Liver & Diabetic Emergencies Flashcards
What are 4 functions of the liver?
Secrete bile, metabolize fats and proteins, detoxify blood, convert ammonia to urea.
How does the liver protect itself?
Regenerate itself my repairing injured tissue.
What is cirrhosis? What is it a result from?
Scarring of the liver - from inflammation and healing with fibrosis. When hepatocytes regenerate nodules form. End result of chronic liver disorders.
What are manifestations of alcoholic liver injury (5)?
Asterixis, spider angiomas, palmar erythema, jaundice, pruitis.
What are 5 actual and 1 possible nursing diagnosis for liver disease?
Impaired hemostasis r/t impaired protein synthesis, nutritional deficiencies r/t inability to metabolize vitamins, edema/ascited r/t hypoalbuminemia, hyperammonemia r/t ineffective clearance of urea, hepatic encephalopathy r/t hyperammonemia, and risk for hemmorhage r/t esophageal varcies.
What are 3 goals of liver injury treatment?
Remove/alleviate underlying cause, prevent further liver damage, and prevent/treat complications.
What are 2 interventions for toxic hepatitis?
Remove causative agent by lavage, catharsis or hyperventilation. Patient teaching (use of proper drugs, cleaning agents etc)
How is Hep A transmitted?
Food/water/fecal-oral.
How is Hep B transmitted?
Any body fluid
How is Hep C transmitted?
Blood
What are 2 medications a patient with Hep C can take?
Interferon and ribavirin.
What are main interventions for individuals with Hep C?
REST, small meals in high calorie and protein - low fat, patient teaching about medical check ups, no alcohol, mnfts of recrrence, no contact sports.
What are interventions for cirrhosis (6)?
H2RA (GI bleed), ativan (withdrawal), B Blocker (dec. portal HTN), spironalactone/lasix, lactulose, metronidazole.
What is an intervention for portal HTN?
Beta blockers.
What are 2 interventions for ascited?
Paracentesis, spironalactone/lasix.
What are 3 treatment options for esophageal varices?
Balloon tamponade, sclerotherapy, and transjugular intrahepatic portosystemic shunting (TIPS).
What are some causes of NAFLD (5)?
Obesity, high cholesterol, T2DM, malnutrition (weight loss/weight gain), medications.
_______ is the most common cause of chronic liver disease in children.
NAFLD
What is the treatment for NAFLD?
Transplant. No medication options.
How can we do health promotion for NAFLD (6)?
Education & awareness, healthy diet, increase physical activity, lose weight, manage other conditions (T2DM), protect liver from hepatotoxins
In diabetic emergencies, what can result from rapid fluid resuscitation?
Cerebral edema
What are the most common type of emergency leading to death in children?
Diabetic emergencies
Who is DKA more common in? Why? What is the onset? What will the BG likely be? What are 5 mnfts? What lab values will be abnormal?
T1DM. No insulin therefore gluconeogenesis and; lipolysis occur. Rapid (less than 24 hr). Over 13.9. 3 P’s, NV, acetone breath, Kussmaul Respirations, HCT/HGB (high), BUN CREATNINE (HIGH).
Who is HHS more common in? What is the onset? What is the BG? High/low mortality rate? Manifestations (3)?
T2DM. Slower onset, days - weeks. BG >33.3. High mortality rate. Mnfts: hypoTN, dehydrations, inc HR.
What are some causes of HHS (3)?
Stressful events (infection, MI, stroke, trauma, pancreatitis), errors with insulin, diarrhea/vomiting.
How does metformin work to lower the BG?
Improves tissue sensitivity to insulin, increases glucose transport into skeletal muscles and; fat, suppresses gluconeogenesis and; hepatic production of glucose.
How does glyburide work to lower the BG?
Sensitizes functioning B cells to release insulin in presence of elevated BG.
What are the main focuses to treatment of diabetic emergencies?
Fluid resuscitation (rapid 6-10L), electrolyte management: K shift, Na levels… K will decrease as K moves back into cells with presence of insulin), insulin for acidosis.
What needs to be monitored in a pt with a diabetic emergency?
I&O, lytes, BG, ECG, ABGs.
What sort of pt education is necessary for diabetic emergencies?
Healthy diet, proper insulin administration (if learning deficit is there), increased physical activity, weight loss, management of other conditions.
What is hemolytic jaundice a result of?
Results from increased rate of destruction of RBC. Plasma is flooded with bilirubin and liver cannot excrete as quickly as it is forming.
WHat is hepatocellular jaundice from?
Inability of damaged liver cells to clear normal amounts of bili. Caused by toxins, viruses, alcohol.
What is obstructive jaundice a result from?
Occlusion of bile duct from gallstone, inflm. process, tumor or pressure from enlarged organ (liver, gallbladder). Can be an intrahepatic or extrahepatic obstruction.
What are the 1 and 2 top causes of liver disease?
NAFLD and hepatitis.
What are our assessments for the liver?
Palpate, LFT, exposure to hepatotoxic drugs, GGT, albumin, bili, PT/INR, sexual practice history, tattoo/piercings, liver biopsy.
What are manifestations of hepatitis? (7)
Anorexia, N/V/D, pleural effusion, SOB, anemia, bleeding, endocrine abnormality.
How do we protect ourselves/patient from Hep A?
PPE, patient teaching about good hand washing.
How do we protect ourselves from Hep B?
PPE, patient teaching about safe sex/sharing of needles.
How do we protect ourselves from Hep C?
PPE, patient teaching about sharing of needles.
What is the treatment for Hep B?
Lamivudine and interferon.
What is patient teaching for a patient with hepatitis? For B/C carriers?
Medical check ups for 1 year, NO alcohol, SS of recurrence, no contact sports. Sexual safety.
What are 6 main nursing diagnoses for liver disease?
Impaired hemostasis (impaired protein synthesis), nutritional deficiencies (inability to metabolize vitamins), edema/ascites (dec albumin), hyperammonemia (ineffective clearance of urea), and risk for hemorrhage (esophageal varices).
When SS of encephalopathy/ammonia in blood is HIGH what diet change needs to occur for a cirrhosis patient? What if there are no signs of encephalopathy?
LOW protein. HIGH protein.
What kind of diet do we want for a cirrhosis patient with ascites?
Low salt and low fat.
What are the treatments for NAFLD?
No treatment, liver transplant.
How can we prevent NAFLD?
Education/awareness, healthy diet, exercise, weight loss, manage other conditions, no hepatotoxins.
What are some causes of DKA (5)?
Infection, MI, surgery, no insulin, recreational drugs.
What are the three main issues that occur with DKA?
Dehydration, acidosis, hyperglycemia.
What are the three main interventions for DKA?
Fluid resuscitation with NS 6-10 L, IV regular insulin (Novolin R, Humulin R),
What are some causes of HHS? (3)
Stressful events, errors with insulin, diarrhea/vomiting.
What are the interventions for HHS?
6-10 L IVF resuscitation (.45% NS if hyperkalemic or HTN), restore electrolytes, reverse acidosis (with insulin - regular insulin).
