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Medsurg Exam 3 > Hepatic Disorders > Flashcards

Hepatic Disorders Flashcards

1
Q

functions fo the liver

A

breaks down, balances, and creates the nutrients and also metabolizes drugs into forms that are easier to use for the rest of the body or that are nontoxic
detox the body
helps to clot blood
metabolize drugs
synthesis (make) albumin
Glucose Metabolism
Ammonia Conversion
Protein Metabolism
Fat Metabolism
Vitamin and Iron Storage
Bile Formation
Bilirubin Excretion
Drug Metabolism

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2
Q

causes of liver dysfunction

A

Viral and non-viral hepatitis
Biliary Cirrhosis
Autoimmune disorders of liver
Medication use (drug hepatotoxicity)
Toxins

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3
Q

transmission of hep A

A

fecal and oral through food and water

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4
Q

diagnostic of hep A

A

anti-HAV
IgM = active infection
IgG = recovered

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5
Q

treatment for hep A

A

supportive therapy
rest
vaccine

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6
Q

transmission of hep B

A

birth and blood
childbirth, sex, IV drugs

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7
Q

diagnostics for hep B

A

HBsAG = active infection
anti-HBs = immune /recovery

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8
Q

treatment for hep B

A

acute supportive therapy and rest
chronic antivirals
vaccine

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9
Q

transmission of hep C

A

body fluids
most common in IV drug users

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10
Q

diagnostics for hep C

A

anti-HCV
no post exposure immunoglobulin

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11
Q

treatment for hep C

A

antivirals
interferon

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12
Q

transmission for hep D

A

hep D occurs with hep B

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13
Q

diagnostics for hep D

A

HDAg
anti-HDV

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14
Q

treatment for hep D

A

antivirals
interferon

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15
Q

transmission of hep E

A

fecal and oral
food and water uncooled meat
3rd world countries

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16
Q

diagnostics of hep E

A

anti-HEV

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17
Q

treatment for hep E

A

supportive therapy
rest

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18
Q

acute vs chronic for types of nonviral hepatitis

A

hep A = acute
hep B = acute and chronic
hep C = acute and chronic
hep D = acute and chronic
hep E = acute

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19
Q

causes of nonviral hepatitis

A

alcohol
medication

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20
Q

how does alcohol cause liver damage

A

alcohol is metabolized in the liver and excess can cause damage

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21
Q

types of medications that can cause liver damage

A

acetaminophen
antibiotics
anticonvulsants
NSAIDs
antituberculosis agents

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22
Q

end stage liver disease

A

cirrhosis

23
Q

gender differences for cirrhosis of the liver

A

2x more common in men
but women are more succeptable

24
Q

compensated vs decompensated cirrhosis

A

compensated = no symptoms
decompensated = extended to point of loss of function and symptoms

25
Q

clinical manifestations of decompensated cirrhosis

A

Ascites
Jaundice
Weakness
Muscle wasting
Weight loss
Continuous mild fever
Clubbing of fingers
Purpura (due to decreased platelet count)
Spontaneous bruising
Epistaxis
Hypotension
Sparse body hair
White nails
Gonadal atrophy

26
Q

hematologic disorders as clinical manifestations

A

Thrombocytopenia (low platelets)
Leukopenia
Anemia
Coagulation disorders
Endocrine disorders
Related to hormone metabolism

27
Q

PTT use and normal value

A

how long it takes a blood clot to form
normal = 30-40 sec
heparin = 1.5-2.0

28
Q

Accumulation of ammonia and toxins

A

hepatic encephalopathy

29
Q

signs and symptoms of hepatic encephalopathy

A

neuro changes
asterixis
fetor hepaticus

30
Q

portal veins become narrow due to scar tissue

A

portal hypertension

31
Q

dilated, tortuous veins that usually are found in the submucosa of the lower esophagus but may develop higher in the esophagus or extend into the stomach

A

esophageal varices

32
Q

treatment for GI bleed

A

Blood transfusion, O2, volume expanders, electrolyte replacement

33
Q

diagnostics for liver disease

A

Liver enzyme tests
Total protein, albumin levels
Serum bilirubin, globulin levels
Cholesterol levels
Prothrombin time
Ultrasound elastography (Fibroscan)
Liver biopsy

34
Q

keep fluid from leaking out of your blood vessels into other tissues. It is also carries hormones, vitamins, and enzymes throughout your body

A

albumin

35
Q

assessment factors for liver disease

A

History
Social History
Assessment
Neuro
GI
Weight
Skin

36
Q

nursing diagnosis for liver disease

A

Activity intolerance
Imbalanced Nutrition
Impaired skin integrity
Risk for injury
Risk for bleeding

37
Q

what is the goal for the patient with liver disease

A

Increase participation
Improve nutritional status
Improve skin integrity
Decrease risk for potential injury
Improve mental status
Absence of complications

38
Q

planning for ascites

A

Sodium restriction
Albumin
Diuretics
Paracentesis
TIPS - Transjugular intrahepatic portosystemic shunt

39
Q

how to prevent bleeding/ hemorrhage for esophageal and gastric varices

A

Screen for presence with endoscopy
Avoid alcohol, aspirin, and nonsteroidal anti-inflammatory drugs (NSAIDs)
Betablockers, Somatostatin, Octreotide
Esophageal banding

40
Q

planning for liver disease

A

If bleeding occurs, stabilize patient, manage airway, provide IV therapy and blood products
Endoscopic therapy
Band ligation
Balloon tamponade
Mechanical compression of varices
Supportive measures for acute bleed
-Fresh frozen plasma
-Packed RBCs
-Vitamin K
Proton pump inhibitors
Antibiotics

41
Q

long term management of varices

A

Nonselective β-adrenergic blockers
Repeated band ligation
Portosystemic shunts

42
Q

how to reduce ammonia formation

A

Lactulose (Cephulac), which traps ammonia in gut
Rifaximin (Xifaxan) antibiotic
Prevent constipation

43
Q

treatment of precipitating cause of varices

A

Lower dietary protein intake
Control GI bleeding
Remove blood from GI tract

44
Q

interventions for liver disease

A

Rest
Cluster care
Hepatic encephalopathy
Perform neurologic assessment every 2 hours
Control factors known to precipitate encephalopathy
Monitor I and O
Monitor respiratory status
Skin integrity
ROM

45
Q

importance with nutritional status for liver disease

A

High protein diet if indicated
Supplemental vitamins Administration of B-complex vitamins
Small frequent meals
Enteral or parental route
Sodium restriction
Avoidance of alcohol
Minimize constipation
Encourage fluids

46
Q

skin care for liver patients

A

Q2 hour turns

47
Q

reduce risk for injury for liver disease

A

Fall prevention
Minimization or avoidance of aspirin, acetaminophen, and NSAIDs

48
Q

monitoring for complications for liver disease

A

Bleeding and Hemorrhage
Encephalopathy

49
Q

assessment for liver disease

A

Level of responsiveness
Sensory and motor abnormalities
Fluid/electrolyte imbalances
Acid-base balance
Effects of treatment measures

50
Q

evaluation for liver disease

A

Maintenance of food/fluid intake to meet needs
Maintenance of skin integrity
Normalization of fluid balance
Treatment for substance abuse

51
Q

normal range of ALP

A

32-92

52
Q

normal range for ALT and AST

A

0-35

53
Q

normal range of amylase

A

0-130

54
Q

normal range of creatine kinase

A

30-170

Medsurg Exam 3 (4 decks)

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