ginas study guide nuero 5 gi biliary8
TRANSCRIPT
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April 23, 2016, – Up date
STUDY GUIDE FOR
MODULES 5 & 8
1. Understand and know how to evaluate a patient’s level of consciousness using theGlasgow o!a "cale. #now at what level $comatose” is deter!ine
Glasgow oma Scale! a "#$c% pact$cal a'd sta'dad$(ed s)stem *o assess$'g t+eLO,
T+ee aeas assessed- .t/s a0$l$t) to1
23, spea%
43, O0e) omma'ds
3, Ope' t+e e)es w+e' a 6e0al o pa$'*#l st$m#l#s 7ste'al #03 $s appl$ed
T+ee $'d$catos o* espo'se ae e6al#ated123, Ope'$'g o* t+e e)es
43, est 6e0al espo'se
3, est moto espo'se
Spec$*$c 0e+a6$os o0se6ed as espo'ses to t+e test$'g st$m#l#s ae g$6e' '#me$c 6al#es,
9s a :#se; )o# espo's$0$l$t) $s to el$c$t t+e 0est espo'se o' eac+ o* t+e scales,
T+e +$g+e t+e scoes t+e +$g+e t+e le6el o* 0a$' *#'ct$o' a'ge *om !25
omatose $s detem$'ed at a le6el 8 o 0elow,
2. #now the pri!ar% responsi&ilities of the nurse caring for a client with a sei'ure disorder.
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(hen a "ei'ure occurs)
*&serve and record details of event
+ote all aspects(hat event preceded the sei'ure
(hen did the "ei'ure occur
-ow long did each phase last.odomal /e!ission stage &efore an% "" of sei'ure
9#al "u&ective to pt, hase in sensor% warning
Ictal! ull "ei'ure
.ost$ctal hase after sei'ure, rest and recover%
(hat occurred during each phase
4oth su&ective 5aural stage and o&ective data are i!portant
+ote the e7act onset 5which &od% part was affected first and howourse and nature of sei'ure activit% 5loss of consciousness, tongue &iting, auto!atis!,
stiffening, erking, total lack of !uscle tone
8he &od% parts involved and their se9uence of involve!ent
Autono!ic signs such as):ilated pupils
;7cessive salivationAltered &reathing
%anosis
lushing diaphoresis"upil si'e and position
?e!or% loss
?uscle soreness"peech disorder 5aphasia, d%sarthria
(eakness or paral%sis
"leep periodAnd duration of each sign and s%!pto!
3. #now and full% understand all aspects of the ad!inistration of :ilantin 5esp
including teac+$'g; and what possi&le adverse reactions 5signs@s%!pto!s in the pt.,
!ight occur w+e' to
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. 4e a&le to identif% the cl$'$cal ma'$*estat$o's o* a spec$*$c se$(#e t)pe when given
specific client signs and s%!pto!s. BBB =;A"; review under Generali'ed "ei'ures?%oclonic, si!ple focal; comple< *ocal; and t%pical a&sence. lease st#d)=e6$ew the
se$(#e powe po$'t,
SEI>URE DISORDERS 9:D E.ILE.SY
9 seizure $s a paoenous irritation, pain, and
thro!&ophle&itis.
;7travasation can causetissue necrosis
Teac+$'g1
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Se$(#es ae d$6$ded $'to two ma@o classes1 ge'eal$(ed a'd *ocal,
Generalized seizures
$'6ol6e 0ot+ s$des o* t+e 0a$' a'd ae c+aacte$(ed 0) 0$lateal s)'c+o'o#s
ep$lept$c d$sc+ages $' t+e 0a$', eca#se t+e e't$e 0a$' $s a**ected at t+e o'set o*t+e se$(#es; t+ee $s 'o wa'$'g o a#a,
Tonic-clonic seizure
Loss o* co'sc$o#s'ess a'd *all$'g to t+e go#'d $* t+e pat$e't $s
#p$g+t
Followed 0) st$**e'$'g o* t+e 0od) 7to'$c p+ase3 *o 2? to 4? seco'ds
S#0se"#e't @e%$'g o* t+e e
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eg$'s s#dde'l) a'd peso' *alls
o'sc$o#s'ess #s#all) et#'s 0) t$me peso' +$ts go#'d,
a' es#me 'omal act$6$t) $mmed$atel)
Geat $s% *o +ead $'@#)
Tonic seizures
o I'6ol6e s#dde' o'set o* ma$'ta$'ed $'ceased to'e $' t+e e
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Mag'etoe'cep+alogap+) $' co'@#'ct$o' w$t+ EEG
o Geate se's$t$6$t) *o detect$'g small mag'et$c *$elds ge'eated 0) 'e#o'al
act$6$t)
; se#m c+em$st$es; l$6e a'd %$d'e) *#'ct$o'; U9 to #le o#t meta0ol$c
d$sodes
MRI; T; .ET
.$ma) d#gs *o teatme't o* ge'eal$(ed to'$c!clo'$c a'd *ocal se$(#es
.+e')to$' 7D$la't$'3
D$6alpoe< 7Depa%ote3
a0ama(ep$'e 7Tegetol3
.+e'o0a0$tal 7L#m$'al3
.$m$do'e 7M)sol$'e3
7a0ama(ep$'e; p+e'o0a0$tal; a'd p$m$do'e 'egat$6el) a**ect cog'$t$6e *#'ct$o',
D#g $'teact$o's w$t+ ca0ama(ep$'e; p+e')to$'; p+e'o0a0$tal3
.$ma) d#gs #sed to teat a0se'ce a'd m)oclo'$c se$(#es
Et+os#($m$de 7>ao't$'3
D$6alpoe< 7Depa%ote3
lo'a(apam 7lo'op$'3
9't$se$(#e d#gs s+o#ld 'ot 0e d$sco't$'#ed a0#ptl) as t+$s ca' pec$p$tate se$(#es,
ommo' s$de e**ects $'6ol6e
t+e :S a'd $'cl#de d$plop$a; dows$'ess; ata
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C. Understand all the nursing i!plications involved with the procedure laparoscopic
:$sse' F#'dopl$cat$o',
5G;/: and -A
ain control
9ssess
o /esp rate, and rh%th!,
o ulse rate and rh%th!
o "igns of neu!othora7 5d%spnea, chest pain, c%anosis
H+e' pe$stals$s et#'s; o'l) *l#$ds ae g$6e' $'$t$all)
o ?easure
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, #now the commo' d#gs used to treat peptic ulcers and what their therapeutic effect
should &e as well as an% specific nursing i!plications as it relates to side effects,
ad!inistration ti!es, and interactions with other !edications.
eptic !lcer "isease
• Peptic ulcer disease 5U: is a condition characteri'ed &% erosion of the G< !ucosa fro!
the digestive action of h%drochloric acid and pepsin.
• U: is classified as acute 5"U;/
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..I/s1 =ong ter! use or high doses !a% increase the risk of fractures of hip wrist andspine. Also increased risk of :iff in hospitali'ed pt’s. =ong ter! use is also associated
with +A.
. 4e a&le to identif% a specific t%pe of ulcer 5duodenal, gastric given a client’s signs s%!pto!s.
Hypercalcemia, kidney stones,decreases absorption oftetracycline, phenytoin andiron salts, Increases Digitaliseects. Use cautiously with
renal and cardiac patient
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D. Understand and know the pathoph%siolog%@etiolog% of holec%stitis holelithiasis)
and, what happens when the co!!on &ile duct is o&structed as far as a&sorption of certain
!inerals@vita!ins 7*at!sol#0le 6$tam$'s3, (hat possi&le s$g's & s)mptoms !ight the pt. e7hi&it with a deficienc% in an% of these vita!ins.
C#olelit#iasis C#olecystitis"tones in the Gall 4ladder
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• "tones !a% &e lodges in the neck of
the gall &ladder or the c%stic duct.
• :evelops when the &alance that keeps
cholesterol, &ile salts, and calciu! in
solution is altered and precipitationoccurs.
• ?a% produce severe s%!pto!s or
none at all, depending on whether thestones are stationar% or !o&ile and
whether o&struction is present
• Ultrasonograph% is co!!onl% used to
diagnose gallstones
• 8reat!ent
o =aparoscopic cholec%stecto!% is
the treat!ent of choice for
s%!pto!atic holelithiasis.
o ?edical dissolution therap% is
reco!!ended for patients withs!all radiolucent stones who are
!ildl% s%!pto!atic and are poor
surgical risks.
• Acute or chronic
• Usuall% associated with holelithiasis
or &iliar% sludge 5a !i7ture ofcholesterol cr%stals and calciu! salts.
•?anifestations of cholec%stitis var%fro! indigestion to !oderate to severe
pain, fever, and aundice
•
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.
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J, Understand and &e a&le to identif% the nutritional reco!!endations for such disorders asG;/:, -iatus -ernia, eptic Ulcer, and holec%stitis. KKMost $mpota'tl); review
I'g#$'al e'$a and the nursing care of the patient postoperativel% 7Lew$s; pg, JJ!
JJ3,GERD Low Fat D$et; eat small *e"#e't meals;
a6o$d alco+ol a'd smo%$'g a'd
ca**e$'e; Do 'ot l$e dow' *o 4! +o#s
a*te eat$'g; a6o$d eat$'g +o#s
0e*oe 0edt$me, Sleep w$t+ +ead
ele6ated; 9OID c+ocolate;
peppem$'t; tomatoes; *att) *oods;
co**ee a'd tea 7 deceases LED
pess#e3 Lso a6o$d m$l% espec$all) at
"+s 7 $'ceases gast$c ac$d secet$o's3
96o$d co'st$ct$'g game'ts$at#s e'$a! +e'$at$o' o* t+e pot$o'
o* t+e stomac+ $'to t+e esop+ag#s
t+o#g+ a' ope'$'g o +$at#s; $' t+e
d$ap+agm,
Low Fat D$et; eat small *e"#e't meals;
a6o$d alco+ol a'd smo%$'g a'd
ca**e$'e; Do 'ot l$e dow' *o 4! +o#s
a*te eat$'g; a6o$d eat$'g +o#s
0e*oe 0edt$me, Sleep w$t+ +ead
ele6ated; 9OID c+ocolate;
peppem$'t; tomatoes; *att) *oods;
co**ee a'd tea 7 deceases LED
pess#e3 Lso a6o$d m$l% espec$all) at
"+s 7 $'ceases gast$c ac$d secet$o's3
96o$d co'st$ct$'g game'ts, 96o$dl$*t$'g a'd sta$'$'g
.ept$c Ulce 96o$d $$ta'ts s#c+ as ca**e$'e;
el$m$'ate alco+ol, 96o$d +ot a'd sp$c)
*oods; peppe; ca0o'ated d$'%s a'd
0ot+ 7meat e
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Moe commo' $' me'
S#ge) $s t+e teatme't o* c+o$ce *o +e'$as,
I* t+e +e'$a 0ecomes sta'g#lated; t+e pat$e't w$ll e
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5overgrowth of hair
9S9 5aspirin Antiplatelet
Dos$'g) 16032C !g orall%within Dhours of event
5"econdar% proph%la7is C to
100 !g *rall% dail%
S+o#ld 'ot $'gest geate
t+a' 25?mg=%g o ,5 g o*
asp$$',
G< Upset, and tinnitus ?ild to !oderate 8o7icit%) G<upset, tinnitus, tach%pnea, and
respirator% alkalosis.
Se6ee To
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9RE1
.T=OT=Speec+ t+eap) to ma
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a' esol6e spo'ta'eo#sl)
T+eap)
:rug therap%
Anticholinesteraseorticosteroids
"urgical therap%)8h%!ecto!% th%!us tu!or re!oval
*ther therapies
las!apheresis e7change plas!a 5short ter! therap%
A/;):on’t take !eds on e!pt% sto!ach
8ake !eds &efore food 5C !inutes to help ease feeding
8ake !eds*2, suction, e9uip!ent
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?/<
"
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o ?;:
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'o de*$'$t$6e tests
&.
Fat$ga0$l$t) w$t+ #pwad ga(e 7e)es almost closed3
M#scle wea%'ess! $mpo6e a*te est
o EMG; 7electom)ogap+)3
o S$'gle *$0e EMGo Tes's$lo' test!
o a d$ag'ost$c tec+'$"#e *o 6e$*)$'g t+e s$g's o* m)ast+e'$a ga6$s 0) test$'g
t+e powe o* s%eletal m#scles 0e*oe a'd a*te $'@ect$o' o* edop+o'$#m
+)doc+lo$de,
o e6eals $mpo6ed m#scle co'tact$l$t) a*te $'@ect$o' 7e'dop+o'$#m
c+lo$de3 #sed to +elp co'*$m d$ag'os$s 7w+at ae t+e cl#es to d$ag'ose
d$sease3
o I' m)ast+e'$a ga6$s; t+ee ae too *ew eceptos *o acet)lc+ol$'e o' t+e
m#scle, T+e acet)lc+ol$'e $s 0o%e' dow' 0e*oe $t ca' *#ll) st$m#late t+$s
ed#ced '#m0e o* eceptos; a'd; as a es#lt; t+e m#scle $s wea%, )
0loc%$'g t+e act$o' o* acet)lc+ol$'estease; Te's$lo' polo'gs t+e m#scle
st$m#lat$o'; a'd tempoa$l) $mpo6es ste'gt+, I'ceased ste'gt+ *ollow$'g
a' $'@ect$o' o* Te's$lo' sto'gl) s#ggests a d$g'os$s o* MG, T+e Te's$lo' test
$s most e**ect$6e w+e' eas$l) o0se6ed wea%'ess $s pese't; a'd $s less #se*#l
*o 6ag#e o *l#ct#at$'g compla$'ts,
o Atropine is t#e antidote
Sol$d d< e"#$es
Seolog)1 9cet)lc+ol$'e ecepto 9't$0od$es 7alo'g w$t+ com0$'at$o'
w$t+ ot+e tests3
+est !a)
T