Study Guide Flashcards
Discuss the care for the client undergoing endoscopic retrograde choliangiopancreatolgraphy (ERCP). What should the nurse assess for post procedure?
ERCP is a visualization of the bile ducts.
- Monitor VS and Respiratory status
- Notify the provider of bleeding, abdominal or chest pain, any evidence of infection
- Withhold fluids until the return of gag reflex
- Gag reflex
- Chest pain
- Perforation risk
Discuss the use of ursodiol (ursodeoxycholic acid) (Actigall) in the client w/cholethias
Gradually dissolves cholesterol-based gall stones, w/few adverse effects. Use caution in client who have liver conditions or disorders with varices.
- Take with water
- Taken with food
- For cholelithiasis
Discuss the teaching for the client taking pancrelipase (Viokase)
- Client may sprinkle contents of capsules on no protein foods. - Should drink a full glass of water with it - Clients should wipe lips and rinse mouth after taking to prevent skin breakdown or irritation
- For pancreatitis
- Aids in the digestion of fats
- Check blood tests every month. Can be toxic to the liver.
- Should be swallowed whole.
List 3 medications to treat cirrhosis of the liver
Diuretics for ascites, beta-blocking agent, lactulose (cephulac), non absorbable antibiotic. Causes diarrhea. Must check electrolyte levels.
- vitamin supplements
- interferon
Discuss the use of spironolactone (Aldactone) in the treatment of ascites. Which side effects should the nurse monitor for?
It is a potassium-sparing diuretic. It acts as a first treatment for ascites before an invasive procedure is needed (paracentesis). Should monitor S/S: headache, vomiting, check I&O, Rash
Worry about hyperkalemia. Heart.
List the adverse effects of the medication lactulose
Lactulose is a medication that decreases pH of the intestine killing the bacteria that makes ammonia. Adverse reactions are severe diarrhea, bloating, nausea vomiting, and stomach pain
List three expected findings in the client that has cholecystitis
Jaundice, clay-colored stools, steatorrhea (fatty stools), dark urine, pruritus (bile salts on the skin), RUQ pain.
Which medications would you expect to be used for a client with cholelithiasis due to biliary obstruction?
Firstly, would start with analgesics (pain medications) such as Demerol (meperidine) or Dilaudid (hydromorphone)
Describe: Cullen’s sign, Turner’s sign, Trousseau’s sign, and Chvostek’s sign
- Cullen’s sign - bluish gray periumbilical discoloration - Turner’s sign - ecchymoses (bruising) on the flanks - Trousseau’s sign - hand spasm when blood pressure off is inflated - Chvostek’s sign - facial twitching when facial nerve is tapped
List the fx of the liver
Absorption of bilirubin, Detoxification of blood, Storage of fat-soluble vitamins, synthesis of urea, storage for glycogen. makes bile
List the fx of the pancreas
The pancreas produces insulin, glucagon, and digestive enzymes that break down carbohydrates, proteins, and fats, excretion of bilirubin (destruction of RBC) causes jaundice, bicarb
List the three sets of salivary glands
Sublingual gland, submandibular gland, paranoid gland.
in the client with Hep B, which type of precautions should be used?
Choose safe sex such as condoms, mothers should be tested before child is born, contact with blood to blood, don’t share needles.
Standard precautions.
A client has chronic pancreatitis. Which lab would you expect to be elevated?
Increased: Amylase, lipase, WBC, serum liver enzymes and bilirubin, serum glucose
Decreased: Magnesium and Calcium
Give an example of a menu items the should be suggested for the client post cholecystectomy.
Avoid eating high fat or spicy foods. Increase fiber slowly, but include oats and barley, lean protein like chicken. Increase vegetables slowly as most produce gas and can be a discomfort.
Which labs may want to be monitored prior to liver biopsy?
Evaluate baseline lab tests including: CBC, electrolyte panel, BUN, creatinine, PT, aPTT, and liver function studies.
List ways the nurse can teach the client with pruritus to prevent skin breakdown.
Tell them to use their knuckles to scratch instead of their nails. Tell them to use lotion. nails short. give them antihistamine is possible.
Explains the pain typically described by the client who has pancreatitis
sever knife like pain in the LUQ to left shoulder, mid-epigastric, and radiating pain to the back that is unrelieved by nausea and vomiting. watch for tentany. hypocalcemia. fetal position can help
List the fx of the bile duct
It’s role is to carry bile from the gallbladder to the cystic duct. and empty it into the upper part of the small intestine (duodenum.)
it digests our fat. greenish brown color
Describe the position for the client following a liver biopsy and explain why.
The client should lay on their right side post procedure for 2 hours or more with pillows under the ribs. This is to prevent bleeding and relieve pressure.
Define and describe asterixis. from hepatic encephalapathy
Flapping motion of the hand caused by brain defect. Means “no fixed position”
List foods that should be avoided in the client with hepatic encephalopathy (increased ammonia)
They should eat a low to no protein diet. (Protein is converted to ammonia by bacteria in the bowel).
list the S/S of a liver abscess
Chills, fever, extreme weight loss, nausea, vomiting, abdominal distention, right sided pain in the abdomen and shoulder, jaundice
how are hepatitis B and C typically spread
Blood to blood. Usually by needle. sex
Discuss the care of the client post-op common bile exploration
Instruct client to turn, cough, breath, splint incision. Use an incentive spirometry every 2 hours. Promote drainage in semi-fowlers, assess bowel sounds, no morphine, assess for post op complications such as pancreatitis and peritonitis
