Exam 3: Inflammatory intestinal disorders and liver problems

Question 1

Ulcerative colitis symptoms

Answer 1

• Hyperemic, edematous, reddened
• Remissions and exacerbations
• Colicky pain
• Diarrhea, wt loss, blood in stool, malaise, fever

Question 2

Ileostomy nursing care

Answer 2

• Skin protection (skin barrier)
• Pouch care (empty when 1/3 to 1/2 full)(change entire pouch every 3-7 days)
• Nutrition
• Drug therapy (avoid enteric-coated and capsule medications)

Question 3

Ileostomy symptoms to watch for

Answer 3

• If drastic increase or decrease in drainage, report to provider

If stomal swelling, abdominal cramping, or distention occurs or if ileostomy contents stop draining:

• remove the pouch with faceplate
• Lie down, assuming a knee-chest position
• Begin abdominal massage
• Apply moist towels to the abdomen
• Drink hot tea
• If none of these maneuvers is effective in resuming ileostomy flow or if abdominal pain is severe, call your health care provider right away

Question 4

Total proctocolectomy

Answer 4

• Permanent ileostomy
• Involves removal of colon, rectum, and anus with surgical closure of the anus
• For patients who are not candidates for or do not want the ileo-anal pouch

Question 5

Crohn’s disease symptoms

Answer 5

• Diarrhea, abdominal pain, weight loss
• low-grade fever
• Steatorrhea
• Anemia
• increase Erythrocyte Sedimentation Rate and C-Reactive Protein

Question 6

Cirrhosis assessment

Answer 6

• Irreversible, inflammatory disease of the liver
• Extensive degeneration and destruction and necrosis liver parenchymal cells,
• Regeneration abnormal (nodular)
• Replacement with fibrous connective tissue (Hepatic Fibrosis)
• Distorts lobules, impedes vascular flow
• Leads to structural and function changes of liver

Question 7

Cirrhosis types: Alcoholic Cirrhosis “Laennec’s”

Answer 7

• Toxic effect of alcohol
• Causes fatty infiltration, (accumulation of fat in liver cells) Reversible
• If alcohol intake continues…
  Eventual nonfunctioning fibrotic nodules

Question 8

Cirrhosis types: Postnecrotic Cirrhosis

Answer 8

• Complication of viral, toxic, or idiopathic hepatitis

- Broad bands of scar tissue

Question 9

Cirrhosis types: Biliary Cirrhosis

Answer 9

• Seen with chronic biliary obstruction and infection
• Diffuse fibrosis
• Jaundice

Question 10

Cirrhosis types: Non-alcoholic Fatty Liver Disease (NAFLD)

Answer 10

• Most common cause of liver disease in the world
• Up to 25% of Americans
• Can progress to cirrhosis, liver cancer

Question 11

Compensated Cirrhosis

Answer 11

Scarred, but essential functions performed

Question 12

Decompensated Cirrhosis

Answer 12

Liver function impaired, liver failure begins

Question 13

Ascites and what it is caused by

Answer 13

Accumulation of serous fluid in peritoneal cavity

Caused by:

• Hypoalbuminemia
• Portal HTN

Question 14

Fulminant Hepatic Failure symptoms

Answer 14

• Hepatic encephalopathy
• GI Bleeding from decreased clotting factors
• Jaundice
• Edema
  (decreased Albumin (3rd spacing, decreased oncotic pressure, fluid in interstitial space))
• Pain in RUQ
• Asterixis ( tremor of hands with arms extended)
• Fatigue, malaise, anorexia, hyperventilation,
• Palmar erythema
• Low grade fever

Question 15

Fulminant Hepatic Failure treatment

Answer 15

Decrease ammonia levels
- Remove nitrogenous wastes
Neomycin or rifaximin
Destroys normal flora in bowel, decreases protein breakdown & prevents ammonia production

• Lactulose
  keeps ammonia in intestines and expelled from colon (BM)
• Protein intake monitored
• Control bleeding
  Stress ulcer prophylaxis
  Vitamin K, FFP, Platelets

Question 16

Fulminant Hepatic Failure management and nursing care

Answer 16

• Prevent infection
• Protect from injury
• Prepare for transplant
• Provide comfort