Care of-clients-with-problems-in-oxygenation-part-3


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Care of-clients-with-problems-in-oxygenation-part-3

  1. 1.  Examination of the upper GI tract under fluoroscopy after the client drinks barium sulfate
  2. 2.  NPO after midnight the day of the test A laxative may be prescribed Instruct client to increase oral fluid intake to help pass the barium Monitor stools for the passage of barium (chalky white stools) because barium can cause a bowel obstruction
  3. 3.  A fluoroscopic and radiographic examination of the large intestine is performed after rectal instillation of barium sulfate
  4. 4.  A low-residue diet is given for 1 to 2 days before the test A clear liquid diet and laxative are given the evening before the test NPO after midnight the day of the test Cleansing enemas on the morning of the test
  5. 5.  Instruct client to increase oral fluid intake to help pass the barium Administer a mild laxative as prescribed to facilitate emptying of the barium Monitor stools for the passage of barium Notify the physician if a bowel movement does not occur within 2 days
  6. 6.  Requires the passage of a nasogastric tube into the stomach to aspirate gastric contents for the analysis of acidity, appearance, and volume; the entire gastric contents are aspirated, and then specimens are collected every 15 minutes for 1 hour
  7. 7.  Fasting for 8 to 12 hours is required before the test Tobacco and chewing gum are avoided 6 hours before the test Client may resume normal activities after Refrigerate gastric samples if not tested within 4 hours
  8. 8.  Also known as esophagogastroduodenoscopy Following sedation, an endoscope is passed down the esophagus to view the gastric wall, sphincters, and duodenum; tissue specimens can be obtained
  9. 9.  The client must be NPO for 6 to 12 hours before the test A local anesthetic (spray or gargle) is administered along with medication that provides conscious sedation and relieves anxiety, such as IV midazolam (Versed), just before the scope is inserted
  10. 10.  Atropine sulfate may be administered to reduce secretions Client is positioned on the left side to facilitate saliva drainage and to provide easy access of the endoscope Airway patency is monitored during the test and pulse oximetry is used to monitor oxygen saturation
  11. 11.  Client must be NPO after the procedure until gag reflex returns Monitor for pain, bleeding, unusual difficulty swallowing, elevated temperature Maintain bed rest for the sedated client until alert
  12. 12.  Requires the use of a rigid scope to examine the anal canal Client is placed in the knee-chest or left lateral position
  13. 13.  Require the use of a flexible scope to examine the rectum and sigmoid colon The client is placed on the left side with the right leg bent and placed anteriorly
  14. 14.  Enemas are given before the procedure until the returns are clear Monitor for rectal bleeding and signs of perforation and peritonitis
  15. 15.  The lining of the large intestine is visually examined; biopsies can be performed Performed with the client lying on the left side with the knees drawn up to the chest; position may be changed during the test to facilitate passing of the scope
  16. 16.  A clear liquid diet is started on the day before the test Consult the physician regarding medications that must be withheld before the test Client is NPO after midnight on the day of the test
  17. 17.  Midazolam (Versed) is administered intravenously to provide sedation Provide bed rest until alert Monitor for signs of bowel perforation and peritonitis Instruct the client to report any bleeding
  18. 18.  Examination of the hepatobiliary system is performed via a flexible endoscope inserted into the esophagus to the descending duodenum Multiple positions are required during the procedure to pass the endoscope
  19. 19.  Client is NPO for several hours before the procedure Sedation is administered before the procedure Monitor vital signs Monitor for the return of the gag reflex
  20. 20.  Transabdominal removal of fluid from the peritoneal cavity for analysis
  21. 21.  Have client void before the start of the procedure to empty the bladder and to move the bladder out of the way of the paracentesis needle Measure abdominal girth, weight, and baseline vital signs Fowler’s position is used for the client confined to bed
  22. 22.  Monitor vital signs Measure fluid collected, describe and record Label fluid samples and send to the laboratory for analysis Apply a dry sterile dressing to the insertion site; monitor site for bleeding
  23. 23.  Measure abdominal girth and weight Monitor for hematuria Instruct the client to notify the physician if the urine becomes bloody, pink, or red
  24. 24.  A needle is inserted through the abdominal wall to the liver to obtain a tissue sample for biopsy and microscopic examination
  25. 25.  Assess results of coagulation tests Administer a sedative as prescribed Position client supine or left lateral to expose the right side of the abdomen Assess vital signs
  26. 26.  Asses biopsy site for bleeding Monitor for peritonitis Maintain bed rest for several hours Place the client on the right side with a pillow after the procedure Instruct the client to avoid coughing and straining as well as heavy lifting for 1 week
  27. 27.  Detects the presence of Helicobacter pylori, the bacteria that cause peptic ulcer disease The client consumes a capsule of carbon-labeled urea and provides a breath sample10 to 20 minutes later
  28. 28.  Is the backflow of gastric and duodenal contents into the esophagus The reflux is caused by an incompetent lower esophageal sphincter, pyloric stenosis, or motility disorder
  29. 29.  Pyrosis Dyspepsia Regurgitation Pain and difficulty with swallowing Hypersalivation
  30. 30.  Instruct the client to avoid factors that decrease lower esophageal sphincter pressure or cause esophageal irritation Instruct the client to eat a low-fat, high fiber diet Instruct client to avoid anticholinergics Instruct client to avoid caffeine, tobacco, and carbonated beverages
  31. 31.  Instruct client to avoid eating and drinking 2 hours before bed time, and wearing tight clothes Elevate the head of the bed on a 6 to 8 inch blocks Instruct the client regarding prescribed medications, such as antacids, H2- receptor antagonists, or proton pump inhibitors
  32. 32.  Inflammation of the stomach or gastric mucosa Caused by ingestion of food contaminated with disease causing microorganisms or food that is too irritating, or too highly seasoned, the overuse of aspirin and NSAIDS, excessive alcohol intake, smoking, or reflux
  33. 33.  Abdominal discomfort Anorexia, nausea,and vomiting acute Headaches Hiccuping
  34. 34.  Anorexia, nausea,and vomiting Belching Heartburn after eating chronic Sour taste in the mouth Vitamin B12 deficiency
  35. 35.  Food and fluids may be withheld until symptoms subside; afterward, ice chips can be given followed by clear fluids, and then solid food Monitor for signs of hemorrhagic gastritis such as hematemesis, tachycardia and hypotension
  36. 36.  Instruct client to avoid irritating foods, fluids and other substances, such as spicy and highly seasoned foods, caffeine, alcohol, and nicotine
  37. 37.  Is an ulceration in the mucosal wall of the stomach, pylorus duodenum, or esophagus in portions accessible to gastric secretions May be referred to as gastric, duodenal, esophageal, depending on its location The most common are gastric and duodenal ulcers
  38. 38.  Antral region and  Pyloric region lesser curvature Peak age 50-60  Peak age 30-45 years old years old Normal to  Increased acid decreased acid secretion secretion  Melena Hematemesis
  39. 39.  H. pylori (60-80%)  H. pylori (100%) Food-pain pattern  Pain-food-relief pattern Weight loss is  No weight loss common Gnawing sharp pain  Burning pain occurs in or left of the in the midepigastric midepigastric region area 1 ½ to 3 hours 30 – 6o minutes after after a meal and meal during the night
  40. 40.  Monitor vital signs and for signs of bleeding Administer small, frequent bland feedings during the active phase Administer H2 antagonist as prescribed to decrease the secretion of gastric acid Administer antacids as prescribed to neutralize gastric seretions
  41. 41.  Administer anticholinergics as prescribed to reduce gastric motility Administer mucosal barrier protectants as prescribed 1 hour before each meal Inform client to avoid consuming alcohol and substances that contain caffeine or chocolate Avoid aspirin or NSAIDs
  42. 42.  Avoid smoking Obtain adequate rest and reduce stress
  43. 43.  Total Gastrectomy – removal of the stomach with attachment of the esophagus to the jejunum or duodenum Billroth 1 – partial gastrectomy, with the remaining segment anastomosed to the duodenum
  44. 44.  Billroth 2 – Partial gastrectomy with the remaining segment anastomosed to the jejunum Pyloroplasty – enlargement of the pylorus to prevent or decrease pyloric obstruction, thereby enhancing gastric emptying
  45. 45.  Monitor vital signs Place in a Fowler’s position for comfort and to promote drainage Monitor intake and output Administer fluids and electrolytes as prescribed
  46. 46.  Assess bowel sounds Monitor nasogastric suction as prescribed Do not irrigate or remove the nasogastric tube; assist physivian in irrigation and removal Maintain NPO status as prescribed for 1 to 3 days until peristalsis occurs
  47. 47.  Progress the diet from NPO to sips of clear water to six small bland meals a day, as prescribed when bowel sounds return Monitor for postoperative complications of hemorrhage, dumping syndrome, diarrhea, hypoglycemia, and vitamin B12 deficiency
  48. 48.  The rapid emptying of the gastric contents into the small intestine that occurs following gastric resection Symptoms occurring 30 minutes after eating Nausea and vomiting
  49. 49.  Feelings of abdominal fullness and abdominal cramping Diarrhea Palpitations and tachycardia Perspiration Weakness and dizziness Borborygmi
  50. 50.  Eat a high-protein, low carbohydrate diet Eat small meals and avoid consuming fluids with meals Lie down after meals Take antispasmodic as prescribed to delay gastric emptying
  51. 51.  An inflammatory disease that can occur at anywhere in the GI tract but most often affects the terminal ileum and leads to thickening and scarring, a narrowed lumen, ulcerations, and abscesses Characterized by remissions and exacerbations
  52. 52.  Fever Cramp-like and colicky pain after meals Diarrhea, which may contain pus and mucus Abdominal distention Anorexia, nausea, and vomiting
  53. 53.  Weight loss Anemia Dehydration Electrolyte imbalances
  54. 54.  Restrict clients activity to reduce intestinal activity Monitor bowel sounds and for abdominal tenderness and cramping Monitor stools, noting color, consistency and the presence of blood
  55. 55.  Instruct client to avoid gas-forming foods, milk products, nuts, raw fruits and vegetables, pepper, alcohol, and caffeine containing products Instruct the client to avoid smoking
  56. 56.  Inflammation of the gallbladder that may occur as an acute or chronic process Acute inflammation is associated with cholelithiasis Chronic cholecytitis results when inefficient bile emptying and gallbladder muscle wall disease cause fibrotic and contracted gallbladder
  57. 57.  Acalculous cholecystitis occurs in the absence of gallstones and is caused by bacterial invasion via the lymphatic or vascular system
  58. 58.  Nausea and vomiting Inidgestion Belching Flatulence Epigastric pain that radiates to the scapula 2 to 4 hours after eating fatty foods and may persist for 4 to 6 hours
  59. 59.  Pain localized in the right upper quadrant Guarding, rigidity, and rebound tenderness Mass palpated in the right upper quadrant Murphy’s sign
  60. 60.  Elevated temperature Tachycardia Signs of dehydration Jaundice Dark orange and foamy urine Steatorrhea and clay-colored feces
  61. 61.  Maintain NPO status during nausea and vomiting episodes Maintain nasogastric decompression as prescribed for severe vomiting Administer antiemetics as prescribed Administer analgesics as prescribed (morphine sulfate and codeine sulfate are avoided)
  62. 62.  Administer antispasmodics as prescribed to relax smooth muscles Instruct the client with chronic cholecystitis to eat small, low-fat meals Instruct the client to avoid gas forming foods Prepare the client for surgical interventions
  63. 63.  Cholecystectomy – is the removal of the gallbladder Choledocholithotomy – requires incision into the common bile duct to remove the stone Surgical procedures may be performed by laparoscopy
  64. 64.  Monitor for respiratory complications caused by pain at the incisional site Encourage coughing and deep breathing Encourage early ambulation Instruct the client about splinting the abdomen to prevent discomfort during coughing
  65. 65.  Administer antiemetics as prescribed for nausea and vomiting Administer analgesics as prescribed for pain relief Maintain NPO status and nasogastric tube suction as prescribed Advance diet from clear liquids to solids when prescribed as tolerated by the client
  66. 66.  Maintain and monitor drainage from the T tube, if present
  67. 67.  A T tube is placed after surgical exploration of the common bile duct. The tube preserves patency of the duct and ensures drainage of bile until edema resolves and bile is effectively draining into the duodenum] A gravity drainage bag is attached to the t tube to collect the drainage
  68. 68.  Position the client in a semi-Fowler’s position to facilitate drainage Monitor the amount, color, consistency, and odor of the drainage Report sudden increases in bile output to the physician Monitor for inflammation and protect the skin from irritation
  69. 69.  Keep the drainage system below the level of the gallbladder Monitor for foul odor and purulent drainage and report its presence to the physician Avoid irrigation, aspiration, or clamping of the T tube without a physician’s order
  70. 70.  Inflammation of the pancreas appears to be caused by a process called autodigestion Commonly associated with excessive alcohol consupmtion
  71. 71.  Abdominal pain (midepigastric or left upper quadrant) with radiation to the back Pain aggravated by a fatty meal or alcohol Abdominal tenderness and guarding
  72. 72.  Nausea and vomiting Weight loss Cullen’s signs Turner’s sign Absent or decreased bowel sounds
  73. 73.  Elevated WBC, glucose, and bilirubin Elevated serum lipase and amylase levels
  74. 74.  Maintain NPO status and maintain hydration with IV fluids as prescribed Administer parenteral nutrition for severe nutritional depletion Administer supplemental preparations and vitamins and minerals to increase caloric intake if prescribed
  75. 75.  Maintain nasogastric tube to decrease gastric distention and suppress pancreatic secretion Administer meperidine hydrochloride as prescribed for pain Administer antacids as prescribed Administer H2 receptor antagonists as prescribed
  76. 76.  Administer anticholinergics as prescribed Instruct the client in the importance of avoiding alcohol Instruct the client in the importance of follow-up visits with the physician Instruct the client to notify the physician if acute abdominal pain, jaundice, clay- colored stools, or dark colored urine develops
  77. 77.  Continual inflammation and destruction of the pancreas, with scar tissue replacing pancreatic tissue The acinar, or enzyme-producing cells of the pancreas ulcerate in response to inflammation
  78. 78.  Abdominal pain and tenderness Left upper quadrant mass Steatorrhea and foul-smelling stools that may increase in volume Weight loss Muscle wasting Jaundice
  79. 79.  Instruct client to limit fat and protein intake Instruct the client to avoid heavy meals Instruct the client about the importance of avoiding alcohol Provide supplemental preparations
  80. 80.  Administer pancreatic enzymes as prescribed Administer insulin and oral hypoglycemic agents as prescribed Instruct the client in the importance of follow-up visits
  81. 81.  Also known as gluten enteropathy or celiac sprue Intolerance to gluten, the protein component of wheat, barley, rye, and oats Results in the accumulation of the amino acid glutamine, which is toxic to intestinal mucosal cells
  82. 82.  Intestinal villi atrophy occurs, which affects absorption of ingested nutrients
  83. 83.  Acute or insidious diarrhea Steatorrhea Anorexia Abdominal pain Muscle wasting
  84. 84.  Vomiting Anemia Irritability
  85. 85.  Maintain a gluten-free diet, substituting corn and rice as grain sources Instruct parents and child about lifelong elimination of gluten sources such as wheat, rye, oats, and barley Administer mineral and vitamin supplements
  86. 86.  Teach client about a gluten-free diet and about reading food labels carefully for hidden sources of gluten
  87. 87.  React with gastric acid to produce neutral salts or salts of low acidity Inactivate pepsin and enhance mucosal protection but do not coat the ulcer crater Taken 1 t0 3 hours after each meal
  88. 88.  Should be chewed thoroughly and followed with a glass of milk or water Aluminum hydroxide preprations Calcium carbonate (Tums) Magnesium hydroxide preparations Sodium bicarbonate
  89. 89.  Misoprostol (Cytotec) › Suppresses secretion of gastric acid › Promotes secretion of bicarbonate and cytoprotective mucus Sucralfate (Carafate) › Creates a protective barrier against acid and pepsin
  90. 90.  Cimetidine (Tagamet) › Food reduces rate of absorption Ranitidine (Zantac) › Not affected by food Famotidine (Pepcid) › Not affected by food
  91. 91.  Suppress gastric acid secretion Headache, diarrhea, abdominal pain, and nausea Esomperazole (Nexium), Lansoprazole (Prevacid), Omeprazole (Prilosec)
  92. 92.  To control vomiting and motion sickness Monitor for drowsiness and protect the client from injury Ondansetron (Zofran), Metoclopramide (Reglan), Promethazine hydrochoride (Phenergan)