NUR326 Exam 2 Flashcards

1
Q

Hepatitis A: Cause, Symptoms, Risk Factors, and Prevention

A

Cause: Unsanitary practice of healthcare workers or food handling workers, transmitted by fecal-oral, parenteral, sexual, or by IV drug use
Symptoms: acute onset with fever, fatigue, nausea, stomach pain, vomiting, no appetite, dark pee, pale poop, diarrhea, and jaundice
RF: sharing contaminated food, touching contaminated objects, unprotected sex, and sharing drug items.
Prevention: vaccine and hand hygiene

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2
Q

Hepatitis B: Cause, Symptoms, Course, and Prevention

A

Cause: transmitted through parenteral and sexual routes (common with contaminated needles)
Symptoms: insidious onset with long incubation period
Course: may develop into chronic disease (10%)
Prevention: HBV vaccine, safe sex, hand hygiene

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3
Q

Hepatitis C: Cause, Symptoms, Course, Prevention

A

Cause: parenteral, sexual, some mother to fetus
Symptoms: insidious onset with mild to severe symptoms (many don’t have any)
Course: can lead to hepatocellular carcinoma or liver transplant
Prevention: no vaccine (in the works), hand hygiene, screening blood

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4
Q

Cirrhosis: definition and cause

A

definition: irreversible, inflammatory, fibrotic liver disease
cause: hepatitis B & C, excess alcohol intake, idiopathic, and nonalcoholic fatty liver disease

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5
Q

Relationship of Alcoholism and Liver Disease
Stages before Cirrhosis

A

alcoholic cirrhosis is the most common type of liver disease, there are various stages before cirrhosis:
alcoholic fatty liver, alcoholic steatohepatitis, alcoholic cirrhosis

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6
Q

Cirrhosis Pathogenesis

A
  1. liver cells destroyed
  2. cells try to regenerate
  3. disorganized process
  4. abnormal growth
  5. poor blood flow and tissue eschar
  6. hypoxia
  7. liver failure
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7
Q

Stages of Liver Damage

A
  1. healthy liver
  2. fatty liver
  3. liver fibrosis
  4. cirrhosis
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8
Q

Early vs Late CM of Cirrhosis

A

Early: GI disturbances (N/V, anorexia, flatulence, change in bowel habits), fever, weight loss, palpable liver
Late: jaundice, peripheral edema, decreased albumin and PT, ascites, skin lesions, hematologic problems, endocrine problems, esophageal and anorectal varices, and encephalopathy

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9
Q

portal hypertension: def, causes, symptoms, and treatment

A

def: resistant portal blood flow that leads to varices and ascites
causes: systemic hypotension, vascular underfilling, stimulation of vasoactive systems, plasma volume expansion, and increased CO
symptoms: asymptomatic until complications arise (variceal hemorrhage, ascites, peritonitis, hepatorenal syndrome, cardiomyopathy)
treatment: prevent and treat complications (can’t treat portal hypertension without liver transplant)

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10
Q

hepatic encephalopathy: incidence, grading scale, and symptoms

A

incidence: 30-45% of cirrhosis patients
grading: minimal, Grade I, Grade II, Grade III, Grade IV (based on severity)
symptoms: LOC changes (correlate with liver labs - ammonia is the primary LOC driver)

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11
Q

Acute Liver Failure: Definition, Cause, Patho, Course, and Treatment

A

Definition: liver failure that is not caused by cirrhosis or other type of liver disease
Cause: most commonly by acetaminophen overdose (acystelene)
Patho: swollen hepatocytes and patchy areas of necrosis and inflammatory cell infiltrates disrupt liver tissue
Course: 6-8 weeks after viral hepatitis or metabolic liver disease, 5-8 days after acetaminophen overdose
Treatment: Liver transplant

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12
Q

lactulose

A

reduces ammonia absorption for hepatic encephalopathy
MOA: converts ammonia to ammonium
must have S/S of encephalopathy, not just high ammonia
** Make sure patient is not hypokalemic

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13
Q

rifaximin

A

second line treatment, could be preventative
MOA: blocks bacterial DNA synthesis by binding to bacterial DNA
SE: edema, n, ascites, dizziness, fatigue, pruritis, skin rash, abdominal pain, anemia
** Has been associated with an increased risk of CDiff

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14
Q

cholelithiasis: definition, RF, patho, CM

A

gallstones
RF: woman, older than 40, high estrogen levels, lifestyle, high cholesterol and fat diet, low fiber diet, family history
Patho: bile stasis, super saturation with cholesterol, precipitation, stones may stay or migrate through ducts
CM: could be asymptomatic, severity depends on movement and size of obstruction, **biliary colic, jaundice, dark urine, clay colored stools, steatorrhea, pruritis, intolerance to fatty foods, bleeding tendencies

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15
Q

cholecystitis: definition, causes, patho, CM

A

definition: inflammation of GB
cause: obstruction of gallstones or biliary sludge (could also be due to NPO status, bacterial infections, parenteral nutrition, DM)
patho: obstruction causes swelling which causes scarring and decreased functioning
CM: similar to cholelithiasis, could cause systemic symptoms (fever, n/v, restlessness, diaphoresis) causes an increase in bilirubin, LFT, WBC, and amylase

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16
Q

gallbladder pharm:
ketorolac
antiemetics
anticholinergics
bile acids

A

ketorolac - pain control
antiemetics - control nausea and vomiting
anticholinergics - decrease gallbladder secretions and stop smooth muscle spasms
bile acids - dissolve stones

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17
Q

pancreatitis - RF, etiology, patho, CM, complications

A

RF: middle age and African American
etiology: biliary tract disease (women), alcohol abuse (men)
patho: cells are injured, enzymes are activated inappropriately, autodigestion
CM: LUQ or epigastric pain (sudden and may radiate to back), tenderness, n/v, distention, hypoactive bowel sounds, fever, hypotension, tachy, jaundice, cyanosis, ecchymoses (grey turner’s sign and cullen’s sign)
increased amylase, lipase, glucose, and WBC
complications: pseudocyst, abscess, pulmonary complications, hypotension, tetany, increased risk for clotting

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18
Q

chronic pancreatitis: definition, patho, CM

A

definition: inflammation of the pancreas that lasts weeks to months, mainly caused by alcohol abuse
patho: destruction of the tissue, fibrosis, loss of pancreatic enzymes and insulin, may continue after alcohol abuse stops
CM: attacks of acute pancreatitis with progressive signs of dysfunction after the attack stops, **chronic pain, could include DM, malabsorption of fat, and weight loss

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19
Q

pancreatitis pharm:
morphine
dicyclomine
antacids
H-2 receptor antagonist
pancrealipase
insulin

A

morphine - pain
dicyclomine - decrease secretions and relax smooth muscle
antacids - decrease HCl secretion in the stomach which decreases the secretion of pancreatic enzymes
H-2 receptor antagonist - decrease HCl secretion in the stomach which decreases the secretion of pancreatic enzymes
pancrealipase - replace pancreatic enzymes
insulin - treat DM

20
Q

jaundice vs bilirubin

A

jaundice - increased level of bilirubin, could be hemolytic, hepatocellular, or obstructive
bilirubin - by-product of heme breakdown, direct (can’t get bilirubin out of liver) or indirect (bilirubin overproduction/impaired liver function)

21
Q

CM of jaundice

A

dark urine
increased LFT
normal or clay colored stools
pruritis

22
Q

3 important endocrine functions of the kidney

A
  1. produces erythropoietin
  2. activated vitamin D
  3. produces renin
23
Q

kidney blood supply

A

1/4 of CO is delivered to the kidneys
1200mL/min

24
Q

nephron functions

A
  1. filter water soluble substances from the blood
  2. reabsorb filtered nutrients, water, and electrolytes
  3. secrete waste and excess
25
kidney obstructions (name/cause): renal pelvis ureter bladder/urethra
renal pelvis - renal calculi ureter - renal calculi, pregnancy, tumors bladder/urethra - bladder cancer, neurogenic bladder, prostatic hyperplasia, prostate cancer, urethral strictures
26
nephrolithiasis: definition, RF, etiology, patho, CM
definition- renal calculi or kidney stones RF- male, 20-30s, white, family history, congenital defect, hot weather, obesity etiology- crystalized solutes in urine patho- super saturation of urine, crystals form in the nephron, crystal formation enhanced by dehydration and immobility CM- acute renal colic, N/V, diaphoresis, tachy, increased respirations
27
risk factors for UTI
CAUTI, female, increased age, pregnancy, sexual activity, urinary obstruction
28
ascending pattern of UTI
contaminated perineum, urethra, bladder, ureter, kidney
29
pylonephritis: def, RF, etiology, patho
inflammation of the kidneys RF- pregnancy etiology- ascending E coli infection, bloodstream infection patho- inflammatory response causes kidney tissue damage
30
urosepsis: definition, high risk, prognosis
definition - severe systemic response to UTI high risk - elderly, DM, immunosuppressed prognosis- high mortality
31
first line antibiotics for UTI
ciprofloxacin and vancomycin
32
renal cell carcinoma: RF, prognosis, CM, treatment
RF- smoking, obesity, increased age, male, genetics prognosis- normally found late, 5 year survival rate CM- normally no early CM, late = CVA tenderness, hematuria, palpable abdominal mass resistant to chemo
33
bladder cancer: type, RF, CM, treatment
fourth most common cancer in males (urothelial carcinoma) RF- smoking, male, exposure to toxins, low fluid intake early symptoms- hematuria late symptoms- frequency, urgency, dysuria treated with instravesical chemo (early), systemic chemo for late stages
34
normal lab values: BUN creatinine GFR
BUN - 10-20 creatinine - 0.5-1.2 GFR - >90mL/min
35
chronic kidney disease: causes, RF, patho, CM
causes - **DM, HTN, glomerulonephritis RF - family history, increased age, male, African American, HTN, DM, smoking, overweight patho - glomerulosclerosis, interstitial fibrosis, interstitial inflammation CM - HTN starts in stage 3, manifestations become apparent in stage 4, stage 5 includes uremia **effects whole body system (high electrolytes, weight loss, anemia)
36
drugs used to slow the progression of CKD
ACE, ARB, statins
37
how to treat: volume overload hyperkalemia metabolic acidosis hyperphos renal osteodystrophy anemia
volume overload - loop diuretic hyperkalemia - combo metabolic acidosis - sodium bicarb hyperphos - calcium carbonate renal osteodystrophy - calcitrol anemia - erythropoietin
38
glomerular nephritis: def, location, primary and secondary, symptoms
def - variety of conditions that cause inflammation of glomeruli location - local or diffuse primary - isolated to kidney secondary - caused by systemic disease symptoms - hematuria, azotemia, retention, proteinuria
39
treatments for glomerulonephritis
corticosteroids diuretics immunosuppressants antihypertensives dialysis diet
40
diabetic neuropathy
major complication of glomerilopathy caused by gross thickening of GBM ends in thick urine and more toxins
41
hypertensive glomerular disease
underlying pathology - decreased renal perfusion, sclerotic glomerular changes
42
nephrotic syndrome
glomerulus is too permeable to plasma proteins, eliminate >3g per day patho - increased glomerular permeability, proteinuria, hypoalbuminemia CM - edema, HTN, HL, hypercoagulation, loss of antithrombin and plasminogen
43
prerenal AKI
commonly caused by inadequate perfusion decreased GFR due to low glomerular pressure failure to restore blood volume, BP, and oxygen delivery
44
intrarenal AKI
caused by acute tubular necrosis can come from prerenal
45
postrenal AKI
rare condition that usually occurs with obstruction
46
AKI
sudden decline in function CM - oliguria pharm - stabilize patient until function returns (lasix, dextrose, binders, sodium bicarb)