Pathopysiology

Sign and symptoms

Nurse assessment
Nursing intervention

Definition/description
What is it?
Reason/rationale (patho)
Why it happen?
Why it matter?
Underlying reason or cause
Connection (s&s; assessment, intervention)
How does it connect?

Neurological Disorders
Cerebrovascular Accident (Stroke)
Head Injury
Spinal Cord Injury (SCI)
Seizures
Brain Tumors
Meningitis
Parkinson’s Disease
Substance Abuse
Amyotrophic Lateral Sclerosis (ALS or Lou Gehrig’s Disease)
Encephalitis

Cardiac Disorders
Hypertension
 is susteained elevation of systemic arterial BP
 Sys => 140 or Dia => 90. Home: 135/85
 Diabetes: < 130/80
 stage 1 hypertension (SBP 140–159 or DBP 90–99 mm Hg), stage 2 hypertension (SBP
=160 or DBP =100 mm Hg)
 Isolated systolic HTN: sys<140, dia<90: increase pulse pressure, loss of elasticity of the
arteries => widening of the pulse pressure. Risk factor for cardiovascular disease and
end-organ damage. Eg: cardiomegaly, MI, stroke
Etiology:
Primary: incr. SNS activity, overproduction of sodium retaining hormones and casoconstrictor,
incr. Na+ intake, high BMI, DM, alcohol
Secondary: hypoK, ab. Bruit, tachycardia, sweating, tremor, family hx renal disease
(1) coarctation or congenital narrowing of the aorta;
(2) renal disease such as renal artery stenosis and parenchymal disease
(3) endocrine disorders such as pheochromocytoma, Cushing’s syndrome, and
hyperaldosteronism
(4) neurological disorders such as brain tumours, quadriplegia, and head injury;
(5) sleep apnea;
 (6) medications such as sympathetic stimulants (including cocaine), monoamine oxidase
inhibitors taken with tyramine-containing foods, estrogen replacement therapy, oral
contraceptive pills, and nonsteroidal (NSAIDs);
(7) pregnancy-induced hypertension

Congestive Heart Failure

Angina/Myocardial Infarction
Coronary Artery Disease
Valvular Heart Disease
Dysrhythmias and Conduction Problems
Inflammatory Cardiac Disorders

Peripheral Vascular Disorders

Arterial Hypertension
Arterial Occlusive Disease
Atherosclerosis
Abdominal Aortic Aneurysm
Deep Vein Thrombosis
Peripheral Venous Disease

Hematological Disorders
Leukemia
Lymphoma
Anemia
Bleeding Disorders
Blood Transfusions
Sickle Cell Anemia

Respiratory Disorders
Upper Respiratory Infection (URI)
Lower Respiratory Infection
Chronic Obstructive Pulmonary Disease (COPD)
Reactive Airway Disease (Asthma)
Lung Cancer
Cancer of the Larynx
Pulmonary Embolus
Chest Trauma
Acute Respiratory Distress Syndrome

Gastrointestinal Disorders
Gastroesophageal Reflux (GERD)

Inflammatory Bowel Disease

Ulcerative Colitis (UC) and Crohn’s disease

 Idiopathic inflammation and ulceration

 Factors: environment, genetic, immune system (alteration)
 Teenage to early adulthood, 50-70

Ulcerative Colitis
Patho:

 15-25; 50-70 age

 Inflamation and ulceration of the rectum and the colon (mucosa and submucosa) with
alternate periods of exacerbation and remissions
 Begin in rectum and spread along the colon
  Hyperemic and edematous in affected area -> abscesses break through the crypts in the
sub-mucosa, leaving ulceration
 Destroy the mocosal epithelium -> bleeding and diarrhea
 Loss of fluid and electrolytes -> decrease of mucosal surface area for absorption, protein
loss throught the stool
 Inflamed mucosa can form pseudopolyps-tonguelike projection into the bowel lumen.
Granulation tissue dep. -> thickened, shortening the colon
 Tumour necrosis factor-alpha (TNF-a): promoting inflammatory response
 Symptoms: bloody diarrhea (servere: mucus) and abdominal pain; systemic symptoms
(fever, malaise, anorexia)
Complication:

 peritonitis
 Hemorrhage: inflamed, ulcerated mucosa ->med; emerg. Surg.
 Toxic megacolon: extensive dilation and paralysis of th colon, bleeding and fulminant
colitis. Transvercolon
 Perforation: associated with toxic megacolon, left side (most case)
 Risk of colorectal cancer: regularly screened with colonoscopy
 Anemia, leukocytosis, thrombocytosis
 Skin lesion: erythema nodosum and pyoderma gangrenosum
 Musculo-skeletal: Peripheral arthritis (colitic), Ankylosing spondylitis, Sacroiliitis,
Osteoporosis, Finger clubbing
Diagnosis

 Blood studies: CBC (iron deficiency), serum electrolyte (decrease Na, K, Cl, Bicar, Mg -
>diarrhea), serum protein, elevate WBC (toxic megacolon or perforation), elevate
erythrocyte sedimentation rate/C-reactive protein (inflammation)
 Hypoalbuminemia (servere): protein loss
 Stool: bllod, pus, mucus, cultures (rule out infectious)
 Imaging studies: barium enema, small bowel series, transabdominal untrasound, CT,
MRI, sigmoidoscope and colonoscope (mucosa of lower GI tract), colonoscope (large
intestine), biopsy (definitive dianosis)
 **Risk of perforation when severely inflamed: no scopes
Care
(1) rest the bowel
(2) control the inflammation
(3) manage fluids and nutrition
(4) manage patient stress
(5) provide education about the disease and treatment
(6) provide symptomatic relief
  sulphasalazine + 5-ASA: mild to moderate
 corticosteroid (left-side UC and proctitis) + IV fuild and electrolytes, rectal foam,
enema (spread beyond the rectum)
 Immuno-suppressive (cycloporin): renal dysfunction, HTN, muscle cramps
 Immuno-modulators: inhibit the cytokine tumour necrosis TNF-a
 Antimicrobial broad spectrum while using immuno suppressive
 Antidiarrheal agent
Surgical: total proctocolectomy with permanent iileostomy, total proctocolectomy with iileoanal
reservoir
Nutrion: NPO (accute), high calorie, high protein, low residue diet with vitamin and iron
supplement
Activity: rest is important, resteicted activity and bedrest may be order if servere exacerbation
occurs
Meticulous perianal skin care using plain water or a skin cleanser (no harsh soap) is necessary
to treat and prevent skin breakdown. Use of skin barrier creams may help to protect perianal
skin.

Pharmacological treatment for IBD aims to decrease the inflammation to induce and then maintain a
remission. Five major classes of medications used to treat IBD are antimicrobials, corticosteroids,
aminosalicylates, biological and targeted therapy, and immunosuppressants. Medications are chosen
based on the location and severity of inflammation. Depending on the severity of the disease, clients
are treated with either a "step-up" or "step-down" approach. The step-up approach uses less toxic
therapies (e.g., aminosalicylates and antimicrobials) first, and more toxic medications (e.g., biological
and targeted therapy) are started when initial therapies do not work. The step-down approach uses
biological and targeted therapy first.

Crohn’s disease

Peptic Ulcer Disease

Colorectal Disease
Diverticulosis/Diverticulitis
Gallbladder Disorders
Liver Failure
Hepatitis
Gastroenteritis
Abdominal Surgery
Eating Disorders
Constipation
Diarrhea:
Patho: can be decrease fluid absorption, increase fluid secreasion, mobility disturbances, or
combination of these.

 Decrease fluid absorption: oral intake absorbable solutes (laxatives), maldigestion and
malabsorption, mucosal damage (celiac disease, inflammatory bowel disease, radiation
injury, ischemic bowel), pancreatic insufficiency (cystic fibrosis), intestinal enzyme
deficiencies (lactase), bile salt deficiency, decrease surfacearea (intestinal resection,
short gut syndrome)
 Increase fluid secreasion: infectious: bactireal endotoxins (cholera, E coli, Shigella,
Salmonella, Staphylococcus, C. diff), rotavirus (viral), and Giardia lamblia (parasite).
Drugs (laxatives, antibiotics, suspension, elixirs contain sorbitol. Food (candy, gum).
Hormonal (pancrease, thyroid, gastrin secreation). Tumor (vilous adenoma)
 Motility Disturbances: irritable bowel syndrome (increase visceral sensitivity and
transit), diabetic enteropathy (increase transit 2nd to autonomic neuropathy), gastrectomy
(increase transit as result of duming syndrome)
OA is most suffer life-threatening diarrhea since stomach acid decrease (kill pathogen)
Nursing assessment:
Health information:

 Past health hx: recent travel, infections, stress, diverticulitis or malabsorption, metabolic
disorder, inflammatory bowel disease, irritable bowel syndrome, chronic laxative abuse
 Medication: laxatives, Mg containing antacids, sorbitol containing suspension or elixirs,
antibiotics, methyldopa digitalis, colchicine, OTC antidiaheal medication
 Surgery or other treatments: stomach or bowel surgurgy, radiation
Symtoms: malaise, food intolerance (nausea, comiting), weight loss, thirst, increase stool
frequency, color and character of stool, steatorrhea (fat in stool), decrease unrinary output,
abdominal bloating, ab. Tenderness, pain and creamping, tenesmus (need to past stool put
bowel empty)
General: lethargy, sunken eyeballs, fever, malnutrition
Integumentary: pallor, dry mucous membranes, poor skin turgor, perianal irritation
GI: frequent soft and liquid stool alterate with constipation, altered stool color, ab. Distension,
hyperactive bowel sounds, presence of pus, blood, mucus, fat in stool, fecal inpaction
UI: decrease output, concentrated urine
Possible finding: abnormal electrolyte, anemia, leukocutosis, eosinophilia, hypoalbuminemia;
positive stool cultures; presence of ova, parasites, leukocytes, blood, or fat in stool; abnormal
sigmoidoscopic or colonoscopic findings; abnormal lower GI series (barium enema study)
Nursing intervention:
Goal:
1. not transmit the infectious microbe,
 PPE, precaution and handwashing
  Teach pt the principal of hygiene, infection control practice and precautions, potential
dangers of an illness that is infectious to themselves and others
 Proper handling, cooking, and storage food
 C. diff: single room with toilet
 Commode; signage contact precaution
2. cease diarrhea and resume normal bowel pattern,
 Demulcents: soothes coats, and protect mucous membranes
 Anticholinergic: inhibit GI motility
 Antisecretory: decrease intestinal secretion
 Opioid: decrease CNS stimulation of GI tract motility and secretion
 Probiotics: alter balance of intestinal flora
3. normal fluid/electrolyte/acid-base balance,
4. normal nutrient intake,
5. no perianal skin breakdown

Acute Abdominal Pain

Endocrine Disorders
Diabetes Mellitus
Pancreatitis
Cancer of the Pancreas
Adrenal Disorders
Pituitary Disorders
Thyroid Disorders
Genitourinary Disorders
Acute Renal Failure (ARF)
Chronic Kidney Disease (CKD)
Fluid and Electrolyte Disorders
Urinary Tract Infection (UTI)
Benign Prostatic Hypertrophy
Renal Calculi
Cancer of the Bladder

Reproductive Disorders
Breast Disorders
Pelvic Floor Relaxation Disorders
Uterine Disorders
Ovarian Disorders
Prostate
Testicular Disorders
Sexually Transmitted Diseases

Musculoskeletal Disorders
Degenerative/Herniated Disk Disease
Osteoarthritis
Osteoporosis
Amputation
Fractures
Joint Replacements

Integumentary Disorders
Burns
Pressure Ulcers
Skin Cancer
Bacterial Skin Infection
Viral Skin Infection
Fungal/Parasitic Skin Infection

Immune System Disorders

Multiple Sclerosis
Guillain-Barré Syndrome
Myasthenia Gravis
Systemic Lupus Erythematosus
Acquired Immunodeficiency Syndrome
Allergies and Allergic Reactions
Rheumatoid Arthritis (RA)
Sensory Deficits
Eye Disorders
Ear Disorders

Emergency Nursing
Shock
Bioterrorism
Codes
Disasters/Triage
Poisoning
Violence, Physical Abuse, and Neglect

Perioperative Care
Preoperative
Intraoperative
Postoperative
Acute Pain

End-of-Life Issues
Advance Directives
Death and Dying
Chronic Pain
Ethical/Legal Issues
Organ/Tissue Donation

Front oF card
Classification of Drug: Route:
Action of Drug:
Uses:
Nursing Implications (When would I question giving the medication?)
How will I monitor to see if it is working?

Back oF card
Side Effects:
common
life threatening
Teaching Needs:
Drug Names: