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Adult Health Pt 2 > Hepatic/Biliary PT 2 > Flashcards

Hepatic/Biliary PT 2 Flashcards

1
Q

Jaundice

A
  • liver is unable to adequately metabolize and secrete bilirubin
  • bilirubin > 3
  • result of liver damage/disorders
  • yellowing of the skin and sclera of eyes
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2
Q

Portal Hypertension

A

increase in pressure in the portal vein system that travels throughout liver
-leads to enlarged, swollen veins in stomach, esophagus, intestines, and umbilical area

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3
Q

Major Complications of Portal Hypertension

A

Ascites

Gastroesophageal varices

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4
Q

Ascites

A

abnormal build-up of fluid in the peritoneal cavity

-the fluid that accumulates in peritoneal cavity is rich in albumin

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5
Q

S/S of Ascites

A
  • increased abdominal girth
  • increased weight
  • pedal edema
  • dyspnea
  • obvious abdominal hernia
  • striae
  • fluid that shifts w/ movement
  • feeling of fullness
  • anorexia/weakness
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6
Q

Treatment for Ascites

A
  • Na+ restriction to limit fluid retention
  • diuretics
  • paracentesis
  • TIPS
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7
Q

Paracentesis

A

removal of ascites through a small puncture in the abdomen

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8
Q

Complications of Paracentesis

A
  • leakage of ascetic fluid
  • bleeding
  • bowel perforation
  • bladder perforation
  • pain at site
  • dizziness/hypotension
  • infection
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9
Q

Nursing Care for Ascites

A
  • low sodium diet
  • daily weights
  • monitor for side effects of diuretics
  • monitor for complications of paracentesis
  • monitor for complication from TIPS procedure
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10
Q

Esophageal Varices

A

Life threatening complication of liver disease
-veins in the esophagus become dilated and over distended secondary to increased pressure and blood flow through the portal vein

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11
Q

What exacerbates bleeding w/ Esophageal Varices?

A
  • veins are low in elasticity/weak
  • alcohol use
  • strenuous exercise
  • heavy lifting
  • straining
  • vomiting
  • coughing
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12
Q

S/S of Esophageal Varices

A
  • hematemesis/melena
  • altered mental status
  • string history of alcohol
  • shock
  • malnutrition
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13
Q

Treatment for Esophageal Varices

A
  • protect airway-intubation/suction
  • control bleeding
  • prevent hypovolemic shock
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14
Q

Pharmacological Treatment for Esophageal Varices

A
  • IV antibiotics (cipro, ceftriaxone)
  • vasoconstriction (vasopressin IV)
  • synthetic hormones (octreotide)
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15
Q

Endoscopy Variceal Banding

A

elastic band is placed around bleeding esophageal vein cutting off blood flow through the vein; banded tissue develops into small ulceration that quickly heals after several days-weeks

  • difficult w/ active bleeding
  • safe/does not increase pressure in portal
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16
Q

Balloon Tamponade of Esophageal Varices

A

-balloon is inflated w/in the esophagus and stomach to apply pressure on bleeding vessel, compress the vessel, and stop the bleeding

17
Q

Hepatic Encephalopathy

A

occurs when ammonia and other toxins can no longer be filtered by the liver; leads to accumulation in toxic proportions and alteration in mental status/neuro function

18
Q

How many stage of Hepatic Enceph are there?

A

4

19
Q

Stage 1 HE

A

normal LOC w/ alternating periods of lethargy and euphoria; sleep patterns altered
-“hand flap”

20
Q

Stage 2 HE

A

increased drowsiness/confusion, mood swings, agitation

-breath smells sweet/musty

21
Q

Stage 3 HE

A

sedated, difficult to arouse, extreme confusion, incoherent speech
-increased DTR’s, extremities become rigid

22
Q

Stage 4 HE

A

coma/may not respond to pain/death may occur

-absence of tremor, DTR’s, flaccid extremities

23
Q

Treatment for Hepatic Encephalopathy

A
  • lactulose to excrete ammonia through stool
  • monitor for hypokalemia
  • neomycin reduces bacteria in intestines
  • IV supplementation
24
Q

Lactulose

A
  • Oral, NG, enema
  • adjust dose to obtain 2-3 stools each day/decrease w/ watery stool
  • dilute w/ fruit juice
  • monitor for hypokalemia
25
Q

Nursing Management for Hepatic Encephalopathy

A
  • frequent neuro checks
  • strict I&O’s
  • VS q 4
  • turn q 2
  • monitor ammonia levels and electrolytes
  • low protein diet
  • small frequent meals w/ complex carb snack
  • communicate w/ fam
  • offer realistic expectations
26
Q

Vitamin A Deficiency

A

night blindness

27
Q

Vitamin C Deficiency

A

swollen, bleeding gums

28
Q

Vitamin D Deficiency

A

osteoporosis, fractures

29
Q

Vitamin K Deficiency

A

bruising, bleeding

Adult Health Pt 2 (8 decks)

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