low SpO2, diminished breath sounds

Tension Pneumothorax

accumulation of air in pleural space, causes mediastinal shift and reduces cardiac output

Hemothorax

bleeding in the chest cavity, massive hemothorax is >100ml

Chest Tubes

remove air or fluid from pleural space, reestablishes negative pressure

Chest Tube system

collection chamber= receives fluid and air from pleural space

water seal chamber= 2cm of water which acts as a one way valve

suction control chamber= applies suction to the chest drainage system

Tidaling

rising with inspiration and falling with expiration, should see bubbling on inspiration not continuous bubbling

Nursing management of Chest Tubes

monitor color and output, mx for drainage >200ml per hour and subcutaneous emphysema; never tip system, keep 4×4 and tape at bedside

Pneumonia

acute infection of lunch parenchyma; caused by spiration of normal flora

Community Acquired Pneumonia

occurs in patients who have not been hospitalized or resided in a long-term care facility within 14 days of onset

Hospital Acquired pneumonia

occurs 48 hours or longer after hospitalization and not present at time of admission

Ventilator associated pneumonia

occurs more than 48 hours after ET intubation

Aspiration pneumonia

results from abnormal entry of secretions into lower airway; risk factors include decreased LOC, difficulty swallowing, and insertion of NG tube

Opprotunistic Pneumonia

risk by severe calorie malnutrition, immunodeficiencies, chemo/radiation, and long term steroid use

Complications from Pneumonia

meningitis, acute respiratory failure, sepsis, empyema and lung abscess

Prevention/Nursing care of pneumonia

pneumonia vaccine, antibiotics, hydration, nutrition, sit up for meals; prevention= elevate hob, copd pt. should tripod

Tuberculosis

infection caused by mycobacterium tuberculosis, lungs most commonly affected, leading cause of death in pt. with hiv/aids; gram positive, acid fast bacilus

Isoniadization of tuberculosis

infection gets walled off in lung to prevent further infection

Latent TB

positive skin test but is asymptomatic, initial dry cough that becomes productive, causes malaise, anorexia, fatigue, weight loss, low grade fevers and night sweats

Medication for TB

two phases- 8 weeks then 18 weeks; four-drug regimen= Isoniazid, Rifampin, Pyrazinamide, and Ethambutol; monitor liver function*

Meds for latent TB

treated with isoniazid for 6-9months

Vaccine for TB

Bacille-Calmette-Guerin(BCG) , can cause a positive PPD reaction

Pulmonary Emboli

collection of particular matter that enters venous circulation and lodges in the pulmonary vessels (blood clots, fat emboli or air); large emboli in the lung that block blood flow

Risk factor for Pulmonary Embolism

birth control*, prolonged immobility, central lines, pregnancy, smoking, and history of thromboembolism

Signs and Symptoms for PE

sudden onset of dyspnea, sharp stabbing pain that does not radiate, crackles and potentially petechiae

Management of PE

high fowlers, oxygen, asses lungs and cardiac as well as monitoring PTT and INR

Thoracentesis

needles inserted into pleural space to remove fluid

Obstructive Sleep Apnea

breathing disruption that happens during sleep for at least 10 seconds and 5 times/hour; contributing factors include obesity, large vulva, short neck, smoking and enlarged tonsils

Nonsurgical OSA intervntions

position fixing devices, CPAP= positive pressure during inhalation

Asthma

chronic disease where reversible airway obstruction occurs, primarily caused from exposure to allergens or irritants, problem is in the airway d/t inflammation

Peak flow meter

adjust to personal settings, green=controlled; yellow=used prescribed med; red=reliever drugs and seek medical help

continuously in yellow may need better treatment plan

Bronchodilators

short and long acting beta 2 agonists; cholinergic antagonists; theophyllinea

Anti-inflammatory agents for Asthma

corticosteroids, leukotriene modifiers

SABA and LABA

saba=short acting rescue inhaler

laba= long acting maintenance inhaler

Severe life-threatening asthma exacerbation

silent chest, severely diminished breath sounds, absence of wheeze

Status asthmaticus

severe-life threatening acute airway obstruction, rescue meds do not work and pt. can develop pneumothorax

Chronic bronchitis

inflammation of bronchi and bronchioles caused by irritants(smoking), affects airway only and produces large amounts of thick mucuse

Emphysema

loss of lung elasticity and hyperinflation of lungs, air is trapped in alveoli and is not reversible

Nutrition for COPD pt.

meal related dyspnea, food intolerance → malnourished causing decreased gas exchange

Enteral Tube Feeds

must have functional gi tract, provides liquified foods to GI tract, bolus= resembles normal meal feeding(high fowlers 30-60 min after eating) Continuous= 24 hour feeds, semi fowlers, cyclic feeds= 8-12

Assessing residual

less than 100 is okay to resume tube feeds, do not administer if hypoactive bowel sounds

Levin tube

single lumen used to remove gastric contents or provide tube feedings

Salem sump tube

double lumen NG tube with an air vent to provide decompression and intermittent suctioning

Lavage Tube

used to remove toxic substances, provides continuous suctioning

Parameters to remove NG tube

stop feeding and suctioning, make sure there is decreased output, pinch tube shut

Colostomy

3-5 days to begin function, stool initially watery green/brown, becomes thicker over time

Ileostomy

24-48 hours to begin function, loose and watery stool, must increase fluid intake