GI/GU 13 Q Flashcards by K D

Chronic progressive disease of the liver. There is extensive degeneration and destruction of the parenchymal cells that leads to irreversible fibrosis and degeneration of the liver.

Cirrhosis

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2 major risk factors for cirrhosis

Alcohol, hepatitis (esp. C)

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Early onset of cirrhosis is insidious. When you start seeing signs and symptoms the life expectancy is _ to _ years

5-10 years

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With cirrhosis, you can see hepatic encephalopathy from increased ammonia. This can lead to asterexis. What is the normal ammonia level?

ammonia 15-45

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To reduce ammonia, you can give _ PO, NG, or by enema.

lactulose

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4 things you should teach the cirrhosis patient to avoid

Alcohol, aspirin, acetaminophen, NSAIDs

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All patients with cirrhosis should have an EGD to screen for

varices

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Your patient had a paracardiocentisis for ascites. Afterwards yoiu should monitor for signs of bladder _

bladder perforation (pain, hematuria)

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Enlarged swollen veins secondary to portal hypertension. There is fragile tissue that bleeds easily

Esophageal/gastric varices

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3 medications that may be used for varices

octreotide (Sandostatin), vasopressin, nonselective beta blockers (ex. propranolol)

Note: Vasopressin is used with caution in elderly d/t cardiac effects. It is often given with nitro.

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What is a major risk factor for varices?

Cirrhosis

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3 treatments tha may be used for varices

Sclerotherapy, banding, Blakemore tube

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Position a patient with varices HOB 30-45. If hypotensive position

flat and on their side

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What lab shoud you check before and after q 4 units of PRBCs

Ionized calcium

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Each unit of PRBCs should raise the Hgb by _ to _

1-1.5

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Within how many hours of thaw should FFP be used?

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If a blood infusion is needed before type can be determined what should be used? (universal donor)

O-

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Terminal complication of liver disease due to the liver being unable to convert ammonia to urea

Hepatic encephalopathy

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Is asterixis an early or late sign of hepatic encephalopathy?

Early

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Important nursing intervention in hepatic encephalopathy is preventing

constipation

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A rapid onset of severe liver dysfunction in an individual without prior history of liver disease

fulminant (acute) hepatic failure

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What is the first sign of fulminant hepatic failure

change in cognitive function

Note: there will be hour by hour changes in LOC

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In fulminant hepatic failure, keep _ from rising

ICP

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Risk factors for fulminant hepatic failliure (2)

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2 major complications of fulminant hepatic failure

renal failure, brainstem compression Note: brainstem compression is the most common cause of death due to cerebral edema

Inflammation of the pancreas from activated pancreatic enzymes autodigesting pancreas.

Acute pancreatitis

What 2 enzymes will be 3x the normal in acute pancreatitis?

Lipase, amylase Note: lipase is more specific Note: height of elevation does not correlate with severity

Acute pancreatisis can be sudden with out warning and manifest as a

diabetic coma

What type of fluid spacing is seen with acute pancreatitis?

major 3rd spacing Note: watch for hypovolemic shock

The acute pancreatitis patient is at risk for \_, this makes assessing lung sounds a priority.

Heart failure

3 signs that occur in acute pancreatitis

Grey turners, Cullen's sign, abdominal pain that radiates to the back

It is important to place the acute pancreatitis on _ status to starve the pancreas

NPO

What medication should not be administered to a patient with acute pancreatitis?

Morphine

In acute pancreatis, _ will be low due to autodigestion. Monitor Chvostek's and Trousseau signs!

Calcium

3 things that worsen the pain of acute pancreatitis

Fatty foods, alcohol, and supine

2 appropriate pain medications for acute pancreatitis

demerol, dilaudid

3 times enteral nutrition is contraindicated

absent bowel sounds, intestinal obstruction, acute pancreatitis

Nasal/oral tubes for enteral nutrition should be for short term use (\<\_)

4 weeks

2 important concerns for a patient with enteral nutrition

Aspiration, dislodged tube Note: HOB 3-45 (prefer 45) during and for 30-60 minutes after

To flush a tube for enteral nutriton it can be done with 30 mL of tap water. If the patient is _ use sterile water

Immunocompromised

Discard open feeding system after _ hour or a closed system after _ hours

Open: 24 h Closed: 48 h

What type of AKI? Insult to kidneys leads to decreased renal perfusion Ex. Blood loss, hypotension

Prerenal

In prerenal oliguria is there danage to the kidney tissue (parenchyma)?

What type of AKI? Insult that affects thhe insides of the kidneys ex. prolonged ischemia

Intrarenal

AKI: Suspect _ causes if the pateint has had nephrotoxic agents or contrast media

Intrarenal

AKI: which type is caused by a mechnical obstruction of outflow of urine ex. stone, BPH, prostate cancer

Post renal

3 stages of AKI

Oliguric --\> diuretic --\> recovery

In the oliguric phase (1st) of AKI the UOP will be \<

\<400 mL/day

Which one for oliguric phase of AKI? Resp. acidosis Resp. alkalosis Metabolic acidosis Metabolic alkalosis

Metabolic acidosis Note: there is accumulation of waste products (watch neuro)

Patient in oliguric phase of AKI will have hyper\_ and hypo\_

hyperkalemia, hyponatremia

During the diuretic phase (2nd) of AKI UOP increases to _ to _ L/day

1-3 liters/day

2 problems that can occur during the diuretic phase of AKI

hypotension, hypotension Note: Monitor for hyponatremia, hypokalemia, dehydration Note: Diuretic phase usually lasts 1-3 weeks

The recovery stage of AKI (3rd) begins when _ increases allowing BUN and Creatinine to decrease

GFR increases

Usually the first test or AKI

Kidney ultrasound

Normal GFR

120-125 Note \<100 renal insufficiency \<20 renal failure \<10 life threatening

Gain or loss of 1 kg is equal to _ mL of fluid

1000 mL

General rule for fluid restriction is to add all losses for previous 24 hrs plus _ mL for insensible losses. This total becomes their fluid allocation for the next day

Losses + 600 mL = fluid allocation for next day

Most common risk factor for AKI

ATN

Treatments for hyperkalemia

Calcium gluconate, bicarb, insulin, dexstrose, kayexelate, dialysis

What is the primary cause of deah in AKI?

Infection

Progressive and irreversible. presence of kidney damage or decreased GFR \<60 for \>3 months

Chronic Kidney disease

Primary cause of death in CKD

Cardiovascular disease

Most common cause of CKD

Diabetes

Hyperkalemia can occur in CKD. At what levels can it be fatal?

7-8

Controlling _ is one of the most important therapeutic goals for CKD

Controlling BP

For CKD how should you take BP

Supine, sitting, standing

GFR \< _ is ESRD

GFR \<15=ESRD

For CKD you may administer erythropoietin. What do you need to remember about this?

Give iron supplements. Give folic acid. Avoid blood transfusions.

CKD usually need 2 or more \_

antihypertensives

In CKD, a depressed _ occurs in stage 5

CNS

What is the target BP for dialysis?

\< 130/80 Note: \<125/75 if significant proteinuria

What GFR usually warrants dialysis?

GFR \<15

3 complications from hemodialysis

Hypotension, muscle cramps, loss of blood when not fully rinsed from dialyzer/holding pressure on sites

What is added to the blood during dialysis?

Heparin

3 things to assess before dialysis

Fluid status (weight), condition of vascular access, and temp

Difference between last post dialysis weight and present pre dialysis weight determines

amount of fluid to remove

First priotity for a postop renal transplant

Fluid and electrolyte balance

What will these cause? Resp. acidosis or resp. alkalosis? CNS depression, asphyxia, hypoventilation

Resp. acidosis

Resp. acidosis or resp. alkalosis? Hyperventilation, hypoxia, gram negative bacteria

Resp. alkalosis

7.35-7.45

CO₂

35-45

PO2

80-100

hCO3

22-26