Drte

Dchronrc ob6hructfue pumonar dfbea6e 8

An6R
DeFfne
HOumbvel ld term (6ed to clescribe chysontc fung
alocoseb n cohfch air floco fo ob6truced bej emphy5ena
chenfcbrandftfa, refracter cfreverejble)aGthmia
e 6evere brsonchÝecte6f6

COPD.
Afr flowobstticHon
Chronfc Emphq6ema
o d Asthma
e
h
baonchtHfo6 Impaired gas exchange Tn flam effr

ta
EXces6tUe accumulctfom-6 from de6trdcHo Constiched
-wapobotric

n r
0Fmicu6 8 Gecretons oFthe coals OF
oUerdfetended aieFlo

a
alveblP.
ecouGes
i cfoarete 6mokin?
Occopoton-Exoéurekri
Ambient air polcdfon
pasatce GmokinpP
)family hietar
AGthma.
nfectton
8 ong grcDth
Bronchfo
Gene fc abnasmalPHes-dlepPiepcH OF alpha- antf-trtpsfn
Enzgjme
 Pagp No
Da

pathophy6folog8
OFthe Copp.)degrcren
Doe +o cause6 e rH6kfactors antitrypsln
-lantf OF elastHh
Breakdocon
ContinciaJ bronchia) 1
Ltrtatfon e nfiommatfom in tf6sue
connective

Mucue hypersecretfon hcredsed recoTlos

cFifar duofunctfog nFldmmator9] lo66 oP elqsHC
medfceter6 brenchfa coal.

d
cytokihases

o of
EdemaelSmooth DestechHam
muBcle
CoOfractiom brandhfal
ta
fPbrost6 el thickenin2
tDau. h aveblar
and capilbfes
cOcll6

r
Of

n
Enfarged ARC mpatre
Narrouoing orthe
Small dfrwY
ri a focappn
0n expy-
gos
aPFfUsfos

k
8pace
(Afrcocy ObStUcHfon) taHon

ch ronfc boanchi#1s Dejnomtc bypertnPla}bn)

Emphy6ema.
&ymptemo
choonfc coughin
o
1 Oheexinq)
harHne66 breath.Cduapne) ) 0eizRt Joes
-Frequent respf(0tar nEecHrons Tachypneg
9psocucHon o purdent) Re6picutorp
9chrso0Yc coughtng. T05uFFCencu)
acute chronfe respiratep fatlure prolomed
a)fhcreg6ed Dok of breathino ex pfraH
)Decreaed erercfse teleace. 18-Rdaue
Tghrtne66 Chthechest
19 ptn9 peffpheal edema
 Medfèal Mnag ement 8

smo king cesscton u6tng nfcotine replocement

theraptes tottne
f tngredfent
the n po
carette
pafmorilp reponstble for the fction
cdck
.NTcotfne lacr
exf6 d-chewing gum.tcoffne replacementitherapp
pathes are 6old under-fo locofng teode nomes.2 nfcodefm,
ncorool and Habiol
Theuse af antidere66ant bupro pon 16 ePFecie
a nonnfcofime ord-to srmoing ce66ddron. Buprop/o9
6 people coho have not
may dde be eFfectfve-fe s 4ho6e
cDfh nicotne replacement

d
been able -to qeftsmokin

o
therapre6

Antf-TO Flammatory
ta ho
Agenta

r
ronehodflator6 8
These are mo6t eFfecHTUe 'cdhen nhaled,

ri a
Seueral del fvercp methods n fo90haled medrcoutdn6,

k
Tnclud fng melereal-do6e Pohalers,
actiafed tnhalers dep
edbcurzer6
reathr
pobdeb Tnhalefs-el

kTheophfne f6 a lronchod flator on-bnt-TnFlamma

Hor agent

Corifco derofd6 are otlen: U6ed fo feat îhPlamed ataas

but fhelr long ferm benett 16 not deor 6terofdo haue
hot been 6houn 40 6oo tung decme 7n copb.

oral CovHcooterode re u6eel when

hedose requîrement
htgher than can be delfwered b tnhales ar cohen the
pafent conno ue an nhaler
Mucolytfc6
spufUm2
agens not onl reduce
Mucolg-ffc
bat al6o frmpiode 4pukR) clearance
LugTfenesîn el potosafcim fodfde are deken.
orall
NaCelylojetene ts commonly fakeh ttrou
a eubl Trer

An Hbbtfc6
o
n he pople a?h copp, chonfc TofeatHo)
ofan4BTo4f
fhe locderatrwa#6 5ommonhegoa

d
therap t6 netfo elimtnate agantsm6 buto
reat dute exdcerbaffon6
ta h o
Fmst me treattnent chofc es nclude qmovcIT0-

n r
detmetho pot 3ufemethoxazole ceFaclo1

ri a
second lînetreatment chofces tclude art+hromich,

k
ckrtomgdn .e-Auoroquinoláneg

Imm anTzatfon68
pateDt6 coh copD Shouud dtscuG6 Huenka
pneurmoccoaj Ymmuntkatfbn eoth ther phsTcjian6.

Treatment of Alota-4 A ghtfirpetngdetf/enep2

Emphyoema condevekop eta verp youn
age Tn come puterto cofth@were alphaartep6in
dejrcrenep(AAT)

Non-pharmacdogc Meceures

Nebulzatfon 8.fnholea bronchodflatarG are oflen

ej6edto routche dfrect bronchoclfketor6 offento
the afrcixy thereby mprouinp airFoo.
Oxugen therapPa
T
Ympiooe6 the qial PoF /Pte e surufval

d
Remootn Bronchfal &ecretfonG

ta ho
clfent may be treaded coPth nebcured
buonchodflcdor gl po6?4fue preb6ure afrfloco ar poolHTue

r
end -expiradop pre66ure ( DEEP) ceufce #oTncreaeo
the cahbe of afrcoay6
Exercfce:
ri a n
k
hcourcige dfaphoaqmaffc bseodhfng e pir6ed p
boeothin9 8 ofocoUragerapid,6hallo ci paofc
oreatitOC
*8urgfcal Mandgement
60me orme of Gevere emphycema oho
aren helped 6uprffontH by medtcatfom6 alorez
Balleckome7
(Ohen -theodls oF-he afr Sac6 are eefoea
farge atr 6pacee called bullae ferm,
Thesedir spaces can become&olagetha
dhe Toterfere cofHh breathing

RemoUe one ar moe derp lorge buwlae fro

dhefungs:
BulectomD moD make the lung e DorK6

ergerh o d
betey Eo more oxjgen gets rto the blood,

a)Luno Uolume Weductfon

ar t
surgeon remodes 6malco edqes oF domaged

n
lung fo6Ue

ri a
Thfacrectes exbe6poce fo chest cout9
thatthe remaning lung tfo6ue el he dfaphaaqm
o

ompl
Ook mre efffefentl
Pcatfon6-
k
DRespfrator tnGU FFPcfenc efaiture
Poeunomfa
oUercohelm fop re6piradorap fnFecHon
49 Atelectosts
9 pnau mathorar
6 shaHG oGthmatfc6
Hypoxemfo
Pespfratora acdo6
9 CorcPac Feilare
l)Co'pumonae.
Dgeh yttmfaG
B)Skeletal mu6cde depregsiom
 Corte

Nurs1n Management

A66e66ment 1-

DA66e66 nurstoPhtotorp famtIp Katerp e sbtafng

otugh Smáking htetorp of dhe patfeo
note qualMD rate pettern.cdepth
A66es6 re6p?redfone 2
El
breafh Yng effert
A65es6 fung sound6, notf0P area6 ofdecredcea
UenHflatfbn
9n6peck6 the chest Ho determfne breathin9 rake e
patlem al6cuHate6 Ahechest fo deleminet dept

o d
OF PO6pfratfon e +o IPeten brathsou nd6.
fechejcoodia

h
Gign6e 6ymptams ofhypoxemd 3

ta
obe66 Fer
6nes6, draphorosfs. hoadache, lethargyP conto
tie6 ABG6 note change6 ncreoGing Paco B 7HdOa
Moner e

n r
are.sigh6.of reoptretorp feallure

a
oxnmehep ei manfter exygen 6cturatfen

ri
906e pulGe
puw6eoximehe t6 a 05eful tool to deleck

k
paube rafe
changesîm oxggenatH8n
8)A6SEe6 patfen e eFfectfuelyto clear
ab?I?tep +o cough
8ecreton6 Mote qIanttep color e/ con6t6encp ag
oputum.
Mentes fer changes To oxfentatfon,încreaGed restfesG
neBs anwtebp e aît hunger. Pesftecsne66 on
16 eartyp2
ignoF hypoka.
co
19Ak fhe dfent 6 dafiy clephabts ho long
a nap oFlenuoakep during sleep auGed bqYpolo
Gleep

Hchng unatfen, diygfuultyelother

 Nursinq) diagno6?s?-

)neFfectfe Afraoy clearame retated fo

,
bronchoconstcHöN rcrea6ed mucu6 podactf
06 eufdenced bp d'pfculfp 9n breothTng1.
dbnamay breath 80unde

a)Impaired Go6 Dxchange related-+o deoreased

dentrictHen o6 euTdenced bcP dc/6pned .ConFuoTone
eon changes în otlal sfgn6

hePPectfoe boeathin pattem-t shartne66 oF

o d
brreath OG CUPdenced bP deioprnea, restfessnes6.

mboalanced nut1fon: les6 than

ta h bod requtremenHs
related-to 9ncrea6ed coat
n r OF breathih as eudenced

a
cwefoht fo66 lo660F muBdentges PoórTmU6ole
be
one
AcHO7tP k ri
HHolerance rtt fataue tnadegciate
dy6pn
OXggenctfon e) eg06 eufcleneced bp
ichgcordta, FeEfes6neg6 8 decreooed egerctoe
toleranae

ritaCute breathng dPAfcltfes e) fear

Anxek
60PFocatfon
OF
knoc0ledge regarding condPHon ytreatmet
Detfent
Rel Fare el diochage need6 redcuted-to lack oF mfestnatfen
 Cate

R)Myoordfal Tn Fracton 8
OePinHfon of ML
The proce66 by oh fth mqocordfad tfasuesore
pemanentt desheyed îm theregton of the heart ar
are
that deprfved otanadequate suppl o blood
because of a reduced coronarp bload flow3 sub6aqde
necrost6 ordeath fo +ne mcjocorclfau +f66ue6 Occro

Degree of damoqe:
Occuto the heart mugcle
Xone of necro6t6:
one eoFoFDnfury:
on fchemfa:
o d
ta h
r
RYGk acter6/ cau6es: /Predsposinp foctora 3
9HTgh blood ipfd leoel Non modP#fble RPsk
2 noktng
Hperfensfèn
ri a nfacters-
)fFarmtlyhr6or o

k
) rabetu6 meltu6. Coronarp nrierý disease
physfcal nacfifurr 2 Agebefng olde
ObestH Gender beng tMale
teso type h personal Hp 4) 8ng member oF RAeS
8lack OF echegen î'n coomen
Coenary atherasclerotfchearfdioeace
1 Corond thrombosb oe embol?omn.
1Decreaged blood flo@ Oh 6hock 8)/0r hemorrhagpe

clPnfcal tManffestatfoni
chest paln
Anxrouse restes66
Dfaphorest6. Coolclom mp most
Heark rakerecpraarp
8 skin e feefal pallor
mayoe be faster
Decfes 6ed cardfoc conacHIPHO Cardfacoutpu
 shotros6 of breoth
chockfng 6enGatfon
proFuGe sc0eatingp
NcwGea8I Uomttin
Epiqashfc orabdominal oTsbess
DYsorfenteffon con Rusion fefnHny

Medlcal Management
The goa of medrcal Marnagement f63
To minimze mocardta damage
regerue myoordfal fincHon
peent comp/fcatfon6
D Oxgen therobcP
o d
h
O2 IPhes baP ho6al Cannuwa,

r ta
TmprooeG oxygenatfon to Psch emfc heor
muGde oTYmprodeG myocardad oxgensupply

a)Thrombolgtetherape
ri a n
Orokina6e SheptokfnaGe 2/tfs6ue
plo6minogen
k actroator6 ore u6ed to drssolue
Jot6 e alloco blocd flon te the myOcordum
Odminiotered orTnte coonar)
Ahalgestc thergpp?
Morphfne ro 0sed to relfee pafn tHo

Pmprooe cardfcc hanmoodynamf bpreduin? peload

e qFter foad +o proufdeanxtek relfer
MepefdTne Po uGePUFer pafn mCunogem en
90 those patfenti6 allergfefo movphîne
4 Va6odflator therapy
roglg cerih (Sublrngua TU Pa6te)
temporoHIY open3 arterfals blood Deß6el6, poomotes
Veno uG and arferfal relOX aon preen Coronaly)
 orfery Spasm e Tmproutn blood floDto E) Ferm bea

AngotenGin conuertin Enxyme TnhTETHoT

ACE Tonuerts angfo4en6fn I Angrotensfn I
Causes the blood vessel6 to canshfct e the kfdney
to retaun Godtum e
ufd
conuer6fon of dngfotensjfn
ACE mhfB7toT6 poeUen fhe
from o I 8 emote oa6oolaufon drurest6 b
aFerfodid preload ) decreaged uorkload oF heart
apfopr? e enalapf

6Beda Adrenergtc Blocking agent62

o d
-blockers Impo0e6 Oxygen
ta h
Gdppl e
elemond bpcegeastng2 hesrt-tate-blese- pre664re- eLeHetn
CorehettesselsEdeerea6e
r
6ympahekc

n
6HmulaHfonfo

a
desselG OF the hear
heart8 ornoke blood Flod Inte smaul
egpropenolol.

CalcPum
k ri
chonnel blockers6
fmprouesme balancebeleueenoxggen
g
6UPplo demand bcdecreastn hegd- rateblood pes sure
el dflathg coonar debGele ea TFedrpine

Heo cLglaothergpy
An
Heparto ts d6cfu aG on celtunck to to mbolyffe
theap hepartn 16gtuenntbauenou6lp orby an tnfeton
CIncler sKin alera heart attack.

PFesyle chorges
2ieytnpphqsicalp ccfUe eafno, healthy food6,
mohten healh otgh e teditng managtn
8hess
 Burgfcal Managementt

D CoronarD arterjP Bypa66 6U@ge

percufeneods tendlumfna coronap Angroplao
Coronary Gent
Ahreckom
5) Tronsmyoardrcal fcoser Reua6 culamRaton

Acomplfc cdfon6 of mgocordfal mAracton8

DeI6rhythmfas pwmonary edema
Heart foure Grdogenfe.shock
poGfOFracHoncngtna
poGfO VentfculaT upture

d
însufflerency

o
thomboph lebiH?s Mhal valve
9
h
perfrordPG Aneurysm
6yndrome:
8Dres6/eri6
perfdrdid
(combtnatfon
epu6fon e)
r
of
ta
pericardPHP6
plewral erfusfonoccu
cohfch can

n
Severa coeeko to months followng on t)

ri
Nursino Monagement a
et k , nurse6hocdd
An aftack oF acute Mf the
fhe health hi6tory of the patrept by oskh26cme
que6tHong about fhe onGe e) 6everfy ofchest diGcomsont
cofth other 066ocfased sympfom6.1 Cufren
alon?
med fen es he patteN+ Y6 HaktnP al alergre
Ourfno 6amefime the ftme nurse ob6erve6
the genera appedrance of fhe pafent 8/ a66e66 the
heart tate ithgth E Bloocl pres6ure Once the patfent
76 6table From the deteiled hfstor con be obtained
GeneraaGAc66ment
66fem fc a66C66met ncludes a
coréPu
e
hfstorpD
regardn pafenAG Chebt Pan- ratlre ntenshy
ncet e dradfon lo cadf 8) ratfa}fon precipadeton
o
el aggrev afn factors.
 otheg 6ymptemG experfenee
66e6s th e pofent For
Clooceed coPth poufn
npct 1U Ines Forpodencyp e msertfon SHeeFr8fans
of fnflammotfon. Blood pre66ue
9A05es6 heart rote, respîratorp rate 1B8
e obtalh 6erta)12-tead Ecg
S8AG6CAS Paferte med fcal hfeton e famil btoteo
CAD
fnfortmcutfon regardinp carde rok
A66e66 ecuther
factero cdekeotapplfcatonGe
2 perFarm phyofcal cye6pSSmen to

d
anp diange fn patfent sedeiG emotfoncd SteterG.

o
A66e66 COfnPue behaw foural el

h
A66e66 patent 16 e famfly 6 le0al of anxTe

A6sess pattfent 6 e]-amftyG

r ta
knooledge ofePsa 6e

r a n
Acute po
edemand
i
keet eto
rto tMt
a6
el mgocordfal
eUTdenced b)
arme
oxygen
Severecheot
&upp
pan 8

Tadfatonof pam eck el

Cordfopulmonap per fpheal +fesue
hePFecHue coronar? bloco loD
perfusion rejcuted to redceo
from coTonar rrombU6 eautheroscel ero6t6 ts
poessure DqSpnco
mantesed bp deerease tn 8lood
berrpheral edema 8l oligusta

felated fo deerea Cerdra 6

Deorea ced cardficouLpat
to ordtac rupture
contsacHTA9 due
 Dats

chronfe efeney bPsea6e Dfeeg6e

8)Chaonft renal Peflure End stage Renal

A progre6stoe Trreuerstble deterforatfon

n
n Renal fonctfon ohfch the boclfes abi
Afd e elechelpte
4omoitein metabolfe 8)
vrome
balance fafl6 rescuLtin tn Uremra
Axotemid.
Pnfal e aborete
CHologDe RiSk fachors:- sndrome
Decréasad Renal Blood flocð retlecHnpdyean
) systemfe drseg6e6
o d -cHfen ofall &ogon

h
DM 6964emSuchas
HTY
SLE
rta inheate aguke
Orchoonfe RF

n
polgath afHP6

AmyloTdo66
ri a
stckle cell dfseaGe

k
G/omeruoneph1R?6
pyelon epheftto
Aeute renal fature
Infectfon6
4) tMedfeaton 8 toxîn cc
obetvecHfon of heurnarD
HeredPtarptesfon6
fec-
pofucy6tfckTdneg dfoease
Uaseular dfoea6e
8 Enufronmenfal er ocoupatfonal AgenG
-Cead
Coclmtum
tMercur
cheormfom
 Date

badhophy6folog
Duefo Etfologîtal facdors

Decrea6ed GFR. ( Glomercdar fPitate Rade)

Hyperhoph or remaingnp Nepons

Ihabil4o concerpete orne

further o66 of íopon fundfon

o d
h
066 of ton Excreforp el Excredorip functfon

ieges of CRf
r ta
an
Reduced Renal fažuret-Reberue

ri
BUN Tn hfgh or Marmal
Crent hds
G0-9 k roCIM
fo66 oF Yephmon funcHion

3)RenalfnsufffoncD
+og0 lo6 Of ephron-funcHfn
Lmpafrêd urfne concembaton
ockufo Mfid anemfa creatihînee BO
Renal faflure
8evere dRofemfa
Impaied urtne dflulfon
6evereanemfa
Elecholyfe Imbalanes
Hgper natremfa
huperkalemfa
.Hype pbo6phatemfa
 End stage Penal DfseaGe
fo perrenfage nephrons funchfonfng
Maltfsgstem dysfuncion

*
iieal Man?festetlon
Elecholyte e Acid-base balance
Hemcdologfe syatem
Anemt
Bleedfmg fendencfes
În FectHo
Metabolfc changes

d
osfe product dccumuwatfon
AHered
o
CHO metabolPGm.
.Eleuated hfglyerfdes
GasbetrtesHin al chang es ta h )Resptrator chenges

r
kU6smaul ëe6pfroton
Mucosc Ufceradfon6
stomatHfs
Parott6
ri a n Dy6pnea.
GmgtUPHPG
Oesopha gPifs
GasbfHHS
k pumongrep oeclema
/remfc pleuaR
pleural ePUston
ColPY6 Uremfc [ung
6t bleeding Cough reFlex ?s
Ofarrhoea r depves6eo
Constpatfon.
Metallfc toGte tn Mocth. CardPo uascular
Ahorexia Changes
Nal6eq HT leod6to
Uomftfngp2
CHF
Retin opath?
Ercephalo pth)
Yophopeth
 Pago No

eurologfe changes 3- fatgue

pertpheral europath p Headache
Burnfng feeh Slee.dfsturbane
Gaft changes fethar9?
foot drop ConPusfon
Comq
paraplegta
Ynuoluement
feaures of CS
forgetRUneG6.
Inab7 IPty to concerbete
Ghot attentfon 6pan
2Musculoskeletal Change6:
o d
O6tecmaleca. O6tetf6
ta h fYbre6o dGteo porosts

8Intea umentarychanges
n r
a
yellou grey dPcoloaradfon of 6kn
pale
DreScalp
.Hatr ba-fte
16 k ri
frall6 dre +hin el boftHe

Monagement

Poe6erue he renal finchfon dfaly6t6 8->

Conhef lîne) thedfsed 6e pro ces6
Conbel I7? Bp b dfet conhel, cot conhel e MedfeaHen
Reducn dfetar proten îtake
Alleofcte exba renal Man?festatfane?
2 paurtG:
Topfcal emollfent 8 Iotfon
Ant?hY6famine
u tfdocaYne
 Ciate

mouro logfoal
ManfestatfonG
&afelp meaGure-fto pretech from Tnfur)
AntfconUcusanto
Redatdes.
Hematolog?
Therapp o1h
-
changes
epo etfn etfi A1fa 3trhmeg
q Loeek
Supplemental Ion UPt B12. el folfcacfe
mprode Badpchemtsh)3
a) dfalyst6
o d
6MedeottènG
Dte ta h
n r
a
Dty6f6

ri
perttaneal dfotyet6

k
Hemoraly6t6
6MedfatfonG
DHyperRalemfa:
msuln odmtntehedfon £NU
Sod fum bfcarboncete
Calcfum gfucondte-fl0
8odfum
s
bolyctrepe. SuHonade
Ckayexalate)
HgperfensPon
Rod tum efrutd reghfcHHon
Antthypertenstue dreugs.
Dfuretfe6
Beta ddrenergc
drdgs
Cathanne) blocker6
ACE fhhiEfors
 Paga
Dstio
a 2

Rena Osteody6trophy8
Regulatfon of caldfum, phosphorus elacdosts
Trecdment oF hgpes perarthgrofdiamn.
Calcffero
pardcalcftel CurF-D anadog)
. calcfJm based phoGphate. binders
Calcrum acetate
Calcfum calbonatte
)Andemia:
ERthoopofetfn-LlU 8Ubautan eOU slp
EPOgen CEpoeHn alFa)
o d
h
parental tron
folfc add
- r
ma)
ta
dul

n
Druretfes

dFfamnG r a
GfUen earfyto sAimuuate exureHonofFKOater

-ki aater
SOpplemental Goluble UTiamins

dDiet-
pooteln restfcHfon anr
-0-6-fo 0.95 gm/ kq of fdea bodp cit/da)
- 1-2 de:3gm /k of deal bod) Oldoy snce
the
pt sfarts dralgss
ader restrfctfon.
pt rot recefung dfaly6t6 600 ml +an amocUh
equalto fhepreurou6 day6 urneout put
pt on dfalgsfs- fluPd înteke Psalu6ted $o thct
0e gafn6 are not more than Ito 3 kpbl0 daly6ts.
 pho6phate re6tftfon
ood mgP dap ,
Tce oream
Drarp proddc6 (mfk
cheege ete)

potac6fum re6 icHfon.

te4gm/daporange 1 melOnG
5ou/ce6 Gre tbanand
domatoe6 bcanGegumes ete

o d
h
Godlumrestfctfons
to gm/dap
pfckled foocks
r taanned 6oups saya Sculce

Colcftm.
ri a n
k
ff Serum Ca feue)6 arelow deg tiafe
Calcfum Pntake fa Importent

Magnesf um
MPtd M reshtfon May befmpaSecd
urgfcal Managem ent-

krdne TranGpla natfm

Dfabees MekIs -
A metabalfc d'border co7th foo mafor type6,
yper e tYpeIr
a Condffon th otresuls fro m lock oFthe hormone
roulfnn a personi6 bood, d0conen the body
Cinsu/
bas
problem I6Tng the nsuln t produces fn

fesfotance)
Anadomg of Pan dreas
Pan crea6 6 along' slender ogani mo6tbF
k
cohtch 6 located pOoterfar to the bottom halforthe

d
&fermach

o
The panoreg6e haG an endocrthe in 6 ÞancreaH
CYsleks- clusters of cell6
8ecrele fthe
ta h
fermert
hormo
knouon
ne
e6 the Tslets
glucag0), 7nsln
r
OF langerhane
+o Somcteste+fn pancreatfc plypep+fele Cbp)

TYPeT?
ri a
Cau6e by lackn of Insulfn Producifon

k
101) Of Beda cells(nsulfn adepehden t)
cu or
Typel: aNsed b defden nadequ acp of
Ca0-9insumreccptar6 în cells (ron Pnsufn
asdependent
Pancrea6e felure
+e produce cell6faPl to
Lnsul?n respond fo
ngl fn prolpety
Risk factors
D obestHp
2 Pace
9 HTN
9PhyGtcal aclfAE)
S)amlPal histor)
GaGlafonal dFabeke6.
 infca ManfFestatfons g-

Polycif polydfpoi polyphagra

fextlede, cOeakne66, sudden orsfON changes
tTngihg ornumbneas ?n handg or Feek
e recyrent
dy skm,Sores that heal slocolp
9nfecton.
onset of ftype t dTibetes may be ds6o fated
cOPHh naUGeT 0Om?Hn ep eT 6temach pafnG

increased blood glu cw6cu level.

o d
eOfagno6tic fests
ta h
n r
DfasHing plaoma gluco6etolerance fe6t
2Oral giuce6e
ri
fojera n
ace
te6t (OGTT)

k
Glgcosglated Hemoglo bin ( Hb Ai)
Ormalysts (Glgco6cyfa i ketene bodPes)
One fer protefn / microolbum?nurfy-Dipstftk
method dha
Hgpoglycemfa(s/s)
oc fevel of însulh)
T TachgcErdfa
T- frrtab7lp
R Restle66
Excesstve hunge
Dp horest6
Depres6fon
 ooY DM
Pathophy876| Pago io 14
O6
Enuironmen mFecifon or Emotfonal stvessor

Decrea6ed omount of In6ulh

Decrea6ed|
Decreg6e Prokefn
breakdown8reakdownoF
breakdoCon
HeRat în cell6 glycocen to U6e oF
9lcicose
OF gldco6e
Fatte fermatfon crease
5ome free Hgperglycemia

d
acYdl8 fo lrUer OFned BUN

9Fang
O6mottc
dfurests
ta h o gluco6e

r
1PHHHe

for matfon

n
Exhacellular

a
of kehone dehgdraton

ri
bodfes

k
Hgpokalemfa t
Renal nauFEfcfencip
&hock
&eere c6mohyperosm
-olalk hgpoxio
osUe d

Thracel lular
dehydrafon
COMA

Treatnent maineUn_
Treadrnent goal6 are io Gympjom6 dhd
aG nomal blood glucosea6 po66fble cohout
Ynducn hypoglycemio toclecrea6e the rfsk oF lon
Complfcatfon
murse 6hocud em pha6txe nut?Hon exerc6e
hfch de UPtal for ofcHfmG
Dfabete6 Managemen a3
a Complex disea6e coh multrorg 9D
nUotoement com pleaufons
fer older people mon?lov?hopfor
COniCh can fead fo tlower exbem?ip amputarfonn
ML 16heke crofon lo66 or fephro pathq) shoula
Carrfed oth especfaltp 9nt9pe 2 diabefc pE

nsulm therapp
2 Dfetary Management
physfcal exercfo6e
9)preuenHòn compl?catfon
of
o d
h
Spromotfon of grooth

c
r ta
Emotfona) social developmen

n
Care

ri a
9Imbalanced Nuhffon le66 than bodg requfrement

k
:

relcted fo mbalance ofmou/m food el phy6fcal

acH

obtefn current cot e t hfstorP afthe pafent

pt coPth tpe-f dPaibees fyprall demonshate
wefght loG3

A6S6 for sfgn6 OFhyperglycem restult6 cohen

tnadequafe Yngulm T6 presenEfou6® qtuco6e

Dcu66 he mportance of con6umtng a nutIHPonaU

aclequatedfeh: Irdfordaal ciDYihedype
L
mayneed fo Yncred6e cajonre6 to gan oncecfabetes
Pneul Pn 16
wt
conhalYnp qluc06e level6.
 Airdnge
fer Consut wPth q dPetfatan tor the
dUelopmen of q plan that fs accepteab lete thepatYent

TnGhuch he patfent to report anp feot furyp r

heuma to_preJent further tnjury
Plurd volume derfcft tfto hHperg/ycemtg e Osmotit
dfuresf6:
e
MonfteT record 90take e) output, check daflyiDefght
6kin turgor 8 mucous membrane fer
ec66es6

d
hydratfoy D proufde m-ornatfon aboit novmay
Pufd leuel.

e t h o
ar
Adminfster fU PnsuW?n mon?tor erfecfweness oE
Yngulfnhrough hger Giftk giucose test ewerp 0-6o

a n
min. belpe to calculate the lewel of fnsulm 8n theboel

ri
Monto loborato
ArBGS 8erum
k
Osmoloafp
clata elood &Uqar
3erumej uzfne ketone
eum 6odfum ercm elecholyes e/Otmesped kgrV
POtC 661Um

Regults of laborato) values proofdes fn Formatf

Gou the Hufd el oletholyte balance
Ael minfsfer LU Auld. t maîntaîn flufd 8 elechelyke
balance

Anxfet related to (o66 OPconpelIfear o înabfl?tP

o Mdnage dabeke6

Obfatn through h?Gio dpOD addmf66ton,Hf3fovg

takin allo@6 PdentPcatfon oF PO66tble
Co ottbcu HnD
Racto1G to
onxtet)
 ERe

Pea 66ure the patent that anxtetp

Help the patfent 1eavn to recognfxe e/
Nemal t
dert
Physial 8ymptoms oP anxfetp

o d
ta h
EBplatn all pracedcre qnd Ratfêmale tor
pro cecltre Pn clear ConsPGe elSîmple term6
COT
r
enhance Co Operatfon

n
oufde atfeaGt 20
ri a to 20 mîm ever 4hrs hrle
adake
dnxfeky
to focu6
k -on anxtep
reducHHon-proofcle
oppontunTep For proctfce of Hechnfque6
toredue
6Petftoo?+Y3 OR Acute a bdomen
AlocalTzeo orgeneraxed trflammator)
process OP pefoneum
perftonfHP6 96 an MfecHon cau6ed b an
OPlammatfon of the (Pnfn oP #heabdominal
Caotkp knocon a6 the perffoniÉUm
fs
Theperffoneum a thin membrane tha
Ine he fnsde OFthe a bdomen e surtound6 8
Supports the abdominad orqanG, &uch a6 hestomach
e fver
TYpes of perftonPHfa
o d
Dpafmar pertfton?+f8 -vOhen
ta ha
blood os (qmph mtecHfon

n r
Caul&e6 fhe fnFectfon of perftoneym a6 hell m prfmear
pertton7HP6 an mFeetfon dewelops mthe peftoneum

a&ecendarp
this type
r
ik -a
OF petonTE

perftanTHt3
P6 0ery ae
0hen baterta o0 enkymes rom the
DPlTarep gashetnte6tfna tact get fhte
perfteneumiel cause6pesttonHf6.
Thfs 60 OF perTtonf As
Caueg Rigk feotort 9-
Irta abscess
abdom?naJ Hf'stoP of perftomf4f6
2 pertfoneal dfalyst6 perforatee bome
Ruptured appendx 19 pelurCYnflammattep
PeptfE ulcers drsease
ivertfculPHfG 1) Auld buPld upt
9 hfurY or hauma. abdomfnal caDH
Crrho06P6 OF IUe
 Fage N
Cate

Cmfcal ManPfestaffon

Abdomfnaj pa'n or HendernesG

8loHhp a
or feelPnp or fulines6 in abdome r
)lufd Pn 4he cbdomen
habPIp to pg66 6tobl o g6
paostnP lo66urine -loo ufneoutput
ercessfo e fetfque
sNausea e dom?tin

t
) Lo6s oF appetHe
o d
h
îmbalance
198eathing dfffcultfeb
E)8km urns pade cold &

6)hceased heart rates ebreathfng

rta
12)oco
Shock
blood

a
pressture

ri n
EKpathophystolog
k
Oue fo Etfologtcal facker6.
InFlammatfbn oF the per?fo neal
aof
Abceosof înfectfon duefo Tnflammatfon

Rpread of mfecHfon throughaut

the body
Death ?n 6euee ca6e6.
 Managemen F

Medfcal Mng
The cau6e mustbe PdentPEfed 8 teated
pomptlp Treofment f9pfcallg fmuofues anHbfotfts.
Ma66tU e antfbfot¥c fherap) usu dlp Pndudes
adminetetton of cefoxtm uoth dn aminog!yce
Scle openidllin G el dîndamycin oTth an
aminoglyDsde dependin on the nFectPnp
Organtsm6.06ual [9 eottment la6t fer 1-2 oeks.

Pet-Pets 8FFer
edho from asc?Hes cre treated
DTth diureHc6to utne
fncrea6e
o
oupput
d he

h
eloinatfon of eKces6fue Auwd from the bodP.
Analgesfc6
pain
may- be admîn

r ta
fsteredto reduce

8argtcal Manaqement
ri an
Laparotomy
k
oFten neces6ary fo remoUe in feoted
tRsue teat fheTndertytng cause OFtheînfeeHfon
pteuent #he fnFecfon fromspread ing
a perforadeol peptfc ulcerordHver-Pctu Hrs
may befhe cauGeoF fnPectfon

8)Nsa Management
a)Abdominal pafn 6 Aud oolume detfcPt
AHeaHfon în Hosue pePusfon:
.MonHer el document 4he seuertj con6t6tency
locatton e other chaiackertettt6 af pafn.
 PE te placed on the sfde of co?th knees Hexed
fhTs poGf ffon fensfon on the dbdom fna
ogansemaxinmtxe com.fort

Pccurate recordtnp ofcdl 9ntake el output e

Cenpal oenocG poes Gure a66f6t m cakud cctmg
sA lufd replacemen t
Monfor fhe quantfty el qualPt) of ocUputrOTY
haGogoshft fobe

o d
h
Mantap fnhaUenous fherapp

Monfer the
r ta
patent for syns e SympomsoFghock

Montor the patfent

ri a
'G n
bomel found6 by o66e667ng

k
for flatuG orbocdel mowem ent

Momt+or the patPent'S,mental, aoadfac ef puumon

tMonttor sqns fha eeducles

IndPcates the
perftenf4P 7 Cub6fcdmp mclud e
Tn temperatirre
adecre6e
8 Pulse rate, soPteninott
abdomenreurn Of perPeteultfe cound6,
pa66tn9 6 ffa#US 8 bowl mouemen
 Pogo
a/
heark doesnot punp blood Date

l Conqestue Cardlac flure 8

A
n
condHon
apump 1s tnadeqiate
ohich the hearti61uncdfon
oxygen
a6 tfo delrJer tfthb lood
to the body
A gerfocGG pa0greestue
conctonthat Ts
CI6Ually haonrc Can be 1Fe threatenin@
Chaonfc heart Fallure mosttp
u6e cohen reFering do ght
fs to coomonl
el JeFt fded Heart
felure
Heart Faflufe can bedetned a6 phy6fo logfc
State 9n cohich the heart fs unable to pump enough

o d
blood fo meet fhe mefabolPc need6 oF the bodu

ta h
at rest crdufng exerdbe even ttrough tlrn
pres6ures dre adequate

n r -
a
ee6 OF Congestroe heart faslue

59stoIPc dgsRuncHon:
k ri
Coronary artery df6ea6e
Hyperfenson
Lorgesalt totake m dfet S

MetabolPc dfsorder6
In FecHfon
of heart mu6de (Myocord tfe)
OUcroelght, dfabees ,smoke oroho abu6e
alcohol ar Cocafne
Heart daJuedfeea6e Cespeofall ofhe artt
emfhel vajues)
Drlated Cardfomopath
Abhormal heart rhythm6 CArhythmfa6)
ConducHon depeos
Congen4a) heart defeche (degech6 yoU
Coftb)
rebom
 dasfolfc dgGRuncHfen8
Corongrp heat+dRged 6e
poeufouUG heart aHacks (myocarda YhFraofn
Hyperfoph
Frrost6 oF aduanced cge
Conetfdfue perfardtf6
1h FecHon ofthe heat mu6de (Myoarditio
Hpertensfon
Aptotfc sienos6
Uentfcuuas remocdelfng
collcgen dkea6e Amtofdo6t6

o d
Rak facters
ta h
phgsfcal or emofònal Ghes
Dysorrbythmfg6
n r
hFeoHon
ri a
k
Anemta
Thrord dfrders
9 preqnancp
9 ataftfonal defcfenc
) pcumonatg dfoca6e
Hgpercolemta
1 Dfgbet6
1)
reqcdarheartbea
to) physfcal fnactOPtY)
)Renal îhsureRcfendp
 patho phy6tologP
RenYo-angfofen6in 66tem

Renm t Angfotensfnogen
(Angfofendin T

Angio ten

Pertpheral AldoGteroneseoreHon
Ua6oconshfctfoN

Lhaea6ed
RalF&

o d
c0dter retenHom
OFerlopad
ta h
ncrecsed

r ptuéma (Etema

n
Decred6ed Uolume
a
Cardfalc
Output

Hecrt kri fncreased preload

hcreasederrdfa
fafure orke load.

clfnfco Manfeetatfon8-
SCDollen legs ej perfphera edema oFlouoer extim?+fes
)tuer 8 6pleen enlargement
Right Upper qua drant abdomina pafn
su0ollen or distended neck vem6
flufd bufldupîh the Gtamach CAsHe6)
Nausea DomHfng1 dfKztn eG6 el fainHfncy eptoode6
9loco oefaht gan
frreqular hert rhythm.
 Page Mo
Date

Medoal Management 3

9Dfurefcs;- Bmetanfde (Bumex) e Riro6emlde

CLa6Tx)
Angroten6tn-onver ng enzyme (ACE) Inhtb1t076
ACE Pnhfbffors cEnalaprf16fnopmil
e captopaF YnhfbPL#he dduer6e efecr o5
Angfofengin n (pokent oa6o conEtfedfon GolfumretenHen)

Angfofenstn T receptfor Blocker (ARB

o d
AngiotenGin T receptar blockers (loeafan

h
8 Ualsorian) Similar do ACE mhtbitaS

ta
fn petfen cuho con no-t foleiade
OGed

r
ACE nhfbHers due-te cough ov angfoedema,

poGPHfOe

ri a n
tnotepfc agents (Dfgoxtn (Lanoxin))

k
ncreaGe fhe hearfio chflAly to pump more
eFfectfoelg bp mproon)
he
he conbacHHle ferce of
mu6cle

Belablocker6b
Bela adrengfc bocker6 (carved flol
metopaolol e brbopielol) decrea
Ge myocardfeu
DOTkIoad e proet dgafnt
by blocking norepTnephefne
fetal cy6thqthmfa6
Gumpodhetfc nedod6 SyGlem
effects of dhe

Aldo6-erane Antagohfot6
AldoGkerone
antagonfGt
eperenhone decrea6e sodram (spronolactene
Rumpathette Neruous reHentfon
stem adjaffon el
remodelin e cardfac
cardfIC
 Uasadflato therapp 3
decrea6e fhe cdorklodd of the beart b)
df latfnp pertpheral dessel6.nTheglycerfn,
hudralaxXne P60GOxbiade dinthate mosphfme
Auphate nBhv uA
Surgfal Management:
D coronary angfoplasty
a
procedure uoed fo corden
blocked 0r narouwd coronaty alerfeo
A Shot cute mesh +übe called a sfet 16
thserHedntoan arterp +o alocd blood te fbco more
freelg thaough1
o d
t h
Hso Enoona6 Percutaneou6 transumînad

ar
Coronarg angfoplasteD Cpfca) o percutaneous
Coronorep Tnterucnffon Cpct)W w

2
ri a n
Coronarg artery bypao6 Grgey8

k
a Surgeon remooe6 a blood uesse) from
dnotherpart of bodp. Th6 blood desse) t6
faohfoned 0to a neuwpo-thoay fo coorkaround.
a clogged arter 4ho
)fmplantable ordfac deFrtbPllader (POD):
Smplentedunde kiN 1Pke a pacemaker
cores tunnel toough vfn6to monftar hear
hyethm, IP-Ahe rhyfhm rdeufades dangerausl
theD tfeb toghock F+ baok nomal to
9 Ltia cdotPc ballon pump C NGEP):
a small ballon thot Fnflaed mafdedhe Qafg
tohen the heart mu6des reanco, Beane the heast
 mu6de pumps, the ballon 96 deglaled, halpTng)
blood flow from the heast

9 eP Oeocular a66tot deufce8 (LVAD)

a
A mechanfcal deufceG are PmplaDie
nto fhe abdomen e cheot a/ attached to fhe
DCeekend heat fo help ?t pump
Cocders d ffrGt used heartpump5 to hep
keep heart pensplant Candfdale6al fue whrie
thep coaPled fethe domos hedr

Ua ve repa 8 value replacement8ger

o d
Cordac
ta h
resynch oenfzatfon theap :(CRT

n r
UGo called a6 bfUentafeula pacemaker

ri a
4hfo deufce helps the eentafole% pump moe
eftcrenitp bg 6end 1ng elethal 9mpulGes

Heaf k
hansplanfattan -2

Nustng Management
0
AGce6 ments
pcHept6 health bfsterc).
U6e
obtafn hibtery of 6umptom6
mt6 ofocHfot9,respon6e
do rest and hislorqoF reepon6e do dru therapp
)The hUr6e expiores sleep
drslurbances
&uddeni Toterropted bp Por4fcwarlo
8leeP
6hovtness ef brtath.
The nur6e col6o 06k6 abocd the nomber of PloaDG
needed fes 6leep acHoTHfes of dalP 1tufn2 hat cauge
6hortne66 0P bJeath

) The nurse helps paifenk6 fe rdentp thfng6 thedhe)

haue loGt becallGe off thediagnosfs, thefr emotfona
re6ponse tothot lo66 8 6UCce6sFud copîng 6kT|l6 4hct
thephave used prebfod6l

phusfcal examinodfoD:

heart Sound, astan of heark

d
D AuGcuUtae heart for Sa

ta h o
2A66%66 theGfan6 e 6ympiomG ofthepumonar
ea6yGtemifc flfd ouestodd

n r
Agsess pesphera
ri a
atefa
pause6 notequal2

k
chorackers a86e6s heart Hhythm ,
ete E) BP
AGSe6s pafet Fer presence of pertpheral edema
Assess exbemfes for el Colour el temperecture

btafn hemodunamfc meaGurement6 c6 Tndfcated

enote hong e fro boselme 32

8A6seSS fuguor ven distenston periphera

A5606S the fuogG fo ales ough pinkOged

pcitd o decreaeed boeath G0undo ueto pumongiP
edarm YAA
 SMenfor e) record
ntaka el od pu E o606
CDePqht el aGk about buselPoe t

ote resuts cA Gerum electrol ye levels 8 ctheT

3 rep
abonato fe6hs
dontHy seep battens 8 Gleepcrd6 com mon
Oed bp patfen+

AG6e6Gthe qctUtHfesof da3I 1FUT7 Hhe

qcoHe6 that cayses shortne66 Of bTO.

o d
h
6ee6 abcomen farr hepadomegalp cs GH

Nasing dignosfo 8
r ta
DecreaGed
ri a n
Cardfac outpat 0e TmpaJred

k
ContiatPIPD TDerea6ed preload e oPter
oad altered heart rate rbythm a6
rdeurdenced bp bradg Carda

lurd SodTam
delume exces6 riEardac output
e e ater relentOn aG erdencea bp
oackle8 an boh Jung Held e edemo om
exbemfesgecondon o chrooTc
heastfoture
DnePEectfoe +osde perfusfon
decreg6ed Cordfacoutpat
related to

AckPOPD
tolerance related to Tmbalan ced
Suppl demand a6 eudenced b 02
generaRzed Cdeaknes6.
(mited RoM,
 Pago No 29
Date

Bk complcatfon6-

Dnactable Or reFracdorP heark faflure

be come6 prsgres6Tue)p tefractep therap9

Cordrac dy6thyhmfoG
o d
MyocardTod Falure
e) cardacorrect o
ta h
igoxIn
r
toxTCHp Hrom decreased
m
n
ena FyncHes

a
ePotassfu depletToo
pumonarg
kri
hfraconpreumon Pa eembol

h
ntetina ob6hucHfon
a SitgnrHcant mechanfca impalrment chrCh Ts
Pattal omcompleke blockage of the bocwe thd febclhe
nhrough
#ho fafture of 4he po660ge of Potestfnal condeno
the ttestfne.
Mechanfcal
obehudfon dfUfded nto
a) obohucfon of Small întesHHhe
6 obshucfon of lcrge tnie6+fne
KTpe6of nteettha ob@tucHom

o d
h
6fmple întestfnal obobucHbn
In
r ta
a SimplePntestnal cbobcHfon blockage
preuents nteatfnal condent 5 fom pa6stne

n
elackage occur6 o7ha ut dae cuor om pro 5

ri a
&hengul ated ntestfnal obohufon8
n
k
P blood Gupplp Ho par OT all the
obsbected gechfbn OFfntestfne tG cut oFF Pn addfclfom
toblockage of lumen.
denod6 obshucifon occur6
FirGt follocued bp
Orterfal oCCHlsfon 1e6uHfn cP raprd
In sch erfia oP
the bopel twal.6

) clo6ed-oop intestinal obstUCHOT

Pntestfnal obobucHon both endo o nodo6edtoo
pP

&eotfon ore obôhuc-ed of ende o fan fotestfne

Lsola-fng rom the rematntn
oFthe totestfhe
 CoU6e68

Mechanfal Ob6bucdfon
A a
physfcal block to pr66dge oFtntectfnal
Contente cotthaut olfgtorbfng blood 6upplp oFbocDe
CondftfonG
CondHfons are= HemfatfonAdh esfon6
IntuGsUGceptfon Uolvulu6

Hemfatton Adhestn6 ntu66U <epten oluculu6.

o d
Tumoro 8i neopla6m6
ta h
Teleicopfn Twfsted
feresrgn bodfeb
Inflammado) bODe dfbease
n r OFthetntesihe. I0opoffntes!

r
8hfchres Orstenosf6

xi
a
Acdhesfon6 În the PArteettne
Henfas
Abscesse6
Ahesfa.
k 94
ofverdfcuw fs
)fFuncttonal obshuctôn JneFpectPue înteotfnal perfstalsfs
Amglofdotf6 depo6ion oFamglotd exthacellulap
MuGcar dyehephep
Endocrfne dfooidefs Guch as DM
eurologfc dgorders uch a6 pkneon6 Jrseaoe
pmal covd 9nfurPebs uerieboalfackures
paralyffe eu6: paralyots dHh distenGion
oFPntestfne
 Uascularobebu chfon3
gn
Occurs fn the large mtesttn e cohen
afthetoscelerotft oaroofn 9ntenupts the blood
Uplp ot the bocoe) u

Pathophysrolog9 aF nbestfhal ob6bucfon 3

Due to eHologfcal focier6-)

Mechantcal func bnal wagculor
obobucHoD cbsbucHom obGbUCHO

(Cesoatfon, of perfstalst6
o d
GaGes 8 fiuds
ta
ocrcmulate
htn theptestne
Increage conbecHom

n r Ototentfon oOF

OF proXima Tnteetthe

ri a fntesHne

ncrea6ed
k
noreaGed tnbe luminal pre6 sure

seorefonG nto the ntestine

ompresobn ofvehe

MOecreosed Abcorptton) w
Edema of tntestine

DecreaGed arfetal Blood suppl)ompress on of emm7na

(rero6rG OFtheîntestfhe ba nch e6 of-mesentC
artery

Gangsenou6 InteoHtnal wa Perfesetfon ef evotH

Segment
Pertton
C clfnfca Manffeetatton

DfAruse cemal dbdomnal pon ofacblRkp nature

Ab6olcate consfbotfon
ep
naused vomih oh fecal tnatier
el
Ofarthea
HfccupG
Dehydratfon
rabTIH fo ar fo
paGs haue bocoel a
mouemen
l
3oel in p or dfofengfon of the clbcdomen
Anore Xia amdKof lo66
ReverGe perfstalG modements

o d
h
Med fcal Manaqement-

r
plCce IntavenouG Ifne Tnto tavefn Tn the atm so

n
hctt flufd6 may be gfuen to replace he depleted
hiater Sodtum

ri a
chlofde e porta667um

dhdhto the k
2) pauttng a Na6ogGHd¢
Gtomach toGuck
ar NGtube ouh
out futd
dbdomen
thenose
as0ella6
air fo release suellng nthe
3) A col on Osapp may be performed rto untorst e
T
clecompressthe bocool. DR

may tnserted to decompre6 an

4 A rectal tube be
Orea the P6 locder fn the booel,ob

OpfoId6 ) an+P omeHPes can be ddmfnfstered

6 cntbo1PCS5
o relteuepaln & Nau6edAdm9n?6ten
o doeat bactefa qowth AntmiG Ca snPc /
a0tHtholfnerqtc drug6 are uGed o manage colfckp
 coall drotens
Patn to 6mooth muGdespasm el bome

8Utgerg tManagement 8
surgeon uGual lg enters he abdomina
he large
CauTHp b? oay of a laprotom ohTch 16 a
fnc6ton macde hockah he ptis adomfna Weu.

depend6 on n
Teatnp hbenetfnal cbstucfon
CondFifon call6ng fhe blockage.

Iy6to OF AdhesfonG

d
processOf remoding bad6 oFgcaf HGsue
o
h
6 Called Iysts. APler he abdomimcu CabHy has ben
delfcatel csseots the
r ta
openec thesageen 9locates obstuched ared 8-
adhesfonG fiorm the 9ntesftne

n
uctng sdssors el fercep6

2 Henfa repafrs-
ri a
k
Pncfston placed hear he locatfon of he
herfa fhrougb whfch the hesAfa 6ac 76 opened. The
n
henfatec fntestibe Po phckd back abdomfina caurt2
-he mcIGde cwall fepaired
Pesecfon rh end fo end anaGonmo 6Y63-
femovepart orel te of q Hf6sue or Stuctee.
tnoolues theremodal oFhe obohuc-ed os dfsea6ed
Sectfono otb 3
Anbstomost 96 #he Connechtop of o0 tut en d6 oF
attbetor shechire to fertm a conffh uou6 Channe
aAnagtemo6fs Che Pote6tne
aCcomplf6hed 16 mo6 ofte
wfh Sutres or 6Urgfcal6tapleh.
 NovsfngP Monagement2-

) Nc Ditrgnoss
0 Acdte pofn relted to di6tenglbn or nfestfnal tfosue
O6eutdenced by festfesones6,anxfoUG

o)Dmpalr ed bowd ehmfnatfan related +o presenceo

obshuctPon tn pert6falsf6 a6 eufdenced bpal4eratfon6
rn boudel Sounde.

mtala hced nubPtfonal status less than bodp

d
resulrements related te less Tntake of foad aG
eufdenced bp cansÝpatfon

ta h o
cdefqht+loss

r
Karstnp Care ?

D A6se66 the pain tnten6

ri an Ptp duraton el frequencp

of Pain pain a66066menf helpe te etal uate the

k
degree of dfscemfert 8/ ePfecHvenes6 oFanalgesfc6

Prodfde routnecomfort measure6 eg mothcare,

back rab repo5ttfonTnp. preuent cleying of ora
muco6a el o6socfaded dtoccmfert el prormote
relaxatfan

Encourage o6eof reloxatfðn technTques Encourage

edfy ambotiton Eleuate the headof bed to a66fst
WTn padfent oenttiatèn.

Admtn tefer analgesfcto rel feue pan.n po6t operctfUe

peftbd patfentco rhell ed analgesfd eleprdulalecan be
more U60 feul m contheltnp fFeln
 befqht pt palegalort
9 Montfer tntake e) cutput carefullD.
proutcde Prech Pnd fcators of flufd balance

Monfor OPfal stgn6 nottng po6turau hypotenso

tochyardrd eualuate skfn turg or cop?lla reme
mucouG membrane

Admtnfster the fuffufd el elechelyle as îndrca

Pke Ringers lactate, NS DNS

Malhtafh atrway breathino el freudatfon o6 the highe

palcetd The patfent requfre endobecheal ntubaffon
domonage afrway e brtathfmg
o d
A66e66 ourgfcoal
ta h
nEla
6He fer anq rednae6 mmatfo G

r
dransfer dny dfscharge. Ihsbech6tema pertGte mal skÍn

n
ared. nofe frrtfattbn brut6e6 el rash e6.

19
ri a
eegital 6?t0 pomon shate
Teoch pt hocofo cleanse

CPocodlen k
hocofe applp &m bartter de pratect-skin.
gi paGte)
Ercoulage pé fo change poottfon ader2halyte
comferb: PraURd e boaok-care to poeient bed Goreo

1A66ecs th e NCtFon Statas bg dofly calfe

Dauntdetchar e ntake el outfak
1A6Gebo teyel oF krocledge bg askT0g que6tfon6
Qboa fhe care becdment e

Encorage
angpoblems.
pt e expre66 therFeelîn gs
eVerbal ze
feach dRrecice Cond
E 8
to pé OA