what is the focus for Reyes
- neuro
- GI
- integumentary
what is a small bowel obstruction
something blocking the passage of food, waste, and gas through the intestines and disrupting food absorption
what causes small bowel obstruction
- tumors
- previous surgeries, causes scar tissue formation which can cause blockage
- hernias
- Intussusception parts of the intestine telescope into each other causing poor blood flow and blockage
what are the s/s of small bowel obstruction
- abdominal pain/ cramping
- abdomen distention
- N/V
- constipation
- hyper/hypoactive bowels depending on the stage
what are the stages of cancer
stage 0: non-invasive and only in one spot
stage 1: localized cancer, tumor is growing but not spreading to other areas
stage 2: cancer has spread to nearby by lymph nodes
stage 3: local and regional spread so it has spread to surround lymph nodes
stage 4: metastatic meaning cancer has gone to other organs
what are the diagnosis for bowel obstruction
- physical examination of abdomen distention and auscultate for bowel sounds
- CT scan gives detailed picture of the intestines and why might be causing the blockage
- blood tests like CBC and electrolytes due to N/V there could be dehydration
what are the tx’s for bowel obstruction
- NG tube to remove contents that could be causing blockage
- antiemetics to reduce N/V
- surgery to remove the tumor or scars that are causing the blockage
What interventions pre-op would you expect to see for a small bowel obstruction?
- patient NPO
- IV fluids
- NG tube to decompress the stomach and relieve pressure
what is a NG tube for
to decompress the stomach and relieve pressure by removing fluids and gas that via lavage
it could also be to deliver substances like nutrition to stomach via gavage
what is low intermittent suctioning for a NG tube
gentle suctioning to remove contents in stomach without harming intestinal lining
when can NG tube be removed
- if bowel sounds are present patient is passing gas
- decreased abdomen distention
- none to minimal drainage of fluid from NG tube
- doctors order
what are the nursing considerations for a patient with a NG tube
- ax the integrity of nares, ears, throat
- pain
- ensure proper placement of NG tube
- site to source no kinks or obstructions
- monitor the drainage
pale yellow or clear indicating stomach fluid or slight bile
black or coffee ground colour indicates old blood
green/ purulent indicates bile or infection
what is a PCA pump
patient controlled analgesia where patient can self-administer high alert meds (morphine , hydromorphone and fentanyl) medication when needed
what type of patient is on a PCA
who is
- physically
- cognitively
- psychologically competent to work and understand a PCA pump
how often do PCA checks need to be done
- every 15 mins for the first hour
- Q1H for the next 4 hours
- Q4H after that
what is the LPN role in PCA’s
- are only to monitor the device and patients response
site to source
correct dose
ax respirations, sedation, and O2
encourage fluids for constipation
why is Grey getting lactated ringers
- to replace fluids and maintain hydration from vomiting and suctioning fluid out of the stomach
what is a JP drain and how does it work
is a closed suction drain that removes fluid from surgical site to promote healing and prevent infections
works by suctioning the bulb and closing it so it can suction fluid out of the surgical site
when can a JP drain be removed
- less than 25 cc in last than 24 hours
- drainage is light colour
- no signs of infection
what is the difference between a JP drain and a Hemovac
JP - used in smaller surgical wounds
Hemovac - used in larger wounds as it could hold more fluid
what should the drainage look like in the JP
- serosanguinous (pale in colour) indicating healing
- bright red not healing active bleeding
- yellow indicates infection
- brown is poop or bile
what is morphine
opioid used to relieve moderate to severe pain by blocking pain signals in brain
what are the side effects of morphine
- respiratory depression
- constipation
- drowsiness
- low BP and HR
what are small bowel obstruction complications
- paralytic ileus, intestines are paralyzed for some time due to surgery
- perforation due to bowel wall rupturing
- infection due to the surgical wound or the bowels perforating and introducing bacteria
