Gastrointestinal

Question 0

Why do you get pancreatitis?

Answer 0

Acute: #1 cause alcohol, #2 cause gallbladder disease

Chronic: #1 cause alcohol

Question 1

What does the pancreas do?

Answer 1

Endocrine- insulin

Exocrine- digestive enzymes

Question 2

Pancreatitis S/S

Answer 2

Pain: increases with pain 
Abdominal distention/ascites 
Abdominal mass: swollen pancreas
Rigid board-like abdomen (bleeding, destroying pancreatic bleeding leading peritonitis) 
Bruising around umbilical area (Cullen's sign) 
Flak area Gray Turner's sign 
Fever 
N/V 
Jaundice 
Hypotension (b/c bleeding or ascites)

Question 3

Diagnosis of pancreatitis

Answer 3

Serum lipase and amylase increase (amylase normal: 45-200 U/L, lipase: 0-110 U/L)
WBC: increase
Blood sugar increased
ALT, AST elevated (normal: ALT 10-30 U/L, AST 8-40 U/L)
PT, PTT longer (can bleed more)
Serum bilirubin elevated
H/H elevated and decreased (normal Hgb: 12-18, normal Hct: 38%- 54%)

Question 4

Treatment for pancreatitis

Answer 4

Main goal is to control pain

1. Decrease gastric secretions (NPO, NGT to suction, doing this to keep stomach empty and dry)
2. Pain medications (PCA narc. Morphine or Dilaudid), Fentanyl)
3. Steroids to decrease inflammation (risk of getting too much and getting diabetes and cushings)
4. Anticholinergics to dry up stomach
5. Pantoprazole (protonix) PPI
6. Ranitidine HCI, Pepcid
7. Antacid
8. Maintain fluid and electrolyte balance
9. Maintain nutritional status
10. Insulin (why? pancreas is sick, on steroids so the blood sugar is up, may be getting TPN)
11. Daily weights
12. Eliminate alcohol
13. Refer to AA if that’s the cause

Question 5

Liver, tell me what comes to mind!

Answer 5

Liver detoxifies the body
Helps your blood clot
Helps metabolize drugs…so decrease medication dose
Lover synthesizes albumin

Question 6

First concern when you’re liver is sick…

Answer 6

Bleeding!!!!

Question 7

What medication do you avoid with liver people?

Answer 7

Tylenol (acetaminophen)

Antidote: Mucomyst
needs to be mixed in carbonated drink, smells like egg

Question 8

Cirrhosis, how does it happen?

Answer 8

Liver cells are destroyed and are replaced with connective/scar tissue > alters circulation > the BP in the liver ^ this is called portal hypertension

Question 9

Cirrhosis S/S

Answer 9

Firm nodular liver
Abdominal pain
GI upset
Change in bowel habits
Ascites (back albumin is low causing fluid to go out of vascular space)
Splenomegaly
Decreased serum albumin (liver makes albumin)
Increased ALT and AST
Anemia
Can progress to hepatic encephalopathy/coma (liver transplant?, can Tylenol OD, ammonia builds up -that’s a sedative)

Question 10

Dx for Cirrhosis

Answer 10

Ultrasound
CT, MRI
Liver biopsy (CONFIRMATION)

Question 11

Liver biopsy

Answer 11

Clotting studies pre- PT and PTT
Vital signs pre- procedure
Position client supine with R arm behind head
Exhale and hold breath for 2 sec. (to get diaphragm out of the way)
Post: lie on R side (VS and worried about bleeding)

Question 12

Tx for Cirrhosis

Answer 12

Antacids, vitamins, diuretics 
No more alcohol 
I&O and daily weights 
Rest 
Bleeding precautions 
Measure abdominal girth 
Paracentesis
Monitor jaundice 
Avoid narc.

Question 13

Paracentesis

Answer 13

Removal of fluid from peritoneal cavity

Have client void
Position sitting up
VS

Pulling out fluids, worry about shock!!!!

Question 14

Diet for Cirrhosis

Answer 14

Decrease protein

Low Na diet

Question 15

Hepatic coma patho

Answer 15

Liver is impaired and is unable to transform protein to ammonia to urea. So the ammonia builds up in the blood which leads to decreased LOC.

Question 16

Hepatic Coma S/S

Answer 16

Minor motor changes/ mental 
Difficult to awake 
Asterixis (flapping tremor oh hand) 
Handwriting 
Reflexes will decrease 
EEG slow