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JEJUNOGASTRIC INTUSSUSCEPTION • Procedure

Prior to procedure Procedure Post-procedure Discharge

▪ Anesthesia ▪ Incision made ▪ Stay in hospital ▪ 1-2 months for

options (local, in the skin for 5-14 days limb to heal
general, below the ▪ Given pain ▪ Physical
regional) knee. meds activity will be
▪ Allergies ▪ Muscles will ▪ Give meds to limited during
▪ Current meds be divided and prevent blood recovery
may be stopped blood vessels clots ▪ Learn ways to
▪ Fasting clamped ▪ Raise leg to do daily tasks
midnight before ▪ A special saw ease swelling (may take up to
▪ Need a ride is used to cut ▪ Apply ice to 1 year)
DEFINITION SIGNS& DIAGNOSTICS TREATMENT
SYMPTOMS
home through the area
Rare complication of Severe PE: Distended abdomen, Reduction or ▪ Tests needed bone ▪ Prevent
gastric surgery where epigastric pain epigastric tenderness, vague resection with ▪ Muscles are infection (wash
part of the organ slied Vomiting feeling of an epigastric mass on revision of the then sewn and hands, wear
into adjacent parts Hematemesis deep palpation previously shaped gloves or
This intussusception performed ▪ It will form a masks, keep
may cut off blood History of gastric surgery anastomosis stump that will incisions
supply Emergency CT scan of abdomen cushion the covered)
bone
▪ Nerves are
BELOW KNEE AMPUTATION divided and
placed so they
• Surgical removal of the leg below the knee
do not cause
• Reasons: • Possible complication pain
o Poor blood flow o Excess bleeding ▪ Skin closed
that cannot be o Problems from anesthesia over muscles
fixed o Infection ▪ Drains inserted
o Severe infection o Blood clots into stump to
o Trauma or injury o Skin breakdown and allow fluids to
o Tumors swelling of remaining limb drain
o Problems at birth o Poor healing
o Phantom pain

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HOW TO CARE
Empty it!
CARE OF CLIENT WITH JP DRAIN AND WOUND CARE - Empty when halfway full
- Usually amounts to 1-2x/day
1. Unplug cap
2. Turn bulb upside down and squeeze contents in measuring cup
3. Clean plug off w alcohol
4. Compress the bulb
5. Re-cap bulb
6. Document how much emptied

Milk it!
- To prevent clot formation
1. Use thumb and index finger of one hand to secure tubing close to insertion site
2. Use other thumb and index finger to strip down tubing 3-4x to move any drainage
or debris into bulb
Keep it secured!
WHAT IS A JP DRAIN DOCUMENTING COMPLICATIONS - Keep drain secure and lowered at insertion site so it will drain proper
Assess it regularly!
Jackson-Pratt Drain – closed Use a flowsheet to keep Clot formation Signs of infection: Redness/warmth, pain, swelling, hardness
system drain that uses bulb track of: - Signs (no drainage,
suction to prevent wound - JP drainage abrupt decrease in
drainage from collecting - If you emptied the drainage, appearance
around the surgical site drain of dark stringy debris
- When you in tubing, drainage
Drainage: Serosanguineous performed a around site)
but as wound heals, drainage dressing change Catheter falls out
will go from light pink to - If you milked the - Stitches come loose
light yellow drain - Notify doctor
Signs for infection: Cloudy - Noted the drain was Bulb won’t compress
yellow or tan or green w foul secured - Notify physician
odor

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GRAVES’ DISEASE RUPTURED APPENDICITIS

• A rupture spreads infection throughout your abdomen (peritonitis)

SYMPTOMS CAUSES Dx & Treatment

• Sudden pain that begins A blockage in the Diagnosis
on the right side of the lining of the appendix Physical exam to assess pain
• Immune system disorder that results in overproduction of thyroid hormones lower abdomen that results in infection Blood test
(hyperthyroidism), may complicate to thyroid storm (life-threatening) • Sudden pain that begins is the likely cause of Urine test
around your navel and appendicitis. The Imaging test
SYMPTOMS CAUSES DIAGNOSIS TREATMENT often shifts to your lower bacteria multiply
Bulging eyes Family history Blood tests Radioactive iodine right abdomen rapidly, causing the Treatment
Gritty sensation in Sex Radioactive iodine therapy • Pain that worsens if you appendix to become Appendectomy
the eyes Age uptake Anti-thyroid cough inflamed, swollen and Draining abscess
Pressure or pain in Emotional/physical Ultrasound medications • Nausea and vomiting filled with pus. If not
the eyes stress Imaging tests Surgery • Loss of appetite treated promptly, the Lifestyle & home remedies
Puffy or retracted Other autoimmune Lifestyle and home appendix can rupture. Avoid strenuous activity
• Low-grade fever that
eyelids disorders remedies Support abdomen when cough
may worsen as the
Reddened or Pregnancy Slowly increase activity
illness progresses
inflamed eyes smoking Rest
• Constipation or diarrhea
Light sensitivity
Double vision • Abdominal bloating
Vision loss • Flatulence

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SMALL BOWEL OBSTRUCTION PUD continuation…

RISK SIGNS/SYMPTOMS ASS & DX TREATMENT

FACTORS
65yo above Silent PUD – older adults PE: Pain, Antibiotics
Stress and and those taking NSAIDs epigastric (metronidazole or
anxiety tenderness, amoxicillin)
Transmission of Dull, gnawing pain or abdominal Proton inhibitor
bacteria (H. burning sensation in distension (lansoprazole)
pylori) midepigastrum or back Upper endoscopy Bismuth salts
Use of NSAIDs Gastric: Pain after eating Biopsy/Histologic H2 Blockers
• Partial or complete blockage of the small intestine Familial Duodenal: pain during exam of tissue Smoking cessation
tendency night (relief with food) specimen Dietary modification
CAUSES SIGNS/SYMPTOMS DX TREATMENT
Zollinger- Pyrosis, vomiting, CBC (avoid oversecretion of
Adhesions (bands Abdominal cramps Medical history Hospitalization – IV Ellison constipation, diarrhea, acid and hypermotility)
of scar tissue) Bloating (prev. abdominal or fluids, NPO, bowel syndrome bleeding, sour eructation,
Hernias (segments Vomiting pelvic surgeries) decompression vomiting, emesis
that break through Nausea Physical exam through NGT Surgery:
abdominal wall) Dehydration Blood tests and Anti-emetics – Bleeding PUD: GI > vagotomy w/ or w/o
Inflammatory Malaise electrolyte analysis relieve n/v bleeding pyloroplasty
disease Lack of appetite Abdominal x-rays Surgery – > anterectomy
Malignant tumors Severe constipation CT scan resection/removal

PEPTIC ULCER DISEASE

• Excavation (hollowed-out are)
that forms in the mucosa of the
stomach, in the pylorus, in the
duodenum or in the esophagus
• This erosion may extend as
deeply as the muscle layers or
through the muscle to the
peritoneum
• More likely to occur in
duodenum than stomach

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ILEOSTOMY
Surgery that makes a temporary
or permanent opening called a
stoma. A stoma is a pathway
from the lowest part of the
small intestine, called the
ileum, to the outside of your
abdomen. This helps solid
waste and gas exit the body
without passing through the
colon or rectum.
INDICATIONS
Large intestine blocked or
damaged
Part of large intestine
surgically removed
Ruptured colon causes
abdominal infection
TYPES
Standard – aka Brooke;
most common. The end of
small intestine is pulled
through the right lower part
of the abdomen and secured Risks:
to the outside skin
Continent – does not require
to wear a collection bag.
Surgeon creates a pocket and
valve in the end of the small
intestine
Ileo-anal reservoir – aka J-
pouch or pelvic pouch.
Surgeon creates a pouch
from SI and rectum.
Connects pouch to anus to
store waste.
Ileostomy Care
Emptying your ileostomy bag
- Best to empty bag when less than half full
- 2 main types:
1. One-piece pouches attach directly to skin barrier
2. Two-piece pouches inside skin barrier and pouch that can detach from body
Draining waste with a catheter
- Surgeon may leave a tube in pouch to drain waste (indwelling catheter)
- May last 3-4 weeks
Ileostomy concerns
High stool output
- Larger than normal stool is common after surgery and will decrease after few days
- If unable to decrease in amount, you may be losing too many fluid
- Losing too much may lead to imbalance in electrolyte levels
Managing gas
WHAT TO EXPECT - Reduce gas by avoiding food such as beans, onions, milk, alcohol; chewing gum or
drinking with straw
• General anesthesia
Whole pills or capsules in stool
• Surgical incision: - Contact physician if this happens, medication was not absorbed and pt may be
large cut in abdomen prescribed liquid or gel meds instead
or laparoscopic Stoma obstruction
- Avoid solid foods which may lead to blockage
- Bleeding - Try massaging abdomen around stoma or drawing knees to chest and rocking side
- Damage to nearby to side
organs - If ineffective, contact healthcare team
- Infection
- Unable to absorb
enough nutrients
from food
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ACUTE DIVERTICULITIS Risk factors:

Aging
Obesity
Smoking
Lack of exercise
Diet high in animal
fat, low in fiber
Certain meds
(steroids, opioids,
NSAIDs)

DIAGNOSIS TREATMENT
• Diverticula – small, bulging pouches that can form in the lining of your digestive PE: Abdominal tenderness Uncomplicated
system Blood and urine tests - Antibiotics
• Diverticulosis – presence of diverticula Liver enzyme test - Liquid diet for few days
Stool test Complicated
• Diverticulitis – when one or more of the pouches become inflames and/or infected
CT scan - Intravenous antibiotics
SYMPTOMS CAUSES COMPLICATIONS PREVENTION - Insertion of tube to drain abdominal abscess
Pain (lower-left) Diverticula usually Abscess Exercise regularly Surgery
Nausea/vomiting develop when Blockage in bowel (at least 30min) - Primary bowel resection – surgeon removes
Fever naturally weak Abnormal Eat more fiber diseased segments of intestine and reconnects healthy
Abdominal places in your colon passageway of bowel Drink plenty of segments
tenderness give way under peritonitis fluids - Bowel resection with colostomy – opening a stoma
Constipation pressure. This Avoid smoking in abdominal wall
causes marble-sized
pouches to protrude
through the colon
wall.
Diverticulitis occurs
when diverticula
tear, resulting in
inflammation, and in
some cases,
infection.

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IV COMPUTATIONS 3) 2000 mL to infuse in 12 hrs using 10gtts/mL. Calculate for the flow rate.

𝑻𝒐𝒕𝒂𝒍 𝑽𝒐𝒍𝒖𝒎𝒆 (𝒎𝑳)

➢ mL / hour = 𝑵𝒖𝒎𝒃𝒆𝒓 𝒐𝒇 𝒉𝒐𝒖𝒓𝒔 (𝒉𝒓)
𝑻𝒐𝒕𝒂𝒍 𝑽𝒐𝒍𝒖𝒎𝒆 (𝒎𝑳)
➢ Number of hours = 𝒎𝑳/𝒉𝒓

𝒎𝑳 𝒈𝒕𝒕𝒔
➢ IV Flow rate or Drops / minute = 𝒙 4) D5IMB 500mL was hooked at 10:30 AM regulated at 10 gtts/min. What time will the
𝒎𝒊𝒏𝒔 𝒎𝑳 IV dose be consumed? (Drop factor = 15gtts/mL)
Practice:
1) BSW 1000 mL IV is added to be infused at pump rate 1000ml/hr. How many hours
will it take to infuse?

5) A volume of 1250mL is to infuse in 12hrs using 15 gtts/mL set. Calculate for the
gtts/min.

2) DSLR 1L at 600mL level left is to infuse 3 hours. Calculate how many ml/hr should
the IVF be infused?

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