acute complex conditions exam 2

GI assessment subjective data

pain, dyspepsia, intestinal gas, N,V, change in stool: color, consistency, frequency

GI assessment objective data

inspection, auscultation (1 min each quadrant), palpation, percussion

GI diagnostics

AST, ALT, Amylase, lipase, CBC-hgb,hct, stool, x-ray, ct w/wo contrast, endoscopy, colonoscopy

Pharmacotherapy for GI

H2 blockers- famotidine
PPI's-omeprazole,pantoprazole
Anti-biotics- metronidazole, clarithromycin

acute gastritis

disruption of mucosal barrier that normally protects the stomach tissue from digestive juices

acute gastritis cases

medications, alcohol, bile reflux, radiation therapy, ingestion of strong acid or alkali

acute gastritis manifestations

- Epigastric pain
- Dyspepsia
- Anorexia
- Hiccups
- N/V
-erosive gastritis-melena
-hematemesis
-hematochezia

acute gastritis med management

refrain from alcohol and food until symptoms subside NG tube suction, IV maintenance or replacement fluids, pharmacotherapy

acute gastritis nursing management

promote fluid balance, promote optimal nutrition, discourage caffeinated beverages, alcohol, cigarette smoking, pain tmt, NPO!

peptic ulcer disease

erosion of the mucus membrane (H-pylori)

risk factors of peptic ulcer disease

smoking, dietary factors, chronic use of NSAIDS, alcohol, family tendency

Peptic ulcer disease manifestations

-dull gnawing pain
-burning in mid-epigastrium
-heartburn
-vomiting

Peptic Ulcer Disease Treatment

medications, lifestyle changes, occasional surgery

Peritoneal perforation

the erosion of an ulcer through gastric serosa into peritoneal cavity

Peritoneal perforation tmt

EMERGENCY SURGERY

Peritoneal perforation manifestations:

severe abdominal pain, rigid abdomen, referred pain to shoulder, vomiting, collapse, hypotension, tachycardia

hematemesis

vomiting blood

coffee ground emesis

dark brown emesis that implies blood

coffee ground stool

big upper GI bleed

hematochezia

passage of fresh, bright red blood from the rectum

melena

Black tarry stool

occult blood

blood present in such minute quantities that it cannot be detected with the unassisted eye

Origins of acute gi bleeds

stomach and duodenal-PUD, stress related mucosal disease
Esophageal- chronic esophagitis, mallory-weiss tear, esophageal varices

acute diarrhea

Sudden onset in a previously healthy person
Lasts from 3 days to 2 weeks
Self-limiting
Resolves without sequelae

appendicitis

Dangerous infection of the appendix

intestinal obstruction

partial or complete blockage of the small or large intestine caused by a physical obstruction

parenteral nutrition

giving nutrients through a catheter inserted into a vein

crisis event phases

1. exposure to stress
2. known coping mechanisms are ineffective
3.calls on resources
4. reaching breaking point

Crisis intervention phase

phase 1 - assessment
phase 2- planning
phase 3 - implementation
phase 4 - outcome evaluation

crisis treatment essential

value of social support

Crisis potential phases

1.Perception of every event strongly influenced by personal symptoms
2. perception of degree of threat
3.personal coping style

psychological stress

effective coping=ability to manage internal and environmental stressors
result depends on stressful event perceptions, the psychological meaning applied to them and the physiologic responses associated with that meanint

Adaptation

ability to perceive reality and response manner that supports the individuals emotional and physical well-being and that of others in the social environment

Mal-adaptation

-result of ineffective coping
-has effect of tension and distress in the individuals social environment

Resources that assist effective coping

problem-solving ability
prior experience with stressors
adequate knowledge about the cause of the stressor
available support system
adequate sleep, nutrition, and physical hygiene support normal mental/physical fxn

Acute Distress Disorder

catastrophic life event
dissociative symptoms: numbing detachment, sense of unreality, feeling of watching self but not feeling emotions, inability to recall important aspects of trauma

crisis intervention

clinical actions that reduce the potential for crisis of stabilize individual/group when crisis occured
family, home visiting nurse, community
hospital ED

Elderly stress reactions

more stress with age
same stress coping behaviors as used with younger age
social support helps treat
retirement can be huge stressor

Treatment Modalities

therapeutic milieu
behavior modifications
group therapy
psychopharmacology
electroconvulsive treatment

group therapy

therapy conducted with groups rather than individuals, permitting therapeutic benefits from group interaction

impatient admissions

voluntary and involuntary
involuntary: admission and discharge are by someone other than client, psychiatrist will determine if commitment is necessary, case must be reviewed by judge, pt has a writ of habeas corpus

criteria for involuntary commitment

1.danger to self
2.danger to others
3. gravely disabled

involuntary admissions

-ed commitment: clear and present danger to self and others,limited to 3-60 days
-temporary commitment: longer period up to 6 months
-extended commitment: diagnosis of insanity, indefinite or criminal, valid for unspecified time

goal of community mental health

return client to their community as quickly as possible by being concerned about the whole person and providing preventative and supportive care

Mental health care team functions

know normal growth and development, encourage family caring, teach responsibility and effective ways to deal with stress

role of the nurse in mental health settings

assessing the whole person: includes all aspects of client functioning
Nursing process: assess,plan, implement, evaluate

Suicide risk factors

men, older adults (65 and older), white/native american, religion, marital status (decrease), family hx, Lgbtq community (higher risk), type of method chosen, recent significant loss, colder darker climate, physical health, mental health, prior attempt

suicidal ideation

thinking about suicide, usually with some serious emotional and intellectual or cognitive overtones
unwanted repetitive

suicidal plan

vision of how to kill oneself
more specific= more dangerous

Suicide Assessment

be direct
Do you have thoughts of suicide?
Do you have a plan?

Role of listening to prevent suicide

people want to be seen and heard

3 things to never do in suicide prevention

Don't criticize complain or condemn

Nursing care for suicidal client

medications, 1:1 observation (25hrs), safety of environment, evaluate impulsivity, establish psychotherapy, group and family tx

suicide effects on others

remorse, regret, risk of complicated grief

Satiation

fullness; satisfaction

cultural and society influences

eating is a social activity: holidays, special events
culture defines ideal of beauty particularly for women

eating disorder DSM5 criteria

chronic disruption of ones ability to ingest food and derive nutrition because of one or more emotional issues that lasts less than or equal to 3 months.

anorexia nervosa

an eating disorder in which an irrational fear of weight gain leads people to starve themselves

bullimia nervosa

an eating disorder involving gorging with food, followed by induced vomiting or laxative abuse

binge eating disorder

significant binge-eating episodes, followed by distress, disgust, or guilt, but without the compensatory purging, fasting, or excessive exercise that marks bulimia nervosa

Anorexia nervosa behaviors

morbid fear of obesity
refusal to eat
gross distortion of body image
excessive exercise
preoccupation w/ food

Anorexia BMI

mild: >17kg/m2
moderate: 16-16.99
severe: 15-15.99
extreme:

body image distortion

Extreme discrepancy between one's perception of one's own body image and others' perceptions of one.

anorexia assessment findings

hypothermia, bradycardia, hypotension w/orthostatic changes, peripheral edema, hair loss, lanugo, amenorrhea, metabolic disorder.

excessive exercise

more than 3 hrs
more than the intake of calories

Bulimia nervosa behaviors

-episodic uncontrolled rapid ingestion of large quantities of food
-secretive
-purging: self induced vomiting, excessive laxative use, diuretic use

bulimia physical assessment findings

can be normal weight, dehydration, tooth enamel decay, fluid and electrolyte imbalance, callouses on knuckles, battling bulimia

Binge eating disorder symptoms

rapid food consumption

eating disorder influences

biological, neurobiological, psychodynamic, family

Nursing care of eating disorder

-integrated care
-stabilize medical issues
-dental issues
-mental assessment
-dietary
-family intervention
-cognitive behavioral therapy
-psychopharmacology

substance use disorder

use of the substance interferes in normal roles and responsibilities
addiction occurs when tolerance to substance increases to reach same effect
Attempts to stop use leads to syndrome of symptoms dependent on substance of use

Alcohol

3rd most abused
legal intoxication .08
depressant
metabolized in liver

Developmental phases of alcohol abuse

phase 1: pre alcoholic phase, drinking too much but not all the time
phase 2: early alcoholic phase, drinking increase
Phase 3: crucial phase, drinking to prevent withdrawal
phase 4: chronic phase, drinking more than the average person to get a buzz alone

Alcohol abuse effects

peripheral neuropathy, alcoholic myopathy, Wernicke's encephalopathy, korsakoff psychosis, alcoholic cardiomyopathy, esophagitis, gastritis, pancreatitis, alcoholic hepatitis, liver cirrhosis, leukopenia, thrombocytopenia, sexual dysfunction.

Alcohol withdrawal

onset 4-12 hrs p cessation, life threatening, tremors (hands, tongue, eyelids),n & v, malaise or weakness, tachycardia, increased bp, sweating, anxiety, depression or irritability, HA, insomnia, hallucinations

sedative hypnotics anxiolytics

cns depressants, 15% of population; highly addictive, activity of brain, nerves, muscles and heart decreased, additive, can produce physiologic and psychologic addiction, cross tolerance/ dependence

sedative hypnotics anxiolytics health effects

interfere with REM, resp. depression, cardio, liver fxn, decrease body temp, sexual fxn.

sedative hypnotics anxiolytics withdrawal

onset and duration depend on half life of drug use
severity increase w/ high dose and prolonged use
s/s ANS hyperactivity, increased hand tremor, psychomotor agitation, anxiety, N, V, insomnia, hallucinations , grand mal seizures, delirium

Stimulants

Drugs (such as caffeine, nicotine, and the more powerful amphetamines, cocaine, and Ecstasy) that excite neural activity and speed up body functions.

Stimulants health effects

-increase restlessness
-increased blood pressure heart rate arrythmias resp infections
GI and renal anorexia
increased sexual urges

Stimulant withdrawal

fatigue, cramps, HA, nightmares, depression

Opioids

sedative and analgesic effects, tolerance, physiologic psychologic addiction, responsible for 66% of overdose deaths

Opioid health effects

decreased respirations, hypotension, dysrhythmia, increased tone, constipation, fecal impaction, decrease secual function, less than 8 breaths/ min is high alert

Opioid withdrawal symptoms

Excessive sweating, restlessness, and dilated pupils
Agitation, goose bumps, tremor, and violent yawning
Increased heart rate and blood pressure
Nausea/vomiting and abdominal cramps and pain
Muscle spasms and weight loss, Anxiety, irritability, chills and hot flashes, joint pain, lacrimation, rhinorrhea, diaphoresis, nausea, vomiting, abdominal cramps, diarrhea, confusion, agitation, insomnia, flu-like symptoms, yawning, sweating, diarrhea

Pharmacotherapy for alcoholism

antabuse (disulfiram)
benzodiazepines
ativan (lorazepam)
librium (chlordiazepoxide)
valium (diazepam)

pharmacotherapy for opiate withdrawal

methadone
buprenorphine
buprenorphine/naloxone

pharmacotherapy for barbiturate withdrawal

phenobarbital (luminal)

pharmacotherapy for stimulant withdrawal

quiet environment, antidepressants

What nursing diagnosis is present for this patient:
the patient makes statements such as:" I don't have a problem with (substance), I can quit any time I want to", delays seeking assistance, does not perceive problems related to substance use, minimizes use of substances, unable to admit impact of disease on life pattern

denial

What nursing diagnosis is present for this patient:
patient abuses chemical agents, has destructive behaviors towards self and others, fails to meet basic needs and role expectations, and practices regular risk taking behaviors

ineffective coping

What nursing diagnosis is present for this patient:
the patient has s/s of malnutrition, an altered immune system, and fails to avoid exposure to pathogens

risk for infection

What nursing diagnosis is present for this patient:
Patient has lost weight, has pale conjunctiva and mucous membranes, decreased skin turgor, electrolyte imbalance, anemia, and drinks alcohol or takes drugs instead of eating

imbalanced nutrition:less than body requirements
deficient fluid volume

What nursing diagnosis is present for this patient:
Patient criticizes self and others, practices self-destructive behavior, abuses substances as a coping mechanisms, and has family conflicts

chronic low self esteem

What nursing diagnosis is present for this patient:
patient denies that substance is harmful and continues to use substance in light of obvious consequences

deficient knowledge

What nursing diagnosis is present for this patient:
risk factors: cns agitation( tremors, elevated blood pressure, nausea, vomiting, hallucinations, illusions, tachycardia, anxiety, seizures)
This patient is withdrawing from CNS depressants

risk for suicide

What nursing diagnosis is present for this patient:
RISK FACTORS; intense feelings of lassitude and depression, "crashing", suicidal ideation
This patient is withdrawing from CNS stimulants

risk for suicide

Malignant hyperthermia

A hereditary condition of uncontrolled heat production occurs when susceptible people receive certain anesthetic drugs.

circulating nurse

a nurse who assists the scrub nurse and the surgeons during surgery, positioning the patient and equipment, obtaining additional supplies, and adjusting lighting as needed
*safety

scrub nurse

Surgical assistant who hands instruments to the surgeon. This person wears sterile clothing and maintains the sterile operative field.

OR nurse

Reports type of surgery, physicians orders, EBL, vital signs, ABC, intake & output, LOC, pain on awakening, medications, drains/equipment, complications to PACU nurse