NR 226 MID Exam 3

NR 226 MID Exam 3 3 types of urgencies - - Elective Urgent Emergent Ablative Surgery - -Removal, especially by cutting with a laser or electrocautery. (Appendix, cholecystectomy, amputation) Palliative Surgery - -Used to improve a patient's quality of life by easing pain or other symptoms. (Colostomy, debridement of necrotic tissue) Procurement for transplant - -Kidney, heart, liver transplant Constructive - -Repair of cleft palate, heart defect Priorities for the first 24 hours include maintenance of: - -o Respiratory o Circulatory o Neurological status o Pain control ABC - -Airway, Breathing, Circulation Surgical openings are created in the small intestine with the ends of the intestine brought through the abdominal wall to create the stoma - -Ileostomy Bypasses the entire large intestine. As a result, stools are frequent and liquid. - Ileostomy Pts. with ileostomies are more at risk for _____________________ due to the acidity of the stool (It is more acidity because of the acid from the stomach) - -Skin breakdown A colostomy of the _____________ colon have stools that are frequent and liquid (just like stools of an ileostomy) - -ascending A colostomy of the______________ colon generally results in a more solid, formed stool - -transverse A colostomy of the _______________ colon or sigmoid colon releases a near-normal stool - -descending -Are temporary in the transverse colon, usually in emergent situations. NUR 226 NUR 226 -A surgeon pulls a loop of the bowel onto the abdomen and an external supporting device is placed under the bowel loop to prevent it from slipping back into the abdomen (to keep it at the surface of the abdomen) -The surgeon then cuts a slit into the loop colon and sutures it to the abdomen wall -The supporting device is removed in 7-10 days - -Loop colostomy -This procedure is permanent -The proximal end of the incision of the bowel forms the stoma. -The Distal end is either removed or sewn closed (called Hartmann's Pouch) and left in the abdominal cavity - -End colostomy -The bowel is surgically cut, and both ends are brought through the abdominal wall -The proximal end releases stool whereas the distal end stays inactive and releases mucous -When the intestinal injury has healed, the colostomy is reversed, and the divided ends are brought back together - -Double-barrel colostomy created using the pts. small intestine, changing its cylindrical shape into a spherical reservoir or pouch. This procedure is occasionally used in the treatment of ulcerative colitis. The pouch has a continent stoma (a nipple type valve) that is drained with an external catheter. In other words, a pouch is created outside the small intestine. The intestine fills with stool and is only released when the valve is opened and drained. - -Kock Continent Ileostomy when muscles in the abdomen detach or tear and portions of the intestine protrude through these tears in muscle tissue - -Hernia when the bowel protrudes through the stoma opening at abnormal lengths - -Prolapse stoma is flush or below skin level Causes leakage problem - -Retracted Stoma caused by food and contents of the bowel Typically get cramps and no stoma output - -blockage •marginal or unsupported grief (socially unacceptable) •Their relationship to the deceased person is not socially sanctioned, cannot be openly shared, or seems of lesser significance NUR 226 •Examples include the death an ex-spouse, a gay partner, or a pet or death from a stigmatized illness such as alcoholism or during the commission of a crime - Disenfranchised grief •Physically present but psychologically unavailable •Occurs when the lost person is physically present but not psychologically available, as in cases of severe dementia or severe brain injury. Other times the person is gone (e.g., after a kidnapping or as a prisoner of war - -Ambiguous grief Kübler-Ross stages DABDA - -Denial Anger Bargaining Depression Acceptance Numbing Yearning/seeking Disorganization and despair Reorganization - -Bowlby Theory •Protecting the person from the full impact of loss •It is characterized by the lack of feeling or feeling stunned by the loss; may last a few days or many weeks. - -Numbing (Bowlby Theory) •Acute distress •It is characterized by emotional outbursts of tearful sobbing and acute distress. - Yearning/Seeking (Bowlby Theory) Disorganization and despair (Bowlby Theory) - -•Examines loss and expresses anger •An individual endlessly examines how and why the loss occurred. •Accepting change with new role or skill •During this phase, which sometimes requires a year or more, the person begins to accept unaccustomed roles, acquire new skills, and build new relationships - Reorganization (Bowlby Theory)