Medical Management of FVD and FVE PDF

NCM112 Medical Management of FVD Oral route is preferred Fluid and Electrolytes IV for acute or sev...

NCM112 Medical Management of FVD Oral route is preferred Fluid and Electrolytes IV for acute or severe losses Types of Solutions Fluid and Electrolyte Balance Isotonic Necessary for life, homeostasis (internal equilibrium) Hypotonic Nursing role: anticipate, identify, and respond to possible Hypertonic imbalances Colloid Fluid Approximately 60% of typical adult is fluid (water and electrolytes) Nursing Management of FVD Varies with age, body fat, gender I&O at least every 8 hours, sometimes hourly Intracellular fluid (fluid in cells) Daily weight 2/3 of body fluid, skeletal muscle mass Vital signs closely monitored Extracellular fluid (fluid outside the cells) Skin and tongue turgor, mucosa, urine output, mental status Intravascular (fluid within blood vessels): plasma, erythrocytes, Measures to minimize fluid loss leukocytes, thrombocytes Administration of oral fluids Interstitial (fluid that surrounds the cell): lymph Administration of parenteral fluids Transcellular: cerebrospinal, pericardial, synovial Fluid Volume Excess (Hypervolemia) Electrolytes Expansion of the ECF caused by the abnormal retention of water Active chemicals that carry positive (cations) and negative (anions) and sodium in approximately the same proportions in which they electrical charges normally exist in the ECF Major cations: sodium, potassium, calcium, magnesium, hydrogen Secondary to an increase in the total‐body sodium content ions Major anions: chloride, bicarbonate, phosphate, sulfate, negatively Causes of FVE charged protein ions Due to fluid overload or diminished homeostatic mechanisms Expressed in terms of millequivalents (mEq) per liter Heart failure, kidney injury, cirrhosis of liver Electrolyte concentrations differ in ICF and ECF compartments Contributing factors: Consumption of excessive amounts of table salt or other sodium salts Regulation of Fluid #1 Excessive administration of sodium-containing fluids Osmosis—the diffusion of water caused by fluid and solute concentration gradients Medical Management of FVE Movement of fluid through capillary walls depends on Diuretics Hydrostatic pressure: exerted on walls of blood vessels Dialysis Osmotic pressure: exerted by protein in plasma Nutritional Direction of fluid movement depends on differences of hydrostatic Dietary restrictions of sodium pressure and osmotic pressure Nursing Management of FVE Regulation of Fluid #2 I&O and daily weights; assess lung sounds, edema, other Osmosis: area of low solute concentration to area of high solute symptoms concentration Monitor responses to medications—diuretics and parenteral fluids Diffusion: solutes move from area of higher concentration to one of Promote adherence to fluid restrictions, patient teaching related to lower concentration sodium and fluid restrictions Filtration: movement of water, solutes occurs from area of high Monitor, avoid sources of excessive sodium, including medications hydrostatic pressure to area of low hydrostatic pressure Promote rest Active transport: Sodium–potassium pump Maintains higher concentration of extracellular sodium, intracellular Electrolyte Imbalances potassium Sodium: hyponatremia, hypernatremia Potassium: hypokalemia, hyperkalemia Gains and Losses of Fluid and Electrolytes Calcium: hypocalcemia, hypercalcemia Gain Magnesium: hypomagnesemia, hypermagnesemia Healthy people gain fluids by drinking and eating Phosphorus: hypophosphatemia, hyperphosphatemia Daily I&O of water are equal Chloride: hypochloremia, hyperchloremia Loss Kidney: urine output of 1mL/kg/hr Hyponatremia - Serum sodium less than 135 mEq/L Skin loss: sensible due to sweating and insensible due to fever, Medical and Nursing Management of Hyponatremia exercise, and burns Treat underlying condition Lungs: 300 mL everyday, greater with increased respirations Sodium replacement GI tract: large losses due to diarrhea and fistulas Water restriction Medication Fluid Volume Disturbances Assessment: I&O, daily weight, lab values, CNS changes Encourage dietary sodium Fluid volume deficit (FVD): hypovolemia Monitor fluid intake Fluid volume excess (FVE): hypervolemia Effects of medications (diuretics, lithium) Fluid Volume Deficit (Hypovolemia) Hypernatremia - Serum sodium greater than 145 mEq/L and Occurs in May occur alone or in combination with other imbalances patients with normal fluid volume, FVD,FVE Loss of extracellular fluid exceeds intake ratio of water Medical and Nursing Management of Hypernatremia Electrolytes lost in same proportion as they exist in normal body Gradual lowering of serum sodium level via infusion of hypotonic fluids electrolyte solution Dehydration Diuretics Not the same as FVD Assessment for abnormal loss of water and low water intake Loss of water alone, with increased serum sodium levels Assess for over-the-counter sources of sodium Causes of FVD Monitor for CNS changes Abnormal fluid losses Vomiting, diarrhea, sweating, GI suctioning Hypokalemia - Below-normal serum potassium, Less than 3.5 mEq/L and Decreased intake May occur with normal potassium levels: when alkalosis is present a Nausea, lack of access to fluids temporary shift of serum potassium into cells occurs Third-space fluid shifts Medical and Nursing Management of Hypokalemia Due to burns, ascites Potassium replacement: Increased dietary potassium, oral Additional causes potassium supplements or IV potassium for severe deficit (unless Diabetes insipidus, adrenal insufficiency, hemorrhage oliguria present) Monitor ECG for changes  Monitor ABGs Vitamin D preparations, calcium-binding antacids, Monitor patients receiving digitalis for toxicity phosphate-binding gels or antacids, loop diuretics, IV fluids Monitor for early signs and symptoms (Normal Saline), dialysis Administer IV potassium only after adequate urine output has been Monitor phosphorus and calcium levels established Avoid high-phosphorus foods Patient teaching related to diet, phosphate- containing substances, Hyperkalemia - Serum potassium greater than 5.0 mEq/L, Seldom occurs in signs of hypocalcemia patients with normal renal function, Increased risk in older adults and Cardiac arrest is frequently associated. Hypochloremia - Serum level less than 97 mEq/L, Aldosterone impacts Medical and Nursing Management of Hyperkalemia reabsorption, Bicarbonate has an inverse relationship with chloride and Monitor ECG, heart rate (apical pulse) and blood pressure, assess Chloride mainly obtained from the diet labs, monitor I&O, obtain apical pulse Medical and Nursing Management of Hypochloremia Limitation of dietary potassium and dietary teaching Replace chloride-IV NS or 0.45% NS Administration of cation exchange resins (sodium polystyrene Ammonium chloride sulfonate) Monitor I&O, ABG values and electrolyte levels Emergent care: IV calcium gluconate, IV sodium bicarbonate, IV Assess for changes in LOC regular insulin and hypertonic dextrose IV, beta-2 agonists, dialysis Educate about foods high in chloride (tomato juice, bananas, eggs, Administer IV slowly and with an infusion pump cheese, milk) and avoid drinking free water (water without electrolytes) Hypocalcemia - Serum level less than 8.6 mg/dL, must be considered in Hyperchloremia - Serum level more than 107 mEq/L and Hypernatremia, conjunction with serum albumin level and Serum calcium level controlled by bicarbonate loss, and metabolic acidosis can occur parathyroid hormone and calcitonin. Medical and Nursing Management of Hyperchloremia Medical and Nursing Management of Hypocalcemia Correct the underlying cause and restore electrolyte and fluid IV of calcium gluconate for emergent situations (monitor for risk of balance extravasation) Hypertonic IV solutions Seizure precautions Lactated Ringers Oral calcium and vitamin D supplements Sodium bicarbonate, diuretics Exercises to decrease bone calcium loss Monitor I&O, ABG Patient teaching related to diet and medications Focused assessments of respiratory, neurologic, and cardiac systems Hypercalcemia - Serum level greater than 10.4 mg/dL and Mild and moderate Patient teaching related to diet and hydration hypercalcemia usually asymptomatic. Medical and Nursing Management of Hypercalcemia Treat underlying cause (Cancer) Fluid, Electrolyte, and Acid–Base Balance Administer IV fluids, furosemide, phosphates, calcitonin, Homeostasis bisphosphonates Ability to maintain internal equilibrium by adjusting physiologic Increase mobility processes Encourage fluids Reestablishment and maintenance a goal in managing fluid, Dietary teaching, fiber for constipation electrolyte, and acid–base imbalance Ensure safety Body Fluid Composition Hypomagnesemia - Serum level less than 1.8 mg/dL and Associated with Water hypokalemia and hypocalcemia. Transport of nutrients Medical and Nursing Management of Hypomagnesemia Medium for metabolic reactions Magnesium sulphate IV is administered with an infusion pump; Regulation of body temperature monitor vital signs and urine output Electrolytes Calcium gluconate or hypocalcemic tetany or hypermagnesemia Water balance regulation Oral magnesium Acid–base balance Monitor for dysphagia Enzyme reactions Seizure precautions Neuromuscular activity Dietary teaching (green, leafy vegetables; beans, lentils, almonds, peanut butter) Body Fluid Distribution Intracellular fluid (ICF) Hypermagnesemia - Serum level greater than 2.6 mg/dL, Rare electrolyte ▪ Found within cells abnormality, because the kidneys efficiently excrete magnesium ▪ Essential for normal cell function Medical and Nursing Management of Hypermagnesemia Extracellular fluid (ECF) IV calcium gluconate ▪ Located outside of cells Ventilatory support for respiratory depression ▪ Interstitial fluid Hemodialysis ▪ Intravascular fluid Administration of loop diuretics, sodium chloride, and LR ▪ Transcellular fluid Avoid medications containing magnesium Patient teaching regarding magnesium-containing over-the-counter Solutes medications ICF Observe for DTRs and changes in LOC Potassium Magnesium Hypophosphatemia - Serum level below 2.7 mg/dL and Hypophosphatemia Phosphate can occur when total‐body phosphorus stores area normal Glucose Medical and Nursing Management of Hypophosphatemia Oxygen Prevention is the goal ECF Oral or IV phosphorus replacement (only for patients with serum Sodium phosphorus levels less than 1 mg/dL not to exceed 3 mmol/hr), Chloride Burosumab, correct underlying cause Bicarbonate Monitor IV site for extravasation Monitor phosphorus, vitamin D and calcium levels Body Fluid Movement Encourage foods high in phosphorus (milk, organ meats, beans Osmosis nuts, fish, poultry), gradually introduce calories for malnourished Osmolality patients receiving parenteral nutrition Concentration of a solution Osmotic pressure and tonicity Hyperphosphatemia - Serum level above 4.5 mg/dL and Can occur with Diffusion increased intake, decreased excretion, or shifting of phosphate from Simple intracellular to extracellular spaces Facilitated (carrier-mediated) Medical and Nursing Management of Hyperphosphatemia Filtration Treat underlying disorder Balance of hydrostatic, osmotic pressure Active transport Sodium-potassium pump 0.225% sodium chloride cause cell lysis, including at the insertion (1/4NS) site. Monitor plasma sodium levels. Body Fluid Regulation Do not administer to patients at risk for Thirst increased intracranial pressure (e.g., head Primary regulator of water intake trauma, stroke, neurosurgery). Kidneys Do not administer to patients at risk for Regulates volume, osmolality of body fluids third-space shifts (burns, trauma, liver disease, malnutrition). Renin–angiotensin–aldosterone system Helps maintain intravascular fluid balance and blood pressure Antidiuretic hormone Hypertonic Solutions Monitor for inflammation and infiltration at D5 NS IV insertion site because hypertonic Regulates water excretion from kidneys D5 in lactated Ringer's solutions cause cells to shrink, exposing the Atrial natriuretic peptide solution 10% dextrose in basement membrane of the vein. Released by atrial muscle cells in response to distention from fluid water (DoW) Monitor plasma sodium levels. overload 3% sodium chloride Monitor for circulatory overload. 5% sodium chloride Do not administer to patients with diabetic The Patient with a Fluid Volume Deficit Parenteral nutrition ketoacidosis or impaired cardiac or kidney Decrease in intravascular, interstitial, and/or intracellular fluid in the body. solutions function. Clinical Alert: Hypertonic solutions should be administered through a Dehydration central venous access device to reduce the risk of vessel damage. Loss of water alone Often used interchangeably The Patient with a Fluid Volume Excess Causes Pathophysiology Vomiting and diarrhoea Heart or renal failure Gastrointestinal suctioning, intestinal fistulas, and intestinal Cirrhosis of the liver drainage Adrenal gland disorders Diuretics, renal disorders, and endocrine disorders Corticosteroid administration Hot environment Stress conditions causing release of ADH and aldosterone Hemorrhage Excessive sodium intake Pathophysiology Medication side effects Hypovolemia from loss of ECF Manifestations Third spacing Extracellular Shift of fluid out of vascular space into unusable space Hypovolemia Triggered by stress hormones Circulatory overload Difficult assessment Interstitial Shock, multiorgan failure Peripheral Manifestations Generalized Rapid weight loss and pale skin Complications Decreased skin turgor and urine output Congestive heart failure, pulmonary edema Tachycardia Diagnosis Decreased systolic blood pressure and venous pressure Serum electrolytes, osmolality Diagnosis Serum hematocrit, hemoglobin often decreased Serum electrolytes Renal, liver function Serum osmolality Medications Hemoglobin and hematocrit Diuretics Urine specific gravity and osmolality Loop Hemodynamic pressures Thiazide-type Fluid management Potassium-sparing Oral rehydration Safest, most effective Treatments IV therapy Fluid management Health promotion Dietary management Teaching to prevent fluid volume deficits Health promotion Carefully monitor intake and output Relationship between sodium intake and water retention Assessment Assessment Health history Health history Physical assessment Physical assessment Priorities of care Weight, vital signs, circulatory signs Restoration of adequate fluid volume Lung sounds, dyspnea, cough Diagnoses, outcomes, and interventions Urine output, mental status Deficient Fluid Volume Priorities of care Ineffective Tissue Perfusion Supporting cardiovascular, respiratory function Risk for Injury Diagnoses, outcomes, and interventions Continuity of care Fluid Volume Excess Assess patient's understanding of cause of the deficit Risk for Impaired Skin Integrity Impaired Gas Exchange Commonly Administered IV Fluids with Nursing Implications Continuity of care Teaching to manage underlying cause of fluid volume excess Isotonic Solutions Monitor for fluid overload; if manifestations 0.9% sodium chloride occur, discontinue fluids and notify the Prevent future episodes of excess fluid volume (normal saline) healthcare provider. Lactated Ringer's solution Do not administer lactated Ringer's solution Sodium Imbalance Plasma-Lyte 148 to patients with severe liver disease because Normal levels: 135–145 mEq/L 5% dextrose in water the lactate may not convert to bicarbonate, Affects distribution of fluids (D5W) leading to acidosis. Do not administer if the Kidney is primary regulator patient has a blood pH of >7.50. Renin–angiotensin–aldosterone system If administering lactated Ringer's solution, monitor potassium levels and cardiac Antidiuretic hormone (ADH) rhythm; if abnormal, notify the healthcare Atrial natriuretic peptide (ANP) provider. Manifestations of Sodium Imbalance Hypotonic Solutions Monitor for inflammation and infiltration at 0.45% sodium chloride IV insertion site because hypotonic 0.225% Hyponatremia Hypernatremia (1/2NS) sodium chloride (1/4NS) solutions may  Sodium–potassium pump Plasma sodium < 135 Plasma sodium > 145 mEq/L Kidneys and aldosterone mEq/L Increased serum osmolality Decreased serum Increased thirst, oliguria, increased osmolality urine specific gravity The patient with Hypokalemia Muscle cramps, weakness Dry skin and mucous mem-branes, Serum potassium less than 3.5 mEq/L Headache decreased skin turgor, furrowed tongue, Pathophysiology Anxiety dry mouth Inadequate potassium intake Lethargy, stupor, coma Headache, restlessness Excessive renal, intestinal, or skin losses Anorexia, nausea, vomiting Seizures, coma Redistribution between the ICF and ECF Hypotension, shock Tachycardia, hypotension, vascular collapse Manifestations Nausea and vomiting Muscle weakness The patient with Hyponatremia Cramps Serum sodium less than 135 mEq/L Decreased cardiac output Pathophysiology Polyuria Excessive loss via kidneys, GI tract, skin, cerebral wasting,third Diagnosis spacing Serum potassium Water gains from systemic diseases Serum electrolytes Manifestations Arterial blood gases Depend on rapidity, severity, and cause of the imbalance Renal function studies Diagnosis ECF readings Serum sodium Medications Serum osmolality Oral and/or parenteral supplements 24-hour urine specimen Nutrition Medications Diet high in potassium-rich foods Sodium-containing fluids Health promotion Fluid and dietary management Balanced electrolyte solutions to replace abnormal fluid losses High in sodium Assessment Fluids often restricted Health history Health promotion Physical assessment Teach manifestations Priorities of care Teach importance of drinking liquids with sodium, electrolytes Cardiac impulse transmission when perspiring, in high temperatures Cardiac and skeletal muscle function Assessment Diagnoses, outcomes, and interventions Health history Decreased Cardiac Output Physical assessment Activity Intolerance Priorities of care Risk for Imbalanced Fluid Volume Restoring sodium, water balance Continuity of care Preventing cerebral edema Recommended diet Diagnoses, outcomes, and interventions Prescribed medications, supplements Risk for Imbalanced Fluid Volume Use of salt substitute Risk for Ineffective Cerebral Tissue Perfusion Continuity of care The patient with Hyperkalemia Underlying cause of sodium deficit Serum potassium greater than 5.3 mEq/L Prevention Pathophysiology Input Inadequate renal excretion of potassium Manifestations Rapid IV administration Acidosis, tissue trauma, chemotherapy, starvation The patient with Hypernatremia Manifestations Serum sodium greater than 145 mEq/L Neuromuscular Pathophysiology Muscle weakness Excessive water loss Tremors Excessive sodium intake GI discomfort Manifestations Cardiac Thirst, altered neurologic function ECG changes Can progress to seizures, coma, and death Dysrhythmias Diagnosis Cardiac arrest Serum sodium Diagnosis Serum osmolality Serum electrolytes, ABGs, and ECG Medications Medications Oral, enteral, IV fluid replacement Calcium gluconate, calcium chloride Health promotion Insulin and glucose, hypertonic dextrose, sodium bicarbonate Prevention Sodium polystyrene sulfonate Adequate water for patients receiving tube feedings Dialysis Assessment Peritoneal or hemodialysis Health history Health promotion Physical assessment Reading food, dietary supplement labels Assessment Priorities of care Health history Mental status, brain function Physical assessment Diagnoses, outcomes, and interventions Priorities of care Risk for Injury Electrical conduction and contractility of the heart Continuity of care Diagnoses, outcomes, and interventions Importance of responding to thirst and consuming adequate fluids Risk for Decreased Cardiac Output Guidelines for low-sodium diet Risk for Activity Intolerance Importance of schedule for monitoring serum electrolyte levels Continuity of care Educate on: Potassium Imbalance Diet restrictions Normal serum level: 3.5–5.3 mEq/L Manifestations Functions OTC medications to avoid Nerve impulses Cardiac rhythms Calcium Balance Muscle contraction Normal serum level: 9–11 mg/dL Regulation Functions  Stabilising cell membranes Risk for Injury Muscle contraction and relaxation Risk for Fluid Volume Excess Cardiac function and blood clotting Continuity of care Regulation Educate on limiting intake, medications, increasing fluid intake, and Parathyroid hormone, calicitriol, calcitonin, acid–base balance, weight-bearing exercise plasma protein levels Magnesium Imbalance Manifestations of Calcium Imbalance Normal serum concentration: 1.8–3.0 mg/dL Functions Hypocalcemia Hypercalcemia Intracellular processes Neuromuscular transmission Serum calcium level < 9 mg/dL Serum calcium level > 11.0 Cardiovascular function ( 4.5 Long-term regulation of acid–base balance in body < 2.5 mg/dL (2.6 mEq/L) Kidneys regulate: Intention tremor, paresthesias Paresthesias Confusion, stupor Muscle weakness Elimination of excess non-volatile acids produced during Bone pain Nausea and vomiting metabolism Joint stiffness Dysphagia Bicarbonate levels in ECF Bleeding disorders (platelet Tetany dysfunction) Decreased blood pressure Accessing Acid-Base Balance Impaired white blood cell function Cardiac dysrhythmias Arterial blood gases measured Seizures PaCO2 PaO2 Overview of Normal Phosphate Balance Serum bicarbonate Essential to intracellular processes Base excess Production of ATP Red blood cell function Normal Arterial Blood Gas Values Nervous system, muscle function Value Range Significance Metabolism of fats, carbohydrates, protein Regulation Parathyroid hormone, calcitonin, vitamin D pH 7.35-7.45 Reflects hydrogen ion (H+) concentration The patient with Hypophosphatemia 7.45 = alkalosis Pathophysiology and manifestations Decreased GI absorption PaCO2 35-45 mmHg Partial pressure of carbon dioxide (CO2) Increased renal excretion in arterial blood Refeeding syndrome 45 mmHg = hypercapnia Pathophysiology and manifestations Alcoholism PaO2 80-100 mmHg Partial pressure of oxygen (02) in arterial Hyperventilation blood Respiratory alkalosis 26 mEq/L) High-acuity care Risk factors Intubation, mechanical ventilation Hospitalization, hypokalemia, alkalinizing solutions Rarely primary disorder Health promotion Identify, monitor, and teach patients at risk Pathophysiology Receiving anesthesia, narcotic analgesics, sedatives Hydrogen loss via gastric suctions Chronic lung disease Hydrogen loss via kidneys Hydrogen shifts into cells Priorities of care Excess bicarbonate from antacids Restoring effective alveolar ventilation and gas exchange Manifestations and complications Diagnoses, outcomes, and interventions Similar to hypocalcemia Impaired Gas Exchange CNS Ineffective Airway Clearance Tetany, confusion, and dizziness Cardiovascular Continuity of care Depressed respirations and possible respiratory failure Focus on underlying cause Diagnosis ABGs: pH and bicarbonate The patient with Respiratory Alkalosis Serum electrolytes pH > 7.45; PaCO2 < 35 mmHg Urine pH ECG Risk factors Anxiety Medications Hyperventilation Potassium chloride Sodium chloride Pathophysiology Acidifying solution High fever Hypoxia Gram-negative bacteremia Health promotion Thryrotoxicosis Risks of using sodium bicarbonate as an antacid Aspirin overdose Encephalitis Priorities of care High progesterone levels Risk for impaired gas exchange as a compensatory response to Mechanical ventilation metabolic alkalosis Manifestations Diagnoses, Outcomes, and interventions Lightheadedness, dizziness, numbness and tingling Risk for Impaired Gas Exchange Palpitations, sensation of chest tightness Deficient Fluid Volume Seizures and loss of consciousness Continuity of care Diagnosis Educate on appropriate antacids, potassium supplements and ABGs: pH and PaCO2 manifestations Medications The patient with Respiratory Acidosis Sedative or antianxiety agent pH < 7.35 and PaCO2 > 45 mmHg Drugs for underlying conditions Risk factors Respiratory therapy  Paper bag Ventilator settings Hypersensitivity reactions e.g. Autoimmunity -immune hay fever responses of an organism Oxygen against its own cells and tissues Health promotion Identify patients at risk in hospital Physical agents e.g. radiation Progression from acute Monitor assessment data, ABGs to identify early manifestations inflammation e.g. suppurative if an abscess is formed Diagnoses, outcomes, and interventions Ineffective Breathing Pattern Chemicals e.g. acid Continuity of care Control underlying cause Purpose of Inflammatory Process Refer anxiety cases to counselor The purpose of the inflammatory process is to protect the body Teach how to identify hyperventilation from harmful stimuli and initiate tissue repair. It is a crucial defence mechanism that helps remove or neutralise Common Causes of and Compensation for Primary Acid-Base pathogens, foreign substances, and damaged cells. Imbalances The inflammatory process also plays a role in initiating the adaptive immune response and facilitating wound healing. Imbalance Common Causes Compensation Phases of the Inflammatory Process Metabolic acidosis Increased acid production Rate and depth pH < 7.35 Lactic acidosis of respirations Vascular Phase HCO3 < 22 mEq/L Ketoacidosis related to increase, The vascular phase is the initial response to tissue injury and diabetes, starvation, c eliminating involves changes in blood vessel permeability. Critical values alcoholism additional CO2. pH < 7.20 Decreased acid excretion Increased blood flow to the affected area leads to redness and HCO3 < 10 mEq/L Renal failure warmth, while increased vascular permeability causes swelling and Increased bicarbonate loss edema. Diarrhea, ileostomy These changes allow immune cells, antibodies, and other drainage, intestinal fistula inflammatory mediators to enter the tissue and initiate the immune Biliary or pancreatic fistulas response. Increased chloride Sodium chloride IV solutions The cellular phase is characterised by the migration of immune Renal tubular acidosis cells, such as neutrophils and macrophages, to the site of inflammation. Metabolic alkalosis Increased acid loss or Rate and depth Neutrophils are the first cells to arrive and are involved in pH >7.45 excretion of respirations phagocytosis to remove pathogens and cellular debris. HCO3 > 26 mEq/L Vomiting, gastric suction decrease, Macrophages are responsible for phagocytosis, antigen Hypokalemia retaining CO2. presentation, and production of inflammatory mediators. Critical values Increased bicarbonate pH > 7.60 Alkali ingestion (bicarbonate Interventions and Nursing Care HCO3 > 40 mEq/L of soda) Excess bicarbonate administration Collaborative Care Respiratory Acute respiratory acidosis Kidneys 1. Medications for Inflammation acidosis Acute respiratory conditions conserve Providing an overview of medications commonly used to manage pH < 7.35 (pulmonary edema, bicarbonate to inflammation. Explaining the mechanism of action and potential side effects of PaCO2 > 45 mmHg pneumonia, acute asthma) restore these medications. Discussing the importance of adherence to medication Opiate overdose carbonic regimens and monitoring for therapeutic effectiveness. Highlighting the role of Critical values Chest trauma acid:bicarbonat healthcare professionals in educating patients about their medications. pH < 7.2 e ratio of 1:20 PaCO2 > 77 mmHg Chronic respiratory acidosis Multiple sclerosis, other 2. Surgical Interventions neuromuscular diseases Discussing common surgical interventions used in the management of various conditions. Explaining the indications for surgery and the expected outcomes. Respiratory Anxiety-induced Kidneys Describing the preoperative, intraoperative, and postoperative nursing care alkalosis hyperventilation excrete required for patients undergoing surgery. Highlighting the importance of pH > 7.45 Fever bicarbonate effective communication and collaboration among healthcare team members. PaCO2 < 35 mmHg Early salicylate intoxication and conserve Hyperventilation with H+ to restore 3. Rehabilitation Services Critical values mechanical ventilator carbonic Explaining the role of rehabilitation services in promoting recovery and рН > 7.60 acid:bicarbonat PaCO2 < 20 mmHg e ratio improving functional outcomes. Discussing different types of rehabilitation services, such as physical therapy, occupational therapy, and speech therapy. Describing the goals and techniques used in rehabilitation programs. Highlighting the importance of a multidisciplinary approach in achieving Definition of Inflammation optimal outcomes. Definition of Inflammatory Process Nursing Interventions The inflammatory process is the body's response to tissue injury, infection, or damage caused by irritants. Pain Management Techniques It is a complex biological process involving the immune system, Discussing various pain management techniques used in nursing practice. blood vessels, and various inflammatory mediators. Explaining the use of pharmacological and non- pharmacological interventions Inflammation is characterized by redness, swelling, heat, pain, and for pain relief. Describing the importance of individualized pain assessment sometimes loss of function. and the implementation of appropriate pain management strategies. Highlighting the role of nurses in advocating for optimal pain control for their patients. What causes inflammation? Applying Cold and Heat Therapy Explaining the application of cold and heat therapy in nursing care. Discussing ACUTE CHRONIC the therapeutic benefits and risks associated with cold and heat therapy. Describing the safe and effective techniques for applying cold and heat to Tissue Necrosis Transplant rejection different body parts. Highlighting the importance of monitoring the patient's response to cold and heat therapy. Microbial Infections Persistent infection (recurrent acute inflammation) Assisting with Positioning and Mobility Discussing the importance of proper positioning and mobility for patient appropriate use of antibiotics and antiviral medication, can help control comfort and prevention of complications. Explaining the principles of body infections and prevent complications. mechanics and safe patient handling techniques. Describing the nursing interventions required to assist patients with positioning, transferring, and Inflammatory Disorders Peritonitis, Crohn's Disease, Ulcerative Colitis ambulation. Highlighting the importance of regular assessment and documentation of the patient's CONTENTS positioning and mobility status. 1. Definition and Overview 2. Symptoms and Diagnosis Providing Wound Care 3. Treatment and Management Describing the nursing interventions involved in providing wound care. 4. Crohn's Disease Explaining the principles of aseptic technique and wound cleaning. Discussing 5. Ulcerative Colitis different types of wound dressings and their appropriate use. Highlighting the importance of regular assessment and documentation of wound healing 1. Definition and Overview progress. Explanation of Peritonitis Monitoring and Managing Infection Risk Peritonitis is an inflammation of the peritoneum, a thin membrane Explaining the importance of infection prevention and control in nursing that lines the abdominal cavity and covers the abdominal organs. practice. Describing the nursing interventions for monitoring and managing It is commonly caused by infection, injury, or a medical condition. infection risk. Discussing the role of hand hygiene, personal protective Peritonitis can be life- threatening if not treated promptly. equipment, and proper disinfection techniques. Highlighting the importance of patient and family education regarding infection prevention. Causes and Risk Factors Bacterial or fungal infections can lead to peritonitis, often as a Educating the Patient and Family result of a ruptured appendix, diverticulitis, or other abdominal Discussing the importance of patient and family education in promoting self- infections. care and recovery. Describing the nursing interventions involved in patient and Bacterial or fungal infections can lead to peritonitis, often as a family education. Explaining the use of various teaching strategies and result of a ruptured appendix, diverticulitis, or other abdominal materials to enhance learning. Highlighting the importance of tailoring infections. Injury Trauma or surgery to the abdomen can cause education to the patient's individual needs and preferences. peritonitis if the peritoneal lining is damaged Medical Conditions Certain medical conditions, such as cirrhosis, Complications and Prevention pancreatitis, or inflammatory bowel disease, can increase the risk of developing peritonitis. Potential Complications 2. Symptoms and Diagnosis Infection Common Symptoms of Peritonitis Infections can occur as a result of various factors, including surgical Abdominal pain and tenderness procedures or compromised immune systems. Common types of infections Fever and chills include surgical site infections, urinary tract infections, and pneumonia. Swelling or distension of the abdomen Preventive measures, such as strict adherence to infection control protocols Decreased appetite and weight loss and proper wound care, can reduce the risk of infections. Nausea and vomiting Chronic Inflammation Symptoms Chronic inflammation refers to long-term inflammation that can lead to tissue Symptoms of peritonitis include: damage and organ dysfunction. Conditions such as rheumatoid arthritis, Belly pain or tenderness inflammatory bowel disease, and chronic hepatitis are examples of chronic Bloating or a feeling of fullness in the abdomen inflammatory diseases. Lifestyle changes, such as maintaining a healthy diet Upset stomach and vomiting and regular exercise, can help reduce chronic inflammation. Loss of appetite Diarrhea Organ Dysfunction Reduced urine Organ dysfunction can occur as a result of complications from surgeries, Thirst injuries, or underlying health conditions. Common examples of organ Not able to pass stool or gas dysfunction include acute kidney injury, respiratory failure, and liver failure. Feeling tired Early detection and appropriate treatment of the underlying causes can help Confusion prevent or minimize organ dysfunction. Diagnostic Methods for Peritonitis Prevention Measures Physical Examination A healthcare provider may perform a thorough physical examination to assess the signs and symptoms Proper Hygiene Practices of peritonitis. Proper hygiene practices, such as handwashing, can significantly reduce the Imaging TestsImaging techniques like X- rays, ultrasounds, or CT risk of infections. Regular cleaning and disinfection of surfaces can help scans can help visualise the abdominal cavity and identify any prevent the spread of infectious agents. Education and awareness campaigns abnormalities. promoting good hygiene practices can further enhance prevention efforts. Laboratory Tests Blood tests may be conducted to check for signs of infection, inflammation, or other abnormalities. Immunizations Immunizations play a crucial role in preventing various infectious diseases. 3. Treatment and Management Vaccines stimulate the immune system to produce specific antibodies against certain pathogens, providing immunity. Routine immunizations, such as those Medical Interventions for Peritonitis for influenza, hepatitis, and measles, can greatly reduce the incidence and Antibiotics Intravenous (IV) antibiotics are typically administered severity of related diseases. to treat the underlying infection causing peritonitis. Fluid Resuscitation Intravenous fluids may be given to restore Health Promotion and Lifestyle Changes proper hydration and maintain blood pressure. Promoting a healthy lifestyle, including a balanced diet, regular exercise, and Pain Management Medications may be prescribed to alleviate adequate sleep, can strengthen the immune system. Avoiding smoking, abdominal pain and discomfort. excessive alcohol consumption, and illicit drug use can also enhance overall health and minimize complications. Education and awareness programs can Surgical Procedures for Peritonitis help individuals adopt and maintain healthy habits. Exploratory Laparotomy This surgical procedure involves making an incision in the abdomen to examine the extent of infection or Early Detection and Treatment of Infections damage and remove any infected tissue. Early detection and timely treatment of infections can prevent complications Abscess DrainageIf an abscess is present, a surgeon may need to and reduce organ dysfunction. Regular health check-ups and screenings can drain it surgically. aid in the early detection of infections. Effective treatment protocols, including  Repair of Underlying CauseSurgery may be necessary to repair Ulcerative colitis is a chronic inflammatory bowel disease that primarily affects any underlying conditions that contributed to the development of the colon and rectum. It is characterized by recurring episodes of inflammation peritonitis. and ulcers in the inner lining of the colon and rectum. The exact cause of ulcerative colitis is unknown, but it is believed to involve an abnormal immune 4. Crohn's Disease response to the gut microbiota in genetically susceptible individuals. Introduction to Crohn's Disease Factors Influencing Ulcerative Colitis Background of Crohn's Disease Genetics: Having a family history of ulcerative colitis increases the Crohn's disease is a chronic inflammatory bowel disease (IBD) that risk of developing the condition. primarily affects the digestive tract. It was first described by Dr. Burrill B. Crohn Environmental Factors: Certain environmental factors, such as a in 1932. Crohn's disease can occur at any age, but it is more common in Western diet high in refined carbohydrates and low in fiber, may young adults. The exact cause of Crohn's disease is unknown, but it is increase the risk of ulcerative colitis. believed to involve a combination of genetic, environmental, and immune Immune System Dysfunction: Ulcerative colitis is thought to result system factors. from an abnormal immune response, where the immune system mistakenly attacks the cells of the colon and rectum. Signs and Symptoms Symptoms and Complications Common Symptoms of Crohn's Disease Common Symptoms of Ulcerative Colitis Abdominal pain and cramping Diarrhea: The most common symptom of ulcerative colitis is Persistent pain in the abdomen, often accompanied by cramping. ongoing diarrhea, often containing blood or pus. Diarrhea: Frequent and watery bowel movements. Abdominal Pain: Many individuals with ulcerative colitis experience Fatigue: Feeling tired and lacking energy. abdominal pain, cramping, or discomfort. Weight loss: Unintentional weight loss due to reduced appetite and Rectal Bleeding: Ulcerative colitis can cause bleeding from the absorption issues. rectum, which may be visible in the stool or on toilet paper. Rectal bleeding: Blood in the stool or bleeding from the rectum. Fatigue: Chronic inflammation and ongoing symptoms can lead to fatigue and a reduced ability to perform daily activities. Potential Complications Intestinal strictures Narrowing of the intestinal passages due to Potential Complications Arising from Ulcerative Colitis inflammation, leading to obstruction. Fistulas: Abnormal connections between different parts of the Colon CancerIndividuals with long- standing ulcerative colitis have an intestine or between the intestine and other organs. increased risk of developing colon cancer. Abscesses: Infected pockets of pus that can form within the Bowel Obstruction: In some cases, the inflammation and scarring intestinal walls. associated with ulcerative colitis can narrow the colon, leading to Nutritional deficiencies: Malabsorption of nutrients leading to bowel obstructions. deficiencies in vitamins and minerals. Perforation: Severe inflammation can cause the colon to become Increased risk of colorectal cancer: People with Crohn's disease perforated, leading to a lite threatening condition called a have a higher risk of developing colorectal cancer compared to the perforated colon. general population. Osteoporosis: Ulcerative colitis and its treatment can increase the risk of osteoporosis, a condition marked by weak and brittle bones. CROHN'S DISEASE PATCHY INFLAMMATION THROUGHOUT SMALL AND LARGE BOWEL Diagnostic Methods for Ulcerative Colitis Medical History and Physical Examination The healthcare provider ULCERATIVE COLITIS will review the patient's medical history and perform a physical CONTINUOUS AND UNIFORM INFLAMMATION IN THE LARGE BOWEL examination to look for signs of ulcerative colitis. Laboratory Tests: Blood tests may be performed to check for Diagnostic Methods for Crohn's Disease indicators of inflammation and to rule out other potential causes of Endoscopy a procedure that allows a healthcare provider to symptoms. examine the inside of the digestive tract using a lighted tube with a Endoscopic Procedures: Colonoscopy and flexible camera. sigmoidoscopy are commonly used to visually analysis Biopsy: Removing a small tissue sample from the digestive tract for examination under a microscope. Differential Diagnosis of Ulcerative Colitis Imaging tests: X- rays, CT scans, and MRI scans can help Crohn's Disease Crohn's disease is another type of inflammatory bowel visualize abnormalities in the digestive tract. disease that can have similar symptoms to ulcerative colitis. Differentiating Blood tests: Blood tests can help detect inflammation, anemia, and between the two often requires further testing and evaluation. nutritional deficiencies. Infectious Colitis: Infections, such as those caused by bacteria or parasites, can also cause symptoms similar to ulcerative colitis. Differentiating Crohn's Disease from Other Conditions Ulcerative colitisAnother type of IBD that primarily affects the colon; can be Treatment Approaches distinguished from Crohn's disease based on the location of inflammation. Medications for Managing Ulcerative Colitis Irritable bowel syndrome (IBS): A functional disorder that affects the normal Aminosalicylates: These anti-inflammatory drugs, such as function of the bowel; does not cause inflammation like Crohn's disease. sulfasalazine and mesalamine, are commonly used to induce and maintain remission in mild to moderate ulcerative colitis. Treatment Options Corticosteroids: Corticosteroids, such as prednisone, may be prescribed to reduce inflammation during flare- ups of ulcerative Medications for Managing Crohn's Disease colitis. They are typically used for short-term treatment due to their Anti- inflammatory drugs Corticosteroids and aminosalicylates can potential side effects. help reduce inflammation in the intestines. Immunomodulators: Medications that suppress the immune Immunomodulators: Medications that suppress the immune system system, such as azathioprine and methotrexate, may be used in to reduce inflammation. certain cases to help maintain remission and reduce the need for Biologics: Targeted therapies that inhibit specific molecules corticosteroids. involved in the inflammatory process. Surgical Options for Ulcerative Colitis Surgical Interventions for Crohn's Disease Colectomy: In severe cases of ulcerative colitis that do not Stricture plasty Surgical widening of narrowed respond to medical treatment, surgical removal of the colon portions of the intestine. (colectomy) may be necessary. This can often lead to a permanent Resection: Removal of a diseased portion of the intestine. ostomy or an ileal pouch- anal anastomosis (IPAA or J- pouch) Ostomy surgery: Creating an opening in the abdomen for the surgery. diversion of waste when bowel functionality is severely affected. Proctocolectomy:Proctocolectomy involves the removal of both the colon and the rectum. It may be performed in cases with 5. Ulcerative Colitis extensive disease or if there is a high risk of developing colon cancer. Depending on the circumstances. it may be followed by Definition and Background creation of an ileostomy or an IPAA  Diagnosis of hepatitis A is primarily based on clinical symptoms and confirmed through laboratory testing. Blood tests can detect specific antibodies or viral RNA to confirm the presence of the hepatitis A virus. Liver function tests may 01 Diverticular Diseases show elevated levels of liver enzymes, indicating liver inflammation. Other 02 Hepatitis 03 Acute Pancreatitis tests, such as ultrasound or liver biopsy, may be done to assess the severity of 04 Chronic Pancreatitis the disease. 05 Cholecystitis 06 Cholelithiasis Hepatitis Virus Source Prevention Treatment Diverticular Diseases Diverticulosis is a condition characterised by the presence of small pouches or A HAV Contaminated Improved Rest, sacs, called diverticula, in the wall of the colon. These diverticula generally do food and water Hygiene Adequate not cause any symptoms and are often discovered incidentally during Vaccination nutrition diagnostic tests for other conditions. The exact cause of diverticulosis is and fluids unknown, but it is believed to be linked to a combination of factors including age, diet, and genetics. B HBV Contact with Blood Nucleoside infected body screening analogs fluids Vaccination Pegylated Risk Factors interferon Age is a significant risk factor for diverticulosis, with the condition being more common in individuals over the age of 40. A low- fiber diet is thought to C HCV Syringes, Body Blood HCV direct contribute to the development of diverticulosis, as it can lead to constipation fluids, From Screening acting and increased pressure in the colon. Other risk factors include obesity, lack of HCV Improved antiviral physical activity, smoking, and certain medications. infected mother hygiene (DAA) agents Diverticulosis occurs when weak spots in the colon wall allow the formation of small pouches or diverticula. These pouches can develop in any part of the D HDV Blood and body Practice safe Pegylated colon but are most commonly found in the sigmoid colon. The exact fluids sex interferon pathophysiology of diverticulosis is not fully understood, but it is believed to Improved alpha hygiene therapy involve increased pressure in the colon and alterations in the structure of the colon wall. E HEV Fecal-oral route Drink clean Neuropath Contaminated water y, Anemia water Avoid raw Definition and Overview Uncooked meat meat Diverticulitis is a condition that occurs when the diverticula in the colon becomes inflamed or infected. It is a progression of diverticulosis and usually develops when faecal matter becomes trapped In the diverticula, leading to HEPATITIS CLASSIFICATION bacterial overgrowth and inflammation. Diverticulitis can range from mild cases with minimal symptoms to severe cases requiring hospitalisation and INFECTIOUS HEPATITIS Surgical Intervention. Viral Hepatitis Bacterial Hepatitis (with leptospirosis, syphilis) Clinical Presentation Parasites Hepatitis (with amebiasis, fascioliasis, toxoplasmosis, The clinical presentation of diverticulitis can vary opisthorchiasis) depending on the severity of the condition. Common symptoms include abdominal pain. usually localised to the lower left side, fever, changes in bowel TOXIC HEPATITIS habits, nausea, and vomiting. Alcoholic Hepatitis In severe cases, complications such as abscess formation, perforation of the Medicinal Hepatitis colon, or fistula formation may occur. Chemical Hepatitis Diagnosis and Imaging Hepatitis B The diagnosis of diverticulitis is primarily based on clinical presentation and physical examination. Epidemiology Imaging studies such as computed tomography (CT) scan or ultrasound may Hepatitis B is a viral infection that primarily affects the liver, caused by the be use to confirm diagnosis. assess the severity of the condition, hepatitis B virus (HBV). It is a major global health problem, especially in and rule out possible causes of abdominal pain. Blood tests may also be regions with high rates of chronic infection. Hepatitis B can be transmitted performed to evaluate White blood cell count and markers of inflammation. through contact with infected blood or body fluids, including sexual contact, Most cases of uncomplicated diverticulitis can be needle sharing, or perinatal transmission. managed with conservative treatment, which includes rest. a clear liquid diet. Immunization programs have led to a significant decline in new hepatitis B and oral antibiotics. In severe cases or in those with complications, infections in many countries. hospitalisation may be required For Intravenous antibiotics and supportive care. Surgery may be necessary for recurrent, complicated, or chronic Clinical Manifestations civeruiculluis. and it may involve the removal of the affected part of the colon Hepatitis B infection can range from asymptomatic to acute or chronic liver (sigmoidectomy). disease. Many people with chronic hepatitis B infection remain asymptomatic for years. Acute infection may cause symptoms such as fatigue, jaundice, abdominal pain, and dark urine. Chronic infection can lead to liver cirrhosis, Hepatitis liver cancer, and other complications. Hepatitis A Transmission Routes Hepatitis B can be transmitted through direct contact with infected blood or Epidemiology body fluids. It can be spread through sexual contact with an infected person. Hepatitis A is a viral infection that primarily affects the liver. It is usually spread Sharing needles or other drug paraphernalia can also lead to transmission of through the consumption of contaminated food or water. The virus is prevalent the virus. Mother-to- child transmission during childbirth is another common in areas with poor sanitation and hygiene practices. Hepatitis A can cause route of infection. outbreaks in communities and can be prevented through vaccination. Management and Treatment Clinical Features Antiviral medications are commonly used to treat chronic hepatitis B infection. Hepatitis A often presents with flu- like symptoms such as fever, fatigue, and Regular monitoring of liver function and viral load is crucial to assess the loss of appetite. Jaundice, a yellowing of the skin and eyes, is a effectiveness of treatment. In some cases, treatment may be supplemented characteristic symptom of hepatitis A. The infection is usually self-limiting and with pegylated interferon or liver transplantation. Prevention through does not lead to chronic liver disease. In some cases, severe vaccination is considered the most effective strategy to control hepatitis B hepatitis A can lead to acute liver failure, which is rare but potentially transmission. life-threatening. Diagnosis and Laboratory Findings Hepatitis C Epidemiology Clinical Presentation and Diagnosis Hepatitis C is a viral infection caused by the hepatitis C virus (HCV). It is a Symptoms of acute cholecystitis include sharp pain in the upper right major global health concern, with a significant burden of disease. Hepatitis C abdomen, fever, nausea, and vomiting, whereas chronic cholecystitis can have is primarily transmitted through exposure to infected blood, such as through similar but milder symptoms.nDiagnosis may involve imaging tests like sharing needles or contaminated medical equipment. There is no vaccine for ultrasound, CT scans, or MRI, and blood tests to check for inflammation and hepatitis C, but effective treatment options are available. infection. Screening and Diagnosis Treatment Options Screening for hepatitis C involves testing individuals at risk, including those Treatment options include pain management, antibiotics for infections, and with a history of injection drug use, blood transfusions before 1992, or certain surgical removal of the gallbladder (cholecystectomy) in severe cases. high-risk sexual behaviors. Diagnostic tests for hepatitis C include blood tests Lifestyle changes like a low- fat diet, exercise, and weight loss can also help to detect HCV antibodies, RNA tests to confirm active infection, and liver prevent future episodes of cholecystitis function tests to assess liver health. Further diagnostic tests, such as a liver biopsy or imaging studies, may be done to evaluate the extent of liver Definition and Overview damage. Cholelithiasis, commonly known as gallstones, refers to solid deposits of cholesterol or bilirubin in the gallbladder or bile ducts. It is one of the leading Management and Treatment causes of cholecystitis and can also lead to other complications. Treatment for hepatitis C includes direct- acting antiviral medications that can cure the infection in most cases. The choice and duration of treatment depend ACUTE VS CHRONIC on various factors, such as the genotype of the virus and the extent of liver damage. Regular monitoring of liver function and viral load is important during and after Acute Pancreatitis Chronic Pancreatitis treatment to assess the effectiveness of therapy. Harm reduction strategies, such as needle exchange programs and education on safe injection practices, Acute, Isolated Episode Chronic, Ongoing Disease can help prevent the spread of hepatitis C. Active Inflammation Chronic Changes/Damage Acute Pancreatitis Sudden and Severe Symptoms Fluctuate Etiology and Risk Factors Short Term Long Term Risk factors include gallstones, alcohol abuse, smoking, high triglyceride levels, certain medications, and genetic predisposition. Days - Weeks Months - Years Inflammation of the pancreas caused by autodigestion due to premature activation of pancreatic enzymes. Elevated Pancreatic Enzymes Normal Pancreatic Enzymes Clinical Presentation and Diagnosis Common Causes Common Causes Severe abdominal pain that radiates to the back is the hallmark symptom. Alcohol Recurrent Acute Episodes Other symptoms include nausea, vomiting, fever, and abdominal tenderness. Gallstones Alcohol, Hereditary, Diseases Diagnosis is made through clinical evaluation, blood tests, imaging (CT scan, ultrasound), and/or endoscopic procedures. Management of Patients with Biliary Disorders Management and Treatment 1. Acute pancreatitis often requires hospitalization for supportive Anatomy and Physiology Overview care. 2. Treatment includes pain management, fluid resuscitation, and Gallbladder nutritional support. Bile 3. In severe cases, procedures like endoscopic retrograde Pancreas cholangiopancreatography (ERCP)or surgery may be necessary. Exocrine: amylase, trypsin, lipase, secretin Endocrine: insulin, glucagon, somatostatin Chronic Pancreatitis Pathogenesis and Causes Cholelithiasis Chronic inflammation of the pancreas causing irreversible damage. Common causes include long-term alcohol abuse and recurrent Pathophysiology episodes of acute pancreatitis. Pigment stones Cholesterol stones Clinical Features and Diagnosis Symptoms vary but can include persistent abdominal pain, weight Clinical Manifestations of Cholelithiasis loss, malabsorption, and diabetes. None or minimal symptoms, acute or chronic Diagnosis requires a combination of clinical evaluation, imaging Pain (CT scan, MRI), and pancreatic function tests. Biliary colic Jaundice Treatment and Medical Management Changes in urine or stool color Treatment focuses on pain management, nutritional support, and Vitamin deficiency, fat soluble (vitamins A, D, E, and K) managing complications like diabetes. Lifestyle modifications such as alcohol cessation and smoking Medical Management of Cholelithiasis cessation are crucial ERCP In advanced cases, surgical intervention may be necessary to Dietary management alleviate pain or resolve complications. Medications: ursodeoxycholic acid and chenodeoxycholic acid Laparoscopic cholecystectomy Definition and Overview Cholecystitis refers to inflammation of the gallbladder, which can be acute or Nonsurgical removal chronic in nature. It is commonly caused by gallstones blocking the cystic duct By instrumentation or due to infection, trauma, or structural abnormalities. Intracorporeal or extracorporeal lithotripsy Causes and Risk Factors Pancreatitis Gallstones, the primary cause of cholecystitis, can form due to a variety of Acute: pancreatic duct becomes obstructed, and enzymes back factors such as genetics, obesity, and a high- fat diet. Certain medical up, causing autodigestion and inflammation of the pancreas conditions like diabetes, liver cirrhosis, and Crohn's disease can also increase Chronic: progressive inflammatory disorder with destruction of the the risk of cholecystitis. pancreas; cells are replaced by fibrous tissue; pressure within the  pancreas increases, obstructing the pancreatic and common bile Women of childbearing age ducts 5% present in childhood (puberty) Assessment of the Patient Undergoing Surgery for Gallbladder Disease Rare in children younger than 9 years of age Patient history Chronic, progressive, systemic inflammatory disease that can Knowledge and education needs cause major organs and systems to fail Respiratory status and risk factors for respiratory complications CONNECTIVE TISSUE and FIBRIN deposits collect in blood postoperative vessels on collagen fibers and on organs. Nutritional status The deposits lead to necrosis and inflammation in blood vessels, Monitor for potential bleeding