peripheral artery disease
progressive narrowing/degeneration of upper and lower extermities
PAD s/s
intermittent claudication, pain at rest, paresthesia
intermittent claudication
ischemic muscle ache/pain that is precipitated by constant level of exercise; resolves within 10 minutes or less with rest
paresthesia
numbness/tingling in the toes or feet; produces loss of pressure and deep pain sensations
PAD complications
non-healing arterial ulcers and gangrene are most serious complications; may result in amputation
PAD interventions
smoking cessation, exercise, BMI <25, dietary cholesterol <200mg, decreased intake of saturated fat, sodium <2g/day, foot care daily, surgery in severe cases
critical limb
characterized by chronic ischemic rest pain >2x/week, arterial leg ulcers, gangrene, pulse most likely not detected by doppler; need to restore circulation with surgery
pain, pulse, paresthesia, pallor, paralysis (movement)
5 P's of neurovascular check
PAD post-op assessments
operative extremity q 15 min. pain management, assess for bleeding, hematoma, thrombosis, embolism; watch for loss of pulse or increase in pain - notify surgeon; get them walking
Raynaud's Phenomena
episodic vaso-spastic disorder, arterial disease, etiology unknown
raynaud's s/s
color changes in fingers, toes, ears, nose; cold and numbness followed by thobbing, aching, swelling, and tingling before returning to normal
Venous Thrombosis
most common disorder of the veins; caused by stasis of venous flow, damage of endothelium, hypercoagulability of the blood
SVT
superficial arm/leg veins; s/s are venous inflammation, tender, red, warm, may or may not have edema
DVT
iliac and femoral veins; s/s are unilateral edema, pain, warmth, erythema, numbness, fullness
Heparin gtt
monitor PTT
Lovenox or heparin injections
monitor Platelets and CBC
Coumadin
monitor PT/INR
Nursing Interventions for venous thrombosis
vena cava filter, venous thromboectomy, bed rest, mild analgesia
Venous Insufficiency
caused by damage valves in the veins resulting in pooling of blood in the legs
venous insufficiency s/s
lower leg swelling (edema), leathery brown appearance, stasis dermatitis, itching
venous insufficiency complications
pain, edema, infection, long-term non-healing venous ulcers may result in amputation
Venous Insufficiency Nursing Interventions
compression stockings, elevation, analgesics, wound care (heavy drainage present), antibiotics
nausea
feeling of discomfort in the epigastric region, with a desire to vomit
vomiting
forceful ejection of partially digested food or secretions - stomach contents up through the esophagus, into the pharynx, and out of the mouth
N/V manifestasions
dehydration, anorexia, weight loss, electrolyte imbalance, metabolic alkalosis or acidosis, pulmonary aspiration
Nursing assessments N/V
BS in all four quadrants, precipitating factors, color, quality, and quantity of emesis
nursing interventions n/v
determine and treat the cause; medications, NPO until acute episode is over, cool washcloth to forehead, oral care, assess for dehydration, place on I&O, provide odor free room, hydration with IV fluid, TPN, NG tube
Nursing interventions post n/v
initiate clear liquids and assess tolerance/BS; advance to soft bland diet, provide oral care; watch for possible hypotension
upper GI bleed
esophageal origin, stomach and duodenal origin, obvious vs. occult
hematemesis
blood vomitus appearing as fresh, bright red blood or "coffee-ground" appearance (dark, grainy, digested blood)
melena
black, tarry stools (often foul-smelling) caused by digestion of blood in the GI tract
occult bleeding
small amounts of blood in gastric secretions, vomitus, or stools not apparent by appearance
Upper GI bleed nursing assessments
emphasis ABCs, early ID of shock, monitor VS q 15-30 min (BP and HR), assess LOC, BP, HR, pulse ox, peripheral pulses, perfusion, vein distention, and assessment; decreased BS and rigid abdomen
GI Bleed Treatment
NPO, hydrate, foley catheter, blood transfusions, if BP low anticipate bolus of normal saline, IV infusion or IV push protonix, endoscopic treatment
nursing interventions GI bleed
smoking cessation, avoid alcohol, decrease stress, side effects of medications, med adherence, s/s of upper/lower GI bleed, how to test for occult blood, treat URI promptly
GERD
syndrome based on chronic symptoms or mucosal damage secondary to reflux of gastric contents into lower esophagus
GERD s/s
heartburn (pyrosis), dyspepsia, regurgitation, respiratory s/s (wheezing, coughing, SOB, sore throat), chest pain
GERD complications
esophagitis (inflammation and ulcerations), Barrett's esophagus (pre-cancerous lesions), aspiration, cough, bronchospasm, asthma, pneumonia, dental erosion
gastritis
inflammation and breakdown of the normal gastric mucosal barriers by HCL acid and pepsin
gastritis s/s
anorexia, N/V, epigastric tenderness, feeling of fullness
gastritis treatment
ID the cause, similar to N/V treatment (NPO, IVF, anti-emetics, possible NG); H2 receptor blockers, teach diet modification, decrease alcohol intake, smoking cessation, treat H. Pylori
Peptic Ulcer Disease
erosion of the GI mucosa from the digestive action of HCL acid and pepsin; acute, chronic, gastric, or duodenal
gastric ulcer manifestations
high epigastric dyspepsia occuring w/in 1-2 hours after eating; more prevalent in women and older adults; higher mortality rate
duodenal ulcers manifestations
mid-epigastric pain that radiates to back burning or cramping 2-5 hours after eating - relief obtained with antacids/foods; more common in men (35-45 y)
PUD nursing interventions
advance diet as tolerated; teach to avoid foods that cause gastric distress (hot spicy, carbonated beverages, pepper), alcohol and smoking cessation, side effects of OTC meds, drug therapy, decrease stress/coffee
PUD complications
hemorrhage (most common), perforation (most lethal), gastric outlet obstruction
treatment of PUD complications
NPO, IVF, hemorrhage/perforation - stop the bleeding, restore blood volume; gastric outlet obstruction - NG to decompress stomach/give F/E
dumping syndrome
large bolus of hypertonic fluids enter the intestine
dumping syndrome s/s
weakness, sweating, palpitations, dizziness, loud abdominal sounds and cramping waiting 30 minutes of eating - lasts less than 1 hour
postprandial hypoglycemia
caused by uncontrolled gastric empyting of fluids high in CHO
postprandial hypoglycemia s/s
similar to hypoglycemia - weakness, sweating, confusion, tachycardia, anxiety occurring 2 hours after eating
bile reflux gastritis
if the pylorus is removed bile can enter the stomach
post-op care for PUD
usual care w/ GI focus (bowel sounds, distention); care of NG tube - observe gastric content, pain
appendicitis
inflammation of the appendix; the blood supply is impaired by inflammation and bacterial infection in the wall of the appendix
appendicitis s/s
difficult to diagnose; pre-umbilical pain w/ anorexia and N/V; pain is continuous and shifts to RLQ, localized tenderness, rebound tenderness, muscle guarding, worse with coughing, sneezing, deep breathing; want to lay still; may have low grade fever
appendicitis older adults s/s
discomfort at right iliac fossa, pain is less severe; slight fever; diagnosis is often delayed
appendicitis treatment
NPO, treat pain with ice and meds; antibiotics and IVF, immediate appendectomy
peritonitis
localized or general inflammatory process of peritoneum
peritonitis s/s
abdominal pain (sudden/severe), tenderness over the involved area, patient lies very still with shallow Respirations; rebound tenderness, muscle rigidity, spasm, abdominal distention or ascites, fever, N/V, tachycardia, tachypnea, altered bowel habits
appendicitis complications
abscess, perforation, peritonitis if not dx/tx soon enough
peritonitis complication
hypovolemic shock, sepsis, intra-abdominal abscess, paralytic ileus (common), acute respiratory distress, can be fatal if not treated
peritonitis nursing assessment
Pain (knees flexed, rigid abdomen), abdominal, VS, urine output (foley - best indicator that we have good perfusion to vital organs - take hourly UO), hypovolemic shock
hypovolemic shock s/s
anxious, cool/clammy skin, generalized weakness, confusion, increased RR/HR, low BP, fever
peritonitis nursing interventions
IV (fluid replacement and antibiotics), NG monitoring/care, I&O, N/V, drain monitoring, incision and drain site care
Crohn's disease
inflammation of segments of the GI tract; can occur anywhere; most common in the terminal ileum and colon
ulcerative colitis
inflammation and ulceration of the colon and rectum
IBD s/s (both)
diarrhea, bloody stool, fatigue, abdominal pain, weight loss, fever
Crohn's s/s
diarrhea, colicky abdominal pain, fever, bleeding infrequent, weight loss, nutritional deficit
ulcerative colitis s/s
bloody diarrhea, abdominal pain, rectal bleeding, severity can range from 1-20 stools/day
IBD complications GI
nutritional deficits, hemorrhage, strictures, perforation (possible peritonitis)
Crohn's complications
fistula, perineal abscess
UC complications
toxic megacolon
fistula
can develop between bowel and bladder, bowel and vagina, and bowel and abdominal wall
toxic megacolon s/s
abdominal pain, distention, tenderness, tachy, loss of bowel sounds; perforation is highly likely
IBD systemic complications
inflammation of joints, eye, mouth, kidneys, bone, vascular, skin; increased risk of liver failure
IBD post-op nursing care
I&O, assess stoma for shrinkage and output; assess for hemorrhage, abdominal abscess, small bowel obstruction, dehydration
nursing interventions IBD
teach rest/activity, dietary modifications, smoking cessation, stress reduction, med adherence, supplements as needed, stoma care, perianal skin care
perforation s/s
sudden/severe pain, rigid abdomen, found w/ knees drawn in, grunting respirations
gastric outlet obstruction
N/V, abdominal distention despite NG tube
post-op appendectomy
watch for peritonitis (can occur with or without perforation), ambulate day of surgery, assess incision, advance diet as soon as bowel sounds return
PAD nursing assessment
diminished/absent radial, pedal, popliteal, femoral pulses; pallor of foot with elevation, reactive hyperemia of foot w/ dependent position; skin thin, shiny, taut, loss of hair on lower legs; mobility or sensation impairment
critical limb nursing interventions
assess 5P's; cleanse, do not soak; lubricate, frequent dressing change (CD&I), protective footwear, avoid cold/heat extremities, may need HBO tx
Venous thrombosis assessment findings
unilateral edema, decreased/absent pulses, numbness/tingling, increased warmth/redness in skin, initially may feel numbness/tingling, cramping; site tender to palpation; fear, anxiety-potential; monitor for PE, MI, CVA
intestinal obstruction
occurs when the intestinal contents cannot pass through the GI tract; can be in small or large intestine
paralytic ileus
cause of intestinal obstruction; lack of peristalsis and absence of bowel sounds - occurs to some degree after any abdominal surgery
small intestine obstruction s/s
rapid onset, frequent and copious vomiting, colicky/cramp-like intermittent pain, feces for a short time, abdominal distention greatly increased
large intestine obstruction s/s
gradual onset, vomiting rare, low-grade cramping, abdominal pain, absolute constipation, increased abdominal distention
intestinal obstruction nursing assessment
monitor for dehydration, electrolyte imbalances, hypovolemia; assess pain, emesis, bowel sounds, distention; I&O
intestinal obstruction treatment
NPO, restful environment, hydrate IVF, NG tube, TPN, may need to prep patient for surgery
intestinal obstruction complications
severe reduction in circulating blood volume and electrolyte deficiencies; intestinal strangulation or intestinal infarction, peritonitis
ostomy nursing interventions pre-op
emotional support, site selection, care for ostomy, treat patient with dignity
ostomy nursing assessments post-op
usual post-op plus assess stoma q 4 hours and PRN, assess pouch, record output
ostomy nursing interventions post-op
teach the patient: stoma care, change the appliance, proper skin care, odor control/passing gas, irrigation, s/s of complications
colostomy irrigation
used to stimulate emptying of the colon; use only when the stoma is from the distal colon or rectum; promotes regular evacuation of stool
ostomy complications
skin breakdown, infection, obstruction, electrolyte imbalances