3191 Med Surg Exam 2 Class Notes 2023
Chpt 48, 49, 50, 51 + 52
Chapter 48: Assessment and Management of Patients with Obesity
OBJECTIVES:
1. Describe the causes, classifications, and diseases and disorders associated with obesity.
2. Identify strategies aimed at preventing and treating obesity, including lifestyle modification, pharmacologic
therapy, and nonsurgical interventions.
3. Explain nursing management considerations for the patient with obesity using nonsurgical interventions.
4. Compare and contrast surgical modalities indicated to treat patients with obesity in terms of preoperative,
postoperative, and long-term management and complications.
5. Use the nursing process as a framework for care of patients who undergo bariatric surgical procedures.
GLOSSARY:
adiposopathy: dysfunction of adipose tissue that causes chronic inflammation and disease bariatric: relating to
obesity; term derives from two Greek words meaning “weight” and “treatment” body mass index (BMI): a
weight-to-height ratio, calculated by dividing weight in kilograms by height in meters squared; the most
common measure used to classify and diagnose obesity
dumping syndrome: physiologic response to rapid emptying of gastric contents into the jejunum, manifested by
nausea, weakness, sweating, palpitations, syncope, and possibly diarrhea
dysphagia: difficulty swallowing
genome: the total complement of individual genes in an organism microbiome: the
collective genome of all microbes in a microbiota microbiota: the complement of
microbes in a given environment
obesity: a disease characterized by an abnormal or excessive accumulation of body fat that impairs health
obesogenic: a factor that promotes weight gain and obesity orexigenic: a
factor that stimulates appetite
satiety: feeling of having eaten sufficient quantities of food
NOTES:
-
Written by Abel Saboke ()
,Chapter 49: Assessment and Management of Patients with Hepatic Disorders
OBJECTIVES:
1. Identify the metabolic functions of the liver and the alterations that occur with hepatic disorders.
2. Explain liver function tests and the clinical manifestations of liver dysfunction in relation to pathophysiologic
alterations of the liver.
3. Relate jaundice, portal hypertension, ascites, varices, nutritional deficiencies, and hepatic encephalopathy
and coma to pathophysiologic alterations of the liver.
4. Describe the medical, surgical, and nursing management of patients with esophageal varices.
5. Compare the various types of hepatitis and their causes, prevention, clinical manifestations, management,
prognosis, and home health care needs.
6. Use the nursing process as a framework for care of the patient with cirrhosis of the liver.
7. Differentiate between the nonsurgical and surgical management of patients with cancer of the liver.
8. Specify the postoperative nursing care of the patient undergoing liver transplantation.
GLOSSARY:
ascites: an albumin-rich fluid accumulation in the peritoneal cavity asterixis:
involuntary flapping movements of the hands
cirrhosis: a chronic liver disease characterized by fibrotic changes, the formation of dense connective tissue within
the liver, subsequent degenerative changes, and loss of functioning cells
constructional apraxia: inability to draw figures in two or three dimensions
endoscopic variceal ligation (EVL): procedure that uses a modified endoscope loaded with an elastic rubber band
passed through an overtube directly onto the varix (or varices) to be banded to ligate the area and stop
bleeding
fetor hepaticus: sweet, slightly fecal odor to the breath, presumed to be of intestinal origin; prevalent with the
extensive collateral portal circulation in chronic liver disease
fulminant hepatic failure: sudden, severe onset of acute liver failure that occurs within 8 weeks after the first
symptoms of jaundice
hepatic encephalopathy: central nervous system dysfunction frequently associated with elevated ammonia levels
that produce changes in mental status, altered level of consciousness, and coma
jaundice: condition where the body tissues, including the sclerae and the skin, become tinged yellow or greenish-
yellow, due to high bilirubin levels
orthotopic liver transplantation (OLT): grafting of a donor liver into the normal anatomic location, with removal of
the diseased native liver
portal hypertension: elevated pressure in the portal circulation resulting from obstruction of venous flow into and
through the liver
sclerotherapy: the injection of substances into or around esophagogastric varices to cause constriction,
thickening, and hardening of the vessel and stop bleeding xenograft: transplantation of organs from one species
to another
Written by Abel Saboke ()
,NOTES:
-
Written by Abel Saboke ()
, Chapter 50: Assessment and Management of Patients with Biliary Disorders
OBJECTIVES:
1. Identify the structure and function of the biliary tract and pancreas.
2. Describe the pathophysiology, clinical manifestations, and medical management of cholelithiasis.
3. Use the nursing process as a framework for care of patients with cholelithiasis and those undergoing
laparoscopic or open cholecystectomy.
4. Differentiate between acute and chronic pancreatitis.
5. Apply the nursing process as a framework for care of patients with acute pancreatitis.
6. Explain the nutritional and metabolic effects of surgical treatment of tumors of the pancreas.
GLOSSARY:
amylase: pancreatic enzyme; aids in the digestion of carbohydrates cholecystectomy:
removal of the gallbladder
cholecystitis: inflammation of the gallbladder which can be acute or chronic cholecystojejunostomy:
anastomosis of the jejunum to the gallbladder to divert bile flow
cholecystokinin (CCK): hormone; major stimulus for digestive enzyme secretion; stimulates contraction of the
gallbladder
cholecystostomy: surgical opening and drainage of the gallbladder
choledocholithiasis: stones in the common bile duct choledochostomy:
opening into the common bile duct cholelithiasis: calculi in the
gallbladder
dissolution therapy: the use of medications to break up/dissolve gallstones endocrine:
secreting internally; hormonal secretion of a ductless gland
endoscopic retrograde cholangiopancreatography (ERCP): procedure using fiberoptic technology to visualize the
biliary system
exocrine: secreting externally; hormonal secretion from excretory ducts
lipase: pancreatic enzyme; aids in the digestion of fats lithotripsy:
disintegration of gallstones by shock waves pancreatitis: inflammation of the
pancreas; may be acute or chronic
secretin: hormone responsible for stimulating bicarbonate secretion from the pancreas; also used as an aid in
diagnosing pancreatic exocrine disease
steatorrhea: frothy, foul-smelling stools with a high fat content; results from impaired digestion of proteins and
fats due to a lack of pancreatic juice in the intestine
trypsin: pancreatic enzyme; aids in the digestion of proteins
Written by Abel Saboke ()
Chpt 48, 49, 50, 51 + 52
Chapter 48: Assessment and Management of Patients with Obesity
OBJECTIVES:
1. Describe the causes, classifications, and diseases and disorders associated with obesity.
2. Identify strategies aimed at preventing and treating obesity, including lifestyle modification, pharmacologic
therapy, and nonsurgical interventions.
3. Explain nursing management considerations for the patient with obesity using nonsurgical interventions.
4. Compare and contrast surgical modalities indicated to treat patients with obesity in terms of preoperative,
postoperative, and long-term management and complications.
5. Use the nursing process as a framework for care of patients who undergo bariatric surgical procedures.
GLOSSARY:
adiposopathy: dysfunction of adipose tissue that causes chronic inflammation and disease bariatric: relating to
obesity; term derives from two Greek words meaning “weight” and “treatment” body mass index (BMI): a
weight-to-height ratio, calculated by dividing weight in kilograms by height in meters squared; the most
common measure used to classify and diagnose obesity
dumping syndrome: physiologic response to rapid emptying of gastric contents into the jejunum, manifested by
nausea, weakness, sweating, palpitations, syncope, and possibly diarrhea
dysphagia: difficulty swallowing
genome: the total complement of individual genes in an organism microbiome: the
collective genome of all microbes in a microbiota microbiota: the complement of
microbes in a given environment
obesity: a disease characterized by an abnormal or excessive accumulation of body fat that impairs health
obesogenic: a factor that promotes weight gain and obesity orexigenic: a
factor that stimulates appetite
satiety: feeling of having eaten sufficient quantities of food
NOTES:
-
Written by Abel Saboke ()
,Chapter 49: Assessment and Management of Patients with Hepatic Disorders
OBJECTIVES:
1. Identify the metabolic functions of the liver and the alterations that occur with hepatic disorders.
2. Explain liver function tests and the clinical manifestations of liver dysfunction in relation to pathophysiologic
alterations of the liver.
3. Relate jaundice, portal hypertension, ascites, varices, nutritional deficiencies, and hepatic encephalopathy
and coma to pathophysiologic alterations of the liver.
4. Describe the medical, surgical, and nursing management of patients with esophageal varices.
5. Compare the various types of hepatitis and their causes, prevention, clinical manifestations, management,
prognosis, and home health care needs.
6. Use the nursing process as a framework for care of the patient with cirrhosis of the liver.
7. Differentiate between the nonsurgical and surgical management of patients with cancer of the liver.
8. Specify the postoperative nursing care of the patient undergoing liver transplantation.
GLOSSARY:
ascites: an albumin-rich fluid accumulation in the peritoneal cavity asterixis:
involuntary flapping movements of the hands
cirrhosis: a chronic liver disease characterized by fibrotic changes, the formation of dense connective tissue within
the liver, subsequent degenerative changes, and loss of functioning cells
constructional apraxia: inability to draw figures in two or three dimensions
endoscopic variceal ligation (EVL): procedure that uses a modified endoscope loaded with an elastic rubber band
passed through an overtube directly onto the varix (or varices) to be banded to ligate the area and stop
bleeding
fetor hepaticus: sweet, slightly fecal odor to the breath, presumed to be of intestinal origin; prevalent with the
extensive collateral portal circulation in chronic liver disease
fulminant hepatic failure: sudden, severe onset of acute liver failure that occurs within 8 weeks after the first
symptoms of jaundice
hepatic encephalopathy: central nervous system dysfunction frequently associated with elevated ammonia levels
that produce changes in mental status, altered level of consciousness, and coma
jaundice: condition where the body tissues, including the sclerae and the skin, become tinged yellow or greenish-
yellow, due to high bilirubin levels
orthotopic liver transplantation (OLT): grafting of a donor liver into the normal anatomic location, with removal of
the diseased native liver
portal hypertension: elevated pressure in the portal circulation resulting from obstruction of venous flow into and
through the liver
sclerotherapy: the injection of substances into or around esophagogastric varices to cause constriction,
thickening, and hardening of the vessel and stop bleeding xenograft: transplantation of organs from one species
to another
Written by Abel Saboke ()
,NOTES:
-
Written by Abel Saboke ()
, Chapter 50: Assessment and Management of Patients with Biliary Disorders
OBJECTIVES:
1. Identify the structure and function of the biliary tract and pancreas.
2. Describe the pathophysiology, clinical manifestations, and medical management of cholelithiasis.
3. Use the nursing process as a framework for care of patients with cholelithiasis and those undergoing
laparoscopic or open cholecystectomy.
4. Differentiate between acute and chronic pancreatitis.
5. Apply the nursing process as a framework for care of patients with acute pancreatitis.
6. Explain the nutritional and metabolic effects of surgical treatment of tumors of the pancreas.
GLOSSARY:
amylase: pancreatic enzyme; aids in the digestion of carbohydrates cholecystectomy:
removal of the gallbladder
cholecystitis: inflammation of the gallbladder which can be acute or chronic cholecystojejunostomy:
anastomosis of the jejunum to the gallbladder to divert bile flow
cholecystokinin (CCK): hormone; major stimulus for digestive enzyme secretion; stimulates contraction of the
gallbladder
cholecystostomy: surgical opening and drainage of the gallbladder
choledocholithiasis: stones in the common bile duct choledochostomy:
opening into the common bile duct cholelithiasis: calculi in the
gallbladder
dissolution therapy: the use of medications to break up/dissolve gallstones endocrine:
secreting internally; hormonal secretion of a ductless gland
endoscopic retrograde cholangiopancreatography (ERCP): procedure using fiberoptic technology to visualize the
biliary system
exocrine: secreting externally; hormonal secretion from excretory ducts
lipase: pancreatic enzyme; aids in the digestion of fats lithotripsy:
disintegration of gallstones by shock waves pancreatitis: inflammation of the
pancreas; may be acute or chronic
secretin: hormone responsible for stimulating bicarbonate secretion from the pancreas; also used as an aid in
diagnosing pancreatic exocrine disease
steatorrhea: frothy, foul-smelling stools with a high fat content; results from impaired digestion of proteins and
fats due to a lack of pancreatic juice in the intestine
trypsin: pancreatic enzyme; aids in the digestion of proteins
Written by Abel Saboke ()
