Final Exam: Liver, Pancreas, Biliary Tract Flashcards
The most common cause of Hepatitis C is?
IV drug abuse
Risk factors for Hepatitis (6)
- body piercings
- unprotected sex
- IV drug abuse
- hemodialysis
- blood transfusions before 1992 (no blood screenings)
- alcohol abuse
Clinical manifestations of hepatitis in the preicteric phase? (5)
Fatigue, anorexia, weakness, headache, joint pain
Clinical manifestations of hepatitis in the icteric or anicteric phase? (2)
Complete jaundice from head to toe (results from an abnormal rise in bilirubin) and clay-colored stools
Which molecule is responsible for ascites and edema in patients with hepatitis (3rd spacing aka interstitial spacing)
Albumin (protein) attracts water
What is the best way to distinguish the type of viral hepatitis that the patient has?
Test patient’s blood for the specific antigen or antibody
What diet is used in the management of hepatitis?
A high-calorie diet with supplemental vitamins to address nutrient deficits, such as less than body requirements related to anorexia
Water-soluble vitamins? (4)
ADEK : vitamins A, D, E, K
What do you expect will be administered to a patient with hepatitis to address nutrient deficiency?
Banana bag: contains water-soluble vitamins
One of the most challenging nursing interventions to promote healing in the patient with viral hepatitis is?
Adequate nutrition
It is expected for patients with cirrhosis to present? (2)
Clay-colored stools and extreme anorexia at this stage in the disease process
S/S of Cirrhosis? (5)
- jaundice
- anorexia and ABD pain
- ascites and hypoalbuminemia
- hyponatremia
- cognitive changes
What are serious complications of portal hypertension and esophageal/gastric varices? (2)
Constipation and straining: can lead to the rupture of esophageal varices which can be life-threatening
What are ascites?
Accumulation of serous fluid in the peritoneal and ABD cavity
What is the priority nursing measure for patients with peripheral edema and ascites?
Proper oxygenation and ventilation due to fluid accumulation
Nursing diagnosis for peripheral edema and ascites?
Inability to maintain an adequate oxygenation / expanding lungs
What are the first and last choices of treatment for peripheral edema and ascites?
First choices: lasix, sodium restriction, administer albumin
Last choice: paracentesis (needle to aspirate peritoneal cavity)
What should the patient do before a paracentesis procedure?
Patient should urinate because the bladder can be punctured
Patient manifestations of hepatic encephalopathy? (3)
Asterix (flapping tremor), change in LOC, sleep disturbances
Etiology of hepatic encephalopathy?
Excess ammonia crossing the blood-brain barrier and causing neurologic s/s
Treatment for hepatic encephalopathy?
Administer lactulose (causes the patient to have bowel movements to excrete ammonia; s/s: mental status changes)
Nursing management for patients with cirrhosis? (nutrition)
High calorie, high carbohydrate, and low-fat diet (do not restrict protein, may lead to more muscle wasting)
During the treatment of the patient with bleeding esophageal varices, it is most important that the nurse:
Manages airway and prevents aspiration (remember ABC)
A patient with advanced cirrhosis has a nursing dx of imbalanced nutrition: less than body requirements r/t anorexia and inadequate food intake. An appropriate midday snack for the patient would be:
A fresh tomato sandwich with salt-free butter
In discussing long term management with the patient with alcoholic cirrhosis, the nurse advises the patient that:
Abstinence from alcohol is the most important factor in improving the patient’s condition
When planning care for a patient with cirrhosis, the nurse will give the highest priority to which nursing diagnosis?
Ineffective breathing pattern related to pressure on the diaphragm and reduced lung volume
Nursing management for patients with acute pancreatitis (first line of action)?
Place patient on NPO and drop an NG tube
What is ERCP in treating acute pancreatitis?
Endoscopic retrograde cholangiopancreatography may be performed when pancreatitis is related to gallstones
What should be assessed for after an emergent ERCP?
Assess for changes in temperature, could indicate an infection
What type of diet causes gallstones?
Diet high in fat
How often should blood sugar be checked when a patient is on TPN and lipid nutritional therapy?
Every 6 hrs if a patient is started on parenteral nutrition (unrelated to diabetes)
Care for chronic pancreatitis is similar to?
Care of acute pancreatitis
Combined with clinical manifestations, the lab finding that is most commonly used to diagnose acute pancreatitis is?
Increased serum amylase
What is the most common disorder of the biliary system?
Cholelithiasis (stones in the gallbladder)
What is cholecystitis?
Inflammation of the gallbladder wall
Common s/s of cholelithiasis? (3)
Jaundice, pain, pruritus
When common bile duct obstruction occurs, what s/s are related to the blockage? (2)
Dark amber urine and steatorrhea (fat-like stool that is foul-smelling and yellow)
Nursing management for cholecystitis and cholelithiasis?
Surgical therapy that consists of laparoscopic cholecystectomy
Following a laparoscopic cholecystectomy, the nurse would expect the patient to?
Have four small abdominal incisions covered with small dressings
During discharge instructions for a patient following a laparoscopic cholecystectomy, the nurse advises the patient to?
Report any bile colored or purulent drainage from the incisions (infection)
When providing discharge teaching for the patient after laparoscopic cholecystectomy, which information should the nurse include?
A lower-fat diet may be better tolerated for several weeks
2 main risk factors for cirrhosis?
- previous Hepatitis C infection
- alcohol consumption
What treatment is used to decrease ascites formation in patients with cirrhosis?
Aggressive diuretic therapy
