appendicitis, peritonitis, diverticular disease,

whats the therapeutic measures for peritonitis?

NPO bc of impaired peristalsis. fluid and electrolyte replacement to correct hypovolemia and prevent or treat shock. abdominal distention relieved through insertion of an orogastric or NG tube with low intermittent suction. antibiotics to treat or prevent sepsis. surgery depending on cause to excise, drain, or repair cause. an ostomy may be formed to divert feces, allowing resolution of the infection.

trtmnt for appendicitis:

NPO, surgery if perforation or peritonitis. Oce and keep pt in semi fowlers to reduce pain.

describe the pain a pt. might feel with appendicitis?

generally starts in upper abdomen. within hours its in the rt. lower quadrant at McBurney's point, midway between the umbilicus and the rt. iliac crest

pt with diverticulitis has a nursing dx of acute pain f/t inflammatory process what's your interventions?

have pt rate pain to determin pain level. give analgesics or antispasmodic drugs as ordered to relive pain. use semi fowlers position changes, diversion, and relaxation exercises to help relive pain. provide frequent mouth care if an NG tube is in place to increase comfort

after an appendectomy whats the therapeutic measures?

if it had ruptured, may have an orogastric or ng tube to decompress the stomach. v/s and abd data are collected to monitor for s/s of peritonitis. pain control to promote early ambulation, coughing, deep breathing, and movement help prevent respiratory complications.

monitor the pt with diverticulosis closely and notify the physician immediately when?

if pain increases, especially is associated with abdominal rigidity. increased pain may indicate that the bowel has ruptured and peritonitis is developing.

diverticulitis can be prevented how?

increasing dietary fiber to prevent constipation and onset of diverticulosis

whats peritonitis?

inflammation of the peritoneum

what happens to the bowel sounds/ peristalsis during peritonitis?

initially, the intestinal tract responds with hypermotility, but this is soon followed by paralysis (paralytic ileus)

complications of peritonitis

intestinal obstruction, hypovolemia (caused by the shift of fluid into the abdomen), septicemia (from bacteria entering the bloodstream), shock and ultimately death may result. wound dehiscence or evisceration can occur if pt has had abd. surgery

pt with diverticulosis is getting a barium enema, what will this show us?

may show irregular narrowing of the colon and thickened muscle walls.

whats the cause of periotonitis

most common is ruptured appendix, trama, ischemia, or tumor perforation in any abdominal organ that causes leakage of the organs contents into the peritoneal cavity. perforation of a peptic ulcer, gangrenous gallbladder, intestinal diverticula, incarcerated hernia, or gangrenous small bowel. peritoneal dialysis.

assessment of what is essential for pts with inflammation or infection?

pain

what is one of the classic symptoms of appendicitis?

pain at McBurney's point, midway between the umbilicus and the rt. iliac crest

how do you know theres been a perfusion with appendicitis?

pain is severe and temp is elevated to at least 100

what are complications of appendicitis?

perforation, abscess of the appendix, and periotonitis are major complications

whats the most common group to experience diverticulitis

ppl older than 60

when diverticulitis is present what are the s/s?

pt exhibits bowel changes, possibly alternating between constipation and diarrhea. steady or crampy pain in the left lower quadrant of abd.

pt with an inflammatory or infectious d/o with a fever may mean what

pt is developing sepsis

with acute diverticulitis what's the therapeutic measures

pt may be hospitalized for administration of IV antibiotics and pain control. NG tube, IV fluids, NPO status until pain, N/V, fever, and inflammation decrease.

how do you determine your goals are met for the pt with diverticulitis or an inflammatory or infectious d/o?

pt reports that pain is controlled, v/s and urinary output are stable, and pt has regular, comfortable bowel elimination

pt with diverticulitis has nursing dx of risk for deficient fluid volume r/t diarrhea or fluid shifting from the circulation to the peritoneal cavity, whats the nursing interventions

record intake and output to determine fluid balance. weigh pt daily to determine fluid loss. monitor v/s and urine output and report changes. maintain IV fluid replacement as ordered to maintain fluid balance if output is greater than intake.

how does peritonitis come about?

results from the inflammation or infection that is caused by the leakage of any abdominal organs contents into peritoneal cavity. tiss becomes edematous and begin leaking fluid containing increasing amounts of blood, protein, cellular debris, and WBC's

diverticulitis is most common where

sigmoid colon

pt with an inflammatory or infectious d/o will have intake and output monitored and recorded accurately for what

so appropriate fluid replacement therapy is ordered

whats the most common symptom of diverticulitis?

steady or crampy pain in the left lower quadrant of the abdomen

whether or not perforation occurs, what may be done to allow the inflammation to subside and the diseased portion of the colon to rest?

surgical resection with anastomosis or a temporary colostomy

pt with diverticulitis has nursing dx of risk for deficient fluid volume r/t diarrhea or fluid shifting from the circulation to the peritoneal cavity, whats the expected goal/outcome?

the pt will maintain v/s and urine output WNL at all times

nursing diagnoses acute pain r/t inflammatory process with the pt with diverticulitis, whats the expected goal?

the pt will report pain is at an acceptable level within 3o minutes of report of pain

whether or not perforation occurs why would surgical resection with anastomosis or a temporary colostomy be done

to allow the inflammation to subside and the diseased portion of the colon to rest

why would they do a stool specimen with diverticulosis

to detect occult blood

why would they do an abdominal x ray examination with diverticulosis

to identify a perforated diverticulum

whats diverticulitis

when food and bacteria are trapped in a diverticulum, inflammation and infection develop

how is diverticulosis confirmed?

with sigmoidoscopy, colonoscopy, or barium enema. stool specimen. abd. x ray may be done to identify a erforated diverticulum. CT if abscess is suspected

after surgery due to peritonitis whats the therapeutic measures?

wound drain, ng tube and a urinary cath. pain control to overall recovery. severely compromised pts may receive tpn to meet nutritional needs for increased immune function and healing

dietary considerations for a pt with diverticulosis include what?

(diverticulosis=without evidence of inflammation) include foods that are soft but high in fiber, such as prunes, raisins, and peas. unprocessed bran can be added to soups, cereals, and salads to give added bulk to the diet. Fiber increased in diet slowly to prevent excess gas and cramping. if over wt. it's encouraged to lose weight

if the appendix has ruptured whats the therapeutic measures?

IV fluids, and antibiotic therapy started, surgery may or may not be done right away. if infection is present Ng tube or orogastric tube to drain the infection may be inserted into the abdomen. surgery may be delayed for up to several weeks while the infection is resolved.

Dx tests for appendicitis:

CBC reveals elevated leukocyte and neutrophil counts/ WBC's. U/S or CT scan reveals an enlargement in the area of the cecum

if pt with suspected diverticulosis with an abscess suspected what dx tests will be done

CT scan may be done

whats diverticulosis?

a condition in which multiple diverticula are present without evidence of inflammation

whats a diverticulum?

a herniation or outpouching of the bowel mucous membrane caused by increased pressure within the colon and weakness in the bowel wall.

whats an abscess r/t appendicitis?

a localized collection of pus separated from the peritoneal cavity by the omentum or small bowel. treated with parenteral antibiotics and surgical drainage. Appendectomy is done about 6 weeks later

when the acute diverticulitis is over what diet is started?

a progressive diet from NPO

dx tests for peritonitis

abdominal xray or CT to show distention or perforation; WBC elevated; paracentesis and lab studies to identify a causative organism; or exploratory surgery to identify the cause

after appendectomy whats the diet

advanced from NPO as ordered and tolerated

as diverticulits worsens, what's the s/s?

bledding may occur, along with weakness, fever, fatigue, and anemia. Guarding and rebound tenderness may be present.

how is diverticulosis managed?

by preventing constipation

chronic what usually precedes (comes before) the development of diverticulosis by many years?

constipation

whats a major cause of diverticular disease?

decreased intake of dietary fiber

to detect fluid volume imbalances on a pt with an inflammatory or infectious d/o the nurse needs to monitor for what

decreased urinary output, dropping bp, and rising pulse

some hcp's recommend avoiding nuts or foods with small seeds that can get caught n diverticula such as tomatoes and raspberries, for the pt with diverticulosis but it hasn't been shown to prevent what?

diverticulitis

upon evaluation of a pt. a firm mass is palpated in the sigmoid area, you would suspect what?

diverticulitis

Pt with diverticulitis has an abscess to develop, what does this cause?

diverticulum may rupture, leading to peritonitis

pt with an inflammatory or infectious d/o will have v/s monitored for what

fever or signs of septic shock

what symptoms need to be reported to the physician promptly with the pt with an inflammatory or infectious d/o such as diverticulitis?

fever, decreased urinary output, drop in bp, increasing pulse rate.

what are the s/s of appendicitis?

fever, increased WBCs, pain in upper abdomen at first, then at McBurneys point, N/V, anorexia, slight abdominal muscular rigidity (guarding), normal bowel sounds, and local rebound tenderness (intensification of pain when pressure is released after palpation) in the rt. lower quad of abd. sometimes pain is felt in rt. lower quad when lft. side is palpated. pt may keep rt. leg flexed for comfort and experience increased pain when leg is straightened.

what are the s/s of peritonitis?

generalized abd pain evolves into localized pain at the site of the perforation or leakage. the area is extremely tender and aggravated by movement. rebound tenderness and abdominal rigidity are present. decreased peristalsis results in n/v. infection causes fever, increased WBCs, and an elevated pulse

whats the s/s of diverticulosis

generally asymptomatic