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concepts 4 > final med portion > Flashcards

final med portion Flashcards

1
Q

function of the liver

A
  1. metabolism (medications, alcohol)
  2. detoxification
  3. production of proteins (plasma proteins, coagulation factors, albumin)
  4. bile production (what aids us in digesting fats so we can absorb vitamins)
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2
Q

what are some causes of liver dysfunction?

A
  • vital infections (hep B & C)
  • alcohol abuse
  • non alcoholic fatty liver disease –> obesity –> fat accumulation in the liver
  • autoimmune conditions
  • toxins & medications (tylenol/alcohol OD or misuse)
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3
Q

acute liver failure

A

rapid deterioration of the liver function resulting in encephalopathy and coagulopathy in persons with no known hx of liver disease

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4
Q

most common cause of acute liver failure

A

medications in combination with alcohol

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5
Q

clinical manifestations of acute liver failure

A

jaundice, coagulation abnormalities, encephalopathy, changes in cognitive function

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6
Q

liver cirrhosis

A

chronic inflammation of the liver which leads to scar tissue development

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7
Q

S/S of cirrhosis

A
  • peripheral edema
  • ascites
  • anorexia
  • dyspepsia
  • SOB
  • jaundice
  • pruritus
  • pale “clay” stool
  • pain
  • splenomegaly
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8
Q

hepatic encephalopathy

A

neuropsychiatric condition of advanced liver disease

neurotoxic levels of ammonia d/t it crossing the blood-brain barrier which causes an altered LOC, inappropriate behaviour, concentration difficulties

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9
Q

nursing management for encephalopathy

A

lactulose to reduce ammonia levels and expel ammonia from the colon (ensure a regular bowel regimen)

rifaximin used if lactulose unsuccessful alone

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10
Q

esophageal varices

A

enlarged and swollen veins at the lower end of the esophagus d/t portal hypertension

at risk of bleeding = EMERGENCY

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11
Q

ascites

A

accumulation of serous fluid in the peritoneal cavity d/t low albumin levels

management: sodium restriction, diuretics, fluid removal (paracentesis drain)

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12
Q

medications for hepatic dysfunction

A
  • lactulose (to reduce ammonia)
  • rifaximin (antibiotic for hepatic encephalopathy)
  • diuretics (decrease fluid)
  • beta-blockers (decrease portal htn)
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13
Q

what meds should pts with hepatic dysfunction avoid?

A

ASA, NSAIDS, sedatives, alcohol

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14
Q

what should we be monitoring for pts with hepatic dysfunction?

A
  • labs (albumin, ammonia, urea, clotting factors, LFTs, CBCs, ETOH level)
  • ins & outs
  • CIWA
  • LOC
  • nutrition
  • daily weights
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15
Q

pancreatitis

A

inflammation and necrosis of the pancreas –> autodigestion and leakage of enzymes

  • severe pain
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16
Q

causes of pancreatitis

A
  • gallstones (middle aged women)
  • alcohol use disorder (men)

Others: trauma, viral infection, penetrating duodenal ulcer, cysts, abscesses, cystic fibrosis, medications, metabolic disease

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17
Q

S/S of pancreatitis

A
  • RUQ or LUQ epigastric pain which radiates to back
  • tender/distended abdomen
  • pale, diaphoretic
  • nausea/vomiting
  • diarrhea
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18
Q

what are the main systemic complications of acute pancreatitis?

A

cardiovascular & pulmonary (hypotension, tachycardia, pleural effusion, atelectasis, pneumonia, acute respiratory distress)

pulmonary complications due to passage of exudate containing pancreatic enzymes from peritoneal cavity through lymph channels

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19
Q

primary diagnostic tests for pancreatitis

A
  1. serum amylase (3x normal level)
  2. serum lipase
  3. increase in liver enzymes, triglycerides, glucose, bilirubin and low calcium levels
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20
Q

nursing interventions for pancreatitis

A

keep pt NPO to reduce pancreatic secretion

urgent ERCP may be performed

monitor glucs

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21
Q

hepatitis A

A

transmitted by fecal-oral route

no specific tx, rarely leads to hepatic failure

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22
Q

hepatitis B

A

transmitted through exposure to contaminated blood or body fluids

vaccine preventable

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23
Q

hepatitis C

A

transmitted through blood or bodily fluids (primarily percutaneously)

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24
Q

hepatitis D

A

extremely low prevalence

typically acquired at the same time as HBV

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25
Q

hepatitis E

A

transmitted through fecal-oral route most commonly through contaminated water

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26
Q

peritonitis

A

inflammation of the peritoneal cavity

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27
Q

inflammatory bowel disease

A

autoimmune disease that refers to Crohn’s disease and ulcerative colitis

characterized by idiopathic inflammation and ulceration

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28
Q

3 characteristics of the etiology of inflammatory bowel disease

A
  1. genetics
  2. altered dysregulated immune response
  3. altered response to gut microorganisms
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29
Q

ulcerative colitis

A

inflammation and ulceration of the rectum and colon

inflammation is diffuse and involves mucosa and submucosa with alternate periods of exacerbation and remission

disease begins in rectum and spreads proximally along the colon in a CONTINUOUS fashion

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30
Q

clinical manifestations of ulcerative colitis

A
  • bloody diarrhea (multiple BMs/day)
  • abdominal pain
  • fever, malaise, anorexia (when severe)
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31
Q

how is ulcerative colitis diagnosed?

A

BW: CBC, serum electrolytes, serum protein

sigmoidoscope, colonoscopy

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32
Q

nursing management for ulcerative colitis

A
  1. rest the bowels
  2. control the inflammation
  3. manage fluids & nutrition
  4. manage pt stress
  5. symptom relief (corticosteroids, sulphasalazine)
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33
Q

Crohn’s disease

A

chronic inflammation of any part of the GI tract from mouth to anus (most commonly in terminal ileum and colon)

skip lesions

(15-30 yrs, higher in women, Jewish & upper middle class urban populations)

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34
Q

clinical manifestations of Crohn’s disease

A

insidious onset with nonspecific symptoms

diarrhea (non-bloody), abdominal pain

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35
Q

how is Crohn’s disease diagnosed?

A
  1. lab work (electrolyte imbalances)
  2. barium studies
  3. endoscopic studies
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36
Q

nursing management for Crohn’s disease

A
  • sulphasalazine (when large intestine is involved)
  • corticosteroid therapy
  • immunosuppressive agents (when corticosteroids fail)
  • metronidazole (used to treat Crohn’s of the perianal area)
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37
Q

role of the thyroid

A

regulates metabolism, digestion, temperature, growth/development, thoughts/feelings, energy levels

38
Q

thyroid hormones

A

pituitary gland –> TSH –> T3/T4

39
Q

hypothyroidism

A

underactive thyroid gland (HIGH TSH, LOW T4)

everything is LOW and SLOW

mostly affects middle aged women

40
Q

main causes of hypothyroidism

A
  1. hashimotos disease (immune system attacks the thyroid)
  2. iodine deficiency
  3. pituitary gland tumour
41
Q

clinical manifestations of hypothyroidism

A

fatigue, lethargy, impaired memory, somnolence, depression, low exercise tolerance, weight gain, anemia, constipation, hair loss, weight gain

42
Q

worst case scenario of hypothyroidism

A

MYXEDEMA COMA

medical emergency

unresponsive, appears like respiratory failure, bradycardic, low blood glucose

43
Q

how do we treat hypothyroidism

A

synthroid (levothyroxine)

44
Q

hyperthyroidism

A

overactive thyroid gland (LOW TSH, HIGH T4)

everything is in OVERDRIVE

45
Q

main causes of hyperthyroidism

A
  1. graves disease (protruding eyeballs, frail, thin)
  2. toxic goiter
  3. increased iodine
  4. thyroiditis
46
Q

clinical manifestations of hyperthyroidism

A

goiter, abnormal eye appearance, weight loss, increased nervousness, confusion, agitation

47
Q

worst case scenario of hyperthyroidism

A

THYROID STORM

medical emergency

severe tachycardia, heart failure, shock, hyperthermia, abdominal pain, restlessness, diarrhea, vomiting, coma

48
Q

reatment for hyperthyroidism

A
  1. PTW or tapazole (decreases production)
  2. thyroidectomy (afterwards will need to take synthroid)
  3. radioactive tx (pill that destroys thyroid tissue and hyperactive cells)
  4. beta-blockers
  5. dietary changes (avoid seafood, dairy, eggs)
49
Q

goitre

A

abnormal growth of the thyroid gland

can be nodular or diffuse

can occur with hyper or hypothyroidism

50
Q

tuberculosis

A

infectious disease caused by mycobacterium tuberculosis most often affecting the lungs but can be disseminated throughout the body

51
Q

pathophysiology of tuberculosis

A

bacteria multiply and attack the lungs and other parts of the body (eg. lymph nodes)

from the lungs the bacteria move through the blood/lymphatic system to different parts of the body

52
Q

who is most at risk for tuberculosis?

A
  • low socioeconomic groups
  • residing in overcrowded institutions
  • immigrants and indigenous peoples
  • smoking or air pollution
  • people with chronic conditions
  • people unvaxxed against TB
  • immunocompromised pts
53
Q

how is tuberculosis transmitted?

A

airborne droplets, can remain airborne for hours

gets stuck in the lungs/mucus lining

54
Q

extrapulmonary tuberculosis

A

infection outside of the lungs

(kidneys, bones, lymph nodes, genitals)

55
Q

S/S of ACTIVE TB

A
  • frequent cough with sputum
  • chest pain
  • fever
  • weight loss
  • night sweats
  • anorexia

symptoms are vague and often mild therefore, it is easy to unintentionally spread

can lead to abdominal pain, joint pain, pallor, anemia if gone systemic

56
Q

latent TB

A

NO SYMPTOMS, NOT CONTAGIOUS

can live in granulomas and can lay dormant in macrophages and immune cells

when immune system decreases then TB becomes active

57
Q

what is a granuloma?

A

masses of granulation tissue in which monocytes trap the mycobacteria within

58
Q

how do you diagnose tuberculosis?

A
  1. TB skin test (looking for induration, assessed 48-72 hrs after injection)
  2. chest x-ray (looking for irregular patches in the lungs)
  3. sputum sample (AFB test; 3 samples on different days in the AM)
59
Q

how do you treat tuberculosis?

A

95% curable rate
- antibiotics (streptomycin)
MUST TAKE WHOLE COURSE 4-6 MONTHS
- DOTS (Direct Observation Therapy Short Course) done by public health authorities (watch pt swallow all meds and assessing tx adherence)

60
Q

is tuberculosis a reportable disease?

A

YES, must be reported to the public health authority

61
Q

tuberculosis prevention

A

BCG (Bacille Calmette Guerin) vaccine

62
Q

HIV

A

human immunodeficiency virus

attacks the immune system

63
Q

pathophysiology of HIV

A

HIV infects CD4 cells (WBCs) –> replicate –> destroy –> weakens the immune system = opportunistic infections & malignancies

64
Q

who is at risk for HIV

A
  1. healthcare workers
  2. indigenous population
  3. sex workers
65
Q

how is HIV transmitted?

A

through blood and bodily fluids

(blood transfusion/needle stick; unprotected sex*; breast milk)

*most common

66
Q

does every exposure to HIV indicate an infection?

A

not necessarily

depends on:
- amount of virus in the blood
- frequency and duration
- volume of fluid
- immune system of the host

67
Q

what are the three stages of HIV?

A
  1. ACUTE
  2. EARLY CHRONIC
  3. SYMPTOMATIC
  4. AIDS (LATE)
68
Q

Acute (initial) stage of HIV

A

within a few weeks post infection, increased amount of virus in the blood

  • flu like symptoms (lethargy, malaise, fever, sore throat, fatigue)
  • usually the body can fight it off
  • may not test positive right away
69
Q

Early chronic stage of HIV

A

prolonged period (10-12) years of LOW HIV in the blood

  • few clinical symptoms (immune system constantly compensating)
  • transmissible to other people
70
Q

Symptomatic stage of HIV

A

CD4 counts fall below 500 *

  • night sweats, fever, weight loss, more susceptible to opportunistic infections, lack of immunity
71
Q

Late stage of HIV = AIDS

A

CD4 counts less than 200 *

  • increased viral load, decreased T cells
  • development of one opportunistic infection
72
Q

what are some common opportunistic infections associated with AIDS?

A

candidiasis, Kaposi’s sarcoma, tuberculosis, pneumonia, herpes simplex virus, neurological complications

73
Q

where can you get tested for HIV?

A
  • hospital
  • sexual health clinics
  • primary care clinics
74
Q

what are the diagnostic tests for HIV?

A
  1. self-administration testing (rapid test)
  2. EAI: Enzyme Immuno Acid Test (antibody/antigen test)
  3. NAT: Nucleic Acid Test (looks for virus in blood)
  4. Western blot test
75
Q

treatment for HIV

A

antiretroviral load therapy (decreases the viral load in the body)

  • requires strict medication adherence
76
Q

what are the nationally reportable STI’s in Canada, and where do you report?

A

gonorrhea, syphilis, and chlamydia

must be reported to the Communicable Disease Division in each province or territory

77
Q

gonorrhea

A

bacterial infection spread through direct physical contact with an infected host

S/S: greenish-yellow purulent urethral/anal discharge develops 2-5 days after infection, swollen testicles, vaginal discharge, dysuria, menstrual changes, frequency of urination

78
Q

effect on babies being born to a mother with gonorrhea

A

newborns can develop gonorrhea during delivery, if left untreated babies can develop permanent blindness

79
Q

nursing management for gonorrhea

A
  • all sexual contacts must be examined and treated as well
  • pt should abstain from sexual intercourse and alcohol during tx
  • pts also treated for chlamydial infection
  • ceftriaxone and azithromycin is preferred tx
80
Q

syphilis

A

bacterial infection thought to enter through very small breaks in the skin or mucous membranes with contact with infectious indurated lesion

can affect many tissues in the body

81
Q

S/S of syphilis

A

primary chancre (painless indurate lesion)

secondary (flu like symptoms; symmetrical rash that begins on the trunk and involves palms and soles; weight loss; alopecia)

late (gummas - chronic destructive lesions)

82
Q

risk of pregnancy and syphilis

A

high risk for miscarriage, still birth or death of a newborn

83
Q

nursing management for syphilis

A

penicillin G (tx of choice)
- all sexual contacts in last 90 days be treated

84
Q

chlamydia

A

bacterial infection transmitted during penetrative sexual intervourse

high prevalence of asymptomatic infections

85
Q

S/S of chlamydia

A

“silent disease”

urethritis, epididymitis, proctitis, purulent discharge, edematous area, pain with intercourse, menstrual abnormalities

86
Q

pregnancy and chlamydia

A

baby may be born premature, have eye infections or develop pneumonia

87
Q

nursing management for chlamydia

A
  • rule out gonorrhea
  • doxycycline or azithromycin with erythromycin or ofloxacin used as alternative tx regimen
88
Q

HSV

A

herpes simplex virus

non-reportable

virus enters through mucous membranes or breaks in the skin during contact with an infected person

HSV-1: above the waist
HSV-2: below the waist

89
Q

S/S of HSV

A

burning, itching, tingling at site of inoculation

small, vesicular painless lesions and when ruptured form shallow, moist ulcerations

they then crust over

90
Q

pregnancy and HSV

A

high risk of transmission of genital herpes to the newborn

typically an indication for a C-section delivery if an active genital lesion is present

91
Q

treatment for HSV

A
  • encourage symptomatic treatment
  • keep lesions dry and clean
  • antiviral agents
92
Q
A

concepts 4 (4 decks)

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