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Medsurg FINAL study guide

Medsurg FINAL study guide - STUDY GUIDE MED-SURG II SECTION...

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STUDY GUIDE MED-SURG II SECTION I A. Hepatitis B- Contaminated blood products, needles, or surgical equipment Route of Infection- Parenteral, oral, fecal, direct contact, breast milk, & sexual contact. Incubation period- 6-20 weeks (1.5- 5 months) Vaccine available- 3 IM injections B. Cholelithiasis- formation and presence of stones in gallbladder Cholecystitis- inflammation of gallbladder acute associated with stones S&S- indigestion and pain R upper quadrant (maybe acute w/ n&v, restlessness, and diaphoresis) Radiates to scapula 2-4 hrs. after eating fatty food Guarding, rigidity & rebound tenderness Murphy’s sign: cannot take deep breath when examiner are passed below Hepatic margin Dx: H&P, US, ERCP, WBC(d/t inflammation), serum bilirubin, Intervention- Do not usually give morphine or codeine for pain because they can cause spasms T-Tubes- preserves patency of common bile duct after surgery; gravity bag Attached to collect drainage Interventions- Semi fowler’s position Monitor drainage; report odor or purulent drainage Keep drainage system below gallbladder Avoid irrigation, aspiration, or clamping without orders When clamping is prescribed observe for signs of abdominal Discomfort, cramping; unclamp in case of N&V C. Characteristics Ulcerative Colitis- bloody diarrhea 10-20xday & ab pain Chrohn’s Disease- diarrhea & colicky ab pain Diarrhea Common Common Abdominal Cramping Possible Common Fever During acute attack Common Weight Loss Common Severe Rectal Bleeding Common Infrequent Tenesmus (pain&ineffective Straining of Stool) Severe Rare Malabsorption nutritional deficiencies Minimal Common Location Starts distally and spreads In continuous pattern up Any where along GI Frequent site terminal
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colon- continuous Ileum- segmental Distribution Continuous areas of inflam Interspersed (“skip lesions”) Depth Mucosa and submucosa Entire thickness Granulomas Absent Common Cobblestone Rare Common Pseudopolyps Common Rare Small bowel involvement Minimal Common Fistulas Rare Common Strictures Rare Common Anal abscesses Rare Common Toxic Megacolon (>5cm)-----Risk for perforation Sx Common Rare Carcinoma > after 10 yr. w/ disease Slight > si and colon Recurrence after surgery Cure with colectomy 40—60% > rate D. Bowel Obstruction - Mechanical: Adhesions, hernias, Vluvulus (twisting), Intrussuception telescoping), and Tumor Neurogenic: paralytic ileus, spinal cord lesion Vascular: messentric artery occlusion S&S- Constipation, thready stools, rectal bleeding Interventions: NPO, NG tube (low intermittent suction, document q. 8 hrs., irrigate With NS), IV fluids, Surgical Prep, Preop teaching High Bowel Obstruction: ABG’s Alkalotic Low Bowel Obstruction: ABG’s Acidic E. Diverticulitis- Inflammation of one or more Diverticula → diverticulum perforation → can progress to intra abdominal perforation→ peritonitis S&S: Left lower quadrant abdominal pain > with coughing straining or lifting Palpable, tender rectal mass Blood in stool Interventions: Maintain NPO or clear liquid during acute phase Monitor for perforation & hemorrhage Avoid gas forming foods or foods containing indigestible roughage i.e. nuts, and seeds
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Teach pt. to consume sm. Amount of bran or bulk forming laxative daily
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