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NURSING 210 > Final Test > Flashcards

Final Test Flashcards

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1
Q

Nagele’s Rule

A

minus 3 months from LMP and add 7 days

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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

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3
Q

What are presumptive(possible) signs of pregnancy?

A

(subjective)
-amenorrhea
-fatigue
-urinary frequency
-breast changes
-uterine enlargement
-quickening (movement)

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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

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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)

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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

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7
Q

what is important to remember with previa?

A

NO cervical exams

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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

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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

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10
Q

what is an ectopic pregnancy?

A

abnormal implantation of the ovum outside of the uterus (typically in the fallopian tube)

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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.

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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

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13
Q

risk factors for placental abruption?

A

maternal HTN, blunt force trauma, cocaine use, smoking, folate deficiency, premature rupture of membranes, multifetal gestation

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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)

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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

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16
Q

HELLP syndrome stands for

A

hypertension in pregnancy as well as Hemolysis, Elevated Liver enzymes, Low Platelet

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17
Q

antidote for magnesium sulfate?

A

calcium gluconate or calcium chloride

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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

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19
Q

what is gestational hypertension

A

BP is 140/90 in normotensive woman after 20 weeks gestation on two occasions and without proteinuria

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20
Q

when does bp return to normal after gestational hypertension

A

12 weeks postpartum

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21
Q

when is the glucose tolerance test done

A

24-28 weeks gestation

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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

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23
Q

Difference between pre-eclampsia and eclampsia

A

eclampsia has siezures

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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

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25
Q

severe preeclampsia consists of bp greater than what?

A

160/110 along w/ more severe symptoms

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26
Q

how long should a woman wait to get pregnant after receiving a rubella vaccine

A

atleast 3 months

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27
Q

what are rubellas effects on embryo or fetus

A

microcephaly
mental retardation
congenital cataracts
deafness
cardiac effects
IUGR

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28
Q

how can rubella effect a developing fetus

A

early in pregnancy- disrupt formation of major body systems
later in pregnancy- damage to already formed organs

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29
Q

when can Rh incompatibility occur

A

ONLY if the woman is Rh neg and the fetus is Rh pos

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30
Q

when it comes to kick counting how much do you count

A

until you feel up to 10 kicks within a 2 hour time period

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31
Q

when is kick counting most often used?

A

high risk pregnancies

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32
Q

what is a non stress test

A

-indirect measurement of uteroplacental function
-observe for signs of fetal activity w/ a concurrent acceleration of the fetal heart rate

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33
Q

what is RPR?

A

(Rapid plasma reagin)
a screening test for syphillis

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34
Q

what are the components of the biophysical profile?

A

fetal movement
fetal tone
fetal breathing movement
amniotic fluid volume
non stress test
(each category is worth 2 points)

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35
Q

definition of fetal movement in regards to BPP

A

3 body or limb movements

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36
Q

definition of fetal tone in regards to BPP

A

1 episode of active extension&flexion of the limbs; opening and closing of hand

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37
Q

definition of fetal breathing movement in regards to BPP

A

episode of >or = 30 seconds in 30 minutes; hiccups are considered breathing activity

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38
Q

definition of amniotic fluid volume in regards to BPP

A

single 2 cm X 2cm pocket is considered adequate

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39
Q

definition of non stress test in regards to BPP

A

2 accelerations > 15 bpm of at least 15 sec durations

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40
Q

what is a normal BPP score?

A

8/10

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41
Q

what is stage one in labor

A

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

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42
Q

what is stage 2 of labor

A

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

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43
Q

what is stage 3 of labor

A

begins with birth of baby and ends with delivery of placenta
average length is 5-15 minutes

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44
Q

what are the three phases of stage 1 of labor

A

latent
active
transition

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45
Q

in the fourth stage of labor the uterus should be

A

firm well contracted and located between umbilicus and pubic symphysis

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46
Q

what is a variable deceleration

A

abrupt slowing of 15 or more BPM for at least 15 seconds, has an unpredictable shape (u, v, w), associated with cord compression

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47
Q

what can cause late decelerations of fetal heart rate

A

abruption, previa, gestational diabetes

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48
Q

when do late decelerations of fetal heart rate occur

A

after the peak of the contraction

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49
Q

what actions are taken for early deceleration

A

no action required as long as it turns back to base line

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50
Q

what are the risk factors for postpartum hemorrhage

A

uterine atony
previa or abruption during pregnancy
precipitous delivery (less than 3 hours of labor)
lacerations and/or hematomas
retained placental fragments
prolonged labor

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51
Q

what vitals of the neonate should the nurse report

A

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

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52
Q

nursing care for pp hemorrhage?

A

vital sign assessment; assess fundus; assess lochia; assess for signs of bleeding from lacerations, episiotomy, or hematoma; assess for bladder distention

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53
Q

Nonshivering thermogenesis

A

NEWBORN’S PRIMARY METHOD OF HEAT PRODUCTION!

Brown fat is oxidized in response to cold exposure

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54
Q

Postpartum hemmorhage meds

A

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)

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55
Q

what does misoprostol do

A

synthetic prostaglandin E2
Controls postpartum hemorrhage (dose specific)
stimulates uterine contractions

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56
Q

what are symptoms of postpartum blues

A

irritability, anxiety, fluctuating mood, and increased emotional reactivity

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57
Q

what are symptoms of postpartum depression

A

excessive guilt, anxiety, anhedonia, depressed mood, insomnia/hypersomnia, suicidal ideation, & fatigue

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58
Q

what are the symptoms of postpartum psychosis

A

mixed or rapid cycling, agitation, delusions, hallucinations, disorganized behavior, cognitive impairment, and low insight

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59
Q

Methods of heat loss

A

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

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60
Q

major signs of sepsis in preterm infant?

A

low temp, tachypneic, bradycardic

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61
Q

what is our first intervention if a newborn is showing signs of hypoglycemia

A

heal stick to get an accurate blood glucose reading

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62
Q

how do we first supply glucose to a hypoglycemic newborn

A

glucose gel on our finger and rub it on the inside of their cheeks

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63
Q

manifestations of respiratory distress syndrome (RDS)?

A

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

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64
Q

nursing care of infant with RDS?

A

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

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65
Q

tx for RDS?

A

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

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66
Q

Pathophys of pancreatitis

A

is an auto-digestion of the pancreas by its own digestive enzymes released too early in the pancreas

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67
Q

what medications are used to treat PUD

A

h2blockers and PPIs

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68
Q

what medications do you avoid with PUD

A

NSAIDs & aspirins

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69
Q

causes of acute pancreatitis

A

gallstones, alcohol(ETOH), infection, medications, tumor or trauma

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70
Q

causes of chronic pancreatitis

A

repeated episodes of acute pancreatitis, excessive and prolonged consumption of alcohol and cystic fibrosis

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71
Q

what 2 drugs are used to treat gallbladder disease and dissolve stones of cholesterol

A

ursodiol and chenodiol

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72
Q

labs for pancreatitis

A

high amylase, high lipase, high WBCs, high bilirubin, high glucose, low platelets, low calcium and low magnesium

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73
Q

how long must the drugs for gallbladder dx be used to be effective

A

6-12 months

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74
Q

side effects of ursodiol &chenodiol

A

headache, pruritis, gi symptoms

75
Q

what to monitor for pancreatits

A

glucose,BP, I&Os, labs and stools

76
Q

pain management drugs for gallbladder dx

A

iv analgesics such as ketorolac and hydromorphone

77
Q

Crohn’s disease patho

A

inflammation that occurs anywhere in the GI tract from the mouth to the anus-no cure

78
Q

Crohn’s signs and symptoms

A

cobble stone appearance, fever, cramping after meals, mucus like diarrhea, abdominal distention, nausea and vomiting

79
Q

lab results for cushings disease

A

high glucose
high sodium
low potassium
low calcium

80
Q

treatment for cushings

A

adrenalectomy (requires lifelong corticosteroid tx)
administer chemo agents if adrenal tumor is present

81
Q

lab results for addisons disease

A

low glucose
low sodium & h20
high potassium

82
Q

diet for crohn’s and ulcerative colitis

A

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
Q

ulcerative colitis patho

A

inflammation and ulceration of only the large intestine and the rectum

cure:colectomy with ileostomy

84
Q

lab results for hyperthyroidism

A

increased T3 &T4
decreased TSH

85
Q

lab results for hypothyroidism

A

decreased T3 & T4
increase TSH

86
Q

ulcerative colitis signs and symptoms

A

ulcers cause:rectal bleeding, bloody diarrhea and abdominal cramping, high HR&low BP-hypovolemic shock, malnutrition, malaise, dehydration and vitamin K deficiency

87
Q

meds for both crohn’s and ulcerative colitis

A

corticosteriods, immunosuppressants, antidiarrheals and salicylate compounds

88
Q

nursing process for hyperthyroidism

A

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
Q

what to monitor for crohn’s and ulcerative colitis

A

bowel sounds, bowel perforation, peritonitis, hemorrhage and stool (color, consistency and presence of blood)

90
Q

what is rheumatoid arthritis

A

chronic systemic autoimmune disorder

91
Q

5 general pharmacologic approaches for rheumatoid arthritis

A

aspirin
nsaids
dmard
immune modulators
tumor necrosis factor

92
Q

rheumatoid arthritis diagnostic tests

A

-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
Q

what is systemic lupus erythematosus

A

a chronic inflammatory connective tissue disease that affects almost all body systems. Caused by deposition of antigen-antibody complexes in connective tissues

94
Q

lupus diagnostic tests

A

-complement levels (C4 will be low)
-H&H low (anemia)
-ANA would be positive
-sed rate would be high

95
Q

lupus pharmacologic therapy–skin/arrhythmic manifestations

A

antimalarial drugs
(plaquenil)

96
Q

lupus pharmacologic therapy

A

immunosuppressants, NSAIDS, steroids, DHEA (mild male hormone therapy that helps treat mild to moderate lupus symptoms)

client at risk for infection

97
Q

alpha adrenergic blockers(relax smooth muscle) used for BPH

A

doxaozosin
prozosin
tamsulosin
terazosin

98
Q

2 5-alpha reductase inhibitors (decrease prostate size) for BPH

A

finasteride(Proscar)
dutasteride(avodart)

99
Q

what is refeeding syndrome?

A

when the body rapidly changes from catabolic to anabolic metabolism

100
Q

3 prostate cancer surgical treatments

A

open procedure
laparoscopic/ robotic procedure
TURP

101
Q

s/s of refeeding syndrome?

A

confusion, F&E imbalance, weakness, cardiac dysrhythmias

102
Q

3 types of prostate biopsy’s

A

transrectal
transurethral
transperineal

103
Q

when do you give TPN?

A

when nutrition is needed for 2 weeks or longer

104
Q

when do you use PPN?

A

when nutrition is needed for 2 weeks or less

105
Q

what do you need to verify before giving TPN?

A

verify central line placement via xray(will also show is there is a pnumothrorax)

106
Q

informed consent is always signed before

A

ANY medications are given

107
Q

coming out of surgery what is the main priority

A

oxygenation

108
Q

complications of TPN?

A

hypoglycemia(from quickly d/cing the infusion), infection, metabolic complications, mechanical complications and refeeding syndrome

109
Q

first reliable sign of malignant hyperthermia

A

increased carbon dioxide level (EtCO2)

110
Q

what do you administer if the patient is experiencing malignant hyperthermia

A

IV dantrolene (muscle relaxant)

111
Q

goals of parenteral nutrition?

A

improve nutritional status, establish positive nitrogen balance, maintain muscle mass, promote weight maintenance or gain, and enhance the healing process

112
Q

what are some surgical complications that can occur

A

airway obstruction
neg pressure pulmonary edema
hypoxia
pulmonary embolism
hemorrhage
hypovolemic shock
dvt
paralytic ileus
wound dehiscence or evisceration

113
Q

emergent surgery vs urgent surgery

A

emergent is without delay
urgent is within 24-32 hours

114
Q

normal ranges for:
sodium
magnesium
calcium

A

sodium 135-145
magnesium 1.3-2.1
calcium 8.5-10.5

115
Q

Diabetes Insipidus (DI) assessment findings

A

Polydipsia, polyuria, nocturia, dehydration, sunken eyes, tachy, hypotension, poor skin turgor, dry mucus membranes, weight loss, dizziness, constipation, weak pulses, decreased LOC

116
Q

Diabetes Insipidus (DI) lab tests

A

-Urine (think dilute): urine specific gravity <1.005
-Blood(think concentrate): Na+ >145

117
Q

Diabetes Insipidus (DI) diagnostic tests

A

-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
Q

Syndrome of inappropriate anti diuretic hormone (SIADH) signs and symptoms

A

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
Q

Syndrome of inappropriate anti diuretic hormone (SIADH) treatment

A

-eliminate underlying cause (if possible)
-restricting fluid intake
-demeclocycline, vasopressin agonists and furosemide

120
Q

define AKI

A

reversible syndrome that results in decreased gmr and oliguria

121
Q

define CRF

A

ends with ESRD, a progressive irreversible deterioration of renal function that results in azotemia

122
Q

normal gfr
kidney disease gfr
kidney failure gfr

A

normal 60-120
kidney dx 15-60
kidney failure 0-15

123
Q

4 phases of AKI

A

initiation
oliguria
diuresis
recovery

124
Q

pharmacologic therapies for aki

A

meds to increase bp
diuretics
iv fluids
volume expanders
keyexalate
phosphorus binding capsules

125
Q

pharmacologic therapies for crf

A

antihypertensives
phosphorus binders
folic acid
iron supplements
dig or dibutamine
possible blood transfusion

126
Q

causes of fluid volume defecit

A

vomitting
diarrhea
gi suctioning
sweating
decreased intake

127
Q

lab data in regards to fluid volume defecit

A

increased BUN
increased HCT

128
Q

with aki you will see a sudden increase in what

A

BUN
Creatinine
potassium

129
Q

prerenal is generally a _______ problem

A

perfusion

130
Q

what is dialysis

A

diffusion of solutes across semipermeable membrane

131
Q

advantages of hemodialysis

A

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
Q

advantages of peritoneal dialysis

A

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
Q

how is hepatitis A & E transmitted

A

enteral route

134
Q

how is hepatitis B, C, & D transmitted

A

parenteral route

135
Q

nursing interventions for hepatitis A

A

report illness to state
supportive care
re-education about handwashing, personal hygiene, environmental sanitation

136
Q

medications for chronic hep b

A

alpha interferon and antiviral agents: entecavir (ETV) and tenofovir (TDF)

137
Q

medications for hep c

A

antiviral meds
meds that effect liver should be avoided

138
Q

metabolic functions of the liver

A

bile formation
protein metabolism
drug metabolism
fat metabolism
carb/glucose metabolism
vitamin and iron storage
ammonia conversion
bilirubin excretion

139
Q

Bile is essential for ______.

A

digestion and absorption

140
Q

what happens when there is altered functioning of bile production in liver?

A

malabsorption of fat and fat soluble vitamins (bile carries those to walls of intestines for absorption)

141
Q

what are the 3 components of protein synthesis?

A

albumin, clotting factors, transport proteins

142
Q

what happens when there is altered functioning of protein synthesis in liver?

A

elevated blood ammonia levels, decreased levels of plasma proteins (albumin), and increased bleeding tendency

143
Q

what happens when there is altered level of functioning for metabolism of drugs in the liver?

A

decreased drug metabolism (duh lol), decreased plasma binding of drugs due to decreased albumin production

144
Q

what does carbohydrate metabolism do in the liver?

A

stores glycogen and synthesizes glucose from amino acids, lactic acid, and glycerol

145
Q

what happens when there is altered level of functioning for carbohydrate metabolism in the liver?

A

hypoglycemia may develop when glycogenolysis and gluconeogenesis are impaired

146
Q

what does fat metabolism do in the liver?

A

formation of lipoproteins; conversion of CHO and proteins to fat; synthesis, recycling, and elimination of cholesterol; formation of ketones from fatty acid

147
Q

what happens when there is altered level of functioning for fat metabolism in the liver?

A

impaired synthesis of lipoproteins and altered cholesterol levels

148
Q

What is BAD FOLK?

A

minerals and vitamins stored in liver;
B- Vit B12
A- Vit A
D- Vit D
FOL- folic acid
K- vit K

149
Q

what happens when there is altered functioning in the storage of vitamins and minerals in the liver?

A

deficiency of fat soluble and other vitamins stored in liver

150
Q

what is vitamin K needed for?

A

protein synthesis, part of clotting cascade to stop bleeding

151
Q

damaged liver cells cannot make _______.

A

vitamin K

152
Q

thiamine (B1) deficiency can lead to _______.

A

wernicke-korsakoff psychosis

153
Q

symptoms of wernicke-korsakoff psychosis?

A

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
Q

What tests are included in liver function testing? (9)

A

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
Q

what are age related changes that happen in the liver?

A

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
Q

what should be included in health history regarding the liver?

A

exposure to hepatotoxic substances or infectious agents, history of drug and alcohol use, current meds, travel history

157
Q

what are early symptoms of liver disease?

A

fatigue, significant changes in weight, GI sx, abdominal pain or liver tenderness, pruritus NOT usually seen in early liver disease

158
Q

what happens in acute liver failure?

A

hepatocellular dysfunction that develops rapidly, blood flow through the liver is disrupted, and cerebral edema and intracranial hypertension occur

159
Q

In acute liver failure, hepatocellular dysfunction that develops rapidly causes liver to stop synthesizing plasma proteins. What happens due to this?

A

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
Q

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?

A

portal HTN, and leads to esophageal varices, bleeding and ascites

161
Q

what does portal HTN cause?

A

congestion/engorgement of venous circulation

162
Q

In acute liver failure, cerebral edema and intracranial hypertension occur because neurotoxins are not cleared from the GI system. How does it happen?

A

they accumulate in the systemic circulation, the brain swells and disruption of blood-brain barrier leads to intracranial HTN and irreversible neurologic damage

163
Q

What is hepatic cirrhosis?

A

normal liver tissue is replaced with diffuse fibrosis; slow progressive liver disease

164
Q

what are the 3 types of cirrhosis?

A

alcoholic cirrhosis, postnecrotic cirrhosis, and biliary cirrhosis

165
Q

clinical manifestations in early cirrhosis?

A

liver is firm and easier to palpate

166
Q

clinical manifestations in late cirrhosis?

A

liver is enlarged, palpable several finger breadths below the rib; jaundice, ascites, portal HTN, esophageal varices

167
Q

what are the different kinds of jaundice?

A

hemolytic, hepatocellular, obstructive, hereditary

168
Q

what is increased bilirubin levels in jaundice?

A

2.5mg/dL

169
Q

cause of hemolytic jaundice?

A

lysis of RBCS, transfusion reactions

170
Q

cause of hepatocellular jaundice?

A

infections, toxins, meds

171
Q

causes of obstructive jaundice?

A

gallstones, tumors, pressure stool colored clay, dark urine

172
Q

causes of hereditary jaundice?

A

hyperbilirubinemia, inherited disorders, gilberts syndrome, genetic disorders

173
Q

what are causes of ascites?

A

portal HTN, vasodilation of splanchnic circulation, changes in ability to metabolize aldosterone, decreased synthesis of albumin, movement of albumin into peritoneal cavity

174
Q

sx of ascites?

A

increase abdominal girth, rapid weight gain, SOB, fluid and electrolyte imbalances, protein containing fluid, increased lymphatic flow, increased sodium, decreased albumin

175
Q

tx for ascites?

A

aimed at preventing complications; diet (low sodium, fluid restriction); diuretics, albumin, bed rest, paracentesis, TIPS

176
Q

what do you assess with ascites?

A

fluid wave

177
Q

what does portal HTN cause?

A

esophageal varices, caput medusae, hemorrhoids, marked ascites, hypersplenism, AV shunting

178
Q

assessment findings for esophageal varices?

A

black, tarry stools;
bloody stools;
lightheadedness;
paleness;
sx of chronic liver disease;
vomiting;
vomiting blood;
low bp;
rapid HR

179
Q

tx for bleeding varices?

A

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
Q

what is hepatic encephalopathy/coma?

A

life threatening complication of liver disease; occurs with end-stage liver disease; due to ammonia buildup in the brain

181
Q

onset of hepatic encephalopathy can be _______.

A

insidious

182
Q

sx of hepatic encephalopathy?

A

mental status changes, motor disturbances, and difficult to awaken

183
Q

assessment for hepatic encephalopathy and coma?

A

EEG, changes in LOC. potential seizures, fetor hepaticus, monitor fluid, electrolyte, and ammonia levels

184
Q

management for hepatic encephalopathy?

A

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

NURSING 210 (5 decks)

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