Exam 1 Review pt.4 Flashcards
Routine screening for HIV
At least once, if without risk factors and are ages 13-75 years of age
Yearly Screening for high risk
MSM
Injection drug users
Persons who exchange sex for money / drugs
Sex partners of people who are HIV infected, bisexual, IVDU
Having sex with partners of unknown status
HIV antibody testing
ELISA Enzyme-linked immunosorbent assays
HIV-1/HIV-2 differentiation assays
Western blot
HIV antibody and antigen test
Four generation combination test
Able to identify early/acute infection
HIV criteria for postive
Postive ELILSA or combination assay followed by a postive confirmatory (western blot)
HIV criteria for negative
A negative screening ELISA or combination
HIV indeterminate
ELISA or combination assay is postive but confirmatory test is negative
What do you have to take into consideration when testing for HIV
The window period
Time between exposure to HIV infection and the point when the test will give an accurate result
Patient is VERY infectious
What is the best indicator of how active HIV is in patient body
VIral Load
When are the worse symptoms during HIV infection
2-6 weeks whenever HIV viral load peaks
Flu like symptoms
Stage 1 of HIV infection
Early infection
-Rapid replication
-Not detectable
-No symptoms
-INFECTIOUS
SEROCONVERSION
-Antibodies are detectable
-Flu like symptoms
-HIGHLY infectious
Stage 2 of HIV infection
Clinical latency
-Virus levels stabilized
-3-12 years without treatment
-Decades with treatment
-Asymptomatic
Rapid virus production
Persistent drop in CD4 cell count
Stage 3 of HIV infection
AIDS
HIV can be transmitted via
Semen
Vaginal secretions
Blood
Breastmilk
Cerebrospinal fluid
Synovial fluid
Post exposure prophylaxis
Initiate drug therapy ASAP (within 1-2 hours)
Follow up testing for HIV indicated 6-12 weeks and 6 months
Candidates for Pre-Exposure Prophylaxis
Have had anal or vaginal sex in past 6 months and:
-partner with HIV or unknown status
-Have not used condom
-Have been diagnosed with STD
People who inject drugs and have partner with HIV
People who share needles or syringes
Education Patient with AIDS
Avoid crowded areas or traveling to countries with poor sanitation
Avoid raw foods and undercooked foods
Avoid litter boxes
Keep home clean don’t allow sick visitors
Frequent monitoring of CD4 and viral load labs (every 3/4 months)
Abdominal Ultrasounds
Detects tumors cysts and stone
NPO 8 hours beforehand. Food can cause gallbladder to contraction
What is the best way to determine if patient has gallstones
Abdominal Ultrasounds
Hepatobiliary Scintigraphy
HIDA scan
Diagnose cholecystitis if it remains uncertain following ultrasound
Nuclear medicine injected via IV that is taken up by hepatocytes and excreted into bile
HIDA scan demonstrates
Patency of common bile duct and ampulla
Endoscopic Retrograde Cholangiopancreatography
Visualizes and accesses the pancreatic, hepatic, and common bile duct
NPO 8 hours
Consent
Sedation
ERCP post procedure
Check V.S (looking for perforation or infection)
Pancreatitis is most common
Check for gag reflex
Before liver biopsy the nurse should
Check coags
Ensure patients blood is typed and crossmatched
Consent form signed
Baseline vitals signed
Before needle insertion of liver biopsy patient should
Hold breath after expiration
Liver Biopsy: Post procedure
Frequent V.S
Keep on right side x 2 hours
HOB flat 2-4 hours
Assess for complications
LIver Labs
ALT
AST
Alk phos
Bilirubin
Ammonia
Protein
Albumin
PT
Increase in Serum Ammonia will alter
LOC
Intellectual function
Neurological function
What is the only way to distinguish between different types of hepatitis
Antigen / Antibody Testing
Which enzyme digest carbohydrates
Amylase
Which enzyme digests fats
Lipase
Cholelithiasis
Presence of glasstone
Cholecystitis
Inflammation of gallbladder
Cholelithiasis RF’s
Middle age females
Fair skin
Overweight
High-fat diet
Oral contraceptives
Cholelithaisis and Cholecystitsis Manifestations
Episodic upper abdominal pain that radiates to right shoulder
Pain triggered by high-fat or high-volume meal
N/V/dyspepsia/eructation/flatulence
CHRONIC:
Jaundice
Clay stools
Dark urine
Steatorrhea
Chole pain is typically triggered by
High fat or high volume meals
Cholecystitis Non-surgical care
Avoid fatty foods (NPO during flare)
Opioids
Anti-emetics - antispasmodic
Cholecystitis Surgical Care
:laparoscopic cholecystectomy
Open cholecystectomy w/ T tube
Lap chole post op care
Remove bandages day after surgery then shower
Gradually resume activities (1 week)
Eventually can resume normal diet - try to stay low fat
Lap chole post op: notify the provider if
redness, swelling, purulent/bile-colored drainage from site
Severe abdominal pain - N/V - fever - chills
Hepatitis Clinical manifestations
Anorexia
N/V
Weight loss
RUQ discomfort
Malaise
Hepatomegaly
Jaundice
Pruritus
Dark urine
Many hepatitis cases are asymptomatic
HCV = 80%
HBV = 30%
Hepatitis Incubation period manifestations
Last 5-10 days
Flu like symptoms
RUQ discomfort
Hepatitis acute infection period
1-4 months
Icteric or anicteric
Palpable tender liver
Hepatitis convalescence period
Malaise and fatigue
Full recovery 2-4 months
Chronic Hepatitis infection is only from
Hep B and Hep C
High rate in hep C
HBV is the leading cause of
Liver cancer
HCV is the leading cause of
Liver transplant
HAV is spread via
Fecal-oral
HBV and HCV is spread via
Blood and high risk behaviors
Which hepatitis have a vaccine?
Hep A
Hep B
Jaundice is present if bilirubin is above
2.5
Types of jaundice
Hemolytic (increase breakdown RBC)
Hepatocellular (liver unable to take from blood)
Obstructive (decreased or obstructed flow of bile)
Hepatitis: Patient and Family Education
-Maintain sanitation and wash hands
-Drink water treated by purification
-If traveling to underdeveloped country only drink bottled water. Avoid ice and tap water
-Do not share bed linens
-Do not share needles
-Do not share razors
-Use condoms during sex
-Cover cuts and sores
-If infected never donate blood, organs or body tissues
Hepatitis Treatment
No specific treatment
Emphasis is on REST
-degree of which is determined by symptoms
Cirrhosis: Early manifestations
Insidious
Weight loss
Weakness
GI disturbances
Hepatomegaly
RUQ pain
Cirrhosis: Late manifestations
Jaundice
Decrease albumin and PT
Portal hypertension
Ascites
Splenomegaly (LUQ)
Spider angiomas and caput medusae
Esophageal varices
Encephalopathy
Asterixis (liver flap)
Cirrhosis: Measures to manage ascites / excess fuid volume
Assess/measure abdominal girth
Sodium restriction / possibly fluid restriction
Diuretics
Paracentesis
Portosystemic Shunt (TIPS)
IV albumin
Patient family teaching
Paracentesis goal
Releve respiratory distress
Paracentesis
Informed consent
Baseline VS
Void prior
Position supine or high fowlers
Transjugular Intrahepatic Portosystemic Shunt
Non surgical procedure used to control ascites and varices
Bypass the liver so can increase hepatic encephalopathy
Measures to manage varices
No ASA - Alc - Spicy - Bulky foods
Monitor for ecchymosis - purpura - petechiae
Avoid straining
Apply pressure to bleed x 5 min
Procedures for varices
Sclerotherapy
Variceal ligation (banding)
Hepatic Encephalopathy Care
Restrict protein to 20-40 grams daily
Control Gi bleeding
Avoid constipation
Lactulose and titrate to 2-4 stools per day
Assess EMV
Acute pancreatitis definition
Premature activation of excessive pancreatic enzymes that destroy pancreatic cells, resulting in autodigestion and fibrosis of pancreas
What are the most common causes of acute pancreatitis
Gallstone
ETOH
What is the best way to diagnose Pancreatitis
CT scan
Shows pancreatic diameter, calcificiations, pancreatic cysts or pseudocysts
Acute pancreatitis: Clinical Manifestations
Pain - inflammation
N/V - Viscera pain
Low-grade fever
Jaundice - obstructive process
Paralytic ileus - irritation causes motility to stop
Cullens and Turners - enzymes leak into cutaneous tissues
Hypovolemia / Tachy - plasma being last
Increase amylase and lipase - pancreatic cell injury
Increase triglycerides - fat necrosis
Decrease calcium - fat necrosis
Acute pancreatitis: Complications
Pseudocyst:
-Cavity surrounding outside of pancreas
Abscess:
-Large fluid-containing cavity within pancreas
Acute Pancreatitis: Measures to relive pain
IV morphine
Assume positions that flex the trunk
NPO- NG/LWS
Chronic Pancreatitis
Progressive destruction with remission and flares caused by inflammation and fibrosis
Chronic Pancreatitis: Clinical Manifestations
Intense abdominal pain
Mass (pseudocyst or abscess)
Ascites
Respiratory compromise
Steatorrhea
Dark urine
PERT
Pancreatic Enzyme Replacement Therapy
Standard care to prevent malnutrition, malabsorption, and weight loss
Pancrelipase
Record number of stools per day to monitor effectiveness
LESS FREQUENT AND LESS FATTY = goal
Chronic Pancreatitis Weight Loss
Can be significant may require TPN because we want 4000-6000 calories per day
Prevention of exacerbations of chronic pancreatits
Avoid things make symptoms worse
Avoid alcohol ingestion
Avoid nicotine
Avoid caffeine
Eat bland - low fat - high protein
Eat small meals and snacks high in calories
Take enzymes with each meal and snack
Rest frequently
