MS2 - Quiz - Lower GI/Hepatic Flashcards

Question

Toxic and drug induced hepatitis

Answer 1

- Drugs can cause hepatitis | - Some of same symptoms as Hepatitis, depending on degree of inflammation

Answer 2

- Unknown cause, presence of antibodies and immunoglobins, frequently occurs with other autoimmune diseases

Answer 3

- Rapidly progressive disease with liver failure within a couple of weeks of symptoms - Rare - Hep B, especially B+D - Death usually occurs

Answer 4

- Prevent bleeding and hemorrhage - avoid alcohol, aspirin, NSAIDs - Upper endoscopy (EGD) to screen for varices - B-blocker reduces incidence of hemorrhage, high portal pressure Variceal bleeding: - Stabilize patient, manage airway, IV therapy initiated (may include blood products) - combination of endoscopal therapy and drug therapy (vasopressin / nitroglycerin often combination therapy) - Band ligation (band around base of varix) or sclerotherapy (injection of sclerosant solution) - may be used to prevent rebleeding - Balloon tamponade if cannot be controlled via endoscopy and bleeding acute - mechanically compresses the varices (* deflate balloons for 5 min every 8-12 hrs to prevent tissue necrosis) - Fresh frozen plasma, packed RBCs, vit K, PPIs, antibiotics to prevent infection Shunting: - Surgical and nonsurgical methods available - Used more after 2nd major bleeding episode than 1st - TIPS - nonsurgical - shunt between systemic and portal venous systems to redirect portal flow - Surgical - usually portacaval shunt or distal splenorenal shunt

Answer 5

- Gastric balloon breaks or is deflated - esophageal balloon will slip upward, obstructing airway and causing asphyxiation - cut the tube or deflate balloon - keep scissors at bedside - Minimize regurgitation - oral and pharyngeal suctioning, pt in semi-Fowler's - Patient is unable to swallow saliva - encourage to expectorate, provide emesis basin and tissues - Frequent oral and nasal care

Answer 6

- Abdominal distention with weight gain - Abdominal striae with distended abdominal wall veins - Signs of dehydration (dry mouth/skin, sunken eyeballs, muscle weakness) and decreased urine output - Hypokalemia common Management - Sodium restriction - Diuretics - Fluid removal (paracentesis - needle puncture of abdominal cavity to remove fluid or test for infection) - reserved for patient with impaired respiration or ab pain caused by severe ascites - temporary measure b/c fluid builds back up - Usually NOT on fluid restriction unless severe ascites develops - TIPS when ascites does not respond to diuretics

Answer 7

- Accurate I&O, daily weights - Observe F&E imbalances - high risk for hypokalemia - Measurements of abdominal girth and extremities - Have patient void immediately before paracentesis to prevent bladder puncture - After paracentesis - patient sits on side of bed or in high-Fowler's - monitor for hypovolemia, electrolyte imbalances; check dressing for bleeding/leakage - Dyspnea - semi-Fowlers or Fowlers; use pillows to support arms and chest - Edematous tissues subject to breakdown - meticulous skin care, turning schedule min 2 hr, alternating-air pressure mattress, ROM exercises, coughing/deep breathing - Elevate lower extremities; scrotal support for scrotal edema

Answer 8

Clinical manifestations - Changes in neurological/mental responsiveness - Impaired consciousness - Inappropriate behavior - range from sleep disturbances to lethargy to deep coma - Asterixis - flapping tremors - characteristic manifestation Goal of mgmt - reduce ammonia formation - Lactulose - drug that traps ammonia in the gut and has laxative effect to expel (can be given orally, NG tube, enema) - Antibiotics can be given - Constipation should be prevented - Treatment of precipitating causes (GI hemorrhage, constipation, hypokalemia, hypovolemia, infection, etc) - Controlling GI bleeding, and removing blood from GI tract to decrease protein in intestine

Answer 9

- Assess patient's level of responsiveness, sensory and motor abnormalities, fluid and electrolyte imbalances, acid-base imbalances, effect of treatment measures - Neurologic status at least Q2H - Institute measures to prevent constipation to reduce ammonia production - give drugs, laxatives and enemas as ordered, encouraged fluids if indicated - Any GI bleeding will worsen encephalopathy - Assess pt taking lactulose for diarrhea and excessive fluid/electrolyte losses - Control factors known to precipitate, including anything that may cause constipation

Answer 10

Aminosalicylates - first line therapy for mild-moderate CD, more effective for UC - achieve and maintain remission - Decrease GI inflammation through direct contact with bowel mucosa - Yellowish orange discoloration of skin and urine Antimicrobials - Prevent or treat secondary infection Corticosteroids - used to achieve remission - given for SHORTEST period of time - Decrease inflammation - Tapered to low levels when surgery is planned Immunosuppressants - maintain remission after corticosteroid induction therapy - Suppress immune response - Require regular CBC monitoring - can suppress bone marrow and lead to inflammation of pancreas or gallbladder - Delayed onset of action Biologic and targeted therapy - Inhibit cytokine tumor necrosis factor (TNF); prevent migration of leukocytes from bloodstream to inflamed tissue - Do not work for everyone; costly and may produce allergic reactions - Most effective when given at regular intervals and must not be d/c'd unless pt can't tolerate - Before starting anti-TNF, pt must be tested for TB and hepatitis; cannot receive live virus immunizations

Answer 11

- Instruct pt to record color, volume, frequency and consistency of stools - Perform actions to rest bowel (NPO, liquid diet) - Stress-reduction techniques - Frequent, small feedings, add bulk gradually; eliminate gas-forming and spicy foods - Low-fiber, high-protein, high-calorie diet - Weigh at specified intervals

Answer 12

Female: less than 20 mm/hr Male: less than 15 mm/hr

MS2 - Quiz - Lower GI/Hepatic Flashcards

(36 cards)