Digestion & Metabolism Exam 3 Flashcards
What are the most common causes of drug-induced hepatitis?
Acetaminophen
statins
combining alcohol with these meds
What measures should you teach your patient about preventing drug-induced hepatitis?
no herbals (harmful to liver)
OTC meds
What are the clinical manifestations of acute hepatic failure?
fatigue
anorexia
constipation/diarrhea
chalky/oily stool
ascites
jaundice
hepatic encephalopathy (results in a coma)
Coagulation abnormalities
What diagnostics are used for acute hepatic failure?
ammonia level
drug screen
CT/MRI
increased PT & INR (bleeding)
increased bili
increased AST/ALT
What is the normal ammonia level?
15-45
What are the priority nursing interventions for acute hepatic failure?
neuro & ICP assessments
paracentesis (ascites)
liver transplant (only tx for acute liver failure)
monitor for new onset of restlessness, confusion, & deteriorating LOC
monitor airway, resp status, ET tube & oral airway
daily weights & abdominal girth
assess pain
What medications should be used for acute liver failure?
lactulose (decrease ammonia)
beta-blockers or vasoconstrictors (varices)
diuretics (ascites)
vit K (risk for bleeding)
What meds should you avoid with acute liver failure?
nephrotoxic meds (NSAIDs)
sedatives (harmful effects on mental status)
What are some potential complications of acute liver failure?
Portal HTN (esophageal varices)
renal failure
neurological deterioration
sepsis
What kind of diet should a patient with acute liver failure be on?
high carb
high protein (low w/ hepatic encephalopathy)
moderate fat
fluid restriction
possibly enteral feedings
What vitamins should pts with acute liver failure take?
thiamine
folate
B12
vit. A D E K (fat-soluble)
What is esophageal varices caused by?
portal vein hypertension
What are the clinical manifestations of esophageal varices?
hematemesis
melena
hypotension
tachycardia
decreased H & H
What is the #1 priority intervention for esophageal varices?
Control bleeding to prevent hemorrhage & hypovolemic shock
What are the nursing interventions for esophageal varices?
large-bore IV access
monitor for tachycardia and hypotension
watch for bleeding and H & H
educate pt on not straining (coughing, sneezing, alcohol, heavy lifting)
What medications are used to treat esophageal varices?
Beta-blockers: propranolol (vasodilates to decrease the risk of hemorrhage)
Octreotide (reduces bleeding/vasodilates)
Vasoconstrictors (if bleeding)
What treatment procedures are used for esophageal varices?
Banding
TIPS
Balloon Tamponade
What is the banding procedure?
Banding: places rubber band at the base of varices to stop bleeding during an upper endoscopy
What is the TIPS procedure?
TIPS: a catheter is placed in the liver b/w the portal & hepatic vein (helps relieve portal HTN)
What is a balloon tamponade?
EG tube w/ esophageal & gastric balloons are used to compress blood vessels in the esophagus & stomach
What does the upper GI tract contain? What causes acute hemorrhage?
esophagus: varices
stomach: gastric or duodenal-commonly caused by PUD, gastritis, tumors, esophagitis
What does the lower GI tract contain? What causes acute hemorrhage in that area?
Small & large intestine
rectum
anus
causes: diverticulosis, cancer, polyps, IBD, UC
What are the signs of an upper GI tract hemorrhage?
hematemesis: bloody vomit
melena: black tarry stool
What are the signs of a lower GI tract hemorrhage?
hematochezia: bright red bloody stool
abdominal pain
What are the general signs if a GI tract hemorrhage?
cool/clammy skin
restlessness
cap refill >3 sec
rigid abdomen
s/sx of anemia
What are the s/sx that suggest hemodynamic compromise?
pallor
fatigue
chest pain (NOT GOOD)
Palpitations
dyspnea
tachypnea/syncope
Tachycardia
postural changes
What diagnostics are used for a general GI tract hemorrhage?
CBC
BUN
blood type and crossmatch
H. pylori
stool sample
What diagnostics are used specifically for an upper GI hemorrhage?
upper endoscopy (EGD)
NG tube
What diagnostics are used specifically for a lower GI hemorrhage?
Colonoscopy
Endoscopy
Abdominal CT, MRI, X-ray
What are the nursing interventions for an upper GI hemorrhage?
IV fluids
transfusion if needed
Antibiotics (metronidazole)
PPIs to prevent recurrence and treat PUD
What are the nursing interventions for a lower GI hemorrhage?
IV fluids
blood transfusion
NPO during a bleeding episode and usually clear liquids after
What is the major complication of a GI tract hemorrhage? What are the S/SX?
Hypovolemic shock!!
-chest pain
-tachycardia and hypoTN
- pallor
-restlessness
What are the nursing actions for hypovolemic shock?
admin O2 and IVFs
transfuse PRBCs
needs to be in the ICU
What patients are eligible for a liver transplant?
end-stage liver disease
chronic liver disease
Who is not eligible for a liver transplant?
severe cardiac or respiratory diseases
Metastatic malignant liver cancer
alcohol/substance use disorder
What are the nurse’s actions pre-op for a liver transplant?
witness consent
x-ray
enema
shower with chlorhexidine soap
What are the nurse’s actions post-op for a liver transplant?
monitor VS
neuro checks
monitor for infection (fever, redness, drainage)
rejection signs
clotting
What should you educate your patient following a liver transplant?
They will take immunosuppressants for life
Why are patients with acute pancreatitis NPO?
Eating stimulates the release of amylase and lipase
What are the signs of acute pancreatitis?
10/10 epigastric pain radiating to the back and, left flank & shoulder
pain worsens when lying down, the fetal position helps
Turner’s sign
Cullen’s sign
Trousseau’s sign
Chvostek’s sign
tetany
constipation/steatorrhea
What is turner’s sign?
Ecchymosis on flanks (appears blue from the blood pooling)
What is Cullen’s sign?
Bluish-gray discoloration around the belly button
What is trousseau’s sign?
hand spasm when BP cuff is inflated
What is Chvostek’s sign?
facial twitching when the facial nerve is tapped
What are the priority nursing interventions for acute pancreatitis?
ABCs
rest the pancreas!! NPO!!
consider TPN
NG tube to empty the stomach so no more enzymes are released
FLUIDS!!!
monitor glucose (may need insulin)
What meds can be given to help w/ pancreatitis?
antiemetics to help w/ N/V
antibiotics
What are the potential complications of acute pancreatitis?
hypovolemia
pancreatic infection
type 1 diabetes
MODS
What is pyloric stenosis/intestinal obstruction?
an obstruction/hardening between the stomach & small intestine
can be due to tumor’s, hernias, impactions, diverticulitis
What are the s/sx of pyloric stenosis & intestinal obstruction?
projectile vomiting
palpable olive size mass in RUQ
abdominal pain & distention
signs of dehydration
hypoactive bowel sounds
What are the diagnostics for pyloric stenosis & intestinal obstruction?
ABGs: indicate metabolic alkalosis
X-ray
Endoscopy (cause of obstruction)
CT scan (cause and exact location of the obstruction)
ultrasound
What is diverticulitis?
Inflammation of the bowel where bacteria, food or fecal matter is trapped in the little pockets causing an infection
What is diverticulosis?
small pouches form in the intestinal wall but do not always lead to an infection
What are the clinical manifestations of diverticulitis and diverticulosis?
Diverticulosis is usually asymptomatic
-constipation/straining could lead to herniation
N/V
LLQ pain
fever/chills
tachycardia
What are the priority actions for severe symptoms of diverticulitis?
NPO
NG tube suctioning
IV fluids
IV antibiotics
opioids for pain
assess for s/sx of peritonitis
What should you educate your patient on regarding diverticulitis/diverticulosis?
NO popcorn, seeds, nuts
clear liquid diet until symptoms subside, then progress to a low-fiber diet
add fiber to the diet when solid foods are tolerated w/o side effects
avoid alcohol and fatty foods
What is a bowel perforation?
puncture to the GI tract due to an ulcer, infection, or surgical procedure
obstruction in the bowel causing contents to be released into the interstitial space and into the blood stream
What are the s/sx of bowel perforation?
severe epigastric pain across abd.
abd. tender & rigid (boardlike/stiff)
hypoactive bowel sounds
hypoTN, tachycardia, fever, N/V
What are the nursing interventions for bowel perforation?
NPO and go to surgery
monitor for peritonitis, infection and signs of sepsis
What is dumping syndrome?
A shift of fluid to the abd. which is triggered by rapid gastric emptying to high-carb ingestion
-food is moving too fast to the small intestine
What are the s/sx of dumping syndrome?
symptoms can occur 10-90 min after eating
feeling full
weakness
diaphoresis
tachycardia
hypoTN
abd. cramps
Late sign: hypoglycemia
What should you educate your patient on with dumping syndrome?
lie down after eating to delay gastric emptying
eat small frequent meals (5-6)
no liquids with meals (wait 30 min after meals)
What kind of diet should a patient with dumping syndrome be on?
high protein
high fat
low fiber
low-moderate carb diet
avoid milk & sugars
What medication can be given to help dumping syndrome?
Octreotide
given SQ to help manage symptoms
blocks gastric acid and pancreatic hormones
