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Gastrointestinal 5
- Management
- sclerotherapy - injection of a sclerosing agent into varices
- balloon tamponade
- sangstaken-Blakemore tube is inserted into the stomach
- gastric balloon is inflated and presses on lower esophagus while allowing suctioning
- esophageal balloon places pressure on varices
- pressure is released as ordered to prevent necrosis
- traction for increased pressure added by attaching tube to football helmet
- assess for bleeding and signs of shock
- assess for respiratory distress - aspiration or displacement of tube, suction PRN
- keep head of bed elevated
- medications
- vasopressin
- nitroglycerin will decrease myocardial effects
- beta-adrenergic neuron-blocking agentsmay decrease risk of recurrent bleeding by decreasing pressure in portal system
- cathartics to remove blood from GI tract and decrease absorption of ammonia
- surgical intervention
- shunt to decrease blood flow to liver and therefore pressure Splenorenalshunt
- TIPS (transjugular intrahepatic portosytsemic shunt) - shunt placed between hepatic and portal vein
- Nursing interventions
- prevent bleeding
- avoid intake of alcohol, irritating or rough food
- avoid increased pressure in abdomen
- if bleeding occurs - administer transfusions, fresh frozen plasma, vitamin K
- monitor for infection
- Ascites
- Definition/etiology - accumulation of fluid in the peritoneum
- Pathophysiology
- portal hypertension causes increased plasma and lymphatic hydrostaticpressure in portal system
- hypoalbuminemia causes decreased colloid osmotic pressure
- hyperaldosteronism due to liver's inability to metabolize aldosteronecauses body to retain sodium and water
- Findings
- abdominal distention, protruding umbilicus, dull sound on percussionof abdomen, fluid wave
- bulging flank
- dyspnea
- Diagnostics
- abdominal x-ray
- CT scan
- ultrasound
- Medical management
- diuretics - spirnolactone (Aldactone) - aldosterone antagonist, spares potassium
- iv albumin
- paracentesisto remove fluid
- diet low in sodium
- peritoneal venous shunt - allows drainage of fluid from the peritoneum to superior vena cava
- Nursing interventions
- abdomen will have excess fluid, blood vessels too little
- measure I & O, daily weight, abdominal girth, skin turgor
- restrict fluids
- monitor for ineffective breathing patterns
- semi-Fowler's position
- monitor for impaired skin integrity
- remedy knowledge deficit
- Hepatic encephalopathy - mental dysfunction associated with severe liver disease
- Definition/etiology
- impaired ammonia metabolism in liver poisons brain tissue
- ammonia produced in bowel from action of bacteria on protein
- Findings
- changes in LOC from confusion to coma
- changes in sleep pattern
- memory loss
- asterixis - flapping tremor
- impaired handwriting
- hyperventilationwith respiratory alkalosis
- fetor hepaticus - musty, sweet odor to breath
- Diagnostics - serum ammonia level
- Management
- neomycin sulfate (Mycifradin) - inhibits action of intestinal bacteria
- lactulose (Cephulac) - absorbs ammonia and produces evacuation of the bowel
- low protein diet
- Nursing interventions
- tremor, confusion can lead to injury: maintain safety
- ascites and low intake decrease fluid volume
- diarrhea from medications
- Disorders of Pancreas and Gallbladder
- Acute pancreatitis
- Definition/etiology - inflammation of the pancreas
- alcohol ingestion
- gall stones
- drug ingestion
- viral infections
- trauma
- Pathophysiology
- autodigestion from premature activation of pancreatic enzymes
- proteases and lipases, normally active in small intestine, are activated in the pancreas
- phospholipase A digests adiposeand parenchymal tissues
- elastase digests elastic fibers of blood vessels, producing bleeding
- amylase digests carbohydrates
- inflammation response occurs from enzyme release
- Findings
- left upper quadrant abdominal pain
- pain worsens after eating and when lying flat
- nausea and vomiting
- fever, agitation, confusion
- hypovolemiaand shock
- hemorrhage into retroperitonealspace may produce ecchymosisin flank or around umbilicus
- tachypnea, pulmonary infiltrates, atelectasisfrom circulating enzymes
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