Midterm Notes

Arrhythmias
These are irregular heartbeat, is a problem with the rate or rhythm of your heartbeat. The heart
may beat too quickly, too slowly, or with an irregular rhythm. It is normal for your heart rate to
speed up during physical activity and to slow down while resting or sleeping.
Atrial fibrillation (AF or AFib)- these are common type of arrhythmia.

 The heart beats irregularly and faster than normal > 140 beats/min Chaotic heart
signaling causes a rapid, uncoordinated heart rate.
 The condition maybe temporary, but some A-fib episodes may not stop unless treated.
 fib is associated with serious complications such as stroke.
Atrial Flutter
Atrial flutter is similar to A-fib, but heartbeats are more organized. Atrial flutter is also linked to
stroke.

 heart to beat in a fast, but usually regular, rhythm

 "saw-toothed pattern on an electrocardiogram.
Supraventricular tachycardia (SVT)

 As high as 250 beats per minute, but is usually between 140 and 180 bpm.
 Episodes of abnormally fast heart rate at rest.
 Is a broad term that includes arrhythmias that start above the lower heart chambers
(ventricles).
 Supraventricular tachycardia causes episodes of a pounding heartbeat (palpitations) that
begin and ends abruptly.
Ventricular Tachycardia

 This rapid, regular heart rate starts with faulty electrical signals in the lower heart
chambers (ventricles).
 The rapid heart rate doesn't allow the ventricles to properly fill with blood.
 As a result, the heart can't pump enough blood to the body. Ventricular tachycardia may
not cause serious problems in people with an otherwise healthy heart.
• Procainamide is a sodium channel blocker, used for AF, Atrial Flutter, sit and Vtach
• Since Procainamide may reduce blood pressure, patients receiving parenteral hypotensive
drugs and Procainamide, or in high oral doses, should be observed for possible hypotensive
effects.
• Lidocaine its use is indicated in the management of acute ventricular tachydysrhythmias. It
also has roles as an adjuvant analgesic in managing acute and chronic pain.
• Used broadly in the management of neuropathic pain, postoperative pain, neuralgia, centrally
mediated pain, and headache. Lidocaine is a relatively safe drug, which can be used at low
doses without any notable safety concerns.
Ventricular fibrillation
This type of arrhythmia occurs when rapid, chaotic electrical signals cause the lower chambers
(ventricles) to quiver instead of contacting in a coordinated way that pumps blood to the rest of
the body, losing the ability to pump effectively.
Туреs:
Coarse V-fib -may be more responsive to defibrillation.
Fine V-fib can mimic the appearance of asystole on a defibrillator or cardiac monitor set to a
low gain.
Sinus Bradycardia - a heart rhythm that's slower than expected (fewer than 60 beats per minute
in an adult) but is otherwise normal. It's sometimes a symptom of certain heart conditions but it
can also be a sign that a person is in very good shape because of regular exercise
Premature Ventricular Contraction

 are extra heartbeats that begin in one of the heart's two lower pumping chambers
(ventricles).
 These extra beats disrupt the regular heart rhythm.
 Skipped beat.

Nursing Responsibility:
 Document any arrhythmias in a monitored patient.
 Notify the doctor if a change in pulse pattern or rate occurs in an unmonitored patient.
 As ordered, obtain an ECG tracing in an unmonitored patient to confirm and identify the
type of arrhythmia present.
 Be prepared to initiate cardiopulmonary resuscitation, if indicated, when a life-
threatening arrhythmia occurs.
 Administer medication as ordered, monitor for adverse effect, and perform nursing
interventions related to monitoring vital signs, hemodynamic monitoring, and
appropriate laboratory work.
 Provide adequate oxygen- reduce heart workload while carefully maintaining metabolic,
neurologic, respiratory, and hemodynamic status,
  Evaluate the monitored patient's ECG regularly for arrhythmia.
 Monitor for predisposing factors, such as fluid and electrolyte imbalance, and signs of
drug toxicity, especially with digoxin.
 Emphasize the importance of keeping laboratory results.

Devices to correct arrhythmias.

Devices a provider puts into your body can treat irregular heart rhythms. These devices monitor
your heartbeat. They send electrical impulses to your heart when an arrhythmia starts. You may
receive one of these devices:
*Pacemakers
Implantable Cardioverter Defibrillators (ICDs)
Pacemaker is a small, battery-powered device that prevents the heart from beating too slowly.
 It needs surgery to get a pacemaker.
 The device is placed under the skin near the collarbone.
 The generator is attached to a wire (electrodes) that's guided through a blood vessel to
the heart.
Nursing Responsibility:
 Check for the site for any bleeding-keep the site dry and clean.
 Chest pain or tightness, or any other pain at the incision site pain medication might be
helpful.
 After the period of bed rest has been completed assist patient when they want to stand
up observe for dizziness
 Check patient blood pressure while you are lying in bed, sitting, and standing.
 Patient will be able to eat or drink once they are completely awake.
 Apply an arm sling for a day or so.
 Chest X-ray-checking if the systems are stable-collapsed lung.
 Limit arm movement
 Regular evaluation should be done to check its function.
 Ask patient to always wear an ID band that's states she/he has an ICD.
Cardioversion - is a medical procedure that uses quick, low-energy shocks to restore a regular
heart rhythm treatment for certain types of irregular heartbeats (arrhythmias), including atrial
fibrillation (A- Sometimes cardioversion is done using medications).
Cardioversion is usually scheduled in advance but is sometimes done in emergencies. Usually,
cardioversion quickly restores a typical heart rhythm.
Cardioversion is different from defibrillation, an emergency procedure that's done when the
heart stops or quivers uselessly. Defibrillation delivers more powerful shocks to the heart to
correct its rhythm.
Synchronized cardioversion involves the delivery of a low-energy shock which is timed or
synchronized to be delivered at a specific point in the QRS complex (see the image below). A
synchronized shock is delivered at this precise moment to avoid causing or inducing ventricular
fibrillation.
Defibrillation or unsynchronized cardioversion is indicated in any patient with pulseless VT/VE
or unstable polymorphic VT.

Acute GI Bleeding
 GI bleeding is a symptom of a disease or condition, rather than a disease or condition
itself. Acute
 The blood often appears in stool or vomit but isn't always visible, though it may cause
the stool to look black or tarry.
 The level of bleeding can range from mild to severe and can be life-threatening.
Upper GI bleeding
Causes can include:
1.) Peptic ulcer
 This is the most common cause of upper GI bleeding. Peptic ulcers are sores that
develop on the lining of the stomach and upper portion of the small intestine. Stomach
acid, either from bacteria or use of anti-inflammatory drugs, damages the lining, leading
to formation of sores.
2.) Tears in the lining of the tube that connects your throat to your stomach (esophagus).
 Known as Mallory-Weiss tears, they can cause a lot of bleeding.
 These are most common in people who drink alcohol to excess.
3.) Abnormal, enlarged veins in the esophagus (esophageal varices).
 This condition occurs most often in people with serious liver disease.
4.) Esophagitis.
 This inflammation of the esophagus is most commonly caused by gastroesophageal
reflux disease (GERD).
Lower GI bleeding
Causes can include:
1. Diverticular disease involves the development of small, bulging pouches in the digestive
tract, (diverticulosis). If one or more of the pouches become inflamed or infected, it's
called diverticulitis.
2. Inflammatory bowel disease (IBD) causes inflammation and sores in the colon and
rectum, and Crohn's disease, and inflammation of the lining of the digestive tract.
3. Tumors. Non-cancerous (benign) or cancerous tumors of the esophagus, stomach, colon
or rectum can weaken the lining of the digestive tract and cause bleeding.
4. Colon polyps. Small clumps of cells that form on the lining of your colon can cause
bleeding.
5. Hemorrhoids- swollen veins in your anus or lower rectum, similar to varicose veins.
6. Anal fissures- small tears in the lining of the anus.
7. Proctitis- Inflammation of the lining of the rectum can cause rectal bleeding.
Symptoms:

✓ Signs and symptoms of GI bleeding can be either obvious (overt) or hidden (occult).
Overt bleeding might show up as:

 Vomiting blood, which might be red or might be dark brown and resemble coffee
grounds in texture.
 Black, tarry stool
 Rectal bleeding, usually in or with stool
With occult bleeding, you might have:

 Lightheadedness
 Difficulty breathing
 Fainting
 Chest pain
 Abdominal pain
Complications:
 Anemia
 Shock
 Death
Diagnosis:

 Blood tests - platelet count and liver function tests.

 Stool tests
  Nasogastric lavage. A tube is passed through patient nose into her/his stomach to
remove the stomach contents.
 Upper endoscopy- This procedure uses a tiny camera on the end of a long tube, which is
passed through patient mouth to enable doctor to examine patient upper
gastrointestinal tract.
 Colonoscopy- This procedure uses a tiny camera on the end of a long tube, which is
passed through your rectum to enable your doctor to examine your large intestine and
rectum.
 Capsule endoscopy. In this procedure, you swallow a vitamin-size capsule with a tiny
camera inside. The capsule travels through your digestive tract taking thousands of
pictures that are sent to a recorder that a patient wear on a belt around his/her waist.
This enables your doctor to see inside your small intestine.
How to prevent GI Bleeding

 Limit intake of NSAIDs

 Limit alcohol intake
 Limit smoking
Treatment:
Medications
 Proton pump inhibitor - to suppress stomach acid production omeprazole, pantoprazole
rabeprazole, and esomeprazole (Nexium)
 Intravenous Fluids-
 Blood Transfusions
 Discontinue aspirin or NSAID
Surgery:

 Upper GI bleeding- urgent

 Lower GI bleeding persistent active/recurrent bleeding 4 units of transfusion within 24
hrs.
 Hemodynamic instability with refractory resuscitation
 Laparoscopy or Laparotomy - "open" procedure. In this procedure, the surgeon makes a
comparatively large incision through the skin and muscle of the abdomen that allows
them to see various organs, tissues, and blood vessels.
Nursing Responsibilities:
 Observing patient vital signs
 Assist and collaborate with other professionals to optimize patients' comfort.
 Administering the necessary patient medication.
 Assist in positioning left lateral decubitus position with a sheet draped over the body.
  Low fiber diet several days and clear liquid diet before the day of procedure. No colorful
or purple liquids, chewing gum, and alcohol. No liquids after 10:00 pm. You may drink a
sip of water to take regular evening medications.
 Have patient take laxative evening before the procedure to clean the colon.
 If patient is under warfarin tablet or anti-coagulant, physician usually advice to
discontinue it 2-3 days for fondaparinux and a day before for warfarin.
 Anesthesia is not commonly for colonoscopies but for patient safety it may be the best
option for people who have airway abnormalities or are at high risk for aspiration of
stomach contents however a light sedative may be given so patient won't feel any
discomfort like drug called propofol. "It is a short-acting anesthetic that has the
advantage of wearing off relatively. After procedure if patient is outpatient, stay at least
2 hours till sedation wears off.
 Inform patient that he/she may feel bloating or nausea after the procedure, sore throat
for 1 or 2 days, physician will prescribe at home meds.
 For coloscopy-Observe the patient closely for signs of bowel perforation. Signs of bowel
perforations such as severe abdominal pain, nausea, vomiting, fever, and chills must be
reported immediately.
 Obtain and record the patient's vital signs.
 Hydrate

Liver Failure
ERCP – Endoscopic retrograde cholangiopancreatography
- Has the capacity to regenerate after damaged, it can make new cells called
"hepatocytes", worked like a stem cells.
Liver Failure
 Making blood proteins - aid in clotting, transporting oxygen and supporting immune
system.
 It makes bile-a substance needed to help digest food.
 Helping body to store sugar (glucose) in the form of glycogen.
 Cleans toxins (harmful substances) out of the bloodstream, including drugs and alcohol.
 Breaking down saturated fat and producing cholesterol.
Causes:

 Hepatitis B and C
 Non-alcohol related fatty liver disease-a large amount of fat in your liver; related to the
metabolic syndrome.
 Alcohol abuse
  Hemochromatosis - a disorder when body absorbs too much iron from food.
 Overused of acetaminophen, antibiotics and anti-seizure medications, man-made
hormones and antifungal drugs) and herbs (green tea extracts and kava)
 Overuse of certain drugs or toxins, like acetaminophen (Tylenol), and the use of other
medications (including certain antibiotics, anti-fungal, antidepressants drugs and man-
made hormones drugs like pills.
 Vascular (vessels that carry fluids, such as arteries) disorders, such as Wilson disease-
when the body cannot remove extra copper (abnormal copper accumulation)
 Autoimmune hepatitis - when your body's own immune system attacks your liver.
Cirrhosis
 Is the scarring of liver from repeated or long-lasting injury, such as from drinking alcohol
excessively over a long period of time or chronic hepatitis infection.
 As scar tissue replaces healthy liver tissue, the liver then loses its ability to function.
Symptoms:

 Fatigue
 Nausea
 Loss of appetite
 Sweet musty odor from urine and breath
 Diarrhea
 Vomiting blood
 Blood in the stool
Severe Symptoms:

 Jaundice (yellowing of your skin and eyes).

 Extreme tiredness.
 Disorientation (confusion and uncertainty).
 Fluid build-up in your abdomen and extremities (arms and legs).
Diagnosis:

 Symptoms
 Medical history
 Blood tests
 Urine tests
 Abdominal imaging
Treatment:
Acute Sudden Liver Failure:
  Intravenous (IV) fluids to maintain blood pressure.
 Medications such as laxatives or enemas to help flush toxins (poisons) out.
 Blood glucose (sugar) monitoring.
Treatment:
Chronic Liver failure:

 Avoiding alcohol or medications that can harm your liver.

 Eating less of certain foods, including red meat, cheese and eggs.
 Weight loss and management of metabolic risk factors, including high blood pressure
and diabetes.
 Cutting down on salt in your diet (including not adding salt to food).
 Blood transfusion
 Liver Transplant
Prevention:
 Vaccinated for hepatitis B.
 Cutting down on alcohol consumption.
 Maintaining a weight that's healthy for you and active lifestyle.
 Following directions when using medications like acetaminophen (Tylenol).
 Having a physical examination every year (at least) with a primary care provider, with
screening for obesity, high cholesterol, high blood pressure and diabetes.
Intra-Abdominal Hypertension/ Abdominal Compartment Syndrome
 Usually develops after an illness or injury that affects your internal organs, resulting in
inflammation and swelling. These changes can then raise the pressure within your
abdominal cavity.
 Intra-abdominal hypertension is a serious condition that can lead to severe problems
with your kidneys, heart, lungs, and other internal organs.
 Normal intra-abdominal pressure ranges between 0 and 5 millimeters of mercury
(mmHg).
 In critically ill people, the range is between 5 and 7 mmHg.
 High intra-abdominal pressure may be defined as: Intra-abdominal hypertension (IAH),
in which pressure is 12 to 20 mmHg.
 Intra-abdominal hypertension refers to high pressure within the abdominal cavity. It can
reduce the blood supply and oxygen to the area, which may lead to abdominal
compartment syndrome (ACS), a condition that causes multiple organ dysfunction.
 If not treated, intra-abdominal hypertension can lead to intra-abdominal compartment
syndrome, a potentially life-threatening condition that develops when pressure within
your abdominal cavity reaches 20 mm Hg.
What causes intra-abdominal hypertension and ACS?
Primary causes:

 Abdominal trauma
 Bleeding
 Intestinal obstruction
 Abdominal aortic aneurysm rupture bursting of an enlarged area in the main artery in
the abdomen
 Peritoneal hematoma, which is a pool of mostly clotted blood that forms in the tissue
lining the
 abdominal wall and pelvic cavity
Secondary causes:

 Burns
 Intra-abdominal sepsis
 Ileus- a temporary deficit in normal intestinal movements
 Pregnancy
 Ascites
 Large-volume fluid replacement
Sign and Symptoms:
 Shortness of breath or difficulty breathing is the first symptom of intra-abdominal
hypertension because pressure on the lungs, the diaphragm, and other muscles
necessary for breathing are under abnormal pressure.
 Vomiting - usually occurs at end inspiration when intra-abdominal pressure is highest.
The diaphragm abruptly relaxes, and abdominal pressure is suddenly transmitted to the
chest.
 Diarrhea
 Constipation because of pain
 Distention or abdominal swelling/bloating - increase of abdominal girth
 Abdominal pain may or may not be seen especially in mild cases.
 Absence of bowel sounds
 Tense abdomen
 Syncope - loss of consciousness for a short period of time
Diagnosis:

 Physical exam -when being assessed found to have abdominal tense and difficulty of
breathing.
 Ct scan - can help determine the cause.
  Measuring intra-abdominal pressure - the most accurate method of confirming the
disease.
Treatment: overall goal to improve the following:

 Abdominal wall compliance with decreased muscle contraction

 Evacuation of luminal contents by decompression (NG tube)
 Evacuation of abdominal fluid by drainage, and correction of imbalances.

BARIATRIC SURGERY
o Procedures work by modifying your digestive system - usually the stomach, and
sometimes also the small intestine to regulate how many calories you can consume and
absorb.
o They can also reduce the hunger signals that travel from your digestive system to your
brain.
o These procedures can help treat and prevent many metabolic diseases related to
obesity, including diabetes and fatty liver disease. But weight loss surgery isn't an easy
"quick fix".
What kinds of conditions can bariatric surgery treat?
Obesity is associated with many chronic diseases, many of which can be life-threatening:

 High cholesterol - These can add up and lead to blockages in your blood vessels. This is
why high cholesterol can put you at risk for a stroke or heart attack.
 High blood pressure -These wears down the walls of your blood vessels and puts you at
greater risk of heart attack and stroke.
 High blood sugar -linked to insulin resistance and is considered a precursor to diabetes
Left untreated, it can damage your nerves, blood vessels, tissues and organs, increasing
your risk of many diseases.
 Heart disease - Obesity can lead to impaired cardiac function and congestive heart
failure. It can also cause plaque to build up inside your arteries and increases your risk of
heart attack and stroke.
 Kidney Disease Metabolic syndromes associated with obesity, including high blood
pressure, insulin resistance and congestive heart failure, are major contributors to
chronic kidney disease and kidney failure.
 Obstructive Sleep Apnea People with untreated sleep apnea stop breathing repeatedly
during their sleep when their upper respiratory tract becomes blocked. These episodes
reduce oxygen flow to the vital organs and particularly endanger the heart.
 Osteoarthritis Having excess weight puts extra pressure on joints like your knees. This
makes it more likely that you'll develop osteoarthritis.
  Non-alcohol related fatty liver disease (NAFLD) NAFLD occurs when your body begins
depositing excess fat in your liver. It can lead to non-alcohol related steatohepatitis
(NASH).
 Cancer
Procedure Details:
Class III Obesity
 Have a BMI of 40 or higher.
 A score of 40 or higher is associated with a high risk of related diseases. It usually
equates to about 100 lbs overweight.
 Have a BMI of at least 35 and at least one related health problem.
 A BMI of 35 without a related health problem is considered class II obesity.
The criteria are slightly higher for adolescents. An adolescent may be a candidate if they have.
 BMI of at least 40 and an obesity-related medical condition.
 BMI of at least 35 and a severe obesity-related medical condition.
How is weight loss surgery performed?
Weight loss surgery is usually performed through minimally invasive methods (laparoscopic
surgery) That means small incisions, faster healing and less pain and scarring than any patient
would have with traditional open surgery.
Types of Surgery:
• Gastric sleeve -The gastric sleeve, also called sleeve gastrectomy, is the most commonly
performed bariatric surgery. This may be because it's a relatively simple procedure that's safe to
perform on most people with little risk of complications. The gastrectomy simply removes a
large portion of your stomach - about 80%-leaving behind a small, tubular portion, like a sleeve.
Reduces the hunger hormones
• Gastric bypass - the gastric bypass is also known as the "Roux-en-Y," which is a French term
meaning "in the form of the letter Y." With this procedure, the small intestine will end up in that
form. First, surgeons create a small pouch at the top of your stomach, separating it from the
lower portion with surgical staples. Then they divide your small intestine and bring the new
segment up to connect to the stomach pouch. Food will now flow through the new, smaller
stomach and lower segment of your small intestine, bypassing the rest.
Surgical Complications:

 Bleeding
 Infection
 Blood clots
  Hernias
 Small bowel obstruction
 Anastomotic leaks
Surgery Side-Effects:

 Dumping Syndrome-stomach dumps food too fast into small intestine-nausea, diarrhea,
abdominal cramping and hypoglycemia
 Malabsorption and malnutrition-reduced calories absorption leading loose stools
 Bile reflux-if the valve not close properly causing reflux of bile to the stomach-causing
erosion to stomach lining-gastritis and ulcers
 Gallstones-bile-gallbladder-forming cholesterol gallstones-travels back and stuck in bile
ducts.
What are the advantages of bariatric surgery?
 Significant, sustained weight loss-
 Reduced hunger hormones and improved metabolism.
 Cholesterol and blood sugar management
 A longer, healthier life
Recovery?

 Few days for recovering in the hospital, and few weeks at home.
 Avoid strenuous activities-6 weeks.
 12 weeks to resume normal diet.

Acute Pancreatitis
Pancreas

 Is a large gland that involved in digestion producing digestive juices like insulin and
regulating our blood sugar.
 An organ in your abdomen- it sits between our stomach and our spine.
 If you lay your right hand across your stomach, that's roughly the size and shape of your
pancreas behind it.
 It makes digestive enzymes and hormones, such as insulin.
 It delivers digestive enzymes to your small intestine through the pancreatic duct.
 Amylase- digestion of carbohydrates
 Lipase break down fats.
 Trypsin and chymotrypsin digest proteins
Pancreatitis
 Inflammation in the pancreas- causes swelling and stomach pain- that radiates to back.
 Acute-sudden can be temporary.
 Inflammation is your immune system's response to injury. When your pancreas is
injured, it's most often from gallstones blocking the pancreatic duct, or from alcohol.
Types:
Acute Pancreatitis
Is a temporary condition. It happens when your pancreas is attempting to recover from a minor,
short-term injury. Most people with acute pancreatitis will recover completely in a few days
with supportive care: rest, hydration and pain relief.
Chronic Pancreatitis
Is a long term, progressive condition. It doesn’t go away and get worse over time. It happens
when the injury or damage to your pancreas never stops. Chronic pancreatitis will eventually
do lasting damage to your pancreas, although it may take many years.
Signs and Symptoms

 Abdominal pain – (upper abdominal region) moderate to severe that radiates to the
back, abdomen is tender to touch, triggered by eating high fat foods.
 Ingestion and pain after eating.
 Loss of appetite and unintended weight loss
 Nausea and vomiting

Acute Pancreatitis
Sign and Symptoms:
 Indigestion- nausea and vomiting
 Abdominal pain
 Loss of appetite and unintended weight loss
 Fatty poops that leave an oily film in the toilet.
 Lightheadedness (low blood pressure)
 Fast heart rate
 Fast, shallow breathing
 Fever

Common Causes:
  Gallstones - are hard, pebble-like pieces of material, usually made of cholesterol or
bilirubin, that develop in your gallbladder. When gallstones block your bile ducts, they
can cause sudden pain, which means you need medical attention right away.
 Heavy drinking - because it is sensitive to alcohol it produces viscous secretions that
block small pancreatic duct resulting in inflammation (pancreatitis) and scarring of the
pancreas.

Complications:
 Inflammation and swelling
 Loss of blood supply
 Necrosis-Infection
 Feast for roaming bacteria
 Thrive and replicate-going to bloodstream.
 Septicemia- which activates immune response against infection (SIRS)
 Blood vessels enlarge which in turn blood pressure drop (SEPTIC SHOCK
 Leading to reduced blood flow to vital organs causing multiple organ failure

Pancreatic Pseudocyst
Inflammation in the pancreas can disrupt the pancreatic duct that needs pancreatic juices to
the intestine causing leakage around pancreas and cause inflammation in the surrounding
tissue. Overtime will form a hardened capsule around the fluid called pseudocyst.

Diagnosis:
 Blood test - looks for elevated levels of pancreatic enzymes (amylase and lipase) in your
blood.
 Amylase enzyme helps your body digest carbs
 Lipase enzyme helps your body digest fats.
o If levels are at least three times higher than normal, the physician will suspect
pancreatitis.
 CT scan or MRI - this cross sectional imaging test can show swelling and fluid deposits in
your pancreas as well as other abnormalities.

Additional test

 Glucose test - to see whether your pancreas is still producing insulin effectively
 Stool elastase test to see if your pancreas is making enough digestive enzymes
 Fecal fat analysis to test for excess fat in your poop, a sign of fat malabsorption

Treatment:
  If the cause has been resolved and you don't have severe or complicated pancreatitis,
care will focus on supporting your body's natural healing process. This usually includes:
 Antibiotics -patient may need antibiotics only when pancreatitis is associated with chest
or urinary infection.
 IV fluids - Pancreatitis is dehydrating, and fluid hydration is very important for healing.
 Tube feeding If you're unable to tolerate food by mouth, your doctors may administer
food via a tube placed through your nose or stomach to help you get enough nutrition.
 Parenteral nutrition - In very severe cases, your doctors may elect to provide nutrition
through an intravenous line or central catheter.
 It's what we call TPN -is a method of feeding that bypasses the gastrointestinal tract.
 Parenteral" means "outside of the digestive tract. Whereas enteral nutrition is delivered
through a tube to your stomach or the small intestine
 Surgery - resection and total pancreatectomy

o If a patient have gallstone pancreatitis, the provider may need to remove an impacted
gallstone from the bile ducts. They'll also recommend gallbladder removal surgery to
prevent gallstones from causing you future problems.
o Gallbladder removal is the standard treatment for gallstones that cause complications.
It can usually be done through minimally invasive (laparoscopic) surgery. A laparoscopic
cholecystectomy) removes your gallbladder through a few small incisions, using the aid
of a laparoscope, and a tiny camera is inserted through one of the incisions. Some
people may require traditional open surgery depending on their condition.
o Endoscopic retrograde cholangiopancreatography (ERCP) - This procedure goes inside
your bile ducts with an endoscope-a thin, flexible catheter with a camera attached. Most
gallstones in your bile ducts can be removed this way. The endoscope passes down your
throat and through your esophagus into your stomach and bile ducts. It sends images to
a monitor. Watching the monitor, the endoscopist can insert tools through the catheter
to remove gallstones.

Prevention:

 Moderating your alcohol consumption.

 You can reduce your risk of gallstones, the other leading cause, by reducing cholesterol
If you've had acute pancreatitis, you can help prevent it from happening again by
quitting alcohol and smoking.
 If patient have had gallstone pancreatitis, removing your gallbladder can prevent it from
recurring.
Diabetic Ketoacidosis

Diabetic Ketoacidosis - DKA

 Is a life-threatening condition that affects people with diabetes and those who have
undiagnosed diabetes. It happens when the body does not have enough insulin
(hormone that is produced by the pancreas) to use sugar for energy. (the blood pH is
too low). This creates an emergency medical situation thequires immediate attention
and treatment.
 Instead, the body breaks down fat for energy, which causes your body to release ketone
in the blood stream. Too many ketones cause your blood to turn acidic. the blood pH is
too low). This creates an emergency medical situation that requires immediate attention
and treatment.
 Diabetes related ketoacidosis is considered an acute complication, meaning it has a
severe and sudden onset.
 DKA can develop within 24 hours.

Hyperglycemia

(high blood sugar) and diabetes-related ketoacidosis both happen when the body doesn't have
enough insulin or isn't using the insulin it has properly. Under 0.6mmol/L is normal. 0.6 to
1.5mmol/L is slightly high-test again in 2 hours. 1.6 to 3mmol/L means you're at risk of DKA.

Early Sign and symptoms of DKA:

 Peeing more often than usual (frequent urination)
 Extreme thirst
 Dehydration.
 Headache
 High amounts of ketones in your pee or blood (as shown by at home urine ketone test
strips or a blood meter test)
 High blood glucose (blood sugar) levels (over 250 mg/dL).

Diabetes-related ketoacidosis (DKA) affect?

 Individuals who have undiagnosed Type 1 diabetes.

 Type 1 diabetes (also known as Diabetes Mellitus or Insulin-Dependent diabetes and
formerly known as juvenile diabetes) is a chronic autoimmune disease in which your
immune system attacks the insulin-producing beta cells in the pancreas.
 Type 1 diabetes typically develops during childhood or adolescence but can also
develop in adulthood. Patient can develop Type 1 diabetes even if you don't have a
family history of diabetes. Approximately 20% to 40% of DKA cases are from people who
are newly diagnosed with Type 1 diabetes.
  Patient who has been diagnosed with Type 1 diabetes can develop DKA at any point
throughout their life if their body does not get as much insulin as it needs.
 Individuals who have Type 2 diabetes.

Severe Symptom:
 Nausea and vomiting
 Abdominal pain
 Shortness of breath
 Fruity-smelling breath
 Feeling very tired or weak
 Feeling disoriented or confused
 Decreased alertness.

What causes DKA?

 New diagnosis of Type 1 diabetes - Oftentimes people have diabetes-related

ketoacidosis (DKA) when they're first diagnosed with Type 1 diabetes because they no
longer have enough insulin io their body to use glucose for energy and they missed the
early signs of Type 1 diabetes.
 Forgetting to take or not taking one or more insulin doses - Forgetting to take or not
taking insulin, especially with a meal, can cause DKA.
 Insulin pump issue
 Using expired or spoiled Insulin: All types of insulin are affected by extreme cold or
heat. If your vial or pen of insulin or inhaled insulin is exposed to extreme heat or cold,
the insulin can become, ineffective (it won't work as it should.
 Illness - cortisol (stress hormone) and adrenaline. Vomiting from an illness can also
trigger DKA to develop.
 Infection: Oftentimes if you have diabetes and have an infection, your body needs more
insulin than usual. The most common infections that can lead to DKA include
pneumonia, urinary tract infections (UTI) and skin infections.
 Pregnancy
 Emotional or physical trauma: High amounts of cortisol make it difficult for your body
to use insulin properly.
 Pancreatitis - Some cases of pancreatitis can cause lower than normal levels of insulin,
which could trigger DKA
 Heart attack or stroke
 Alcohol abuse
 Antipsychotic and corticosteroids

Factors related:
 Family history of diabetes
 Family history of autoimmune diseases:
  Poorly managed Type 1 diabetes
 Poorly managed Type 2 diabetes

Diagnosis:
 Blood glucose (sugar) level is above 250 mg/dl, euglycemic diabetes-related ketoacidosis
[euDKA]
 Blood pH is less than 7.3 (acidosis)
 Positive (+) ketones in urine and/or blood
 Serum (blood) bicarbonate level is less than 18 mEg per L.

Test to diagnose:
 Blood glucose test
 Ketone testing (through a urine or blood test
 Blood ketone
 Arterial blood gas.
 Basic metabolic panel
 Blood pressure check
 Osmolality blood test

Treatment:
 IV fluids
 Insulin:
 Other treatments
 Drink fluids to prevent dehydration
 Try to eat normally
 Don't exercise
 Diabetic ketoacidosis

Complications:
 Very low potassium levels (hypokalemia)
 Swelling inside of the brain cerebral edema)
 Fluid inside of the lungs (pulmonary edema)
 Damage to your kidneys and other organs
 Coma

Hyperosmolar Hyperglycemic Syndrome

⚫ Hyperglycemic hyperosmolar nonketotic syndrome or coma (HHNS) is also known as
hyperglycemic hyperosmolar syndrome (HHS) is a life-threatening complication of diabetes-
mainly type 2 diabetes. HHS happens when your blood glucose (sugar) levels are too high for a
long period, leading to severe dehydration and confusion.
Hyperosmolarity
• If a client do not drink enough to replace the fluid she/he lost, blood sugar levels get even
higher and the blood becomes more concentrated. Blood that is too concentrated starts to take
water from other organs, including your brain.

Treatments:

 A medical professional can typically treat HHNS using four steps:

 giving fluids through an IV
 helping manage your electrolytes- monitor at least 2 hourly
Potassium -3.3 to 5.2 me3/
giving insulin through an IV Adequate fluid replacement must begin before insulin is
administered. Giving insulin before fluids moves intra-vascular water into the cells, exacerbating
hypotension and potentially causing vascular collapse or death,
diagnosing and managing the causes, and determining if there is a coexisting condition-
Medications should be reviewed to identify any that may precipitate or aggravate IS; these
medications should be discontinued or reduced. Investigation for other causes may be indicated
after reviewing the precipitating factors.

Possible factors that can lead to HHNS include:

 very high blood sugar levels from undiagnosed or unmanaged diabetes

 substance misuse
 coexisting conditions
 infections, such as pneumonia, urinary tract infection, or sepsis
 certain medications, especially second-generation drugs for psychosis
 not following a diabetes treatment plan

Complications
• Complications from inadequate treatment include vascular occlusion (e.g., mesenteric artery
thrombosis, myocardial infarction, disseminated intravascular coagulopathy) and
rhabdomyolysis
• Although there is a temporary prothrombotic environment during the treatment of HHS,
evidence is not available to recommend anticoagulation for all patients. Overhydration may lead
to respiratory distress syndrome in adults and induced cerebral edema, which is rare in adults
but often fatal in children.
Renal Failure
Functions of the kidney are as follows
• Electrolyte and volume regulation
Excretion of nitrogenous waste
Elimination of exogenous molecules, for example, many drugs
Synthesis of a variety of hormones, for example, erythropoietin
Metabolism of low molecular weight proteins, for example, insulin
Renal Failure
 When the kidneys don't work correctly, we products build up in your body. If this
happens, you' teal sick and eventually die without treatment.
 Mary people can manage kidney failure with the proper treatment.
Renal Failure (Acute and Chronic)

 is condition in which one or both of the Kidneys no longer work on their own
 Causes include diabetes, high blood pressure and acute kidney Injuries.
 Most people have two wording kidneys, but you can live well with only one kidney as
long as its working correctly.
 Symptoms, include argue, nausea and wing, swelling, changes in how often you go to
the bathroom and brain fog
Risk Factors:

 diabetes
 high blood pressure (hypertension)
 heart disease
 family history of kidney disease
 abnormal kidney structure
 Are Black, Hispanic, Native American, Alaska Native or First Nation
 Are over 60
 long history of taking pain relievers, including over-the-counter products such as non-
steroidal anti-inflammatory drugs (NSAIDs).

Stages of Kidney disease:

  Stage I - GFR is higher than 90 but below 100. At this stage, your kidneys have mild
damage but still function normally.
 Stage II -GFR may be as low as 60 or as high as 89. You have more damage to your
kidneys than in stage 1, but they still function well.
 Stage III - GFR may be as low as 30 or as high as 59. You may have mild or severe loss of
kidney.
 function.
 Stage IV - GFR may be as low as 15 or as high as 29, You have severe loss of kidney
function.
 Stage V - GFR is below 15. Your kidneys are nearing or at complete failure.

Kidney failure usually doesn't happen quickly. Other chronic kidney disease causes that may
lead to kidney failure include:
 Polycystic kidney disease - PKD is a condition you inherit from one of your parents
(inherited condition) that causes fluid-filled sacs (cysts) to grow inside your kidneys.
 Glomerular disease - Glomerular diseases affect how well your kidneys filters waste.
 Lupus is an autoimmune disease that can cause organ damage, joint pain, fever and skin
rashes.
Kidney failure con also develop quickly because of an unexpected cause. Acute kidney failure
(acute kidney injury), is when your kidneys suddenly lose their ability to function.
 Autoimmune kidney diseases.
 Certain medications that can cause nephrotoxicity
 Antibiotics - These include aminoglycosides, cephalosporins, amphotericin B, bacitracin,
and vancomycin.
 Some blood pressure medicines.
 Nonsteroidal anti-inflammatory drugs (NSAIDS) such as ibuprofen (Motrin, Advil) and
naproxen sodium (Aleve) are some of the most common culprits in causing drug-induced
nephrotoxicity- Severe dehydration A urinary tract obstruction and Untreated systemic
diseases, such as heart? disease or liver disease.
Diagnosis:

 Blood test
 Urine test-protein and albumin
 Imaging test-kidney ultrasound, CT urogram and MRI
Treatments:

 Regular blood tests

 Blood pressure checks
  Medication- What medications are used to treat kidney failure?
 Angiotensin-converting enzyme (ACE) inhibitor, or angiotensin Il receptor blocker (ARB)
these medications help lower your blood pressure.
 Diuretics- these help remove extra fluid from your body.
 Statins these help lower your cholesterol levels.
 Erythropoietin-stimulating agents these help build red blood cells if patient has anemia
 Vitamin D and calcitriol-these help prevent bone loss.
 Phosphate binders - these help remove extra phosphorus in your blood.

If patient is in kidney failure, he/she needs treatment to keep him/her alive. There are two main
treatments for kidney failure:
Dialysis - helps your body filter blood. There are two types of dialysis:

✓ Hemodialysis - In hemodialysis, a machine regularly cleans your blood for you. Most people
get hemodialysis three to four days a week at a hospital or dialysis clinic.

✓ Peritoneal dialysis - In peritoneal dialysis, a provider attaches a bag with a dialysis solution to
a catheter in your abdominal lining. The solution flows from the bag into your abdominal fining,
absorbs waste products and extra fluids and drains back into the bag. Sometimes people can
receive peritoneal dialysis at home.
Kidney transplant - A surgeon places a healthy kidney in your body during a kidney transplant
to take over the damaged kidney. The healthy kidney (donor organ) may come from a deceased
donor or a living donor. Patient can live well with one healthy kidney.

How long can you live with kidney failure?

 Without dialysis or a kidney transplant, kidney failure is tatal. Patient may survive a few
days or weeks without treatment.
 If patient is on dialysis, the average life expectancy is five to 10 years. Some people can
live up to 30 years on dialysis.
 If one has a kidney transplant- the average life expectancy is- if received a kidney from a
living donor is 12 to 20 years.
 The average life expectancy if patient receive a kidney from a deceased donor is eight to
12 years.