hepato pancreatio-biliary Flashcards
1
Q
functions of the liver
A
- protein synthesis such as albumin
- detoxification of the blood
- glycemic control from the storage of the glycogen
- producing clotting factors
2
Q
what are certain education points for preventative teaching of liver disease
A
- decrease alcohol consumption
- only taking medication when needed and monitoring 24 hours
- early liver disease screening
- nutrition and education
- regular exercise
- vaccine
3
Q
what are the assessments specific to the liver
A
- health history
- medication history and use
- alcohol and substance use
- drug use
- diet
- sexual health
- vital signs
- abdominal assessment
- pain, skin and neuro assessment
4
Q
what do ALT and AST represent
A
identify hepato-cellular injury and inflammation specific to the liver
5
Q
ALP
A
enzymes responsible for breaking down proteins and found in liver and bones
6
Q
albumin
A
plasma protein of the blood
7
Q
Bilirubin
A
- produced in the liver, spleen and bone marrow and is a by-product of hemoglobin breakdown
- excreted in the GI tract
8
Q
what is the route of transmission of hepatitis A
A
oral-fecal
9
Q
Prevention of hepatitis A
A
- safe food handling
- handwashing
- vaccination
10
Q
What is the route of transmission of B and C
A
blood and bodily fluids
11
Q
what are preventative actions for hep B and C
A
- safe sexual teaching and needle practices
- screening of blood products
- vaccinations for hep. B
12
Q
Nutritional management for liver disease
A
- monitor nutritional intake
- monitoring weights
- small frequent meals
- patient positioning
- mouth care
- antiemetics
- avoid spicy foods
13
Q
integumentary management for liver
A
- itching skin –> anti-histamine
- short nails
- comfortable room temperature
14
Q
Pain
A
- analgesic as needed
- anti-histamine
- avoid using Tylenol
- distraction
15
Q
What can cause acute liver failure
A
- Hepatitis B/C
- alcohol use disorder
- acetaminophen toxicity
16
Q
pathophysiology of acute liver failure
A
- liver injury less than 26 weeks
- impacts protein synthesis, hepatic encephalopathy and impaired coagulation factors
17
Q
signs and symptoms of acute liver failure
A
- nausea and vomiting
- right upper quadrant pain
- abdominal distention
- pruritis
- fatigue
- malaise
- jaundice
- bruising
- petechiae
- hypoglycemia
18
Q
what diagnostic testing should be done for acute liver disease
A
X-ray
CT of liver and brain
biopsy
LFT
CBC
electrolytes
ABG serum toxicology
CBGM
19
Q
nursing interventions for acute liver disease
A
- bowel rest
- decrease activity
- treating acetaminophen toxicity
- lactulose
- IV fluids
- vasopressors
- monitor bleeding risk, vitamin k INFUSION
20
Q
chronic liver disease
A
continuous progressive damage that leads to fibrosis and can progress overtime to cirrhosis
21
Q
what can cause chronic liver diease
A
Hep B and C
ALD and NAFLD
gentic components
22
Q
risk factors for cirrhosis
A
alcohol
NAFLD
viral hepatitis
biliary obstruction
obesity
right heart failure
23
Q
what are important assessments for a patient presenting with cirrhosis
A
- abdo. assessment
- pain
- elimination patterms
- mental status
24
Q
what are hallmark symptoms for cirrhosis
A
- jaundice
- pruritis
ascites - brusing
- skin lesion
- peripheral edema
25
portal vein HTN
elevated portal vein pressure from blockage of blood flow
26
how isportal vein HTN surgically managed
shunt is inserted to connect the portal vein to a branch of the hepatic vein which reduces blood pressure and also fluid accumulation in the peritoneal cavity
27
when si surgical interventions of portal HTN indicated
recurrent ascites or variceal bleeding
28
esophageal varices
dialted veins that are located on the lower or higher esophagus or stomach
29
why are esophangeal varices so concerning
they are thin and easy to tear, if they start bleeding it is life-threatening
30
signs and symptoms of varices bleed
melena
hematemsis
changes in mental status
cool slammy skin
Hypotension and tachycardia/
31
what are interventiosn to prevent the bleeding of varices
avoid alcohol and NSAIDs
avoid straining or lifitng heavy weights
administer non-selective B-blockers to reduced portal HTN
insert sunts and tips if indicated
32
if a varice were t begin to bleed, what are you priority interventions
- manage airway with oxygen therapy and assess need for breathing tube
- IV therapy, fluid resuscitation
- Blood or platelet transfusion
- stopping the bleed - identify source, mechanical pressure against the bleed
- administer vasopression, nitroglycerine or beta-blockers as needed
- continous monitoring of vital signs, Ins and outs
33
what are non-pharmacological ways to manage ascites
- sodium and fluid restriction (less than 2 g, and 800-1000ml per day)
- albumin transfusion or pracentesis when indicated
- avoid NSAIDs and alcohol
34
pharmacological interventions for ascites
- lasix and potassium sparing diuretics
35
abdominal paracetesis
removal of peritoneal fluid from the paritneal cavity via needle or catheter
36
when is paraentesis indicated
resp. difficulty
abdominal discomfort
diuretics being ineffective
37
nurses role in paracentesis
attach the drainage device
monitor output and VS
assess insertion site
38
what are nursing led interventions for jaundice
- offer cold compress, gentle moisturizers and antipruiritc meds
39
hepatic encephalopathy
- combination or neurotoxic ammonia, abnormal neurotransmission, astrocyte swelling and inflammatory cytokines
40
main signs and symptoms of encephalopathy
- neuro and mental responsiveness
- asterixis
- writing impairements
- hyperventilation
- hypothermia
- grimacing
- fector hepaticus - very bad breath from exhaling toxins
41
what are primary interventions for encephalopathy
reducton of ammonia formation (2-3 stools a day)
contipation and bleeding prevention
enteral nutrition support
protein restriction
portecting airway
maintain safe environmentl to prevtn bleeding, injury and infection
42
nutritional therapy for liver disease
high calories and protein (except for ammonia)
low sodium diet
enteral feeds if needed
vitamin supplementation
oral care before and after meals
43
which meds should be avoided for liver disease
* no opioids - slows down GI transit
* avoid tylenol - liver toxicity
* minimize the use of NSAIDs
44
pancreatitis
blockage or inflammation causes early activation of the enzyme and causes auto-digestion of the pancrease
45
diagnostic studies for pancreatitis
serum amylase increasesd quickly then return to normal in 3-5 days
46
prevention of pancreatitis
abstinence of alchol and smoking
47
acute interventions for hmodynamic stability
IV hydration
Plasma or plasam volume expander for shock
monitoring lab values, VS, intake and output
48
nutritional interventions for pancreatitis
- NPO
- avoiding fatty foods
- clear liquid diet
- enteral feeding tube
- Ng sunctions
- oral care
- glycemic control
49
pharmacological interventions for pancreatitis
- histamin antagonists
- antiemetics
- insulin in cases of hyperglycemia
- antibiotics in cases of sepsis
- pancreatic enzyme supplements
- bile acid sequestrants
- opiois for pain management
50
cholelithiasis
gallstones
51
sgns an symptomsof gallstones
mild pain
abdominal distention
RUQ pain
feeling full
Nausea and vomiting
52
cholecystitis
gallbladder inflmation
53
what symptoms differ gallstones from inflammation
- fever
- tachycardia
- elevated RR
54
interventiosn for gallstones
- biles acids opioids and antibiotics
- rest
- IV fluids
- surgical removal
55
inflammation fo gallbladderinterventions
- weight management, avoidng fatty foods, liquid diet for severe pain
- NG sunctioning, oral care
- antibitoics, antiemetics, pain management
