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Respiratory care may range from close monitoring of arterial blood gases to use of humidified oxygen to intubation and mechanical ventilation (see Chap fungal nail treatment proven 2mg kytril. The patient who undergoes pancreatic surgery may have multiple drains in place postoperatively as well as a surgical incision that is left open for irrigation and repacking every 2 to 3 days to remove necrotic debris medicine 2015 song effective kytril 2 mg. Medical Management Management of the patient with acute pancreatitis is directed toward relieving symptoms and preventing or treating complications symptoms 5 dpo order 1mg kytril. All oral intake is withheld to inhibit pancreatic stimulation and secretion of pancreatic enzymes medicine organizer box trusted kytril 2 mg. Parenteral nutrition is usually an important part of therapy, particularly in debilitated patients, because of the extreme metabolic stress associated with acute pancreatitis (Dejong, Greve & Soeters, 2001). Nasogastric suction may be used to relieve nausea and vomiting, to decrease painful abdominal distention and paralytic ileus, and to remove hydrochloric acid so that it does not enter the duodenum and stimulate the pancreas. Morphine and morphine derivatives are often avoided because it has been thought that they cause spasm of the sphincter of Oddi; meperidine (Demerol) is often prescribed because it is less likely to cause spasm of the sphincter (Porth, 2002). Triple-lumen tubes consist of ports that provide tubing for irrigation, air venting, and drainage. If the episode of pancreatitis occurred during treatment with thiazide diuretics, corticosteroids, or oral contraceptives, these medications are discontinued. The pain of acute pancreatitis is often very severe, necessitating the liberal use of analgesic agents. Meperidine (Demerol) is the medication of choice; morphine sulfate is avoided because it causes spasm of the sphincter of Oddi (Porth, 2002). The patient is maintained on parenteral fluids and electrolytes to restore and maintain fluid balance. Nasogastric suction is used to remove gastric secretions and to relieve abdominal distention. The nurse provides frequent oral hygiene and care to decrease discomfort from the nasogastric tube and relieve dryness of the mouth. The acutely ill patient is maintained on bed rest to decrease the metabolic rate and reduce the secretion of pancreatic and gastric enzymes. If the patient experiences increasing severity of pain, the nurse reports this to the physician because the patient may be experiencing hemorrhage of the pancreas, or the dose of analgesic may be inadequate. The patient with acute pancreatitis often has a clouded sensorium because of severe pain, fluid and electrolyte disturbances, and hypoxia. Therefore, the nurse provides frequent and repeated but simple explanations about the need for withholding fluid intake and about maintenance of gastric suction and bed rest. Frequent changes of position are necessary to prevent atelectasis and pooling of respiratory secretions. Pulmonary assessment and monitoring of pulse oximetry or arterial blood gases are essential to detect changes in respiratory status so that early treatment can be initiated. The nurse instructs the patient in techniques of coughing and deep breathing to improve respiratory function and encourages and assists the patient to cough and deep breathe every 2 hours. Laboratory test results and daily weights are useful in monitoring the nutritional status. In addition to administering parenteral nutrition, the nurse monitors serum glucose levels every 4 to 6 hours. Between acute attacks, the patient receives a diet high in carbohydrates and low in fat and proteins. In addition, the patient who has undergone surgery, has had multiple drains inserted, or has an open surgical incision is at risk for skin breakdown and infection. The nurse assesses the presence of pain, its location, its relationship to eating and to alcohol consumption, and the effectiveness of pain relief measures. A history of gastrointestinal problems, including nausea, vomiting, diarrhea, and passage of fatty stools, is elicited. The nurse assesses the abdomen for pain, tenderness, guarding, and bowel sounds, noting the presence of a board-like or soft abdomen. It also is important to assess respiratory status, respiratory rate and pattern, and breath sounds. Normal and adventitious breath sounds and abnormal findings on chest percussion, including dullness at the bases of the lungs and abnormal tactile fremitus, are documented. The nurse assesses the emotional and psychological status of the patient and family and their coping, because they are often anxious about the severity of the symptoms and the acuity of illness. Chapter 40 Assessment and Management of Patients With Biliary Disorders 1139 drainage sites, and skin for signs of infection, inflammation, and breakdown.

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A conservative surgical treatment of internal hemorrhoids is the rubber-band ligation procedure treatment 4 sore throat cheap 2mg kytril. The hemorrhoid is visualized through the anoscope medicine quiz safe kytril 1 mg, and its proximal portion above the mucocutaneous lines is grasped with an instrument symptoms 4 days post ovulation kytril 2mg. Tissue distal to the rubber band becomes necrotic after several days and sloughs off medications peripheral neuropathy quality 1 mg kytril. Fibrosis occurs; the result is that the lower anal mucosa is drawn up and adheres to the underlying muscle. Although this treatment has been satisfactory for some patients, it has proven painful for others and may cause secondary hemorrhage. Cryosurgical hemorrhoidectomy, another method for removing hemorrhoids, involves freezing the hemorrhoid for a sufficient time to cause necrosis. Although it is relatively painless, this procedure is not widely used because the discharge is very foul smelling and wound healing is prolonged. The previously described methods of treating hemorrhoids are not effective for advanced thrombosed veins, which must be treated by more extensive surgery. Hemorrhoidectomy, or surgical excision, can be performed to remove all the redundant tissue involved in the process. During surgery, the rectal sphincter is usually dilated digitally and the hemorrhoids are removed with a clamp and cautery or are ligated and then excised. After the operative procedures are completed, a small tube may be inserted through the sphincter to permit the escape of flatus and blood; pieces of Gelfoam or Oxycel gauze may be placed over the anal wounds. It is commonly associated with recent anal-receptive intercourse with an infected partner. Symptoms include a mucopurulent discharge or bleeding, pain in the area, and diarrhea. The pathogens most frequently involved are Neisseria gonorrheae (53%), Chlamydia (20%), herpes simplex virus (18%), and Treponema pallidium (9%) (Yamada et al. Symptoms are similar to proctitis but may also include watery or bloody diarrhea, cramps, pain, and bloating. Enteritis involves more of the descending colon, and symptoms include watery, bloody diarrhea; abdominal pain; and weight loss. Samples are taken with rectal swabs, and cultures are obtained to identify the pathogens involved. The treatment of choice for bacterial infections is antibiotics (ie, cefixime, doxycycline, and penicillin). Antibiotics of choice for Campylobacter infection are erythromycin and ciprofloxacin. It may also be formed congenitally by an infolding of epithelial tissue beneath the skin, which may communicate with the skin surface through one or several small sinus openings. Hair frequently is seen protruding from these openings, and this gives the cyst its name, pilonidal (ie, a nest of hair). The cysts rarely cause symptoms until adolescence or early adult life, when infection produces an irritating drainage or an abscess. In the early stages of the inflammation, the infection may be controlled by antibiotic therapy, but after an abscess has formed, surgery is indicated. After the acute process resolves, further surgery is performed to excise the cyst and the secondary sinus tracts. Gauze dressings are placed in the wound to keep its edges separated while healing occurs. Bulk laxatives such as Metamucil and stool softeners are administered as prescribed. The patient is advised to set aside a time for moving the bowels and to heed the urge to defecate as promptly as possible. It may be helpful to have the patient perform relaxation exercises before defecating to relax the abdominal and perineal muscles, which may be constricted or in spasm. The nurse identifies specific psychosocial needs and individualizes the plan of care.

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