Odette's Final Exam - NRSG 2203 Solved Correctly,new
2023 update
Pathophysiology of Distention with risk of rupture
Vasocompression with risk of ischemia?
Hypotension and shock
1.Accumulation of food /secretions above obstruction
2. Swallowed air increases distension
3.Decreased oxygenation decreases peristalsis which further increases distention
•Distension leading to venous compression and decreased oxygenation
•Leakage of compressed capillaries which leak fluid
•Vomiting
•Sepsis also causes vasodilation
What is sepsis?
1.Over growth of commensal bacteria /dead tissue
2.Bacteria move into blood stream
3.They release endotoxins which are vasodilator, and which damage the endothelial
lining causing leakage, and initiation of the clotting mechanism
4.Septic shock
Signs and symptoms: Nausea and Vomiting
High
Middle
Low
High: Frequent vomiting, not distension, intermittent pain but not classic crescendo type
Middle: Moderate vomiting, moderate distension, intermittent pain
Low: Vomiting late, feculent. Marked distention. Variable pain, but may not be classic
crescendo type
Clinical manifestations of small and large intestinal obstructions:
Small intestine
Large intestine
Onset?
Vomiting
Pain
,BM?
Abdominal distention?
Small intestine:
Rapid
Frequent
Colicky, cramplike and intermittent
Feces for a short time
depends on location, minimal to greatly increased
Large intestine:
Gradual
Late manifestation
Low-grade, cramping abdominal pain
Complete constipation
Greatly increased
Where does it hurt?
Right upper quadrant or epigastric pain?
Suprapubic or sacral pain?
Epigastric pain?
Periumbicial pain?
Hypogastric pain?
Billiary tree and liver
Rectum
The stomach, duodenum or pancreas
The small intestine, appenxid or proximal colon
Colon, bladder or uterus
Fluid balance?
PO?
Monitor how freq?
Fluid replacement how?
Renal function?
Blood tests?
•Nil by mouth
•Intake /output - hourly monitoring
•Fluid replacement with aggressive intravenous (IV) resuscitation using isotonic saline
or lactated Ringer solution is indicated ( based on urine output, fluid chart and CVP)
•Renal function - urine output greater than 0.5ml/kg/hr
, •Blood results to assess for dehydration, electrolyte imbalance and renal function.
Pilonidal sinus?
Pilonidal means?
Commonly affects?
Can affect what other regions?
Leading causes of ingrowth of hair?
Warning sign?
Pilonidal sinus is a condition where in a hair follicle begins to grow inward, near the
coccyx (tail bone) and can cause a great deal of pain.
Nest of hair
Men between ages 15 and 24
Though the back is most common part of affliction, it may even happen in the navel,
armpits or genital region.
One of the leading causes is the ingrowth of hair. With the increasing amount of time
people spend sitting, not exercising enough, incorrect postures, badly- constructed
chairs, this condition is becoming common. Other topical reasons like obesity,
secondary occupation, family history can also be responsible for this condition.
The warning sign is usually a painless lump. There is usually a fluid filled inside this
cyst. Sometimes, when this fluid drains out, it reduces the pain. This means, the
medication is working, and a continuous antibiotic dosage can fix the problem.
However, some people suffer from chronic sinus, so they have to undergo surgery.
Chances are that the condition will not recur if a surgical procedure is done.
What is a mechanical bowel obstruction?
Most obstructions occur where? and why?
Most common causes of large bowel obstruction?
Mechanical obstruction may be caused by an occlusion of the lumen of the intestinal
tract. Most intestinal obstructions occur in the small intestine and are usually due to
adhesions. Adhesions can develop after abdominal surgery. Obstruction can occur
within days of surgery or years later. Carcinoma is the most common cause of large
bowel obstruction, followed by volvulus and diverticular disease.
What is a non mechanical bowel obstruction?
Common causes?
2023 update
Pathophysiology of Distention with risk of rupture
Vasocompression with risk of ischemia?
Hypotension and shock
1.Accumulation of food /secretions above obstruction
2. Swallowed air increases distension
3.Decreased oxygenation decreases peristalsis which further increases distention
•Distension leading to venous compression and decreased oxygenation
•Leakage of compressed capillaries which leak fluid
•Vomiting
•Sepsis also causes vasodilation
What is sepsis?
1.Over growth of commensal bacteria /dead tissue
2.Bacteria move into blood stream
3.They release endotoxins which are vasodilator, and which damage the endothelial
lining causing leakage, and initiation of the clotting mechanism
4.Septic shock
Signs and symptoms: Nausea and Vomiting
High
Middle
Low
High: Frequent vomiting, not distension, intermittent pain but not classic crescendo type
Middle: Moderate vomiting, moderate distension, intermittent pain
Low: Vomiting late, feculent. Marked distention. Variable pain, but may not be classic
crescendo type
Clinical manifestations of small and large intestinal obstructions:
Small intestine
Large intestine
Onset?
Vomiting
Pain
,BM?
Abdominal distention?
Small intestine:
Rapid
Frequent
Colicky, cramplike and intermittent
Feces for a short time
depends on location, minimal to greatly increased
Large intestine:
Gradual
Late manifestation
Low-grade, cramping abdominal pain
Complete constipation
Greatly increased
Where does it hurt?
Right upper quadrant or epigastric pain?
Suprapubic or sacral pain?
Epigastric pain?
Periumbicial pain?
Hypogastric pain?
Billiary tree and liver
Rectum
The stomach, duodenum or pancreas
The small intestine, appenxid or proximal colon
Colon, bladder or uterus
Fluid balance?
PO?
Monitor how freq?
Fluid replacement how?
Renal function?
Blood tests?
•Nil by mouth
•Intake /output - hourly monitoring
•Fluid replacement with aggressive intravenous (IV) resuscitation using isotonic saline
or lactated Ringer solution is indicated ( based on urine output, fluid chart and CVP)
•Renal function - urine output greater than 0.5ml/kg/hr
, •Blood results to assess for dehydration, electrolyte imbalance and renal function.
Pilonidal sinus?
Pilonidal means?
Commonly affects?
Can affect what other regions?
Leading causes of ingrowth of hair?
Warning sign?
Pilonidal sinus is a condition where in a hair follicle begins to grow inward, near the
coccyx (tail bone) and can cause a great deal of pain.
Nest of hair
Men between ages 15 and 24
Though the back is most common part of affliction, it may even happen in the navel,
armpits or genital region.
One of the leading causes is the ingrowth of hair. With the increasing amount of time
people spend sitting, not exercising enough, incorrect postures, badly- constructed
chairs, this condition is becoming common. Other topical reasons like obesity,
secondary occupation, family history can also be responsible for this condition.
The warning sign is usually a painless lump. There is usually a fluid filled inside this
cyst. Sometimes, when this fluid drains out, it reduces the pain. This means, the
medication is working, and a continuous antibiotic dosage can fix the problem.
However, some people suffer from chronic sinus, so they have to undergo surgery.
Chances are that the condition will not recur if a surgical procedure is done.
What is a mechanical bowel obstruction?
Most obstructions occur where? and why?
Most common causes of large bowel obstruction?
Mechanical obstruction may be caused by an occlusion of the lumen of the intestinal
tract. Most intestinal obstructions occur in the small intestine and are usually due to
adhesions. Adhesions can develop after abdominal surgery. Obstruction can occur
within days of surgery or years later. Carcinoma is the most common cause of large
bowel obstruction, followed by volvulus and diverticular disease.
What is a non mechanical bowel obstruction?
Common causes?
