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Med/Surg > ETOH, liver, GB and Pancreas > Flashcards

ETOH, liver, GB and Pancreas Flashcards

1
Q

ETOH withdrawal factors

A

Height r/t blood volume has a greater impact on length of withdrawal rather than BMI

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2
Q

BAC serious complications

A

> 0.40

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3
Q

Withdrawal time-line

A

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

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4
Q

subjective questions to ask regarding alcohol consumption

A

What are you drinking? How much? What time of day/night?

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5
Q

s/s of withdrawal

A

1st signs: preemptive neuro increases
Clammy skin, HA, vomiting, anxiety, depression, irritability, fatigue, dilated pupils, sweating, hallucinations (visual/audio)

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6
Q

Pt education for long term effects of ETOH

A

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

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7
Q

alcohol withdrawal care plan

A

seizure precautions, delirium tx, fall risk, benzos, CIWAs, fluids, vitamins

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8
Q

Withdrawal medications and general timeline

A

Long acting: valium, librium
Short acting: ativan, versed,

Big guns: (need to be transferred to ICU) phenobarbital (IV push x3)
precedex

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9
Q

Wernicke’s encephalopathy

A

acute neurological condition caused by thiamine deficiency

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10
Q

Wernicke’s s/s

A

confusion, ataxia, nystagmus

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11
Q

functions of the liver

A

glucose, drug, protein, and fat metabolism
ammonia conversion, Vitamin/iron storage, bilirubin excretion, bile formation

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12
Q

LFT’s and what they indicate

A

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

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13
Q

Jaundice

A

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)
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14
Q

Hepatitis B transmission

A

blood, mucosal (semen, vaginal secretion), mother to infant

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15
Q

Hepatitis C transmission

A

IV, needle sticks, parenteral route

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16
Q

Who’s at risk for Hep B?

A

close contact with carrier, healthcare workers, hemodialysis pt, IV injection drug use, multiple sexual partners, tattooing

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17
Q

Hep B manifestations

A

1-6 month incubation
fever, arthritis, rashes, loss of appetite, dyspepsia, abdominal pain, generalized aching, malaise, weakness, jaundice (light colored stools, dark urine)

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18
Q

Cirrhosis

A

replacement of normal tissue with fibrotic tissue
- disrupts function and normal structure: necrosis, scar tissue overruns functioning liver tissue
- “hobnail appearance”

19
Q

Alcoholic Cirrhosis intake

A
  • 60-80g/daily for men
  • 40-60g/daily for women
20
Q

expected lab values for cirrhosis

A

Elevated: AST and ALT, serum globulin, pt/INR, bilirubin
Lowered: albumin and platelets

21
Q

What to monitor in pt with cirrhosis?

A

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

22
Q

Portal HTN

A

increased pressure in the portal venous system. Obstruction of blood flow in and throughout liver

23
Q

Ascites assessments

A
  • percussion: dullness = fluid
  • fluid wave
  • abdominal growth
  • weights
  • fluids (I/O), e- imbalance
24
Q

Ascites Rx tx

A

diuretics: torsemide (works for truncal edema/ascites- can lead to hyponatremia), furosemide (extremities)

25
Q

Ascites mgmt

A
  • monitor e-
  • PO intake, UO observation
  • weights
  • abdominal girth
  • blood work: albumin, Cr, e-, liver enzymes
  • mentation (worsens with lowering potassium
26
Q

RN interventions before/after a paracentesis

A

before: vitals, client weight, at bedside, empty bladder to avoid accidental perforation

after: Vitals, dressing, insertion site, abdominal pain, BR

27
Q

Cholecystitis

A

inflammation of the gallbladder

28
Q

s/s of cholecystitis

A

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

29
Q

Cholelithiasis

A

gall stones

30
Q

Pigment stones

A

AKA bilirubin stones: high risk w/ patients: hemolysis, cirrhosis, and bile infections
- have to be surgically removed

31
Q

cholesterol stones

A

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
32
Q

s/s of gall stones

A

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

33
Q

Cholelithiasis dx

A

MRCP: “just looking”
ERCP: visualize and grab the stone
Cholecystogram: visualize gallbladder and bile duct

34
Q

Cholelithiasis tx

A

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

35
Q

Cholecystectomy

A

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.
36
Q

Cholecystectomy post op care

A

Semi-fowlers, fluids, advance diet, NG tube, splint for abdominal pain, pain meds, ambulate x3, incisional site assessment

37
Q

pancreatitis

A

inflammation of the pancreas, auto digestion of pancreas
- pancreatic duct obstructed + hyper secretion = bile duct with bile causing reflux = inflammation

38
Q

acute pancreatitis

A

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

39
Q

RF pancreatitis

A

alcohol consumption, tobacco, gallstone RF, hereditary

40
Q

s/s of pancreatitis

A

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

41
Q

pancreatitis enzymes

A

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

42
Q

Pancreatitis dx

A

2 of 3 criteria
- amylase/lipase enzyme increase
-imaging
-hx of abdominal pain
-other known labs

43
Q

Pancreatitis mgmt

A

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
44
Q

Drain mgmt

A

500 mL -1L / 24 hours (serosanguineous to bile)

Med/Surg (6 decks)

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