Final Exam Flashcards
What are the signs of occult blood loss?
yellow pallor
tachypnea
tachycardia
hypotension
Define hepatic encephalopathy
-changes in neurological and mental functioning due to the build up of ammonia due to liver injury
-ammonia moves from the intestines into the blood stream to the liver where it is converted into urea then excreted by the kidneys but this doesn’t happen
What are the precipitating factors of hepatic encephalopathy
GI bleed- results in more protein in the GI tract and therefore more ammonia (NH3) production
Constipation- NH3 is more likely to be produced when there is prolonged contact of bacteria with
the stool
Infection- causes increased tissue catabolism, leading to increased NH3 levels
PPIs- reducing gastric acid can lead to the overgrowth of GI bacteria which can lead to increased
NH3 production
Renal Failure
Hypokalemia and/or metabolic alkalosis
Dehydration
What is the treatment for hepatic encephalopathy?
-correct precipitating conditions
-lactulose
-rifaximin (when lactulose alone is not working, or for reoccurring HE)
Why is lactulose used for hepatic encephalopathy and not another kind of laxative?
Lactulose:
* lowers colonic pH (it adds free H+) which converts NH3 to NH4 (ammonium).
* ammonium cannot enter the blood stream, and therefore is excreted out in feces.
* as a laxative, it also reduces the time the bacteria is in contact with intestinal contents, resulting
in less ammonia production. It can be given PO (or via NG) or via enema
What are the care considerations for hepatic encephalopathy?
-protect client from injury r/t altered LOC
-a protein restriction may be ordered
-perform neuro assessment prn, monitor for acute changes
-ongoing ammonia level is not needed as LOC is used to measure the effectiveness of the pt’s treatment
When the patient has HE, there is an increase in RR due to ammonia stimulating the breathing center in the medulla. What other reasons might a pt with CLD develop tachypnea?
Because of this increased RR, which acid-base imbalance would be most likely?
Describe a type and screen
Testing for ABO and RH type and red cell antibodies in the plasma (Manitoba Transfusion Best Practice Manual, 2017).
Pts at risk of bleeding may have a type & screen already on file
with Canadian Blood Service (CBS).
It is good for 3 months if no units of blood are sent out for
transfusion in this time period. If the pt has a valid T&S, units can be requested, and CBS will then do
the additional step of crossmatching the requested number of units of RBCs
Describe a crossmatch
Includes a type and screen and additional testing is done on a specific unit of available
donated RBCs to see if it is compatible so it can be sent out for transfusion. Therefore, when ordering a crossmatch, the number of units of blood must be indicated.
- A crossmatch expires after 72h (note: it’s not the blood that expires, it’s the results of the crossmatch, as the pt may have developed additional antibodies in this time). Once the cross-match has expired, a new blood sample must be sent for a new crossmatch. Any unused units of blood that were initially sent will be returned to CBS so it can be available to other patients
What is lipohypertrophy?
-fat formation at the site of insulin injection when it’s been injected in one spot consistently
-interferes with absorption rates– causes labile BG
-increased risk for both hyper and hypoglycemia
-looks like a benign tumor of fatty tissue
How do you prevent lipohypertrophy?
proper rotation of insulin sites– at least 1cm apart
