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
What is the purpose of a t-tube
A t-tube is placed in the common bile duct in an open cholecystectomy when there is exploration of the common bile duct. Purpose is to detect stones or stone fragments and other abnormalities in the bile ducts.
Describe the care of the client with a t-tube
Monitor drainage, place in semi fowlers, asses for bowel sounds, medication for pain but no morphine,
Why do clients with cirrhosis have ascites?
it usually develops when the liver is starting to fail. the development of ascites indicates advanced liver disease.
Why is lactulose administered to clients with hepatic encephalopathy?
Lactulose decreases the pH of the intestine killing bacteria that makes ammonia.
Discuss the client preparation for a paracentesis.
Determine clients readiness. Review lab results. Verify pt has signed consent form. Have the client void before procedure. Position sitting up. Review baseline vitals. Administer sedation as prescribed
What is an abdominal paracentesis and when is it used?
It is a procedure in which a needle is inserted into the abdomen to drain excess fluid. Used on a a patient with ascites.
List the nursing interventions following a paracentesis:
Maintain pressure at insertion site for several minutes. Apply a dressing to the site (dry sterile). Check vitals, weight, and measure abdominal girth. Monitor temp every 4 hours for 48 hours. Monitor I&O every 4 hours. Administer meds as prescribed. Assist client to get comfortable while promoting lung expansion. Document.
Why would the client with acute pancreatitis possibly experience hypocalcemia?
The patient will be on a bland, low fat diet with no stimulants. Calcium binds to fat which in turn gets rid of calcium faster. Not enough fat - less calcium.
List two possible complications of acute pancreatitis:
- Hypovolemia- Up to 6L of flu can be third-spaced. Can develop hypovolemic shock. 2. Multi System organ failure. Inflammation of pancreas believed to trigger systemic inflammation.
Infection!
Which medications should be avoided by clients with hepatitis? Give examples.
No NSAIDS. can kill liver cells if you drink alcohol. Acetaminophen, naproxen, ibuprofen. No sleeping pills or tranquilizers. herbal meds. watch sedatives, narcotics, and opioids.
Decide icteric:
Linked with jaundice. Yellowing of the eyes.
Define fetor hepaticus:
AKA the breath of death. Characteristic of hepatic disease caused by hyperglycemia.
List the type of diet that would be appropriate for the client with cirrhosis:
High calorie, moderate fat. Low sodium. Low protein. Small frequent meals. Supplemental vitamin enriched liquids given. Vitamins because liver has an inability to store them. Fluid intake restrictions if serum sodium is low.
List the nursing intervention for the client with ascites?
elevating the HOB, restricting Na+, albumin, give diuretics as ordered.
List meds used to treat chronic hepatitis:
Peginterferon afla-2a and interferon alfa-2b can be administered to clients with chronic HBV or HBC to induce remission. Antivirals such as lamivudine (Epivir), adeforvir (Hepsera), or ribiavarin (Rebetol) an be given to clients with chronic HBV to decrease incidence of cirrhosis.
Give an overview of cirrhosis:
Cirrhosis is extensive scarring of the liver caused by necrotic injury or a chronic reaction to inflammation over a prolonged period of time. Normal liver tissue is replaced with fibrotic tissue that lacks function. Scarring affects the livers ability to handle the flow of bile. 3 types: post necrotic (caused by viral hepatitis, meds, or toxins), laennec’s (alcoholism), and Billiary (obstruction to autoimmune disease)
How do clients with cholecysistitis typically describe their pain?
Sharp pain in the RUQ of the abdomen, often radiating to the right shoulder. Pain with deep inspiration during hight subcostal palpation
How long does the client with hepatitis typically feel fatigued?
As long as the disease takes place. Can last up to 4-6
How is hep A transmitted?
oral-fecal route. Oral or anal sex.
How is hep B transmitted?
blood, blood products, needles
Discuss then nursing interventions for the client hospitalized with acute pancreatitis
Rest the pancreas, position for comfort (fetal, side lying), administer analgesics, monitor blood glucose, monitor hydration status, monitor client receiving IV fluids and electrolyte replacement.
List he risk factors for pancreatitis:
Billiary tract disease. Alcohol use. ERCP. Gastrointestinal surgery. Metabolic disturbances. Kidney failure. Trauma. Penetrating ulcer. Medication/drug toxicity. increased glucose
List appropriate food items for a low fat diet:
whole-grain products, fruits, and vegetables. Lean meats and fat free dairy.
List the symptoms of hep A:
Mild fever, malaise, jaundice, fatigue, nausea, loss of appetite, abdominal pain, joint and muscle aches
List a priority of care for the client with cholelithiasis:
Priority is to treat pain
List the risk factors for gallbladder disease:
gallstones, females are higher risk, high fat diet, high cholesterol, rapid weight loss, fatigue, pain RUQ
Why does the client with cirrhosis tend to bleed?
Because they have a high BP or esophageal varices.
Which type of precautions will protect the client from hep B?
Wearing condoms, no contact with blood or needles that have already been used by a person with hep b
What is portal hypertension? Describe the teaching for the client with this disorder.
An increase in BP of the hepatic portal system. Don’t strain
Lis the S/S of cholecystitis:
RUQ pain, rebound tenderness, jaundice, dark urine, clay stool, steatorrhea, pruritus.
List the S/S of pancreatitis:
jaundice, ascites, fatty stool, severe epigastric pain, flank pain, worse when lying down or eating.
What causes jaundice in cirrhosis clients?
An increase in serum bilirubin. Causes bile salts to accumulate on the skin.
What are esophageal varices?
Unlatched thin walled veins that form in the submucosa of the esophagus (large veins that connect throat and stomach)
Why are clients kept NPO following GI surgery?
Because lack of bowel sounds and no peristalsis.
List two foods clients who have had cholecystectomies should avoid:
Fried foods, nuts, chocolate.
Describe the Whipple procedure:
Removal of the wide part of the pancreas, removal of the duodenum, and removal or a portion of the common bile duct, gall bladder, or sometimes the stomach. Procedures that remove tumours in the pancreas
List 3 functions of saliva:
Breaks down food with enzymes, keeps the mouth healthy and moist, allows food to be balled as a bolus down the esophagus in an easy passing.
Why are sedative used cautiously in clients with cirrhosis?
Increased the risk of liver damage.
Trace the path of bile from production to elimination
Bile is made in the liver by cholesterol –> stored by the gallbladder –> the small intestine breaks down fat excreted in feces
