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Critical Care > Exam #3 Part 2 > Flashcards

Exam #3 Part 2 Flashcards

1
Q

what is the function of the liver?

A

produces bile, albumin, immune factors, removes bacteria from blood, stores and releases glucose, stores and maintains iron, converts ammonia to urea, clears drugs and toxin, regulates clotting, clears bilirubin

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2
Q

what are the labs for a liver patient?

A

total bilirubin, direct bilirubin, urine bilirubin, AST, ALT, Platelets, PTT, INR, Albumin, Ammonia

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3
Q

what bilirubin in conjugated?

A

direct bilirubin

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4
Q

how is bilirubin supposed to be excreted?

A

through stool

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5
Q

what happens if bilirubin cant be excreted throughnstool?

A

it is passed to urine

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6
Q

what color is stool if it does have bili in it?

A

light clay

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7
Q

what color is urine if it has bili?

A

darker and foamy

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8
Q

what does conjugated bilirubin mean?

A

it has a sugar attached

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9
Q

what is the best lab to look at for liver function?

A

ALT

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10
Q

why are platelets/PTT/INR check in liver patients?

A

because your liver is responsible for controlling clotting

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11
Q

what effect does liver damage have on clotting?

A

it causes you to be at risk for bleeding

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12
Q

other than labs what do you watch for in liver patients in regards to bleeding?

A

urine and stool

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13
Q

why is albumin checked in liver patients?

A

because your liver is responsible for creating albumin

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14
Q

what effect does bad liver function have on albumin?

A

it decreased

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15
Q

what are the symptoms of low albumin?

A

third spacing/ fluid retention outside of vasculature

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16
Q

protein and albumin???

A
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17
Q

why is ammonia checked in liver patietns?

A

because a damaged liver is not good at processing ammonia

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18
Q

what does a build up of ammonia lead to ?

A

hepatic encephalopathy

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19
Q

what is cirrhosis of the liver?

A

this occurs when repetead damage occurs to the liver and scars form causing less filtration

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20
Q

what percentage will you start to see symptoms in liver cirrhosis?

A

80%

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21
Q

what can cause liver cirrhosis?

A

alcohol, hepatitis, drugs, toxins, gallbladder issues, Right sided HF, Nonalcoholic fatty liver disease

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22
Q

what drugs can cause liver cirrhosis?

A

acetaminophen

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23
Q

what gallbladder issues cause liver cirrhosis?

A

backing up of the bile ducts

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24
Q

what can cause non alcoholic fatty liver disease?

A

age, obesity, type 2 diabetes, metabolic syndrome

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25
Q

what are complications of cirrhosis of the liver?

A

jaundice, portal hypertension, ascites, esophageal varcies, hepatic encaphalopathy

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26
Q

what is jaundice?

A

yellowing of the skin due to excessive bilirubin

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27
Q

why is jaundice a symptom of cirrhosis of the liver?

A

because your live is responsible for breaking down bilirub

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28
Q

why are symptoms of jaundice?

A

yellowing of skin, yellowing of sclera, no appetite, puritis, dark orange foamy urine, light clay stools, intolerant to fats, abd pain

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29
Q

what are treatments(Non pharmaceutical )for jaundice?

A

cool water on skin, avoid drying soaps, no lotions with alcohol, dont use excessive lotion, watch for scratching, loose fitting clothes, light colored clothes, keep cool, short finger nails

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30
Q

what is portal hypertension?

A

scar tissue on the liver prevents it from filtering blood at a particular rate….the slower rate causes blood to back up into smaller vessels

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31
Q

what is ascities?

A

build up of fluid in the abdomen

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32
Q

how does liver cirrhosis cause ascities?

A

its triggered by portal hypertension and low amounts of albumin

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33
Q

how does portal hypertension cause asciteis?

A

the back up of blood/fluid at the liver has to find a way around so it takes the path of smaller vessels…..the vessels cant withstand the fluid so it seeps out into the third space

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34
Q

what fluid state are ascites patients in?

A

hypervolemic on their body but hypovolemic in vasculature

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35
Q

what are symptoms of ascites?

A

rapid weight gain, hypotension, bulging flanks, fluid wave on palpation, umbilical hernia, SOB, Striae, Fluid and electrolyte imbalance

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36
Q

what do you do for management of ascites?

A

avoid…..Na, canned foods, margarin, use diuretics, get albumin, bed rest, paracentesis, admin 02, Trans jugular intrahepatic portal-systemic shunt, assess abd girth at least every 4, Weight loss, fluiids, Electrolytes, Banana bag, I/os

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37
Q

what should you do during a parecentesis?

A

have the patient sit in up right posistion….needle inserted through umbilicus….record bp frequently, monitor for signs of vascular collapse….

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38
Q

what should you phenomenom monitor for during a paracentesis?

A

vascular collapse

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39
Q

what are symptoms of vascular collapse?

A

pallor, increased pulse, decreased blood pressure

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40
Q

what causes vascular collapse?

A

removal or alot of fluid causing hypovolemia

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41
Q

what patients get banana bag?

A

ascites and xxxxxxxxxxxxxxxxxxxxxxxxxxxx

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42
Q

whats in a banana bag?

A

thiamine, folic acid, MgSO4, and vitamin A,D,E,K

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43
Q

why is vitmain A, D, E , K given to liver patietns?

A

inability to digest fat soluble vitamins

44
Q

who gets a transjugular inrehepatic portal shunt?

A

done with patients who have ascites

45
Q

what is trans jugular intrahepatic portal shunt?

A

xx

46
Q

what should patient do before paracentesis?

A

void

47
Q

what should you monitor for after trans jugular intrahepatic shunt?

A

hepatic encephalopathy

48
Q

what is esophageal varices?

A

fluid build up in the esophagus cause pouches to be formed

49
Q

what question do you alway ask liver patients?

A

if they have a history of eosphegel variceis

50
Q

what happens if a varicies rupture?

A

if its fast they can bleed out….if its slow they can make their condition worse by the body breaking down the blood

51
Q

why is it bad if the stomach digests blood in a liver patient?

A

it releases xxxxxxxxxxxxxxxxxxxx

52
Q

what do you look at for in patients with eosphagela varices?

A

hematemesis, melena, bloody stool, tachycardia, hypotension, tachycardia, continous swallowing, change in LOC, can be hypovolemic shock

53
Q

what are interventions for esophageal varicies?

A

blood, beta blockers, vasopressin, variceal banding, sclerotherapy, ballon tamponade, NG tube

54
Q

what should be avoided in esophageal variceis?

A

no straining, no increased abd pressure,

55
Q

what should nurses never do with a esopheageal varices patien?

A

ng tube

56
Q

what is done during variceal banding?

A

band is put around varices that is bleeding stopping the bleed

57
Q

what is done during scleratherapy?

A

meds are given to basically cauterize

58
Q

what is balloon tamponade?

A

tube down nose with balloon on the end….balloon is inflated against the varices

59
Q

what is the risk of balloon tamponade?

A

asphyxia, aspiration, esophagus perforation

60
Q

when is a balloon tamponade done instead of the other interventions?

A

emergent situations

61
Q

why are esophageal varices patients on NG tube suction?

A

to prevent blood from being digested

62
Q

what causes hepatic encephalopaty?

A

the liver not removing ammonia and nitrogen due to liver function or transjugualr shunt

63
Q

is hepatic encephaloptoy reversible?

A

only if its caught early

64
Q

what are the risk factors for hepatic encephalopathy?

A

high protein, infection, GI bleed, meds, trans jug shunt, liver function

65
Q

what meds put patient at risk for hepatic encephalopaty?

A

hypnotics, opoids, sedative’ analgesics

66
Q

what are symptoms of hepatic encephalopaty?

A

confusion, apathy, slurred speech, combative, slow thought proccess, asterixis, feter hepaticus,

67
Q

what is asterixis?

A

uncontrolled hand movements

68
Q

what is feter hepaticus?

A

musty breath from hepatic encephalopathy

69
Q

what are nursing interventions for hepatic encephalopathy?

A

neuro assessment, labs, fall precautions, seizure precautions, lowered protein levels

70
Q

what are the medical interventions for hepatic encephalopathy?

A

metronidazole, neomycin, glucose, banana bag, hydration, dc sedatives and tranquilizers

71
Q

what is pancreatitis?

A

inflammation to necrosis of the pancreas

72
Q

what is an endocrine function of the pancreas?

A

regulates blood sugar by releasing glucagon and insulin

73
Q

what is the exocrine function of the pancreas?

A

secretes digestive enzymes

74
Q

what are the enzymes excreted by the pancreas?

A

amylase, lipase, and protease

75
Q

what does amylase digest?

A

carb

76
Q

what does lipase digest?

A

fat

77
Q

what does protease digest?

A

protein

78
Q

what are causes of pancreatitis?

A

gall stones and alcoholism

79
Q

how do gall stones cause pancreatitis?

A

the pancreatic duct becomes obstructed leading to the digestive enzymes breaking down the pancrea

80
Q

how does alcoholism cause pancreatitis?

A

the secretions thicken and obstrcut the duct

81
Q

what are the labs checked for pancreatitis?

A

amylase, lipase, protease, wbc, glucose, total bili, alt, ast, H/h, Ca, Mg

82
Q

what happens to amylase, lipase, and protease lab?

A

elevated

83
Q

what hapens to wbc in pancreatitis?

A

elevated due to inflammation

84
Q

what happens to glucose in pancreatitis?

A

elevated

85
Q

what happens to alt/ast in pancreatitis?

A

elevated

86
Q

what happens to h/h in pancreatitis?

A

decreased due to bleeding

87
Q

what happens to ca/mg in pancreatitis?

A

decrease

88
Q

what are symptoms of pancreatitis?

A

boring abd pain, abd gaurding, weight loss, n/v, dehydration, hypovolemic shock, pulmonary symptoms, jaundice, grey turners sign, cullen sign, hypoactive bowel sounds, parlyitic illeus,m febrile, can progress to sepsis, third spacing

89
Q

where is the pain felt in pancreatitis?

A

mid epigastric to left upper quadrant….can somtimes radiate into shoulder/arm/back

90
Q

what is grey turners sign

A

bruising onthe flanks

91
Q

what is cullens sign?

A

bruising above belly button

92
Q

if calcium is low what signs will be postive?

A

chevostek and treso

93
Q

what does a psotive chevostek sign?

A

twitching of the eye when tappedd

94
Q

what is a positive treseau

A

wrist tightening when blood pressure cuff is inflated

95
Q

how is pancreatitis diagnose?

A

ct with contrast and ultrasound

96
Q

how often should you assess abdomnai girht in asciites patiens?

A

at least every 4 hours

97
Q

how often should ascites patiens be weighed?

A

daily

98
Q

what is the max amount of weight a ascites patient can loose in one day?

A

2lbs

99
Q

what are the interventions for pancreatitis?

A

pain control, strict NPO, TPN, jujenum, fluids, bed rest, fetal position, tripod, oral care, turning, daily weights, foley

100
Q

what meds are given to pancreatitis patient?

A

morphine, hydromorphone, fent, H2s, PPI,

101
Q

what pulmonary issues can pancreatitis have?

A

dyspnea, hypoxia, resp distress, pleural effusion

102
Q

can pancreatits have jaundice?

A

yes

103
Q

what complications can pancreatitis have?

A

Type 1 diabetes, necrotising hemmorhagic pancreatitis,DIC

104
Q

what are the symptoms of necrotizing hemorrhagic pancreatitis?

A

bleeding, hypovolemia, sepsis,organ failure

105
Q

what is DIC?

A

occurs when your body used all of its clotting factor at once

106
Q

what are symtptoms of DIC?

A

clotting and bleeding

Critical Care (6 decks)

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