Hepatic

Question 1

hepatitis A transmission

Answer 1

fecal-oral

Question 2

hep a s/s

Answer 2

GI, not severe

Question 3

hepatitis tx

Answer 3

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

Question 4

hepatitis labs

Answer 4

elevated ALT, AST, ALP, & bilirubin

Question 5

hep B transmission

Answer 5

blood to blood

Question 6

hep C transmission

Answer 6

blood to blood

Question 7

hep C s/s

Answer 7

mostly asymptomatic until it gets severe, slow progression over decades

Question 8

hep D transmission

Answer 8

blood to blood - coinfection with hep B

Question 9

hep E transmission

Answer 9

fecal-oral, usually waterborne from foreign travel

Question 10

hep E tx

Answer 10

supportive care, usually resolves on its own

Question 11

complications of hepatitis

Answer 11

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

Question 12

fulminating hepatitis

Answer 12

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

Question 13

what is cirrhosis

Answer 13

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

Question 14

liver failure

Answer 14

death without transplant

Question 15

hepatitis B & D s/s

Answer 15

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

Question 16

how is the liver biopsied? why

Answer 16

usually trans-jugular to reduce risk of bleeding/hemothorax

Question 17

priority problems w hep

Answer 17

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

Question 18

weight loss interventions

Answer 18

high calorie high carb moderate protein diet

Question 19

fatigue interventions

Answer 19

promote rest - helps it heal

Question 20

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

Answer 20

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

Question 21

how to limit hep spread to others

Answer 21

no sex in B, C, & D

Question 22

s/s of alcohol toxicity

Answer 22

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

Question 23

tx for alc toxicity

Answer 23

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

Question 24

wernicke’s encephalopathy s/s

Answer 24

confusion, ataxia, ocular changes

Question 25

korsakoff syndrome s/s

Answer 25

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

Question 26

tx for wernicke-korsakoff

Answer 26

IV thiamine, multivitamin w b-vitamins & folic acid

Question 27

neuro effects of chronic alc use

Answer 27

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

Question 28

immune effects of chronic alc use

Answer 28

decreased immune fx - more prone to infections

Question 29

hematologic effects of chronic alc

Answer 29

pancytopenia, clotting issues

Question 30

cardiac effects of chronic alc

Answer 30

stroke, HTN, sudden death

Question 31

GI effects of chronic alc

Answer 31

gastritis, ulcers, GI bleeding, esophageal varices

Question 32

nutrition effects of chronic alc

Answer 32

anorexia, malnutrition

Question 33

integ effects of chronic alc

Answer 33

red palms & nose, spider angiomas

Question 34

CIWA categories

Answer 34

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

Question 35

CIWA score indicates

Answer 35

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

Question 36

alc withdrawal s/s

Answer 36

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

Question 37

alc withdrawal tx

Answer 37

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

Question 38

alc withdrawal delirium

Answer 38

potentially deadly complication of alc withdrawal

Question 39

alc withdrawal delirium s/s

Answer 39

hallucinations, disorientation, seizures

Question 40

alc withdrawal delirium tx

Answer 40

lorazepam, valproate haloperidol

Question 41

cirrhosis labs

Answer 41

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

Question 42

s/s of cirrhosis

Answer 42

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

Question 43

priority problems for cirrhosis pt

Answer 43

FVO, bleeding risk, encephalopathy

Question 44

FVO interventions

Answer 44

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

Question 45

bleeding risk interventions

Answer 45

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

Question 46

encephalopathy interventions

Answer 46

moderate protein diet to prevent ammonia buildup lactulose

Question 47

common complications of cirrhosis

Answer 47

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

Question 48

why does ascites occur

Answer 48

low albumin & portal HTN

Question 49

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

Answer 49

no more than 2L - risk of severe hypotension

Question 50

how do u know when someone needs paracentesis

Answer 50

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

Question 51

pre-procedure paracentesis

Answer 51

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

Question 52

during paracentesis

Answer 52

monitor VS, send specimen to lab

Question 53

post procedure paracentesis

Answer 53

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

Question 54

how to prevent hypovolemia in ascites

Answer 54

drain slowly, albumin bolus before

Question 55

esophageal varices d/t portal HTN

Answer 55

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

Question 56

what causes coag defects in cirrhosis

Answer 56

lack of vitamin K, thrombocytopenia from splenomegaly

Question 57

best place to assess jaundice on dark-skinned patients

Answer 57

oral mucosa & hard palate

Question 58

cause of portal-systemic encephalopathy

Answer 58

elevated serum ammonia

Question 59

contributing factors to encephalopathy

Answer 59

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

Question 60

s/s of portal-systemic encephalopathy

Answer 60

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

Question 61

tx of encephalopathy

Answer 61

lactulose

Question 62

complications of portal HTN

Answer 62

splenomegaly - thrombocytopenia slow GI tract bleeding - anemia