MEDICAL SURGICAL NURSING 1

Division OF Nursing / Second year

Dr. HIND AFANDY

 Basic Human Needs
Definition:
A need is anything that is essential for human' existence that is necessary for a
person's survival.
Hierarchy:
Hierarchy means that in any list of items some items are classed as more important
than others.
Maslow's Hierarchy of Human Needs:
Abraham Maslow identified in 1968 five basic level of basic human needs that are
arranged in the order of priority for satisfaction.
Basic Human Needs:

Needs Example
Physiological Oxygen, water, food, temperature (shelter and clothing),
elimination, sleep, activity and sex.
Safe and security feelings of security of body, employment, heath
Love /belonging Feeling of belonging, love relationships, and friendship.
Self-esteem Feeling of confidence, achievement, respect of others
Self -acturization Creativity, problem solving and acceptance of facts

1. Physiological needs:
They are the lower-level needs. They have the highest priority overall the
other needs because they are essential to life. They include the needs for air,
food, water, temperature maintenance, rest or sleep, elimination, sexuality,
and avoidance of pain. some physiological needs are more important to
survive than others e.g the need for oxygen takes priority over the need for
the food or water. Also, the body can survive longer without food than
without water.
A primary nursing function is to meet these needs as they are vital to the
survival of patients.

2. Safety and security needs:

These needs come next in priority. They can be aliened through adequate
shelter and protection from harmful factor in the environment. Safety means
physical as well as psychological safety. Individual usually feel most secure in
a familiar environment e.g. home with people they can trust and the things
they can knew.

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 As important function of the nurse is the promotion of patient's physical
safety and emotional security in a health care setting E.G bed railing for an
unconscious patent.
3. Love and belonging needs:
Once individuals ar satisfied with the basic physiological safety and security
needs, they seek their need for love and belonging (higher level needs). these
needs include understanding, group acceptance, affection, well desires the
companionship and recognition of his family or friends.
The nurse should always consider love and belonging needs of the patients
by way of care and by establishing a nurse -client relationship based on
mutual understanding and trust.
4. Self-esteem needs:
It is necessary to feel pride, to feel a sense of accomplishment, in what one
does and to believe that others also share this regard. Self-esteem gives the
individual confidence, independence, worth, strength adequacy, usefulness
and importance.
Lack of self esteem gives a feeling of inferiority, inadequacy weakness and
helplessness. The feeling of self dislike leads to frustration and sense of
failure.
Nurses can meet patient's self esteem needs by accepting their values and
beliefs, encourages them to set attainable goals and facilitating support
support by family or friends.
5. Self-actualization needs:
Self-actualization is the highest level of human needs. when the need for self-
esteem is satisfied the individual strives for self-actualization, of one's
potential through full development of one's unique capabilities. Cognition
(the need to know and understand) is a strong desire of a human being. The
intelligent individual seeks information, analysis it, and searches for her or
himself.
The nurse must focus on the strength and capabilities rather than on problem
to meet patient's self-actualization needs. She must aim at caring the total
individual need (holistic care) and must provide a sense of hope to maximize
his potentials.

Goals for patients experiencing unmet psychological needs:

1. Improve self-steem
2. Establish trusting relationships.
3. Develop social skills.
4. Cope with losses

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 ❖ socio-cultural dimension:
As social creatures, all people rely on others to some extent. "the need for others
seems as vital to our health as food and shelter.
Social connections are correlated with positive health outcomes.
It is difficult for some people to ask for help or to accept helped.
It is important for nurses to assess client's degree of dependence.
Maintain equilibrium between client's needs for dependence and independence.
Encourage active participant in treatment rather than a passive recipient of care.
Nurses empower clients by teaching them and their families how to develop skills for
self- care and for healthier living.
❖ Intellectual dimension:
It consists of cognitive functions as judgment, orientation, memory, and ability to
take in and process information.
Using words easily comprehended by client and appropriate teaching strategies o
developmental level promotes patient leaning.
❖ Spiritual dimension:
• Spirituality is referring to one's relationship with one's self, a sense of
connection with others, and a relationship with a higher power or divine
source.
• Spirituality assists in determining sense of meaning or purpose in one's life.
• Spirituality is a personal, individualized set of beliefs and practices that are
not church related.
Factors that affect spirituality:
1. Family
2. Health status
3. Individuals with spiritually satisfying lives
4. Seriously ill patient may turn to religion for support.
Implication of HUMAN NEED in nursing practice:
Knowledge of human needs helps nurses to:
❖ Understand themselves, so that they can meet their personal needs outside
the health care setting. E.g maintenance of body temperature.
❖ Set priorities as in giving care e.g working and playing will assume a low
priority during a period of critical illness.
❖ Better to understand patient's behavior so that they can respond
therapeutically rather than emotionally.

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 ❖ Relieve the distress of patients, e.g helping patient to meet his unmet need of
love and affection.
❖ To get used to all ages and in all health care setting both at heath and illness.
It is an approach for holistic nursing care.
❖ Help client to develop and grow e.g nurse can help clients to move towards
self-actualization by helping them to find meaning on their illness experience.
❖ Provide a framework and be applied the nursing process at the individual and
family level.

Nursing Process

Definition of Nursing Process:

Is a critical thinking process that professional nurses use to apply the best available
evidence to caregiving and promoting human functions and responses to health and
illness.
It is systemic method of providing care to clients.
Purposes of Nursing Process:
1. To identity a client's health status and actual or potential health care
problems or needs.
2. To establish plans to meet the identified needs.
3. To deliver specific nursing intervention to meet those needs.
Characteristics of Nursing Process:

• Systemic and Cyclic

• Dynamic nature
• Centeredness
• Focus on problem solving and decision making.
• Interpersonal Collaborative style
• Universal applicability
• Client centeredness
Components of nursing process:
It involves the following.
1. Assessment (data collection)
2. Nursing diagnosis
3. Planning

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 4. Implementation
5. Evaluation

ASSESSMENT
Definition:
Assessment is the systematic and continuous collection, organization, validation
and documentation of data (information)
Types of assessment:
The four different types of assessment are:
1. Initial nursing assessment.
2. Problem-focused assessment
3. Emergency assessment
4. Time-lapsed reassessment
1.initial nursing assessment: performed within specified time after admission. to
establish a complete database for problem identification.
e.g nursing admission assessment
2. problem focused assessment: to determine the status of a specific problem
identified in an earlier assessment.
e.g hourly checking of vital signs of fever.
3- emergency assessment: during emergency status to identify any life-threatening
situation.
e.g rapid assessment of an individual's airway, breathing status, and circulation
during a cardiac arrest.
4-time-lapsed reassessment: several months after initial assessment. To compare
the client's current health status with the data previously obtained.

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 Data Collections
Definition:
Data collection is the process of gathering information about a clint's health status.
-it includes the health history,physical examination, results of laboratory and
diagnosis tests, and material contributed by other health personnel.

Types of Data:
There are two types of data collections:
1. Subjective data, also referred to as symptoms or covert data, are clear only to
the person affected and can be described only by that person.
Examples: itching, pain, and felling or worry.
2- Objective data, also referred to as signs or overt data, are detectable by an
observer or can be measured or tested against an accepted standard. They
can be seen, heard, felt, or smelled, and they are obtained by observation or
physical examination.
For example: a discoloration of the skin or a blood pressure reading.

SOURCES OF DATA
Sources of data are primary or secondary.
1.Primary: it is the direct source of information.
The client is the primary source of data.
2.secondary: it is the indirect source of information.
All sources other than the client are considered secondary sources. Family
members, health professionals, records and reports, laboratory and
diagnostic results are secondary sources.

Methods of data collection

. the methods used to collect data are observation, interview, and

examination.

❖ Observation: it is gathering data by using the senses, vision, smell

and hearing are used.
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 ❖ Interview: an interview is a planned communication or a
conversation with a purpose.
There are two approaches to interviewing:
1-the direct interview: is highly structured and directly ask the
questions. And the nurse controls the interview.
2-A nondirective interview: or rapport building interview and the
nurse allows the client to control the interview.
Stages of an interview:
An interview has three major stages:
1. The opening or introduction
2. The body or development
3. The closing
❖ Examination: the physical examination is a systematic data collection
method to detect health problems.
❖ To conduct the examination, the nurse uses techniques of inspection,
palpation, percussion and auscultation.

Organization of Data

The nurse uses a format that organizes the assessment data systematically. This is
often referred to as nursing health history or nursing assessment form.

Validation of Data

The information gathered during the assessment is 'double-checked' or verified to

confirm that it is accurate and complete.

Documentation of Data

To complete the assessment phase, the nurse records client data. Accurate
documentation is essential and should include all data collected about the client's
health status.

DIAGNOSIS

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Definition:

Diagnosis is the second phase of the nursing process.

In this phase, nurses use critical thinking skills to interpret assessment data to
identify client problems.

The official NANDA definition of a nursing diagnosis:

A clinical judgment concerning a human response to health conditions/ life

processes, or a vulnerability for that response, by an individual family, group, or
community.

Status of the Nursing Diagnosis

The status of nursing diagnosis is actual, health promotion and risk.

1-An actual diagnosis: is a client problem that is present at the time of the nursing
assessment.

2-A health promotion diagnosis: relate to client's preparedness to improve their

health condition.

A risk nursing diagnosis is a clinical judgement that a problem does not exist, but the
presence of risk factors indicates that a problem may develop If adequate care is not
given.

Component of a NANDA Nursing Diagnosis

A nursing diagnosis has three components:

1- The problem and its definition

2- The etiology
3- The defining characteristics

1-the problem statement describes the client's health problem.

2-the etiology component of a nursing diagnosis identifies causes of the health

problem.

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3-defining characteristics are the cluster of signs and symptoms that indicate the
presence of health problem.

Formulating Diagnostic Statements

The three-part Nursing diagnosis statement is called the PES format and includes the
following:

1. Problem: statement of the client's health problem (NANDA Label)

2. Etiology: causes of the health problem
3. Signs and symptoms: defining characteristics manifested by the client

For example:

Acute pain related to abdominal surgery as evidenced by patient discomfort and

pain scale.

Problem Etiology Sings & symptoms

Pain Surgery of Pain scale and discomfort of patient
abdomen
Differentiating nursing diagnosis from medical diagnosis:

Nursing diagnosis Medical diagnosis

A nursing diagnosis is a statement of A medical diagnosis is made by a
nursing judgment that made by nurse, physician
by their education, experience, and
expertise, are licensed to treat
Nursing diagnosis describe the human Medical diagnosis refers to disease
response to an illness or a health processes
problem.
Nursing diagnosis may change as the A client's medical diagnosis remains the
client's responses change same for as long as the disease is
present.

PLANNING

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Definition:

Is the process of formulating client goals and designing the nursing interventions
required to prevent, reduce, or eliminate the clients' health problems.

Types of Planning:

1. Initial planning
2. planning
3. Ongoing Discharge planning.

1-Initial planning:

Planning which is done after the initial assessment.

2-ongoing planning:

It is a continuous planning.

3-discharge planning:

Planning for needs after discharge.

Planning Process

Planning includes:

• Setting priorities
• Establishing client goals/ desired outcomes
• Selecting nursing interventions and activities
• Writing individualized nursing interventions on care plans

Setting Priorities

• The nurse begins planning by deciding which nursing diagnosis requires

attention first, which second, and so on.
• Nurses frequently use Maslow's hierarchy of needs when setting priorities.

Establishing Client goals/ desired outcomes

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After establishing priorities, the nurse set goals for each nursing diagnosis. Goals
may be short term or long term.

Nursing Interventions

A nurse intervention is any treatment, that a nurse performs to improve patient's

health.

 -Types of nursing intervention:

1. Independent interventions: are those activities that nurses are licensed
to initiate based on their knowledge and skills.
2. Dependent interventions: are activities carried out under the orders or
supervision of a licensed physician.
3. Collaborative interventions: are actions the nurse carries out in
collaboration with other health team members.

Writing individualized nursing intervention:

After choosing the appropriate nursing interventions, the nurse writes them on the
care plan.

Nursing care plan is a written or computerized information about the client's care.

IMPLEMENTATION

Implementation consists of doing and documenting the activities.

The process of implementation includes:

1- Implementing the nursing interventions

2- Documenting nursing activities

EVALUATION

Definition:

is a planned Evaluation, ongoing purposeful activity in which the nurse determines:

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 a- The client's progress toward achievement of goals/ outcomes
b- The includes effectiveness of the nursing care plan.

The evaluation:

✓ Comparing the data with desired outcomes

✓ Continuing, modifying, or terminating the nursing care plan.

CRITICAL THINKIHNG AND PROBLEML SOLVING

Definition of critical thinking:

It means the use of knowledge and skills to make the best decision possible in
patient's care situation and to increase the probability of a desirable outcome.

Definition of problem solving: is one type of critical thinking skill.

Critical thinking skills:

1. Gathering data
2. Identify the problem.
3. Decide what outcome.
4. Plan what to do.
5. Implement the plan of care.
6. Evaluate the plan care.

Hemostasis

Definition:

It means stoppage o f bleeding.

The process of hemostasis occurs due to:

1- Vascular spasm
2- Formation of platelet plug
3- Blood clotting

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(1)-Vascular spasm:

Vascular spasm result from contraction of smooth muscles of the blood vessels wall

Reflex contraction occurs due to:

• Local contraction as an inherited phenomenon of smooth muscles

• Factors secreted from injured site and platelets e.g endothelin
thromboxane A2
• Muscle contraction by nerve signal.

The opposite endothelial surfaces approximate and sticks to each other and seal off
the injured site in the vessels temporarily.

Vascular spasm is proportional to the degree of injury.

(2)-Formation of platelet plug:

Platelet normally don’t adhere to the smooth vessel wall.

After injury endothelial surface become rough and it is collagen exposed, so platelets
attach to the collagen and become active

The attached platelets contract and release ADP and thromboxane A2

These substances make the platelets stick and attract other platelets into the site of
injury.

Platelets start to aggregate and form a plug.

More ADP and thromboxane A2, is released and more aggregates formed until the

injury site is sealed.

• The platelet plug seal the injured site temporarily.

• It becomes permanent when coagulation process started, and the plug is
reinforced by fibrin threads.

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 Blood Clotting (coagulation)

-coagulation is the body's most powerful hemostatic mechanisms.

-it involves the formation of a cot on top of the platelet plug to seal off the break in
the vessel permanently

-coagulation is a chain reaction (cascade form of reactions) involving plasma proteins

(clotting factors) in the plasma.

-most of the clotting factors are synthesized by the liver and remain inactive in the
plasma.

-once one factor is activated the process continue in a cascade form.

-two pathways are involved in coagulation: the extrinsic and intrinsic pathways.

- the final steps of coagulation:

• Platelets that entrapped in the fibrin mesh, secrete stabilizing factor and
contract using their action and myosin fibrils.
• This lead to express of fluids (serum) from the clot and approximation of the
vessel ends.
• The clot become hard, and the vessel is sealed.

Stress and Stressor

Definition:

Stress: is a state produced by a change in environment that is perceived as

challenging, threatening or damaging to person's dynamic balance or equilibrium.

Stressor: a stressor is an internal or external event or situation that creates the

potential for physiologic, emotional, cognitive, or behavioral changes in an
individual.

Classification of Stressors:

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 1. Physical stressors include as cold, heat, chemical agents...act
2. Physiologic stressors include as pain and fatigue.
3. Psychosocial stressors: as of failing and examination and losing a job.

Stressor have also been classified as:

1- Day-to-day frustrations or daily hassles: having argument with a spouse.

2- Daily hassles: can lead to increase BP, palpitations, or other physiologic
problems.
3- Major complex occurrences: involving large groups as terrorism and war.
4- Stressors that occur less frequently and involve fewer people include death,
birth, marriage, divorce, and retirement, have a permanent functional
disability.

A stressor can also be categorized according to duration. It may be:

❖ Acute, time-limited stressor, as studying for final examinations.

❖ Stressor sequence: a series of stressful events result from initial event as job
loss.
❖ Chronic intermittent stressor, such as daily hassles.
❖ Chronic enduring stressor persists over time, as chronic illness, a disability, or
poverty.

Stress can be also:

-positive: provide sense of urgency and alertness needed for survival when meeting
threatening situation e.g graduation, marriage.

-negative: excessive, prolonged unrelieved stress leads to harmful effects.

Causes of stress:

A)-Environmental:

1.inadequate housing.

2.noise

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3.color: exposure to red light lead to increase BP, exposure to blue has opposite
effect.

4.pollution.

5.poverty

6.crowdign

B-life events and pace of change

Death of postdivorce and retirement

C-personal relationship:

Parent child relationship, neighbor relationship

Successful relationship depends on:

✓ Communication
✓ Listening
✓ Respects self and other
✓ Realistic expectation

D-Occupational stress

Example: overwork, under-work, conflict, and relationship at work

E-Characteristics behavior patterns of type a & b personalities

F-unrealistic expectations.

Factors influencing the manifestation of stress:

1. Age of individual
2. Number of stressors
3. Nature of stressor
4. Perception of stressor
5. Duration of exposure to stressor
6. Previous experience with stressor
7. The type of personality

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Indicators of stress.

A-COMMON SIGNS & SYMPTOMS OF STRESS:

Exposure to excessive result in hormonal imbalance which can produce a variety of

symptoms:

a)-Physiological symptoms:

1. cardiovascular/ respiratory effects:

o Increased pulse
o Increased blood pressure
o Palpitation
o Rapid, shallow breathing

2.neuollogic effects:

o Dizziness, fainting
o Headaches
o Dilated pupils
o Tingling in hand and feet

3.gasrointestinal effects:

o Nausea and vomiting

o Altered appetite.
o Diarrhea or constipation
o Indigestion

4.genitourinary effects:

o Polyuria

5.musculoskeletal effects:

o Tension of muscles
o Pain in defferent body parts
o Twitching

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b)-psychological symptoms:

o Irritability
o Depression
o Feeling sad
o Tearfulness
o Impatience

c)-cognitive:

o Lack of concentration
o Disorientation
o Confusion
o Poor decision making
o Impaired memory
o Impaired judgment
o Delayed response time

D)-Behavioral symptoms:

o Nail biting
o Pacing
o Withdrawal
o Insomnia
o Restlessness
o Sweaty palms
o Rapid speech
o Appetite changes (eat too much or too little)

E)-Spiritual:

o Alienation
o Social isolation
o Feeling of emptiness

Responses to stress

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Compenatory or defense mechanisms are initiated to help individual cope with the
stressors through psychological and physiological responses.

A-PSYCHOLOGICAL RESPONSES TO STRESS:

1-appraisal of the stressful event:

a. Primary appraisal: identified situation as non-stressful .

-if non-stressful, the situation is benign(positive)
-a stressful situation may be : harm or loss, threatening or challenging

b. secondary appraisal : evaluation of what might and can be done about this
situation. Action include:

-blame to responsible for a frustrating event

-thinking about coping potential and determining future expectancy.

-reappraisal, a change of opinion based on new information.

-stored information learned from an adaptation to be used in future.

2-Coping with the stressful event:

a. Emotion focus coping: feel by better by lessening emotional distress.

b. Problem focused coping aims to make direct changes in the environment.
c. Both types of coping usually occurs in a stressful situation.

B)-PHYSIOLOGIC Response to stress:

Cascade of neural and hormonal events to maintain homeostatic balance.

a- Increase of blood pressure

b- Increase of heart rate
c- Cold clammy skin
d- Increase muscle tension.
e- Increase mental activity.

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 Adaptation

Definition of adaption:

Adaption is a constant, ongoing process that requires a change in structure, function,

or behavior to respond to changing condition in both internal and external
environment.

Phases of general adaption syndrome consist of:

1-alarm reaction stage

-Neuro-endocrine system is activated. Body is prepared physiologically for

sympathetic fight or flight response with optimum oxygenation and circulation. The
alarm reaction is defensive and anti-inflammatory but self-limited.

2-Resistance reaction stage:

In this stage body is adapting to stressor by neutralizing or destroying the threat.

Physiological process diminished through cycles of negative feedback.

3-exhaustion reaction stage:

Occur when the body is unable to neutralize the threat and if exposure to stressor is
prolonged and endocrine activity increases. It produces deleterious effects on body
systems (circulatory, digestive, and immune system)

Interpretation of stressful stimuli by the brain:

Physiologic responses to stress are mediated by the brain through a complex

network of chemical and electrical messages.

Maladaptive responses to stress:

It is chronic, recurrent response over time that does not promote the goals of
adaption.

• Maladaptive responses include faulty appraisal and inappropriate coping.

• Other forms of inappropriate coping include denial, avoidance, and
distancing.

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 Inflammation

Definition:

Is a process by which the body's white blood cells and the mediators defends the body
from harmful agents, such as bacteria and viruses.

Types and symptoms:

There are two main types of inflammation:

1-Acute inflammation:

Definition:

It is the immediate and ealy response to injury, designed to deliver leuckocytes to the
site of injury.

Signs of acute inflammation

1- Pain: this may occur continuously or only when a person touches the affected
area
2- Redness: this happens because of an increase in the blood supply to the
capillaries in the area
3- Loss of function: there may be difficult moving a joint, breathing, sensing
smell and so on
4- Swelling: a condition called edema can develop if fluid builds up
5- Heat: increased blood flow may leave the affected area warm to the touch

Sometimes inflammation is silent without symptoms. Apperson may also feel tired,
generally unwell and have a fever.

Symptoms of acute inflammation last a few days. Subacute inflammation lasts 2 – 6

weeks.

Chronic Inflammation:

Definition:

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It is considered to be an inflammation of prolonged duration (weeks to months or
years) in which active inflammation tissue injury and healing proceed
simultaneously.

Chronic inflammation can continue for months or years. It either has or may have
links to various diseases. Such as: DM, CVD, Allergies, rheumatoid arthritis. The
symptoms will depend on the disease, but they may include pain and fatigue.

MEASURING INFLAMMATION

When inflammation is present in the body, there will be higher level of substances
knowns as biomarkers.

And example of a biomarkers is C-reactive protein (CRP) .if a doctor wants to test for
inflammation, they may assess CRP levels.

CRP levels tend to be higher in older people and those with conditions such as
cancer, and obesity.

Causes:

Inflammation happens when a physical factor triggers an immune reaction.

Inflammation does not necessarily mean that there is an infection, but an infection
can cause inflammation.

 Factors that can lead to acute inflammation:

• Acute bronchitis, appendicitis and other illnesses ending in it is
• An ingrown toenail
• A sore throat from cold or flu
• Physical trauma or wound.

Chronic Inflammation:

Chronic inflammation can develop if a person has.

• Sensitivity: inflammation happens when the body senses something that

should not be there. Hyposensitivity to an external trigger can result in an
allergy.

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 • Exposure: sometimes, long term, low level exposure to an irritant, such as an
industrial chemical, can result in chronic inflammation .
• Autoimmune disorders: the immune system mistakenly attacks normal
healthy tissue, as in psoriasis.
• Autoinflammatory diseases: a genetic factor affects the way the immune
system works.
• Persistent acute inflammation: in some cases, a person may not fully recover
from acute inflammation. Sometimes, this can lead to chronic inflammation,
 Factors that may increase the risk of chronic inflammation include:
1. Older age
2. Obesity
3. A diet that is rich in unhealthy fats and added sugar.
4. Smoking
5. Stress and sleep problems

Complications of chronic inflammation include:

it increases the risk of various diseases such as cancer, rheumatoid arthritis,

atherosclerosis, periodontitis.

Management of acute and chronic inflammation:

1. NSAIDs
2. Pain relief
3. Corticosteroids
4. Immune suppressing drugs
5. Herbal supplements
6. Diet may also help to relieve symptoms of inflammation.

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 SHOCK

Definition.

Is a life-threatening medical condition that occurs when the body is not

getting enough blood flow.

Lack of blood flow means the cells and organs do not get enough oxygen
and nutrients to function properly. Many organs can be damaged as a
result.

Types of shock:

1- Septic shock: result from bacteria multiplying in the blood and

releasing toxins.
Common cause of this is pneumonia, urinary tract infection, skin
infection, intra-abdominal infections (such as appendix)
2- Anaphylactic shock: is a type of severe allergic reaction. Causes
include allergy to insect stings, medicines, or food (nuts, berries, sea
food)
3- Cardiogenic shock: happens when the heart is damaged and unable to
supply sufficient blood to the body. This can be the result of a heart
attack or congestive heart failure.
4- Hypovolemic shock: is caused by sever blood and fluid loss, such as
from traumatic bodily injury, which makes the heart unable to pump
enough blood to the body or severe anemia where there is not
enough blood to carry oxygen through the body.
5- Neurogenic shock: is caused by spinal cord injury, usually because of a
traumatic accident or injury.

There are several main causes of shock:

• Heart conditions (heart attack, heart failure)

• Heavy internal or external bleeding, such as from a section injury or rupture
of a blood vessels
• Dehydration, especially when severe or related to heat illness.

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 • Infection (septic shock)
• Severe allergic reaction (anaphylactic shock)
• Spinal injuries(neurogenic shock)
• Burns
• Persistent vomiting or diarrhea

Symptoms of all shock:

Low blood pressure and rapid heart rate (tachycardia) are the key signs of shock.

Symptoms of all types of shock include:

1- Rapid, shallow breathing

2- Cold, clammy skin
3- Rapid, weak pulse
4- Dizziness or fainting
5- Weakness

Depending on the type of shock the following symptoms may also be observed:

• Eyes appear to stare

• Anxiety or agitation
• Seizure
• Confusion or unresponsiveness
• Low or no urine output
• Bluish lips and fingernails
• Sweating
• chest pain

treatment of shock:

-depending on the type or the cause of the shock. Treatment differ, in general, fluid
resuscitation (giving a large amount of fluid to raise blood pressure quickly) with an
i.v in the ambulance or emergency room is the first-line treatment for all types of
shcok.

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The doctor will also administer medications such as epinephrine, norepinephrine, or
dopamine to the fluids or try to raise a patient's blood pressure to ensure blood flow
to the vital organs.

Do some medical tests:

• X-rays
• Blood tests
• ECG

Will determine the underlying cause of the shock and uncover the severity of the
patient's illness.

Treatments:

1. Septic shock

Is treated with prompt administration of antibiotics depending on the source and

type of underlying infection. These patients are are often dehydrated and require
large amounts of fluids to increase and maintain blood pressure.

2. Anaphylactic shock:

Is treated with diphenhydramine , epinephrine , steroid medications,

methylprednisolone and sometimes a H2 blocker medication (for example,
famotidine, cimetidine.

3. Cardiogenic shock:

Is treated by identifying and treating the underlying cause. A patient with a heart
attack may require a surgical procedure called a cardiac catheterization to unblock
an artry . a patient with congestive heart failure may need medications to support
and increase the force of the heart's bear. In sever or prolonged cases, a heart
transplant maybe the only treatment.

4. Hypovolemic shock:

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Is treated with fluids (saline) in minor cases but may require multiple blood
transfusion in severe cases. The underlying cause of the bleeding must also be
identified and corrected.

5. Neurogenic shock:

Is the most difficult to treat. damage to the spinal cord is often irreversible and
causes problems with the natural regularly functions of the body. Besides fluids and
monitoring, immobilization (keeping the spine from moving), anti-inflammatory
medicines such as steroids, and sometimes surgery are the main parts of treatment.

6. Start I.V cannula.

7. Immobilize the pt. who suspected has a spinal cord injury.

BRAIN TUMOR

Definition:

A brain tumor is a localized intracranial lesion which occupies space with the skull
and tends to cause a rise in intracranial pressure.

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The effect of brain tumors are caused by inflammation, compression, and infiltration
of tissue. A variety of physiologic changes result, and causing any or all of following
pathophysiologic events:

• Increase intracranial pressure and cerebral edema.

• Seizure activity and focal neurologic signs
• Hydrocephalus
• Altered pituitary function.
❖ The cause of primary brain tumors is unknown.

Risk factors of brain tumors:

1. Environmental factors
2. Chemical substances, use of hair dyes
3. Use of cellular telephones
4. Exposure to high tension wires
5. Head trauma
6. Genetic abnormalities

Classification of brain tumors:

A-according to charactristics of tumors:

1-Benign brain tumors BBT

2-Malignant brain tumor

 Benign brain tumor

-BBT do not contain cancer cells, can be removed and they seldom grow back.

-the border or edge of BBT can be clearly seen. Cells do not invade tissues around
them or spread to other parts of the body.

-BBT can press on sensitive areas of the brain and cause serious health problems

-very rarely, a benign brain tumor may become malignant.

 Malignant brain tumors:

28
Malignant brain tumors are generally more serious and often is life threatening.

B-according to causes of the brain tumors classified to:

❖ Primary brain tumors: arising from the tissues within the brain
❖ Secondary: it results from metastasis from a malignant neoplasm that
originates in some other parts of the body.
Signs and Symptoms of Brain Tumors:

Brain tumors can produce either forcal or generalized neurologic signs and
symptoms. Generalized symptoms reflect increased ICP, and the most common focal
or specific signs and symptoms result from tumors interfering with functions in
specific brain regions.

1. Symptoms related to increased ICP such as:

a. Decreased in level of consciousness such as confusion and lethargy.
b. Headache most common in the Ealy morning and made worse by
coughing or staining.
c. Vomiting
d. Papilledema( edema of optic nerve) and visual disturbance.
2. Localized symptoms such as:
a. Aphasia
b. Personality changes as in case of frontal lobe tumor
c. Sensory defects(smell, hearing)
d. Seizures
e. Motor abnormalities

Diagnosis of brain tumor:

• Physical exam
• Neurological examination
• Brain CT scan
• MRI on brain
• Angiogram
• Spinal tap

29
 • Biopsy

Treatment of brain tumor:

❖ A variety of medical treatment modalities, including chemotherapy and

radiotherapy are used alone or in combination with surgical resection.
❖ Supportive care include:
a. Steroids
b. Anticonvulsant drugs.
❖ Surgical treatment:
a. Resection
b. Craniotomy
c. biopsy

Fluid and Electrolyte Imbalances

Definition:

Fluid and electrolyte imbalances occur to some degree in most patients with a major
illness or injury because illness disrupts the normal homeostatic mechanism.

-Some fluid and electrolyte imbalances are directly caused by illness or disease e.g.
burns, heart failure.

-At other times, therapeutic measures (e.g I.V fluid replacement, diuretics) cause or
contribute to fluid and electrolyte imbalances.

Physical signs and symptoms of fluid volume imbalance:

A)-Hypovolemia:

✓ poor skin, dry mucous

✓ flat neck
✓ tachycardia
✓ orthostatic hypotension
✓ weight loss

30
 ✓ hypothermia
✓ sunken eyes
✓ oliguria

B)-Hypervolemia:

✓ shortness of breath at rest or with exertion

✓ hepatojugular reflex.
✓ Ascites
✓ Pitting edema
✓ Weight gain

1.Sodium:

Normal serum sodium level is 135 to 145 mEq/L.

 HYPONATREMIA:

Hyponatremia is defined as: serum sodium levels less than 135Me/L.

Clinical manifestation of hyponatremia:

1.Headache, fatigue, and fever

2.Confusion

3.Seizures and coma

4.muscle cramps

5.nausea and vomiting

6.oliguria, and hypotension

ETIOLOGY:

a. Renal failure
b. Hypothyroidism
c. Pain drugs
d. Adrenal insufficiency
e. Vomiting, diarrhea, and pancreatitis

31
 Treatment:

Water restriction

 HYPERNATREMIA:

Serum sodium greater than145 mEq/L

Signs and Symptoms;

a. Confusion
b. Lethargy
c. Coma
d. Seizures
e. Hyperreflexia

The neurologic symptoms of hypernatremia result from dehydration of brain cells.

Etiology of hypernatremia:

1. Diabetes insipidus
2. Excessive Sweating
3. diarrhea

Treatment:

a. correction of fluid deficit(0,45 saline, 5% dextrose.)

b. oral water replacement of deficit

2.Potassium:

Serum potassium is 3.5 to 5.5 mEq/L

HYPOKALEMIA:

Hypokalemia is defined as serum potassium less than 3,5 mEq/L

ETIOLOGY

1. decrease dietary intake.

2. gastrointestinal losses
3. renal losses

32
Signs and Symptoms of hypokalemia:

1. muscle weakness and paralysis

2. polyuria and polydipsia
3. U- wave, ST depression

Treatment of Hypokalemia:

1. Treatment for hypokalemia initially is aimed at correcting the existing

metabolic abnormalities.
2. Potassium chloride is administered at 10mEq/L/h peripherally or 20 mEq/l/h
centrally if EKG changes are present.
3. Hypokalemia alone rarely produces cardiac arrythmias.

 HYPERKALEMIA

Is defined as serum potassium greatere than 5.1 mEq/L

Causes of hyperkalemia:

a. Excessive renal excretion

b. Blood transfusions

Signs and Symptoms

1. Weakness
2. Flaccid paralysis
3. Cardiac arrest
4. Ventricular fibrillation

Treatment:

1. Calcium gluconate
2. Sodium bicarbonate
3. Sulfonate
4. Dialysis

3.Calcium

33
Normal calcium concentration is 8.8 to 10.5mg/dl.

 HYPOCALCEMIA

Is defined as serum calcium less than 8.5 mg/dl.

Signs and Symptoms:

1. Anxiety
2. Depression
3. Psychosis
4. Tetany

Treatment:

- 1 g calcium (gluconate or chloride ) in 50 ml dextrose5% in water or normal

saline. Intravenous solutions should be infused for 30 minutes.
 HYPERCALCEMIA

Is serum calcium greater than 10.5 mg/dl.

Signs and Symptoms:

• Hypertension
• Bradycardia
• Constipation
• Anorexia
• Nausea and vomiting
• Nephrolithiasis
• Bone pain
• Psychosis
• Pruitus

Treatment:

Treatment include hydration with normal saline, calcitonin, glucocorticoids, and

phosphate.

4.Magnesiium

34
Magnesium concentration in the extracellular fluid ranges from 1.5 to 2.4 mg/dl

 HYPOMAGNESEMIA

Is defined as serum magnesium is lower than 1.5mg/dl

Causes of hypomagnesemia:

1. People with gastrointestinal problems such as crohn's disease

2. D.M
3. Burns
4. Malnutrition

Signs and Symptoms:

1. Abnormal eye movements

2. Convulsions
3. Fatigue
4. Muscle spasms or cramps
5. Muscle weakness
6. Numbness

Treatment

Magnesium replacement.

 HYPERMAGNESEMIA

Is defined as serum magnesium greater than 2.3 mg/dl.

Signs and Symptoms:

1. Respiratory depression
2. Hypotension
3. Cardiac arrest
4. Nausea and vomiting

Treatment:

- Calcium infusion

35
 - Saline infusion with a loop diuretic

Preoperative Care

Preoperative phase:

It is a period when the decision for surgical intervention is made to when the patient
is transferred to the operating room.

Surgical classifications:

Surgery: is performed to correct an anatomical or physiological defect intervention

or to provide therapeutic.

1-According to the degree of urgency:

a. Emergent: patient requires immediate attention; disorder may be life

threatening. without delay
b. Urgent: patient requires prompt attention. Within 24 – 30 hours.
c. required: patient needs to have surgery. Plan within a few weeks or months.
d. Elective: patient should have surgery. Failure to have surgery not
catastrophic.
e. Optional: decision rests with patient. Personal preference.

2-according to the purpose of surgery:

Surgery may be performed for various reasons. A surgical procedure may be:

✓ Diagnostic and exploratory

✓ Curative
✓ Reparative
✓ Reconstructive or cosmetic
✓ Palliative.

Surgical risk factors:

1. Age
2. Nutritional status

36
 3. Medical problems

Nursing intervention in preoperative phase:

❖ Routine preparative diagnostic tests

❖ Preoperative consent
❖ Preoperative psychosocial preparation
❖ Preparative physical preparation
❖ Preoperative teaching
❖ Preoperative medications

Postoperative Care

Postoperative care:

Is the phase that begins at the point when the patient enters the post anesthesia
care unit until they have recovered sufficiently to be transferred from the PACU
and into the appropriate recovery unit or discharged home.

The postoperative care divided into:

 PHASE 1:
The post anesthesia care unit the nurse assess.
• the patient's level of consciousness,
• breath sounds
• respiratory effort and oxygen saturation
• Vital signs
• Patient is being prepared for transfer to an ICU or to the world.
 PHASE 2
• Phase 2 is continued recovery , when the patient's consciousness return to
baseline and the patent has stable respiratory, cardiac and renal functions.
 PHASE 3

37
 • Phase 3 is ongoing care for patient's needs , extended observation and
interventions after phase 1 or 2 such as 24 hours observation unit or in
hospital unit.
• Nursing care continues until the patient completely recovers from anesthesia
and surgery and is ready for self-care.

INTERVENTIONS

1. Monitoring vital signs, airway patency and neurologic status

2. Monitoring for possible complications
3. Assessing and managing pain
4. Assessing the surgical site
5. Assessing and maintaining fluid and electrolyte balance.
6. Providing a thorough report of the patient's status to the receiving nurse on
the recovery unit, as well as the patient's family.

COMPLICATIONS:

a. Respiratory: hypoxemia
b. Cardiac: hypotension, hypertension, and dysrhythmias
c. Thermoregulatory: hypothermia or hyperthermia
d. Gastrointestinal: nausea and vomiting
e. Neurologic: it may occur as a complication of anesthesia
f. Additional complications: pain, surgical site complications, fluid management
and patient's safety.

BREAST CANCER

38
Definition:

It is a disease in which abnormal breast cells grow out of control and form tumors.

- In this type of cancer, the cells in the breast region grow abnormally and in an
uncontrolled way. Through breast cancer is mostly found in women, in rare
cases it is also found in men,
- Breast cancer begins in the lining of the milk duct, sometimes in the lobule.

Risk factors:

The exact cause of breast cancer remains unclear, but some risk factors make it
more likely. It is possible to prevent some of these risk factors.

1. Sex, it occurs in females more than males.

2. Age: more than 85% of women with breast cancer over age of 45.
3. Genetics
4. Multiparity
5. Infertile women
6. Women who have the first child after the age of 34 year.
7. History of breast cancer.
8. Exposure to carcinogenic factors as irradiation.
9. Presence of other cancer in endometrial, colon, rectum, salivary gland, ovary.
10. Immunodeficiency
11. Smoking
12. Contraceptive use

39
Clinical Manifestations:

• Pain in the armpit or breast that doesn’t change with the monthly cycle.
• Lump in the upper lateral quadrant (painless)
• Pitting or redness of the skin of the breast, similar to the surface of an orange
• A rash around or on one of the nipples
• Discharge from a nipple, possibly containing blood.
• A sunken or inverted nipple
• A change in the size or shape of the breast
• Peeling, flaking, or scaling of the skin on the breast or nipple.

Diagnosis evaluation:

1. Clinical breast examination.

2. Imaging tests
3. U/S
4. MRI
5. Biopsy

Management:

A combination of surgery irradiation and chemotherapy are the lines of

management.

Hormone blocking therapy.

Respiratory Tract Disorders

40
1)- Bronchitis

Definition: is an inflammation or swelling of bronchi the air passage between the nose

Causes of bronchitis:

1. Virus or bacteria
2. Smoking
3. People who exposed to a lot indistestrial smoke and secondhand smoke
4. The elderly and infants
5. People with gastroesophageal reflux disease
6. People who are exposed to air pollution.

Signs and Symptoms:

41
 1. Inflammation or swelling of the bronchi.
2. Coughing
3. Production of clear, white, yellow, grey mucus
4. Shortness of breath
5. Wheezing
6. Fatigue
7. Fever and chills
8. Chest pain or discomfort
9. Blocked or runny nose

Types of Bronchitis:

A- Acute bronchitis: is a shorter illness that commonly follows a cold or viral

infection. It lasts a few days or weeks.
B- Chronic bronchitis: is characterized by a persistent mucus producing cough
on most days of the months or the years it is usually related to smoking or
industrial smoke. It lasts of months to years.

Diagnosis of bronchitis:

. physical examination

. nasal swab

. chest X-ray

. Blood tests

. sputum test

Management of Bronchitis:

1. Antibiotics
2. Cough suppressants
3. Anti-inflammatory medications
4. bronchodilators

42
2)-Bronchial Asthma

Definition:

Is a chronic inflammatory disease of the airways that causes airway

hyperresponsiveness, mucosal edema, and mucus production?

the risk factors of asthma:

1. chronic exposure to airway irritants or allergens such as (grass.

Tree and weed pollens, dust or animal dander)

2. exposure to some strong orders

such as perfume and smoke.
3. Overweight
4. To be a negative smoker

Asthma causes:

1. Cold and heat

2. Emotional upsets
3. Sinusitis with postnasal drip
4. Medications (inflammatory drugs such as ibuprofen.
5. Viral respiratory tract infections.
6. Physical activities

Clinical Manifestations:

1. Cough
2. Shortness of breath
3. Chest tightness or chest pain
4. Wheezing when exhaling
5. Dyspnea

43
 6. Tachycardia
7. Asthma attacks often occur at night or early morning.

Diagnosis:

1. Medical history
2. Physical examination
3. Lung function test(spirometry)
4. Chest X-ray

Medical Management of asthma:

1. Bronchodilators
2. Anti-inflammatory drugs.
3.

3)-Emphysema

Definition:

Is a lung disease that result from damage to the walls of the alveoli in the lung.

Cause of emphysema:

1. Cigarette smoking
2. Genetic disorder
3. Secondhand smoke

Signs and symptoms

1. Shortness of breath
2. Chest expansion
3. Hyperventilation

44
Diagnostic evaluation

• Stethoscope
• Chest X-ray
• MRI

Treatment

1- Don’t smoke or stop smoking.

2- Oxygen therapy
3- Bronchodilators
4- Steroids
5- Antibiotics
6- Exercise

4)-Pneumonia

An inflammation process in lung parenchyma usually associated with a marked

increase in interstitial and alveolar fluid.

Types of Pneumonia

1)-hospital acquired pneumonia (HAP): IS define as pneumonia that develops at least

48 hours after a hospital admission

2)-health care associated pneumonia: is pneumonia that develops in outpatient

settings or nursing homes

45
3)-community acquired pneumonia: develops in the community and is usually less
serious than other forms

Causes of pneumonia:

1. Bacterial pneumonia (streptococcus pneumonia, staphylococcus aureus).

2. Viral pneumonia: influenza viruses
3. Fungal pneumonia: candida and aspergillus
4. Aspiration pneumonia: some pneumonias are caused by aspiration of foreign
substances.
5. Ventilator-associated pneumonia: develops in patients who are intubated and
mechanically ventilated.
6. Chemical pneumonia: inhalation of toxic chemicals can cause inflammation
and tissue damage, which can lead to chemical pneumonia.

46
 Risk Factors:

• Very young and adults over age 65.

• People with acquired immunodeficiency syndrome (AIDs)
• Alcoholism
• History of smoking
• Upper respiratory infection
• Tracheal intubation
• Prolonged immobility
• Immunosuppressive therapy
• Cigarette smoking
• Recent viral respiratory infection (common cold, laryngitis, influenza)
• Chronic lung disease
• Difficulty swallowing (due to stroke, dementia)

Clinical Manifestation:

1. Fever.
2. Chillis
3. Sweats
4. Pleuritic chest pain
5. Productive cough
6. Sputum purulent
7. Hemoptysis
8. Hemoptysis
9. Dyspnea
10. Headache and fatigue
11. Crackles and wheezed may be heard on lung auscultation

Diagnosis:

• Physical examination
• Chest X-ray
• Sputum culture

47
 • Blood culture
• CT scan for thorax
• Bronchoscopy with biopsy
• ABG
• Pulmonary function test

Medical Management:

- Specific antibiotic therapy: broad spectrum antibiotics

- Bronchodilators and analgesics may be given for comfort and symptom relief.
- Respiratory support:
a. Administer oxygen.
b. Bronchodilator medication
c. Postural drainage
d. Chest physiotherapy
e. Tracheal suctioning
- Nutritional support
- Fluid and electrolyte management.

5)-Bronchiectasis

Is a condition where damage causes the tubes in the lungs(airways) to widen or

develop punches.

Risk factors:

• Airway obstruction
• Diffuse airway injury
• Pulmonary infections and obstruction of the bronchus or complications of
long-term pulmonary infections
• Genetic disorders such as cystic fibrosis.
• Abnormal host defense e.g., ciliary dyskinesia or abnormal immunodeficiency
• Idiopathic causes

Clinical Manifestation:

48
 • Chronic cough
• Production of purulent sputum in copious amounts
• Hemoptysis
• Clubbing of the fingers
• Repeated episodes of pulmonary infections

Medical Treatment:

• Chest physiotherapy
• Smoking cessation
• Antibiotic
• Take Bronchodilator.

6)-Empyema:

Definition:

Is a cumulating of thick, purulent fluid within the pleural space.

Causes of empyema:

1. It occurs as a complication of bacterial pneumonia or lung abscess.

2. Penetrating chest trauma
3. Nonbacterial infections (it may occur after thoracic surgery or thoracenteses)

Clinical Manifestations:

• Fever
• Night sweats
• Pleural pain
• Cough

49
 • Dyspnea
• Anorexia
• Weight loss

Diagnosis:

1. Chest auscultation
2. Chest x-ray
3. CT scan

Medical Management:

1.drain to the pleural cavity

2.antibiotics 4-6 weeks.

7)-Pleurisy

Definition:

Is an inflammation of both layers of the pleurae (parietal and visceral)

Causes:

Pleurisy may develop in conjunction with pneumonia or an upper respiratory

infection. TB, pulmonary infection, after trauma of the chest and …ect

Clinical Manifestations:

1. Pain that is usually occurs in one side. The pain may be come minimal or absent
when the breath is held, or it may be localized or radiate to the shoulder or
abdomen. Later, as pleural fluid develops, the pain decreases.

Diagnosis:

1-by auscultation of the chest (a pleural friction rub can be heard with
stethoscope)

2. Chet X-ray
3. Sputum examination

50
 4. Thoracentesis to obtain a specimen of pleural fluid.

Medical Management:

- analgesic
- anti-inflammatory drugs
- deep breathing exercises

8)-Pleural Effusion

Definition:

Is a collection of fluid in the pleural space.

Causes of pleural effusion:

1. viral infection
2. heart failure
3. pneumonia
4. lung cancer
5. inflammatory disorders like lupus

Clinical Manifestations:

• fever
• chills
• pleural chest pain
• dyspnea
• coughing
• shortness of breath
1. chest X-ray
2. chest CT scan
3. bacterial culture
4. blood test

Medical Management:

51
 1. detect the underlying cause to manage it.
2. Thoracentesis
3. For malignant pleural effusion pleurectomy is needed

9)-Hemothorax

Definition:

Occurs when pleural space fills with blood.

It is usually occurring due to lacerated blood vessel in thorax

As blood increases, it puts pressure on heart and other vessels in chest cavity.

Causes of hemothorax.

1. Blood clotting disorder

2. Lung cancer
3. Pulmonary infection
4. tuberculosis

Signs and Symptoms:

1. Anxiety/ restlessness
2. Tachypnea
3. Signs of shock
4. Frothy, blood sputum
5. Diminished breath sounds affected side
6. Tachycardia
7. Flat neck veins

Diagnosis:

• Chest X-ray
• CBC
• Physical examination

Medical Management:

1. Secure airways assist ventilation if necessary.

52
 2. General shock care due to blood loss.
3. Consider left lateral recumbent position if not contraindicated.
4. Chest tube
5. Medications as orders.

THORACIC SYRGERY

Definition:

It is any operation in the chest.

Thoracic surgery can include a variety of operations in the thorax which include:

Esophagus, trachea, diaphragm, chest wall (ribs, breastbone, and the muscles around
them), and mediastinum.

-thoracic trauma is a leading cause of death.

Thoracic surgery treats the following conditions:

1. Chest wall tumors
2. Emphysema
3. Pulmonary fibrosis
4. End stage of lung disease

53
 Urinary Tract Infection
1)- Pyelonephritis
Acute pyelonephritis:
Definition:
Is a bacterial infection of the renal pelvis, tubulars, and interstitial tissue of one
or both kidneys.
The causes of pyelonephritis:
It causes by bacterial E. coli.
Signs and symptoms:
1. The pt. appears ill with chilis and fever.
2. Lower urinary tract infection
3. CVA tenderness
4. Dysuria
Medical Management:
1. Antibiotics
2. Antimicrobial agent.

Chronic pyelonephritis:
Repeated of acute pyelonephritis may lead to chronic pyelonephritis.
Signs and symptoms:
1. Fatigue
2. Headache
3. Poor appetite
4. Poly urea
5. Excessive thirst and weight loss
Diagnosis:
1. BUN
2. Renal function tests
Medical Management:
1. Antimicrobial agent
2. Monitoring of renal function.

54
2)-Urolithiasis
Definition:
Refers to stones(calculi) in the urinary tract.
Stones are formed in the urinary tract when urinary concentration of substances
such as calcium oxalate, calcium phosphate, and urine acid increase.
Factors that increase formation of stones:

• Infection
• Urinary stasis
• Cancer
• Excessive intake of vitamin
• Excessive intake of milk and alkali
Clinical Manifestation
Depend on stone location and size
1. Acute renal colic (one of the strongest pain sensation)
Sudden onset of severe pain, at least 50% of patients will also have nausea
and vomiting.
2. Hematuria
3. Urinary frequency, urgency, dysuria, stranguries
4. Fever and chilis because of infection.
Risk Factors:

• Low fluid intake: major factor in stone formation.

• Dietary: get enough dietary calcium limit from animal protein, sodium and
oxalate.
Diagnosis:

• Urine analysis
• Urine culture
• Serum uric acid and calcium level
• X-ray
Medical Management:
✓ The basic goal of management is to eradicate the stone.
✓ Analgesic to relive pain.
✓ Adequate fluid intake
✓ Thiazide diuretics

55
 Gastrointestinal Disorders
1)- Cancer of Esophagus
Risk factors.
1. Smoking
2. Drinking alcohol
3. Obesity
4. unhealthy food
5. not eating enough fruit and vegetables.
symptoms of esophageal cancer:
- difficulty of swallowing
- chest pain, pressure or burning.
- Coughing or hoarsness
- Weight loss without trying
- Worsening indigestion or heartburn
Diagnosis:
1. Endoscope
2. Biopsy
3. Barium swallow
Medical management:
1. surgery: esophagectomy
2. radiation therapy
3. chemotherapy

2)- Hiatus Hernia

Definition:
Herniation of the abdominal part of esophagus or a part of the stomach or both into
the posterior mediastinum through the esophageal hiatus in the diaphragm.
Risk factors:
1. pregnancy
2. obesity
3. getting old age
4. constipation
5. bring born with an unusually large hiatus.
6. injury or trauma to the area such as force
Clinical Picture:

56
 1. heartburn
2. noncardiac chest pain
3. indigestion: feeling full soon after eating with a burning type of abdominal
pain.
4. Burping and regurgitation
5. Difficulty swallowing
6. Sore throat and hoarseness
7. Nausea
8. Shortness of breath
9. Pain in the upper abdomen or the lower chest
Diagnosis:
- By physical examination
- Signs and symptoms
- Gastroscopy
- Barium swallow and meal
-
Management:
- Treatment for hiatus hernia depend on how severe symptoms are. Patient
usually no need treatment at all if it is not causing any problems.
- Surgical treatment is sometimes required to repair large hiatal hernia and
treat heartburn symptoms.
- Antacids and alginates
- Proton pump inhibitors.
3)- Gastritis
Definition:
It is an inflammation of the gastric or stomach mucosa.
Types of Gastritis:
1. Acute gastritis:
It is usually caused by dietary indiscretion. The person eats food that is contaminated
with diseases causing microorganisms.
Other cause is overuse of aspirin, anti-inflammatory drugs, and alcohol intake.
2. Chronic gastritis:
It caused by prolonged inflammation of the stomach or by the bacteria Helicobacter
Pylori. Chronic gastritis sometimes associated with autoimmune disease or dietary
factors such as caffeine, medications, NSAID, alcohol and smoking.
Signs and symptoms

57
 1. Gnawing or burning pain in the upper abdominal part.
2. Abdominal discomfort
3. Nausea and vomiting
4. Headache
5. Hiccupping
6. Anorexia
7. Heartburn
Diagnosis:
It can be determined by endoscopy.
Medical Management:

• Antibiotic medications to kill Pylori's such as clarithromycin and amoxicillin.

• Medication that blocks acid production and promote healing such as
omeprazole.
• Medication that neutralizes stomach acid
4)- Enteritis
Definition:
It is inflammation of small intestine.
Causes of enteritis:'
1. Viral or bacterial infection
2. Food poisoning
Signs and Symptoms:
1. Fever
2. Abdominal pain
3. Diarrhea
4. Nausea and vomiting
5. Loss of appetite
6. Blooding discharge in poop
Diagnosis and tests:

• History
• Signs and symptoms
• Analyze the stool.
• Endoscopy
Management and treatment:

• Rest
• Rehydration
• Antibiotic

58
 Gallbladder Disorders

1)-cholecystitis
Definition:
is an inflammation of the gallbladder.

Signs and symptoms:

• Pain and tenderness

• Rigidity of the upper right abdomen that may radiate to midsternal or right
shoulder.
• Nausea and vomiting
• Clay colored stool
• Very dark color of urine
• Biliary colic

Causes:

1. Calculous cholecystitis is the cause which obstruct bile outflow.

2. Pooling or stasis
3. Obesity
4. Excessive cholesterol intake
5. Infection
6. Frequent changes in weight
 CHOLELITHIASIS

Calculi or gallstones, usually form in the gallbladder from the solid constituents of
bile.

Types:

❖ Cholesterol stone
❖ Pigment stone
❖ Mixed stone

Diagnosis:

1. Abdominal x-ray

59
 2. Ultrasonography

Management:

• Removing of gallbladder (cholecystectomy)

• Nutritional and supportive therapy
• Medicines as orders
• Non-surgical treatment:
Dissolving gallstones
Stone removal by instrumentation
Intracorporeal lithotripsy

60
61