Abdominal paracentesis and culture of fluid CT scan or ultrasound

Abdominal paracentesis and culture of fluid ct scan

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Abdominal paracentesis and culture of fluid CT scan or ultrasound Peritoneoscopy (Lewis pg.974-975) Intestinal Obstruction - Clinical manifestations o Higher level of obstruction S/S: Rapid onset Profuse, projectile vomiting with bile Vomit usually relieves the abdominal pain Colicky, crampy Intermittent pain Hyperactive bowel sounds above the obstruction Hypoactive/absent bowel sounds below the obstruction o Distal small bowel: Gradual onset, Orange-brown , foul smelling vomitus
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o Large bowel obstruction: May not have vomiting, May eventually vomit fecal material, Vague, diffused, constant pain, Significant abdominal distention Mechanical obstructions Types of Mechanical obstructions= Intussusception= telescoping of bowel, most common in children 1-2 years Fecal impaction= constipation Encirclement or compression of intestine by adhesions, tumors, fibrosis, or strictures Mechanical obstructions: Accounts for 90% of all obstructions Usually requires surgery Most intestinal obstructions are small bowel (adhesions are the most common cause) Most often in the ileum Pain comes and goes in waves due to? Peristalsis Most common cause of large bowel obstruction? Cancer, tumor in colon; colon cancer Carcinoma followed by volvulus and diverticular disease S/S of nonmechanical obstruction: Nonmechanical obstructions (paralytic ileus) Result of decreased peristalsis from: Neurogenic disorders (surgery & spinal cord injury) Vascular disorders (insufficiency & mesenteric emboli) Acute Pancreatitis Appendicitis Electrolyte imbalance (hypokalemia) Inflammatory responses (peritonitis or sepsis) Constant generalized discomfort - Nursing diagnoses for Intestinal Obstruction o Pain: location, duration, intensity, frequency, tenderness/rigidity, o N/V: onset, frequency, color, odor, and amount o Inspection: peristaltic waves=small bowel obstruction. Significant bowel distension= large bowel obstruction o Auscultation= above obstruction= hyperactive, high-pitched bowel sounds , below obstruction= hypoactive/absent o Percussion= if bowel has a lot of air in it then it sounds like tympany o Palpation= tender, guarding? - Acute pain r/t abdominal distention - Fluid volume deficit r/t decreased intestinal fluid absorption and vomiting - Imbalanced Nutrition: less than required r/t obstruction and vomiting - Diagnostic studies for Intestinal Obstruction o History & Physical o Laboratory tests CBC – Inflammation or Infection Elevated WBC = Strangulation, Perforation
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Elevated H&H = Dehydration (blood is more consolidated) Amylase – ? check for pancreatitis BUN – Fluid status Stool – Occult Blood Acid-base balance assessment: Metabolic alkalosis with high obstruction (from high obstructions from loss of gastric hydrochloride and r/t vomiting) Metabolic acidosis with low obstruction (from lower levels of obstruction as alkaline fluids are not absorbed) o Electrolytes – Fluid status ↓ Na, K, CL with small bowel obstructions(related to losses) CT Scan!!
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  • Spring '16
  • Bowel obstruction, paralytic ileus, projectile vomiting

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