CARE OF THE CLIENTS WITH GASTROINTESTINAL
DISORDERS
ANATOMY AND PHYSIOLOGY
 Digestion starts from the MOUTH.
 Mechanical Digestion- MASTICATION
 Chemical Digestion- salivary amylase (PTYALIN)---
breaks down starches to maltose
 Deglutition (Swallowing)---food bolus (small pieces)
 LOWER ESOPHAGEAL SPHINCTER( cardiac sphinter)-
distal end of esophagus. Prevents reflux.
 STOMACH- left upper quadrant (capacity of
1500ml) has lesser and greater curvature
 Gastric juice- 1500 to 3000ml ( mucus, hcl,
pepsinogen and H20)
 DIGESTION OF CHON and FATS- starts in stomach by
pepsin (converts CHON to polypeptides)
 The following are emptied:
- CHO (1 to 2 hours)
- Proteins (3-4 hours)
- Fats (4 -6 hours)
 DIGESTIVE PROCESS- Duodenum
 ABSORPTION- small intestine (by OSMOSIS and
DIFFUSION)
 Small Intestine
- 6meters (20-22 ft)
- Duodenum, jejunum and ileum
 Large Intestine
- 1.5 m (5-6ft)
- Cecum, colon, rectum, anus
- Colon (ascending, transverse, descending and
sigmoid)
- Absorption of water, sodium and chloride
- Vitamin synthesis
- Defecation and formation of feces (3/4 H20, ¼
solid form)
ASSESSMENT
“IAPePa”
 No ABD. PALPATION if with liver or kidney
tumor to prevent the rupture and hemorrhage.
 Empty bladder before auscultation
 No ABD. PERCUSSION if suspected with
abdominal aneurysms and abd organ
transplants.
PROCEDURES
 Decompression
- Ryles Tube / NGT
- Remove gas, fluids, and no gastric and intestinal
distention
- LEVINE TUBE- single-lumen (NGT feeding/
gastric gavage)
- SALEM-SUMP- double-lumen (decompression)
Airvent(blue pigtail) prevents adherence to
gastric mucosa, the other is connected to low
suction
- CANTOUR TUBE- single-lumen (balloon inflated
with special chemical before insertion)
- MILLER- ABBOT- double-lumen (like salem
sump)
- AFTER insertion, turn the pt to right side to
allow passage to duodenum.
 Esophageal Balloon Tamponade
- For liver cirrhosis patients with ruptured
esophageal varices
- Sengstaken-blakemore (triple lumen)
For inflation of balloon---- inflation of gastric
balloon and middle is for connection to suction.
- Sponge rubber to nares- for placement
- SCISSORS in the bedside to cut for emergency
situations such as punctured balloons. AIRWAY
is priority.
 Enteral Feeding
- Formula @ room temp
- Semi to high fowlers
- Ph( 1-3)
- Greenish/ yellowish gastric content
- If more than 100ml/half of feeding is RESIDUAL,
WITHHOLD FEEDING and notify physician.
- Reinstill gastric content to prevent metabolic
ALKALOSIS
- Check residual q4-6 hours
 Gastrostomy feeding
- Check placement by instilling 15 to 30 ml tap
water
- Infusion pump for continuous feeding (infused
for 3 hours)
- Check residual q4-6 hours
- After feeding side lying position with slightly
elevated or semi-high fowlers
  Traction- pulling outward of esophageal
 Total Parenteral Nutrition wall due to scarred/ enlarged peribronchial
- Pt needs extensive support lymph node
- Usual site: SUBCLAVIAN VEIN - S/Sx:
- During insertion, TREDELENBURG POSITION to  Dysphagia
prevent air embolism and engorgement of vein  Fullness in the neck
for facilitating insertion  Regurgitation
- Primary purpose: administer glucose  Coughing/belching, tracheal irritation
- Consume within 24 hrs to prevent - Mgt:
contamination  Blenderized food, SFF
- Change IV tubing q24 hrs  Antacids
- Usually Hypertonic solution (25 to 35 %  Backrest after eating
dextrose)  No irritating foods
- If infusion is delayed “do not catch up” inform  Hiatal Hernia (Diaphragmatic Hernia)
physician for recalculation - Sliding HH- protrusion of esophagogastric
- Monitor urine and cbg. GLYCOSURIA is expected junction into the thoracic caviy and back into
for few days. Give small doses of insulin abdominal cavity depending on position
- Watch out for infection! changing
- If TPN is interrupted/ discontinued, give D10W t - d/to muscle weakness, obesity trauma, sx, aging
o prevent HYPOGLYCEMIA  Recumbent position- stomach slides up
 Upright position- stomach slides down
DISORDERS OF GIT: - Paraesophageal Hernia/ rolling hernia-
 Achalasia protrusion of fundus of stomach and greater
- Impaired motility of lower 2/3 of esophagus curvature in the thorax. Remains below
- LES fails to relax when swallowing diaphragm. D/to anatomic defect
- Treatment: - S/sx:
 Bougienage- esophageal dilation w/  Dysphagia and odynophagia
pneumatic/hydrostatic balloon under  Abdominal pain
fluoroscopy  Heartburn
 Esophagomyotomy  Dyspnea, n&v, gastric distention
- Mgt:
 GERD
 Antacids
- Backward flow of gastric content d/to failure of
 Antiemetics
relaxing of LES
 Avoid drugs that lowers pressure
- Elevate HOB 6-8 in
(anticholinergics, calcium-channel blockers,
- Weight reduce
xanthines, diazepam)
- Avoid tobacco, salicylates,phenylbutazone
 High CHON diet
- Sx:
 Eat slowly and chew food, SFF
 Nissen’s fundoplication
 No irritating foods
 Hill’s operation
 Upright position before and after eating for
 Belsey’s repair (Mark IV)
1-2 hrs
 Esophageal Diverticulum
 No eating 3 hrs prior to bedtime
- Outpouching of mucosa
 Reduce weight.
- Types:
 Elevate head. No activities that increase
 Pulsion- weakness in muscle wall
abdominal pressure
 No smoking
 - Sx:  Increase fluid intake
 Nissen fundoplication/ gastric wrap around  Bed rest
 Antibiotics and antispasmodics
 Vancomycin- Resistant enterococcus (VRE)  Wt reduction If obese
- Gram + bacteria normally residing in GIT  Hemorrhoids
- Frequent cause of nosocomial diarrhea - External- below anal sphincter
- CONTACT PRECAUTION - Internal-above anal sphincter
 Appendicitis - Prolapsed- thrombosed/ inflamed
- RLQ pain / mcburney’s point (halfway bet - d/to constipation
umbilicus and anterior spine of ilium) - pregnancy, valsalva maneuvers
- Rebound tenderness( blumberg’s sign) - ssx:
- Psoas sign- Cope’s psoas test/ obratzsovas sign  constipation, anal pain, rectal bleeding with
(RLQ pain when extending hip) defecation, anal itchiness
- Obturator sign- pain on internal and external - Mgt:
rotation of right hip  High fiber diet, sool softeners/laxatives
- Rovsing’s sign  Apply cold packs in anal area then warm sitz
- Dunphy’s sign- increased pain when coughing bath
- Fever and leukocytosis  Apply witch hazel soaks and topical
- Decreased/ absent bowel sounds anesthesia ( Nupercaine)
- No enema, heat, laxatives  Pre-op: low residue diet
- Spinal anesthesia for surgery
- If pt has peritonitis:
 Insert penrose drain
 Semi-fowlers
 Watch out for infection
 Pulling out of penrose drain 1in daily
 Diverticulitis
- Acute inflammation and infection due to
trapped fecal material in the colon with
outpouching
- Diverticulum- single outpouching
- Diverticula- “diverticulosis” multiple
outpouching
- d/to low fiber diet
- ssx:
 crampy LLQ pain worsens when coughing,
moving and straining
 chronis constipation w/ episodes of
diarrhea
 low grade fever
 nausea and vomiting
- Mgt:
 High fiber diet but low fiber during acute
episode
 NPO during acute episode then clear liquids
 NO SEEDS
  GGT( Gamma Glutamyl Transpeptidase)
 High in liver cirrhosis (laennec’s)

CARE OF THE CLIENTS WITH HEPATO-BILIARY AND

PANCREATIC DISORDER PROCEDURES

ANATOMY AND PHYSIOLOGY  Biopsy of the liver

- Vitamin K injection before proc if PT is
 LIVER- has 2 lobes, RUQ
prolonged
 Blood supply of liver is portal vein and hepatic
- Position during: left lateral position
artery, receives unoxygenated blood
- Position after: right side for 4 hrs to apply
 Fx Unit: HEPATIC LOBULE
pressure
 Sinusoids are lined with Kupffer cells
- Instruct to exhale deeply, hold breath for 5 to
(PHAGOCYTOSIS)
10 sec during insertion to prevent trauma in
 Metabolism of CHON, CHO, fats
diaphragm
 Produce BILE
 Paracentesis
 Glycogenesis ( formation and storage of glucose
- Check initial vs
to glycogen)
- Empty bladder prior to proc
 Glycogenolysis ( breakdown of glycogen to
- Upright/sitting position
glucose)
- After proc, watch out for hypovolemic shock y
 Gluconeogenesis (breakdown of fats and CHOn
hypotension and peritonitis
into glucose)
 Endoscopic Retrograde Cholangiopancreatography
 GALLBLADDER- storage and concentrates bile
(ERCP)
 PANCREAS- heterocrine gland
- Upper GI endoscopy
 Exocrine fx: secretes amylase, lipase and trypsin
- Assess for allergy to seafoods and iodine
 Endocrine fx: islets of langerhans
- After proc, assess gag reflex, still NPO if absent
 Beta cells- secrete insulin for CHO metabolism
- Turn to side to prevent aspiration
 Alpha cells- secrete glucagon stimulating
glycogenolysis in liver.

LABORATORY AND DIAGNOSTIC TESTS FOR LIVER

FUNX

 Serum Total cholesterol and c. esters

 Low in hepatocellular damage
 High in biliary obstruction
 Normal range: 140-220mg/dl
 Serum phospholipids
 Low in hepatocellular damage
 High in biliary obstruction
 Normal range: 150-250 mg/dl
 Total serum Protein
 Low in hepatocellular damage
 Immunoglobulins
 IgA, IgG- high in liver cirrhosis
 IgG- high in chronic hepatitis, biliary cirrhosis
 IgM- high in Hepatitis A

CARE OF THE CLIENTS WITH ENDOCRINE DISORDER
ANATOMY AND PHYSIOLOGY
 Pituitary gland (hypophysis)
- Lies in sella turcica of middle cranial fossa (bony
floor supporting brain)
- Anterior pituitary gland (adenohypophysis)
- Posterior pituitary gland (neurohypophysis)
- Hypothalamus controls both A&P p. gland so it
control endocrine gland
ANTERIOR PITUITARY GLAND:
 Growth Hormone ( Somatotropin Hormone)
- Insulin antagonist, increase blood sugar
 Prolactin (Mammotropic hormone, lactotropic,
leutotropic)
- for breast dev’t and lactation
- regulates reproductive function of both sex
 Gonadotropic Hormones
- FSH and LH
- Gametogenesis and sex steroid production
- Dev’t secondary sex characteristics
 Adrenocorticotropic horme
 Melanocyte
 Thyroid stimulating hormone
POSTERIOR PITUITARY GLAND:
 Antidiuretic hormone (ADH)
- Vasopressin
- Major control of osmolality (concentration) and
body volume
- Vasoconstriction
- Increase water reabsorption
 Oxytocin
- Promotes milk “let-down” in lactating breast
- Increased uterine contraction after labor has
begun
 Thyroid Gland
 T3 and t4
- Regulate metabolic rate of cells
- CHON, CHO and fat metabolism regulation
- Insulin antagonists
- Stimulate SNS, affects CNS
- Maintain growth hormone secretion and
skeletal maturation
 Thyrocalcitonin (Calcitonin)
- Lowers calcium
- Inhibits osteoclastic
- Lowers phosphate
- Decrease calcium and phosphorus reabsorption
in GIT
 Adrenal Glands
ADRENAL CORTEX (Sugar, Sex, Salt)
 Glucocorticoids
- Anti inflammatory effect
- For blood glucose balance
- Maintain emotional stability
 Mineralocorticoids
- Maintain sodium and volume status
- Increase sodium reabsorption in distal tubules
- Aldosterone (pro sodium, anti potassium)
 Sex Hormones ( Androgen and Estrogen)
- Secondary sex characteristics
- Every function is high and fast except GI and GU
ADRENAL MEDULLA
 Cathecolamines
- Norepinephrine and Epinephrine
- Stimulated by SNS and medulla oblongata
 Parathyroid Glands
- Produce parathormone (PTH)
- Regulates calcium and phosphorus balance
- PTH and Calcium= direct proportion
- PTH and Phosphorus= indirect proportion
DIAGNOSTIC TESTS OF PANCREATIC DISORDER (
DIABETES MELLITUS)
 Fasting Blood Sugar (FBS)/ FBG
-Normal : 70-110 mg/dl
- DM: above 140 mg/dl for 2 readings
 2 hours PPBS (2 hrs Posprandial Blood Sugar)
- Initial blood specimen is withdrawn
- 100g of carb taken by client
 - 2hrs after meal, blood specimen is withdrawn,
should go back to normal level
 OGTT/ GTT (Oral Glucose Tolerance Test/ Glucose
Tolerance Test)
- High carb 200-300g PO/ IV for 3 days
- Avoid alcohol, coffee, smoking for 36 hrs before  Hypoglycemia
test - Low glucose
- NPO for 10-16 hrs - SNS activation
- Initial blood and urine specimen - Feeling hungry
- Monitor for 1 hr, 2h, 3h  Hyperglycemia
- Done after FBS and PPBS - 3P’s (Polyuria, Polydipsia, Polyphagia)
 Glycosylated Hgb (HbA1c) - Dehydration
- most accurate indicator of DM - Ketoacidosis
- 3-4months blood sugar level
- NV: 4-6%
- Goal for DM: 7.5% or less

BASIC CONCEPTS TO REMEMBER!!!!  Sympathetic Nervous System

 SIADH - Everything is high and fast except GI and GU
- water retention with low sodium (Dilutional - Anticholinergic
hyponatremia) - Norepinephrine is released
- Dilate pupils
 DI
- Constrict peripheral blood vessel
- Water loss
- Beta agonists: bronchodilators

 Hyperthyroidism
 Parasympathetic Nervous System
- Everything is high,fast, wet
- Everything is low and slow except GI and GU
- Eye manifestations
- Cholinergic
- Hypocalcemia
- Constrict pupils
 Hypothyroidism
- Dilate peripheral blood vessel
- Everything is low, slow, dry
- Acetylcholine is released
- Hypercalcemia
- Beta blockers: antihypertensives

 Addison’s disease
- Everything is low except potassium, calcium and
pulse rate
- Dark skin
 Cushing Disease
- Everything is high except potassium, calcium
and pulse rate

 Hyperparathyroidism
- Everything is low and slow except BP
- Hypercalcemia, hypophosphatemia
 Hypoparathyroidism
- Everything is high and fast except BP
- Hypocalcemia, hyperphosphatemia
CARE OF THE CLIENTS WITH BLOOD DISORDER  Administer antihistamine and analgesic
 Avoid high altitude.
ANATOMY AND PHYSIOLOGY
 Iron Deficiency Anemia (IDA)
 Blood cell production (hematopoiesis)- BONE - Microcytic, hypochromic anemia
MARROW - Inadequate dietary intake, blood loss, hemolysis
 SPLEEN- produce RBC during fetal development - Ssx:
- Storage of RBC and platelets  Vinson Plummer’s syndrome
*stomatitis
 Liver- stores iron and filters blood
*dysphagia
DIAGNOSTIC PROCEDURES *atrophic glossitis (smooth, sore tongue)
 Cheilosis (crack in lips)
 Low MCV, MCH- microcytosis and hypochromia  Koilonychi
 High MCV, MCH- macrocytosis  Pica
 Low MCHC- hypochromia  Tinnitus
 High MCHC- spherocytosis  Increased HR, chest pain, DOB
 Rh Positive- has D antigen - Mgt:
 Rh negative- has no D antigen  Blood transfusion
 COOMB’s TEST- differentiate types of hemolytic  Ferrous sulfate after meals
anemia; detects immune antibodies; detects Rh  Ferrous gluconate and ferrous fumarate before
factor meals.
 Direct- detect antibodies attached to RBC  Iron Dextran (Imferon)- administer by ztrack to
 Indirect- detect antibodies in serum prevent staining in skin. Do not massage site to
 Methylmalonic acid- helps to identify cobalamin prevent leakage.
deficiency from folate deficiency  Oral liquid iron by straw to prevent permanent
teeth staining.
 BONE MARROW EXAMINATION  VITAMIN C increase absorption of IRON (orange
juice)
- Preferred site for adult: POSTERIOR ILIAC CREST  No iron with tea, milk and antacid.
- Alternative site: anterior iliac crest and sternum  Iron cause constipation. Increase OFI.
but sternum is for aspiration only  Iron salts change stool color to dark green or
- After proc, apply pressure for 5-10 mins. black (normal). Adverse effect is nausea,
- If bleeding persists, lie on the side to maintain vomiting, Epigastric pain, pallor and drowsiness.
pressure for 30-60 mins. Rolled towel may be  Diet: Iron-rich foods
placed. *organ meats. Lean meat, egg yolk
*beans
DISORDERS: *green leafy vegetables
 Polycythemia Vera *raisins and dried fruits
- Hyperplasia of bone marrow  Folic Acid Deficiency Anemia (Megaloblastic
- Unknown, genetics Anemia)
- High RBC, Platelet, WBC - Vit B9 deficiency
- Ssx: - Prolonged TPN, poor dietary intake, malignancy
 Ruddy complexion/ Plethora - Same with cobalamin deficiency but has NO
 Headache, dizziness, fatigue, blurred NEUROLOGIC DEFICITS
vision,hyperuricemia, hepatosplenomegaly - Ssx:
- Mgt: *cracked lips, sore tongue
 Increase OFI - 1mg/day PO folic acid supplement
 Pernicious Anemia
- Vitamin B12 deficiency
- Cause is related to gastrointestinal
- Decreased intrinsic factor by parietal cells of
stomach
- Schilling’s Test
- Sx:
*beefy red tongue
*neurologic deficit
*jaundice
- Mgt:
 Monthly vit B12 IM for life instead of oral
 Physical examination q 6 months
 HCL 4-10ml PO with meals during 1st week of VIt
B12 therapy
 High incidence for gastric cancer and thyroid
function test is required.
 Aplastic Anemia
- Bone marrow hypoplasia or aplasia resulting in
pancytopenia (all blood cells are decreased)
- Caused by chloramphenicol, fanconi’s anemia
(congenital), idiopathic, hepatitis
- Ssx: all manifestation related to decreased
blood cells
 Thalassemia Major (Cooley’s Anemia)
- Most severe beta-thalassemia syndrome
- Inherited hemolytic anemia
- RBC has short lifespan, low hgb
- Most prevalent in Mediterranean basin, middle
east and southeast asia, Africa
- Hemosiderosis (high iron in blood)
- Pathologic fractures
- Growth retardation
- Frontal and maxillary bossing sign
- Mgt:
 Splenectomy
 Blood transfusion
 Decrease dietary iron
 Iron chelation therapy with Desferal
(Deferoxamine) be alert for visual and hearing
deficits
 Avoid contact sports
CARE OF THE CLIENTS WITH MUSCULOSKELETAL
DISORDER
ASSISTIVE DEVICES
 CANE
 Hold by unaffected hand
 Cane and affected leg advanced together
 Height of cane is hip level
 WALKER
 “lift and walk”
 When going up, use walker at the back
 When going down, use walker at front
 CRUTCH
 2-3 fingerbreadths distance of crutch and axilla
to prevent crutch palsy
 Elbows slightly flexed (30 degrees)
 Weight on palms (hand)
 Four-Point Gait
- Advance right crutch, followed by left foot,
followed by right foot. Weight bearing is
allowed
 Two-Point Gait
- Advance right crutch and left foot together,
then left crutch and right foot together. Weight
bearing is allowed
 Three-Point Gait
- Advance both crutches and affected leg
together, followed by unaffected leg. Little or
no weight bearing is allowed. (after total hip
replacement or knee)
 Swing to Gait
- advance both crutches, swing the body so that
feet will be to the level of crutches
 Swing Though Gait
- Advance both crutches, swing the body so that
the feet will be past the level of the crutches.
 Up with the good, down with the bad
 Up: good leg, bad leg, crutch
 Down: bad leg, crutch, good leg
 TRIPOD POSITION
- Put crutch 2in. forward and 6in. to the side
- Basic crutch stance for balance and support
TOTAL HIP REPLACEMENT
- Maintain abduction of affected limb by
abductor splint or 2 pillows between legs
- No external rotation by placing trochanter rolls
along hip
- Head of bed flat
- Ambulation 2-4 days post op
- Avoid adduction and hip flexion. No low chair
- 3-pint gait
CARPAL TUNNEL SYNDROME
- Median nerve affected
- Pain from wrist to shoulder
- Tinel’s sign ( tingling sensation on percussion of
inner wrist)
- Phalen’s sign (tingling sensation on holding the
wrist flexion for few minutes)
- Weak grip of hands
AMPUTATION OF LIMB
- Observe stump for bleeding
- Prevent edema by raising extremity with pillow
support for first 24 hours
- No sitting on chiar
- Prone position
- No elevation of stump after 24 hrs: keep stump
adducted with the unaffected leg
- Wear cotton or woolen stump socks, no nylon
- Put on prosthesis upon arising and keep it all
day
- No pillow between thighs, under hip or knee
- No hanging of stump over bed
CARE OF THE CLIENTS WITH RESPIRATORY DISORDER >dullness
 Normal breath sounds:
ANATOMY AND PHYSIOLOGY
 Bronchial
 Processes of respiration:  Bronchovesicular
 Ventilation- movement of gas in and out  Vesicular
 Inhalation-voluntary  Adventitious sounds
 Exhalation- involuntary  Crackles/Rales (FINE)- high-pitched, soft
 Diffusion- from high to low popping (rolling strand of hair between fingers)
 Perfusion  Crackles/Rales (COARSE)- loud/low-pitched,
 Visceral pleura- cover lungs bubbling, gurgling (opening of velcro fastener)
 Parietal pleura- lines the cavity  Pleural friction rub- coarse, low-pitched, grating
sound
 Right lung- has 3 lobes, shorter, broader
 WHEEZE:
 Left lung- 2 lobes
- High pitched, squeaking sound sibilant ronchi
 RESIDUAL VOLUME- amount of air that remains to
- Low pitched, musical snoring, moaning sound
prevent lung collapse during exhalation. (1200 ml)
sonorous ronchi
increase when aging.
 TIDAL VOLUME- amount of air in and out of lungs ASSESSMENT
(500 ml)
 TOTAL LUNG CAPACITY- total of four volumes:  AUSCULTATING
Residual, tidal, inspiratory and expiratory volume  Use diaphragm at intercostals muscles
 FUNCTIONAL RESIDUAL CAPACITY- amount of air  N: high-pitched sound
remains after normal exhalation  Start to posterior to anterior chest
 Pneumocytes:  Top to bottom (lung apices to bases)
I- line the alveoli  Side to sude
II-produce surfactant (lipoprotein that decrease  Anterior chest- start above the clavicle
tension in alveoli) - Nipple line to midaxillary line
 12 ribs  VOICE SOUNDS
 12cm (4-5 in) trachea  Egophony
 RESPIRATORY CENTERS: -say prolonged “e”
 Medulla oblongata- primary respiratory center; -“a” (lung consolidation)
increased CO2 stimulates breathing  Whispered Pectoriloquy
-whisper 1,2,3
 PONS:
-N: muffled 1,2,3
 Pneumotaxic center- rhythmic quality of
-Distinct (lung consolidation)
breathing
 Bronchophony
 Apneustic center- deep, prolonged inspiration
-say “99”
 Carotid and aortic bodies- decreased oxygen
-increased resonance, words clear (lung
stimulates breathing
consolidation)
High BP= Low RR
High BP= RESPIRATORY ACIDOSIS  ALTERED BREATHING PATTERNS
Low BP= High RR  Cheyne-stokes
Low BP= RESPIRATORY ALKALOSIS -rhythmic, waxing and waning
-very deep/ shallow and temporary apnea
 I:E = 1:2
 Kussmaul’s (HYPERVENTILATION)
 Percussion:
-increase rate and depth
>resonance
 Hypoventilation
>hyperresonance
-slow, shallow respiration
  Biot’s  LUNG SCAN
-shallow breaths interrupted by apnea  Measure blood perfusion through the lungs
“irregularity”  Confirm pulmonary embolism
 Apneustic  SCALENE/ CERVICOMEDIASTINAL
-prolonged, gasping inspiration followed by very  Metastases of lung cancer
short inefficient expiration  BIOPSY
 ABNORMAL RESPONSES VIBRATION  Transbronchoscopic- done during bronchoscopy
 Increase Fremitus  Percutaneous Needle Aspiration- done with
-fluid-filled aspiration needle
-pneumonia, tumor  Open lung biopsy- done during surgery
 Decrease Fremitus
-air-filled ARTERIAL BLOOD GASES
-pneumothorax, emphysema
- Assess ventilation and acid-base balance
 PERCUSSION TONES - Common site: radial artery
 Resonant - Test for ulnar artery
-heard over normal lung tissue - Dx: Allen’s test- test of adequacy of collateral
-“HOLLOW” circulation of hand
 Flat - Within 6 seconds
-airless tissue (muscles and bones) - Place specimen In ice to prevent hemolysis
-“extremely dull” - Sa02
 Dull
-dense lung tissues (heart and liver) OXYGEN NARCOSIS
-tumor/ lung consolidation
- “thud like” - Respiratory Alkalosis
 Tympanic SUCTIONING
-large tension
-Pneumothorax, stomach - Negative pressure
-“drumlike” - 3-5 inch catheter
 Hyperresonant - 5-15 secs
-emphysema and pneumothorax - Vagal stimulation- hypotension, bradycardia
-“Booming” - Suction pressure: 120-150 mmHg

DIAGNOSTIC PROCEDURES THORACOSTOMY TUBE

 MANTOUX TEST - 2-3 ft below chest

 Used PPD (Purified Protein Derivative) - 2-3 cm tube
 ID: 48-72 hrs - 10-20 cm H20 in sterile NSS
 (+) MT= 10 mm= TB - Pleur Evac:
 (+) MT= 5mm= immunocompromised/ HIV  1st- collection
 (+) MT= w/ BCG  2nd- water seal
 CHEST X-RAY  3rd- suction
 Hold breath
NASAL PACKS
 DB exercise
 No metals - 3-5 days 3 days (external); 5 days (internal)
 FLUOROSCOPY - Not longer to prevent TOXIC SHOCK SYNDROME
 Lung and chest motion (TSS) caused by staph A.
- No blowing for 2 days after removal
SINUSITIS - Leukotriene antagonists
 Singulair/ Montelukast
- Acute: URTI  No to constriction, decrease edema and mucus
- Chronic: more than 3 wks with nasal polyps (
NO to ASA it can cause nasal polyps) COR PULMONALE
- Give codeine (vicodin)= can cause drowsiness
- Hot wet packs - Right side hypertrophy due to pulmonary HPN

THEOPHYLLINE
PERITONSILLAR ABSCESS
 Toxicity: nausea, vomiting, seizure, insomnia
- Hot potato voice
 No to coffee
TONSILLECTOMY
STATUS ASTHMATICUS
- Prone/ lateral
- No straw, colored foods, citrus and milk  if no wheezing, it means complete airway
- Throat discomfort is normal for 4-8th day) obstruction
expect black stool  connect to mechvent

LARYNGECTOMY BRONCHIECTASIS

- Pilocarpine (HCL) (Salagen)= increased - dilation of bronchi

salivation - high resolution CT Scan (HRCT)
- Radiation cause xerostomia CONTROLLED MANDATORY VENTILATION
COPD  alarm turns on:
 CHRONIC BRONCHITIS - low high pressure
- Productive cough lasting for 3 mos. For 2 - disconnection
consecutive years - obstruction
 EMPHYSEMA HAP
- Overdistended non-functional alveoli
- Deficiency of alpha-1 antitrypsin - Pseudomonas aeroginosa
- 48-72 hours
 Diet: high calorie, CHON, low CHO
PULMONARY EMBOLISM
 2-3lpm oxygen only
 Smoking cessation - Thrombus in the right side of heart
 Expectorant (guiafenesin)
 Mucolytics(Mucomyst) MEDICATIONS
 Antitussive at night (Codeine and
- Dobutamine for hypotension
Dextrometorphan)
- Clindamycin for anaerobic lung infection (lung
BRONCHODILATOR AND STEROID INHALATION abscess)

- Bronchodilator first then steroid - Flail chest- fracture

- Bronchodilator: tachycardia, palpitation
- Long acting anticholinergic= Tiotropium - Coughing triggers pleuritic pain so splint.
(Spiriva) bronchospasm and dyspnea in COPD
- Rinse mouth after steroid inhalation to prevent
moniliasis
CARE OF THE CLIENTS IN PERIOPERATIVE NURSING  PLANNED REQUIRED- scheduled weeks or
months
 PERIOPERATIVE PERIOD  ELECTIVE- not absolutely necessary for
 PREOPERATIVE PHASE- from surgical unit to survival; delay or omission will not cause effect
operating room  OPTIONAL- requested by the patient
 INTRAOPERATIVE PHASE- from operating room
to PACU/recovery room NURSING CONSIDERATIONS:
 POSTOPERATIVE PHASE- from PACU to
 Most diabetic patients should be continued right up
discharge (follow-up care)
until surgery despite NPO status; however,
CLASSSIFICATION OF SURGICAL PROCEDURES Metformin (Glucophage) should be held owing to
the risk of lactic acidosis when food and fluids are
 BASED ON PURPOSE: held.
 DIAGNOSTIC- to confirm presence of disease  Consent should be signed before giving preop
(biopsy) medications.
 EXPLORATORY- to determine extent of disease
 If surgery will be done on a body part that has both
(exploratory laparotomy)
sides, practice “TIME OUT” if right patient is send to
 CURATIVE- to treat disease condition:
surgery. Avoid SENTINEL EVENT related to surgery
 ABLATIVE- removal of an organ “ectomy”
of body part.
*Oophorectomy- removal of an ovary
 CONSTRUCTIVE- repair of congenital STEAM STERILIZATION
abnormality “plasty”, “oorhapy”, “pexy”
*Uranoplasty- cleft palate repair  Temp: 250-254 F (121-123 C)
 RECONSTRUCTIVE- involves repair of damaged  Pressure: 15-17 psi
organs (plastic surgery after burns, scar  Minimum of 15 mins exposure
revision)  PRE-VACUUM STERILIZERS
 PALLIATIVE- to relieve but not cure  Temp: 270-276 F (132-135 C)
*colostomy, debridement of necrotic tissues,  Pressure: 27-30 psi
resection of nerve roots  Minimum exposure of 4 minutes for wrapped
 PREVENTIVE- to inhibit transformation of items
benign to malignant tumors
 COSMETIC IMPROVEMENT
 BASED ON MAGNITUDE/ EXTENT:
 MAJOR SURGERY
-involves high risk morbidity/mortality
-extensive and prolonged
-large amount of blood loss
-vital organs manipulated/ removed
-great risk of complications
 MNOR SURGERY (plasty, appendectomy,
tonsillectomy)
-procedure not prolonged
-lesser risk
-not usually involve serious complications
 BASED ON URGENCY:
 EMERGENCY- done immediately to save client
 IMPERATIVE- done within 24-48 hours