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Adult health 2 > test 3 > Flashcards

test 3 Flashcards

1
Q

functions of the liver

A

-metabolizes carbs, fats proteins, steroids
-storage
-detoxification
-production and excretion of bile
-blood glucose regulation

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2
Q

which 3 hepatitis can develop into a chronic form

A

B,C,D

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3
Q

what hepatitis have vaccine

A

A,B,D

C and E dont

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4
Q

autoimmune hepatitis

A

chronic disorder caused by autoimmunity that leads to liver damage.

more common in females

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5
Q

autoimmune hepatitis signs and symptoms

A

loss of appetite, RUQ pain, abdominal bloating, spider angiomas

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6
Q

autoimmune hepatitis diagnostics and care

A

labs-ANA , antiDNA antibodies

Meds- prednisone, innueron- active form

If not responding:
cyclosporine, methotrexate, tacrolimus

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7
Q

chemically induced liver disease

A

liver metabolizes alcohol, drugs and environmental toxins

alcohol is most common toxin

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8
Q

chemically induced liver disease- alcohol s/s

A

enlarged liver
jaundice
increase in liver enzyme
ascites

Improves when patient stops drinking

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9
Q

chemically induced liver disease- drug induced

A

jaundice
increased liver enzyme

could lead to acute liver failure

most common drug- tylenol

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10
Q

what causes pruritus in liver patients

A

jaundice in skin

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11
Q

acute hepatitis manifestations

A

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

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12
Q

viral replication phase- hepatitis

A

asymptomatic, only seen in lab levels

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13
Q

prodromal phase- hepatitis

A

usually diagnosed with a GI virus due to symptoms

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14
Q

acute phase- hepatits

A

1-4 months
malaise, anorexia, N/V, fatigue, abdominal pain
may be icteric or anti-icteric

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15
Q

icteric

A

having jaundice

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16
Q

convalescent phase- hepatitis

A

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

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17
Q

most common hepatitis under age 5

A

B

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18
Q

Epculsa

A

new med for chronic hep C
98% cure rate so far

pill taken once daily for 12 weeks

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19
Q

hepatitis complications

A

acute liver failure
chronic hepatitis
hepatocellular carcinoma
cirrhosis
necrosis of liver

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20
Q

what percent of chronic hep patients develop liver cirrhosis

A

25%

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21
Q

hepatits diagnosis

A

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

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22
Q

LFT tests that look assess the severity of diseases

A

albumin
prothrombin time (PT)

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23
Q

What does bilirubin total conjungated test look at

A

can diagnose jaundice and looks at severity

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24
Q

what can alkaline phosphate test diagnose

A

diagnosis of obstructive jaundice

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25
Q

AST/ALT liver function test

A

measures the amount of aspartate and alanine transaminase in blood

a increase can help diagnose early

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26
Q

chronic Hep B meds

A

pegyloated interferon (injection weekly)
nucleotide analogs (epivir)

we want to decrease viral load and slow progression

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27
Q

chronic hep C meds

A

pegyloated interferon
ribavirin
epculsa

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28
Q

care for hepatits

A

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

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29
Q

non alcoholic fatty liver disease (NAFLD)

A

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

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30
Q

NASH

A

type of NAFLD

varying degrees of inflammation and fibrosis

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31
Q

risk factors of NAFLD

A

obesity, severe weight loss, diabetes, hyperlipidemia

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32
Q

hepatic cirrhosis

A

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

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33
Q

cirrhosis patho steps 1-5

A

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

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34
Q

early vs late signs and symptoms of cirrhosis

A

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

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35
Q

cirrhosis complications

A

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

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36
Q

ascites

A

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

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37
Q

portal hypertension

A

obstruction of normal blood-flow- veins may protrude

s/s- increase venous pressure, splenomegaly, ascites, gastric and esophageal varicies

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38
Q

hepatic encephalopathy

A

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

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39
Q

grade I-IV hepatic encephalopathy

A

I- Shortened attention span
II- lethargy with slight disorientation
III- somnolence (excess sleepiness) with gross disorientation
IV- coma

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40
Q

hepato-renal syndrome

A

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

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41
Q

esophageal varices

A

result of portal hypertension. distention of esophageal blood vessels

s/s if they rupture- hematemesis, hematochezia (blood in stool), melana (black tarry stool)

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42
Q

diagnostics and care for esophageal varices

A

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

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43
Q

active bleed meds for esophageal varices

A

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

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44
Q

liver failure

A

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

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45
Q

2 onsets of liver failure

A

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

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46
Q

liver failure diagnostics and care

A

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

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47
Q

oral cancer risk factors

A

tobbaco
alcohol
sun
HPV

most common in african american men

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48
Q

where are most oral malignancies

A

lower lip (due to chew)

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49
Q

oral cancer manifestations

A

indurated painless ulcer, slurred speech, dysphagia, leukoplakia, erythroplakia, lump/thickening of cheek, hyperkeratosis, difficulty chewing

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50
Q

oral cancer diagnostics and treatment

A

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

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51
Q

esophageal cancer

A

adenocarcinoma and squamous cell

uncommon
usually occurs in mid - lower part of esophagus

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52
Q

esophageal cancer risk factors

A

GERD
Barrett’s esophagus
obesity

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53
Q

esophageal cancer manifestations and diagnostics

A

feels like “food isn’t passing”, dysphagia, pain

diagnosed by barium swallow, endoscopic ultrasound or biopsy

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54
Q

esophageal cancer nursing care

A

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

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54
Q

acute abdominal pain diagnostics and treatment

A

diagnostic-
H&P
pain description
CBC
UA
EKG - due to electrolyte changes
pregnant test
abdominal xray

treated by fixing cause

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54
Q

GI infection care

A

IV fluid
pain meds, abx, antiemetics
monitor vitals for sepsis
NG tube to decompress the abdomen
parenteral nutrition via PICC
NPO

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54
Q

Gastritis

A

inflammation of the gastric mucosa

most common stomach issue

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55
Q

GI infection manifestation

A

pain, distention, fever, N/V, loss of appetite, diarrhea, low urine output, thirst, inability to pass gas, fatigue

55
Q

gastritis risk factors

A

drugs- NSAIDs
diet
microorganism- H pylori
environment- smoke
conditions

56
Q

acute gastritis symptoms

A

abdominal discomfort
headache
lassitude (loss of energy)
N/V
hiccups

57
Q

chronic gastritis s/s

A

epigastric discomfort
anorexia
heartburn
belching
sour taste in the mouth
N/V
intolerance of some foods
vitamin B12 deficiency

58
Q

gastritis diagnostics and treatment

A

diagnostics- history, endoscopy, CBC, stool, biopsy

treatment- eliminate the cause, supportive measures, NG tube, H2 receptor blockers (zantac), PPI, abx

59
Q

GI bleed

A

can occur in upper or lower GI

2 types- obvious, occult

3 types of severity- capillary, venous, arterial

60
Q

worst type of GI bleed

A

arterial

61
Q

what is considered a massive GI bleed

A

1500 mL or 25% of volume

62
Q

causes of GI bleed

A

drug induced
esophagus
stomach and duodenum
systemic disease

63
Q

GI bleed diagnostic and nursing care

A

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

64
Q

appendicitis

A

inflammation of appendix
most common in age 10-30

most common emergency abdominal surgery

65
Q

appendicitis S/S

A

RLQ pain
N/V
low grade fever
rebound tenderness at mcburneys point

RUPTURED- paralytic illeus, diffuse pain, abdominal distention

66
Q

appendicitis diagnostics and care

A

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

67
Q

what not to give if have appendicitis

A

enema and laxative

67
Q

perironitis

A

inflammatory process of peritoneum

2 causes-
primary- infection starts there
secondary- infection comes from else where, like from peritoneal dialysis (most common)

68
Q

perironitis manifestations

A

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

69
Q

peritonitis dx and tx

A

H&P, CBC- WBC, electrolytes, abdominal x-ray, CT scan, paracentesis

tx- abx, NG tube, analgesics, IVF, surgery

70
Q

intestinal obstruction

A

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

71
Q

types of intestinal obstructoin

A

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

72
Q

intestinal obstruction s/s

A

depends on location
colicky abdominal pain
N/V
distention
constipation/decreased flatus (later sign)
foul smelling vomit

73
Q

intestinal obstruction dx and tx

A

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

74
Q

how much of small intestine can be removed without issue

A

50%

75
Q

Short bowel syndrome

A

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

76
Q

stomach/colon cancer risk factors

A

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)

77
Q

stomach/colon cancer s/s

A

dyspepsia
early satiety
weight loss
abdominal pain
loss or decrease in appetite
bloating after meals
N/V
rectal bleeding
bowel change habits

78
Q

stomach/colon cancer dx and tx

A

dx by CEA above 2.5 (not definite), biopsy, endoscopy

tx - surgical removal, chemo

79
Q

acute pancreatitis

A

acute inflammation of pancreas
most common in middle ages, african americans

biggest causes - alcohol (men), Gall stones (women)

80
Q

manifestations of acute pancreatitis

A

pain worse right after eating, and with movement
pain that radiates to back
jaundice
N/V
fever/sweats
steatorrhea
decreased bowel sounds

81
Q

acute pancreatitis complications

A

pseudocyst
abscess
pulmonary symptoms if infection gets into lymphatic system

82
Q

acute pancreatitis dx and tx

A

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

83
Q

chronic pancreatitis

A

upper abdominal pain, weight loss, indigestion, steatorrhea

need lifestyle change
fix the problem
pancrelipase

84
Q

pancreatic cancer risk factors

A

chronic panc.
smoking
family hx
blacks
chemicals

85
Q

pancreatic cancer manifestation

A

abdominal pain, anorexia jaundice, nausea

86
Q

pancreatic cancer dx and tx

A

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

87
Q

chloelithiasis

A

stones in gall blader

factors - infection, cholesterol disturbance, female (hormones), obesity

symtoms vary from none to severe

pain worse 3-6 hours after meal

88
Q

chloelithiasis stones

A

pigment- bile

cholesterol- bile with cholesterol

89
Q

chloecystitis

A

inflammation of gall bladder

s/s- pain RUQ, jaundice, N/V, fat intolerance, feeling of fulness, abdominal distention

90
Q

chloecystitis and chloelithiasis dx and tx

A

dx by ultrasound, ERCP, ALT/AST, WBC, bilirubin, stool evaluation

lithotripsy
cholecystectomy
drugs- ursodiol and chenodiexychloric acid

91
Q

gall bladder cancer

A

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

92
Q

what causes UTI

A

E coli (bacteria)- most common
fungal or parasitic infections

93
Q

upper UTI

A

renal parenchyma, pelvis, ureters, and everything below like bladder

94
Q

lower bladder

A

confined to bladder and urethra

95
Q

complicated UTI

A

resistant, upper UTI, recurring, pregnant woman, foley Cath patient, someone that has coexisting problems

96
Q

uncomplicated UTI

A

only involves the bladder and has nothing else going on

97
Q

What can we try before cathing a patient

A

ambulation
bathrooom schedule
running water
purewick/condom cath
bladder scan

98
Q

types of health care associated UTI

A

catheter associated (CAUTI)
E coli
pseudomonas

99
Q

UTI manifestations

A

lower- pain, burning, frequency, nocturia, incontinence, suprapubic, hematuria (early sign), changes in urine pattern

upper- flank pain, fever, chills, asymptomatic

100
Q

flank pain assessment

A

CVA

101
Q

diagnostics and care for UTI

A

UA, C&S, clean catch, CT

antibiotics, antifungal (whatever drug is needed)

Urinary anagesic- pyridium - turns urine orange

102
Q

uncomplicated abx for UTI

A

1-3 DAYS
cephalosporin- ex amoxiciillin

103
Q

complicated abx for UTI

A

7-14 days
fluroquinolones

104
Q

prevention of UTI

A

Hydration, wipe from front-back, avoid bubble bath, urinate after sex

105
Q

positive for nitrates in dipstick

A

E coli is the cause of UTI

106
Q

pyelonphritis

A

inflammation of renal parenchyma and collecting system
most common cause is bacteria

begins with lower UTI

107
Q

manifestations of pyelonephritis

A

fatigue
fever
chills
vomiting due to pain
malaise
flank pain
lower UTI s/s
CVA tenderness

108
Q

diagnostics for pyelonephritis

A

CVA tenderness, UA, c&s, CBC-WBC, blood cultures, radiologic imaging if chronic

109
Q

when would a patient be hospitalized with pyelonephritis

A

dehydration, confused, noncompliant, sepsis

110
Q

care for pyelonephritis

A

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

111
Q

minimum amount of urine/hr

A

30 ml

112
Q

acute kidney injury

A

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

113
Q

prerenal acute kidney injury

A

from severe drop in BP to kidneys

114
Q

intrarenal acute kidney injury

A

from damage to kidney

115
Q

postrenal acute kidney injury

A

from obstruction of urine flow

116
Q

manifestations of acute kidney injury

A

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

117
Q

4 phases of AKI

A

onset
oliguric- when dialysis may be needed
diuretic- occurs when AKI is corrected
recovery- GFR becomes more normal

118
Q

AKI diagnostics and care

A

UA, serum, kidney ultrasound, MRI

TREAT THE CAUSE
fluid restriction of 600mL and previous 24hr loss
restrict protein, Na, K, P
Dialysis if needed

119
Q

meds to lower K

A

K axelate - binds to K and causes pt. to move bowels

insulin

120
Q

why are AKI patients on a fluid restriction if they have little UO

A

Bc they have a hard time excreting

121
Q

glomerlonphritis

A

inflammation of glomeruli

tubular, insterstial, and vascular changes

can be acute or chronic

122
Q

risk factors for glomerulonephritis

A

infection- strep, hepatits
immune diseases- lupus
vasculitis
anything that causes scarring of glomeruli

123
Q

acute glomerulonephritis

A

sudden- such as after throat infection
kidney stop working unless treated

facial puffiness, hematuria, low UO, SOB, HTN

DX by UA and biopsy

124
Q

chronic glomerulonephritis

A

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

125
Q

glomerulonephritis care

A

symptom relief
rest
fluid and Na restrict
diuretics
protein restricted in elevated BUN
antiHTN
abx if from strep

126
Q

renal calculi

A

kidney stones
aka nephrolithiasis

common in whites
reoccurs 50% of time

risk factors- dehydrated, high protein diet, metabolic-gout, genetics

127
Q

manifestation of renal calculi

A

severe pain
renal colic
dysuria
foul smelling urine
hematuria
urgency/frequency
fever/chills

128
Q

renal calculi dx and care

A

CT, KUB, IVP, UA, ultrasound

assess the cause
hydration
opioids
abx
tamulosin/terazosin- gets flow going
remove stones

129
Q

nephrotic syndrome

A

damage to the glomerular capillaries from massive inflammation triggered by the immune system.

proteinuria causes low plasma albumin and edema

130
Q

causes/risk factors of nephrotic syndrome

A

primary glomerular disease
multisystem disease
infections
neoplasms
allergens
drugs

Risk factors- glomerunophritis, lupus, DM, kidney infections, renal cancer

131
Q

manifestations of nephrotic syndrome

A

peripheral edema, ascites, facial edema
proteinuria
frothy urine
HTN
hyperlipidemia
hypoalbuminemia
decreased serum albumin and protein, elevated cholesterol
blood clots
renal failure

132
Q

care of nephrotic syndrome

A

fix cause provide symptom relief
low Na
low protein
strict I&O, daily weights
abdominal girth
small frequent meals

drugs- corticosteroids, diuretcis, statins

133
Q

renal cell carinoma

A

cancerous lesion of kidney

treated by partial or radical nephrectomy, freezing/ablation

134
Q

bladder cancer

A

risk factor- smoking

treated by TURB, partial or radical cystectomy, intravesical chemo-med goes straight to bladder, or radiation

135
Q

transurethral resection of bladder tumor (TURBT)

A

scraped cancer away from superficial bladder wall

may cause bleeding, burning and changes in stream after procedure

136
Q

radical cystectomy in men vs women

A

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

137
Q

ileal conduit

A

Harvests a portion of bowel, sanitize it, connects the ureter to it then creates a stoma

138
Q

neobladder reconstruction

A

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

Adult health 2 (4 decks)

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