exam 3 Flashcards
asterixis
involuntary flapping of the the hands
which lab level being affected causes jaundice?
bilirubin-high
direct serum bilirubin
0.1-0.4 mg/dL
direct serum bilirubin
0.1-0.4 mg/dL
total serum bilirubin
0.3-1mg/dL
Serum albumin
3.5-5.2g/dL
AST
10-40U/mL
ALT
8-40U/mL
Ammonia
15-45 mcg/dL
Where does the liver get blood from?
Nutrient rich but no oxygen from the GI tract via the portal vein and oxygen rich from the hepatic artery
What are the metabolic functions of the liver?
Glucose metabolism, ammonia conversion, protein metabolism, fat metabolism, vitamin and iron storage, bile formation, bilirubin excretion, drug metabolism
What can happen if the drugs aren’t being metabolized properly?
Toxicity
How much damage has occurred before liver function studies are abnormal?
70%
What is the serum aminotransferase test for?
Useful in detecting hepatitis; abnormal levels indicate injury to liver cells
Alanine aminotransferase (ALT)
levels increase in liver disorders; used to monitor the course of hepatitis, cirrhosis, the effects of treatments that may be toxic to the liver
Aspartate aminotransferase (AST)
not specific to liver diseases; however levels of AST may increase with cirrhosis, hepatitis, and liver cancer
Gamma-glutamyl transferase (GGT)
levels are associated with cholestasis; alcoholic liver disease
What should the nurse be aware of post liver biopsy?
Watch for signs of bleeding as the liver is very vascular-tachycardia, hypotension. Watch for peritonitis
What is peritonitis?
Life threatening condition in which the peritoneum (the tissue that lines the inside of the abdomen) becomes inflamed or infected
What are the symptoms associated with liver disease?
Hematemesis, bloody stool, easy bruising, anorexia, weight gain d/t fluid, increasing abdominal girth. abdominal pain, jaundice, fatigue, dry/itchy skin, ascites
What are some drugs that can affect the liver?
IV drug use, NSAIDs, Anti-fungals (ending with-zole), and valproic acid seizure meds.
What is cirrhosis?
Cell destruction and fibrosis (scarring) of hepatic tissue; typically due to alcohol use
How much fluid is considered to be ascites?
greater than 500 mL
Symptoms that come with ascites:
Abdominal pain, bloating, increased abdominal girth, nausea, SOB
Why is there an increased risk of bleeding for patients with cirrhosis?
The liver produces prothrombin which is a clotting factor; the liver is very vascular and damage could cause bleeding; a clinical manifestation for cirrhosis is thrombocytopenia which is decreased platelets
Portal hypertension
Obstructed blood flow through the liver results in increased pressure throughout the portal venous system; life-threatening as it can cause esophageal varices
What is hepatic encephalopathy?
A brain disorder caused by the buildup of ammonia when the liver does not properly filter it out
What is the Sengstaken-Blakemore tube used for?
To apply pressure to esophageal varices and slow bleeding
Diet for cirrhosis patients:
Restrict fluid, sodium, and protein.
Why should you restrict protein for a patient with hepatic disorders?
More protein=more ammonia, which can build up and cause hepatic encephalopathy
What medicine can help lower BP in portal hypertension?
Beta -blockers(which end in -lol)
You can check for edema in:
arms, legs, sacrum (bottom of the back)
Skin issues seen in cirrhosis:
Jaundice, petechiae
Which vitamin can be administered to help with clotting?
Vitamin K
What medicines should patients be educated not to take with cirrhosis?
Tylenol and herbal supplements
Palmar erythema
redness of the palm
Hepatocellular jaundice:
Caused by liver cells being damaged; symptoms include lack of appetite, nausea, weight loss, malaise, fatigue, weakness
Obstructive Jaundice:
Caused by obstruction in bile duct from liver= increased levels of bilirubin not being able to be excreted; clay-colored stools, jaundiced urine, dyspepsia, intolerance of fats, pruritus
Most common diuretic for patient with ascites
spironolactone-potassium sparing
Fetor hepaticus
bad breath (sweet and fecal) d/t accumulation of toxins
Manifestations of hepatic encephalitis
EEG can show progressive slowing, changes in LOC, potential seizures, fetor hepaticus
Medical management of hepatic encephalopathy
Lactulose- which will cause patient to excrete excess ammonia through feces, IV glucose to minimize protein catabolism, protein restriction, reduction of ammonia from GI by gastric suction, enemas, and oral antibiotics. DISCONTINUE USE OF: sedatives, analgesics, and tranquilizers as liver can not metabolize
Manifestations of esophageal varices:
MEDICAL EMERGENCY. Hematemesis, melena, general deterioration, and shock-hypotension and tachycardia
How often should a cirrhosis patient have an endoscopy to check for varices?
Every 2 to 3 years
Treatment for bleeding varices:
Treat shock-administer oxygen and IV fluids (NS only in case blood is needed )through large gauge. Vasopressin or octreotide which can decrease pressure in portal vein. Octreotide inhibits release of vasoactive peptides that widen vessels. Somatostatin constricts vessels. Beta blockers to decrease BP
Nursing management of varices:
Administer prescribed treatments and monitor for complications. Encourage deep breathing and sitting up to prevent aspiration
Hepatitis A and E
spread by fecal-oral route; E also by contaminated water; A by poor hand hygiene
Hepatitis B and C
Bloodborne
Hepatitis D
Only people with Hepatitis B are at risk
Nonviral hepatitis is caused by:
hepatic toxins or drug induced
Pancreas-endocrine
insulin, glucagon, somatostatin
How does the pancreas lower glucose?
By allowing glucose into liver cells
Choledocholithiasis
Gallstones
What is murphy’s sign?
Deep breath causes increase in pain while examiner palpates; positive with cholecystitis
Why should morphine not be used with cholecystitis?
Can cause spasm in sphincter of oddi
Complications of laparoscopic or open cholecystectomy
Infection, bleeding, peritonitis. Risks increase with gall bladder perforation, multiple abdominal surgeries, and morbid obesisty
What diet started and when after cholecystectomy?
Soft diet after bowel sounds return
What simple nursing intervention can help with pain post-cholecystectomy?
Splinting or holding a pillow to the site
Nursing management post cholecystectomy
turn, cough, deep breathe q1h; watch for washboard abdomen; monitor vitals -fever, hypotension, tachycardia; soft diet-low in fat and high in carbs and protein to aid in healing.
How long should a patient be on a restricted fat diet post-cholecystectomy?
4-6 weeks
Acute pancreatitis
Inflammation of the pancreas; caused by the release of pancreatic enzymes that “autodigest’ the pancreas
Signs of peritonitis:
Steatorrhea (fatty stools), elevated BP, nausea and vomiting, elevated temp, severe epigastric pain
What is Cullen’s sign?
edema and bruising around the umbilicus; can indicate internal bleeding: hemorrhage d/t necrotizing pancreatitis
What is Turner’s sign?
Bruising of the flanks or lower back that indicates internal bleeding; hemorrhage d/t necrotizing pancreatitis
What electrolyte is affected by acute pancreatitis?
Calcium- can be low. Monitor closely for Trousseu’s and Chvostek’s
Why does hypocalcemia happen in acute pancreatitis?
Chelation of calcium salts by increased fatty acids; Causes calcium to bind to the chelating agent and lower the level in circulation
What medications to be used with acute pancreatitis and why?
Opioid narcotics-treat pain; anticholinergic-decrease intestinal motility and pancreatic enzyme release; spasmolytics-relaxes smooth muscle and sphincter of oddi; PPI-decreases gastric acid secretions
What are Histamine 2 Antagonists such as cimetidine used for in the treatment of acute pancreatitis?
Reducing pancreatic secretions
Which labs should be reviewed for chronic pancreatitis?
Amylase, lipase, bilirubin, alkaline phosphatase, and elevated blood glucose
Normal amylase
25-120 units per liter
Normal lipase
0-160 units per liter
After a Whipple procedure or pancreaticoduodenectomy:
NGTs are maintained to decompress the stomach, prevent bloating, and remove gastric acid secretions to minimize pressure on surgical site. DO NOT MANIPULATE NGT
