1 / 68

Nursing of Adult Patients with Medical & Surgical Conditions

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

liza
Download Presentation

Nursing of Adult Patients with Medical & Surgical Conditions

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. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Nursing of Adult PatientswithMedical & 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 • 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.)

  26. Cirrhosis • Alteration of liver function • Reduced ability to metabolize albumin • Obstruction of portal vein • Increased pressure in the veins that drain the GI tract

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

  28. Ascites • accumulation of fluid and albumin in the peritoneal cavity

  29. 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

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

  31. 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

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

  33. 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

  34. 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

  35. Cirrhosis • 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

  36. LeVeen Peritoneal Jugular Shunt Paracentesis

  37. 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

  38. Sengstaken-Blakemore Tube

  39. 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

  40. 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

  41. 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

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

  43. Hepatitis • Signs & Symptoms • General malaise • Aching muscles • Photophobia • Headaches • Chills • Abdominal pain • Dyspepsia • Nausea

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

  45. 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

  46. 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

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

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

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

More Related