Exam #3 Part 2 Flashcards
what is the function of the liver?
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
what are the labs for a liver patient?
total bilirubin, direct bilirubin, urine bilirubin, AST, ALT, Platelets, PTT, INR, Albumin, Ammonia
what bilirubin in conjugated?
direct bilirubin
how is bilirubin supposed to be excreted?
through stool
what happens if bilirubin cant be excreted throughnstool?
it is passed to urine
what color is stool if it does have bili in it?
light clay
what color is urine if it has bili?
darker and foamy
what does conjugated bilirubin mean?
it has a sugar attached
what is the best lab to look at for liver function?
ALT
why are platelets/PTT/INR check in liver patients?
because your liver is responsible for controlling clotting
what effect does liver damage have on clotting?
it causes you to be at risk for bleeding
other than labs what do you watch for in liver patients in regards to bleeding?
urine and stool
why is albumin checked in liver patients?
because your liver is responsible for creating albumin
what effect does bad liver function have on albumin?
it decreased
what are the symptoms of low albumin?
third spacing/ fluid retention outside of vasculature
protein and albumin???
why is ammonia checked in liver patietns?
because a damaged liver is not good at processing ammonia
what does a build up of ammonia lead to ?
hepatic encephalopathy
what is cirrhosis of the liver?
this occurs when repetead damage occurs to the liver and scars form causing less filtration
what percentage will you start to see symptoms in liver cirrhosis?
80%
what can cause liver cirrhosis?
alcohol, hepatitis, drugs, toxins, gallbladder issues, Right sided HF, Nonalcoholic fatty liver disease
what drugs can cause liver cirrhosis?
acetaminophen
what gallbladder issues cause liver cirrhosis?
backing up of the bile ducts
what can cause non alcoholic fatty liver disease?
age, obesity, type 2 diabetes, metabolic syndrome
what are complications of cirrhosis of the liver?
jaundice, portal hypertension, ascites, esophageal varcies, hepatic encaphalopathy
what is jaundice?
yellowing of the skin due to excessive bilirubin
why is jaundice a symptom of cirrhosis of the liver?
because your live is responsible for breaking down bilirub
why are symptoms of jaundice?
yellowing of skin, yellowing of sclera, no appetite, puritis, dark orange foamy urine, light clay stools, intolerant to fats, abd pain
what are treatments(Non pharmaceutical )for jaundice?
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
what is portal hypertension?
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
what is ascities?
build up of fluid in the abdomen
how does liver cirrhosis cause ascities?
its triggered by portal hypertension and low amounts of albumin
how does portal hypertension cause asciteis?
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
what fluid state are ascites patients in?
hypervolemic on their body but hypovolemic in vasculature
what are symptoms of ascites?
rapid weight gain, hypotension, bulging flanks, fluid wave on palpation, umbilical hernia, SOB, Striae, Fluid and electrolyte imbalance
what do you do for management of ascites?
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
what should you do during a parecentesis?
have the patient sit in up right posistion….needle inserted through umbilicus….record bp frequently, monitor for signs of vascular collapse….
what should you phenomenom monitor for during a paracentesis?
vascular collapse
what are symptoms of vascular collapse?
pallor, increased pulse, decreased blood pressure
what causes vascular collapse?
removal or alot of fluid causing hypovolemia
what patients get banana bag?
ascites and xxxxxxxxxxxxxxxxxxxxxxxxxxxx
whats in a banana bag?
thiamine, folic acid, MgSO4, and vitamin A,D,E,K
why is vitmain A, D, E , K given to liver patietns?
inability to digest fat soluble vitamins
who gets a transjugular inrehepatic portal shunt?
done with patients who have ascites
what is trans jugular intrahepatic portal shunt?
xx
what should patient do before paracentesis?
void
what should you monitor for after trans jugular intrahepatic shunt?
hepatic encephalopathy
what is esophageal varices?
fluid build up in the esophagus cause pouches to be formed
what question do you alway ask liver patients?
if they have a history of eosphegel variceis
what happens if a varicies rupture?
if its fast they can bleed out….if its slow they can make their condition worse by the body breaking down the blood
why is it bad if the stomach digests blood in a liver patient?
it releases xxxxxxxxxxxxxxxxxxxx
what do you look at for in patients with eosphagela varices?
hematemesis, melena, bloody stool, tachycardia, hypotension, tachycardia, continous swallowing, change in LOC, can be hypovolemic shock
what are interventions for esophageal varicies?
blood, beta blockers, vasopressin, variceal banding, sclerotherapy, ballon tamponade, NG tube
what should be avoided in esophageal variceis?
no straining, no increased abd pressure,
what should nurses never do with a esopheageal varices patien?
ng tube
what is done during variceal banding?
band is put around varices that is bleeding stopping the bleed
what is done during scleratherapy?
meds are given to basically cauterize
what is balloon tamponade?
tube down nose with balloon on the end….balloon is inflated against the varices
what is the risk of balloon tamponade?
asphyxia, aspiration, esophagus perforation
when is a balloon tamponade done instead of the other interventions?
emergent situations
why are esophageal varices patients on NG tube suction?
to prevent blood from being digested
what causes hepatic encephalopaty?
the liver not removing ammonia and nitrogen due to liver function or transjugualr shunt
is hepatic encephaloptoy reversible?
only if its caught early
what are the risk factors for hepatic encephalopathy?
high protein, infection, GI bleed, meds, trans jug shunt, liver function
what meds put patient at risk for hepatic encephalopaty?
hypnotics, opoids, sedative’ analgesics
what are symptoms of hepatic encephalopaty?
confusion, apathy, slurred speech, combative, slow thought proccess, asterixis, feter hepaticus,
what is asterixis?
uncontrolled hand movements
what is feter hepaticus?
musty breath from hepatic encephalopathy
what are nursing interventions for hepatic encephalopathy?
neuro assessment, labs, fall precautions, seizure precautions, lowered protein levels
what are the medical interventions for hepatic encephalopathy?
metronidazole, neomycin, glucose, banana bag, hydration, dc sedatives and tranquilizers
what is pancreatitis?
inflammation to necrosis of the pancreas
what is an endocrine function of the pancreas?
regulates blood sugar by releasing glucagon and insulin
what is the exocrine function of the pancreas?
secretes digestive enzymes
what are the enzymes excreted by the pancreas?
amylase, lipase, and protease
what does amylase digest?
carb
what does lipase digest?
fat
what does protease digest?
protein
what are causes of pancreatitis?
gall stones and alcoholism
how do gall stones cause pancreatitis?
the pancreatic duct becomes obstructed leading to the digestive enzymes breaking down the pancrea
how does alcoholism cause pancreatitis?
the secretions thicken and obstrcut the duct
what are the labs checked for pancreatitis?
amylase, lipase, protease, wbc, glucose, total bili, alt, ast, H/h, Ca, Mg
what happens to amylase, lipase, and protease lab?
elevated
what hapens to wbc in pancreatitis?
elevated due to inflammation
what happens to glucose in pancreatitis?
elevated
what happens to alt/ast in pancreatitis?
elevated
what happens to h/h in pancreatitis?
decreased due to bleeding
what happens to ca/mg in pancreatitis?
decrease
what are symptoms of pancreatitis?
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
where is the pain felt in pancreatitis?
mid epigastric to left upper quadrant….can somtimes radiate into shoulder/arm/back
what is grey turners sign
bruising onthe flanks
what is cullens sign?
bruising above belly button
if calcium is low what signs will be postive?
chevostek and treso
what does a psotive chevostek sign?
twitching of the eye when tappedd
what is a positive treseau
wrist tightening when blood pressure cuff is inflated
how is pancreatitis diagnose?
ct with contrast and ultrasound
how often should you assess abdomnai girht in asciites patiens?
at least every 4 hours
how often should ascites patiens be weighed?
daily
what is the max amount of weight a ascites patient can loose in one day?
2lbs
what are the interventions for pancreatitis?
pain control, strict NPO, TPN, jujenum, fluids, bed rest, fetal position, tripod, oral care, turning, daily weights, foley
what meds are given to pancreatitis patient?
morphine, hydromorphone, fent, H2s, PPI,
what pulmonary issues can pancreatitis have?
dyspnea, hypoxia, resp distress, pleural effusion
can pancreatits have jaundice?
yes
what complications can pancreatitis have?
Type 1 diabetes, necrotising hemmorhagic pancreatitis,DIC
what are the symptoms of necrotizing hemorrhagic pancreatitis?
bleeding, hypovolemia, sepsis,organ failure
what is DIC?
occurs when your body used all of its clotting factor at once
what are symtptoms of DIC?
clotting and bleeding
