Ischemic Bowel for Progressive Care Certified Nurse (PCCN)
Included In This Lesson
Outline
Ischemic Bowel
Definition/Etiology:
- Definition
- (Ischemic Bowel leads to infected bowel. Time is tissue)
- Ischemia = 75% reduction in intestinal blood flow for more than 12 hours.
- Infarction = dead tissue
- The sooner ischemic bowel disease is treated, the more favorable the outcome.
- Etiology – Insufficient blood flow
- Arterial embolism or thrombosis
- Atherosclerosis
- Afib – not as common as CVA, but possible
- Mechanical Occlusion
- Trauma
- Including Direct colon surgery or laparoscopic surgery, too
- Trauma
- Non Occlusive Ischemia
- Hypovolemia
- Arterial embolism or thrombosis
Pathophysiology:
- Pathophysiology
- Intestines supplied by 3 arteries
- Superior and inferior messetaries
- celiac artery = collateral supply
- Mesenteric Vessels are uniquely reactive to several intrinsic and extrinsic factors affecting blood flow.
- Ischemic Attack
- Mucosal sloughing
- Tissue in contact with gut contents
- SEPSIS
- Ulceration begins
- Breakdown of epithelium
- hemorrhage can occur within 3 hours
- Mucosal sloughing
- Intestines supplied by 3 arteries
Noticing: Assessment & Recognizing Cues:
- Subjective – Rapid Onset
- Weak
- Abdominal Cramping & pain
- Nausea & Vomiting
- Frequent urge to defecate
- Objective
- Vitals
- ↓ BP, ↑ fever
- Abdomen: Ischemia vs Infarct
- Distended (Early)/Rigidity(Late)
- Diminished (Early)/Absent bowel sounds (Late)
- Vitals
Interpreting: Analyzing & Planning:
- Labs
- CBC (WBC) – Infection
- Increased Amylase – acute bowel inflammation
- Increased Lactate – Sepsis
- Diagnostics
- Abdominal X Ray/CT – obstruction/ assess for free air
- Abd US – arterial occlusion
- Radiographic Angiography – Blood supply to in the mesenteries to the intestines
Responding: Patient Interventions & Taking Action:
- Pharmacological Interventions
- Anticoagulation – Thrombosis
- Volume replacement – Shocky
- Antibiotics – Infection
- Non-Pharmacological Interventions
- NG tube – gastric decompression
- Angiogram – open occluded vessel = Perfusion
- 2nd Option is TPA within 8 hours of symptoms
- Hemorrhage watch
- 2nd Option is TPA within 8 hours of symptoms
- SURGERY – bowel resection
- May wake up with colostomy
Reflecting: Evaluating Patient Outcomes:
- Anticoagulation or embolic lysis for thrombosis-related ischemia
- Complication = hemorrhage
- Restore fluid and electrolyte balance
- Septic Shock. Bowels are DIRTY!
- Urine output = #1 sign of organ perfusion
- Pain Management
- Ischemia = PAIN
- Not too much = slows the bowels
- Find the sweet spot!
Linchpins (Key Points):
- Notice
- Rapid Acute abdominal symptoms.
- Early vs late
- Interpret
- Labs & Diagnostics
- Help find cause
- Angiography – fix problem right there!
- Labs & Diagnostics
- Respond
- Pharmacology = Etiology. Expect IV Abx
- Reflect
- Restore Perfusion or Colostomy
Transcript
Reference
- AACN, & Hartjes, T. (2023). AACN Core Curriculum for Progressive and Critical Care Nursing (8th ed.). Elsevier Health Sciences (US).
- Dennison, R. D., & Farrell, K. (2015]). Pass PCCN!. Elsevier Health Sciences (US).
- Kupchik, N. (2017). Ace The Pccn®!: You can do it!: Practice question review book. Nicole Kupchik Consulting, Inc.
- Stone, L. M. (2018). Certification and Core Review for High Acuity, Progressive, and Critical Care Nursing (7th ed.). Elsevier Health Sciences (US).
- Trivium Test Prep. (2019). Pccn review book 2019-2020: Pccn Study Guide and Practice Test Questions for the Progressive Care Certified Nurse Exam.
NCLEX
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