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Nursing Semester 3 > Cyndi - Week 4 - Exam 2 > Flashcards

Cyndi - Week 4 - Exam 2 Flashcards

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1
Q

what is bilirubin?

A

yellow‐colored compound, produced when hemoglobin is broken down (by spleen)

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2
Q

what is unconjugated bili?

A

water insoluble, transported to liver by albumin

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3
Q

what is conjugated bili?

A

changed to soluble by liver
• A component of bile
• Excreted in stool and urinef

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4
Q

where is bile formed and what does it do?

A

formed in hepatocytes (if liver damaged → problem)

• aids in fat digestion in the small intestine

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5
Q

where is bile excreted/reabsorbed?

A

Some excreted in stool, some reabsorbed in portal vein

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6
Q

what is in bile? where is it stored?

A
  • Contains conjugated bilirubin

* Stored in gallbladder

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7
Q

T/F the body makes 750 - 1000 mL of bile and holds in the gallbladder

A

TRUE

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8
Q

what is the gallbladder?

A

a storage place for bile

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9
Q

how does the gallbladder know when to release bile?

A

• Stimulated to release bile into the duodenum by secretion of CCK (cholecystokinin - digestive enzymes -stomach msg from fat to get bile)

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10
Q

what are the three common gallbladder problems?

A 
Motility disturbances
biliary sludge (so concentrated/thick → can turn into stones → no movement)
biliary stasis (no movement)
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11
Q

what is cholelithiasis?

A

‐ presence of gallstones in gallbladder

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12
Q

what is cholecystitis?

A

‐ gallbladder inflammation, obstruction, infection
• Biliary Sludge
• Biliary colic

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13
Q

what is choledocholithiasis?

A

• Gallstones occluding the common bile duct

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14
Q

what are the risk factors for gallbladder dysfunction?

A
  • Age >40
  • Female gender, estrogen level, multiparous
  • Low calorie diets (stressing system)
  • Fatty, high cholesterol foods
  • Obesity, sedentary lifestyle
  • Disturbances in metabolism (Diabetics, Pregnant, multiparous, menopausal, or using birth control using pills)
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15
Q

what is an easy way to remember the risk factors (5 F’s)?

A
  • female
  • > 40
  • fertile
  • fat
  • flatulance
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16
Q

what are the clinical manifestations of acute cholecystitis?

A
  • RUQ pain – guarding, radiation
  • May occur after a meal
  • Murphy’s sign (radiating pain)
  • Fever (inflammation)
  • Nausea, vomiting, anorexia
  • Jaundice may occur
  • Rupture of gallbladder relieves pain!
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17
Q

TEST: what are the main clinical manifestations for acute cholecystitis?

A

N + V + A

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18
Q

what are the clinical manifestations of chronic cholecystitis?

A
  • Chronic inflammation
  • Calculi
  • Fibrosis or thickening of gallbladder
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19
Q

what is acute acalculous cholecystitis?

A
  • inflammation of gallbladder without stones

- could be sludge or viral infection

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20
Q

TEST: what are risk factors of acute acalculous cholecystitis?

A
  • Prolonged immobility or fasting (not moving)
  • TPN (no food - gallbladder not effective)
  • Diabetes (hormones/insulin ↑/↓; infect easier)
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21
Q

what are the complications of cholecystitis?

A
  • Choledocholithiasis
  • Gangrenous gallbladder
  • Pancreatitis
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22
Q

what are the diagnostic labs of cholecystitis?

A
  • WBCs
  • Erythrocyte sedimentation rate (ESR), C‐reactive protein (CRP) -inflammation
  • Liver function tests (ALT,AST, Bilirubin,Alk phos)
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23
Q

what are the diagnostic (radiology) tests of cholecystitis?

A
  • AbdominalCT, MRI, X‐ray, and/or ultrasound
  • Hepatobiliary iminodiacetic acid (HIDA scan, aka cholecystogram)
  • Endoscopic retrograde cholangiopancreatography (ERCP)
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24
Q

what is the acute care admission treatment indications for cholecystitis?

A

• NPO/ possible NGT for bowel and pancreas rest
• IV fluids
• Meds
TEST bowel rest and IVF

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25
Q

what meds are used for acute cholecystitis?

A
  • ATBs
  • antiemetics
  • PPIs
  • Questran (removes cholesterol → body doesn’t have to respond to fat)
  • oral meds to dissolve gallstones,
    pain meds –dilaudid recommended (morphine, codeine can cause spasms)
  • anticholinergics (slow motility)
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26
Q

what are the procedures to treat cholecystitis? (5)

A

• ERCP, Extracorporeal Shockwave Lithotripsy (ESWL), T‐tube, intraoperative cholangiography, direct cholelitholysis therapy

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27
Q

what are the surgery decisions for cholecystitis?

A
  • open versus laparoscopic removal of the gallbladder

• Post‐op lap chole may have referred pain due to the CO2 used during surgery

28
Q

what is the discharge teaching for cholecystitis?

A
  • May need dietary changes initially, with small meals, ↓ fat
  • Short tem activity restrictions, may shower in 1‐2 days
29
Q

what are the functions of the pancreas?

A

exocrine function and endocrine function

30
Q

what are the exocrine functions of the pancreas? TEST

A

Pancreatic juices –

Amylase, lipase, trypsin (protein), elastase, phospholipase A, kallikrein

31
Q

what are the endocrine functions of the pancreas?

A

Islets of Langerhans
• Alpha cells (glucogon)
• Beta cells (insulin)
• Delta cells (hormone that inhibits release of A+B)

32
Q

what is pancreatitis?

A

acute or chronic inflammation

•Acute (reversible) versus chronic (progressive‐fibrosis)

33
Q

what are the risk factors of pancreatitis?

A
  • Genetic (ie: cystic fibrosis)
  • Trauma (penetrating wound)
  • Alcohol abuse***
  • Biliary tract dysfunction
  • Men and women equal risk
  • Viruses
  • Hypercalcemia, hypertriglyceridemia
  • Toxins (ie: smoking, insecticide exposure, etc.)
34
Q

what are the characteristics of the inflammatory process of pancreatitis?

A

acute inflammatory response

multi-organ failure - pancreatic enzyme in area of pancreas - liver, stomach, lungs - at risk for ARDS***

35
Q

what are the characteristics of the obstruction of pancreatic ducts?

A
  • Pancreatic ischemia
  • Gallstones
  • Autodigestive effects (Pancreas enzymes in the wrong area cause destruction)
36
Q

T/F 5 - 10% of chronic alcohols get pancreatitis

A

TRUE - ↑ digestive enzymes released too quickly and too much

37
Q

what are clinical manifestations of acute pancreatitis?

A
  • Severe pain, epigastric; may radiate to back
  • Nausea, vomiting
  • Abdominal distention (fluids backing up), hypoactive sounds, changes in stool from fat malabsorption
  • Diaphoresis
  • Dyspnea, shallow respirations (hurts)
  • Low grade fever
  • Tachycardia
  • Hypotension (fluids in wrong place → shock)
  • Jaundice
  • Leukocytosis (↑ WBC → fight off infection)
  • GreyTurner, Cullen’s sign
38
Q

what is Grey Turner sign?

A

bluish flank discoloration - leaking through; not in the right place - at risk for shock

39
Q

what is Cullen’s sign?

A

bluish peri-umbilical discoloration - at risk for shock

40
Q

what are the clinical manifestations of chronic pancreatitis?

A 
Progressive or recurring
•Persistent or recurrent mid‐epigastric pain  
•“Heavy”
•“Cramp like”
•Weight loss
•Malnutrition
•Hyper‐ or hypoglycemia
•Steatorrhea – “foul, fatty, frothy” stools
41
Q

where is chronic pancreatitis most prevalent? test

A

age 30 - 40 years old

- 3x more common in African Americans and those that smoke

42
Q

what is an important teaching to give patients with chronic pancreatitis?

A
  • must have enzymes with every meal and snack

* *test**

43
Q

what are the diagnostic labs for pancreatitis?

A
  • Amylase
  • Lipase
  • Glucose
  • Calcium
  • WBCs
  • Triglycerides
  • AST/ALT
  • Ranson Criteria (tool to assess severity of pancreas upon admission then 24-48 hrs later)
44
Q

what are the diagnostic tests (radiology) for pancreatitis?

A 
•CT scan
•Ultrasound
•HIDA scan
•MRI (magnetic resonance imaging)
•ERCP (endoscopic retrograde
cholangiopancreatography)
•MRCP (magnetic resonance
cholangiopancreatography
45
Q

what is the tx for pancreatitis?

A
  • Pain management
  • IV fluids – usually 200‐250 mL/hour
  • NPO – introduce low‐fat small meals ‐ slowly after pain improves
  • NG tube – possible if vomiting or ileus, or to reduce pancreatic secretions
  • Medications
46
Q

what meds are used to tx pancreatitis?

A

o TPN (possibly‐for sustained or recurrent)
o Pancreatic enzymes (when taking po, if needed),
o Others for symptoms

47
Q

what is the patient education for pancreatitis?

A
  • stop drinking
  • resources (AA, Family member)
  • pancreatic enzymes
  • prevent complications
48
Q

what are the complications of pancreatitis?

A

ARDS, pneumonia, hypoglycemia, hyperglycemia, pseudocyst, shock, necrotic pancreas

49
Q

what are the characteristics of pancreatic cancer?

A

Poor prognosis
•Death within 5‐12 months
• 5% survival to 5 years
• peak 65 - 80 y/o

50
Q

what are the clinical manifestations of pancreatic cancer?

A

same as pancreatitis
• Severe pain, epigastric; may radiate to back
• Nausea, vomiting
• Abdominal distention (fluids backing up), hypoactive sounds, changes in stool from fat malabsorption
• Diaphoresis
• Dyspnea, shallow respirations (hurts)
• Low grade fever
• Tachycardia
• Hypotension (fluids in wrong place → shock)
• Jaundice
• Leukocytosis (↑ WBC → fight off infection)
• GreyTurner, Cullen’s sign

51
Q

what are the risk factors of pancreatic cancer?

A
  • High‐fat diet, red meat, nitrites
  • Smoking ‐ 2‐3X more likely
  • Age
  • Diabetes
  • Exposure to chemicals
  • Family history/genetic predisposition (5‐10%)
52
Q

what are the 4 diagnostic tests used for pancreatic cancer?

A 
• Tumor markers in serum (Elevated CA 19‐9 and CEA tumor marker)
• CT
• Transabdominal ultrasound
• Endoluminal ultrasound (EUS) - Alternative to CT and more refined
• Endoscopy
- Visualize obstruction of ducts
- ERCP (gold standard)
- Biopsy
- Samples of pancreatic secretion
53
Q

what is the treatment for pancreatic cancer?

A
  • Patient care same as for pancreatitis
  • Medications – same as for pancreatitis
  • Combination treatment
54
Q

what are the surgical options for pancreatic cancer?

A

Radical Pancreaticoduodenectomy or Whipple procedure

55
Q

what is the combination treatment for pancreatic cancer?

A

•Radiation therapy
- Shrink tumor
- Pain relief ‐palliative
•Chemotherapy has limited success (response rates <15%)

56
Q

what is a whipple procedure (radical pancreaticoduodenectomy)?

A

Removal of head of pancreas, gallbladder, duodenum, part of stomach, lymph nodes → Reconnection of remaining pancreas and digestive organs

57
Q

TEST: what’s the most common procedure to treat cholecystitis?

A

lap chole

58
Q

TEST: what’s the highest priority of taking care of someone with pancreatic cancer?

A

pain

59
Q

TEST: what kind of treatment would you have for pancreatic cancer?

A

palliative
radiation
chemo
Whipple

60
Q

TEST: if someone has had a chole, other than giving them pain meds, what’s a NI you would wanna do?

A
  • move

- Cough, Turn, Deep breath q 2 hr

61
Q

TEST: why does a patient have clay colored stools?

A

bile isn’t getting there → bilirubin

62
Q

TEST: where is the pain for acute pancreatic pain?

A

epigastric pain

63
Q

TEST where does pain radiate for pancreatitis? gallbladder?

A

back and right shoulder

64
Q

TEST: what do lipase and amylase do?

A

digest fat and starches

65
Q

TEST: Teaching point for pancreatitis?

A

stop drinking

66
Q

TEST: gallbladder teaching?

A

small, frequent meals

lower fat

67
Q

TEST: if they show up with cholecystitis?

A

N + V + A

- guarding

Nursing Semester 3 (29 decks)

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