Final Test Flashcards
1
Q
Nagele’s Rule
A
minus 3 months from LMP and add 7 days
2
Q
Prenatal assessment at each office visit
A
urine dip, weight, BP, listen for fetal heart tones after 12 weeks, measure uterus(#cm=#weeks after 20 weeks) &at end of pregnancy check fetal position and cervix for dialation and effacement
3
Q
What are presumptive(possible) signs of pregnancy?
A
(subjective)
-amenorrhea
-fatigue
-urinary frequency
-breast changes
-uterine enlargement
-quickening (movement)
4
Q
What are probable signs of pregnancy?
A
(objective)
- positive urine pregnancy test
-hegors sign (softening of lower uterus)
-chadwicks sign ( bluish color of cervix)
-goodells sign (softening of cervix)
-ballottement (rebound of unengaged fetus)
-braxton hick contractions
-abdominal enlargement
5
Q
what are the positive signs of preganancy?
A
diagnostic:
audible fetal heart tones via doppler, ultrasound @ 4-6 weeks and feeling baby move by examiner(20 weeks)
6
Q
what is placenta previa?
A
when the placenta implants in the lower segment of the uterus near or over the cervical os;
abnormal implantation results in bleeding in the 3rd trimester as cervix begins to dilate and efface
7
Q
what is important to remember with previa?
A
NO cervical exams
8
Q
risk factors for placenta previa?
A
previous placenta previa, uterine scarring from surgery or infection, advanced maternal age, multifetal gestation, closely spaced pregnancies, smoking
9
Q
manifestations of placenta previa?
A
painless, bright red bleeding in 2nd and 3rd trimester; uterus is soft and nontender; FH noted; make sure H and H stable; rhogam if needed; US to diagnose
10
Q
what is an ectopic pregnancy?
A
abnormal implantation of the ovum outside of the uterus (typically in the fallopian tube)
11
Q
betamethosone use
A
it can help speed up lung development in preterm babies. Betamethasone causes the release of surfactant, a substance that lubricates the lungs so that they do not stick together when the infant breathes.
12
Q
What is placental abruption?
A
premature separation of the placenta from the uterus which can be partial or complete detachment;
significant maternal and fetal morbidity and mortality; leading cause of maternal death
13
Q
risk factors for placental abruption?
A
maternal HTN, blunt force trauma, cocaine use, smoking, folate deficiency, premature rupture of membranes, multifetal gestation
14
Q
what is terbutaline?
A
beta-adrenergic agonist used as a tocolytic to relax smooth muscle and inhibit uterine activity; administer SQ, monitor for CNS stimulation (tachycardia, tremors, nervousness, etc)
15
Q
What is magnesium sulfate?
A
tocolytic that is a CNS depressant and relaxes smooth muscles, thus inhibiting uterine activity by suppressing contractions; administered IV; need to monitor mother closely
16
Q
HELLP syndrome stands for
A
hypertension in pregnancy as well as Hemolysis, Elevated Liver enzymes, Low Platelet
17
Q
antidote for magnesium sulfate?
A
calcium gluconate or calcium chloride
18
Q
what do you monitor for with magnesium sulfate?
A
magnesium toxicity and discontinue for loss of deep tendon reflexes, urine output less than 30ml/hr, resp rate less than 12, pulmonary edema, severe hypotension, or chest pain
19
Q
what is gestational hypertension
A
BP is 140/90 in normotensive woman after 20 weeks gestation on two occasions and without proteinuria
20
Q
when does bp return to normal after gestational hypertension
A
12 weeks postpartum
21
Q
when is the glucose tolerance test done
A
24-28 weeks gestation
22
Q
risk factors for gestational hypertension
A
-age younger than 19 or over 40
-1st pregnancy
-extreme obesity
-family hx of GH
-multifetal pregnancy
-chronic hypertension
-chronic renal disease
-family hx of preeclampsia
-DM
-rheumatoid arthristis
-systemic lupus erythematosus
23
Q
Difference between pre-eclampsia and eclampsia
A
eclampsia has siezures
24
Q
what manifestations are seen with preeclampsia
A
-Gestational hypertension with the addition of proteinuria of greater than or equal to 1+.
-report of transient headaches may occur along with episodes of irritability
edema can be present
25
severe preeclampsia consists of bp greater than what?
160/110 along w/ more severe symptoms
26
how long should a woman wait to get pregnant after receiving a rubella vaccine
atleast 3 months
27
what are rubellas effects on embryo or fetus
microcephaly
mental retardation
congenital cataracts
deafness
cardiac effects
IUGR
28
how can rubella effect a developing fetus
early in pregnancy- disrupt formation of major body systems
later in pregnancy- damage to already formed organs
29
when can Rh incompatibility occur
ONLY if the woman is Rh neg and the fetus is Rh pos
30
when it comes to kick counting how much do you count
until you feel up to 10 kicks within a 2 hour time period
31
when is kick counting most often used?
high risk pregnancies
32
what is a non stress test
-indirect measurement of uteroplacental function
-observe for signs of fetal activity w/ a concurrent acceleration of the fetal heart rate
33
what is RPR?
(Rapid plasma reagin)
a screening test for syphillis
34
what are the components of the biophysical profile?
fetal movement
fetal tone
fetal breathing movement
amniotic fluid volume
non stress test
(each category is worth 2 points)
35
definition of fetal movement in regards to BPP
3 body or limb movements
36
definition of fetal tone in regards to BPP
1 episode of active extension&flexion of the limbs; opening and closing of hand
37
definition of fetal breathing movement in regards to BPP
episode of >or = 30 seconds in 30 minutes; hiccups are considered breathing activity
38
definition of amniotic fluid volume in regards to BPP
single 2 cm X 2cm pocket is considered adequate
39
definition of non stress test in regards to BPP
2 accelerations > 15 bpm of at least 15 sec durations
40
what is a normal BPP score?
8/10
41
what is stage one in labor
begins with onset of labor and ends when the cervix is 100% effaced and completely dilated to 10 cm
the average length for a first time mother is 10-14 hours
42
what is stage 2 of labor
pushing stage
begins with complete effacement and dilation of the cervix and ends with delivery of baby
average length for first time mothers is 1-2 hours
43
what is stage 3 of labor
begins with birth of baby and ends with delivery of placenta
average length is 5-15 minutes
44
what are the three phases of stage 1 of labor
latent
active
transition
45
in the fourth stage of labor the uterus should be
firm well contracted and located between umbilicus and pubic symphysis
46
what is a variable deceleration
abrupt slowing of 15 or more BPM for at least 15 seconds, has an unpredictable shape (u, v, w), associated with cord compression
47
what can cause late decelerations of fetal heart rate
abruption, previa, gestational diabetes
48
when do late decelerations of fetal heart rate occur
after the peak of the contraction
49
what actions are taken for early deceleration
no action required as long as it turns back to base line
50
what are the risk factors for postpartum hemorrhage
uterine atony
previa or abruption during pregnancy
precipitous delivery (less than 3 hours of labor)
lacerations and/or hematomas
retained placental fragments
prolonged labor
51
what vitals of the neonate should the nurse report
temp greater than 100.4
apical pulse less than 110 or greater than 160 bpm
respirations greater than 60 or less than 30
noisy respirations
nasal flaring or chest retractions
grunting
blood glucose less than 40
52
nursing care for pp hemorrhage?
vital sign assessment; assess fundus; assess lochia; assess for signs of bleeding from lacerations, episiotomy, or hematoma; assess for bladder distention
53
Nonshivering thermogenesis
NEWBORN’S PRIMARY METHOD OF HEAT PRODUCTION!
Brown fat is oxidized in response to cold exposure
54
Postpartum hemmorhage meds
Oxytocin(Pitocin)
* Promotes uterine contractions(dose specific)
Methergine(ergot alkaloid)
* Controls postpartum hemorrhage
* *Monitor BP- can cause hypertension
Misoprostol (Cytotec) synthetic prostaglandin E2
* Controls postpartum hemorrhage (dose specific)
55
what does misoprostol do
synthetic prostaglandin E2
Controls postpartum hemorrhage (dose specific)
stimulates uterine contractions
56
what are symptoms of postpartum blues
irritability, anxiety, fluctuating mood, and increased emotional reactivity
57
what are symptoms of postpartum depression
excessive guilt, anxiety, anhedonia, depressed mood, insomnia/hypersomnia, suicidal ideation, & fatigue
58
what are the symptoms of postpartum psychosis
mixed or rapid cycling, agitation, delusions, hallucinations, disorganized behavior, cognitive impairment, and low insight
59
Methods of heat loss
EVAPORATION – heat loss through wet skin
CONVECTION – heat loss from cooler air when exposed
CONDUCTION – heat loss through direct contact with a cold surface (e.g. scales, un-warmed mattress)
RADIATION – heat loss from heat moving towards a cooler surface
60
major signs of sepsis in preterm infant?
low temp, tachypneic, bradycardic
61
what is our first intervention if a newborn is showing signs of hypoglycemia
heal stick to get an accurate blood glucose reading
62
how do we first supply glucose to a hypoglycemic newborn
glucose gel on our finger and rub it on the inside of their cheeks
63
manifestations of respiratory distress syndrome (RDS)?
can take up to several hours after birth to manifest;
respirations increase to 60 breaths/min or higher; tachypnea may be accompanied by gruntlike sounds, nasal flaring, cyanosis, and intercostal and sternal retractions; edema and apnea occur as condition worsens
64
nursing care of infant with RDS?
monitor vs, minimal handling of infant to help conserve energy, IV fluids are prescribed, monitor I&O, oxygen therapy (monitor pulse oximetry), infant on oxygen is at high risk for oxygen toxicity
65
tx for RDS?
betamethasone (if L/S ratio shows lung immaturity and this can be given 2 days before delivery to stimulate lung maturity); surfactant can be administered via ET tube at birth or when symptoms occur
66
Pathophys of pancreatitis
is an auto-digestion of the pancreas by its own digestive enzymes released too early in the pancreas
67
what medications are used to treat PUD
h2blockers and PPIs
68
what medications do you avoid with PUD
NSAIDs & aspirins
69
causes of acute pancreatitis
gallstones, alcohol(ETOH), infection, medications, tumor or trauma
70
causes of chronic pancreatitis
repeated episodes of acute pancreatitis, excessive and prolonged consumption of alcohol and cystic fibrosis
71
what 2 drugs are used to treat gallbladder disease and dissolve stones of cholesterol
ursodiol and chenodiol
72
labs for pancreatitis
high amylase, high lipase, high WBCs, high bilirubin, high glucose, low platelets, low calcium and low magnesium
73
how long must the drugs for gallbladder dx be used to be effective
6-12 months
74
side effects of ursodiol &chenodiol
headache, pruritis, gi symptoms
75
what to monitor for pancreatits
glucose,BP, I&Os, labs and stools
76
pain management drugs for gallbladder dx
iv analgesics such as ketorolac and hydromorphone
77
Crohn's disease patho
inflammation that occurs anywhere in the GI tract from the mouth to the anus-no cure
78
Crohn's signs and symptoms
cobble stone appearance, fever, cramping after meals, mucus like diarrhea, abdominal distention, nausea and vomiting
79
lab results for cushings disease
high glucose
high sodium
low potassium
low calcium
80
treatment for cushings
adrenalectomy (requires lifelong corticosteroid tx)
administer chemo agents if adrenal tumor is present
81
lab results for addisons disease
low glucose
low sodium & h20
high potassium
82
diet for crohn's and ulcerative colitis
clear liquids to decrease fiber, increase protein, vitmains and iron supplements and avoid gas-forming foods(nuts, caffeine, alcohol,whole-wheat grains,dairy,fruits&veggies)
83
ulcerative colitis patho
inflammation and ulceration of only the large intestine and the rectum
cure:colectomy with ileostomy
84
lab results for hyperthyroidism
increased T3 &T4
decreased TSH
85
lab results for hypothyroidism
decreased T3 & T4
increase TSH
86
ulcerative colitis signs and symptoms
ulcers cause:rectal bleeding, bloody diarrhea and abdominal cramping, high HR&low BP-hypovolemic shock, malnutrition, malaise, dehydration and vitamin K deficiency
87
meds for both crohn's and ulcerative colitis
corticosteriods, immunosuppressants, antidiarrheals and salicylate compounds
88
nursing process for hyperthyroidism
assess lab values and vs
listen to lungs and bowels
tx symptoms
start iv/meds
provide comfort
hold throat from back gently to assess thyroid
89
what to monitor for crohn's and ulcerative colitis
bowel sounds, bowel perforation, peritonitis, hemorrhage and stool (color, consistency and presence of blood)
90
what is rheumatoid arthritis
chronic systemic autoimmune disorder
91
5 general pharmacologic approaches for rheumatoid arthritis
aspirin
nsaids
dmard
immune modulators
tumor necrosis factor
92
rheumatoid arthritis diagnostic tests
-rheumatoid factors
-sed rate
-CBC & infectious process/anemia
-asp. of sinovial fluid
-xray (shows demineralization/progression)
-c-reactive protein (will be elevated and shows inflammation)
-ANA & C3&C4 (shows complement levels)
93
what is systemic lupus erythematosus
a chronic inflammatory connective tissue disease that affects almost all body systems. Caused by deposition of antigen-antibody complexes in connective tissues
94
lupus diagnostic tests
-complement levels (C4 will be low)
-H&H low (anemia)
-ANA would be positive
-sed rate would be high
95
lupus pharmacologic therapy--skin/arrhythmic manifestations
antimalarial drugs
(plaquenil)
96
lupus pharmacologic therapy
immunosuppressants, NSAIDS, steroids, DHEA (mild male hormone therapy that helps treat mild to moderate lupus symptoms)
*client at risk for infection*
97
alpha adrenergic blockers(relax smooth muscle) used for BPH
doxaozosin
prozosin
tamsulosin
terazosin
98
2 5-alpha reductase inhibitors (decrease prostate size) for BPH
finasteride(Proscar)
dutasteride(avodart)
99
what is refeeding syndrome?
when the body rapidly changes from catabolic to anabolic metabolism
100
3 prostate cancer surgical treatments
open procedure
laparoscopic/ robotic procedure
TURP
101
s/s of refeeding syndrome?
confusion, F&E imbalance, weakness, cardiac dysrhythmias
102
3 types of prostate biopsy's
transrectal
transurethral
transperineal
103
when do you give TPN?
when nutrition is needed for 2 weeks or longer
104
when do you use PPN?
when nutrition is needed for 2 weeks or less
105
what do you need to verify before giving TPN?
verify central line placement via xray(will also show is there is a pnumothrorax)
106
informed consent is always signed before
ANY medications are given
107
coming out of surgery what is the main priority
oxygenation
108
complications of TPN?
hypoglycemia(from quickly d/cing the infusion), infection, metabolic complications, mechanical complications and refeeding syndrome
109
first reliable sign of malignant hyperthermia
increased carbon dioxide level (EtCO2)
110
what do you administer if the patient is experiencing malignant hyperthermia
IV dantrolene (muscle relaxant)
111
goals of parenteral nutrition?
improve nutritional status, establish positive nitrogen balance, maintain muscle mass, promote weight maintenance or gain, and enhance the healing process
112
what are some surgical complications that can occur
airway obstruction
neg pressure pulmonary edema
hypoxia
pulmonary embolism
hemorrhage
hypovolemic shock
dvt
paralytic ileus
wound dehiscence or evisceration
113
emergent surgery vs urgent surgery
emergent is without delay
urgent is within 24-32 hours
114
normal ranges for:
sodium
magnesium
calcium
sodium 135-145
magnesium 1.3-2.1
calcium 8.5-10.5
115
Diabetes Insipidus (DI) assessment findings
Polydipsia, polyuria, nocturia, dehydration, sunken eyes, tachy, hypotension, poor skin turgor, dry mucus membranes, weight loss, dizziness, constipation, weak pulses, decreased LOC
116
Diabetes Insipidus (DI) lab tests
-Urine (think dilute): urine specific gravity <1.005
-Blood(think concentrate): Na+ >145
117
Diabetes Insipidus (DI) diagnostic tests
-water deprivation test (induced dehydration, freq weights, VS, and withhold fluid for 8-12hrs) test is positive if kidneys can’t concentrate urine
-vasopressin test
118
Syndrome of inappropriate anti diuretic hormone (SIADH) signs and symptoms
Oliguria, dilutional hyponatremia
Early: HA, weakness, anorexia, muscle cramps, weight gain w/o edema, crackles and JVD
Later: personality changes, hostility, sluggish deep tendon reflexes, N/V/D and oliguria
Intake > Output
119
Syndrome of inappropriate anti diuretic hormone (SIADH) treatment
-eliminate underlying cause (if possible)
-restricting fluid intake
-demeclocycline, vasopressin agonists and furosemide
120
define AKI
reversible syndrome that results in decreased gmr and oliguria
121
define CRF
ends with ESRD, a progressive irreversible deterioration of renal function that results in azotemia
122
normal gfr
kidney disease gfr
kidney failure gfr
normal 60-120
kidney dx 15-60
kidney failure 0-15
123
4 phases of AKI
initiation
oliguria
diuresis
recovery
124
pharmacologic therapies for aki
meds to increase bp
diuretics
iv fluids
volume expanders
keyexalate
phosphorus binding capsules
125
pharmacologic therapies for crf
antihypertensives
phosphorus binders
folic acid
iron supplements
dig or dibutamine
possible blood transfusion
126
causes of fluid volume defecit
vomitting
diarrhea
gi suctioning
sweating
decreased intake
127
lab data in regards to fluid volume defecit
increased BUN
increased HCT
128
with aki you will see a sudden increase in what
BUN
Creatinine
potassium
129
prerenal is generally a _______ problem
perfusion
130
what is dialysis
diffusion of solutes across semipermeable membrane
131
advantages of hemodialysis
may be done at home
removes fluid rapidly
excellent for K+ removal
less protein loss
quickly removes urea and creatinine
temporary access may be obtained quickly
132
advantages of peritoneal dialysis
no need for vascular access
less dietary and fluid restrictions
better bp control
not as complicated
can be done at home
causes less cardiovascular problems
easier to manage patients with diabetes
133
how is hepatitis A & E transmitted
enteral route
134
how is hepatitis B, C, & D transmitted
parenteral route
135
nursing interventions for hepatitis A
report illness to state
supportive care
re-education about handwashing, personal hygiene, environmental sanitation
136
medications for chronic hep b
alpha interferon and antiviral agents: entecavir (ETV) and tenofovir (TDF)
137
medications for hep c
antiviral meds
meds that effect liver should be avoided
138
metabolic functions of the liver
bile formation
protein metabolism
drug metabolism
fat metabolism
carb/glucose metabolism
vitamin and iron storage
ammonia conversion
bilirubin excretion
139
Bile is essential for ______.
digestion and absorption
140
what happens when there is altered functioning of bile production in liver?
malabsorption of fat and fat soluble vitamins (bile carries those to walls of intestines for absorption)
141
what are the 3 components of protein synthesis?
albumin, clotting factors, transport proteins
142
what happens when there is altered functioning of protein synthesis in liver?
elevated blood ammonia levels, decreased levels of plasma proteins (albumin), and increased bleeding tendency
143
what happens when there is altered level of functioning for metabolism of drugs in the liver?
decreased drug metabolism (duh lol), decreased plasma binding of drugs due to decreased albumin production
144
what does carbohydrate metabolism do in the liver?
stores glycogen and synthesizes glucose from amino acids, lactic acid, and glycerol
145
what happens when there is altered level of functioning for carbohydrate metabolism in the liver?
hypoglycemia may develop when glycogenolysis and gluconeogenesis are impaired
146
what does fat metabolism do in the liver?
formation of lipoproteins; conversion of CHO and proteins to fat; synthesis, recycling, and elimination of cholesterol; formation of ketones from fatty acid
147
what happens when there is altered level of functioning for fat metabolism in the liver?
impaired synthesis of lipoproteins and altered cholesterol levels
148
What is BAD FOLK?
minerals and vitamins stored in liver;
B- Vit B12
A- Vit A
D- Vit D
FOL- folic acid
K- vit K
149
what happens when there is altered functioning in the storage of vitamins and minerals in the liver?
deficiency of fat soluble and other vitamins stored in liver
150
what is vitamin K needed for?
protein synthesis, part of clotting cascade to stop bleeding
151
damaged liver cells cannot make _______.
vitamin K
152
thiamine (B1) deficiency can lead to _______.
wernicke-korsakoff psychosis
153
symptoms of wernicke-korsakoff psychosis?
confusion, changes to eyes and vision, double vision, loss of muscle coordination, can interfere with walking, confusion can lead to combativeness and violent behavior, exaggerated storytelling, coma, death
154
What tests are included in liver function testing? (9)
bilirubin, aspartate aminotransferase AST (SGOT), alanine aminotransferase ALT (SGPT)- liver specific, international normalized ration (INR), gamma-glutamyl transpeptidase (GGT)- shows alcohol abuse, alkaline phosphatase (ALP), ammonia, albumin, BUN
155
what are age related changes that happen in the liver?
decrease in size and weight, decrease in hepatic blood flow, decreased ability to repair itself after injury, reduced drug metabolism and drug clearance abilities, increased incidence of gallstones
156
what should be included in health history regarding the liver?
exposure to hepatotoxic substances or infectious agents, history of drug and alcohol use, current meds, travel history
157
what are early symptoms of liver disease?
fatigue, significant changes in weight, GI sx, abdominal pain or liver tenderness, pruritus NOT usually seen in early liver disease
158
what happens in acute liver failure?
hepatocellular dysfunction that develops rapidly, blood flow through the liver is disrupted, and cerebral edema and intracranial hypertension occur
159
In acute liver failure, hepatocellular dysfunction that develops rapidly causes liver to stop synthesizing plasma proteins. What happens due to this?
capillary oncotic pressure decreases, fluids shift from intravascular to interstitial space, aldosterone is not inactivated, and the high levels of aldosterone cause kidneys to retain sodium and water and excrete potassium
causes fluid and electrolyte imbalances
160
In acute liver failure, blood flow through the liver is disrupted because cellular inflammation and degeneration in the liver increases resistance to blood flow. What happens due to this?
portal HTN, and leads to esophageal varices, bleeding and ascites
161
what does portal HTN cause?
congestion/engorgement of venous circulation
162
In acute liver failure, cerebral edema and intracranial hypertension occur because neurotoxins are not cleared from the GI system. How does it happen?
they accumulate in the systemic circulation, the brain swells and disruption of blood-brain barrier leads to intracranial HTN and irreversible neurologic damage
163
What is hepatic cirrhosis?
normal liver tissue is replaced with diffuse fibrosis; slow progressive liver disease
164
what are the 3 types of cirrhosis?
alcoholic cirrhosis, postnecrotic cirrhosis, and biliary cirrhosis
165
clinical manifestations in early cirrhosis?
liver is firm and easier to palpate
166
clinical manifestations in late cirrhosis?
liver is enlarged, palpable several finger breadths below the rib; jaundice, ascites, portal HTN, esophageal varices
167
what are the different kinds of jaundice?
hemolytic, hepatocellular, obstructive, hereditary
168
what is increased bilirubin levels in jaundice?
2.5mg/dL
169
cause of hemolytic jaundice?
lysis of RBCS, transfusion reactions
170
cause of hepatocellular jaundice?
infections, toxins, meds
171
causes of obstructive jaundice?
gallstones, tumors, pressure *stool colored clay, dark urine*
172
causes of hereditary jaundice?
hyperbilirubinemia, inherited disorders, gilberts syndrome, genetic disorders
173
what are causes of ascites?
portal HTN, vasodilation of splanchnic circulation, changes in ability to metabolize aldosterone, decreased synthesis of albumin, movement of albumin into peritoneal cavity
174
sx of ascites?
increase abdominal girth, rapid weight gain, SOB, fluid and electrolyte imbalances, protein containing fluid, increased lymphatic flow, increased sodium, decreased albumin
175
tx for ascites?
aimed at preventing complications; diet (low sodium, fluid restriction); diuretics, albumin, bed rest, paracentesis, TIPS
176
what do you assess with ascites?
fluid wave
177
what does portal HTN cause?
esophageal varices, caput medusae, hemorrhoids, marked ascites, hypersplenism, AV shunting
178
assessment findings for esophageal varices?
black, tarry stools;
bloody stools;
lightheadedness;
paleness;
sx of chronic liver disease;
vomiting;
vomiting blood;
low bp;
rapid HR
179
tx for bleeding varices?
treat for shock, administer O2, IV fluids, electrolytes, blood products, vasopressin, nitroglycerin, propanolol, balloon tamponade, endoscopic sclerotherapy, endoscopic variceal ligation, TIPS procedure, fibrin glue, stents, or surgical management
180
what is hepatic encephalopathy/coma?
life threatening complication of liver disease; occurs with end-stage liver disease; due to ammonia buildup in the brain
181
onset of hepatic encephalopathy can be _______.
insidious
182
sx of hepatic encephalopathy?
mental status changes, motor disturbances, and difficult to awaken
183
assessment for hepatic encephalopathy and coma?
EEG, changes in LOC. potential seizures, fetor hepaticus, monitor fluid, electrolyte, and ammonia levels
184
management for hepatic encephalopathy?
reduce or treat cause, give lactulose to reduce serum ammonia levels in feces, IV glucose to minimize protein catabolism, protein diet, gastric suction or enemas to reduce ammonia from GI tract, monitor and treat complications and infections
