GI

Question 1

physical assessment of a client with cirrhosis

Answer 1

focus on symptoms and precipitating factors
alcohol use and abuse
dietary intake and nutritional status
exposure to toxic agents and drugs
assess mental status
abilities to carry adls, maintain a job, maintatin relationships
monitor for signs and symptoms such as bleeding, lower extremety edema, and lab data changes

Question 2

manifestations of cirrhosis

Answer 2

jaundice is a late manifestation
portal hypertension (obstructed blood flow through the liver resulting in increased
pressure throughout the portal venous system), ascites and varices (a varicose vein outpouching of the vein, can rupture)
hepatic encephalopathy (when the nervous system such as the brain is affected by severe
build up of toxins in the blood due to liver failure) or coma
nutritional deficiencies (metastatic cancer, liver will suffer and be diseased without metastasis if you have nutritional deficiencies)
liver enlargement
vitamin deficiencies
anemia
mental deterioration

Question 3

nutrition for a patient with cirrhosis

Answer 3

i&o
encourage small and frequent meals supplemental vitamins and mineral b complex and fat soluble vitamins if steatorrhea
high calorie diet sodium restriction
protien modified for needs and may be restricted if there are ascites

Question 4

ascites causes

Answer 4

portal hypertension resulting in increased pressure and obstruction of venous blood flow
vasodilation of splanchnic circulation (blood flow to the major abdominal organs)
changes in the ability to metabolize aldosterone, increasing fluid retention
decreased synthesis of albumin decreasing serum osmotic pressure
movement of albumin in the peritoneal cavity

Question 5

ascites assessments

Answer 5

abdominal girth and weight daily
patient may have straie distended veins and umbilical hernia
assess for fluid in the abdominal cavity by percussion of shifting dullness or by fluid wave
monitor fluid and electrolytes

Question 6

ascites treatment and nutrional guidelines

Answer 6

low sodium
diuretics
bed rest
paracentesis
administration of salt poor albumin
transjugular intrahepatic portosyemic shunt to remove fluid

Question 7

post op gall blaffer care

Answer 7

fowlers (low and semi)
fluids and NG suction for abdominal distention
soft diet once bowel sounds return (next day)
pain management
increase fiber intake
deep breathing due to bed rest
do not lift heavy objects for 4-6 weeks
prevent infection
avoid tight and coarse clothes

Question 8

hepatic encephalopathy

Answer 8

A life-threatening complication of liver disease. May result from the accumulation of ammonia and other toxic metabolites in the blood
stages 1-4 (1 normal LOC/ lethargic- 4 comatose)

Question 9

hepatic encephalopathy assessment

Answer 9

eeg
changes in LOC
regular neuro checks potential seizures
fetor hepaticus (fecal smelling breath)
monitor fluid, electrolyte, and ammonia levels
asterixis (italian hand reflex) indicates too much ammonia in the blood

Question 10

hepatic encephalopathy medical management

Answer 10

eliminate precipitating cause
lactulose to reduce ammonia levels
iv glucose to minimize proteins catabolism (breakdown of protein for energy)
protein restriction
reduction of ammonia from GI tracts by gastric suction, enemas, oral antibiotics
discontinue sedatives analgesics and tranquilizers
monitor for and promptly treat complications and infections

Question 11

portal hypertension

Answer 11

obstructed blood flow through the liver results in increased pressure throughout the portal venous system
results in ascites (abdominal fluid buildup, usually peritoneal, puts pressure on diaphragm which causes SOB) and esophageal varices (when these rupture, pt vomits bright red BADDD smelling blood)

Question 12

pancreatic cancer supportive care

Answer 12

Use of analgesics
Nasogastric suction to relieve nausea and distention
Frequent oral care
Bed rest
Measures to promote comfort and relieve anxiety

Question 13

acute pancreatitis

Answer 13

pancreatic duct becomes obstructed and enzymes back up into the duct causing autodigestion and inflammation of the pancreas
severe abdominal pain
patient appears acutely ill
abdominal guarding
NV
fever, jaundice, confusion, agitation
flank pain
resp distress hypoxia renal failure hypovolemia shock

Question 14

chronic pancreatitis

Answer 14

recurrent attacks of severe upper abdominal pain and back pain accompanied by vomiting
weight loss
steatorrhea

Question 15

common bile duct obstruction complications

Answer 15

infections
sepsis
liver disease such as biliary cirrhosis
older adults develop type 1 diabetes
jaudice
pruritis
RUQ pain
anorexia
fever
fatigue