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Nursing 202 > Hepatic > Flashcards

Hepatic Flashcards

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1
Q

hepatitis A transmission

A

fecal-oral

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2
Q

hep a s/s

A

GI, not severe

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3
Q

hepatitis tx

A

promote rest, healthy diet - high carb, high calorie, moderate protein; avoid all meds, alc, sex (if B, C, D) chronic - antivirals

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4
Q

hepatitis labs

A

elevated ALT, AST, ALP, & bilirubin

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5
Q

hep B transmission

A

blood to blood

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6
Q

hep C transmission

A

blood to blood

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7
Q

hep C s/s

A

mostly asymptomatic until it gets severe, slow progression over decades

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8
Q

hep D transmission

A

blood to blood - coinfection with hep B

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9
Q

hep E transmission

A

fecal-oral, usually waterborne from foreign travel

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10
Q

hep E tx

A

supportive care, usually resolves on its own

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11
Q

complications of hepatitis

A

chronic hep, fulminating hep, cirrhosis, liver cancer, liver failure

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12
Q

fulminating hepatitis

A

severe & potentially fatal viral help - causes fast onset liver failure

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13
Q

what is cirrhosis

A

permanent scarring of the liver caused by alc, drugs, hep, etc.

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14
Q

liver failure

A

death without transplant

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15
Q

hepatitis B & D s/s

A

RUQ pain, jaundice, joint & muscle pain, fever, fatigue, malaise, n/v, dark urine with light stool, pruritis, diarrhea/constipation

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16
Q

how is the liver biopsied? why

A

usually trans-jugular to reduce risk of bleeding/hemothorax

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17
Q

priority problems w hep

A

weight loss , fatigue, potential for infection, further liver damage, spread to others

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18
Q

weight loss interventions

A

high calorie high carb moderate protein diet

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19
Q

fatigue interventions

A

promote rest - helps it heal

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20
Q

how do we prevent liver from further damage/complications in hep pts

A

educate to avoid foods high in protein, all meds (esp OTC) unless prescribed

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21
Q

how to limit hep spread to others

A

no sex in B, C, & D

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22
Q

s/s of alcohol toxicity

A

CNS depression, behavioral changes, hypoglycemia, hypotension, hypomagnesemia, hypokalemia, possible resp/circulatory failure

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23
Q

tx for alc toxicity

A

maintain ABCs, IV fluids w glucose, Mg, K & multivitamins, IV thiamine - prevents Wernicke-Korsakoff

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24
Q

wernicke’s encephalopathy s/s

A

confusion, ataxia, ocular changes

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25
Q

korsakoff syndrome s/s

A

memory loss, usually short term
confabulation may occur in long term memory loss

26
Q

tx for wernicke-korsakoff

A

IV thiamine, multivitamin w b-vitamins & folic acid

27
Q

neuro effects of chronic alc use

A

seizures, dementia, W-K, mood/sleep issues, impaired cognitive fx

28
Q

immune effects of chronic alc use

A

decreased immune fx - more prone to infections

29
Q

hematologic effects of chronic alc

A

pancytopenia, clotting issues

30
Q

cardiac effects of chronic alc

A

stroke, HTN, sudden death

31
Q

GI effects of chronic alc

A

gastritis, ulcers, GI bleeding, esophageal varices

32
Q

nutrition effects of chronic alc

A

anorexia, malnutrition

33
Q

integ effects of chronic alc

A

red palms & nose, spider angiomas

34
Q

CIWA categories

A

agitation, anxiety, tactile, visual, & auditory hallucinations/disturbances, headache, disorientation, sweating, tremors

35
Q

CIWA score indicates

A

pt’s risk of seizure - amount of lorazepam to be given

36
Q

alc withdrawal s/s

A

agitation/irritability, anxiety, increased HR, RR, BP can go either way, sweating, low glucose, Mg, K, insomnia, tremors, anxiety, hyperactivity

37
Q

alc withdrawal tx

A

lorazepam & midazolam, IV thiamine, IV fluids w Mg, K, & glucose, beta/alpha blockers for BP, resp support

38
Q

alc withdrawal delirium

A

potentially deadly complication of alc withdrawal

39
Q

alc withdrawal delirium s/s

A

hallucinations, disorientation, seizures

40
Q

alc withdrawal delirium tx

A

lorazepam, valproate
haloperidol

41
Q

cirrhosis labs

A

elevated LFTs - return to normal in advanced disease
elevated bilirubin, Cr, ammonia
decreased albumin, RBC, hemoglobin, platelets, Na
prolonged PT & INR

42
Q

s/s of cirrhosis

A

fatigue, wt loss, anorexia, n/v, RUQ tenderness/pain, GI bleeding, ascites, jaundice, spontaneous bruising, itchy, red skin, fat soluble vitamin deficiencies, fetor hepaticus, asterixis, cognitive changes

43
Q

priority problems for cirrhosis pt

A

FVO, bleeding risk, encephalopathy

44
Q

FVO interventions

A

lasix & spiro, paracentesis, sodium & fluid restriction, I&Os, daily wt,

45
Q

bleeding risk interventions

A

propranolol, abx
fluid resuscitation & blood products for active bleed
monitor VS, CBC, PT & INR
insert NG tube to detect bleeding

46
Q

encephalopathy interventions

A

moderate protein diet to prevent ammonia buildup
lactulose

47
Q

common complications of cirrhosis

A

spontaneous peritonitis, ascites, esophageal varices, jaundice, encephalopathy, hepatorenal syndrome, portal HTN, liver cancer

48
Q

why does ascites occur

A

low albumin & portal HTN

49
Q

if paracentesis cath is left in - how much should be drained qday & why

A

no more than 2L - risk of severe hypotension

50
Q

how do u know when someone needs paracentesis

A

when it affects ability of lungs to fully expand - SOB & dyspnea

51
Q

pre-procedure paracentesis

A

check albumin, WBC, electrolytes
albumin bolus
sedation/anesthetic as needed
vitals, weight, measure abd girth

52
Q

during paracentesis

A

monitor VS, send specimen to lab

53
Q

post procedure paracentesis

A

check VS, weight, abd girth, monitor temp & WBC, given spiro & lasix,

54
Q

how to prevent hypovolemia in ascites

A

drain slowly, albumin bolus before

55
Q

esophageal varices d/t portal HTN

A

dilated veins v prone to severe bleeding - hard to due d/t proximity to trachea

56
Q

what causes coag defects in cirrhosis

A

lack of vitamin K, thrombocytopenia from splenomegaly

57
Q

best place to assess jaundice on dark-skinned patients

A

oral mucosa & hard palate

58
Q

cause of portal-systemic encephalopathy

A

elevated serum ammonia

59
Q

contributing factors to encephalopathy

A

high protein diet, infection, constipation, GI bleeding, hepatotoxic drugs, hypoK, hypovolemia

60
Q

s/s of portal-systemic encephalopathy

A

sleep & mood disturbances, AMS, speech problems, altered LOC, impaired thinking, neuromuscular problems

61
Q

tx of encephalopathy

A

lactulose

62
Q

complications of portal HTN

A

splenomegaly - thrombocytopenia
slow GI tract bleeding - anemia

Nursing 202 (7 decks)

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