ETOH, liver, GB and Pancreas Flashcards
ETOH withdrawal factors
Height r/t blood volume has a greater impact on length of withdrawal rather than BMI
BAC serious complications
> 0.40
Withdrawal time-line
stage 1: 8 hours- anxiety, insomnia, nausea, & abdominal pain
Stage 2: 1-3 days [worst window]: high BP, increased body temp
Stage 3: 1 week: hallucinations, fever, seizures, and agitation
subjective questions to ask regarding alcohol consumption
What are you drinking? How much? What time of day/night?
s/s of withdrawal
1st signs: preemptive neuro increases
Clammy skin, HA, vomiting, anxiety, depression, irritability, fatigue, dilated pupils, sweating, hallucinations (visual/audio)
Pt education for long term effects of ETOH
heart disease: cardiomyopathy (muscle stretch out), arrhythmias, stroke,
Liver disease
Vitamin deficiencies: wernicke’s korsakoff syndrome (vision prob, ataxia, impaired memory)- thiamine deficiency
Cancers: mouth, esophagus, throat, liver, breast
pancreatitis
alcohol withdrawal care plan
seizure precautions, delirium tx, fall risk, benzos, CIWAs, fluids, vitamins
Withdrawal medications and general timeline
Long acting: valium, librium
Short acting: ativan, versed,
Big guns: (need to be transferred to ICU) phenobarbital (IV push x3)
precedex
Wernicke’s encephalopathy
acute neurological condition caused by thiamine deficiency
Wernicke’s s/s
confusion, ataxia, nystagmus
functions of the liver
glucose, drug, protein, and fat metabolism
ammonia conversion, Vitamin/iron storage, bilirubin excretion, bile formation
LFT’s and what they indicate
ALT (alanine aminotransferase)- liver disorders, hepatitis, cirrhosis, and Rx toxicity
HIGH IF DRUG/MED OD
AST (aspartate aminotransferase)- present in death of tissues (heart, liver, skeletal, kidney)- also Hep, cirrhosis, liver cancer
ALK phos (alkaline phosphatase)- blockage in bile ducts, liver cancer, hepatitis, cirrhosis, hepatotoxic meds
Serum Proteins- albumin, -globulins, bilirubin, ammonia, clotting factors; also used for dx of liver disease
GGT (gamma-glutamyl transferase)- alcoholic liver disease, cholestasis
Jaundice
Bilirubin > 2.0 mg/dL
- Hemolytic: RBC lysis, liver can’t excrete quick enough (anemia, transfusion rxn)
- hepatocellular: dysfunction, unable to clear bilirubin due to unhealthy liver cells (hepatitis, viral infections, epstein-barr, alcohol, toxins)
- obstructive: obstruction in bile tree
(hepatitis, cholecystitis)
Hepatitis B transmission
blood, mucosal (semen, vaginal secretion), mother to infant
Hepatitis C transmission
IV, needle sticks, parenteral route
Who’s at risk for Hep B?
close contact with carrier, healthcare workers, hemodialysis pt, IV injection drug use, multiple sexual partners, tattooing
Hep B manifestations
1-6 month incubation
fever, arthritis, rashes, loss of appetite, dyspepsia, abdominal pain, generalized aching, malaise, weakness, jaundice (light colored stools, dark urine)
Cirrhosis
replacement of normal tissue with fibrotic tissue
- disrupts function and normal structure: necrosis, scar tissue overruns functioning liver tissue
- “hobnail appearance”
Alcoholic Cirrhosis intake
- 60-80g/daily for men
- 40-60g/daily for women
expected lab values for cirrhosis
Elevated: AST and ALT, serum globulin, pt/INR, bilirubin
Lowered: albumin and platelets
What to monitor in pt with cirrhosis?
bleeding, encephalopathy (mentation- due to NH3 buildup, causes confusion), fluid volume excess (increased CO, fluid retention)
labs: plasma proteins
Ascites: dyspnea, abdominal girth
I/Os: third spacing, weights, edema
Portal HTN
increased pressure in the portal venous system. Obstruction of blood flow in and throughout liver
Ascites assessments
- percussion: dullness = fluid
- fluid wave
- abdominal growth
- weights
- fluids (I/O), e- imbalance
Ascites Rx tx
diuretics: torsemide (works for truncal edema/ascites- can lead to hyponatremia), furosemide (extremities)
Ascites mgmt
- monitor e-
- PO intake, UO observation
- weights
- abdominal girth
- blood work: albumin, Cr, e-, liver enzymes
- mentation (worsens with lowering potassium
RN interventions before/after a paracentesis
before: vitals, client weight, at bedside, empty bladder to avoid accidental perforation
after: Vitals, dressing, insertion site, abdominal pain, BR
Cholecystitis
inflammation of the gallbladder
s/s of cholecystitis
tenderness, pain (midsternal R shoulder), n/v, empyema (pus in gallbladder), 90% r/t calculi- causes edema and compressed blood vessels, gangrene and perforated gallbladder
-50% infected r/t E. coli, klebsiella, streptococcus
Cholelithiasis
gall stones
Pigment stones
AKA bilirubin stones: high risk w/ patients: hemolysis, cirrhosis, and bile infections
- have to be surgically removed
cholesterol stones
caused by decreased bile salts and increased cholesterol
- 2-3x more likely in women (contraceptive use), >40 yrs, >2 pregnancies, and obesity
- not seen on X-ray
- caused by malabsorption and decreased bile salt synthesis (geriatric), and diabetes
s/s of gall stones
mild: HALLMARK: RUQ PAIN AND GREY STOOLS. pain from gallbladder or obstruction of the bile ducts; abd. distention, dark UO (bile pigments), grey stools, jaundice with pruritus
severe pain: passing of gallstone through bile duct, distended, inflamed, and infected. RUQ pain and to back back and R shoulder, anxious
Cholelithiasis dx
MRCP: “just looking”
ERCP: visualize and grab the stone
Cholecystogram: visualize gallbladder and bile duct
Cholelithiasis tx
Lithotripsy- used for bilirubin/pigment stone removal (only used for cholesterol stones if really bad)
- pain meds
- IV abx and fluids
- NG tube to decompress stomach
meds: inhibit synthesis and increased secretion of bile salts
- UDCA
- CDA
Cholecystectomy
laparoscopic, 1 week full recovery, abdomen pumped with CO2 -> R shoulder epigastric pain
- serious injury: bile duct injury, often repaired with stent/found during surgery (S/S of peritonitis)
- pre-op diet: low fat, liquids, increased protein,
- no eggs, cream, pork, fried food, cheese, high fiber veggies, alcohol.
Cholecystectomy post op care
Semi-fowlers, fluids, advance diet, NG tube, splint for abdominal pain, pain meds, ambulate x3, incisional site assessment
pancreatitis
inflammation of the pancreas, auto digestion of pancreas
- pancreatic duct obstructed + hyper secretion = bile duct with bile causing reflux = inflammation
acute pancreatitis
life threatening, high mortality rates
- severe edema and necrosis
- hypovolemic shock
- e/ disturbances
- sepsis
complications:
- necrotizing tissue- self digestion of pancreas and surrounding tissues
- MODS : organ failure, hypoxia, GI bleeds, shock, kidney disease
RF pancreatitis
alcohol consumption, tobacco, gallstone RF, hereditary
s/s of pancreatitis
abdominal pain, tenderness, back pain (exacerbated after a heavy meal/alcohol consumption 24-48 hrs)
- diffused, localized pain
- abdominal distention, palpable mass, n/v bile (temporarily relieved), bruising, fever, jaundice, confusion, agitation, hypotension (hypovolemia, shock: loss of protein rich fluids
pancreatitis enzymes
amylase, lipase (3x more than normal)
- 24 hours of onset, 48-72 hours the amylase decreases
other labs: WBC elevated, hypocalcemia, hyperglycemia, elevated bilirubin levels, peritoneal fluids
Pancreatitis dx
2 of 3 criteria
- amylase/lipase enzyme increase
-imaging
-hx of abdominal pain
-other known labs
Pancreatitis mgmt
NPO (lowers secretion and work of pancreas), TPN, tube feeds (low fat, low carb, high protein and cal count), parenteral feeding if necessary,
- NG tube on low suction: nausea, BR
- H2 antagonist (pepcid), PPI (pantoprazole), pain mgmt
Drain mgmt
500 mL -1L / 24 hours (serosanguineous to bile)
