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332 > Liver & Diabetic Emergencies > Flashcards

Liver & Diabetic Emergencies Flashcards

1
Q

What are 4 functions of the liver?

A

Secrete bile, metabolize fats and proteins, detoxify blood, convert ammonia to urea.

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2
Q

How does the liver protect itself?

A

Regenerate itself my repairing injured tissue.

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3
Q

What is cirrhosis? What is it a result from?

A

Scarring of the liver - from inflammation and healing with fibrosis. When hepatocytes regenerate nodules form. End result of chronic liver disorders.

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4
Q

What are manifestations of alcoholic liver injury (5)?

A

Asterixis, spider angiomas, palmar erythema, jaundice, pruitis.

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5
Q

What are 5 actual and 1 possible nursing diagnosis for liver disease?

A

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.

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6
Q

What are 3 goals of liver injury treatment?

A

Remove/alleviate underlying cause, prevent further liver damage, and prevent/treat complications.

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7
Q

What are 2 interventions for toxic hepatitis?

A

Remove causative agent by lavage, catharsis or hyperventilation. Patient teaching (use of proper drugs, cleaning agents etc)

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8
Q

How is Hep A transmitted?

A

Food/water/fecal-oral.

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9
Q

How is Hep B transmitted?

A

Any body fluid

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10
Q

How is Hep C transmitted?

A

Blood

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11
Q

What are 2 medications a patient with Hep C can take?

A

Interferon and ribavirin.

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12
Q

What are main interventions for individuals with Hep C?

A

REST, small meals in high calorie and protein - low fat, patient teaching about medical check ups, no alcohol, mnfts of recrrence, no contact sports.

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13
Q

What are interventions for cirrhosis (6)?

A

H2RA (GI bleed), ativan (withdrawal), B Blocker (dec. portal HTN), spironalactone/lasix, lactulose, metronidazole.

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14
Q

What is an intervention for portal HTN?

A

Beta blockers.

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15
Q

What are 2 interventions for ascited?

A

Paracentesis, spironalactone/lasix.

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16
Q

What are 3 treatment options for esophageal varices?

A

Balloon tamponade, sclerotherapy, and transjugular intrahepatic portosystemic shunting (TIPS).

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17
Q

What are some causes of NAFLD (5)?

A

Obesity, high cholesterol, T2DM, malnutrition (weight loss/weight gain), medications.

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18
Q

_______ is the most common cause of chronic liver disease in children.

A

NAFLD

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19
Q

What is the treatment for NAFLD?

A

Transplant. No medication options.

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20
Q

How can we do health promotion for NAFLD (6)?

A

Education & awareness, healthy diet, increase physical activity, lose weight, manage other conditions (T2DM), protect liver from hepatotoxins

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21
Q

In diabetic emergencies, what can result from rapid fluid resuscitation?

A

Cerebral edema

22
Q

What are the most common type of emergency leading to death in children?

A

Diabetic emergencies

23
Q

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?

A

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).

24
Q

Who is HHS more common in? What is the onset? What is the BG? High/low mortality rate? Manifestations (3)?

A

T2DM. Slower onset, days - weeks. BG >33.3. High mortality rate. Mnfts: hypoTN, dehydrations, inc HR.

25
Q

What are some causes of HHS (3)?

A

Stressful events (infection, MI, stroke, trauma, pancreatitis), errors with insulin, diarrhea/vomiting.

26
Q

How does metformin work to lower the BG?

A

Improves tissue sensitivity to insulin, increases glucose transport into skeletal muscles and; fat, suppresses gluconeogenesis and; hepatic production of glucose.

27
Q

How does glyburide work to lower the BG?

A

Sensitizes functioning B cells to release insulin in presence of elevated BG.

28
Q

What are the main focuses to treatment of diabetic emergencies?

A

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.

29
Q

What needs to be monitored in a pt with a diabetic emergency?

A

I&O, lytes, BG, ECG, ABGs.

30
Q

What sort of pt education is necessary for diabetic emergencies?

A

Healthy diet, proper insulin administration (if learning deficit is there), increased physical activity, weight loss, management of other conditions.

31
Q

What is hemolytic jaundice a result of?

A

Results from increased rate of destruction of RBC. Plasma is flooded with bilirubin and liver cannot excrete as quickly as it is forming.

32
Q

WHat is hepatocellular jaundice from?

A

Inability of damaged liver cells to clear normal amounts of bili. Caused by toxins, viruses, alcohol.

33
Q

What is obstructive jaundice a result from?

A

Occlusion of bile duct from gallstone, inflm. process, tumor or pressure from enlarged organ (liver, gallbladder). Can be an intrahepatic or extrahepatic obstruction.

34
Q

What are the 1 and 2 top causes of liver disease?

A

NAFLD and hepatitis.

35
Q

What are our assessments for the liver?

A

Palpate, LFT, exposure to hepatotoxic drugs, GGT, albumin, bili, PT/INR, sexual practice history, tattoo/piercings, liver biopsy.

36
Q

What are manifestations of hepatitis? (7)

A

Anorexia, N/V/D, pleural effusion, SOB, anemia, bleeding, endocrine abnormality.

37
Q

How do we protect ourselves/patient from Hep A?

A

PPE, patient teaching about good hand washing.

38
Q

How do we protect ourselves from Hep B?

A

PPE, patient teaching about safe sex/sharing of needles.

39
Q

How do we protect ourselves from Hep C?

A

PPE, patient teaching about sharing of needles.

40
Q

What is the treatment for Hep B?

A

Lamivudine and interferon.

41
Q

What is patient teaching for a patient with hepatitis? For B/C carriers?

A

Medical check ups for 1 year, NO alcohol, SS of recurrence, no contact sports. Sexual safety.

42
Q

What are 6 main nursing diagnoses for liver disease?

A

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).

43
Q

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?

A

LOW protein. HIGH protein.

44
Q

What kind of diet do we want for a cirrhosis patient with ascites?

A

Low salt and low fat.

45
Q

What are the treatments for NAFLD?

A

No treatment, liver transplant.

46
Q

How can we prevent NAFLD?

A

Education/awareness, healthy diet, exercise, weight loss, manage other conditions, no hepatotoxins.

47
Q

What are some causes of DKA (5)?

A

Infection, MI, surgery, no insulin, recreational drugs.

48
Q

What are the three main issues that occur with DKA?

A

Dehydration, acidosis, hyperglycemia.

49
Q

What are the three main interventions for DKA?

A

Fluid resuscitation with NS 6-10 L, IV regular insulin (Novolin R, Humulin R),

50
Q

What are some causes of HHS? (3)

A

Stressful events, errors with insulin, diarrhea/vomiting.

51
Q

What are the interventions for HHS?

A

6-10 L IVF resuscitation (.45% NS if hyperkalemic or HTN), restore electrolytes, reverse acidosis (with insulin - regular insulin).

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