Inflammation Student PPT-FA2022 (4) (1) PDF

Inflammation Acute Abdominal Conditions ALEXANDRA DEES MSN, RN  This Photo by Unknown Author is licensed under CC BY-NC-ND https://create.kahoot.it/share/inflammation-fa-22/ d980510e-12c7-4895-a953-988cd6bb9637 Concept of Inflammation  Inflammation, or inflammatory response, is the body’s...

Inflammation Acute Abdominal Conditions ALEXANDRA DEES MSN, RN  This Photo by Unknown Author is licensed under CC BY-NC-ND https://create.kahoot.it/share/inflammation-fa-22/ d980510e-12c7-4895-a953-988cd6bb9637 Concept of Inflammation  Inflammation, or inflammatory response, is the body’s protective response injury, allergens, or infection. With infection, this response eliminates pathogens and with injury, it allows for tissue repair (Taylor et al., 2015).  The nurse plays an important role in identifying clients at risk for inflammation as well as provide treatment for clients experiencing inflammatory responses to infection or injury. Gallbladder Disease  Pear-Shaped, hollow, saclike organ  Lies in a shallow depression on the inferior surface of the liver  Connected to the common bile duct (CBD) by the cystic duct  Function  Primary role is to store bile  Bile helps digestive system bread down fats  Bile is a mixture of mainly cholesterol, bilirubin, and bile salts  Composed of water and electrolytes( sodium, K, Ca, Chloride and Bicarb)  Gallstones  Cholelithiasis  Hardened deposits of digestive fluid that forms in the gallbladder  Causes  Too much cholesterol (cholesterol gallstones)  Too much bilirubin (pigment gallstones)  Poor emptying of the gallbladder  Risk Factors  Chart 44-1 Cholelithiasis  Clinical Manifestations  Pain and Biliary Colic  Avoid Morphine  Right Abdominal pain, Radiating back and shoulder  Jaundice  Obstruction of the CBD  Bile absorbed by blood giving skin yellow appearance  Changes in Urine and Stool Color  Dark Color Urine  Stool (Grayish or Clay colored)  Vitamin Deficiency  Absorption of Vitamins A,D,E and K Cholecystitis  inflammation of the gallbladder which can be acute or chronic  Calculous  90% of cases  Stone obstructs bile flow  Acalculous  Acute gallbladder inflammation (No obstruction)  Occurs after major surgical procedure Cholecystitis  Clinical Manifestations  Pain  Tenderness  Rigidity of the upper right abdomen (radiates to the midsternal or Right shoulder)  N/V  Empyema ( gallbladder filled with purulent fluid)  Gallbladder Disease  Assessment and Diagnostic Findings Table 44-1 – Studies Used in the Diagnosis of Biliary Tract and Pancreatic Disease Page 1420 ERCP  Gallbladder disease  Medical Management  Nutritional and Supportive Therapy  IV Fluids, NG Suction, Analgesia, Antibiotic  Dietary Management  Low Fat Diet  Avoid Eggs, cream, pork, fried foods, cheese, rich dressings, gas-forming vegetables, and alcohol  Pharmacologic Therapy  Ursodeoxycholic acid (UDCA) and chenodeoxycholic acid (chenodiol or CDCA) Nonsurgical and Surgical  Nonsurgical Removal of Gallstones  Infusion of Solvents inserted via tube or drain (T-Tube drain)  Catheter and instrument utilizing a basket via a tube  Lithotripsy  ERCP  Surgical  Cholecystectomy  Standard of treatment  Laparoscopic Cholecystectomy  Review the Nursing Process  The patient undergoing surgery for Gallblader Disease (Page 1426)  Patient Education  Chart 44-2  Figure 44-5 In laparoscopic cholecystectomy (A), the surgeon Page 1428 makes four small incisions (less than one half inch each) in the abdomen and inserts a laparoscope with a miniature camera through the umbilical incision (B). The camera apparatus displays the gallbladder and adjacent tissues on a screen, allowing the surgeon to visualize the sections of the organ for removal.  Pancreas  Function  Aids in digestion of food by: excretingenzymes such as lipase, amylase, and protease secretes hormones to regulate blood sugar levels Pancreatitis  Acute or chronic  Chronic often not detected until severe exocrine function lost  Acute does not lead to chronic unless complications  Chronic can have acute episodes  Gerontologic Considerations  Mortality rate of acute pancreatitis increases with age  Multiple organ dysfunction syndrome (MODS) increases with age  Require aggressive tx to decrease mortality Pancreatitis  Clinical manifestations  Severe epigastric abdominal pain (radiate to the back)  Occurs after heavy meal  Vomiting (Bile-stained)  Assessment  Serum Levels  Diagnostic Tests Pancreatitis  Medical Management  Pain Control  NPO  Maintaining circulatory and fluid volume  Decrease production of pancreatic enzymes  IV Fluid replacement  Electrolyte replacement  NG Tube  Nursing Management-Patient Education  Alcohol Consumption  Diet  High in Carbs, Low protein and Fats  Avoid Beverages with Caffeine  Diagnostic Tests  Drug Therapy  Concept Map  Enter Pathophysiology  Signs and Symptoms  Assessment  What assessment findings would support that the patient is having an inflammatory response?  Diagnostics/Labs  What diagnostics or lab values would support an inflammatory process and infection?  Treatment/Medications  Nursing Implications  Priority Nursing Diagnosis  Patient Teaching  Diverticular Disorder Patho/Overview  Diverticulum  Saclike herniation of bowel lining  Most common in colon  Diverticulosis  Multiple diverticula  No inflammation or s/s  Risk Factors: low intake dietary fiber, obesity, Hx of smoking cigs, regular use of NSAIDS and acetaminophen, + family hx  Diverticulitis   Diverticula inflamed  Leads to perforation, obstruction, abscess, fistula, peritonitis, hemorrhage Clinical Manifestations  Diverticulosis  Chronic Constipation  Mild S/S  Bowel irregularity  Nausea  Decreased appetite  Bloating  Diverticulitis  Acute Onset ranges from mild to severe, pain LLQ  Change in bowel habits, nausea, fever, leukocytosis  Complications  Abscess, bleeding, peritonitis–(Beware possible Acute Abdomen)  Perforation causes pain over involved segment-local abscess, peritonitis follows  Recurrent diverticulitis-chronic complications-fistula, cramps, narrow stools, obstruction  Assessment/Diagnostic Findings  Diverticulosis  Colonoscopy  CBC (Increased WBC), H&H  UA, c+s  Diverticulitis  CT with contrast  ABD Xray  Gerontology Considerations  S/S less pronounced  No pain until infection  Delay reporting out of fear Sx and Cancer  Medical Management  Treatment based on complications  Hinchey stages- Table 47-3  Stage 1- treated on an outpatient basis  Acute Diverticulitis with symptoms- hospitalization  Higher stages (3&4) surgery and hospitalization  NPO  IVF  NGT if N/V and distention  Broad spectrum Abx  Opiods for pain  Increased PO intake when s/s resolve- High FIBER diet, Low fat Surgical Management  Usually resolved with medical management  Immediate SX for complications  Stage 3 and 4 diverticulitis- SX possible  2 types of surgery 1 stage- inflamed area removed, end to end anastomosis  Multistage-for complications or perforation End to end anastomosis preffered Stage 4-Hartmann procedure- leads to ostomy creation Nursing Management  Encourage PO fluid intake  Educated soft foods with increased fiber  Exercise program  Eating and defecating schedule  Daily bulk laxatives  Avoid triggers (nuts, popcorn) Peritonitis  Inflammatory process  Bacterial proliferation  Edema  Exudate  Peritoneal fluid changes  Hypermotility  Paralytic ileus Early Clinical Manifestations  Early s/s mimic original infection or inflammation process  Discomfort  Abdominal Distention/Tenderness  Temperature 37.8-38.3  Increased HR Peritonitis Progression  Anorexia-N/V  Decreased Peristalsis  Paralytic Ileus  Hypotensive  Sepsis/Septic Shock Peritonitis-Labs/Diagnostic  WBC  Hgb/Hct  Electrolytes  K, NA,Cl  Abdominal Xray  Abdominal U/S  CT scan of abdomen  U/S guided aspiration  C & S Studies Peritonitis- Management  Fluids  Electrolytes  Analgesics  Antiemetics  Oxygen therapy  Antibiotics  Surgery  CT-drainage Improvement VS Complications  Improvement  Temperature  HR  Abdomen Assessment  Peristalsis  Flatus  BM  Complications  Temp  HR  Abdomen Assessment  Emergency Sx