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LPN 194 Final > Liver, pancreas, gallbladder > Flashcards

Liver, pancreas, gallbladder Flashcards

1
Q

ARF is

A

Characterized by sudden & rapid decrease in renal function

Reversible with early, aggressive treatment its contributing etiology

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2
Q

ARF Phases

A

Initiation phase: contributing event  reduced blood flow to nephrons  leads to acute tubular necrosis

Oliguric phase: initial cellular insult  fluid volume excess, azotemia  seizures, coma, death

Diuretic phase: nephrons recover  excretion of wastes & electrolytes still impaired  BUN, creatinine, potassium, & phosphate levels still elevated

Recovery phase: takes 3-12 months for recovery  normal glomerular filtration & tubular function are restored

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3
Q

Acute/ Chronic Renal Failure Findings

A

BUN, creatinine, potassium, magnesium, & phosphorus: elevated

Calcium: decreased

RBC count, H&H: decreased

pH of blood: Acidotic (< 7.35)

Urinalysis: decreased urine specific gravity

IVP: shows evidence of renal dysfunction

Percutaneous renal biopsy: destruction of nephrons

Imaging & US: structural defects

Renal angiography: obstructions in blood vessels

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4
Q

S/S of Kidney transplant rejection

A

Htn, edema, oliguria, fever, abdominal pain, swelling/tenderness over transplanted kidney, shortness of breath, weight gain, increase in serum creatinine levels

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5
Q

If the transplanted kidney was rejected what would you expect next?

A

Hemodialysis than wait for second transplant.

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6
Q

Hemodialysis

A

Artificial Kidney Removes Waste Products and Excess Water from Blood

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7
Q

Peritoneal dialysis

A

The peritoneal membrane is used as a semipermeable membrane across which excess wastes and fluids move from blood in peritoneal vessels into dialysate solution

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8
Q

AV Fistula

A

AV Fistula is made by sewing a vein and artery together under the skin. AV fistulas may take 1-4 months to mature.

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9
Q

AV graft

A

An AV graft uses a tube of synthetic material to attach to an artery and a vein in the upper or lower arm. Needles are inserted into the graft to access the patient’s blood. AV grafts 14 days after insertion.

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10
Q

Hemodialysis Nursing Care

A

Assess & record VS before & during HD

Weigh client; obtain blood for lab tests

Prepare vascular access: “feel the thrill hear the bruit”: Note color of skin, nailbeds, & mobility of fingers. Avoids puncturing the same site used prior

Observe for disequilibrium syndrome

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11
Q

Hemodialysis Teaching

A

Avoid carrying heavy items

Wear clothing with loose sleeves

Do not sleep on vascular access arm

Do not permit venipunctures, injections, or BPs in vascular access arm

Wash skin over vascular access daily

Asses for a thrill or bruit daily

Report s/sx of infections or impaired blood flow

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12
Q

How is peritoneal dialysis done

A

Uses peritoneum to filter fluid, wastes, & chemicals

Hypertonic dialysate due to dextrose

Dialysate instilled & drained from abdominal cavity through a catheter

Catheter is sutured in place with dressing applied

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13
Q

Peritoneal Dialysis Nursing care

A

Obtain & review lab test findings

Record VS & weight

Monitor for s/sx of peritonitis: fever, nausea; vomiting; severe abdominal pain, rigidity, or tenderness before, during, or after PD

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14
Q

More peritoneal dialysis nursing care

A

*Instillation: Warm solution
Add prescribed drugs e.g. antibiotics

Attach dialysate & tubing to catheter

Instill solution & clamp

Record instillation time, volume, type of dialysate, any drugs added

Monitor BP & pulse frequently

Drainage: Open clamp to observe appearance of fluid
Report drainage if cloudy or blood-tinged

Notify HCP if marked abdominal distention
Measure difference between volume instilled & volume removed

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15
Q

Functions of the liver

A

Metabolizes glucose

Regulates blood glucose connectration

Converts glycogen to glucose to maintain normal glucose levels

Synthesizes amino acids fromt he breakdown of protein and form muscles produce during excerise

Coverts ammonia

Metabolizes proteins and fats

Stores vitamin A, B, and some B-complex vitamins as well as iron and copper

Metabolizes drugs

Forms and excretes bile

Extretes bilirubin

Synthesizes factors needed for blood coagulation

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16
Q

Liver Dysfunction (Early and late)

A

*Early:
GI symptoms common-anorexia, n&v, flatulence, diarrhea or constipation

Abd pain- right upper quadrant - enlarged liver

Fever, lassitude (lack of energy, slight wt loss

*Later:
Jaundice

Peripheral edema and ascites

Skin changes / lesions

Hematologic disorders

Endocrine disorders

Peripheral neuropathy

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17
Q

Hemolytic jaundice

A

due to increased breakdown of RBC`s – increased unconjugated bilirubin in the blood

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18
Q

Hepatocellular jaundice

A

due to liver`s decreased ability to take up bilirubin, or to conjugate it or to excrete it

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19
Q

Obstructive jaundice

A

due to impeded flow of bile thru liver or biliary system

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20
Q

Cirrhosis

A

Chronic progressive, degenerative liver disorder caused by generalized cellular damage

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21
Q

Types of Cirrhosis

A
  1. Alcoholic- -associated with excess intake of alcohol and other hepatotoxic substances
  2. Postnecrotic - complication of viral, toxic or idiopathic hepatitis
  3. Bililary- assosicated with bililary infection and obstruction
  4. Nonalcoholic Steatohepatitis (NASH)- fatty live
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22
Q

Hematologic problems

A

Thrombocytopenia

Leukopenia

Anemia

Coagulation disorders

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23
Q

Peripheral neuropathy

A

Due to dietary deficiencies of thiamine, folic acid and vitamin B-12

Characterized by numbness and tingling, loss of feeling or weakness

24
Q

Assessment Findings of Cirrhosis

A

Clinical manifestations: compensated and decompensated

Chronic fatigue, anorexia, dyspepsia, nausea, clay-colored stools, diarrhea

Constipation, tea-colored urine, weight loss, abdominal discomfort

Shortness of breath, nosebleeds, signs of incomplete estrogen metabolism in men

25
Nursing Management Liver
Monitor vital signs, weight, intake, output, and abdominal girth; small meals Client response to drug therapy: change in mental status, signs of GI bleed Client teaching: liver disorder, support groups, treatment regimen, home care
26
Nutritional Therapy for Liver
Fat is restricted for clients with fat malabsorption (steatorrhea). Sodium is restricted to 2 g/day when ascites is present. Fluid restriction is imposed in clients with hyponatremia. A high-calorie diet is recommended for clients with malnutrition, weight loss, or infection. Adequate calories are essential to ensure protein sparing. A high-protein diet is used to prevent muscle wasting. Small, frequent meals and the use of nutritional supplements may help boost intake in clients who have nausea, vomiting, or fatigue Because of the anorexia that accompanies severe cirrhosis, the client may better tolerate frequent, small, semisolid, or liquid meals rather than three full meals a day
27
Client Education Liver
Follow the diet recommended by the primary provider. Consult a dietitian if you require a special diet Avoid situations that could further damage the liver, such as drinking alcohol, taking tranquilizers, or inhaling chemicals such as benzene or vinyl chloride, which are toxic. Rest frequently, especially if activity causes fatigue. Avoid exposure to people with known infections. Continue skin care. Avoid nonprescription drugs (especially aspirin and products that contain it because they contribute to bleeding problems) unless approved by the primary provider. Contact the primary provider immediately about vomiting of blood, tarry stools, extreme fatigue, yellow skin, light-colored stools, or dark urine
28
Major Complications of Cirrhosis
Portal Hypertension Clients can experience: GI bleeding as evidenced by vomiting of blood, or black, tarry stools or bloody stools
29
Portal Hypertension can cause
Esesophageal and gastric varices, caput medusae and hemorrhoids
30
Interventions for Esophageal Varices
Prevent a rupture:
31
Interventions for Ascites
Sodium restriction Fluid restrictions Diuretics Paracentesis Shunting procedures
32
Hepatic Encephalopathy
Hepatic encephalopathy – also called Portal-systemic encephalopathy(PSE) due to an accumulation of ammonia in systemic circulation – the ammonia crosses the blood brain barrier and produces toxic neurologic effects lethargy to deep coma – Confusion, mood swings, personality changes Asterixis – flapping tremors or liver flap Fetor hepaticus- slightly sulfurous (fecal) breath odor
33
Cholelithiasis
stones in the gallbladder Choledocholithiasis: stones located in the common bile duct
34
Cholecystitis
Inflammation or infection of the gallbladder caused by stones.
35
Gallbladder Disorders
1) Initially: belching, n/v RUQ discomfort pain or cramps after high-fat meals Symptoms become acute when a stone blocks bile flow from the gallbladder. 2) With acute cholecystitis, clients usually are very sick fever, vomiting, abdominal tenderness over the liver severe RUQ pain called biliary colic. Slight jaundice dark urine Light-colored stools
36
Pancreas functions
Produces hormones Islets of Langerhans Hormones that regulate blood sugar (insulin, glucagon) Regulate pancreatic secretions Blood sugar is crucial to brain, liver and kidney function.
37
Acute Pancreatitis-
Severe mid-abdominal to upper abdominal pain radiating to sides and back; vomiting Frothy and foul-smelling stools; sign of steatorrhea: increased fat in the stool Physical examination: jaundice, diminished bowel sounds, abdomen is tender to palpate, hypotension. Severe pancreatitis may result in bruising around the umbilicus or on the flanks.
38
Acute Pancreatitis Nursing Management
Monitor client for life-threatening changes; alcohol withdrawal Perform the prescribed treatment measures: NG tube, IV fluids Perform assessments Report any sudden changes to physician Nutrition: TPN cautiously due to high glucose levels Tube feed “Bowel rest”
39
Chronic Pancreatitis Nursing Management
Administer analgesics as ordered.. Withhold oral feedings. “bowel rest” Instruct client to remain on bed rest. Bed rest reduces metabolic rate and thus decreases secretion of pancreatic and gastric enzymes. Report unrelieved pain or sudden increased intensity of pain. Increased pain stimulates secretion of pancreatic enzymes. Sudden increased pain may indicate pancreatic rupture. Administer anticholinergic medications as ordered. They reduce gastric and pancreatic secretions. Maintain continuous nasogastric drainage. Drainage removes gastric contents and prevents gastric secretions from entering the duodenum
40
Pancreatic Cancer
Similar to chronic pancreatitis: Speculation on whether pancreatitis is a precursor or consequence of tumor development Left upper abdominal pain; jaundice, obstructive jaundice; pruritus; ascites tumors of the head of the pancreas tend to cause obstructive jaundice anorexia, weight loss;
41
Pancreatic Cancer Nursing Management
Acute Pain related to surgical procedure Hypovolemia related to hemorrhage and loss of fluids Altered Breathing Pattern related to abdominal discomfort and drainage tubes Infection Risk related to invasive procedure and poor physical condition Malnutrition Risk related to high metabolic requirements and decreased ability to digest food Injury Risk related to failure to consume adequate calories or get enough insulin Death Anxiety related to shortened lifespan and poor prognosis
42
Chronic Traumatic Encephalopathy
Repetitive concussions Sports related Long-term effects: dementia, depression, Parkinson’s disease, and early-onset Alzheimer’s
43
Cerebral Hematomas Management
Burr holes Intracranial surgery: craniotomy, craniectomy, and cranioplasty *Surgical Approaches Supratentorial-through the cerebrum Infratentorial- through the cerebellum
44
Cerebral Hematomas Nursings Management
*Preoperative Nursing Care Hair removal, vital signs, neurologic assessment; antiembolism stockings Restrict fluids *Postoperative Nursing Care Supine or side-lying position Regular monitoring; observe for increased ICP Control thrombus or embolus; cerebral edema
45
Spinal Nerve Root Compression Management
Spinal support and alignment; bed rest in semi-Fowler’s position; tractions Proper body mechanics Muscle relaxants and analgesics; moist heat application Evaluation of client response to therapy
46
Acromegaly (Hyperpituitarism)
oversecretion of GH due to hyperplasia Coarse features; huge lower jaw, thick lips, thickened tongue, bulging forehead Bulbous nose, large hands and feet Enlarged organs, muscle weakness
47
Simmonds’ Disease (Panhypopituitarism)
Hypothyroidism, hypoglycemia, adrenal insufficiency; gonads and genitalia atrophy; premature aging; cachexia
48
Hyperthyroidism (Graves Disease)
Restless, agitated, hand tremors, diarrhea Increased appetite, weight loss, visual changes, exophthalmos, neck swelling Diagnostic Findings: serum T3, T4, TSH; thyroid scan and ultrasonography
49
Thyrotoxic Crisis (Thyroid Storm)
Cardiac dysrhythmias, vomiting, delirium Hyperthyroidism history, laboratory tests High temperature, rapid pulse, dyspnea
50
Hypothyroidism
Slow metabolic rate, lethargy, weight gain, dry skin, menstrual disorders Enlarged heart, atherosclerosis, anemia Diagnostic Findings: serum TSH, T3, T4; FT4; RAI uptake
51
Thyroiditis
High fever, malaise, and swollen Tender thyroid gland Diagnostic Findings: thyroid scan; lab tests
52
Hyperparathyroidism
Fatigue; hypotonic muscles Skeletal tenderness and pain Cardiac dysrhythmias Nursing Management Monitor I and O; urinary calculi; self-care; safe environment Encourage fluid intake Provide postoperative care Client education: effects of disease; adherence to treatment
53
Adrenal Insufficiency (Addison’s Crisis)
Anorexia, vomiting, diarrhea, abdominal pain, hypotension, fever Diagnosis: symptoms; history
54
Cushing’s Syndrome
Cushingoid syndrome, muscle wasting Moon face, buffalo hump, wounds, masculinization, kyphosis Diagnostic findings: dexamethasone suppression test; 24-hour urine; blood test; radiographs; IV pyelogram; CT; MRI
55
Hyperaldosteronism
Muscle weakness, fatigue, cardiac dysrhythmias; Headache; Increased urine; Hypertension Laboratory tests; CT; MRI; adrenal venography
56

LPN 194 Final (4 decks)

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