nursing of adult patients with medical surgical conditions
Skip this Video
Download Presentation
Nursing of Adult Patients with Medical & Surgical Conditions

Loading in 2 Seconds...

play fullscreen
1 / 68

Nursing of Adult Patients with Medical & Surgical Conditions - PowerPoint PPT Presentation

  • Uploaded on

Nursing of Adult Patients with Medical & Surgical Conditions. Gastrointestinal Accessory Organ Disorders. 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

I am the owner, or an agent authorized to act on behalf of the owner, of the copyrighted work described.
Download Presentation

PowerPoint Slideshow about ' Nursing of Adult Patients with Medical & Surgical Conditions' - isaiah-lester

An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.

- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -
Presentation Transcript
nursing of adult patients with medical surgical conditions

Nursing of Adult PatientswithMedical & Surgical Conditions


Accessory Organ


diagnostic studies
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
diagnostic studies1
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.
diagnostic studies2
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
diagnostic studies3
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
diagnostic studies4
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
diagnostic studies5
Diagnostic Studies
  • Nursing Interventions
    • Assess for allergies to iodine
    • Administer 6 Telepaque tablets orally, after the evening meal
    • NPO after midnight
diagnostic studies6
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.
diagnostic studies7
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
diagnostic studies8
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
diagnostic studies9
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
diagnostic studies10
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
diagnostic studies11
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
diagnostic studies12
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
diagnostic studies13
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
diagnostic studies14
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
diagnostic studies15
Diagnostic Studies
  • Hepatitis Virus Studies
    • Rationale
      • Diagnose specific virus causing hepatitis
        • A, B, C, D, and E
diagnostic studies16
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
diagnostic studies17
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
diagnostic studies18
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
diagnostic studies19
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
diagnostic studies20
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
diagnostic studies21
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
diagnostic studies22
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
  • Etiology/Pathophysiology
    • Chronic, degenerative disease of the liver
    • Scar tissue restricts the flow of blood to the liver
    • Types of cirrhosis
      • Laennec’s 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.)
  • Alteration of liver function
    • Reduced ability to metabolize albumin
    • Obstruction of portal vein
    • Increased pressure in the veins that drain the GI tract
    • Portal Hypertension
      • increased venous pressure in the portal circulation caused by compression or occlusion in the portal or hepatic vascular system
    • accumulation of fluid and albumin in the peritoneal cavity
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
  • Hepatic Encephalopathy
    • Brain damage due to elevated ammonia levels
    • Inaapropriate behavior, disorientation, flapping hand tremors, twitching of the extremities, stupor, and coma
  • 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
  • ascites
  • enlarged spleen
  • spider angiomas
  • anemia
  • bleeding tendencies
    • cannot absorb vitamin K, or produce clotting factors
  • epistaxis
  • purpura
  • hematuria
  • bleeding gums
  • jaundice
    • yellow discoloration of the skin, mucous membranes and sclerae or the eyes
    • caused by abnormal amounts of bilirubin in the blood
  • mental disorientation
  • 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
  • Antiemetics
    • Benadryl & Dramamine
    • Contraindicated: Vistaril, Compazine, and Atarax
  • Treatment of Complications
    • Ascites
      • Bedrest
      • Strict I&O
      • 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
  • 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
  • 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
  • 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
  • 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
  • Hepatitis E
    • Fecal contamination of water
    • Rare in the U.S.; usually in developing countries
    • Incubation 15-64 days
  • Signs & Symptoms
    • General malaise
    • Aching muscles
    • Photophobia
    • Headaches
    • Chills
    • Abdominal pain
    • Dyspepsia
    • Nausea
  • Diarrhea
  • Constipation
  • Pruritus
  • Hepatomegaly
  • Enlarged lymph nodes
  • Weight loss
  • Jaundice
  • Dark amber urine
  • Clay colored stools
  • 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
  • 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
liver abscesses
Liver Abscesses
  • Etiology/Pathophysiology
    • May be single of multiple
    • Abscess forms in the liver due to an invading bacteria
liver abscesses1
Liver Abscesses
  • Signs & Symptoms
    • Fever
    • Chills
    • Abdominal pain and tenderness in the RUQ
    • Hepatomegaly
    • Jaundice
    • Anemia
liver abscesses2
Liver Abscesses
  • Treatment
    • IV antibiotics
    • Percutaneous drainage of liver abscess
    • Open surgical drainage
cholecystitis cholelithiasis
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
cholecystitis cholelithiasis1
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
cholecystitis cholelithiasis2
Cholecystitis & Cholelithiasis
  • Low grade fever
  • Elevated WBC
  • Mild jaundice
  • Steatorrhea (fatty stool)
  • Dark amber urine
cholecystitis cholelithiasis3
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
cholecystitis cholelithiasis4
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
  • 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
  • Signs & Symptoms
    • Abdominal pain
    • Anorexia
    • Nausea & vomiting
    • Malaise
    • Restlessness
    • Low-grade fever
    • Jaundice
    • Weight loss
    • Steatorrhea
    • Tachycardia
  • 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)
  • 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
cancer of the pancreas
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
cancer of the pancreas2
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
cancer of the pancreas3
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