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NSG 430 - Critical Care > T13: Hepatitis & Acute Liver Failure > Flashcards

T13: Hepatitis & Acute Liver Failure Flashcards

1
Q

hepatitis

A

inflammation of the liver

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2
Q

causes of hepatitis

A

viral, ALCOHOL, medications (hepatotoxic), fatty liver disease

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3
Q

liver is the only organ in the body that can

A

regenerate

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4
Q

how do we help to regenerate the liver

A

adequate nutrition and rest

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5
Q

Hepatitis A (HAV)
Transmission

A

-Most commonly fecal-oral route-comtaminated water or food

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6
Q

prevention of hepatitis A (HAV)

A

through strict handwashing, stool and needle precautions, HEPATITIS A VACCINE (two doses)

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7
Q

Hepatitis B (HBV) Transmission

A

-Through direct contact with blood or body fluids of infected person

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8
Q

prevention of hepatitis b (HBV)

A

o strict hand washing, screening blood, needle precautions, avoiding sexual contact with anyone who is Hep B positive, HEPATITIS B VACCINE

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9
Q

Hepatitis C (HCV) transmission

A

primarily through blood (IV drug use, high risk-sex behavior, dialysis, blood transfusion before 1992, perinatal)

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10
Q

prevention of hepatitis C

A

strict hand washing, needle precautions, screening of blood, NO VACCINE

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11
Q

which type of hepatitis does NOT have a vaccine

A

Hepatitis C

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12
Q

hepatits clinical manifestations: preicteric stage

A
  • Flu-like symptoms (malaise, fatigue, anorexia, N/V, diarrhea, myalgias (muscle aches), arthralgias (joint pain)
  • Rash: IMPORTANT TO TEACH HOW TO SCRATCH WITH KNUCKLES
  • RUQ tenderness (caused by liver inflammation)
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13
Q

hepatits clinical manifestations: icteric stage

A

-Appearance of jaundice (elevated bilirubin levels)
· Look at sclera and palms/bottom of feet
· Palmar erythema
-DARK/TEA COLORED URINE
-CLAY COLORED STOOLS
-Pruritis

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14
Q

pruritis interventions

A

· Use cholestyramine or hydroxyzine, lotions, soft, or old linen, temperature control, short nails; rub with knuckles

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15
Q

hepatits clinical manifestations: posticteric stage

A
  • Jaundice, urine, and stool color return to normal
  • Energy increases and pain subsides
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16
Q

diagnostics for hepatitis

A

-Elevated bilirubin, gamma GT, AST, ALT
-Prolonged PT and INR
-Leukopenia, transient neutropenia, lymphocytosis
-Blood test for hepatitis associated antigen A, B, C, D
-Liver biopsy

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17
Q

Total bilirubin

A

0.3-1.0 mg/dL

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18
Q

interprofessional care for hepatitis

A

o Adequate nutrition
- IV GLUCOSE OR ENTERAL NUTRITION
-Small frequent meals, use measures to stimulate appetite (mouth care, antiemetics, attractively served meals)
o Rest (degree and strictness varies)
o AVOID alcohol intake and drugs detoxified by liver
o HOB elevated

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19
Q

what drug can be used for hep C infection

A

interferion

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20
Q

Hepatic encephalopathy

A

potentially life-threatening spectrum of neurologic, psychiatric, and motor disturbances (results from liver’s inability to remove toxins)

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21
Q

clinical manifestations of hepatic encephalopathy

A

-lethargic, personality changes
-cannot write well
-asterixis
-Fetor hepaticus (musty, sweet odor of patient’s breath; rotten eggs + garlic)

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22
Q

Asterixis

A

aka Liver Flap, a flapping tremor of the hands. When the client extends the arms & hands in front of the body, the hands rapidly flex & extend.

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23
Q

What causes hepatic encephalopathy?

A

accumulation of ammonia that gets into the brain

24
Q

what do we give for hepatic encephalopathy to get rid of ammonia

A

LACTULOSE

25
Q

Lactulose

A

ammonia binds to the stool and patients gets diarrhea, so we are worried about F&E imbalances

26
Q

manifestations of chronic hepatitis

A

· Coagulation problems
o Easy bruising and bleeding
· Skin manifestations
o Spider angiomas, palmar erythema, and gynecomastia. Some patients have splenomegaly, hepatomegaly, or cervical lymph node enlargement

27
Q

cirrosis

A

end-stage disease liver “scarring”

28
Q

clinical manifestations of cirrosis

A
  • Skin: jaundice (decreased ability to remove bilirubin), palmar erythema (red area that blanches with pressure), pruritus, spider angioma
  • Neuro: asterixis (flapping tremor), portal-systemic encephalopathy
  • Respiratory: dyspnea, hyperventilation, hypoxemia
  • Ascites
  • Clay-colored stools
  • Esophageal varices
  • Hematologic: thrombocytopenia, anemia, leukopenia, coagulation disorders
29
Q

treatment of hematologic conditions of cirrosis (thrombocytopenia, anemia, leukopenia, coagulation disorders)

A

Platelets, FFP, RBCs

30
Q

why do patients get peripheral neuropathy with cirrosis

A

due to dietary deficiencies of thiamine, folic acid, and cobalamin-vitamin B12

31
Q

cor pulmonale

A

right ventricular hypertrophy and heart failure DUE TO pulmonary hypertension

32
Q

portal hypertension

A

characterized by increased venous pressure in the portal circulation, splenomegaly, large collateral veins, ascites, and gastric and esophageal varices.

33
Q

TRANSJUGULAR INTRAHEPATIC PORTOSYSTEMIC SHUNT (TIPS)

A

· used to alleviate ascites that does not respond to diuretics; a nonsurgical procedure in which a tract (shunt) between the systemic and portal venous systems is created to redirect portal blood flow.

34
Q

ascites

A

accumulation of fluid in the peritoneal cavity

35
Q

treatment for ascites

A

diuretics (spironolactone, furosemide, triamterene) and paracentesis
o Limit sodium

36
Q

procedure for ascites

A

paracentesis

37
Q

paracentesis

A

needle into the abdomen to pull fluid off

38
Q

what should the patient do before a paracentesis

A

void

39
Q

what color should the fluid be from a paracentesis

A

pale yellow

40
Q

post care paracentesis

A

§ Patient voids immediately before
§ High Fowler’s position or sitting on side of bed
§ Monitor for hypovolemia and electrolyte imbalances
§ Monitor BP and heart rate
§ Monitor dressing for bleeding/leakage

41
Q

peripheral edema

A

occurs as in the lower extremities and presacral area

42
Q

treatment for peripheral edema

A

exogenous albumin

43
Q

esophageal varicies

A

dilates and tortuous veins in the submucosa of the esophagus that are fragile, thin-walled distended esophageal veins that become irritated and rupture

44
Q

what should you avoid with esophageal varicies

A

alcohol, aspirin, NSAIDs

45
Q

how to screen for esophageal varices

A

endoscopy

46
Q

if bleeding occurs with esohageal varicies what should be done

A

stabilize patient, manage airway, prive IV therapy and blood products
-band ligation
-sclerotherapy
-balloon tamponade

47
Q

band ligation

A

placement of a small rubber band (elastic O-ring) around the base of the varix (enlarged vein)

48
Q

sclerotherapy

A

involves injection of a sclerosing solution into the swollen veins through an injection needle that is placed through the endoscope

49
Q

balloon tamponade

A

mechanical compression of varices

50
Q

SAFETY ALERT for balloon tamponade

A

· Label each lumen to avoid confusion.
· Secure the tube to prevent movement of the tube which could result in occlusion of the airway.
· Deflate balloons for 5 minutes every 8 to 12 hours per institutional policy to prevent tissue necrosis.

51
Q

Portal systemic encephalopathy

A

end-stage hepatic failure characterized by altered level of consciousness, neuro symptoms, impaired thinking

52
Q

jaundice

A

occurs because liver is unable to metabolize bilirubin

53
Q

hepatorenal syndrome

A

progressive renal failure associated with hepatic failure
· Characterized by a sudden decreased in UO, elevated BUN and CRE

54
Q

treatment for hepatorenal syndrome

A

liver transplant

55
Q

care for cirrosis

A

o Rest
o Administration of b-complex vitamins
o Avoid alcohol
o Minimize/avoid aspirin, acetaminophen, and NSAIDs
o Diet for patient without complications
- High in calories (3000 cal/day)
- ↑ Carbohydrate
- Moderate to low fat
- Protein supplements for protein-calorie malnutrition
- Low-sodium diet for patient with ascites and edema
- Seasonings to make food more palatable

56
Q

liver cancer treatment

A

CHEMOTHERAPY
o Triple pronged approach
-Immunosuppressive therapy
o Corticosteroids, Cyclosporine/tacrolimus, Azathiprine, Hepatitis-antiviral therapy

NSG 430 - Critical Care (42 decks)

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