Peritonitis
1. Life-threatening acute inflammation of visceral/parietal peritoneum and endothelial lining of abdominal cavity, or peritoneum
2. Primary or secondary peritonitis
3. Rigid, boardlike abdomen, abdominal pain, distended abdomen, high fever, tachycardia, d
Peritonitis Nonsurgical Management
IV fluids
Broad-spectrum antibiotics
Daily weight monitored
Fluid volume assessed
Nasogastric suctioning
NPO status
Oxygen
Pain management
Peritonitis Surgical Management
Exploratory laparotomy
Semi-Fowler's position
Wound care:
----Care of the incisions and drains
----Peritoneal irrigation
----IV fluid replacement
Inflammatory Bowel Disease (IBD)
Several disorders of the GI tract with no known etiology
1. Ulcerative colitis
2. Crohn's disease
Ulcerative Colitis
Widespread inflammation of mainly the rectum and rectosigmoid colon; can extend to the entire colon
Associated with periodic remissions and exacerbations
Tenesmus
Loose stools containing blood and mucus, poor absorption of vital nutrients, and thickening
Ulcerative Colitis Drug Therapy
Aminosalicylates
Glucocorticoids
Immunomodulators
Antidiarrheal drugs
Other drugs
Total Colectomy with a Continent (Kock's) Ileostomy
Internal ileal reservoir
Intra-abdominal pouch created from the terminal ileum by the surgeon
Stool stored in the pouch drained by catheter
Care of pouch
Effluent, or drainage, monitored
Total Colectomy with Ileoanal Anastomosis (J Pouch)
Removal of the colon and the rectum with the ileum sutured into the anal canal
Spares the rectal sphincter and need for an ostomy
Crohn's Disease
Inflammatory disease of the small intestine and the colon, or both.
It can affect the GI tract from mouth to anus but mostly the terminal ileum.
Transmural inflammation causing thickening of the bowel wall with strictures and deep ulcerations with bowel f
Bone Cancer
1. Primary or Secondary
2. Exact causes is unknown
3. Previous radiation therapy in the anatomic area is a big risk factor
4. Can metastasize to lungs
5. Primary tumors of the prostate, breast, kidney, thyroid and lung are called bone seeking cancers beca
Osteosarcoma
most common type of primary malignant bone tumor, typically metastasizes
Ewing's sarcoma
1. Pelvis and lower extremity are most often affected.
2. Pelvic involvement is a poor prognosis because it often extends into soft tissue
3. ESR elevated from tissue inflammation
4. Anemia may be seen
Chondrosarcoma
dull pain and swelling for a long period
Fibrosarcoma
gradual, without specific symptoms
Bone Cancer Assessment
Ask whether or not the patient has had previous radiation therapy
S&S vary depending on the specific type of lesion
Usually the patient has a group of non specific concerns- pain, local swelling and a tender, palpable mass
Elevated serum alkaline phosphat
Chemotherapy
1. These drugs are high alert medications
2. Cytokines- stimulate immune system
3. Bisphosphonates- help protect bones and prevent fractures
Allografts
1. transplant bone from another human
2. observe for signs of hemorrhage, infection or fracture. Report these changes to the surgeon immediately.
Bone Cancer Post op care includes:
Pressure dressing for several days
Impaired physical mobility
Self care deficit
Muscle strengthening and ROM begin immediately post op
Assess neurovascular status of affected extremity every 1-2 hours
Prevent wound infection
Emotional support
Altered body
Colorectal Cancer (CRC)
Colorectal refers to the colon and the rectum, which together make up the large intestine.
Most CRCs are adenocarcinomas.
Etiology:
----Age older than 50 years
----Genetic predisposition
----Personal or family history of cancer
----Familial adenomatous po
Clinical Manifestations of Colorectal Cancer
1. Most common signs�rectal bleeding, anemia, and a change in the stool.
2. The clinical manifestations of colon rectal cancer depend on the location of the tumor.
Colorectal Cancer Labs
Hemoglobin and hematocrit values usually decreased
Fecal occult blood test
Possible elevation of carcinoembryonic antigen
Imaging assessment
Other diagnostic tests-sigmoidoscopy or colonoscopy
Genetic counseling
Progressive Muscular Dystrophies
1. Exact causes unknown
2. Four forms seen in adults
3. Primary problem is progressive muscle weakness
4. Major cause of death is respiratory failure
5. Diagnosis is difficult
6. Muscle weakness and trophic changes are characteristic of all types of muscu
Muscular Dystrophy Collaborative Care
Supportive
Physical and occupational therapy for mobility and independence
Life span is often shortened
Steroids found to slow the progression
Muscular Dystrophy Nursing Care
1. Nursing focuses on making the patient comfortable and reinforcing techniques taught by physical therapy program
2. Gower's Maneuver- use this maneuver to stand
3. Nursing care for organ involvement
------Cardiac, Respiratory, GI, GU
Gower's Maneuver
a medical sign that indicates weakness of the proximal muscles, namely those of the lower limb. The sign describes a patient that has to use their hands and arms to "walk" up their own body from a squatting position due to lack of hip and thigh muscle str
Osteomyelitis
1. Infection in bony tissue
2. Inflammatory response produces increased vascular leak and edema often involving the surrounding tissue
3. Pus is released into bony tissue followed by ischemia
4. Necrotic bone separates from surrounding bone tissue forming
Osteomyelitis Etiology
Exogenous
Endogenous (also hematogenous) most common type
Contiguous results from skin infection, poor dental hygiene and periodontal infection
Acute hematogenous infection results from bacteremia, underlying disease or non- penetrating trauma