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Nursing 4 Test 3 > Hepatic Disorders > Flashcards

Hepatic Disorders Flashcards

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1
Q

causes of cirrosis

A

Hep. B and C, ETOH, autoimmune, bile duct problems, fat collection (hyperlipidemia)

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2
Q

role of liver

A

metabolizes, detoxifies, stores, produces

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3
Q

chronic scarring of the liver. nodular, bumpy, irreversible

A

hepatic cirrosis

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4
Q

causes of hepatic cirrosis

A

inflammation, fibrosis, bile duct occlusion

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5
Q

risk factors for cirrosis

A

ETOH, chronic viral hep., fatty liver disease/hepatic steatosis, toxic chemical or drug exposure, male, age 40-60

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6
Q

hand flapping

A

asterixis (due to ammonia)

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7
Q

study manifestations of cirrhosis on page 5

A

examples: fatigue, bruising, fetor hepaticus (smell),

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8
Q

the appearance of distended and engorged superficial epigastric veins, which are seen radiating from the umbilicus across the abdomen.

A

caput medusae, due to portal HTN

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9
Q

rash looking on palms

A

palmer erethymea

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10
Q

given to decrease gastric distress and minimize possiblity of GI bleed

A

Pepcid, protonics (antacids, HIstamine 2 )

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11
Q

given to promote healing of damaged livers cells and improve general nutrition

A

adequate diet, vitamines, and nutritional supplements

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12
Q

given to minimize F and E imbalance

A

potassium sparing diuretics (spironolactone or triamterene) to decrease ascites and monitor hypotension

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13
Q

promotes excretion of ammonia via stool

A

lactulose

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14
Q

medication that reduces levels of ammonia

A

neomycin, metronidazole (Flygyl), rifaximin (Xifaxan)

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15
Q

cautious use due to decreased liver function

A

opioids, sedatives, barbiturates

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16
Q

lower albumin leads to

A

fluid excess

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17
Q

impaired skin integrity due to

A

bile salts

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18
Q

Diet

A

high calorie, lower sodium, LOW PROTEIN

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19
Q

provide what kind of vitamins if patient has steatorrhea

A

water soluable

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20
Q

when it comes to vitamins for cirrosis, which is most important

A

B complex

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21
Q

monitor carefully in cirrosis

A

coagulation studies

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22
Q

restrict these due to edema

A

sodium, fluids, proteins, document I/O

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23
Q

elevate legs to prevent peripheral edema and increase venous return

A

assess for dyspnea, increased RR, hypoxia, pleural effusion (fluids pushed into pleural space) everything pushing up

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24
Q

avoid which medication

A

acetaminophen, aspirin contraindicated with GI bleed

25
Q

blood pools back due to blockage of bumpy liver. often caused by portal HTN

A

esphageal varices

26
Q

what often causes esophageal varices

A

portal HTN

27
Q

risk factors for bleeding of esophageal varices

A

heavy lifting, straining, sneezing, coughing, vomiting, swallowing poorly chewed foods, erosion of vessel walls due to gastric acid, ETOH, or meds

28
Q

Clinical manifestions of? bleeding may be the only symptom. Melena. Hematemesis, mental or physical deterioration, hemorrhagic shock

A

esophageal varices

29
Q

clinical manifestions: splenomegaly, ascites, black stool, spontaneous bruising, hypotension

A

hepatic cirrhosis

30
Q

if patient is diagnosed with cirrosis, how often do they need an endoscopy?

A

q 2 years

31
Q

umbrella term for identifying cause and source of bleeding for esophageal varices

A

endoscopy

32
Q

pharm for bleeding that is preferred for immediate control

A

octreotide (Sandostatin)

33
Q

pharm for bleeding that is contraindicated in CAD

A

vasopressin (Pitressin) w/ nitro

34
Q

most common for PREVENTING 1st bleed and PREVENTING re bleed

A

BB - propranolol, nadolol

35
Q

may be used in combination with BB to stop bleed

A

nitrates - isosorbide (isordil)

36
Q

short term use in stopping esophageal bleed. MUST BE INTUBATED IN ORDER TO USE

A

balloon tamponade

37
Q

balloon tamponade is for which use only

A

emergency. used to stablize. risk for rupture, airway obstruction, asphyxiation, aspiration, etc. check q 4-6 hours

38
Q

stops bleeding but does not prevent subsequent bleeding. Need GI protection (Antacids, H2, PPI)

A

endoscopic sclerotherapy

39
Q

preferred method and treatment of choice over sclerotherapy. Reduces re bleeding of Esoph. Varices, mortality, and procedure related complications

A

esophageal Banding - Esophageal Variceal Ligation (EVL)

40
Q

used when EVL or sclerotherapy and meds are ineffective in controlling esophageal variceal bleeding. Rapidly reduces portal pressure

A

transjugular intrahepatic portosystemic shunt (TIPS)

41
Q

effective in decreasing portal HTN and variceal bleeding. Last resort.

A

portal systemic shunts

42
Q

complications of portal shunts

A

thrombosis, encephalopathy, accelerated liver failure

43
Q

major factor in hepatic encephalopathy

A

ammonia

44
Q

neuropsychiatric manifestation of hepatic failure associated with portal HTN and shunting of blood into system circulation

A

Hepatic Encephalopathy

45
Q

which stage of Hep. Enceph? sleep problems, periods of lethargy, euphoria, trouble concentrating, normal EEG

A

Stage 1 - Mild

46
Q

which stage of Hep. Enceph? increased drowsiness, disorientation, inappropriate behavior, mood swings, agitation, asterixis, fetor hepaticus, abnormal EEG with marked slowing

A

Stage 2 - Moderate

47
Q

stage of Hep. Enceph. stuporous, difficult to arouse, incoherent speech, asterixis, rigid extremities, hyperreflexia, markedly abnormal EEG

A

3 - Severe

48
Q

which stage of Hep. Enceph. Comatose, no esterixis, absent deep tendon reflexes, flaccid extremities, markedly abnormal EEG

A

4 - Final

49
Q

what should you do for hepatic encephalopathy to reduce serum ammonia

A

administer lactulose. Goal of 2-3 soft stools/day,

50
Q

cautions for lactulose

A

hypokalemia, watery diarrhea, dehydration

51
Q

administer this for hepatic Eceph. to minimize protein breakdown

A

IV glucose. Also correct vitamin deficiencies: A, B, C, K, folic acid, and electrolyte imbalance

52
Q

administer which antibiotics as needed

A

neomycin (nephrotoxic), metronidazole (Flagyl), rifaximin

53
Q

discontinue which meds that precipitate encephalopathy

A

sedatives, tranquilizers, barbiturates, opiates

54
Q

administer this benzo antagonist for Hep. Enceph

A

flumazenil

55
Q

atixis (flapping) caused by

A

ammonia in brain

56
Q

syndrome of sudden and severely impaired liver function or severe hepatocyte necrosis in teh absence of preexisting liver disease

A

fulminant hepatic failure

57
Q

where is ammonia produced

A

gut

58
Q

Bacteria in your gut and in your cells create ammonia when your body breaks down

A

protein

59
Q

common cause of fulminant hepatic failure

A

viral hep

Nursing 4 Test 3 (11 decks)

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