Nursing of Adult Patients with Medical - PowerPoint PPT Presentation

Loading...

PPT – Nursing of Adult Patients with Medical PowerPoint presentation | free to download - id: 429ecd-NWQ5M



Loading


The Adobe Flash plugin is needed to view this content

Get the plugin now

View by Category
About This Presentation
Title:

Nursing of Adult Patients with Medical

Description:

Nursing of Adult Patients with Medical & Surgical Conditions Gastrointestinal Accessory Organ Disorders Diagnostic Studies Serum Bilirubin Test Normal Values Direct ... – PowerPoint PPT presentation

Number of Views:263
Avg rating:3.0/5.0
Slides: 69
Provided by: RICKH68
Learn more at: http://staff.rmcc.edu
Category:

less

Write a Comment
User Comments (0)
Transcript and Presenter's Notes

Title: Nursing of Adult Patients with Medical


1
Nursing of Adult Patients with Medical Surgical
Conditions
  • Gastrointestinal
  • Accessory Organ
  • Disorders

2
Diagnostic Studies
  • Serum Bilirubin Test
  • Normal Values
  • Direct bilirubin 0.1 to 0.3 mg/dl
  • Indirect bilirubin 0.2 to 0.8 mg/dl
  • Total bilirubin 0.1 to 1.0 mg/dl
  • Total bilirubin


    in newborns 1 to 12 mg/dl
  • Rationale
  • Used to diagnose liver disease, biliary
    obstruction, erythroblastosis fetalis, and
    hemolytic anemia
  • Nursing Interventions
  • NPO

3
Diagnostic Studies
  • Liver Enzyme Tests
  • Normal Values
  • AST (SGOT) 5-40 IU/L
  • elevated with MI, hepatitis, cirrhosis, hepatic
    necrosis, hepatic tumor, acute pancreatitis,
    acute renal failure, and acute hemolytic anemia
  • ALT (SGPT) 5-35 IU/L
  • elevated with hepatitis, cirrhosis, hepatic
    necrosis, hepatic tumors, and hepatotoxic drugs.
  • LDH 45-90 U/L
  • elevated with MI, pulmonary infarction, hepatic
    disease, pacreatitis, hemolytic anemia, and
    skeletal muscle disease.

4
Diagnostic Studies
  • Alkaline Phosphatase 30-85 ImU/L
  • elevated in obstructive disorders of the biliary
    tract, hepatic tumors, cirrhosis, primary and
    metastatic tumors, hyperparathyroidism,
    metastatic tumor in bones and healing fractures
  • Gamma GT 4-38 U/L
  • elevated with hepatitis, cirrhosis, hepatic
    tumors, hepatotoxic drugs, MI (4-10 days after),
    CHF, and alcohol ingestion
  • Rationale
  • Liver is storehouse for many enzymes
  • Injury or diseases affecting the liver will cause
    release of these enzymes into the bloodstream

5
Diagnostic Studies
  • Serum Protein Test
  • Normal Values
  • Total Protein 6-8 g/dl
  • Albumin 3.2-4.5 g/dl
  • Globulin 2.3 to 3.4 g/dl
  • Albumin globulin (A/G ratio) 1.2 to 2.2 g/dl
  • Rationale
  • The liver metabolizes protein, esp. albumin. If
    the liver is diseased it loses the ability to
    metabolize the albumin and the serum albumin
    level is decreased

6
Diagnostic Studies
  • Oral Cholecystography (Gallbladder Series)
  • Rationale
  • Provides x-ray visualization of the gallbladder
    after ingestion of a radiopaque dye.
  • The following factors are necessary for adequate
    dye concentration
  • Ingestion fo correct number of dye tablets
  • Adequate absorption of the dye from the GI tract
    no vomiting or diarrhea
  • Abstinence from food the morning of the test
  • Patency of the cystic duct
  • Concentration of the cye within the gallbladder

7
Diagnostic Studies
  • Nursing Interventions
  • Assess for allergies to iodine
  • Administer 6 Telepaque tablets orally, after the
    evening meal
  • NPO after midnight

8
Diagnostic Studies
  • Intravenous Cholangiography (IV Cholangiogram)
  • Rationale
  • Radiographic dye is administered IV
  • Allows visualization of the hepatic and common
    bile ducts and also the gallbladder if the cystic
    duct is patent
  • Used to visualize stones, strictures, or tumors
    of the hepatic duct, common bile duct, and
    gallbladder.

9
Diagnostic Studies
  • Operative Cholangiography
  • Rationale
  • Common bile duct is injected directly with
    radiopaque dye.
  • Visualization of stones or other obstructions
    during surgery to prevent unneccessary common
    bile duct exploration

10
Diagnostic Studies
  • T-Tube Cholangiogram
  • Rationale
  • Demonstrates good flow of contrast into the
    duodenum
  • Diagnose retained ductal stones and/or leaks in
    ducts
  • Nursing Interventions
  • T-tube to closed drainage system
  • Cover site with sterile dressing, if t-tube
    removed
  • Assess for allergies to iodine
  • NPO after midnight

11
Diagnostic Studies
  • Ultrasound of the Liver, Gallbladder, and Biliary
    System
  • Rationale
  • Visualization of deep structures by recording the
    reflections of ultrasonic waves directed in to
    the tissue
  • Nursing Interventions
  • NPO after midnight
  • Should be done before barium studies or after all
    barium has been expelled

12
Diagnostic Studies
  • Gallbladder Scanning
  • Rationale
  • Injection of technetium 99 is given and scan is
    done to visualize the gallbladder and biliary
    tract
  • Used to diagnose acute cholecystitis
  • Nursing Interventions
  • NPO after midnight

13
Diagnostic Studies
  • Liver Biopsy
  • Rationale
  • Needle is inserted through the abdominal wall
    into the liver to remove a piece of liver tissue
  • Used to diagnose cirrhosis, hepatitis,
    drug-related reactions, granuloma, and tumors
  • Nursing Interventions
  • Informed consent
  • NPO for 4-8 hours
  • Assess lab results for normal platelet count and
    prothrombin time

14
Diagnostic Studies
  • After biopsy
  • Assess for s/s of bleeding
  • Vital signs every 15 min x 1hr, every 30 min x 4
    hrs, then every 4 hrs
  • Assess for s/s of pneumothorax
  • Bed rest for 24 hrs

15
Diagnostic Studies
  • Liver Scanning
  • Rationale
  • Radionuclide is given IV
  • Geiger counter is used to record the distribution
    of radioactive particles in the liver
  • Nursing Interventions
  • NPO after midnight

16
Diagnostic Studies
  • Blood Ammonia
  • Normal Value
  • 15 to 110 micrograms/dl
  • Rationale
  • Ammonia is normally converted into urea and then
    excreted by the kidneys
  • Liver dysfunction or altered blood flow to the
    liver causes blood ammonia levels to rise and BUN
    (blood urea nitrogen) to decrease
  • Nursing Interventions
  • Notify lab if patient is currently taking
    Neomycin can cause decreased ammonia levels

17
Diagnostic Studies
  • Hepatitis Virus Studies
  • Rationale
  • Diagnose specific virus causing hepatitis
  • A, B, C, D, and E

18
Diagnostic Studies
  • Serum Amylase Test
  • Normal Value
  • 25 to 125 U/L
  • Rationale
  • Damage to pancreas cells or obstruction to the
    pancreatic ductal flow will cause an outporing of
    this enzyme and absorption into the bloodstream
  • Levels will rise within 12 hours of onset of
    pancreatic disease.
  • Rapidly cleared by the kidneys levels may return
    to normal within 48-72 hrs
  • Nursing Interventions
  • Note administration of any IV dextrose can cause
    a false-negative result

19
Diagnostic Studies
  • Urine Amylase Test
  • Normal Value
  • 3-35 IU/hr
  • Rationale
  • Disorders affecting the pancreas will cause
    elevated amylase levels in the urine because the
    kidneys rapidly clear amylase
  • Levels remain elevated in the urine for 7-10 days
  • Used to diagnose pancreatitis in patients who
    have had symptoms for 3 days or longer

20
Diagnostic Studies
  • Nursing Interventions
  • Urine collection may be 2 hr spot urine, 6 hr, 12
    hr, or 24 hr collection.
  • Record exact time collection is begun
  • Discard first urine specimen
  • Collect all subsequent urine, including the last
    urine voided exactly 2, 6, 12, or 24 hrs after
    collection began
  • Urine should be kept on ice during collection
    period

21
Diagnostic Studies
  • Ultrasound of Pancreas
  • Rationale
  • Provides diagnostic information with the use of
    ultrasonography of the pancreas
  • Used to diagnose carcinoma, pseudocyst,
    pancreatitis, and pancreatic abcess
  • Nursing Interventions
  • NPO for 8 hours before test
  • Gas or barium will interfere with sound wave
    transmission

22
Diagnostic Studies
  • Computerized Tomography of the Abdomen
  • Rationale
  • Cross-sectional image
  • Used to diagnose inflammation, tumors, cysts,
    ascites, aneurysm, and cirrhosis of the liver
  • Nursing Interventions
  • NPO after midnight
  • Some patients may experience claustrophobia

23
Diagnostic Studies
  • Endoscopic Retrograde Cholangiopancreatography of
    the Pancreatic Duct (ERCP)
  • Rationale
  • A fiberoptic duodenoscope is inserted through the
    oral pharynx, through the esophagus and stomach,
    and into the duodenum. Dye is injected for
    radiographic visualization of the CBD and
    pancreatic duct.
  • Used to diagnose obstructive jaundice, remove
    common bile duct stones, and place biliary and
    pancreatic duct stents to bypass obstructions

24
Diagnostic Studies
  • Nursing Interventions
  • NPO for 8 hours before test
  • Informed consent
  • Must remain still for 1-2 hours
  • After procedure
  • NPO until gag reflex returns
  • Assess for abdominal pain, tenderness and
    guarding
  • Assess for s/s of pancreatitis
  • abd. pain, nausea, vomiting, and diminished or
    absent bowel sounds

25
Cirrhosis
  • Etiology/Pathophysiology
  • Chronic, degenerative disease of the liver
  • Scar tissue restricts the flow of blood to the
    liver
  • Types of cirrhosis
  • Laennecs cirrhosis
  • history of chronic ingestion of alcohol
  • Postnecrotic cirrhosis
  • viral hepatitis, exposure to hepatotoxins, or
    infection
  • Primary biliary cirrhosis
  • destruction of the bile ducts
  • Secondary biliary cirrhosis
  • chronic biliary tree obstruction (gallstones,
    tumor, etc.)

26
(No Transcript)
27
Cirrhosis
  • Alteration of liver function
  • Reduced ability to metabolize albumin
  • Obstruction of portal vein
  • Increased pressure in the veins that drain the GI
    tract

28
  • Complications
  • Portal Hypertension
  • increased venous pressure in the portal
    circulation caused by compression or occlusion in
    the portal or hepatic vascular system

29
  • Ascites
  • accumulation of fluid and albumin in the
    peritoneal cavity

30
  • Esophageal Varicosities
  • veins in the upper part of the body distend,
    including the esophageal veins due to portal
    hypertension. They may rupture causing severe
    hemorrhage

31
Cirrhosis
  • Hepatic Encephalopathy
  • Brain damage due to elevated ammonia levels
  • Inaapropriate behavior, disorientation, flapping
    hand tremors, twitching of the extremities,
    stupor, and coma

32
Cirrhosis
  • Signs Symptoms
  • Early stages
  • Abdominal pain
  • Liver is firm and easy to palpate
  • Late stages
  • dyspepsia
  • changes in bowel habits
  • constipation or diarrhea
  • Nausea and vomiting
  • gradual weight loss

33
Cirrhosis
  • ascites
  • enlarged spleen
  • spider angiomas
  • anemia
  • bleeding tendencies
  • cannot absorb vitamin K, or produce clotting
    factors
  • epistaxis
  • purpura
  • hematuria
  • bleeding gums

34
Cirrhosis
  • jaundice
  • yellow discoloration of the skin, mucous
    membranes and sclerae or the eyes
  • caused by abnormal amounts of bilirubin in the
    blood
  • mental disorientation

35
Cirrhosis
  • Treatment
  • Eliminate the cause
  • alcohol, hepatotoxins, environmental exposure to
    harmful chemicals
  • Diet
  • Well balanced
  • High-calorie (2500 to 3000 cal/day)
  • Moderate protein (75 g/day)
  • Low fat
  • Low sodium (1000 to 2000 mg/day)
  • Supplemental vitamins and folic acid

36
Cirrhosis
  • Antiemetics
  • Benadryl Dramamine
  • Contraindicated Vistaril, Compazine, and Atarax
  • Treatment of Complications
  • Ascites
  • Bedrest
  • Strict IO
  • Restrict fluids to 500 -1000 cc/day
  • Restrict sodium to 1000-2000 mg/day
  • Diuretics Aldactone, Lasix, HCTZ
  • Vitamin Supplements Vitamin K, Vitamin C and
    folic acid
  • LeVeen Peritoneal-Jugular Shunt
  • Paracentesis

37
LeVeen Peritoneal Jugular Shunt
Paracentesis
38
Cirrhosis
  • Ruptured Esophageal Varices
  • Maintain airway
  • Establish IV
  • Vasopressin drip to control bleeding
  • IV or directly into the superior vena cava
  • Sengstaken-Blakemore tube
  • Endoscopic sclerotherapy
  • Portacaval shunt
  • divert blood from the portal vein to the inferior
    vena cava
  • Blood transfusion

39
Sengstaken-Blakemore Tube
40
Cirrhosis
  • Hepatic Encephalopathy
  • Decrease protein in diet
  • Avoid drugs which are detoxified by the liver
  • Lactulose
  • Oral or retention enema
  • decreases the pH of the bowel which decreases the
    production of ammonia
  • Neomycin
  • inhibits protein synthesis in bacteria, therefore
    decreasing the production of ammonia

41
Hepatitis
  • Etiology/Pathophysiology
  • Inflammation of the liver resulting from several
    types of viral agents or exposure to toxic
    substances
  • Hepatitis A
  • Most common
  • Incubation 10-40 days
  • Oral-fecal trasmission

42
Hepatitis
  • Hepatitis B
  • Incubation 28-160 days
  • Transmission by contaminated serum blood
    transfusion, contaminated needles, dialysis, or
    direct contact with infected body fluids
  • Hepatitis C
  • Incubation 2 weeks to 6 months (usually 6-9
    weeks)
  • Transmitted through contaminated needles and
    blood transfusions
  • Hepatitis D
  • Coinfection with hepatitis B
  • Incubation 2-10 weeks

43
Hepatitis
  • Hepatitis E
  • Fecal contamination of water
  • Rare in the U.S. usually in developing countries
  • Incubation 15-64 days

44
Hepatitis
  • Signs Symptoms
  • General malaise
  • Aching muscles
  • Photophobia
  • Headaches
  • Chills
  • Abdominal pain
  • Dyspepsia
  • Nausea

45
Hepatitis
  • Diarrhea
  • Constipation
  • Pruritus
  • Hepatomegaly
  • Enlarged lymph nodes
  • Weight loss
  • Jaundice
  • Dark amber urine
  • Clay colored stools

46
Hepatitis
  • Treatment
  • Treat signs and symptoms
  • Small frequent meals
  • low-fat, high carbohydrate
  • IV fluids for dehydration
  • Vitamin C for healing
  • Vitamin B-complex for absorption of fat soluble
    vitamins
  • Vitamin K for coagulation
  • Avoid unnecessary medications, esp seditives

47
Hepatitis
  • Gamma globulin or immune serum globulin
  • should be given to anyone exposed to Hepatitis A
  • may be given 2 weeks before and 1 week after
    onset of symptoms
  • Hepatitis B imune globulin (HBIG)
  • should be given to anyone exposed to Hepatitis B
  • Hepatitis B Vaccine
  • should be given to persons identified as high
    risk for developing Hepatitis B
  • healthcare personnel
  • high-risk lifestyle (drug users, homosexual men,
    prostitutes)
  • infants born to mothers who are Hepatitis B
    positive

48
Liver Abscesses
  • Etiology/Pathophysiology
  • May be single of multiple
  • Abscess forms in the liver due to an invading
    bacteria

49
Liver Abscesses
  • Signs Symptoms
  • Fever
  • Chills
  • Abdominal pain and tenderness in the RUQ
  • Hepatomegaly
  • Jaundice
  • Anemia

50
Liver Abscesses
  • Treatment
  • IV antibiotics
  • Percutaneous drainage of liver abscess
  • Open surgical drainage

51
Cholecystitis Cholelithiasis
  • Etiology/Pathophysiology
  • An obstruction, gallstone, or tumor prevents bile
    from leaving the gallbladder and the trapped bile
    acts as an irritant causing inflammation.
  • Risk factors
  • Female
  • Native American or white
  • Obesity
  • Pregnancy
  • Diabetes
  • Multiparous women
  • Use of birth control

52
Cholelithiasis
53
Cholelithiasis
54
Cholecystitis Cholelithiasis
  • Signs Symptoms
  • Indigestion after eating foods high in fat
  • Severe, colicky pain in the right upper quadrant
  • may radiate around the midtorso to the right
    scapular area
  • Anorexia
  • Nausea vomiting
  • Flatulence
  • Increased heart respiratory rates
  • Diaphoresis

55
Cholecystitis Cholelithiasis
  • Low grade fever
  • Elevated WBC
  • Mild jaundice
  • Steatorrhea (fatty stool)
  • Dark amber urine

56
Cholecystitis Cholelithiasis
  • Treatment
  • Mild attacks
  • Bedrest
  • NG tube to suction
  • NPO
  • IV fluids
  • Antispasmodic/Analgesic
  • Demerol decreases incidence of spasms of the
    sphincter of Oddi
  • Antibiotics
  • Avoid spicy foods when allowed PO intake

57
Cholecystitis Cholelithiasis
  • Lithtripsy
  • A machine discharges a series of shock waves
    through water or a cushion that breaks the stone
    into fragments
  • Cholecystectomy (Removal of the gallbladder)
  • Laparoscopic
  • Oral liquids post-op
  • Outpatient or discharged next day
  • Resume moderate activity in 48-72 hrs
  • Open
  • Jackson-Pratt drain
  • T-tube
  • NG tube
  • Routine post-op care

58
T-Tube
59
Pancreatitis
  • Etiology/Pathophysiology
  • Inflammation of the pancreas
  • Acute or Chronic
  • Predisposing Factors
  • Alcohol
  • Trauma
  • Infectious disease
  • Certain drugs
  • Obstruction of the pancreatic duct may cause a
    rupture and enzymes digest the pancreas

60
Pancreatitis
61
Pancreatitis
  • Signs Symptoms
  • Abdominal pain
  • Anorexia
  • Nausea vomiting
  • Malaise
  • Restlessness
  • Low-grade fever
  • Jaundice
  • Weight loss
  • Steatorrhea
  • Tachycardia

62
Pancreatitis
  • Treatment
  • NPO
  • IV fluids
  • NG tube
  • Antiemetics
  • Demerol 75 -100 mg q 3-4 hrs
  • Avoid morphine causes spasms of the sphincter of
    Oddi
  • Anticholinergics
  • atropine or Pro-Banthine
  • Antacids or Tagamet (prevent ulcers)

63
Pancreatitis
  • Hyperalimentation
  • may be required to maintain nutrition
  • Prevention
  • bland, low-fat, high-protein, high-carbohydrate
    diet
  • no alcohol or gastric stimulants (coffee)
  • may need oral hypoglycemic agents if destruction
    or the islets of Langerhans

64
Cancer of the Pancreas
  • Etiology/Pathophysiology
  • Unknown
  • Risk factors
  • cigarette smoking
  • exposure to chemical carcinogens
  • diabetes mellitus
  • pancreatitis
  • diet high in meat, fat and coffee
  • May be metastisis form the lung, stomach,
    duodenum or CBD
  • May live only 4-8 months after diagnosis

65
Cancer of the Pancreas
66
Cancer of the Pancreas
  • Signs Symptoms
  • Anorexia
  • Fatigue
  • Nausea
  • Flatulence
  • Change in stools
  • Steady, dull aching pain in the epigastic area
  • Weight loss
  • Jaundice
  • Onset of diabetes mellitus

67
Cancer of the Pancreas
  • Treatment
  • Surgery
  • Whipple procedure
  • resection of the antrum of the stomach, duodenum,
    and part of the pancreas
  • anastomosis between the stomach, CBD, and
    pancreatic ducts and the jejunum
  • Total pancreatectomy with resection of parts of
    the GI tract
  • Chemotherapy
  • 5-FU and BCNU
  • Gemzar
  • Radiation

68
Whipple Procedure
About PowerShow.com