GI / hepatic Flashcards

Question

Medications fo acute exacerbation of chronic pancreatitis Diet

Answer 1

Medications 1. Morphine - used as first line pain med for moderate to severe pain (Others are fentanyl, hydromorphone, methadone, oxycodone) 2. Omeprazole - proton pump inhibitor. Decreases gastric secretions (acid) 3. Pancrelipase - pancreatic enzyme med. made from pig pancrease so important to ask if pt is allergic to pork. Take with meals as this med enhances digestion of food as it is an artificial pancreatic enzyme Diet for acute exacerbation 1. NPO to prevent stimulation of pancreas and secretion of pancreatic enzymes 2. after a few days if food and fuids not tolerated, then pt needs a TPN TPN is administered through a central line

Answer 2

TPN has a high glucose content. Glucose exerts osmotic pressure that is harmful to the lining of peripheral veins. Thus often through a subclavian vein. Nurse assists MD with line insertion TPN is administered via an IV pump TPN tubing changed withh every bag to prevent bacterial growth Monitor

Answer 3

Monitor 1. Record daily weight to monitor nutritional status which could also be affected by the pancreatitis 2. Blood glucose every 4-6 hours. UAP can get BG reading but nurse must analyze findings and what to do about it Intervention prior to transferring from ED to medical floor - Insert NG tube connected to low intermittent suction to relieve N+V, distension, paralytic ileus and remove HCL so it does not enter duodenum and stimulate pancreas - Need to admin O2 via nasal cannula to decrease workload of respiratory system Positions to help alleviate pain from pancreatitis - Side lying with pillow under head and legs to chest. Pain is due to stretching of peritoneum due to edema from inflamed pancreas Other positions are sitting up, leaning forward or fetal position Oxygenation

Answer 4

1. Diabetes - so BG should be monitored 2. Recurring attacks become more painful so important to seek help once first attack begin 3. Weight loss often due to anorexia or fear of another attack

Answer 5

Jaundiced skin and sclera Enlarged liver on palpation Lethargy Ascites - buildup of fluid between abdomen and abdominal organs. results from portal htn. Monitor for FVE an abdominal girth and low levels of albumin Fruity breath d.t. Inability to metabolize the amino acid methionine Clay colored stooled dt decrease in amount of bile in stool Urine will be dark dt to increase in bilirubin in urine

Answer 6

Postnecrotic cirrhosis - most common, due to hepatotoxins like viral hepatitis, toxic chemicals like pesticides, long term hepatotoxic meds use Billiary cirrhosis - due to obstruction in liver and common bile ducts Laennec’s cirrhosis - due to alcoholism

Answer 7

Paracentesis - removal of peritoneal fluid. Pt should be asked to void prior procedure to prevent accidental rupture of bladder. After the procedure pt must be assessed for signs of peritonitis or peritoneal bleeding Angiography with portal pressure measurements - to visualize and also assess for portal hypertension Lab Serum albumin would be decreased because the liverr is unable to produce albumin efficiently Liver enzymes increased APTT prolonged

Answer 8

Spinorolactone - potassium sparing diuretic so monitor for hyperkalemia Furosemide Albumin Vitamin K - reduce bleeding tendencies Folic acid and B12 - coz pt with cirrhosis is likely malnourished

Answer 9

Hepatic encepalopathy Dt Increase in serum ammonia coz liver can’t convert ammonia into urea Pt will be administered lactulose and neomycin to fast track BM to increase excretion of ammonia and improve neurological status Assess glasgow coma scale (highest is 15) Eye opening response 4,3,2,1 spontaneous, to sound, to pain, never Motor response 6,5,4,3,2,1 obeys commands, localizes pain, withdrawal, flexion, extension, none Verbal response 5,4,3,2, 1 oriented, confused, inappopriate, incomprehensible, none shock Dizzy, vomiting blood, pale, skim cold and clammy Position in sidelying position coz this is a sign of impending shock Vitals will show increased pulse and respiration and decreased BP and O2 stat: apply O2, ensure IV patency, notify MD, transfer to critical care

Answer 10

colonoscopy is recommended every 10 years starting at age 50

Answer 11

Before procedure Clear liquids 24 hours before to have a clear colon for visualization Drink polyethyl glycol - a laxative. Causes retention of fluid in the intestinal lumen. By end of the prep most clients expel almost clear watery stool IV is inserted. Make sure to prime tubing set first before insertion Before any procedure or sx with general anesthesia - Hgb and Hct must first be checked. Normally require Hgb to be higher than 10 g/dL after proccedure Pt will have lots of gas dt air pumped into the colon during the procedure. Gas should be expelled normally to prevent painful distention Have significant someone drive pt back home dt to residual effects of sedation or weakness from procedure After procedure - Important to assess HR as tachycardia coud be a sign of many complications like dehydration, shock..., assess potassium if there is vomitting, assess respirations might have atelectasis, assess for DVT During procedure o Normal sedation reactions: ptosis, slurred speech o Sx with general anesthesia require Haemoglobin to be 10 or higher to ensure adequate o2 carrying capacity. Check this before sx and notify MD if abnormal

Answer 12

Warning signs of colorectal cancer: bleeding from rectum, black or tarry stools, rectal pain, change in bowel habits (constipation or diarrhea) o Warning signs of prostate cancer: problems urinating, polyuria, nocturia, hematuria, pain in lower back, pelvis, upper thighs o Risk factors: Personal or family History of colorectal cancer, polyps, IBD; 40 years old and above o Diet linked to bowel cancer: high fat or low fibre o Medications: laxatives and cathartics repeated use can cause diarrhea and loss of intestinal muscle tone, codeine causes constipation, iron turns feces to black and tarry

Answer 13

Health Promotion colonoscopy. o After age 50, ppl increase risk to develop colon cancer, and that risk increases with each succeeding decade of life. o Colonoscopy - prevention by removing polyps before they become cancerous and detecting tumors before symptoms occur. o For the average-risk individual, the recommended screening schedule is every 10 years, starting at age 50.