Peptic Ulcer
Overview:
A peptic ulcer is like an unwelcome visitor in your digestive system. It's a sore that forms on the inner
lining of your stomach or the upper part of your small intestine. Most ulcers are caused by an
infection with a bacterium called Helicobacter pylori (H. pylori) or by long-term use of nonsteroidal
anti-inflammatory drugs (NSAIDs), like ibuprofen or aspirin. Stress and spicy foods don't directly cause
ulcers, but they can aggravate existing ones.
There are two types of peptic ulcers:
Gastric ulcer -- occurs in the stomach
Duodenal ulcer -- occurs in the first part of the small intestine
.
Signs and Symptoms:
 Dyspepsia, including belching, bloating, distention, and fatty food intolerance
 Heartburn
 Chest discomfort
 Hematemesis or melena resulting from gastrointestinal bleeding. Melena may be intermittent
over several days or multiple episodes in a single day.
 Rarely, a briskly bleeding ulcer can present as hematochezia.
 Symptoms consistent with anemia (eg, fatigue, dyspnea) may be present
 Sudden onset of symptoms may indicate perforation.
 NSAID-induced gastritis or ulcers may be silent, especially in elderly patients.
Diagnostic Tests
 Barium Contrast Radiography
Normal findings:
Esophagus: The esophagus should appear as a muscular tube connecting the throat to the stomach. It
should allow the smooth passage of the barium as you swallow.
Stomach: The stomach should have a characteristic shape and should fill with barium, outlining its
contours. There should be no evidence of abnormal masses or strictures.
Small Intestine (Duodenum): The duodenum is the first part of the small intestine. It should allow the
passage of barium into the small bowel, and its lining should appear normal.
Contrast Flow: The contrast material should flow through the GI tract smoothly, highlighting the
anatomy and allowing the radiologist to observe the passage of the barium in real-time.
No Leaks or Abnormalities: There should be no evidence of barium leakage outside the GI tract,
which could indicate a perforation. Additionally, there should be no strictures or abnormal masses
causing obstruction.
Nursing Responsibility
1. **Patient Education:**
- Explain the procedure to the patient, including its purpose and what to expect.
- Provide information about any preparation required, such as fasting before the procedure.
2. **Informed Consent:**
- Ensure that the patient has given informed consent for the procedure.
3. **Assessment:**
- Perform a thorough assessment of the patient's medical history, allergies, and any previous
reactions to contrast media.
4. **Preparation:**
- Ensure that the patient follows any preparation instructions, such as fasting or specific dietary
restrictions.
5. **IV Access:**
- Establish and maintain intravenous (IV) access if required for the administration of contrast
material.
6. **Allergy Assessment:**
- Assess the patient for any allergies, especially to iodine or contrast agents.
7. **Hydration:**
- Encourage the patient to stay well-hydrated before and after the procedure to help eliminate the
contrast material from the body.
8. **Post-Procedure Care:**
- Monitor the patient after the procedure for any signs of adverse reactions, such as allergic
reactions or contrast extravasation.
9. **Documentation:**
- Accurately document the patient's vital signs, any reactions, and other relevant information in the
medical record.
10. - Maintain open communication with the radiology team to ensure a smooth transition for the
patient during the procedure.
11. **Comfort and Support:**
- Provide emotional support to alleviate any anxiety the patient may have about the procedure.
12. **Follow-Up:**
- Monitor the patient for any delayed reactions or complications after the procedure.
Laboratory Testing:
Measuring serum gastrin and serum calcium: High levels of these hormones may indicate a
more serious problem, such as:
Gastrinomas: Tumors associated with a rare gastroenterological disorder called
Zollinger-Ellison syndrome: Multiple endocrine neoplasia (MEN): A disorder in
which endocrine glands are overactive or form a tumor
Normal Findings:
In general, the normal range for gastrin levels is: 0-180 pg/mL (picograms per milliliter of
blood) for adults (this may be higher in older adults) 0-125 pg/mL for children
Testing for H. pylori infection. Your doctor may test for this in a number of ways:
 Endoscopy with biopsy to obtain a tissue sample to test for the bacteria
Normal Findings:The esophagus, stomach, and duodenum should be smooth and of normal color.
There should be no bleeding, growths, ulcers, or inflammation.
 Urea breath tests, a noninvasive method
Normal Findings: . In a normal finding, a low amount of carbon dioxide should be detected in the
breath. This indicates that the urea, which is a substance ingested for the test, is not being broken
down by H. pylori in the stomach. Essentially, a normal result suggests the absence of H. pylori
infection.
 Serologic testing, a blood test
Normal Findings: . In a normal finding, the blood test results would show the absence of these
antibodies, indicating that the person has not been exposed to H. pylori or does not currently
have an active infection. It's important to note that serologic testing may not distinguish between
a current or past infection, so clinical correlation and additional tests may be needed for a
comprehensive diagnosis.
 Stool antigen, another noninvasive method of testing for H. pylori
Normal Values:
consistency: Stool consistency is often described on a scale ranging from hard and lumpy to loose and
watery. Normal consistency varies, but it's generally considered normal if the stool is formed and easy
to pass.
Color: Normal stool color can range from brown to greenish-brown, and variations can occur based on
diet and other factors.
pH: The pH of normal stool is typically slightly acidic to neutral, ranging from 6 to 7.5.
Occult Blood: Occult blood in the stool is not normally present. The presence of occult blood may
indicate bleeding in the digestive tract.
Parasites and Microorganisms: A normal stool test would show the absence of pathogenic bacteria,
parasites, or excessive amounts of harmful microorganisms.
Medication
Brand Name: Aciphex
Generic Name: rabeprazole (Rx)
Classification: Proton Pump Inhibitors
Mechanism of Action: Rabeprazole is a proton pump inhibitor (PPI) and as
such covalently binds with and inactivates the gastric parietal cell proton pump
(H+/K+-ATPase). This inhibits in turn gastric acid production and raises gastric pH.
When to Give: You'll usually take rabeprazole once a day, first thing in the morning. If your
doctor prescribes it twice a day, take 1 dose in the morning and 1 dose in the evening. It's
best to take rabeprazole before a meal. Swallow your tablets whole with a drink of water or
squash.
Nursing Responsibilities:
for patients using proton pump inhibitors include the
following: Proper administration. Administer drug before meals to ensure that the
patient does not open, chew, or crush capsules; they should be swallowed whole to
ensure the therapeutic effectiveness of the drug. Safety and comfort measures.
Nursing Management
1. **Assessment and Monitoring:**
Conduct thorough assessments to gather information about the patient's symptoms, pain level,
and any potential complications.
2. **Pain Management:**
Administer prescribed pain medications as scheduled and assess the effectiveness of pain relief.
Encourage the use of relaxation techniques and positioning to enhance patient comfort.
3. **Medication Administration:**
Ensure that the patient understands and adheres to the prescribed medication regimen, which
may include proton pump inhibitors (PPIs), histamine H2 blockers, and antibiotics for H. pylori
eradication. Monitor for side effects and educate the patient on proper medication administration.
4. **Nutritional Support:**
Collaborate with dietitians to create a suitable diet plan that promotes healing and minimizes
gastric irritation. Emphasize the importance of avoiding spicy foods, caffeine, and alcohol.
5. **Hydration:**
Monitor the patient's fluid intake and output. Encourage adequate hydration to maintain mucosal
integrity and prevent complications such as dehydration.
6. **Education and Lifestyle Modification:**
Educate the patient on lifestyle modifications that can aid in ulcer healing, such as stress
reduction techniques, smoking cessation, and the importance of regular, balanced meals.
7. **Emotional Support:**
Provide emotional support to address the patient's concerns and anxiety related to the diagnosis.
Encourage open communication and involve the patient in decision-making regarding their care.
8. **Infection Control:**
If H. pylori infection is present, emphasize the importance of completing the prescribed antibiotic
regimen. Monitor for signs of infection and collaborate with the healthcare team to address any
issues promptly.
9. **Gastrointestinal Bleeding Management:**
Be vigilant for signs of gastrointestinal bleeding, such as melena or hematemesis. Monitor
hemoglobin and hematocrit levels, and collaborate with the healthcare team for interventions if
bleeding is suspected.
10. **Follow-Up Care:**
Generic Name:
Brand Name:
Classification:
Mechanism of Action:
When to give nursing Responsibilities:
**Medical Management:**
1. **Proton Pump Inhibitors (PPIs):**
PPIs, such as omeprazole and lansoprazole, are commonly prescribed to reduce gastric acid
production and promote ulcer healing.
2. **Histamine H2 Blockers:**
Medications like ranitidine and famotidine block histamine receptors in the stomach, leading to
decreased acid secretion.
3. **Antibiotics:**
If Helicobacter pylori (H. pylori) infection is identified, a combination of antibiotics (such as
clarithromycin, amoxicillin, and metronidazole) may be prescribed to eradicate the bacteria.
4. **Cytoprotective Agents:**
Medications like sucralfate help create a protective barrier over the ulcer, promoting healing and
reducing irritation.
5. **Antacids:**
These provide symptomatic relief by neutralizing gastric acid. They are often used in conjunction
with other medications.
6. **Lifestyle Modifications:**
Patients are advised to make lifestyle changes, including avoiding spicy foods, caffeine, and alcohol.
Smoking cessation is also recommended.
**Surgical Management:**
1. **Vagotomy:**
Vagotomy involves cutting or selectively inhibiting the vagus nerve to reduce gastric acid production.
This procedure is less common today due to the availability of effective medications.
2. **Antrectomy:**
This surgical procedure involves the removal of the lower part of the stomach (antrum), where most
of the gastric acid is produced. It may be done in conjunction with a vagotomy.
3. **Pyloroplasty:**
Pyloroplasty involves widening and relaxing the pyloric valve at the lower end of the stomach,
promoting the emptying of stomach contents.
4. **Gastric Bypass Surgery:**
In cases where ulcers are not responding to other treatments, gastric bypass surgery may be
considered. This procedure redirects the flow of food, bypassing the stomach.
5. **H. pylori Eradication Surgery:**
In some cases, surgical interventions may be aimed at removing the portion of the stomach where H.
pylori is likely to reside.
COMPLICATION
1. **Bleeding:**
A common complication of peptic ulcers is bleeding, which can occur when the ulcer erodes a blood
vessel. It can lead to symptoms such as black, tarry stools (melena), vomiting blood (hematemesis), or
anemia. Severe bleeding may require medical intervention, including endoscopic therapy or surgery.
2. **Perforation:**
If an ulcer extends through the entire thickness of the stomach or duodenal wall, it can result in a
perforation. This is a medical emergency as it allows stomach contents to leak into the abdominal
cavity, causing peritonitis. Symptoms include severe abdominal pain, rigidity, and guarding.
Immediate surgery is typically necessary to repair the perforation.
3. **Gastric Outlet Obstruction:**
Chronic inflammation and scarring from peptic ulcers can narrow the opening between the stomach
and the duodenum, leading to gastric outlet obstruction. This can cause symptoms such as persistent
vomiting, bloating, and weight loss. Treatment may involve endoscopic dilation or surgical
intervention to alleviate the obstruction.
4. **Penetration:**
Penetration occurs when an ulcer extends into adjacent organs, such as the pancreas or liver. This
can lead to localized inflammation and pain in the affected organ. In severe cases, surgery may be
required to repair the damage.
5. **H. pylori-related Complications:**
Peptic ulcers associated with Helicobacter pylori (H. pylori) infection can lead to complications such
as gastritis, gastric cancer, or mucosa-associated lymphoid tissue (MALT) lymphoma. Long-term
infection with H. pylori can contribute to chronic inflammation and increase the risk of these
complications.
Inflammatory Bowel Disease
Overview:
Inflammatory bowel disease (IBD) is a term that describes disorders involving long-standing (chronic)
inflammation of tissues in your digestive tract. Types of IBD include:
Ulcerative colitis. This condition involves inflammation and sores (ulcers) along the lining of your
large intestine (colon) and rectum.
Crohn's disease. This type of IBD is characterized by inflammation of the lining of your digestive tract,
which often can involve the deeper layers of the digestive tract. Crohn's disease most commonly
affects the small intestine. However, it can also affect the large intestine and uncommonly, the upper
gastrointestinal tract.
Both ulcerative colitis and Crohn's disease usually are characterized by diarrhea, rectal bleeding,
abdominal pain, fatigue and weight loss.
Ulcerative Colitis
Overview: Ulcerative
colitis is a condition in which the lining of the large intestine
(colon) and rectum become inflamed. It is a form of inflammatory bowel
disease (IBD). Crohn disease is a related condition.
Pathophysiology Schematice diagram
Signs & Symptoms:
 Pain in the abdomen (belly area) and cramping.
 A gurgling or splashing sound heard over the intestine.
 Blood and possibly pus in the stools.
 Diarrhea, from only a few episodes to very often.
 Fever.
 Feeling that you need to pass stools, even though your bowels are already empty. It may
involve straining, pain, and cramping (tenesmus).
 Weight loss.
Diagnostic Test
Complete blood count (CBC)
Red Blood Cell (RBC) Count:
Men: 4.5 to 5.5 million cells/mcL
Women: 4.0 to 5.0 million cells/mcL
Hemoglobin (Hb) Level:
Men: 13.8 to 17.2 grams/dL
Women: 12.1 to 15.1 grams/dL
Hematocrit (Hct) Level:
Men: 38.3% to 48.6%
Women: 35.5% to 44.9%
White Blood Cell (WBC) Count:
4,000 to 11,000 cells/mcL
Platelet Count:
150,000 to 450,000 cells/mcL
Mean Corpuscular Volume (MCV):
80 to 100 femtoliters (fL)
Mean Corpuscular Hemoglobin (MCH):
27 to 33 picograms (pg)
Mean Corpuscular Hemoglobin Concentration (MCHC):
32% to 36%
Red Cell Distribution Width (RDW):
11.5% to 14.5%
Nursing Responsibility
1. **Patient Preparation:**
- Ensure that the patient is informed about the purpose of the CBC.
- Verify if any specific preparations are required, such as fasting or discontinuing certain
medications.
2. **Informed Consent:**
- Obtain informed consent from the patient before collecting the blood sample.
3. **Identification:**
- Confirm the patient's identity using at least two patient identifiers (e.g., name and date of birth)
to prevent errors.
4. **Venipuncture:**
- Perform or assist in the venipuncture procedure to collect the blood sample for the CBC.
- Follow proper aseptic techniques to minimize the risk of infection.
5. **Labeling:**
- Accurately label the collected blood samples with the patient's information, date, and time of
collection.
6. **Specimen Handling:**
- Ensure proper handling and transportation of the blood specimens to the laboratory to maintain
sample integrity.
7. **Patient Comfort and Safety:**
- Provide emotional support to the patient during the procedure, addressing any concerns or
anxiety.
- Monitor the patient for any adverse reactions, such as fainting or dizziness, and respond
appropriately.
8. **Documentation:**
- Document the collection procedure, including patient information, date and time of collection,
and any relevant details.
9. **Communication:**
- Communicate any relevant information to the laboratory staff, such as special patient conditions
or considerations.
10. **Follow-Up:**
- Monitor and document the patient's response after the procedure, addressing any
complications or issues promptly.
11. **Results Review:**
- After the CBC results are available, review them and report any significant findings to the
healthcare team.
C-Reactive Protein
1. **Normal Range:**
- In general, a CRP level of less than 1.0 mg/dL is considered normal.
2. **Low Risk:**
- CRP levels between 1.0 to 3.0 mg/dL are often considered low risk for cardiovascular disease.
3. **Moderate Risk:**
- CRP levels between 3.0 to 10.0 mg/dL may indicate a moderate risk.
4. **High Risk:**
- CRP levels greater than 10.0 mg/dL may suggest a higher risk for cardiovascular disease or
inflammation.
Nursing Responsibility: Nurses
play a vital role in ensuring the accuracy of CRP test
results and the well-being of the patient throughout the process. Clear
communication and adherence to proper procedures contribute to the overall
quality of care.
1. **Erythrocyte Sedimentation Rate (ESR):**
- Normal values can vary with age and gender.
- For men under 50: 0-15 mm/hr
- For women under 50: 0-20 mm/hr
- Values tend to be slightly higher for individuals over 50.
2. **Stool Calprotectin:**
- Normal values are generally less than 50 micrograms per gram (mcg/g) of
stool.
- Elevated levels may indicate inflammation in the digestive tract, suggesting
conditions such as inflammatory bowel disease (IBD).
3. **Stool Lactoferrin:**
- Normal values are usually less than 7.25 mcg/g of stool.
- Increased levels can be associated with intestinal inflammation, similar to
calprotectin.
4. **Antibody Tests by Blood:**
- Specific reference ranges depend on the type of antibodies being
measured.
Nursing Responsibility:
1. **Erythrocyte Sedimentation Rate (ESR):**
- **Patient Education:** Explain the purpose of the ESR test, and if any
specific preparations (such as fasting) are required.
- **Informed Consent:** Obtain informed consent from the patient if
necessary.
- **Identification:** Confirm the patient's identity using at least two
identifiers before collecting the blood sample.
- **Venipuncture:** Perform or assist in the blood sample collection for the
ESR test.
- **Labeling:** Ensure accurate labeling of the blood sample with the
patient's information, date, and time of collection.
- **Specimen Handling:** Properly handle and transport the blood sample
to maintain its integrity.
- **Documentation:** Document details of the ESR test, including patient
information, date, and time of collection.
2. **Stool Calprotectin or Lactoferrin:**
- **Patient Education:** Explain the purpose of the test and provide
instructions for stool sample collection.
- **Informed Consent:** Obtain informed consent if required.
- **Collection Assistance:** Provide guidance on collecting a stool sample
and ensure proper labeling.
- **Specimen Handling:** Instruct the patient on proper storage and
transportation of the stool sample.
- **Documentation:** Document details of the stool calprotectin or
lactoferrin test, including patient information, date, and time of collection.
3. **Antibody Tests by Blood:**
- **Patient Education:** Explain the purpose of the antibody test, including
the specific antibodies being tested.
- **Informed Consent:** Obtain informed consent if required.
- **Identification:** Confirm the patient's identity before blood sample
collection.
- **Venipuncture:** Perform or assist in the blood sample collection for
antibody testing.
- **Labeling:** Ensure accurate labeling of the blood sample with patient
information, date, and time of collection.
- **Specimen Handling:** Handle the blood sample appropriately to
maintain its integrity during transportation.
- **Documentation:** Document details of the antibody test, including
patient information, date, and time of collection.
Medication
Generic Name: Prednisolone
Brand Name: Millipred Dp 6 Day
Classification: Corticosteroid
Mechanism of action: Corticosteroids produce their effect through multiple
pathways. They produce: anti-inflammatory and immunosuppressive effects; protein
and carbohydrate metabolic effects; water and electrolyte effects; central nervous
system effects; and blood cell effects.
When to give: In patients with UC who have not responded to mesalazine within
2–4 weeks, and those with mild-to-moderate CD, oral corticosteroids should be
started.
Nursing Responsibility: This means monitoring patients for any side effects,
educating them about the medication, and collaborating with the rest of the
healthcare team to ensure a smooth treatment process.
Nursing Management:
Managing ulcerative colitis involves a multidisciplinary approach, with nursing
playing a crucial role in patient care. Here are some nursing management
considerations for ulcerative colitis:
1. **Assessment:**
- Regularly assess the patient's symptoms, including abdominal pain,
diarrhea, and rectal bleeding.
- Monitor vital signs and signs of dehydration.
2. **Patient Education:**
- Educate the patient about the nature of ulcerative colitis, its chronic nature,
and potential triggers.
- Provide information on medications, their purpose, and potential side
effects.
- Emphasize the importance of adhering to the prescribed treatment plan.
3. **Medication Management:**
- Administer medications as prescribed, including anti-inflammatory drugs,
immunosuppressants, and biologics.
- Monitor for medication side effects and report any adverse reactions
promptly.
4. **Fluid and Electrolyte Balance:**
- Monitor fluid intake and output to prevent dehydration.
- Educate the patient on the importance of maintaining hydration, especially
during active flare-ups.
5. **Nutritional Support:**
- Collaborate with dietitians to develop a nutrition plan that meets the
patient's needs during flare-ups and remission.
- Monitor for nutritional deficiencies and provide supplements as needed.
6. **Psychosocial Support:**
- Assess the patient's emotional well-being and provide support for coping
with a chronic condition.
- Encourage the patient to communicate feelings and concerns.
7. **Monitoring for Complications:**
- Watch for signs of complications such as perforation, toxic megacolon, or
severe bleeding.
- Monitor laboratory values, including inflammatory markers and blood
counts.
8. **Wound Care:**
- If the patient has undergone surgery (such as colectomy), provide wound
care and monitor for signs of infection.
9. **Collaboration with Other Healthcare Providers:**
- Communicate effectively with physicians, dietitians, and other healthcare
professionals involved in the patient's care.
- Participate in care planning and interdisciplinary rounds.
10. **Follow-up and Rehabilitation:**
- Schedule regular follow-up appointments to monitor the patient's
progress.
- Collaborate with rehabilitation services if needed, especially in cases of
surgery or prolonged illness.
Complications
1. **Colon Cancer:**
- Individuals with long-standing ulcerative colitis, particularly those with
involvement of the entire colon, have an increased risk of developing
colorectal cancer.
2. **Toxic Megacolon:**
This can lead to a rapid and life-threatening progression of symptoms,
including abdominal distension, fever, and an increased risk of perforation.
3. **Perforation of the Colon:**
. This can result in the leakage of intestinal contents into the abdominal
cavity, leading to peritonitis, a serious and potentially fatal condition.
4. **Strictures and Obstructions:**
- Prolonged inflammation may cause scarring and narrowing (strictures) of
the intestinal walls.
5. **Extraintestinal Complications:**
s. These may include joint problems (arthritis), skin conditions (such as
erythema nodosum), and eye inflammation (uveitis).
**Crohn's Disease:**
1. **Mode of Transmission:**
- Crohn's disease is not infectious or contagious.
- The exact cause is unknown, but it is believed to involve a combination of
genetic, environmental, and immune system factors.
2. **Signs and Symptoms:**
- Symptoms can vary but commonly include abdominal pain, diarrhea,
weight loss, and fatigue.
- Other symptoms may include fever, anemia, joint pain, and skin problems.
- The inflammation associated with Crohn's disease can affect any part of
the gastrointestinal tract, from the mouth to the anus.
3. **Incubation Period:**
- Crohn's disease does not have a typical incubation period because it is not
an infectious disease. Instead, it is a chronic inflammatory condition that may
develop over time.
4. **Causative Agent:**
- The exact cause of Crohn's disease is unknown.
- It is thought to involve a complex interplay of genetic, environmental, and
immunological factors.
- The immune system may mistakenly attack the digestive tract, leading to
chronic inflammation.
Diagnostic Procedure
Colonoscopy:
Normal findings during a colonoscopy may include:
1. **Normal Colonic Mucosa:** The lining of the colon appears healthy and without any
abnormalities.
2. **Absence of Polyps:** Polyps are growths on the inner lining of the colon. If no polyps
are found, it is considered a normal finding.
3. **No Signs of Inflammation:** Inflammatory conditions such as ulcerative colitis or
Crohn's disease may cause inflammation in the colon. A normal colonoscopy would not
show signs of inflammation.
4. **No Tumors or Lesions:** The absence of any tumors or abnormal lesions is a normal
finding.
5. **Clear Passage:** The colonoscope can move easily through the entire length of the
colon without any obstruction.
Nursing Responsibility
Nursing responsibilities for a colonoscopy boil down to ensuring patient comfort, providing
clear instructions for preparation, assisting during the procedure, and offering support postcolonoscopy. It involves thorough communication, monitoring patient well-being, and
collaboration with the medical team. The goal is to make the experience as smooth and
stress-free as possible for the patient.
A computerized tomography (CT)
1. **Head CT:**
- Normal brain structure without any signs of tumors or abnormalities.
- Clear sinuses and normal skull structure.
2. **Chest CT:**
- Normal lung tissue without masses or nodules.
- Intact and properly positioned heart and blood vessels.
- Normal appearance of the chest organs and structures.
3. **Abdominal CT:**
- Normal appearance of abdominal organs such as liver, kidneys, spleen, and pancreas.
- Clear visualization of the gastrointestinal tract without blockages or abnormalities.
- No signs of fluid accumulation or abnormal growths.
4. **Pelvic CT:**
- Normal structure of pelvic organs, including the bladder, uterus (in females), and prostate
(in males).
- Absence of masses or abnormalities in the pelvic region.
5. **Bone CT:**
- Normal bone structure without fractures or signs of bone diseases.
- Clear visualization of joints and surrounding tissues.
Nursing Responsibility
Nursing's role in a CT scan is about guiding the patient, ensuring safety, and staying vigilant
during the procedure. It involves explaining the process, checking for allergies or pregnancy
risks, helping with preparations, keeping the patient at ease, monitoring vital signs, and
MRI
1. **Brain MRI:**
- Normal brain structure without signs of tumors, bleeding, or abnormalities.
- Clear visualization of different brain regions and structures.
2. **Spine MRI:**
- Normal alignment of the spine without fractures or disc herniation.
- Intact spinal cord and nerves without compression.
3. **Abdominal MRI:**
- Healthy appearance of abdominal organs such as the liver, kidneys, and pancreas.
- Absence of masses or abnormalities in the gastrointestinal tract.
4. **Joint MRI:**
- Normal joint structures without signs of arthritis, tears, or inflammation.
- Clear visualization of ligaments and surrounding tissues.
5. **Cardiac MRI:**
- Normal size and function of the heart chambers.
- Clear imaging of blood vessels without blockages.
Nursing Responsibility
Nursing responsibilities during an MRI are all about keeping the patient informed,
comfortable, and safe. This involves explaining the procedure, checking for safety concerns
like metal implants, helping with preparations, ensuring patient comfort during the scan,
and monitoring their well-being. Communication is key, both with the patient and the rest of
the medical team. After the scan, the nurse assists the patient and documents any relevant
information. It's about providing care and support throughout the MRI process.
MEDICATION
Brand Name: Entyvio
Generic Name: Vedolizumab
CLASSIFICATION: gut-selective immunosuppressive biologic.
MECHANISM OF ACTION: Vedolizumab is a humanized monoclonal antibody that
specifically binds to the α4β7 integrin and blocks the interaction of α4β7
integrin with MAdCAM-1. Vedolizumab does not bind to or inhibit the function
of the α4β1 and αEβ7 integrins and does not antagonize the interaction of α4
integrins with vascular cell adhesion molecule-1 (VCAM-1).6
WHEN TO GIVE: weeks 0, 2, and 6 followed by every 8 week infusions.
NURSING RESPONSIBILITY:
1. **Preparation:**
- Help prepare the patient for the medication administration.
2. **Administration:**
- Administer Vedolizumab according to the prescribed dosage and schedule.
3. **Monitoring:**
- Monitor the patient for any immediate reactions during and after the infusion.
4. **Patient Education:**
- Provide information about potential side effects and what to report to the healthcare
team.
5. **Documentation:**
- Document the administration, the patient's response, and any observed side effects.
6. **Communication:**
- Communicate with the healthcare team to ensure coordinated care.
Ustekinumab
Brand Name: Stelara
Generic name: Ustekinumab
Classification: human immunoglobulin (Ig) G1 kappa monoclonal antibody
Mechanism of action:
Interleukin (IL)-12 and IL-23 are heterodimeric cytokines that evoke immune
and inflammatory responses, such as natural killer cell activation and CD4+ Tcell differentiation and activation.6 The role of IL-12 and IL-23 were implicated
in a variety of chronic inflammatory conditions, such as psoriasis and
inflammatory bowel diseases
When to give: After the first dose you'll be given another at four weeks, then
every 12 weeks from then on.
Nursing Responsibility:
1. **Preparation:**
- Get the patient ready for the medication.
2. **Administration:**
- Administer Ustekinumab as prescribed.
3. **Monitoring:**
- Keep an eye on the patient during and after the treatment.
4. **Patient Education:**
- Educate the patient about potential side effects and what to report.
5. **Documentation:**
- Record details about the administration and the patient's response.
6. **Communication:**
- Stay in touch with the healthcare team for coordinated care.
Nursing management:
1. **Assessment:**
- Regularly assess the patient's symptoms, including abdominal pain,
diarrhea, and weight changes.
2. **Education:**
- Provide thorough education about Crohn's disease, its symptoms, and the
importance of medication adherence.
3. **Medication Management:**
Assist
in
managing
prescribed
medications,
including
immunosuppressants or anti-inflammatory drugs.
4. **Nutritional Support:**
- Collaborate with a dietitian to help the patient maintain a balanced diet that
meets their nutritional needs.
5. **Symptom Management:**
- Develop strategies to manage symptoms, such as pain or fatigue.
6. **Monitoring:**
- Monitor for signs of complications or flare-ups and report to the healthcare
team.
7. **Emotional Support:**
- Offer emotional support and encourage the patient to express concerns
about the impact of Crohn's disease on their life.
8. **Collaboration:**
- Work closely with the healthcare team to ensure a coordinated approach
to care.
9. **Patient Advocacy:**
- Advocate for the patient's needs and preferences in the healthcare setting.
10. **Education on Lifestyle Modifications:**
- Provide guidance on lifestyle changes, including stress management and
exercise.
**Medical Management:**
1. **Medication Administration:**
- Administer prescribed medications as directed.
2. **Monitoring:**
- Regularly monitor the patient's response to medications and report any
changes.
3. **Patient Education:**
- Educate the patient about medications, including potential side effects
and the importance of adherence.
4. **Symptom Management:**
- Work on alleviating symptoms and improving the patient's quality of life
through medical interventions.
5. **Collaboration:**
- Collaborate with the healthcare team for a comprehensive approach to
medical care.
**Surgical Management:**
1. **Preoperative Care:**
- Prepare the patient for surgery, including preoperative assessments and
education.
2. **Intraoperative Assistance:**
- Assist during the surgical procedure, ensuring a safe and sterile
environment.
3. **Postoperative Care:**
- Monitor the patient's recovery, manage pain, and watch for any
complications.
4. **Wound Care:**
- Provide care for surgical incisions and promote healing.
5. **Patient Education:**
- Educate the patient on postoperative care, including medications and
signs of complications.
6. **Collaboration:**
- Collaborate with the surgical team and other healthcare professionals to
ensure continuity of care.
Whether it's medical or surgical management, the nurse plays a crucial role in
patient care, from administering treatments to offering support and education.
Coordination with the healthcare
comprehensive and effective care.
team
is
essential
for
providing
Complication:
1. **Intestinal Strictures:**
- Chronic inflammation can lead to the formation of scar tissue, causing
narrowing (strictures) of the intestine. This may result in bowel obstruction and
abdominal pain.
2. **Fistulas:**
- Inflammation can create abnormal connections (fistulas) between different
parts of the digestive tract or between the intestine and other organs, leading
to complications like infection.
3. **Perianal Complications:**
- Inflammation around the anus can cause issues such as fissures (tears in
the lining of the anus), abscesses, or fistulas.
4. **Malnutrition:**
- Chronic inflammation and impaired absorption in the inflamed areas of the
digestive tract can lead to malnutrition, as the body may not absorb nutrients
effectively.
5. **Increased Risk of Colon Cancer:**
- Long-term inflammation and the presence of certain factors in Crohn's
disease can elevate the risk of developing colorectal cancer over time.
APPENDICITIS
OVERVIEW
Appendicitis is an inflammation of the appendix, a small, finger-like pouch
attached to the cecum, the beginning of the large intestine. The exact cause
of appendicitis is not always clear, but it is often associated with an
obstruction in the appendix, such as a small piece of stool, a foreign body, or
a tumor. This obstruction can lead to inflammation, bacterial overgrowth, and
infection.
**Mechanism of Action:**
The obstruction of the appendix can lead to increased pressure, reduced
blood flow, and bacterial proliferation within the organ. As a result, the
appendix becomes swollen, inflamed, and can eventually rupture if not treated
promptly.
**Signs and Symptoms:**
1. **Abdominal Pain:**
2. **Nausea and Vomiting:**
3. **Loss of Appetite:**
4. 4. **Fever:**
5. **Abdominal Tenderness:**
6. **Rebound Tenderness:**
7. **Change in Bowel Habits:**
**Incubation Period:**
Appendicitis doesn't have a typical incubation period like infectious diseases.
Instead, it tends to develop over a variable period, and the symptoms can
progress relatively quickly.
**Causative Agent:**
The primary cause of appendicitis is not an infectious agent but rather an
obstruction that leads to inflammation and infection. However, once the
appendix is inflamed, it can be susceptible to bacterial overgrowth,
complicating the condition.
PATHOPHYSIOLOGY
Diagnostic Procedure
Blood and urine tests
URINE VALUES
1. **Color:** Pale yellow to amber.
2. **Odor:** Slightly aromatic.
3. **pH:** 4.6 to 8.0.
4. **Specific Gravity:** 1.005 to 1.030.
5. **Protein:** 0 to 8 milligrams per deciliter (mg/dL).
6. **Glucose:** Normally, there should be little to no glucose in urine.
7. **Ketones:** Normally, there should be no ketones in urine.
8. **Blood:** Normally, there should be no red blood cells in urine.
9. **White Blood Cells (WBC):** 0 to 5 WBCs per high power field.
10. **Nitrites:** Normally, there should be no nitrites in urine.
BLOOD VALUES
Complete Blood Count (CBC):
 Red Blood Cell (RBC) Count: 4.5 to 5.5 million cells/mcL for men; 4.0
to 5.0 million cells/mcL for women.
 Hemoglobin (Hb): 13.8 to 17.2 grams/dL for men; 12.1 to 15.1
grams/dL for women.
 Hematocrit (Hct): 38.3% to 48.6% for men; 35.5% to 44.9% for
women.
 White Blood Cell (WBC) Count: 4,000 to 11,000 cells/mcL.
 Platelet Count: 150,000 to 450,000 platelets/mcL.
CT SCAN
1. **Normal Appendix:** The appendix would appear as a small, tubular
structure with a closed lumen and a thin, smooth wall.
2. **No Evidence of Inflammation:** There should be no signs of inflammation,
such as thickening of the appendix wall or surrounding tissues.
3. **No Obstruction:** The lumen of the appendix should not be obstructed,
and there should be no blockages or foreign bodies.
4. **No Fluid Accumulation:** There should be no fluid collection (abscess)
around the appendix.
5. **No Enlarged Lymph Nodes:** The lymph nodes in the area should be of
normal size, indicating the absence of significant infection or inflammation.
MEDICATION
BRAND NAME: Cefotan
GENERIC NAME: Cefotetan
CLASSIFICATION: second-generation cephalosporins
MECHANISM OF ACTION: he bactericidal action of cefotetan results from
inhibition of cell wall synthesis by binding and inhibiting the bacterial penicillin
binding proteins which help in the cell wall biosynthesis.
WHEN TO GIVE: It is usually given every 12 or 24 hours.
NURSING RESPONSIBILITY: a nursing responsibility would be to ensure the
proper administration of the medication. This includes checking the
prescription, preparing and administering the dose, and monitoring the
patient for any potential side effects or adverse reactions. It's all about making
sure the patient gets the right dose at the right time and stays safe during the
process.
Nursing management
1. **Assessment:**
- Perform a thorough assessment of the patient, including vital signs, pain
level, and any associated symptoms.
- Obtain a detailed medical history, including any previous abdominal
surgeries or medical conditions.
2. **Pain Management:**
- Administer pain relief as prescribed and assess the effectiveness.
- Use a pain scale to monitor and document the patient's pain intensity.
3. **NPO Status:**
- Keep the patient NPO (nothing by mouth) to prevent complications and
prepare for potential surgery.
4. **IV Fluids:**
- Administer intravenous fluids to maintain hydration and electrolyte
balance.
5. **Preoperative Care:**
- Prepare the patient for surgery by explaining the procedure, addressing
concerns, and obtaining informed consent.
- Administer prescribed preoperative medications.
- Monitor and record vital signs regularly.
6. **Surgical Site Care:**
- Monitor the surgical site for signs of infection or complications.
- Teach the patient about proper wound care and signs of infection
postoperatively.
7. **Ambulation and Activity:**
- Encourage early ambulation to prevent complications such as atelectasis
and deep vein thrombosis.
8. **Postoperative Care:**
- Monitor vital signs and assess for any signs of complications, such as
infection or bleeding.
- Administer prescribed postoperative medications, including antibiotics and
pain relief.
- Assist with ambulation and provide support as needed.
9. **Nutritional Support:**
- Gradually reintroduce oral intake as tolerated, starting with clear liquids
and advancing as per physician orders.
10. **Patient Education:**
- Educate the patient on signs and symptoms of complications and when to
seek medical attention.
- Provide information on postoperative care, including activity restrictions
and follow-up appointments.
Complication
.
Perforation:
If not treated promptly, the inflamed appendix can burst, leading to the release of bacteria into the
abdominal cavity. This can result in a serious infection known as peritonitis.
Peritonitis:
Inflammation of the peritoneum, the lining of the abdominal cavity, due to infection from a ruptured
appendix. It can lead to severe abdominal pain, fever, and a rigid abdomen.
Abscess Formation:
Pockets of pus can develop around the appendix, leading to abscess formation. Abscesses may need
drainage either through surgery or percutaneous drainage.
Sepsis:
In severe cases, the infection can spread throughout the body, causing systemic inflammation and
organ dysfunction. This can lead to sepsis, a life-threatening condition.
Bowel Obstruction:
Inflammation and scarring from appendicitis can lead to bowel obstruction, causing abdominal pain,
bloating, and constipation.
Peritonitis
Overview
MECHANISM OF ACTION
Peritonitis is usually caused by an infection that has spread to the
peritoneum, the thin tissue lining the abdomen. The most common mode of
transmission is through the spread of infectious agents from other parts of the
body, such as the gastrointestinal tract. This can happen through the
bloodstream, direct injury, or perforation of abdominal organs like the
appendix or colon.
SIGNS AND SYMPTOMS :
Signs and symptoms of peritonitis can include abdominal pain and tenderness,
swelling, fever, nausea, vomiting, and an overall feeling of illness. In severe
cases, it can lead to dehydration, shock, and organ failure.
INCUBATION PERIOD:
The incubation period for peritonitis can vary depending on the underlying
cause and the specific infectious agent involved. It may range from a few
hours to several days.
CAUSATIVE AGENT:
Causative agents of peritonitis can include bacteria, viruses, fungi, or parasites.
The most common bacteria involved are often those normally present in the
digestive system, such as Escherichia coli (E. coli) and Streptococcus species.
-
PATHOPHYSIOLOGY
Diagnostic tests
XRAY
1. **No Free Air:** Peritonitis is often associated with the presence of free air
in the abdominal cavity. A normal X-ray would show no evidence of abnormal
air accumulation.
NURSING RESPONSIBILITY
Nurses preparing for an X-ray need to ensure patient comfort and safety.
They'll check if the patient has any metal objects that need to be removed, like
jewelry or belts. During the X-ray, they'll guide the patient to the correct
position and communicate any necessary instructions. After the procedure,
they'll assist with post-X-ray care, ensuring the patient is comfortable and
documenting the process accurately. Clear communication with the radiology
team is also part of the responsibility
A computerized tomography (CT)
1. **Head CT:**
- Normal brain structure without any signs of tumors or abnormalities.
- Clear sinuses and normal skull structure.
2. **Chest CT:**
- Normal lung tissue without masses or nodules.
- Intact and properly positioned heart and blood vessels.
- Normal appearance of the chest organs and structures.
3. **Abdominal CT:**
- Normal appearance of abdominal organs such as liver, kidneys, spleen, and pancreas.
- Clear visualization of the gastrointestinal tract without blockages or abnormalities.
- No signs of fluid accumulation or abnormal growths.
4. **Pelvic CT:**
- Normal structure of pelvic organs, including the bladder, uterus (in females), and prostate
(in males).
- Absence of masses or abnormalities in the pelvic region.
5. **Bone CT:**
- Normal bone structure without fractures or signs of bone diseases.
- Clear visualization of joints and surrounding tissues.
Nursing Responsibility
Nurses getting ready for a CT scan focus on patient preparation and comfort.
They check for any metal objects and ensure the patient follows pre-scan
guidelines, like fasting if required. During the CT scan, they help the patient
into the right position and may provide contrast dye if needed. Post-scan,
they monitor the patient for any immediate reactions and offer support.
Documentation of the procedure and communication with the radiology team
are also part of their role.
.
MEDICATION
GENERIC NAME: Tigecycline
BRAND NAME: Tygacil
CLASSIFICATION: antibiotics
WHEN TO GIVE: This medication
is given by injection into a vein
over 30 to 60 minutes by a healthcare professional. It is given
as directed by your doctor, usually every 12 hours.
NURSING RESPONSIBILITY: Nurses administering Tigecycline need to follow
proper protocols to ensure the safe and effective delivery of the medication.
This includes checking the patient's medical history, confirming the correct
dosage, and monitoring for any potential side effects. Additionally, they
should provide clear instructions to the patient and document the
administration accurately. Regular communication with the healthcare team is
essential for a comprehensive approach to patient care.
Nursing management
1. **Assessment:**
- Regularly assess vital signs and monitor for signs of shock.
- Monitor abdominal pain, tenderness, and distension.
- Assess bowel sounds and watch for changes.
2. **Medication Administration:**
- Administer prescribed antibiotics and other medications.
- Manage pain effectively with analgesics as ordered.
3. **Fluid and Nutrition Management:**
- Monitor fluid balance and administer intravenous fluids.
- NPO (nothing by mouth) status may be necessary initially.
- Gradually introduce oral intake as tolerated.
4. **Monitoring and Observation:**
- Continuously monitor the patient's response to treatment.
- Observe for any signs of complications such as abscess formation.
5. **Wound Care:**
- If surgery is involved, assess and care for surgical incisions.
- Prevent and monitor for signs of wound infection.
6. **Collaboration:**
- Collaborate with other healthcare team members for a multidisciplinary
approach.
- Communicate effectively with the surgical team if intervention is required.
7. **Patient Education:**
- Educate the patient on the importance of completing the full course of
antibiotics.
- Provide information on signs and symptoms to report promptly.
8. **Emotional Support:**
- Offer emotional support to help the patient cope with the illness and
treatment.
- Encourage communication and address concerns.
9. **Prevention of Complications:**
- Monitor for and prevent complications such as sepsis or organ failure.
- Implement measures to prevent deep vein thrombosis (DVT) and other
complications associated with immobility.
10. **Discharge Planning:**
- Plan for patient discharge, ensuring they understand post-discharge care
instructions.
- Provide information on follow-up appointments and medication
management.
COMPLICATIONS
Sepsis:
Peritonitis can lead to a systemic infection that spreads throughout the body, causing
a severe condition known as sepsis. This is a life-threatening complication.
Abscess Formation:
Pockets of pus (abscesses) may form in the abdominal cavity, requiring drainage.
Organ Failure:
Severe peritonitis can lead to dysfunction or failure of organs such as the kidneys or
liver.
Septic Shock:
In cases of severe sepsis, it can progress to septic shock, causing a dangerous drop in
blood pressure and inadequate blood flow to organs.
Adhesive Bowel Obstruction:
Scarring and inflammation from peritonitis may cause the intestines to stick together,
leading to a blockage.
PANCREATIS
Pancreatitis is an inflammation of the pancreas, and its mechanisms of action can be
complex. The pancreas releases digestive enzymes that become activated in the small
intestine to help break down food. When these enzymes activate within the pancreas
itself, it can lead to inflammation.
**Mechanism of Action:**
The activation of digestive enzymes within the pancreas can occur due to various
reasons, such as gallstones blocking the pancreatic duct or excessive alcohol
consumption. The activated enzymes can start to damage pancreatic tissue, leading
to inflammation and other complications.
**Signs and Symptoms:**
- **Abdominal Pain:**
- **Nausea and Vomiting:**
- **Fever:**
- **Elevated Heart Rate:**
- **Jaundice:**
- **Tenderness of the Abdomen:*
**Incubation Period:**
Pancreatitis doesn't really have a specific incubation period like some infections. It's
often more of an acute condition that can develop rapidly. The onset of symptoms
can vary, and it might be sudden or develop over a few days.
**Causative Agents:**
The most common causes of pancreatitis include:
- **Gallstones:** Blocking the pancreatic duct.
- **Alcohol Consumption:** Especially in excess.
- **Trauma:** Injury to the abdomen.
- **Infections:** Viruses or bacteria affecting the pancreas.
- **Certain Medications:** Some can trigger pancreatitis.
PATHOPHYSIOLOGY
DIAGNOSTIC TEST
BLOODTEST
Blood tests are often used to assess pancreatic function and diagnose pancreatitis. Here are some
common blood tests and their normal values:
1. **Amylase:**
- Normal Range: 30 to 110 units per liter (U/L)
2. **Lipase:**
- Normal Range: 0 to 160 U/L
3. **Glucose:**
- Normal Range: 70 to 99 milligrams per deciliter (mg/dL)
4. **Complete Blood Count (CBC):**
- - Normal WBC Range: 4,000 to 11,000 cells per microliter.
5. **Liver Enzymes:**
- - Normal ALT Range: 7 to 56 U/L
- Normal AST Range: 10 to 40 U/L
STOOL TEST
1. **Elastase-1:**
- Normal Range: Greater than 200 micrograms per gram of stool.
- Elastase-1 is an enzyme produced by the pancreas. Low levels may indicate pancreatic insufficiency,
suggesting the pancreas is not producing enough enzymes for proper digestion.
2. **Fat Content:**
- Normal Range: Less than 7 grams of fat per 100 grams of stool.
- Increased fat content in the stool may indicate malabsorption, which can be a sign of pancreatic
dysfunction.
PANCREATIC FUNCTION TEST
1. **Serum Amylase:**
- Normal Range: 30 to 110 units per liter (U/L)
- 2. **Serum Lipase:**
- Normal Range: 0 to 160 U/L
3. **Pancreatic Elastase-1:**
- Normal Range: Greater than 200 micrograms per gram of stool
4. **Glucose Tolerance Test:**
- Normal Fasting Blood Glucose: 70 to 99 milligrams per deciliter (mg/dL)
- Normal 2-Hour Postprandial (after eating) Blood Glucose: Less than 140 mg/dL
5. **Secretin-Stimulated Pancreatic Function Test:**
- Normal Bicarbonate Level: 80 to 140 milliequivalents per liter (mEq/L)
MEDICATION: There is no specific medicine to treat pancreatitis. Treatment begins with
a hospital stay to manage symptoms and complications.
Nursing management
1. **Pain Management:**
- Administer prescribed pain medications and assess pain regularly.
2. **Nutritional Support:**
- Withhold oral intake initially to allow the pancreas to rest (NPO - nothing by
mouth).
- Gradually introduce a clear liquid diet and progress to a low-fat diet as tolerated.
- 3. **Hydration:**
- Maintain adequate hydration to prevent dehydration.
4. **Monitoring and Assessment:**
- Monitor vital signs, intake and output, and laboratory values (amylase, lipase,
electrolytes).
5. **Patient Education:**
- Educate the patient on the importance of adhering to the prescribed diet and
medications.
- Provide information on signs and symptoms of complications and when to seek
medical attention.
- Emphasize the importance of abstaining from alcohol and managing risk factors.
6. **Psychosocial Support:**
- Offer emotional support and assess for signs of anxiety or depression.
- Encourage open communication and involve the patient and family in care
decisions.
- Provide information about support groups or counseling services.
7. **Prevention of Complications:**
- Monitor for signs of infection and administer antibiotics as prescribed.
- Assess for respiratory distress and implement measures to prevent respiratory
complications.
- Collaborate with the healthcare team to manage any complications promptly.
8. **Collaboration with Other Healthcare Providers:**
- Coordinate care with physicians, dietitians, and other healthcare professionals.
- Assist in scheduling diagnostic tests and procedures as needed.
MEDICAL AND SURGICAL MANAGEMENT
**Medical Management:**
1. **Pain Management:**
- Analgesics, including acetaminophen or nonsteroidal anti-inflammatory drugs
(NSAIDs), may be used to manage pain.
2. **Nasogastric (NG) Suction:**
- To relieve the gastrointestinal tract and reduce pancreatic secretions, a
nasogastric tube may be used to keep the stomach empty.
3. **Fasting and Nutritional Support:**
- Initially, the patient may be kept NPO (nothing by mouth) to allow the pancreas to
rest.
- Enteral nutrition may be introduced gradually to support the patient's nutritional
needs while avoiding stimulation of the pancreas.
4. **Fluid Resuscitation:**
- Intravenous (IV) fluids are administered to maintain hydration and prevent
complications like hypovolemia.
5. **Pancreatic Enzyme Replacement:**
- Enzyme supplements may be prescribed to aid digestion and compensate for
pancreatic insufficiency.
6. **Treatment of Underlying Causes:**
- If gallstones are the cause, removal of the gallbladder (cholecystectomy) may be
recommended.
- Lifestyle changes, such as abstinence from alcohol, may be advised.
**Surgical Management:**
1. **Pancreatic Necrosectomy:**
- In cases of severe necrotizing pancreatitis, surgical removal of dead or damaged
pancreatic tissue may be necessary.
2. **Pseudocyst Drainage:**
- Large pseudocysts may require drainage, which can be done through minimally
invasive procedures or surgery.
3. **Biliary Tract Procedures:**
- Surgical procedures to address gallstones or strictures in the bile duct may be
performed.
4. **Pancreatic Duct Drainage:**
- In some cases, surgery may be needed to address blockages or strictures in the
pancreatic duct.
5. **Splenectomy:**
- In severe cases with complications involving the spleen, removal of the spleen
may be considered.
COMPLICATION
1. **Pseudocyst Formation:**
- Inflammation and damage to the pancreas can lead to the development of fluidfilled sacs called pseudocysts. These cysts can cause abdominal pain and, in severe
cases, may rupture or become infected.
2. **Infection:**
- The damaged pancreatic tissue is susceptible to bacterial infection. In severe
cases, this can lead to localized infections (abscesses) or systemic infections
affecting other organs.
3. **Pancreatic Necrosis:**
- Severe inflammation can lead to tissue death (necrosis) in the pancreas. This can
contribute to the formation of abscesses, increase the risk of infection, and impair the
pancreas's ability to function properly.
4. **Respiratory Complications:**
- Pancreatitis, especially in its severe form, can cause respiratory distress. This
may result from the release of inflammatory mediators affecting the lungs or from the
accumulation of fluid in the abdominal cavity, putting pressure on the diaphragm.
5. **Diabetes Mellitus:**
- Chronic pancreatitis, often resulting from repeated episodes of acute pancreatitis,
can lead to damage to the insulin-producing cells in the pancreas. This damage may
result in the development of diabetes mellitus, requiring ongoing management of
blood sugar levels.
Cholecystitis
OVERVIEW
is an inflammatory condition of the gallbladder, often associated with the presence of
gallstones. It is not a condition that is transmitted from person to person like
infectious diseases. Instead, it typically develops due to the blockage of the cystic
duct, which prevents bile from flowing out of the gallbladder.
**Mode of Transmission:**
Cholecystitis is not a communicable disease, and it does not have a mode of
transmission like infectious diseases. Instead, it is often related to the presence of
gallstones or, less commonly, other factors such as tumors, infections, or injury.
**Signs and Symptoms:**
The signs and symptoms of cholecystitis can include:
1. **Pain:**
- Severe pain in the upper right or center abdomen.
- Pain that may radiate to the back or right shoulder blade.
2. **Fever and Chills:**
- Fever may be present, along with chills.
3. **Nausea and Vomiting:**
- Nausea and vomiting are common symptoms.
4. **Jaundice:**
- In some cases, jaundice (yellowing of the skin and eyes) may occur if there is a
blockage of the common bile duct.
5. **Abdominal Tenderness:**
- The abdomen may be tender to the touch.
**Incubation Period:**
Cholecystitis does not have a specific incubation period because it is not caused by
an infectious agent that requires time to multiply and cause symptoms. The
development of cholecystitis is usually associated with the underlying causes, such
as the formation of gallstones, which can occur over an extended period.
**Causative Agent:**
The primary cause of cholecystitis is the presence of gallstones, which are hardened
deposits that form in the gallbladder. These stones can block the cystic duct, leading
to inflammation and infection of the gallbladder. In some cases, cholecystitis can also
be caused by other factors, such as tumors, trauma, or infections.
PATHOPHYSIOLOGY
DIAGNOSTIC TEST
ABDOMINAL ULTRASOUND
1. **Liver:**
- Normal size, shape, and texture.
2. **Gallbladder:**
- Presence of the gallbladder.
3. **Pancreas:**
- Normal appearance with no signs of inflammation or tumors.
4. **Kidneys:**
- - Normal size, shape, and position.
-
5. **Spleen:**
- Normal size and structure.
- No signs of enlargement or abnormalities.
6. **Bladder:**
- Visible and typically empty during the ultrasound.
- Normal size and shape.
7. **Blood vessels:**
- Blood flow in major blood vessels, such as the abdominal aorta and its branches, is usually
assessed for normal flow.
8. **Abdominal wall:**
- Normal thickness and structure of the abdominal muscles.
9. **Ascites:**
- Absence of abnormal fluid accumulation in the abdominal cavity.
10. **Peritoneum:**
- No signs of inflammation or thickening of the peritoneal lining.
Magnetic Resonance Cholangiopancreatography (MRCP)
1. **Bile Ducts:**
- Absence of strictures, dilatations, or blockages.
2. **Pancreatic Duct:**
- Normal size and contour of the pancreatic duct.
3. **Gallbladder:**
- Visualization of the gallbladder.
- Absence of gallstones or evidence of inflammation (cholecystitis).
4. **Pancreas:**
- Normal appearance of the pancreatic tissue.
- Absence of masses or tumors.
5. **Liver:**
- Normal size, shape, and structure of the liver.
- Absence of focal lesions or abnormalities.
6. **Surrounding Structures:**
- Clear visualization of surrounding blood vessels, including the portal vein and hepatic artery.
7. **Periampullary Region:**
- Assessment of the periampullary region, where the bile duct and pancreatic duct enter the
duodenum.
- Absence of abnormalities in this area.
8. **Fluid Collections:**
- Absence of abnormal fluid collections in the biliary or pancreatic ducts.
9. **Duodenum:**
- Visualization of the duodenum, which may help assess the ampulla of Vater.
Sure, let's simplify the nursing management for cholecystitis:
NURSING MANAGEMENT
1. **Pain Management:**
- Administer prescribed pain medications.
- Encourage the use of heat pads for comfort.
2. **Nausea and Vomiting:**
- Administer anti-nausea medications as prescribed.
- Encourage small, frequent meals.
3. **Fluid Intake:**
- Ensure adequate hydration.
- Encourage oral fluids unless contraindicated.
4. **Monitoring:**
- Monitor vital signs regularly.
- Keep an eye on pain levels and report any changes.
5. **Diet:**
- Implement a low-fat diet as prescribed.
- Avoid fried, greasy foods.
6. **Education:**
- Educate on the importance of adherence to prescribed medications.
- Provide information on signs of complications (fever, worsening pain).
7. **Rest:**
- Encourage adequate rest and relaxation.
- Limit physical activity as needed.
8. **Emotional Support:**
- Offer emotional support and address concerns.
- Provide information to alleviate anxiety.
9. **Follow-up:**
- Ensure understanding of follow-up appointments.
- Reinforce the importance of reporting any worsening symptoms.
complications:
Gangrenous Cholecystitis:
If there is a prolonged blockage of the cystic duct, the gallbladder may not receive proper blood
supply, leading to tissue death (gangrene).
Perforation:
Untreated inflammation may cause the gallbladder to rupture, leading to bile leakage into the
abdominal cavity.
Abscess Formation:
In severe cases, infection within the gallbladder can lead to the formation of an abscess.
Bile Duct Obstruction:
Inflammation or gallstones can obstruct the bile ducts, causing jaundice and potentially leading to
liver damage.
Pancreatitis:
Inflammation can extend to the pancreas, causing pancreatitis.
CYSTITIS
OVERVIEW
The mode of transmission is usually through the ascending route, where bacteria from the anus or
genital area enter the urethra and travel up into the bladder.
Signs and symptoms of cystitis include:
1. **Painful urination:** A burning sensation during urination is a common symptom.
2. **Frequent urination:** An increased urge to urinate, even when the bladder is not full.
3. **Urgency:** The feeling that you need to urinate immediately.
4. **Cloudy or strong-smelling urine:** Changes in the appearance or odor of urine may be present.
5. **Lower abdominal discomfort:** A general discomfort or pressure in the lower abdomen.
The incubation period for cystitis can vary, but symptoms often develop within a few days after
exposure to the infectious agent.
Cystitis is typically caused by a bacterial infection, with Escherichia coli (E. coli) being the most
common culprit.
PATHOPHYSIOLOGY
DIAGNOSTIC TEST
1. **Color:** Pale yellow to amber
2. **Appearance:** Clear
3. **Specific Gravity:** 1.005 to 1.030
4. **pH:** 4.6 to 8.0
5. **Protein:** Up to 8 mg/dL
6. **Glucose:** Negative
7. **Ketones:** Negative
8. **Bilirubin:** Negative
9. **Blood:** 0-2 red blood cells per high-power field (RBC/HPF) for men, 0-5 RBC/HPF for women
10. **Leukocytes:** Negative or trace
11. **Nitrites:** Negative
12. **Urobilinogen:** 0.2 to 1.0 mg/dL
13. **Crystals:** Absent or rare
14. **Casts:** Absent or rare
15. **Bacteria:** Negative or trace
NURSING RESPONSIBILITY:
Medication:
Brand name: Furadantin
Generic name: Nitrofurantoin
Classification:
antibiotics.
Mechanism of action: Nitrofurantoin is activated inside bacteria by reduction via the
flavoprotein nitrofurantoin reductase to unstable metabolites, which disrupt ribosomal
RNA, DNA and other intracellular components. It is bactericidal, especially to bacteria
present in acid urine.
If you're taking nitrofurantoin twice a day, leave 12
hours between each dose – for example, take it at 8am and 8pm. If
you're taking it 4 times a day, this will usually be first thing in the
morning, at about midday, late in the afternoon, and at bedtime.
Nursing Responsibility:
For Nitrofurantoin, a common antibiotic for urinary tract infections:
1. **Administering Medication:**
- Give Nitrofurantoin as prescribed to treat the urinary tract
infection.
2. **Monitoring Side Effects:**
- Watch for any side effects and report them to the healthcare team.
3. **Encouraging Water Intake:**
- Advise the patient to drink plenty of water to enhance the
antibiotic's effectiveness.
4. **Patient Education:**
- Educate the patient about completing the full course of
Nitrofurantoin and potential interactions with food.
When to give:
Administration: Give the medication with food to enhance absorption and reduce
stomach upset.
Hydration: Encourage ample water intake to help flush the bacteria from the urinary
tract.
Monitoring: Keep an eye on the patient for any signs of adverse reactions, such as
rash or difficulty breathing.
Nursing Management:
1. **Antibiotic Therapy:**
- Administer prescribed antibiotics to target the specific bacterial infection causing cystitis.
- Ensure the patient completes the full course of antibiotics.
2. **Pain Management:**
- Provide pain relief measures, such as analgesics, to alleviate discomfort during urination.
3. **Fluid Intake:**
- Encourage increased fluid intake to help flush out bacteria from the urinary system.
- Monitor input and output to ensure adequate hydration.
4. **Bladder Irrigation:**
- In some cases, healthcare providers may perform bladder irrigation to help remove
bacteria and relieve symptoms.
5. **Education:**
- Educate the patient about the importance of completing the antibiotic course and
maintaining good hygiene practices.
- Advise on the importance of regular voiding and avoiding holding urine for prolonged
periods.
6. **Comfort Measures:**
- Provide warm compresses or a heating pad to alleviate abdominal discomfort.
7. **Follow-up:**
- Schedule follow-up appointments to monitor the response to
treatment.
- Assess for any complications or recurrence of symptoms.
8. **Preventive Measures:**
- Emphasize the importance of good personal hygiene, including
wiping from front to back after toileting.
- Encourage the use of cotton underwear and loose-fitting
clothing.
- Discuss strategies to prevent future urinary tract infections.
Medical and Surgical:
**Medical Management:**
1. **Antibiotics:**
- The primary treatment for bacterial cystitis involves the use of
antibiotics. Commonly prescribed antibiotics include trimethoprimsulfamethoxazole, nitrofurantoin, or fluoroquinolones.
2. **Pain Management:**
- Analgesics, such as nonsteroidal anti-inflammatory drugs
(NSAIDs), may be prescribed to relieve pain and reduce
inflammation.
3. **Urinary Alkalinizers:**
- In some cases, urinary alkalinizers may be used to make the
urine less acidic, creating an environment less favorable for
bacterial growth.
4. **Hydration:**
- Adequate fluid intake is essential to help flush out bacteria from
the urinary system. This is often a part of the home care plan.
5. **Follow-up Urinalysis:**
- Periodic urinalysis may be performed to monitor the
effectiveness of treatment and ensure the resolution of the
infection.
**Surgical Management:**
1. **Cystoscopy:**
- Cystoscopy is a procedure in which a thin tube with a camera
(cystoscope) is inserted into the urethra and bladder.
2. **Bladder Instillation:**
- Instilling medications directly into the bladder can be done to
reduce inflammation and symptoms. T
3. **Bladder Resection:**
- In cases of severe or recurrent cystitis, where other treatments
have failed, a surgical procedure to remove a portion of the bladder
lining (bladder resection) may be considered.
4. **Urinary Diversion:**
- This involves redirecting the flow of urine from the bladder to a
new pathway.
Complication:
Recurrent Infections:
If the underlying cause of cystitis is not addressed or if the treatment is incomplete, it can
lead to recurrent urinary tract infections (UTIs). Chronic or frequent infections may require
more aggressive management strategies.
Pyelonephritis:
Untreated or recurrent cystitis can lead to the spread of infection to the kidneys, resulting in
a more severe condition known as pyelonephritis. Pyelonephritis can cause kidney damage
and is associated with symptoms such as fever, back pain, and systemic illness.
Sepsis:
In severe cases, particularly if the infection spreads and becomes systemic, cystitis can lead
to sepsis—a life-threatening condition characterized by a systemic inflammatory response to
infection.
Interstitial Cystitis (IC):
In some cases, persistent inflammation of the bladder may lead to a chronic condition
known as interstitial cystitis. This is characterized by long-term bladder pain, urinary
urgency, and frequency.
Bladder Dysfunction:
Chronic or severe cases of cystitis can lead to dysfunction of the bladder, affecting its ability
to store and release urine properly. This may result in urinary incontinence or retention.
Hematuria:
Inflammation of the bladder lining can lead to bleeding, resulting in hematuria (blood in the
urine). While this is usually not a severe complication, it can be a distressing symptom for
the patient.
UROLITHIASIS (STONES)
OVERVIEW
Urolithiasis, commonly known as kidney stones, is not a condition
transmitted from person to person like an infection. Instead, it
develops when certain substances in the urine, such as calcium,
oxalate, and phosphorus, crystallize and form solid particles or
stones in the kidneys or urinary tract.
**Signs and Symptoms:**
1. **Pain:** Severe pain in the back or side, often radiating to the
lower abdomen and groin.
2. **Hematuria:** Blood in the urine, giving it a pink or reddish
color.
3. **Frequent Urination:**
4. **Cloudy or Foul-Smelling Urine:**
5. **Nausea and Vomiting:**
**Incubation Period:**
There is no specific incubation period for urolithiasis because it is
not an infectious condition. The development of kidney stones is
influenced by factors such as diet, genetics, and hydration levels
rather than a contagious agent.
**Causative Agent:**
The primary causative factors for urolithiasis are various substances
that can crystallize in the urine and form stones. Common types of
kidney stones include calcium oxalate stones, calcium phosphate
stones, uric acid stones, and struvite stones.
PATHOPHYSIOLOGY
DIAGNOSTIC TEST
1. **Bones and Soft Tissues:**
- Clear visualization of the spine, ribs, and pelvic bones.
2. **Gas Patterns:**
- Presence of gas in the stomach and intestines, appearing as dark
areas on the X-ray.
3. **Organs:**
- General outlines of abdominal organs, such as the liver, spleen,
and kidneys.
4. **Kidneys, Ureters, and Bladder (KUB):**
- Kidneys are visible as bean-shaped structures on either side of
the spine.
- Ureters are not usually visible unless they contain stones or are
dilated.
- The bladder may be visible if adequately filled.
5. **No Obvious Abnormalities:**
- Absence of abnormal masses, obstructions, or other significant
findings.
Nursing responisility
1. **Patient Preparation:**
- Ensure the patient understands the procedure and removes any metal objects or jewelry.
2. **Positioning:**
- Help the patient get into the correct position for the X-ray, often lying on their back.
3. **Communication:**
- Provide clear instructions and reassurance to keep the patient calm during the procedure.
4. **Safety Measures:**
- Ensure the patient wears a lead apron to minimize radiation exposure to other body parts.
5. **Collaboration:**
- Collaborate with radiology staff to ensure the patient is comfortable and correctly positioned.
6. **Post-Procedure Care:**
- Assist the patient in returning to a comfortable position and address any immediate needs.
7. **Documentation:**
- Document the procedure details, patient positioning, and any relevant information in the medical
record.
MEDICATION
BRAND NAME: Flomax
GENERIC NAME: Tamsulosin
CLASSIFICATION: alpha blockers.
MECHANISM OF ACTION: Tamsulosin is a blocker of alpha-1A and alpha-1D adrenoceptors.
About 70% of the alpha-1 adrenoceptors in the prostate are of the alpha-1A subtype. By
blocking these adrenoceptors, smooth muscle in the prostate is relaxed and urinary flow is
improved.
WHEN TO GIVE: Take tamsulosin 30 minutes after the same meal each day. Follow the
directions on your prescription label carefully, and ask your doctor or pharmacist to explain
any part you do not understand.
NURSING RESPONSIBILITY:
1. **Administration:**
- Administer Tamsulosin as prescribed by the healthcare provider.
2. **Monitoring:**
- Keep an eye on the patient for any side effects or changes in symptoms.
3. **Education:**
- Educate the patient on the importance of taking Tamsulosin as directed.
- Explain potential side effects and when to seek medical attention.
4. **Positioning:**
- Emphasize the need for caution when rising from a sitting or lying position due to the possibility of
dizziness, a common side effect.
5. **Follow-up:**
- Schedule and ensure follow-up appointments to monitor the medication's effectiveness.
Nursing Management:
1. **Pain Management:**
- Administer prescribed pain medications to relieve discomfort.
2. **Hydration:**
- Promote increased fluid intake to help flush out stones and prevent dehydration.
3. **Monitoring and Assessment:**
- Monitor vital signs and assess the patient for signs of infection or complications.
4. **Strain Urine:**
- Instruct the patient to strain urine to catch and analyze stones. This helps determine the stone
composition.
5. **Patient Education:**
- Educate the patient on dietary changes to prevent stone formation.
- Emphasize the importance of maintaining proper hydration.
6. **Comfort Measures:**
- Use heat packs or warm compresses to alleviate pain.
7. **Collaboration:**
- Collaborate with the healthcare team for diagnostic tests and treatment planning.
8. **Follow-up:**
- Schedule follow-up appointments to monitor progress and adjust the care plan as needed.
9. **Emotional Support:**
- Provide emotional support and reassurance to address anxiety or concerns.
10. **Documentation:**
- Maintain accurate and detailed records of the patient's condition, interventions, and responses.
Complication
1. **Obstruction:**
- Kidney stones can obstruct the flow of urine, leading to backflow into the kidneys. This may cause
hydronephrosis (swelling of the kidneys) and potentially damage kidney tissue.
2. **Infection:**
- Stones can create a conducive environment for bacterial growth. Infections may occur in the
urinary tract, leading to conditions such as pyelonephritis.
3. **Hematuria:**
- The passage of kidney stones can cause bleeding, resulting in blood in the urine (hematuria).
4. **Renal Impairment:**
- Persistent or recurrent kidney stones may contribute to kidney damage, impacting renal function
over time.
5. **Perforation:**
- In rare cases, large stones may cause perforation of the urinary tract, leading to urine leakage into
surrounding tissues.
6. **Renal Colic:**
- Intense pain can accompany the movement of stones through the urinary tract, causing renal colic.
Severe or prolonged pain may require medical intervention.
7. **Stricture Formation:**
- Long-term irritation from stones may lead to the development of strictures or narrowed areas in
the ureters.
8. **Complications during Treatment:**
- Certain medical interventions, such as lithotripsy (shock wave therapy) or surgical procedures, may
have associated risks and complications.
Pelvic Inflammatory disease
Overview
Pelvic inflammatory disease (PID) is typically caused by bacterial infections, most commonly from
sexually transmitted infections (STIs) such as chlamydia and gonorrhea. The mode of transmission is
through sexual activity, where the bacteria can travel from the vagina and cervix into the upper
reproductive organs, causing inflammation.
**Signs and symptoms** of PID can vary, but they often include pelvic pain, abdominal pain, irregular
menstrual bleeding, painful urination, and fever. In some cases, there may be no noticeable
symptoms, making it important for individuals at risk to undergo regular screenings.
The **incubation period** for PID is not well-defined, as it depends on the specific causative agent
and the individual's response to the infection. However, symptoms may develop within days or weeks
after exposure to the infecting bacteria.
The **causative agents** are primarily bacteria, with Chlamydia trachomatis and Neisseria
gonorrhoeae being the most common culprits. Other bacteria, such as Mycoplasma genitalium and
anaerobic bacteria, can also contribute to PID.
PATHOPHYSIOLOGY
DIAGNOSTIC TEST:
A urine test is not typically the primary diagnostic test for pelvic inflammatory disease (PID). Instead,
healthcare providers usually rely on tests such as pelvic examinations, blood tests, and imaging
studies to diagnose PID.
However, urine tests may be done to check for the presence of sexually transmitted infections (STIs)
like chlamydia and gonorrhea, which are common causes of PID. In such cases, the normal values in a
urine test would be the absence of these specific pathogens.
TRANSVAGINAL ULTRASOUND
1. **Normal Uterus:** The uterus appears normal in size, shape, and position.
2. **Normal Endometrium:** The lining of the uterus (endometrium) is of normal thickness and
appearance.
3. **Normal Ovaries:** Both ovaries are present and appear normal without any cysts or
abnormalities.
4. **Normal Fallopian Tubes:** The fallopian tubes are not enlarged or blocked.
5. **Absence of Abnormal Masses:** There are no abnormal growths or masses in the pelvic region.
6. **Normal Blood Flow:** Blood flow to the reproductive organs is normal.
NURSING MANAGEMENT
Nursing management involves overseeing and coordinating patient care. It includes tasks like
assessing patient needs, creating care plans, administering treatments, and communicating with the
healthcare team. It's essentially about ensuring that patients receive effective and compassionate
care while promoting their well-being and recovery.
MEDICAL AND SURGICAL MANAGEMENT
In healthcare, **medical management** involves treating patients using non-invasive methods such
as medications, lifestyle interventions, and monitoring. It's about addressing health issues without
resorting to surgery.
On the other hand, **surgical management** involves procedures and operations to diagnose, treat,
or prevent a medical condition. Surgeons use techniques like incisions, sutures, and other
interventions to physically alter or remove tissues.
COMPLICATION
In a medical context, a **complication** refers to an unexpected and often undesirable development
or consequence that arises during the course of a disease, medical treatment, or surgical procedure.
Complications can vary in severity and may hinder the normal recovery process or lead to additional
health issues. Healthcare professionals closely monitor patients to prevent and address complications,
aiming to ensure the best possible outcomes in their care.
BENIGN PROSTATIC HYPERTROPHY
OVERVIEW
BPH, or benign prostatic hyperplasia, isn't something you "transmit" to others like a contagious
disease—it's more of a non-cancerous enlargement of the prostate gland, mainly affecting older men.
The exact cause isn't clear, but age and changes in sex hormone levels are factors.
As for signs and symptoms, think frequent urination, especially at night, difficulty starting or stopping
urination, weak urine stream, and a feeling that your bladder hasn't emptied completely. It's less
about transmission and more about an age-related change in the prostate.
There's no incubation period because it's not an infectious condition. And the causative agent? Well,
blame it on the aging process and hormonal changes.
PATHOPHYSIOLOGY
DIAGNOSTIC PROCEDURE
The prostate-specific antigen (PSA)
1. **Normal Range:** A PSA level between 0 and 4 nanograms per milliliter (ng/mL) is often
considered normal. However, the interpretation can be influenced by various factors, and a higher
PSA level doesn't necessarily mean cancer.
2. **Age Consideration:** PSA levels tend to increase with age. What might be considered normal for
a younger man might be different for an older one.
2. **Baseline PSA:** Establishing an individual's baseline PSA level through regular testing can be
crucial. Significant changes from this baseline might indicate a concern.
3.
Normal urine flow
1. **Initiation:** The stream starts without difficulty.
2. **Stream Strength:** It is a reasonably strong and continuous stream.
3. **Duration:** The time it takes to empty the bladder is within a normal range.
4. **No Pain:** Urination is not accompanied by pain or discomfort.
5. **Complete Emptying:** There is a sense of complete emptying of the bladder, with no residual
feeling of urgency.
MEDICATION
BRAND NAME: Hytrin
GENERIC NAME: Terazosin
CLASSIFICATION: alpha-blockers.
WHEN TO GIVE: Terazosin comes as a capsule to take by mouth. It is usually taken with or
without food once a day at bedtime or twice a day.
MECHANISM OF ACTION: Terazosin comes as a capsule to take by mouth. It is usually taken
with or without food once a day at bedtime or twice a day. Follow the directions on your
prescription label carefully, and ask your doctor or pharmacist to explain any part you do not
understand. Take terazosin exactly as directed.
NURSING RESPONSIBILITY:
1. **Administer Medication:** Give the patient their terazosin as prescribed by the doctor.
2. **Monitor Vital Signs:** Keep an eye on things like blood pressure to make sure the medication is
working as it should.
3. **Educate the Patient:** Teach the patient about how and when to take their medication and
explain any potential side effects or things to watch out for.
4. **Assess for Adverse Reactions:** Keep an eye out for any unexpected reactions to the medication
and report them.
5. **Encourage Follow-Up:** Make sure the patient follows up with their doctor as needed to
monitor progress and adjust the treatment plan if necessary.
NURSING MANAGEMENT
Nursing management involves overseeing and coordinating the care of patients. It includes tasks like
assessing patient needs, creating care plans, assigning tasks to nursing staff, and ensuring quality care.
It's basically the behind-the-scenes work that keeps everything running smoothly so patients get the
best care possible.
MEDICAL SURGICAL MANAGEMENT
**Medical Management:**
1. **Medications:** Provide and ensure the patient takes prescribed medications, such as alphablockers or 5-alpha reductase inhibitors, to manage symptoms.
2. **Lifestyle Changes:** Encourage a healthy lifestyle, including regular exercise and a balanced diet,
which can help alleviate symptoms.
3. **Monitoring:** Regularly check and monitor symptoms, medication effectiveness, and any side
effects.
**Surgical Management:**
1. **Transurethral Resection of the Prostate (TURP):** Involves removing excess prostate tissue to
improve urine flow.
2. **Laser Surgery:** Uses lasers to trim or remove prostate tissue, providing relief from symptoms.
3. **Open Prostatectomy:** In more severe cases, a portion of the prostate is surgically removed.
4. **Minimally Invasive Procedures:** Options like transurethral microwave therapy (TUMT) or
transurethral needle ablation (TUNA) offer alternatives to traditional surgery.
COMPLICATION
It's like an unexpected twist in the BPH storyline. Imagine you're dealing with the usual symptoms,
and suddenly, there's an extra hurdle. These complications could include things like urinary tract
infections, bladder stones, or issues with kidney function. They're the curveballs that healthcare
professionals work to manage alongside the main BPH scenario.
SYSTEM LUPUS
OVERVIEW
Systemic lupus erythematosus (SLE) is an autoimmune disease, which means it's not caused by an
external pathogen like a virus or bacteria. Instead, it occurs when the immune system attacks the
body's own tissues. The exact cause of SLE is not fully understood, but it's believed to involve a
combination of genetic, environmental, and hormonal factors.
As for transmission, you can't "catch" lupus from someone else like you would a cold or flu. It's not
contagious.
Signs and symptoms of SLE can vary widely among individuals, but common ones include joint pain,
skin rashes (especially a butterfly-shaped rash on the face), fatigue, fever, and sensitivity to light.
Internal organs such as the heart, lungs, kidneys, and brain can also be affected in some cases.
There isn't a specific incubation period for SLE because it's not an infectious disease with a distinct
onset. Instead, the symptoms may develop gradually over time.
PATHOPHYSIOLOGY
Diagnostic Test
Normal findings for an ANA test typically involve the absence or very low levels of these
antibodies. The test is reported with a titer, which indicates the dilution of the blood at
which ANAs can still be detected. A common way of expressing the titer is as a ratio, such as
1:40. A lower number in the ratio (e.g., 1:40) suggests a lower concentration of ANAs
compared to a higher number (e.g., 1:320).
1. **Blood Collection:** Collecting a blood sample from the patient for the ANA test.
2. **Patient Education:** Informing the patient about the purpose of the test and any necessary
preparations.
3. **Comfort and Support:** Providing emotional support to patients who may be anxious about the
test.
4. **Documentation:** Recording accurate patient information and test details in the medical
records.
5. **Communication:** Communicating effectively with the healthcare team regarding the test and
any relevant patient information.
MEDICATION
BRAND NAME: Plaquenil
GENERIC NAME: Hydroxychloroquine
CLASSIFICATION: antirheumatic drug
MECHANISM OF ACTION: the exact mechanisms of hydroxychloroquine are unknown. It has
been shown that hydroxychloroquine accumulates in the lysosomes of the malaria parasite,
raising the pH of the vacuole.4 This activity interferes with the parasite's ability to proteolyse
hemoglobin,
preventing
the
normal
growth
and
replication
of
the
parasite.4 Hydroxychloroquine can also interfere with the action of parasitic heme
polymerase, an enzyme that uses ferriprotoporphyrin IX (FP) released from hemoglobin as a
substrate to form beta-hematin. By reducing the activity of heme polymerase without
inhibiting the release of FP, hydroxychloroquine leads to the accumulation of FP in a toxic
form.5
WHEN TO GIVE: Adults—400 mg once a week on the same day of each week starting 2 weeks
before traveling to an area where malaria occurs, and continued for 4 weeks after leaving
the area.
NURSING RESPONSIBILITY:
1. **Administration:** Administering the medication as prescribed by the healthcare provider.
2. **Patient Education:** Providing information to the patient about the purpose of the medication,
how to take it, potential side effects, and any specific instructions (e.g., taking with food).
3. **Monitoring:** Regularly monitoring the patient for any side effects or adverse reactions, such as
changes in vision or gastrointestinal issues.
4. **Assessment:** Assessing the patient's medical history, current medications, and any potential
contraindications or interactions.
5. **Documentation:** Accurately documenting the administration of the medication, the patient's
response, and any observed side effects.
6. **Collaboration:** Collaborating with other healthcare team members to ensure comprehensive
care and address any concerns or issues related to the medication.
7. **Follow-up:** Scheduling and participating in follow-up assessments to evaluate the medication's
effectiveness and address any ongoing concerns.
NURSING MANAGEMENT:
Education: Provide thorough education to the patient about SLE, its nature, and the
importance of adherence to treatment plans.
Medication Management: Assist in medication administration, educate on the
proper use of medications, and monitor for any side effects. Emphasize the
importance of adherence to prescribed medications.
Symptom Monitoring: Regularly assess and monitor lupus symptoms, including joint
pain, skin rashes, and fatigue. Report any significant changes to the healthcare team.
Psychosocial Support: Recognize the emotional impact of a chronic illness. Offer
emotional support, and connect patients with support groups or counseling services.
Pain Management: Implement strategies for pain management, such as positioning,
heat or cold therapy, and collaboration with the healthcare team for pain
medications if necessary.
Fatigue Management: Help patients develop strategies to manage fatigue, including
balancing activity and rest, and encouraging the importance of good sleep hygiene.
Skin Care: Provide guidance on skincare, especially for those with lupus-related skin
manifestations. Emphasize sun protection to prevent flare-ups.
Collaboration: Work closely with other healthcare team members, including
physicians, physical therapists, and occupational therapists, to provide holistic care.
Monitoring for Complications: Keep a vigilant eye for complications such as kidney
involvement, cardiovascular issues, and infections. Report any concerns promptly.
Health Promotion: Encourage a healthy lifestyle, including regular exercise, a
balanced diet, and stress management, to promote overall well-being.
MEDICAL AND SURGICAL MANAGEMENT:
### Medical Management:
1. **Immunosuppressive Medications:**
- Corticosteroids (e.g., prednisone) to control inflammation.
- Disease-modifying antirheumatic drugs (DMARDs) like hydroxychloroquine.
- Immunosuppressants (e.g., azathioprine, mycophenolate mofetil) to suppress the immune
response.
2. **Nonsteroidal Anti-Inflammatory Drugs (NSAIDs):**
- Used for relieving joint pain and inflammation.
3. **Biologic Therapies:**
- In certain cases, biologics like belimumab may be prescribed to target specific immune system
pathways.
4. **Antimalarial Drugs:**
- Hydroxychloroquine is commonly used to manage skin and joint symptoms.
5. **Corticosteroid Creams:**
- Topical steroids for skin rashes.
6. **Pain Management:**
- Analgesics for pain relief.
7. **Anticoagulants:**
- To prevent blood clots in individuals with antiphospholipid antibodies.
8. **Calcium and Vitamin D Supplements:**
- Given to address the potential bone loss associated with long-term corticosteroid use.
### Surgical Management:
1. **Joint Surgery:**
- In severe cases of joint damage, joint replacement surgery may be considered.
2. **Kidney Transplant:**
- For individuals with severe lupus nephritis, a kidney transplant might be an option.
3. **Cardiovascular Procedures:**
- In some cases, procedures such as angioplasty or coronary artery bypass grafting may be needed
COMPLICATIONS
1. **Kidney Involvement (Lupus Nephritis):**
- SLE can cause inflammation of the kidneys, leading to lupus nephritis. This complication can range
from mild to severe and may result in kidney damage or failure.
2. **Cardiovascular Complications:**
- Increased risk of cardiovascular diseases, including heart attacks and strokes, due to inflammation
and the presence of antiphospholipid antibodies.
3. **Joint and Muscle Problems:**
- Persistent inflammation can cause joint pain, stiffness, and damage. Lupus arthritis can be a
significant source of disability.
4. **Skin Issues:**
- Skin rashes, photosensitivity, and lesions are common in lupus. Discoid lupus, a chronic skin
condition, may result in scarring and changes in skin pigmentation.
5. **Lung Complications:**
- Inflammation of the lungs (pleuritis) or the lining around the heart (pericarditis) can occur, leading
to chest pain and breathing difficulties.
MULTIPLE SCLEROSIS
OVER VIEW
Multiple sclerosis (MS) is not considered a contagious or infectious disease, so it doesn't have a
method of transmission like a virus or bacteria. Instead, it is believed to involve a combination of
genetic and environmental factors that contribute to the immune system attacking the central
nervous system.
As for signs and symptoms, MS can vary widely among individuals, but common manifestations
include fatigue, difficulty walking, numbness or tingling, muscle weakness, problems with
coordination and balance, and issues with vision. Symptoms can come and go, and their severity can
also fluctuate.
There is no incubation period for MS, as it is not an infectious disease with a specific time between
exposure and the onset of symptoms.
The exact cause of MS is not known, but it is thought to involve a combination of genetic and
environmental factors. It is considered an autoimmune disorder where the immune system
mistakenly attacks the protective covering of nerve fibers (myelin) in the central nervous system.
PATHOPHYSIOLOGY
DIAGNOSTIC TEST
In the context of multiple sclerosis (MS), normal findings on an MRI (magnetic resonance imaging)
would mean the absence of characteristic abnormalities associated with MS. Typically, in MS, MRI
scans reveal the presence of lesions (areas of damage or scarring) in the central nervous system,
particularly in the brain and spinal cord.
A normal MRI in the context of MS would show a lack of these characteristic lesions. However, it's
important to note that the absence of lesions on a single MRI does not necessarily rule out the
possibility of MS. MS can sometimes be challenging to diagnose, and a healthcare professional may
consider other clinical factors, medical history, and additional diagnostic tests.
NURSING RESPONSIBLITYY
1. **Patient Education:**
- Explain the procedure to the patient, addressing any concerns or questions they may have.
2. **Screening:**
- Conduct a thorough pre-procedure screening to identify and assess any contraindications or
potential risks, such as the presence of metal implants or devices.
3. **Safety Measures:**
- Ensure that the patient removes all metal objects, including jewelry and clothing with metal
fasteners, as these can interfere with the magnetic field.
- Screen the patient for any implants, devices, or objects that may be affected by the magnetic field,
such as pacemakers or metallic foreign bodies.
4. **IV Access:**
- Establish IV access if contrast dye is to be administered during the MRI, and monitor the patient for
any adverse reactions to the contrast agent.
5. **Monitoring:**
- Provide reassurance and support to alleviate any anxiety or discomfort the patient may
experience.
6. **Documentation:**
- Document relevant patient information, including allergies, medications, and any adverse
reactions during or after the procedure.
7. **Post-Procedure Care:**
- - Provide post-procedure care instructions, including any restrictions on activities, and address
any questions or issues the patient may have.
8. **Collaboration:**
- Communicate effectively with the patient, their family, and other healthcare team members.
MEDICATION
GENERIC NAME: Teriflunomide
BRAND NAME: Aubagio
CLASSIFICATION: immunomodulatory agents.
MECHANISM OF ACTION: The exact mechanism by which teriflunomide acts in MS is not
known. What is known is that teriflunomide prevents pyrimidine synthesis by inhibiting the
mitochondrial enzyme dihydroorotate dehydrogenase, and this may be involved in its
immunomodulatory effect in MS.
WHEN TO GIVE: It is usually taken once a day with or without food. Take teriflunomide
at around the same time every day.
NURSING RESPONSIBILITY:
1. **Education:**
- Provide thorough education to the patient about teriflunomide, including its purpose, potential
side effects, and how to take it as prescribed.
2. **Monitoring:**
- Regularly monitor the patient for any signs of adverse reactions or side effects.
- Keep an eye on liver function, as teriflunomide can affect the liver.
3. **Lab Monitoring:**
- Arrange for regular lab tests, especially liver function tests, as part of monitoring the medication's
impact on the patient.
4. **Pregnancy Precautions:**
- Emphasize the importance of contraception for patients of childbearing potential, as teriflunomide
can harm the developing fetus.
5. **Patient Support:**
- Offer support and address any concerns or questions the patient may have about the medication.
6. **Collaboration:**
- Collaborate with the healthcare team, including the neurologist or prescribing provider, to ensure
comprehensive care.
7. **Documentation:**
- Document the patient's response to teriflunomide, any side effects, and the results of monitoring
activities.
NURSING MANAGEMENT
1. **Education:**
- Provide comprehensive education about MS, its progression, and potential symptoms.
-2. **Symptom Management:**
- Assist patients in managing symptoms such as fatigue, muscle weakness, and spasticity.
- Collaborate with other healthcare professionals to address pain and mobility issues.
3. **Medication Management:**
- Ensure patients understand their medications, including dosages, potential side effects, and the
importance of compliance.
- Monitor for any adverse reactions and coordinate with healthcare providers for adjustments.
4. **Rehabilitation Support:**
- Facilitate access to physical therapy, occupational therapy, and other rehabilitation services to
enhance mobility and functional independence.
5. **Psychosocial Support:**
- Provide emotional support and address the psychosocial impact of MS.
- Encourage patients to join support groups or connect with others facing similar challenges.
6. **Nutritional Guidance:**
- Collaborate with a dietitian to develop a nutrition plan that supports overall health and addresses
any specific concerns related to MS.
7. **Assistance with Activities of Daily Living (ADLs):**
- Assess and address challenges with ADLs, providing assistance or adaptive devices as needed.
8. **Safety Measures:**
- Educate patients on strategies to enhance safety and prevent complications.
9. **Regular Monitoring:**
- Monitor the progression of symptoms and collaborate with the healthcare team to adjust the care
plan accordingly.
10. **Coordination of Care:**
- Foster effective communication and collaboration among healthcare providers involved in the
patient's care.
- Coordinate with specialists, such as neurologists, to ensure a multidisciplinary approach.
COMPLICATION
1. **Mobility Issues:**
- Progressive weakness and spasticity can lead to difficulties with mobility, increasing the risk of falls
and injuries.
2. **Fatigue:**
- Fatigue is a common symptom of MS and can significantly impact daily activities and quality of life.
3. **Pain:**
- Chronic pain, including neuropathic pain and musculoskeletal pain, can be a complication of MS.
4. **Spasticity:**
- Increased muscle tone and spasms can result in spasticity, affecting mobility and causing
discomfort.
5. **Bladder and Bowel Dysfunction:**
- MS can lead to problems with bladder and bowel control, ranging from urgency to incontinence.
Acute Glomeruleonephritis
OVERVIEW
Acute glomerulonephritis is typically caused by an immune response to an infection, rather than
direct transmission. The most common infections associated with acute glomerulonephritis are
streptococcal infections, such as those causing strep throat or skin infections. The immune system's
response to the infection can lead to inflammation in the glomeruli of the kidneys.
Signs and symptoms
1. **Hematuria (blood in urine):**
2. 2. **Proteinuria (excess protein in urine):**
3. **Edema (swelling):**
4. 4. **High blood pressure:**
The incubation period for acute glomerulonephritis is usually 1 to 3 weeks after the initial
infection.
The causative agent, in many cases, is Group A Streptococcus bacteria, specifically strains
that produce certain toxins that can trigger the immune response leading to
glomerulonephritis. It's important to note that acute glomerulonephritis is not directly
transmitted from person to person; it's a complication of certain infections.
PATHOPHYSIOLOGY
DIAGNOSTIC TEST
urinalysis:
1. **Color:** Pale yellow to amber
2. **Appearance:** Clear
3. **Specific Gravity:** 1.005 to 1.030
4. **pH:** 4.6 to 8.0
5. **Protein:** 0 to 8 mg/dL (or negative)
6. **Glucose:** Negative
7. **Ketones:** Negative
8. **Blood:** 0 to 2 red blood cells per high-power field (RBC/HPF)
9. **Bilirubin:** Negative
10. **Urobilinogen:** 0.2 to 1.0 mg/dL
11. **Nitrites:** Negative
12. **Leukocytes (WBC):** 0 to 5 WBC/HPF
Blood test
1. **Complete Blood Count (CBC):**
- **Hemoglobin (Hb):** 13.8 to 17.2 grams per deciliter (g/dL) for adult males; 12.1 to 15.1 g/dL for
adult females.
- **White Blood Cell Count (WBC):** 4,000 to 11,000 cells per microliter (cells/µL).
- **Platelet Count:** 150,000 to 450,000 platelets per microliter (platelets/µL).
2. **Blood Glucose:**
- **Fasting Blood Glucose:** 70 to 100 milligrams per deciliter (mg/dL).
3. **Lipid Profile:**
- **Total Cholesterol:** Less than 200 mg/dL.
- **Low-Density Lipoprotein (LDL) Cholesterol:** Less than 100 mg/dL.
- **High-Density Lipoprotein (HDL) Cholesterol:** 40 mg/dL or higher for men; 50 mg/dL or higher
for women.
- **Triglycerides:** Less than 150 mg/dL.
4. **Liver Function Tests:**
- **Alanine Aminotransferase (ALT):** 7 to 56 units per liter (U/L).
- **Aspartate Aminotransferase (AST):** 8 to 48 U/L.
- **Alkaline Phosphatase (ALP):** 44 to 147 U/L.
- **Total Bilirubin:** 0.1 to 1.2 mg/dL.
5. **Kidney Function Tests:**
- **Blood Urea Nitrogen (BUN):** 7 to 20 mg/dL.
- **Creatinine:** 0.84 to 1.21 mg/dL for adult males; 0.62 to 1.04 mg/dL for adult females.
MEDICATION:
BRAND NAME: Bumex
GENERIC NAME: Bumetanide
CLASSIFICATION:
WHEN TO GIVE:
MECHANISM OF ACTION : Bumetanide interferes with renal cAMP and/or inhibits the sodiumpotassium ATPase pump. Bumetanide appears to block the active reabsorption of chloride and
possibly sodium in the ascending loop of Henle, altering electrolyte transfer in the proximal tubule.
This results in excretion of sodium, chloride, and water and, hence, diuresis.
NURSING RESPONSIBILITY:
1. **Check the Prescription:** Ensure the doctor's order for bumetanide is correct.
2. **Assess the Patient:** Evaluate the patient's vital signs, fluid balance, and kidney function before
giving the medication.
3. **Administer Medication:** Administer bumetanide as prescribed, usually orally or through an
injection.
4. **Monitor Output:** Keep an eye on the patient's urine output to assess the effectiveness of the
diuretic.
5. **Watch for Side Effects:** Be alert for potential side effects such as dehydration or electrolyte
imbalances.
6. **Educate the Patient:** Inform the patient about the medication, its purpose, and any potential
side effects. Encourage them to report any unusual symptoms.
7. **Follow Up:** Monitor the patient's response to the medication and report any concerns to the
healthcare team.
NURSING MANAGEMENT
1. **Check Vital Signs:**
- Monitor blood pressure regularly.
2. **Balance Fluids:**
- Keep an eye on fluid intake and output.
- Give diuretics if needed.
3. **Control Blood Pressure:**
- Administer prescribed medications.
- Watch for changes in blood pressure.
4. **Watch Diet:**
- Manage sodium, potassium, and protein intake.
- Collaborate with a dietitian.
5. **Give Medications:**
- Administer antibiotics or immunosuppressants as prescribed.
- Monitor for side effects.
6. **Manage Pain:**
- Provide pain relief as prescribed.
- Address any discomfort.
7. **Prevent Complications:**
- Look out for signs of issues like pulmonary edema.
- Act promptly and report changes.
8. **Educate Patient and Family:**
- Teach about the condition, medications, and lifestyle changes.
- Stress the importance of follow-up appointments.
9. **Offer Emotional Support:**
- Be there for the patient and family.
- Encourage open communication.
10. **Follow-up Care:**
- Schedule and promote regular check-ups.
- Monitor kidney function over time.
**Medical Management:**
1. **Antibiotics:**
- If the cause is a bacterial infection, antibiotics help clear it.
2. **Diuretics:**
- Medications to regulate fluid balance and reduce swelling.
3. **Antihypertensives:**
- Control blood pressure with prescribed medications.
4. **Immunosuppressants:**
- Used in some cases to calm down the immune response.
5. **Pain Relief:**
- Medications to manage discomfort.
**Surgical Management:**
1. **Dialysis:**
- In severe cases, dialysis helps the kidneys filter waste from the blood.
2. **Plasmapheresis:**
- A procedure to remove harmful antibodies from the blood.
COMPLICATION
1. **Hypertension:**
- High blood pressure can be a common complication.
2. **Fluid Retention:**
- The kidneys may struggle to regulate fluids, leading to swelling.
3. **Proteinuria:**
- Increased protein in the urine can occur.
4. **Reduced Kidney Function:**
- Kidney function may decline temporarily or, in severe cases, permanently.
5. **Renal Failure:**
- In extreme cases, acute glomerulonephritis can progress to renal failure.
ALLERGY (hypersensitivity)
OVERVIEW
**Allergy Hypersensitivity:**
- **Mode of Transmission:** Allergies are not infectious, so they aren't transmitted from person to
person. Instead, they develop when the immune system reacts to a substance (allergen) as if it were
harmful.
- **Signs and Symptoms:** Allergic reactions can vary widely. They might include sneezing, itching,
swelling, rashes, or more severe symptoms like difficulty breathing or anaphylaxis.
**Incubation Period:** Unlike infectious diseases, allergies don't have a specific incubation period.
Symptoms can occur immediately upon exposure to an allergen or take some time to develop.
Causative Agent:** The causative agent is the allergen itself—anything from pollen and pet dander to
certain foods or medications.
PATHOPHYSIOLOGY
DIAGNOSTIC TEST
Intradermal tests
- **No Reaction:** In a normal test, there would be no significant reaction at the injection site for
most of the allergens tested.
- **Control Site Reaction:** There's usually a control injection site where a harmless substance (saline
or a diluent) is injected to ensure that the person's skin reacts appropriately.
- **Positive and Negative Controls:** A positive control (histamine) is used to ensure that the
person's skin can react, and a negative control (saline) should not elicit an allergic response.
- **Minimal Redness or Swelling:** Some minor redness or swelling at the injection site is normal and
may occur with both the positive and negative controls.
Nursing Responsibility
1. **Prepare:**
- Gather the necessary equipment: allergens, controls (histamine and saline), and syringes.
- Ensure the patient understands the procedure and potential reactions.
2. **Administer the Test:**
- Cleanse the skin with alcohol at the injection sites.
- Inject small amounts of allergens and controls just under the skin surface.
3. **Monitor:**
- Watch for immediate reactions (within 15-20 minutes).
- Note the size and characteristics of any skin reactions.
4. **Interpret Results:**
- Look for redness and swelling at injection sites.
- Compare responses to allergens, histamine, and saline.
5. **Document:**
- Record the patient's reactions, including the size of any wheals or redness.
- Document any delayed responses if relevant.
6. **Provide Care:**
- Administer appropriate treatments for any allergic reactions.
- Advise the patient on post-test care, including potential delayed reactions.
7. **Follow-up:**
- Schedule a follow-up to discuss results and develop an allergy management plan if necessary.
- Educate the patient on avoiding allergens and managing allergies.
Nursing Management
1. **Assessment:**
- Obtain a detailed allergy history.
- Identify specific allergens through testing.
- Assess the severity and type of hypersensitivity reactions.
2. **Education:**
- Educate the patient about identified allergens.
- Teach avoidance strategies.
- Discuss symptom recognition for early intervention.
3. **Prevention:**
- Implement measures to reduce allergen exposure.
- Collaborate with other healthcare professionals for environmental modifications.
4. **Emergency Preparedness:**
- Ensure the patient has an allergy action plan.
- Provide training on the use of emergency medications (e.g., epinephrine).
5. **Medication Management:**
- Administer prescribed medications (antihistamines, corticosteroids) as ordered.
- Monitor for side effects and therapeutic response.
6. **Documentation:**
- Maintain accurate records of allergy history and interventions.
- Document patient education sessions.
7. **Follow-up:**
- Schedule regular follow-up appointments.
- Adjust management strategies based on the patient's response and changing circumstances.
**Medical Management:**
1. **Diagnosis:**
- Identify the condition through thorough examination and diagnostic tests.
2. **Medication:**
- Prescribe appropriate drugs to manage symptoms or treat the underlying cause.
- Educate the patient on proper medication administration.
3. **Monitoring:**
- Regularly assess the patient's response to medication.
- Monitor for side effects and adjust treatment as needed.
4. **Lifestyle Changes:**
- Recommend and support necessary lifestyle modifications.
- Provide guidance on diet, exercise, and stress management.
5. **Patient Education:**
- Educate the patient about their condition, treatment plan, and potential complications.
- Encourage adherence to prescribed medications and lifestyle changes.
**Surgical Management:**
1. **Indications:**
- Determine if surgery is necessary based on the condition's severity and response to other
treatments.
2. **Preoperative Preparation:**
- Ensure the patient is physically and mentally prepared for surgery.
- Conduct necessary preoperative tests.
3. **Surgery:**
- Perform the necessary procedure using appropriate techniques.
- Monitor the patient's vital signs during surgery.
4. **Postoperative Care:**
- Manage pain and monitor for complications.
- Provide instructions for postoperative care and follow-up.
5. **Rehabilitation:**
- Facilitate rehabilitation if needed, including physical therapy or lifestyle adjustments post-surgery.
COMPLICATION
Anaphylaxis:
This is a severe, life-threatening allergic reaction that can cause a rapid drop in blood
pressure, difficulty breathing, and other serious symptoms. Anaphylaxis requires
immediate emergency medical attention.
Chronic Inflammation:
Prolonged exposure to allergens can lead to chronic inflammation. This can
contribute to conditions such as asthma, rhinitis, or dermatitis, depending on the
site of exposure.
Secondary Infections:
Scratching or rubbing skin affected by allergies can break the skin barrier, increasing
the risk of bacterial or fungal infections. This is particularly relevant in conditions like
eczema.
Impaired Quality of Life:
Hypersensitivity reactions can significantly impact a person's daily life. Chronic
symptoms, avoidance measures, and the psychological impact of living with allergies
can affect mental health and overall well-being.
.
Cross-Reactivity:
Some individuals may experience cross-reactivity, where an allergic reaction to one
substance leads to a reaction with a similar substance. For example, someone
allergic to birch pollen might also react to certain fruits due to cross-reacting
proteins.
RHEUMATOID ARTHRITIS
Overview
Rheumatoid arthritis (RA) is not infectious, so it doesn't have a mode of transmission like
communicable diseases. It's an autoimmune disorder where the immune system mistakenly attacks
the joints. The exact cause is unknown, but it's thought to involve a combination of genetic and
environmental factors.
Signs and symptoms of RA include joint pain, swelling, stiffness, and a decrease in joint function. It
often affects joints on both sides of the body and can lead to deformities over time. Other symptoms
may include fatigue, fever, and weight loss.
RA doesn't have a typical incubation period like infectious diseases do because it's not caused by a
pathogen. Instead, it tends to develop gradually, and its onset can vary from person to person.
If you're experiencing symptoms or concerned about RA, it's important to consult with a healthcare
professional for a proper diagnosis and management.
Pathophysiology
DIAGNOSTIC TEST
.
Rheumatoid Factor (RF) Test:
Normal Finding: While elevated levels of RF can be associated with RA, it's important
to note that a positive RF test alone does not confirm RA. Additionally, some people
with RA may not have elevated RF levels.
Anti-Cyclic Citrullinated Peptide (anti-CCP) Antibody Test:
Normal Finding: Similar to RF, elevated levels of anti-CCP antibodies are associated
with RA, but their absence doesn't rule out the possibility of RA.
C-Reactive Protein (CRP) Test:
Normal Finding: CRP levels may be elevated in RA due to inflammation. However,
increased CRP can also be seen in other inflammatory conditions.
Erythrocyte Sedimentation Rate (ESR) Test:
Normal Finding: Like CRP, an elevated ESR indicates inflammation in the body. It is a
non-specific marker and can be elevated in various conditions.
Imaging Studies (X-rays, MRI, or Ultrasound):
Normal Finding: Imaging can reveal joint damage, erosions, and swelling associated
with RA. Normal findings would show no or minimal joint abnormalities.
.
Medication:
Brand name: Plaquenil
Generic name: Hydroxychloroquine
CLASSIFICATION: a disease-modifying anti-rheumatic drug
Mechanism of action: The exact mechanisms of hydroxychloroquine are unknown. It has been
shown that hydroxychloroquine accumulates in the lysosomes of the malaria parasite, raising
the pH of the vacuole.4 This activity interferes with the parasite's ability to proteolyse
hemoglobin,
preventing
the
normal
growth
and
replication
of
the
parasite.4 Hydroxychloroquine can also interfere with the action of parasitic heme polymerase,
an enzyme that uses ferriprotoporphyrin IX (FP) released from hemoglobin as a substrate to
form beta-hematin.
Nursing responsibility: Administer Hydroxychloroquine as prescribed, monitor for side effects, and
educate the patient about its use.
NURSING MANAGEMENT:
Medication Administration: Administer prescribed medications, such as disease-modifying
antirheumatic drugs (DMARDs) and nonsteroidal anti-inflammatory drugs (NSAIDs), and
educate patients about their proper use.
Pain Management: Assist in pain management strategies, including administering pain
medications as prescribed and implementing non-pharmacological approaches such as heat
or cold therapy.
Joint Protection: Educate patients on joint protection techniques to minimize strain on
affected joints and promote independence in daily activities.
Patient Education: Provide comprehensive education about rheumatoid arthritis, its
progression, and the importance of adherence to medications and lifestyle modifications.
Physical Activity Promotion: Encourage and guide patients in engaging in appropriate
physical activities and exercises to maintain joint function and overall health.
Certainly!
**Medical Management:**
1. **Medications:** Take prescribed drugs, like DMARDs and NSAIDs, to reduce
inflammation and manage pain.
2. **Regular Monitoring:** Keep regular check-ups to assess the condition, adjust
medications, and monitor for side effects.
**Surgical Management:**
1. **Joint Surgery:** Consider surgery for severe joint damage, which may involve joint
replacement or repair.
2. **Synovectomy:** In some cases, surgical removal of the inflamed synovial membrane
may be performed.
Both medical and surgical approaches aim to control inflammation, relieve pain, and
maintain joint function. Regular medical follow-ups and open communication with
healthcare providers are crucial.
Complication:
Rheumatoid arthritis (RA) can lead to various complications, affecting different organs and
systems in the body. Some common complications include:
1. **Joint Damage:** Persistent inflammation in the joints can lead to cartilage and bone
damage, causing joint deformities and functional impairment.
2. **Rheumatoid Nodules:** These are firm lumps that can develop under the skin, often
around pressure points or joints. While usually painless, they can sometimes become
inflamed.
3. **Cardiovascular Complications:** RA increases the risk of cardiovascular diseases such as
heart attack and stroke. Chronic inflammation may affect the heart and blood vessels.
4. **Lung Involvement:** Inflammation can extend to the lungs, causing conditions like
interstitial lung disease. This can lead to breathing difficulties.
5. **Eye Issues:** Dry eyes and inflammation of the sclera (scleritis) or the white part of the
eye can occur.