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Ischemic Bowel for Progressive Care Certified Nurse (PCCN)

Ischemic Bowel for Progressive Care Certified Nurse (PCCN)

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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
- Non Occlusive Ischemia
  - Hypovolemia

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

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)

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
- 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!
Respond
- Pharmacology = Etiology. Expect IV Abx
Reflect
- Restore Perfusion or Colostomy

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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.

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pharmacology

Concepts Covered:

Study Plan Lessons

12 Points to Answering Pharmacology Questions

6 Rights of Medication Administration

ACLS (Advanced cardiac life support) Drugs

Adenosine (Adenocard) Nursing Considerations

Amiodarone (Pacerone) Nursing Considerations

Anesthetic Agents

Anti-Infective – Antifungals

Anti-Platelet Aggregate

Antianxiety Meds

Antidepressants

Atenolol (Tenormin) Nursing Considerations

Atropine (Atropen) Nursing Considerations

Bariatric: IV Insertion

Basics of Calculations

Benztropine (Cogentin) Nursing Considerations

Bisacodyl (Dulcolax) Nursing Considerations

Buspirone (Buspar) Nursing Considerations

Carbidopa-Levodopa (Sinemet) Nursing Considerations

Cefdinir (Omnicef) Nursing Considerations

Celecoxib (Celebrex) Nursing Considerations

Codeine (Paveral) Nursing Considerations

Combative: IV Insertion

Complex Calculations (Dosage Calculations/Med Math)

Cyclosporine (Sandimmune) Nursing Considerations

Dark Skin: IV Insertion

Dimensional Analysis Nursing (Dosage Calculations/Med Math)

Diphenoxylate-Atropine (Lomotil) Nursing Considerations

Drawing Blood from the IV

Drawing Up Meds

Drug Interactions Nursing Mnemonic (These Drugs Can Interact)

Eye Prophylaxis for Newborn

Fentanyl (Duragesic) Nursing Considerations

Geriatric: IV Insertion

Giving Medication Through An IV Set Port

Glipizide (Glucotrol) Nursing Considerations

Guaifenesin (Mucinex) Nursing Considerations

Hanging an IV Piggyback

How to Remove (discontinue) an IV

How to Secure an IV (chevron, transparent dressing)

Hydrocodone-Acetaminophen (Vicodin, Lortab) Nursing Considerations

Hydromorphone (Dilaudid) Nursing Considerations

Injectable Medications

Insulin – Long Acting (Lantus) Nursing Considerations

Insulin – Mixtures (70/30)

Interactive Pharmacology Practice

Interactive Practice Drip Calculations

IV Catheter Selection (gauge, color)

IV Complications (infiltration, phlebitis, hematoma, extravasation, air embolism)

IV Drip Administration & Safety Checks

IV Drip Therapy – Medications Used for Drips

IV Infusions (Solutions)

IV Insertion Angle

IV Insertion Course Introduction

IV Placement Start To Finish (How to Start an IV)

IV Pump Management

IV Push Medications

Ketorolac (Toradol) Nursing Considerations

Labeling (Medications, Solutions, Containers) for Certified Perioperative Nurse (CNOR)

Lidocaine (Xylocaine) Nursing Considerations

Magnesium Sulfate

Magnesium Sulfate in Pregnancy

Maintenance of the IV

Mannitol (Osmitrol) Nursing Considerations

Medication Errors

Medication Reconciliation Review for Certified Perioperative Nurse (CNOR)

Medications in Ampules

Meds for Postpartum Hemorrhage (PPH)

Meperidine (Demerol) Nursing Considerations

Methadone (Methadose) Nursing Considerations

Methylergonovine (Methergine) Nursing Considerations

Metoclopramide (Reglan) Nursing Considerations

Montelukast (Singulair) Nursing Considerations

Mood Stabilizers

Nalbuphine (Nubain) Nursing Considerations

Neostigmine (Prostigmin) Nursing Considerations

NG Tube Med Administration (Nasogastric)

NG Tube Medication Administration

Nitro Compounds

NRSNG Live | The S.O.C.K Method for Mastering Nursing Pharmacology and Never Forgetting a Medication Again

Nystatin (Mycostatin) Nursing Considerations

OB Pharm and What Drugs You HAVE to Know – Live Tutoring Archive

Olanzapine (Zyprexa) Nursing Considerations

Opioid Analgesics in Pregnancy

Oral Medications

Oxycodone (OxyContin) Nursing Considerations

Pain Management for the Older Adult – Live Tutoring Archive

Pain Management Meds – Live Tutoring Archive

Parasympathomimetics (Cholinergics) Nursing Considerations

Patient Controlled Analgesia (PCA)

Pediatric Dosage Calculations

Pentobarbital (Nembutal) Nursing Considerations

Pharmacodynamics

Pharmacokinetics

Pharmacokinetics Nursing Mnemonic (ADME)

Pharmacology Course Introduction

Phenobarbital (Luminal) Nursing Considerations

Phytonadione (Vitamin K) for Newborn

Pill Crushing & Cutting

Procainamide (Pronestyl) Nursing Considerations

Propofol (Diprivan) Nursing Considerations

Quetiapine (Seroquel) Nursing Considerations

Ranitidine (Zantac) Nursing Considerations

Rh Immune Globulin in Pregnancy

Sedatives-Hypnotics

Sedatives-Hypnotics

Selecting THE vein

Spiking & Priming IV Bags

Streptokinase (Streptase) Nursing Considerations

Struggling with Dimensional Analysis? – Live Tutoring Archive

SubQ Injections

Supplies Needed

Tattoos IV Insertion

The SOCK Method – C

The SOCK Method – K

The SOCK Method – O

The SOCK Method – Overview

The SOCK Method – S

The SOCK Method of Pharmacology 1 – Live Tutoring Archive

The SOCK Method of Pharmacology 2 – Live Tutoring Archive

The SOCK Method of Pharmacology 3 – Live Tutoring Archive

Tips & Advice for Newborns (Neonatal IV Insertion)

Tips & Advice for Pediatric IV

Understanding All The IV Set Ports

Using Aseptic Technique

Verapamil (Calan) Nursing Considerations

Anti-Infective – Aminoglycosides

Diuretics (Loop, Potassium Sparing, Thiazide, Furosemide/Lasix)

Eye Prophylaxis for Newborn

Eye Prophylaxis for Newborn (Erythromycin)

Lung Surfactant

Lung Surfactant for Newborns

Magnesium Sulfate

Magnesium Sulfate

Magnesium Sulfate in Pregnancy

Meds for Postpartum Hemorrhage (PPH)

Meds for PPH (postpartum hemorrhage)

Opioid Analgesics in Pregnancy

Phytonadione (Vitamin K)

Phytonadione (Vitamin K) for Newborn

Prostaglandins in Pregnancy

Rh Immune Globulin (Rhogam)

Rh Immune Globulin in Pregnancy

Uterine Stimulants (Oxytocin, Pitocin)

Uterine Stimulants (Oxytocin, Pitocin) Nursing Considerations

Atypical Antipsychotics

Benzodiazepines

Anti-Infective – Penicillins and Cephalosporins

Cardiac Glycosides

Corticosteroids

Opioid Analgesics

Sympathomimetics (Alpha (Clonodine) & Beta (Albuterol) Agonists)

AV Blocks Dysrhythmias for Progressive Care Certified Nurse (PCCN)

Cardiopulmonary Arrest

Hypertension (Uncontrolled) and Hypertensive Crisis for Progressive Care Certified Nurse (PCCN)

Rapid Sequence Intubation

ACE (angiotensin-converting enzyme) Inhibitors

Acute Coronary Syndromes (MI-ST and Non ST, Unstable Angina) for Progressive Care Certified Nurse (PCCN)

Anemia for Progressive Care Certified Nurse (PCCN)

Anesthetic Agents

Anesthetic Agents

Angiotensin Receptor Blockers

Antidiabetic Agents

Antineoplastics

AV Blocks Dysrhythmias for Progressive Care Certified Nurse (PCCN)

Calcium Channel Blockers

Coronary Artery Disease Concept Map

Histamine 1 Receptor Blockers

Histamine 2 Receptor Blockers

HMG-CoA Reductase Inhibitors (Statins)

Hypertension (Uncontrolled) and Hypertensive Crisis for Progressive Care Certified Nurse (PCCN)

Hypoglycemia for Progressive Care Certified Nurse (PCCN)

Ischemic Bowel for Progressive Care Certified Nurse (PCCN)

Nitro Compounds

Nursing Care and Pathophysiology for Hashimoto’s Thyroiditis

Parasympatholytics (Anticholinergics) Nursing Considerations

Proton Pump Inhibitors

Tension and Cluster Headaches

Vascular Disease for Progressive Care Certified Nurse (PCCN)

Toxic Ingestion, Inhalation, Overdose for Progressive Care Certified Nurse (PCCN)