CAPÍTULO 2. FORMULACIÓN Y DIAGNÓSTICO DEL PROBLEMA
2.2. PROCESOS DEL TALLER DE RECUPERACIONES
2.2.2. Problema y cuantificación
I. Upper alimentary canal - function for digestion a. Mouth
b. Pharynx (throat) c. Esophagus
d. Stomach- site of digestion e. 1st half of duodenum
II. Middle Alimentary canal – Function: for absorption - Complete absorption – large intestine
a. 2nd half of duodenum for absorption b. Jejunum
c. Ileum
d. 1st half of ascending colon
III. Lower Alimentary Canal – Function: elimination a. 2nd half of ascending colon for elimination b. Transverse for complete absorption— L I c. Descending colon
d. Sigmoid e. Rectum IV. Accessory Organ
a. Salivary gland b. Verniform appendix c. Liver
d. Pancreas – auto digestion e. Gallbladder – storage of bile I. Salivary Glands
1. Parotid – below & front of ear 2. Sublingual
3. Submaxillary
- Produces saliva – for mechanical digestion - 1,200 -1,500 ml/day - saliva produced
Lacrimal gland- depression on the frontal bone Lacrimal duct- outer canthus
PAROTITIS
– ―mumps‖ – inflammation of parotid gland -ParamyxovirusS/Sx:
1. Fever, chills anorexia, generalized body malaise 2. enlarged parotid gland
3. Swelling of parotid gland 4. Dysphagia
5. Earache – otalgia
Mode of transmission: Direct transmission & droplet nuclei Incubation period: 14 – 21 days
Period of communicability – 1 week before swelling & immediately when swelling begins. Nursing Mgt:
1. CBR
2. Institute a strict respiratory isolation 3. Meds: analgesic
Antipyretic
Antibiotics – to prevent 2 complications
5. General liquid to soft diet 6. Complications
Women – cervicitis, vaginitis, oophoritis
Both sexes – meningitis & encephalitis/ reason why antibiotics is needed Men – orchitis might lead to sterility if it occurs during / after puberty. VERNIFORM APPENDIX – Rt. iliac or Rt. inguinal area
- Function – lymphatic organ – produces WBC during fetal life - ceases to function upon birth of baby
APENDICITIS – inflamation of verniform appendix
Predisposing factor: 1. Microbial infection
2. Feacalith – undigested food particles – tomato seeds, guava seeds 3. Intestinal obstruction
S/Sx:
1. Pathognomonic sign: (+) rebound tenderness 2. Low grade fever, anorexia, n/v
3. Diarrhea &/ or constipation
4. Pain at Rt. iliac region-- MCBURNEY‘S point – site of surgical incision 5. Late sign due pain – tachycardia
Rovsing’s sign – elicited by palpating the left lower quadrant; this paradoxically causes pain to be felt in the right lower quadrant.
Diagnosis:
1. CBC – mild leukocytosis – increase WBC
2. PE – (+) rebound tenderness (flex Rt leg, palpate Rt iliac area – rebound) 3. Urinalysis—(+) acetone in urine
Treatment: - appendectomy 24 – 45 Nursing Mgt:
1. Secure consent
2. Routinely nursing measures: a.) Skin prep
b.) NPO
c.) Avoid enema/laxatives – lead to rupture of appendix
3. Meds:
Antipyretic Antibiotics
*Don’t give analgesic – pre-diagnosis will mask pain Give analgesic – post diagnosis
- Presence of pain means appendix has not ruptured. 4. Avoid heat application – will rupture appendix.
5. Monitor VS, I&O bowel sound 6. Maintain a patent IV line Complications:
Peritonitis Septicemia Nursing Mgt: post op
1. If (+) to Penrose drain – indicates rupture of appendix
Position- affected side to drain
2. Meds: analgesic due post op pain Antibiotics, Antipyretics PRN
3. Monitor VS, I&O, bowel sound- N- borborygmy sound 4. Maintain patent IV line
5. Complications- peritonitis, septicemia
PEPTIC ULCER DISEASE – (PUD) – excoriation / erosion of submucosa & mucosal lining due to: a.) Hyper secretion of acid – pepsin
b.) Decrease resistance to mucosal barrier Incidence Rate:
1. Men – 40 – 55 yrs old
2. Aggressive persons/ type A personality 3. Hereditary
4. Emotional Stress Predisposing factors:
1. Hereditary 2. Emotional
3. Smoking – vasoconstriction – GIT ischemia
4. Alcoholism – stimulates release of histamine = Parietal cell release Hcl acid = ulceration 5. Caffeine – tea, soda, chocolate
7. Rapid eating
8. Ulcerogenic drugs – NSAIDS, aspirin, steroids, indomethacin, ibuprofen
Indomethacin - S/E corneal cloudiness. Needs annual eye check up. NSAID and steroids= gastropathy
9. Gastrin producing tumor or gastrinoma – Zollinger Ellisons syndrome 10. Microbial invasion – helicobacter pylori. Metronidazole (Flagyl)
Types of ulcers
Ascending to severity
1. Acute – affects submucosal lining 2. Chronic – affects underlying tissues –
heals & forms a scar, deeper According to location
1. Stress ulcer 2. Gastric ulcer
3. Duodenal ulcer – most common
Stress ulcers – common among critically ill clients 2 types
1. Curling’s ulcer – cause: trauma & Burns Hypovolemia GIT schemia
Decrease resistance of mucosal barriers to Hcl acid Ulcerations
2. Cushing’s ulcer – cause – stroke/CVA/ head injury
Increase vagal stimulation Hyperacidity
Ulcerations
Treatment: Vagotomy - done to prevent hemorrhage and shock prior to surgery on the stomach
GASTRIC ULCER DUODENAL ULCER
SITE Antrum or lesser curvature Duodenal bulb
PAIN - 30 min – 1 hr after eating - epigastrium
- gaseous & burning
- not usually relieved by food & antacid - Eating leads to pain
- 2-3 hrs after eating - mid epigastrium
- cramping & burning pain
- usually relieved by food & antacid - 12 MN – 3am pain
- Eating lessens pain
HYPERSECRETION Normal gastric acid secretion Increased gastric acid secretion
VOMITING common Not common
HEMORRHAGE hematemesis Melena
WT Wt loss Wt gain
COMPLICATIONS a. stomach cancer
b. hemorrhage a. perforation
HIGH RISK 50 or 60 years old and above 20 years old and above INCIDENCE Male; female = 1:1
15% of peptic ulcers are gastric Male: Female = 2-3:1 80% of peptic ulcers are duodenal
90-95% is cases of duodenal ulcers - less bicarbonate ions, decrease so increase incidence Diagnosis:
1. Endoscopic exam
2. Stool from occult blood (+)
3. Gastric analysis – Gastric Ulcer: normal gastric acid secretion Duodenal: increased gastric acid secretion 4. GI series – confirms presence of ulceration
Nursing Mgt:
1. Diet – bland, non irritating, non spicy
2. Avoid caffeine & milk/ milk products Increase gastric acid secretion 3. Administer meds
a.) Antacids ACA
Aluminum containing antacids Magnesium containing antacids
ex. aluminum hydroxide gel ex. milk of magnesia
(Amphogel) S/E diarrhea
S/E constipation Maalox (fever S/E) b.) H2 receptor antagonist:
1. Ranitidine (Zantac) SE: fever
2. Cimetidine (Tagamet)—hastens the effect of oral anticoagulants 3. Famotidine (Pepcid) SE: fever
- Avoid smoking – decrease effectiveness of drug Nursing Mgt:
1. Administer antacid & H2 receptor antagonist (Cimetidine) – 1hr apart -Cemetidine decrease antacid absorption & vise versa c.) Cytoprotective agents
Ex
1. Sucralfate (Carafate) - Provides a paste like subs that coats mucosal lining of stomach 2. Misoprostol (Cytotec) –SE: menstrual spotting
d.) Sedatives/ Tranquilizers - Valium, lithium e.) Anticholinergics / Antispasmodic
1. Atropine SO4
2. Prophantheline Bromide (Profanthene)
(Pt has history of hpn crisis with peptic ulcer disease. Rn should not administer alka seltzer- has large amount of Na. 3. Surgery: subtotal gastrectomy - Partial removal of stomach
Billroth I (Gastroduodenostomy) Removal of ½ of stomach & anastomoses of
gastric stump to the duodenum.
Billroth II (Gastrojejunostomy)
Removal of ½ -3/4 of stomach & duodenal bulb & anastomostoses of gastric stump to jejunum. Before surgery for BI or BII - Do vagotomy (severing of vagus nerve) & pyloroplasty (drainage) first.
Nursing Mgt:
1. Monitor NGT output or drainage immediately post op- bright red a.) Immediately post op should be bright red
b.) Within 36- 48h – output is yellow green c.) After 48h – output is dark red due to HCl acid 2. Administer meds:
a.) Analgesic b.) Antibiotic c.) Antiemetics 3. Maintain patent IV line 4. VS, I&O & bowel sounds 5. Complications:
a.) Hemorrhage – hypovolemic shock Late signs – anuria
b.) Peritonitis
c.) Paralytic ileus – most feared d.) Hypokalemia
e.) Thrombophlebitis f.) Pernicious anemia g.) Septicemia
7.) Dumping syndrome – common complication – rapid gastric emptying of hypertonic food solutions – CHYME leading to hypovolemia. Sx of Dumping syndrome: 1. Dizziness 2. Diaphoresis 3. Diarrhea 4. Palpitations Nursing mgt:
1. Avoid fluids in chilled solutions, sweets (fluids must be taken after meals)
2. Small frequent feedings-6 equally divided feedings 3. Diet – decrease CHO, moderate fats & CHON 4. Flat on bed 15 -30 minutes after q feeding