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Acute Abdomen 1 - Outline
Generalist Nursing Practice IV: Tertiary Care Across the Lifespan (NURS 4889)
Temple University
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Acute Abdomen:
Abdomen Pain: - N/V - Constipation - Diarrhea
- Fatigue
- Fever
- Increased abd girth
Common Causes: - Abd compartment syndrome (burns) - Acute pancreatitis - Appendicitis - Bowel obstruction - Cholecystitis - Diverticulitis
- Gastroenteritis
- Pelvic inflammatory disease
- Duodenal ulcer
- Peritonitis
- Ruptured AAA
- Ruptured ectopic pregnancy
Life-threatening Causes: - Hemorrhage - Obstruction
- Perforation
During Assessment: - Pain assessment o Frequency, time, location before during and after symptoms o Observe position of patient o Bowel sounds, assess abdomen, lower pelvis kidneys and bladder region Diagnostics: - CBC - UA - EKG - ABD XRAY (flat plate)
- Ultra sound or CT
- Preg test
- Electroytes, liver studies
- Type and Cross
Until Clear of dx, assume going to OR: - NPO - Preop preparation - Remove jewelry
- IV access
- Preop teaching
- Consent
Type of Surgery Examples: - Exploratory Laparoscopy - Appendectomy
- Open exploratory o Bowel resection Post-Op:
- Open abd for GI o NG tube Green, to yellow, to clear white Upper Gi issues can produce dark brown to dark red drainage. Coffee ground can be normal. Yellow green is also normal. Bright red is not normal. Check K+ levels, lab values o Abd binder o ISB
- N/V not uncommon post op o Ok to medicate with antiemetic but also check cause o Decreased peristalsis from manipulation and anesthesia o EARLY AMBULATION o Medication: Reglan or Enereg
Obstruction: - Vascular obstruction o Caused by an emboli or atherosclerosis o Mesenteric or supply to intestine
o Intestine dies and becomes necrotic “dead gut”- Paralytic Ileus:
Occurs after surgery
Proximal small bowel-N/V with projectile emesis
NG drainage is orange and essence of feces
Large bowel matter accumulates in the bowel
No bowel sound, no peristalsis
Bowel Obstruction: - Vomiting relieves pain - Pain comes in waves (peristalsis) - Bowels sounds may be present o High pitched above the obstruction o Absent
o borbygori
- Diagnostics o Xrays: o Show air or fluid in ABD o CBC, amlyase, lipase, BUN elytes
o Sigmoisoscopy o Colonoscopy o surgery
Abdominal Trauma: - Hemorrhage - Injury from blunt trauma or penetration o MVA, stabbing, gunshot, fall - Look For: o Solid Organs Bleed, o Hollow organs cause peritonitis o Lacerated liver o Ruptured spleen o Mesenteric tears
o Diaphragmatic tear o Urinary bladder tear o Great vessel tear o Renal injury o Pancreatic injury
- Result: o Compartment Syndrome o Peritonitis
o Sepsis o Shock
- Assessment: o Obvious injury: ex. /knife.. it in, cover and stabilize o Not obvious: Look for abrasions or ecchymosis Signs of internal bleeding o Airway, O2, IV, control bleeding o CBC, T&C, UA FOLEY, NG (if not bleeding)
Constipation: - High fiber diet - Stool softeners - What is normal for pt.. specifics, every day vs 3x a day. - Impaction, liquid watery stool around stool is not diarrhea
Inflammatory bowel disease
Chrohn’s disease
Colitis
10-20 bm’s/day
Can be bloody
Common problems involving aorta
Occur in men more often than in women
Incidence ↑ with age
Abdominal aortic aneurysms (AAA) o Affect about 1 million adults between 55 and 84 years of age o Most occur below renal arteries o Aorta larger than 3 cm in diameter is considered aneurysmal o Growth rates may be lowered by treatment with statins (e., simvastatin [Zocor]) and antibiotics (e., doxycycline [Doryx]).
Causes o Degenerative o Congenital o Mechanical Penetrating or blunt trauma
o Inflammatory o Infectious o Most common cause is atherosclerosis
- Clinical Manifestations: o Ascending aorta/aortic arch Angina Hoarseness If presses on superior vena cava Decreased venous return o Distended neck veins o Edema of face and arms
- Collaborative Care: o Surgical therapy If ruptured, emergent surgical intervention required 90% mortality with ruptured AAAs Preop Hydration Stabilize electrolytes, coagulation, and hematocrit o Autotransfusion reduces need for blood transfusion during surgery o AAA resection Require cross-clamping of aorta proximal and distal to aneurysm Can be completed in 30 to 45 minutes Clamps are removed and blood flow to lower extremities is restored If extends above renal arteries or if cross-clamp must be applied above renal arteries Check for adequate renal perfusion after clamp removal and before closure of incision. Risk of postop renal complications ↑ significantly when repair is above renal arteries. o Surgical technique – OAR Inserting synthetic graft Dacron or polytetrafluoroethylene (PTFE) Suturing the native aortic wall around graft Acts as protective cover o Endovascular graft procedure Alternative to conventional surgical repair Involves placement of sutureless aortic graft into abdominal aorta inside aneurysm Minimally invasive Done through femoral artery cutdown Potential complications Endoleak
Aneurysm growth Aneurysm rupture Aortic dissection Bleeding
Stent migration Renal artery occlusion Graft thrombosis Incisional site hematoma Site infection
- Nursing Management: o Assessment: Monitor for indications of rupture Diaphoresis Pallor Weakness
Tachycardia Hypotension
Abdominal, back, groin, or periumbilical pain Changes in level of consciousness Pulsating abdominal mass
- AAA Dissection Predisposing Factors: o age, (male 60 +) o aortitis (e., syphilis, Takayasu’s), o blunt or iatrogenic trauma, o congenital heart disease (e., bicuspid aortic valve, coarctation of the aorta), o connective tissue disorders (e., Marfan’s or Ehlers-Danlos syndrome),
o cocaine use, o history of cardiac surgery, o atherosclerosis, o male sex, o pregnancy, o hypertension, o Turner’s syndrome.
Aortic Dissection: - Clinical Manifestations: o Pain characterized as Sudden, severe pain in anterior part of chest, or intrascapular pain radiating down spine to abdomen or legs Described as “sharp” and “worst ever” May mimic that of MI o Cardiovascular, neurologic, and respiratory signs may be present If aortic arch involved Neurologic deficiencies may be present Cardiac tamponade - Complications: o Cardiac tamponade Clinical manifestations include Hypotension Narrowed pulse pressure Distended neck veins
Muffled heart sounds Pulsus paradoxus
- Collaborative Care: o Drug therapy IV β-adrenergic blocker Esmolol (Brevibloc) o Other antihypertensive agents Calcium channel blockers Nitroprusside
Acute Abdomen 1 - Outline
Course: Generalist Nursing Practice IV: Tertiary Care Across the Lifespan (NURS 4889)
University: Temple University
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