Obesity, Hepatic, biliary disorders

Question 1

Bariatic surgery

Answer 1

indicated for class 3 obesity or class 2 obesity with comorbidites

Question 2

most commonly preformed bariatric surgery

Answer 2

sleeve gastrectomy, pouch is created by removal of large portion of stomach, restrictive type of procedure

Question 3

post operative care for patient

Answer 3

maintain client in semi-fowlers position, measure abdominal girth ascultate bowel sounds, implement VTE prevention, monitor for anastomatic leak

Question 4

signs and symptoms anastomotic leak

Answer 4

medical emergency, worsening pain in back/shoulder, abd pain, tachycardia, oliguria

Question 5

liver disease common lab results

Answer 5

increased LDH, albumin decreased, increased serum bilirubin, increased lipids, increased ammonia, increased PT

Question 6

Liver biopsy nursing management

Answer 6

NPO after midnight, have patient remain in right side lying position with pillow placed under right costal margin for several hours

Question 7

Jaundice

Answer 7

damaged liver cells unable to clear normal amounts of bilirubin,
Bilirubin level > 2mg/dL

Question 8

Hepatocellular jaundice S/S

Answer 8

lack of appetite, N/V malaise, fatigue, HA, chills

Question 9

obstructive jaundice S/S

Answer 9

dark orange brown urine, clay colored stools, dyspepsia, intolerance of fats, impaired digestion, pruritis

Question 10

Medical management of ascites

Answer 10

goal is to create a negative sodium balance to reduce fluid retention; includes a 2g Na diet, diuretics

Question 11

Medical management of paracentesis

Answer 11

removal of 5-6L of fluid, have pt void before procedure, monitor ammonia, creatinine and electrolytes, document fluid removed in suction cannister

Question 12

Hepatic encephalopathy

Answer 12

accumulation of ammonia in the brain, Lactulose is given to reduce serum ammonia levels

Question 13

Esophageal varices

Answer 13

occurs from portal HTN and cirrhosis, can hemorrhage from lifting heavy objects

Question 14

clinical manifestations of esophageal varicosity rupure

Answer 14

hematemesis, melena, deteriorating staus, shock S/S

Question 15

clinical manifestations of hepatic encephalopathy

Answer 15

mental status changes, confusion, asterixis (involuntary flapping of hands), apraxia (cannot write), sleeps during day and awake at night, fector hepaticus

Question 16

S/S of hepatits A:

Answer 16

transmitted fecal oral route, low fever, jaundice, epigastric distress, enlargement of liver and spleen

Question 17

S/S of hepatits B

Answer 17

transmitted through blood and sexual contact, same S/S as hep A

Question 18

S/S of hepatitis C

Answer 18

most common, transmitted through blood and sexual contact, flu like symptoms, clay colored stools, jaundice

Question 19

Which hep can be cured

Answer 19

A and C, B can be managed and prevented

Question 20

clinical manifestation of cholecystitis

Answer 20

pain with deep inspiration, sharp pain in RUQ, that radiates to R shoulder, N/V after eating high fat

Question 21

pancreatitis

Answer 21

autodigestion of pancreas by enzymes that activate prematurely before reaching the intestines

Question 22

what is pancreatitis caused by

Answer 22

chronic alcohol use, cholelithiasis

Question 23

clinical manifestations of pancreatitis

Answer 23

sudden onset epigastric pain that is worse when laying down, pain is relived by fetal position, tetany, discoloration of abd wall (cullen’s and turner’s), shock

Question 24

What will labs look like for pancreatitis

Answer 24

increased WBC, increased glucose, decreased calcium, decreased magnesium, serum amylase >200 for 24 hrs, raised lipase after 48 hours

Question 25

nursing care for pancreatitis

Answer 25

NPO till pain free, fetal position with HOB elevated, incentive spirometer ever hours