test 3 Flashcards
functions of the liver
-metabolizes carbs, fats proteins, steroids
-storage
-detoxification
-production and excretion of bile
-blood glucose regulation
which 3 hepatitis can develop into a chronic form
B,C,D
what hepatitis have vaccine
A,B,D
C and E dont
autoimmune hepatitis
chronic disorder caused by autoimmunity that leads to liver damage.
more common in females
autoimmune hepatitis signs and symptoms
loss of appetite, RUQ pain, abdominal bloating, spider angiomas
autoimmune hepatitis diagnostics and care
labs-ANA , antiDNA antibodies
Meds- prednisone, innueron- active form
If not responding:
cyclosporine, methotrexate, tacrolimus
chemically induced liver disease
liver metabolizes alcohol, drugs and environmental toxins
alcohol is most common toxin
chemically induced liver disease- alcohol s/s
enlarged liver
jaundice
increase in liver enzyme
ascites
Improves when patient stops drinking
chemically induced liver disease- drug induced
jaundice
increased liver enzyme
could lead to acute liver failure
most common drug- tylenol
what causes pruritus in liver patients
jaundice in skin
acute hepatitis manifestations
anorexia
N/V
RUQ pain
BM changes
decreased taste/smell
malaise
fever
arthralgia
pruritus
jaundice
tea colored urine
light stools- lack of bilirubin excreted
hepatomegaly with tenderness
splenomegaly
weight loss
viral replication phase- hepatitis
asymptomatic, only seen in lab levels
prodromal phase- hepatitis
usually diagnosed with a GI virus due to symptoms
acute phase- hepatits
1-4 months
malaise, anorexia, N/V, fatigue, abdominal pain
may be icteric or anti-icteric
icteric
having jaundice
convalescent phase- hepatitis
begins as jaundice fades (if they have it)
takes a average of 2-4 months
starts getting better- has malaise and fatigue, liver still enlarged but spleen subsides
most common hepatitis under age 5
B
Epculsa
new med for chronic hep C
98% cure rate so far
pill taken once daily for 12 weeks
hepatitis complications
acute liver failure
chronic hepatitis
hepatocellular carcinoma
cirrhosis
necrosis of liver
what percent of chronic hep patients develop liver cirrhosis
25%
hepatits diagnosis
physical exam-Look for hepatic tenderness /hepatomegaly, splenomegaly
Hepatitis A/B surface antigen test (HAsAg/HBsAg)- a positive confirms
HCV antibody test
biopsy- usually for chronic
LFT tests that look assess the severity of diseases
albumin
prothrombin time (PT)
What does bilirubin total conjungated test look at
can diagnose jaundice and looks at severity
what can alkaline phosphate test diagnose
diagnosis of obstructive jaundice
AST/ALT liver function test
measures the amount of aspartate and alanine transaminase in blood
a increase can help diagnose early
chronic Hep B meds
pegyloated interferon (injection weekly)
nucleotide analogs (epivir)
we want to decrease viral load and slow progression
chronic hep C meds
pegyloated interferon
ribavirin
epculsa
care for hepatits
avoid substances
small frequent meals (due to loss of appetite)
symptom management- zofran for nausea
rest
monitor LFT
prevent scratching
give sedations cautiously!! - usually they are metabolized by the liver
non alcoholic fatty liver disease (NAFLD)
Spectrum of liver diseases- fatty liver, NASH (fat, inflammation and scarring), and cirrhosis
build up of fatty infiltration in the hepatocytes
NO DEFINITE TREATMENT- treat risk factors
NASH
type of NAFLD
varying degrees of inflammation and fibrosis
risk factors of NAFLD
obesity, severe weight loss, diabetes, hyperlipidemia
hepatic cirrhosis
Chronic inflammation leading to Cell necrosis resulting in cirrhosis and fibrosis
more common in men
most common cause is chronic hep C and alcohol induced liver disease
can also be from obesity, malnutrition, genetics, primary biliary cirrhosis
cirrhosis patho steps 1-5
1- cells attempt to regenerate
2- abnormal blood vessel and bile duct placement
*3- overgrowth of new/fibrous connective tissue
4- lobules of irregular size and shape with impeded blood flow
5- results in poor cellular nutrition and poor blood flow causing decreased liver function
early vs late signs and symptoms of cirrhosis
early- fatigue! N/V, indigestion, anorexia, rashes, fever, anemia
later- jaundice, peripheral edema, ascites
eventually will lead to total body involvement- endocrine issues, skin lesions, neuropathies, hematologic disorders, dietary deficiencies
cirrhosis complications
portal hypertension
esophageal and gastric varicies
ascites
hepatic encephalopathy- change in mental status
hepatorenal syndrome
decompensated cirrhosis is having one of these symptoms
compensated is without any
ascites
Abnormal accumulation of serous fluid in peritoneal cavity
limit Na and protein
diuretics
paracentesis
TIPS procedure
peritoneovenous stunt
this issue will keep coming back until liver issue is corrected
portal hypertension
obstruction of normal blood-flow- veins may protrude
s/s- increase venous pressure, splenomegaly, ascites, gastric and esophageal varicies
hepatic encephalopathy
ammonia circulates instead of getting excreted
s/s- confusion, delirium, convulsions, coma, asterexis- hand flapping, fetor hepaticus - musty smell
treated by lactulose- makes patients move BM
neomycin- Decrease bacterial flora of gut and decreases ammonia formation
pt needs protein restriction
goal- reduce ammonia formation
grade I-IV hepatic encephalopathy
I- Shortened attention span
II- lethargy with slight disorientation
III- somnolence (excess sleepiness) with gross disorientation
IV- coma
hepato-renal syndrome
cirrhosis of liver causes renal constriction, but no structural abnormalities of kidney
look at BUN and creatine
s/s- oliguria, intractable ascites, azotemia (elevated BUN)
only treatment is liver transplant
esophageal varices
result of portal hypertension. distention of esophageal blood vessels
s/s if they rupture- hematemesis, hematochezia (blood in stool), melana (black tarry stool)
diagnostics and care for esophageal varices
goal- prevent the bleed. teach no to alcohol, NSAID
monitor BP, HR, do endoscopy, NG tube to decompress abdomen, IV fluids, balloon tamponade if bleed cant get under control
treatment- antacids, PPI,, histamine antagonist, cytoprotective agent (carafate- increase mucosa protection), beta blockers
restrict Na and fluids
small frequent meals
antiemetics if needed
diuretics if needed to decrease BP
daily weights
active bleed meds for esophageal varices
octreotide- decreases blood flow and acid secretion
vasopressin- constricts splanchnic artery
nitro- reduces SE of vasopressein
beta blockers- decrease amount of pressure in veins by lowering BP
Blood products if needed
liver failure
severe impairment of liver function associated with hepatic encephalopathy
caused by drugs (tylenol, NSAID, sulfa drugs) and hepatitis
s/s- jaundice, coagulation abnormalities, encephalopathy, change in mental satus
2 onsets of liver failure
Fulminant- Rapid- usually pt. is healthy then develops s/s rapidly and gets encephalopathy in 8 weeks
Sub fulminant- less healthy patients, take 8-26 weeks for encephalopathy
liver failure diagnostics and care
diagnosed by serum bilirubin, pt, liver enzymes, drug screening, viral serologies, CT/MRI
Treatment- liver transplant
seizure precautions bc of high ammonia, avoid sedatives, monitor I&O and renal function.
ICU may be needed depending on severity
oral cancer risk factors
tobbaco
alcohol
sun
HPV
most common in african american men
where are most oral malignancies
lower lip (due to chew)
oral cancer manifestations
indurated painless ulcer, slurred speech, dysphagia, leukoplakia, erythroplakia, lump/thickening of cheek, hyperkeratosis, difficulty chewing
oral cancer diagnostics and treatment
diagnosed by biopsy, MRI, PET, CT
Toluidine blue- blue dye that’s put on lesion. If lesion uptakes and turns blue cancer is indicated
Treatment- surgery, chemo, paliative care, G tube, lifestyle changes
esophageal cancer
adenocarcinoma and squamous cell
uncommon
usually occurs in mid - lower part of esophagus
esophageal cancer risk factors
GERD
Barrett’s esophagus
obesity
esophageal cancer manifestations and diagnostics
feels like “food isn’t passing”, dysphagia, pain
diagnosed by barium swallow, endoscopic ultrasound or biopsy
esophageal cancer nursing care
focus on pain relief, nutrition and quality of life
treated by surgery, endoscopic therapy, radiation, chemo, targeted therapy
esophagectomy- Aspiration precautions, monitor breathing.
Keep HOB elevated
Use incentive spirometer.
Slowly move to solid foods- patients must stay sitting up for 2 hours after eating
acute abdominal pain diagnostics and treatment
diagnostic-
H&P
pain description
CBC
UA
EKG - due to electrolyte changes
pregnant test
abdominal xray
treated by fixing cause
GI infection care
IV fluid
pain meds, abx, antiemetics
monitor vitals for sepsis
NG tube to decompress the abdomen
parenteral nutrition via PICC
NPO
Gastritis
inflammation of the gastric mucosa
most common stomach issue
GI infection manifestation
pain, distention, fever, N/V, loss of appetite, diarrhea, low urine output, thirst, inability to pass gas, fatigue
gastritis risk factors
drugs- NSAIDs
diet
microorganism- H pylori
environment- smoke
conditions
acute gastritis symptoms
abdominal discomfort
headache
lassitude (loss of energy)
N/V
hiccups
chronic gastritis s/s
epigastric discomfort
anorexia
heartburn
belching
sour taste in the mouth
N/V
intolerance of some foods
vitamin B12 deficiency
gastritis diagnostics and treatment
diagnostics- history, endoscopy, CBC, stool, biopsy
treatment- eliminate the cause, supportive measures, NG tube, H2 receptor blockers (zantac), PPI, abx
GI bleed
can occur in upper or lower GI
2 types- obvious, occult
3 types of severity- capillary, venous, arterial
worst type of GI bleed
arterial
what is considered a massive GI bleed
1500 mL or 25% of volume
causes of GI bleed
drug induced
esophagus
stomach and duodenum
systemic disease
GI bleed diagnostic and nursing care
diagnosis- endoscopy!! CBC, Guiac, type and cross, ABG, liver enzymes, BUN, PT/PTT
treated by identifying and treating cause. Give fluids, blood, o2, have foley in (assess kidneys), NG tube, 2 IVs (fluid and blood).
surgery done if massive bleed
check vitals q15 min
PPI
Vasopressin
octreotide
epinephrine
appendicitis
inflammation of appendix
most common in age 10-30
most common emergency abdominal surgery
appendicitis S/S
RLQ pain
N/V
low grade fever
rebound tenderness at mcburneys point
RUPTURED- paralytic illeus, diffuse pain, abdominal distention
appendicitis diagnostics and care
diagnosed by CT scan! also do H&P
keep pt NPO
abx and immediate surgery if not ruptured
if ruptured - abx for at least 6 hours before surgery
what not to give if have appendicitis
enema and laxative
perironitis
inflammatory process of peritoneum
2 causes-
primary- infection starts there
secondary- infection comes from else where, like from peritoneal dialysis (most common)
perironitis manifestations
abdominal pain
rebound tenderness
muscular rigidity
spasms
distention
N/V
fever
tachypnea/tachycardia
RDS (resp distress syndrome- infection in lymphatic system)
sepsis
paralytic ileus
hypovolemic shock
peritonitis dx and tx
H&P, CBC- WBC, electrolytes, abdominal x-ray, CT scan, paracentesis
tx- abx, NG tube, analgesics, IVF, surgery
intestinal obstruction
contents can not pass thru GI tracts
can be partial or complete, simple or strangulated (no blood flow)
2 causes:
mechanical- detachable occlusion
non-mechanical- neuromuscular or vascular disorder
most common is small bowel obstruction
types of intestinal obstructoin
Hernia- outpouching. Intestines come through abdominal wall but then get stuck
Adhesions- can happen after surgery
Intrasuspesion- intestine telescopes inside its self
Volvulus- twisting- strangulation more likely
intestinal obstruction s/s
depends on location
colicky abdominal pain
N/V
distention
constipation/decreased flatus (later sign)
foul smelling vomit
intestinal obstruction dx and tx
diagnosed by assessment, H&P, colonscopy/sigmoidoscopy, CT, abdominal xray
if strangulated- emergency surgery
NPO, NG, IV fluids sometimes with KCL, analgesic’s
Eat low residue diet after surgery, no ruffage
how much of small intestine can be removed without issue
50%
Short bowel syndrome
small intestine t=not long enough to absorb nutrients
s/s- diarrhea, bloating, heartburn, fatigue
Med- gattex (helps patient absorb nutrients better)
Equestrian- powder mixed with a drink that will slow down diarrhea
Eat high carb low fat
Eat 6 small meals
supplements
stomach/colon cancer risk factors
most commonly caused by adenocarcinomas.
more common in med, native americans, hispanic americans, and african americans
RF- diet of smoked meats and pickled veggies
chronic inflammation of stomach
H pylori infection
percinious anemia
smoking
achlorhydria (little to no gastric acid)
stomach/colon cancer s/s
dyspepsia
early satiety
weight loss
abdominal pain
loss or decrease in appetite
bloating after meals
N/V
rectal bleeding
bowel change habits
stomach/colon cancer dx and tx
dx by CEA above 2.5 (not definite), biopsy, endoscopy
tx - surgical removal, chemo
acute pancreatitis
acute inflammation of pancreas
most common in middle ages, african americans
biggest causes - alcohol (men), Gall stones (women)
manifestations of acute pancreatitis
pain worse right after eating, and with movement
pain that radiates to back
jaundice
N/V
fever/sweats
steatorrhea
decreased bowel sounds
acute pancreatitis complications
pseudocyst
abscess
pulmonary symptoms if infection gets into lymphatic system
acute pancreatitis dx and tx
elevated amylase and lipase
glucose
ERCP
abd ultrasound
liver enzymes
NPO, pain meds, albumin, IV calcium gluconate, LR, PPI, insulin, abx
NG tube
relieve pain, prevent shock, reduce pancreatic secretions, correct fluid and electrolytes, prevent/treat infections
chronic pancreatitis
upper abdominal pain, weight loss, indigestion, steatorrhea
need lifestyle change
fix the problem
pancrelipase
pancreatic cancer risk factors
chronic panc.
smoking
family hx
blacks
chemicals
pancreatic cancer manifestation
abdominal pain, anorexia jaundice, nausea
pancreatic cancer dx and tx
ultrasound, CT, ERCP, MRI, tumor markers
surgery
whipple -head of pancreas- common bile duct, part of stomach, duodneal, proximal pancreas
distal pancreatomy- tail of pancreas
insulin
pancreatic enzyme suppelment
radiation, chemo
palliative care
prognosis not great
chloelithiasis
stones in gall blader
factors - infection, cholesterol disturbance, female (hormones), obesity
symtoms vary from none to severe
pain worse 3-6 hours after meal
chloelithiasis stones
pigment- bile
cholesterol- bile with cholesterol
chloecystitis
inflammation of gall bladder
s/s- pain RUQ, jaundice, N/V, fat intolerance, feeling of fulness, abdominal distention
chloecystitis and chloelithiasis dx and tx
dx by ultrasound, ERCP, ALT/AST, WBC, bilirubin, stool evaluation
lithotripsy
cholecystectomy
drugs- ursodiol and chenodiexychloric acid
gall bladder cancer
caused by adenocarinoma
could be asymptomatic, or haves/s- pain RUQ, jaundice, N/V, fat intolerance, feeling of fulness, abdominal distention
diagnosed by ultrasound, CT, MRI
TX- surgical removal, stents, chemo, radiation
what causes UTI
E coli (bacteria)- most common
fungal or parasitic infections
upper UTI
renal parenchyma, pelvis, ureters, and everything below like bladder
lower bladder
confined to bladder and urethra
complicated UTI
resistant, upper UTI, recurring, pregnant woman, foley Cath patient, someone that has coexisting problems
uncomplicated UTI
only involves the bladder and has nothing else going on
What can we try before cathing a patient
ambulation
bathrooom schedule
running water
purewick/condom cath
bladder scan
types of health care associated UTI
catheter associated (CAUTI)
E coli
pseudomonas
UTI manifestations
lower- pain, burning, frequency, nocturia, incontinence, suprapubic, hematuria (early sign), changes in urine pattern
upper- flank pain, fever, chills, asymptomatic
flank pain assessment
CVA
diagnostics and care for UTI
UA, C&S, clean catch, CT
antibiotics, antifungal (whatever drug is needed)
Urinary anagesic- pyridium - turns urine orange
uncomplicated abx for UTI
1-3 DAYS
cephalosporin- ex amoxiciillin
complicated abx for UTI
7-14 days
fluroquinolones
prevention of UTI
Hydration, wipe from front-back, avoid bubble bath, urinate after sex
positive for nitrates in dipstick
E coli is the cause of UTI
pyelonphritis
inflammation of renal parenchyma and collecting system
most common cause is bacteria
begins with lower UTI
manifestations of pyelonephritis
fatigue
fever
chills
vomiting due to pain
malaise
flank pain
lower UTI s/s
CVA tenderness
diagnostics for pyelonephritis
CVA tenderness, UA, c&s, CBC-WBC, blood cultures, radiologic imaging if chronic
when would a patient be hospitalized with pyelonephritis
dehydration, confused, noncompliant, sepsis
care for pyelonephritis
abx for 2-3 weeks
if relapse- abx for 6 weeks
NSAIDs
observe for urosepsis
symptoms will improve within 72 hours but abx care must continue
minimum amount of urine/hr
30 ml
acute kidney injury
increase in BUN/Creatine, decrease in UO
the degree varies
most common after hypotension, hypovolemia or nephrotoxic agent exposure
reversible if can find cause but is fetal
prerenal acute kidney injury
from severe drop in BP to kidneys
intrarenal acute kidney injury
from damage to kidney
postrenal acute kidney injury
from obstruction of urine flow
manifestations of acute kidney injury
low UO
metabolic acidosis due to kidneys not filtrating
decreased Na due to dilution
increased K bc not excreted
hematologic disorders
Elevated BUN/creatine
nuero changes bc toxins
edema/ascites
pulmonary edema/SOB
4 phases of AKI
onset
oliguric- when dialysis may be needed
diuretic- occurs when AKI is corrected
recovery- GFR becomes more normal
AKI diagnostics and care
UA, serum, kidney ultrasound, MRI
TREAT THE CAUSE
fluid restriction of 600mL and previous 24hr loss
restrict protein, Na, K, P
Dialysis if needed
meds to lower K
K axelate - binds to K and causes pt. to move bowels
insulin
why are AKI patients on a fluid restriction if they have little UO
Bc they have a hard time excreting
glomerlonphritis
inflammation of glomeruli
tubular, insterstial, and vascular changes
can be acute or chronic
risk factors for glomerulonephritis
infection- strep, hepatits
immune diseases- lupus
vasculitis
anything that causes scarring of glomeruli
acute glomerulonephritis
sudden- such as after throat infection
kidney stop working unless treated
facial puffiness, hematuria, low UO, SOB, HTN
DX by UA and biopsy
chronic glomerulonephritis
repeated episodes from glomerular damage - such as from lupus
s/s- asymptomatic for years then renal insufficiency/failure
dx by UA, proteinuria, BUN/Creatine, mental status change, MRI
glomerulonephritis care
symptom relief
rest
fluid and Na restrict
diuretics
protein restricted in elevated BUN
antiHTN
abx if from strep
renal calculi
kidney stones
aka nephrolithiasis
common in whites
reoccurs 50% of time
risk factors- dehydrated, high protein diet, metabolic-gout, genetics
manifestation of renal calculi
severe pain
renal colic
dysuria
foul smelling urine
hematuria
urgency/frequency
fever/chills
renal calculi dx and care
CT, KUB, IVP, UA, ultrasound
assess the cause
hydration
opioids
abx
tamulosin/terazosin- gets flow going
remove stones
nephrotic syndrome
damage to the glomerular capillaries from massive inflammation triggered by the immune system.
proteinuria causes low plasma albumin and edema
causes/risk factors of nephrotic syndrome
primary glomerular disease
multisystem disease
infections
neoplasms
allergens
drugs
Risk factors- glomerunophritis, lupus, DM, kidney infections, renal cancer
manifestations of nephrotic syndrome
peripheral edema, ascites, facial edema
proteinuria
frothy urine
HTN
hyperlipidemia
hypoalbuminemia
decreased serum albumin and protein, elevated cholesterol
blood clots
renal failure
care of nephrotic syndrome
fix cause provide symptom relief
low Na
low protein
strict I&O, daily weights
abdominal girth
small frequent meals
drugs- corticosteroids, diuretcis, statins
renal cell carinoma
cancerous lesion of kidney
treated by partial or radical nephrectomy, freezing/ablation
bladder cancer
risk factor- smoking
treated by TURB, partial or radical cystectomy, intravesical chemo-med goes straight to bladder, or radiation
transurethral resection of bladder tumor (TURBT)
scraped cancer away from superficial bladder wall
may cause bleeding, burning and changes in stream after procedure
radical cystectomy in men vs women
both will have a urinary stoma after
men- removes entire bladder, prostate, seminal vesicles
women- removes bladder, uterus, ovaries, and part of the vagina
complications- UTI, blood clots, blockages
ileal conduit
Harvests a portion of bowel, sanitize it, connects the ureter to it then creates a stoma
neobladder reconstruction
Larger portion of small bowel that is sanitized, then made into a neobladder, then connects to the urethra. Will be as close to a new bladder for them, but doesn’t have the typical feeling of bladder so should be put on a bladder plan on when to go
