Provide bed rest • Kidneys: acute tubular necrosis
• Provide high-calorie diet • Hemorrhage, DIC
• Monitor for signs of GI bleeding • Pancreatic abscess • Monitor mental status: lethargy, • Pancreatic pseudocysts somnolence, personality changes • Pancreas insufficiency • Limit visitors / isolation procedures if ASSESSMENT infectious • Nausea MEDICATIONS: • Severe abdominal pain around umbilicus • Antiemetics • Abdominal rigidity • Antibiotics ( to decrease ammonia • Signs of shock production by intestinal bacteria) • Dark urine, clay-colored stools if due to • Vitamin K bile duct obstruction (stones) CLIENT EDUCATION LAB: • HAV: Good hand washing practice • Elevate amylase, lipase • HBV: Avoid unprotected sexual • If serum calcium low> poorer prognosis intercourse Avoid sharing of needles ANALYSIS: GALLBLADDER • Fluid and electrolyte balance? cholelithiasis = presence of gallstones in the • Adequate nutrition? gallbladder IMPLEMENTATION CHOLELITHIASIS • Keep client NPO • Usually asymptomatic (70%) • Assist with nasogastric tube • May cause biliary colic (20%) • Monitor vital signs • May cause cholecystitis (10%) • Monitor input/output BILIARY COLIC • Assess for respiratory difficulties and base • Steady, cramplike pain in epigastrium of lungs. • Murphy’s sign (inspiratory arrest during CLIENT EDUCATION palpation of liver margin) • Strict avoidance of alcohol • Pain does not subside spontaneously MALDIGESTION ANALYSIS Dysfunction of pancreas • Dehydration due to nausea and vomiting? • Chronic pancreatitis • Risk of acute pancreatitis if stone • Cystic fibrosis obstructs duct Lack of specific enzymes IMPLEMENTATION • Lactase deficiency • No oral food during acute cholecystitis Lack of bile salts DIAGNOSIS: • Biliary cirrhosis • X-ray, ultrasound, scan to visualize stones • Resected terminal ileum • ERCP to visualize ducts • Bacterial overgrowth MEDICATIONS: MALABSORPTION • Analgesics Dysfunction of small bowel • Antibiotics • Short bowel syndrome • Ursodiol: (resolves small cholesterol • Bacterial overgrowth stones, but does not help in acute attack) • Celiac disease POSTOPERATIVE: • Tropical sprue • Monitor T-tube drainage (up to 500ml in Note: Diarrhea often leads to transients first 24h is normal) lactase deficiency: Teach client to avoid milk CLIENT EDUCATION: when having diarrhea of any cause. • Reduce dietary fat and cholesterol intake DIARRHEA PANCREATITIS SECRETORY ACUTE PANCREATITIS • Large volume watery stools Causes – Alcohol abuse, cholelithiasis • Persists with fasting Features – Elevate lipase, amylase (cholera, dysentery) Mortality rate – 10% OSMOTIC CHRONIC PANCREATITIS • Bulky, greasy stools Causes – Alcohol abuse, rarely due to • Improves with fasting cholelithiasis (lactase deficiency, pancreatic insufficiency, Features – pancreatic calcifications short bowel syndrome) COMPLICATIONS OF ACUTE PANCREATIS INFLAMMATORY • Peritoneum: fat necrosis • Frequent but small stools • Lungs: respiratory distress syndrome • Blood and/or pus (inflammatory bowel disease, irradiation, shigella, amebiasis) DYSMOTILITY • Diarrhea alternating with constipation (irritable bowel syndrome, diabetes mellitus) LOWER ABDOMINAL PAIN Appendicitis • Vague periumbilical pain, nausea • Later localizes to lower right quadrant • Perforation: high fever and leukocytosis Diverticulitis • Elderly patients • Steady pain • Localized to lower left quadrant • Left sided appendicitis Inflammatory bowel disease • Chronic, cramping pain • Diarrhea, blood and pus in stool Intestinal obstruction • Hyperactive bowel sounds Intestinal infraction • Absent bowel sounds • Gross or occult blood in stool APPENDICITIS ASSESSMENT • Nausea, anorexia