Nursing 3910A/B Lecture Notes - Lecture 4: Hemoptysis, Catheter, Myocardial Infarction
6 Dec 2017
School
Department
Course
Professor
N3910 – Week 4 Lecture 1
The Perioperative Experience
Outline
• Context for Perioperative = IBD = Paper application
• Preoperative
• Intraoperative
• Postoperative
Word of the Week
• Sequelae: a condition following and resulting from disease
How will the management of diabetes change when a client on an enteral/tube feed?
• Their blood sugar would go up but plateau because they are constantly being feed at the
same rate
Once insulin injections are started, they can never be stopped?
• False, can switch to oral meds
Inflammatory Bowel Disease
• Two chronic inflammatory GI disorders
o Crohs/‘egioal eteritis
o Ulcerative colitis
• Similarities and differences
• 170,000 cases Canada, highest rate
• Cause unknown!
• What happens?
o Pain/cramping
o Bleeding
o Change in bowel patterns
o Altered utritiodot feel like eatig0
Crohs/‘egioal Eteritis
• Usually adolescents/young adults
• Subacute and chronic inflammation of the GI tract wall through all layers
• Commonly distal ileum, ascending colon (but can be everywhere)
• Non-continuous lesions cobblestone
• Fistulas, fissures, abscesses common
Ulcerative Colitis
• Recurrent ulcerative and inflammatory disease of the mucosal and submucosal layers of
the colon and rectum
• Highest in Caucasians and Jewish heritage
• 30 to 50 years
find more resources at oneclass.com
find more resources at oneclass.com
N3910 – Week 4 Lecture 2
• Serious disease with systemic complications and high mortality rate
• ~5% develop carcinoma of colon
• Liquid stools: how many?
o Up to 15-20 liquid stools a day
o Losing a lot of fluid and electrolytes
Diagnostics
• Endoscopy (scoping)
• Stool
o Testing for what?
▪ Blood/occult blood (FOB)
• Blood work
o Test for CBC if you are losing blood
o Hemoglobin
o Electrolytes
• CT Scan
• Barium enema
o Light up the inside, given by enema
• Impaired nutrition
o Albumin (protein)
o Weight
o Overall look
IBD – Management
• We will try to manage it medically first, then surgery
• Nutritional: low residue (low fiber), high protein, high calorie
• Pharmacological (give Imodium (anti diarrhea) is anti inflammatory)
• Crohns – 75% require surgery, 25 – 60% recur
• 25% UC eventually have total colectomies considered curative
How do you promote empathy, dignity and/or autonomy with post-operative clients, on a busy
surgical unit?
• Ex. Draw curtain when patient is using bedpan
Where you live matters: Canadian view on health care quality – January 2014
• 3 – 15% of Canadians, depending on province, do not have a regular doctor or clinic
(Integrated)
• Accessing medical care after hours (non-ER) is difficult for 62%, with 47% using ER in the
absence of GP (Gaps)
• 10% have been invited to email their doctor with a medical question
• 76% of hospitalized clients said hospital helped ensure they had follow up care (Whoop!)
Perioperative or Surgical Client
find more resources at oneclass.com
find more resources at oneclass.com
N3910 – Week 4 Lecture 3
• Considered when non-surgical measures fail to relieve the severe symptoms of IBD
• Medically intractable disease, poor quality of life, complications from the disease or
medical therapy
• Build up fluids, blood and protein prior to surgery
Tanner CJM article
• Clinical judgment is tremendously complex (Tanner, 2006)
• Profound ifluee of urses koledge or alue perspeties
• Sound CJ rests to some degree on knowing the patient à noticing!
• Also on unit culture
• E.g. personal opinion of client influences pain treatment(!)
When is an individual most likely to have surgery. E.g. at what stage of life?
• Last eek of life is he e are ost likely to hae surgery. But…
• What is last week?
• QOL
• Pain
• Recovery
• Baseline
Terms
• Perioperative
o Pre-operative: starts with decision to have surgery until you enter OR room
o Intra-operative: when you arrive in OR till you arrive at PACU
o Post-operative: when you leave PACU to follow up appointment is completed
• Surgery
o Diagnostic (biopsy), curative (curing cancer), reparative (wound not healing well),
reconstructive (reconstruct breast), cosmetic (removing mole off face),
o Palliative (end of life care)
o Emergent (now, needs to happen now), urgent (within 38 hours, you have time),
required, elective (should have surgery), optional (cosmetic surgery)
Impact of Surgery
• Physical
o Scaring
• Psychological
o Anxiety
o Fear of unknown or death
• Spiritual
o Importance of their faith
o Can find new faith
o Or get more intense
find more resources at oneclass.com
find more resources at oneclass.com
Document Summary
Outline: context for perioperative = ibd = paper application, preoperative. Word of the week: sequelae: a condition following and resulting from disease. How will the management of diabetes change when a client on an enteral/tube feed: their blood sugar would go up but plateau because they are constantly being feed at the same rate. Once insulin injections are started, they can never be stopped: false, can switch to oral meds. Inflammatory bowel disease: two chronic inflammatory gi disorders, croh(cid:374)(cid:859)s/ egio(cid:374)al e(cid:374)teritis, ulcerative colitis, similarities and differences, 170,000 cases canada, highest rate, cause unknown, what happens, pain/cramping, bleeding, change in bowel patterns, altered (cid:374)utritio(cid:374)(cid:894)do(cid:374)(cid:859)t feel like eati(cid:374)g0. Croh(cid:374)(cid:859)s/ egio(cid:374)al e(cid:374)teritis: usually adolescents/young adults, subacute and chronic inflammation of the gi tract wall through all layers, commonly distal ileum, ascending colon (but can be everywhere, non-continuous lesions cobblestone, fistulas, fissures, abscesses common.
