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NUR 213 > Unit 2 exam > Flashcards

Unit 2 exam Flashcards

1
Q

Conditions that would put someone at risk for ARDS

A
  • sepsis
  • FVO
  • Shock
  • trauma,
  • neurological injuries
  • burns
  • DIC
  • Drug/alcohol abuse
  • aspiration
  • inhalation of toxic substances
  • PNA
  • Severe trauma
  • Massive transfusions
  • Cigarette smoking
  • Cardiopulmonary bypass
  • Pneumonectomy
  • PE
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2
Q

List clinical manifestations for ARDS

A
  • Tachypnea: earliest sign, can begin from 1-96hr after initial insult
  • Dyspnea
  • Decreased breath sounds
  • Deteriorating ABG
  • Refractory Hypoxemia
  • Decreased pulmonary compliance
  • Pulmonary infiltrates
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3
Q

Earliest sign of ARDS

A

Tachypnea

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4
Q

The following are S/S of what?

-Absent or markly decreased breath sounds
-Cyanosis
Decreased chest expansion unilaterally
-Dyspnea
-Hypotension
-Sharp chest pain
-Subcutaneous
-emphysema AEB crepitus on palpation
-Sucking sound with open chest wound
-Tachycardia
-Tachypnea

A

Pneumothorax

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5
Q

Complications of ARDS

A
  • Barotrauma
  • Renal failure
  • MODS
  • VAP
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6
Q

All of the following are S/S of what?

Fever
Leukocytosis
Increased respiratory effort
Prulent secretions
Sputum cultures will show infection

A

VAP

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7
Q

How to prevent barotrauma

A

Careful application of tidal volume and PEEP to prevent

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8
Q

How to prevent VAP

A

Regular mouth care
Suctioning
Change vent circuit per hospital protocol
Use sterile water for humidification

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9
Q

Acute onset of less than 7 days, refractory hypoxemia, and bilat infiltrates ruling out cardiac pulmonary edema as a cause. Classified by severity with PaO2/FIO2 Ratio. Three phases: Exudative, proliferative, and fibrotic. Can be caused by sepsis, FVO, shock, trauma, neurological injuries, burns, DIC, drug use, aspiration, and inhalation of toxic substances

A

ARDS

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10
Q

Positioning/activity for a vented patient

A
  • Prone
  • Elevate HOB
  • Q2 turn
  • ROM exercises
  • “Good lung down”
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11
Q

Nursing interventions for infection prevention for a vented patient

A
  • Handwashing
  • Monitoring/care of central lines
  • Foley cath care
  • Mouth care
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12
Q

Central line care

A
  • Maintenance of strict sterile technique on insertion is key to infection prevention
  • Routine monitoring for redness or drainage at the insertion site
    dressing changes per hospital protocol
  • IV tubing changes per hospital protocol
  • evaluation of the continued need
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13
Q

Mouth care for a vented patient

A

mouth care every 2 hours. Use chlorhexidine

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14
Q

Expected VS for a patient with ARDS

A

tachycardia, tachypnea, hypotension, hypoxemia

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15
Q

How often should a neuro assesment be done on a patient with ARDS

A

At least every 1-2 hrs

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16
Q

Expected lung sounds for a patient with ARDS Initially

A

Crackles

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17
Q

As ARDS progresses what kind of lung sounds can you expect?

A

diminished

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18
Q

An early sign of poor tissue perfusion

A

Decreased urine OP

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19
Q

Expected initial ABG for a patient with ARDS

A

Respiratory alkalosis

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20
Q

Expected ABG for a patient with ARDS as it progresses

A

Respiratory acidosis

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21
Q

If treatment for ARDS is not working and condition continues to worsen what does the ABG look like?

A

Metabolic acidosis

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22
Q

What does the CHXR of a patient with ARDS look like?

A
  • Ground glass
  • Snow
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23
Q

Why does a patient with ARDS have to have their ECG monitored?

A

Hypoxemia can lead to dysrythmias

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24
Q

List causes of a high pressure alarm on a mechanical ventilator

A
  • Mucous plug or increased seretions
  • Patient biting ETT
  • Pneumothorax
  • Pt anxious and fighting the vent
  • Kink in the tubing
  • Water collecting in vent tubing
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25
Q

If a patient on a vent has a mucus plug or increased secretions what needs to be done to correct it

A

Suction is needed

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26
Q

You have a patient on a vent: the high-pressure alarm goes off, you notice their chest has an a symmetrical rise, and decreased breath sounds on the right side. What do you suspect? What should you do ASAP?

A

Pneumothorax
call the MD

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27
Q

You have a vented patient who is axious and fighting the ventilator. What should be done?

A

Assess pt, provide emotional support, and reevaluate sedation/analgesic as needed

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28
Q

If you notice water accumulating in your patients vent tubing what should you do?

A

Empty water from ventilator tubing

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29
Q

Causes of low presure alarms on a ventilator

A
  • Cuff leak
  • Leak in the ventilator circut
  • Patient stops breathing in the pressure support modes or SIMV
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30
Q

What needs to be done if you suspect a cuff leak on a vented patient

A

Assess of cuff leak, check cuff pressure, and call for respiratory, call MD

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31
Q

You suspect a leak in the ventilator circut. What should you do?

A

Assess all connections and tubing

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32
Q

Acute onset of less than 7 days, refractory hypoxemia, and bilat infiltrates ruling out cardiac pulmonary edema as a cause. Classified by severity with PaO2/FIO2 Ratio.

A

ARDS

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33
Q

What phase of ARDS is this?

Occurs within 24-48 hrs after injury. Fluid moved from capillaries to interstitial space to alveoli. Protein moves from vascular space. All leads to pulmonary edema which causes V/Q mismatch

A

Exudative

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34
Q

The following are S/S of what phase of ARDS

  • Hyperventilation
  • Tachycardia
  • CHXR: Bilat infiltrates or pulmonary edema
  • V/Q Mismatch
  • Respiratory Alkalosis
A

Exudative

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35
Q

List S/S of the exudative phase of ARDS

A

Hyperventilation
Tachycardia
CHXR: Bilat infiltrates or pulmonary edema
V/Q Mismatch
Respiratory Alkalosis

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36
Q

What phase of ARDS is this?

V/Q Mismatch worsens>pulmonary HTN occurs>R-sided heart failure>Fibrotic changes occur in lungs which cause lungs to become “stiff” and “noncompliant” which increases work of breathing

A

Proliferative

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37
Q

The following are all S/S of what phase of ARDS?

  • Hypercarbia
  • Refractory Hypoxiemia
  • Lung Compliance deteriorates
  • If pt is vented inspiratory pressures rise d/t decreased lung compliance which requires more pressure
  • Increasing PaCO2
A

Proliferative

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38
Q

List S/S of proliferative phase of ARDS

A
  • Hypercarbia
  • Refractory Hypoxiemia
  • Lung Compliance deteriorates
  • If pt is vented inspiratory pressures rise d/t decreased lung compliance which requires more pressure
  • Increasing PaCO2
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39
Q

What phase of ARDS is this?

Fibrosis and scarring severely impair gas exchange and lung compliance. Pulmonary HTN worsens, R-sided heart failure worsens Decreased L-sided heart pre-load

A

Fibrotic

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40
Q

The following are S/S of what phase of ARDS

  • Hypotension
  • Decreased cardiac output
  • Severe V/Q Mismatch
  • Diffusion defects
  • Intrapulmonary shunting
  • Refractory hypoxemia
  • Tissue hypoxemia
  • Lactic acidosis
A

Fibrotic

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41
Q

List S/S of the fibrotic phase of ARDS

A
  • Hypotension
  • Decreased cardiac output
  • Severe V/Q Mismatch
  • Diffusion defects
  • Intrapulmonary shunting
  • Refractory hypoxemia
  • Tissue hypoxemia
  • Lactic acidosis
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42
Q

To maximumize patient comfort during mechanical ventilation; Respiratory effort and patient–ventilator synchrony must be optimized to avoid barotrauma. What can be done to acheive this for a patiet with ARDS?

A

Administer paralytic agents, analgesics, and sedative medications as ordered

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43
Q

Medications used to augment cardiac output for an ARDS pt

A

Inotropic agents

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44
Q

What kinds of medications may be necessary to support blood pressure in a patient with ARDS?

A

Vasoactive

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45
Q

Why are abx used in the treatment of ARDS patients?

A

They treat the cause of ARDS so that it can resolve

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46
Q

________ allows for better oxygenation and alveolar recruitment by having the “good” side down. This increases the recruitment of collapsed posterior alveolar units and reduces the V/Q mismatch via gravity as blood flow is directed to the better-aerated anterior portion of the lungs.

A

Proning

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47
Q

__________ allows for better lung expansion and reduces the risk of aspiration.

A

Elevating HOB

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48
Q

Positioning methods for a patient with ARDS

A
  • Prone position
  • Elevate HOB
  • Frequent position changes
  • ROM exercises
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49
Q

______________ are necessary in the sedated or medically paralyzed bed-bound patient to preserve limb functioning and decrease contracture

A

Range-of-motion (ROM) exercises

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50
Q

The number one nursing intervention for infection prevention

A

Hand washing

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51
Q

____________ are a significant source of infection. Maintenance of strict sterile technique on insertion is key to infection prevention. Routine monitoring for redness or drainage at the insertion site, dressing changes per hospital protocol, tubing changes per hospital protocol, and evaluation of the continued need.

A

Monitoring and care of central IV lines:

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52
Q

____________ Increased risk for iatrogenic infections such as urinary tract infection requires routine care and evaluation of necessity of continued use

A

Foley catheter care

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53
Q

Infection prevention measures for patiets with ARDS

A
  • Hand washing
  • Foley cath care
  • Monitoring and care of central IV lines
  • Diligent mouth care
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54
Q

This may develop secondary to changes in pressure in the chest cavity and is associated with positive-pressure modalities of mechanical ventilation. Because the delivered breaths are “pushed” into the lungs via positive-pressure ventilations, the pressure in the chest cavity increases

A

Hypotension

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55
Q

How to treat a patient who is on a vent and has hypotension

three things

A
  • Fluids ordered by the HCP to correct the hypotension
  • ventilator settings need to be adjusted.
  • Sedatives or opioids need to be adjusted
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56
Q

What complication associated with mechanical ventilation is this?

potential complication because the normal defenses of the upper and lower respiratory systems are bypassed. The ETT or the tracheostomy tube can become a direct source to the lungs because both increase the risk of introduction

A

Infection

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57
Q

This occurs d/t the increased positive pressure applied to the lungs, which can cause alveolar rupture. Overdistention of the alveoli can lead to an excessive amount of air entering into the pleural space, causing a tension pneumothorax

A

Barotrauma

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58
Q

____________ of gastric secretions and pulmonary secretions is a potential complication because the natural defense of the epiglottis is bypassed when an artificial airway is in place

A

aspiration

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59
Q

a serious healthcare-associated infection resulting in high morbidity, high mortality, and high costs of treatment. Aspiration of oropharyngeal or gastric fluids is presumed to be an essential step in the development of this, and it typically develops 48 hrs or more after endotracheal intubation

A

Ventilatior-associated pnemonia
or
VAP

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60
Q

How to prevent aspiration

A

Elevate HOB 30 degrees

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61
Q

How to prevent a VAP

A
  1. minimizing sedation, including daily spontaneous breathing trials (SBTs) for patients without contraindications.
  2. facilitating early exercise and mobilization.
  3. using ETTs w/ secretion drainage ports for patients requiring greater than 48 to 72 hrs of intubation.
  4. elevating the HOB 30 to 45 degrees.
  5. changing the ventilator circuit only when visibly soiled or malfunctioning
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62
Q

Reduces the risk of aspiration and clears the airways of secretions for a vented patient

A

Clear airway secretions with suctioning, CPT, frequent position changes, and increasing activity

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63
Q

Medications that reduce gastric acidity have been shown to protect patients from developing peptic ulcer disease and gastrointestinal bleeding in a vented patient

A

Peptic ulcer disease prophylaxis

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64
Q

What is a “sedation vacation”

A

Done daily. Holding sedation to determine pt’s potential for readiness to wean from vent

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65
Q

The following are S/S of what?

  • malnutrition
  • 10% loss of body mass
  • reduced respiratory muscle strength
A

Inadequate nutrition

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66
Q

How long after mechanical ventilation should enteral or parenteral feedings be initiated?

A

48-72 hrs

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67
Q

Prefered method of enteral feedings for vented patients?

A

NG Tube

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68
Q

To prevent aspiration, when a patient is recieving enteral feedings what should be done?

A

Elevate HOB 30 degrees
Turn off feedings when supine

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69
Q

Complication associated with parenteral nutrition

A

Infection at IV site

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70
Q

What will happen if hydration for a vented patient is inadequate?

A
  • Decreased CV output & BP Decreased
  • decreased perfusion to organs
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71
Q

If an ARDS patient is given too much fluid what will happen?

A

ARDS will worsen

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72
Q

Causes of ARDS

A
  • Sepsis
  • FVO
  • Shock
  • Trauma
  • Neuro injuries
  • Burns
  • DIC
  • Drug use
  • Aspiration
  • Inhalation of toxic substances
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73
Q

The following are S/S of what?

  • Abd pain
  • Irritability
  • Pruritus
  • Malaise/fatigue
  • Fever
  • n/V
  • Jaundice
  • Elevated liver enzymes
  • Decreased appetite/anorexia

General

A

Hepatitis

74
Q

 INFLAMMATION OF THE LIVER THAT IMPAIRS THE ABILITY TO DETOXIFY SUBSTANCES,PRODUCE PROTEINS AND CLOTTING FACTORS, STORE VITAMINS , FATS AND SUGARS.

A

Hepatitis

75
Q

List S/S of hepatitis

general

A
  • Abd pain
  • Irritability
  • Pruritus
  • Malaise/fatigue
  • Fever
  • n/V
  • Jaundice
  • Elevated liver enzymes
  • Decreased appetite/anorexia
76
Q

Dark amber urine, clay colored stools, and jaundice is caused by what?

A

Increased Bili

77
Q

HEPATITIS

What does it stand for

A

 HANDWASHING STRICT
 EAT A LOW FAT & HIGH CARBS
 PERSONAL HYGIENE PRODUCTS NOT SHARED
 ACTIVITY CONSERVATION (REST)
 TOXIC SUBSTANCES AVOIDED
 INDIVIDUAL BATHROOM
 Testing results
 Interferon (sub q)
 Small but frequent meals

78
Q

Medications that increase the risk for hepatitis

A
  • Statins
  • Anabolic steroid
  • Azathioprine
  • Methotrexate
  • Isoniazid
  • Valproic acid
  • Tetracyclines
  • Phenytoin
  • Acetaminophen
79
Q

Toxic substances that increase the risk of hepatitis

A
  • Industrial chemicals
  • Carbon tetrachloride
  • Phosphorus
  • Mushrooms
80
Q

How long should someone with hepatitis abstain from sex?

A

Until they are negative for antibodies

81
Q

Risk factors for Hepatitis

A

Autoimmune disorders
Alcoholism
Contaminated food, water
Infected blood
Sexual contact with body fluids

82
Q

Complications of hepatitis

A

Chronic hepatitis
Cirrhosis
Liver Cancer
Liver failure

83
Q

Nursing dx for Hepatitis

A
  • Activity intolerance
  • Acute pain
  • Altered nutrition
  • Altered thought process
  • Knowledge deficit
84
Q

Most common form of hepatitis in children

A

Hepatitis A

85
Q

Which kinds of hepatitis have a vaccine

A

A &B

86
Q

How and when is the Hepatitis B vaccine given

A

series of three injections:
1. at birth before leaving hospital
2. at least 4 weeks after 1st injection
3. at least 8 weeks after 2nd injection but no earlier than 24 weeks of age and at least 16 weeks after initial dose

87
Q

Contraindications to the hep B vaccine

A

Do not give to preemies
Do not give if previous allergic reaction to Hep B injection

88
Q

How and when is the Hepatitis A vaccine given

A

series of 2 injections:
1. at 12-15 months initial dose
2. at 18-33 months or 6-18 months after initial dose.

89
Q

What kind of diet does a child with hepatitis need to follow

A

Low-fat, well-balanced diet

90
Q

After changing a childs diaper with hepatitis what needs to be done?

A

Disinfect diaper changing surfaces thoroughly with bleach solution

91
Q

How long should enteric precautions be utilized with a hepatitis patients?

A

at least 1 week after jaundice appears

92
Q

When caring for a patient with hepatitis, when would you notify the provider

A

neurological status change, bleeding occurs, or fluid retention

93
Q

Medications used to treat Hep B

A
  • tenofovir, entecavir, lamivudine, telbivudine. All oral agents are given once a day for 1 year or longer.
  • IMs = interferon - alpha several times a week ( 6-12 months), pegyalted interferon weekly Inj ( 6-12m )
94
Q

Medication used to treat Hep C

A
  • pegylated interferons ribavirin, peginterferon with ribavirin, interferon with ribavirin.
  • Interferon therapy last 12-8 months, ribavirin therapy last 48 weeks
  • Harvoni ( sofosbuvir + ledipasvir )= polymerase inhibitor 8-12 weeks of ttmt.
95
Q

Oral medications used to treat Hep B, how long are they taken?

A

tenofovir, entecavir, lamivudine, telbivudine
Given once a day for one year

96
Q

IM medications used to treat Hep B and how long they are given

A
  • interferon - alpha several times a week ( 6-12 months)
  • pegyalted interferon weekly Inj ( 6-12m )
97
Q

What kind of hepatitis is a polymerase inhibitor given and for how long?

A

Hep C, 8-12 wks

98
Q

To treat Hep C how long is interferon therapy and ribavirin therapy?

A

Interferon: 12-8 months
Ribavirin: 48 wks

99
Q

What kind of diet should someone with hepatitis follow

A

high carb, high calorie, moderate fat and moderate protein diet, small - frequent meals.

100
Q

How to promote hepatic rest and regeneration of tissue

A

◦ Avoid alcohol
◦ Limit physical activity

101
Q

Expected labs in a patient with hepatitis

A
  • AST / ALT will be elevated
  • Bilirubin will be elevated
  • Ammonia will be elevated
102
Q

What type of hepatitis is this?

  • Acute only
  • Transmission: fecal oral-food and water
  • dx with +IgM & IgG
  • treated with supportive therapy and rest
  • Has a vaccine
A

Hep A

103
Q

What type of hepatitis is this?

  • Acute & chronic
  • Transmission: Body fluids - Birth, sex, childbirth, IV drug use, blood
  • Dx: +HBsAG & Anti-HB
  • Treatment: Acute-supportive therapy & rest chronic-Antivirals
  • Has a vaccine
A

Hep B

104
Q

What type of Hepatitis is this?

  • Acute & Chronic
  • Transmission: Body fluids - IV drug use
  • Dx: +Anti-HCV
  • Treatment: antivirals, liver transplant
  • No vaccine
A

Hep C

105
Q

What type of hepatitis is this?

  • Acute & Chronic
  • Transmission: only occurs if pt has hep B
  • Dx: +HDAg & Anti-HDV
  • Treatment: Antivirals & Interferon
  • No vaccine
A

Hep D

106
Q

What type of hepatitis is this?

  • Acute only
  • Transmission: Fecal & oral - Food & water (uncooked meats, 3rd world countries)
  • Dx: Anti-HEV
  • Treatment: Support therapy & rest
  • No vaccine
A

Hep E

107
Q

Medications used to treat hepatitis

A
  • Antivirals
  • Pegylated interferon injections
  • Immunizations
  • Antiemetics
108
Q

How to definitively diagnose NAFLD

A

Liver biopsy

109
Q

S/S of liver transplant rejection
when do they occur?

A

RUQ pain, fever, tachycardia , changes in bile, jaundice
4-10 days

110
Q

How to treat & reduce the reisk of rejection after a liver transplant

A

Immunosupressive therapy

111
Q

Pre-op for a liver biopsy

A

 Explain the procedure
 Witness informed consent
 Ensure client fasts starting at midnight
 Administer medications as prescribed

112
Q

Post op for a liver biopsy

A

Post op  Assist the client to a r sided lying position and maintain for federal hrs  Monitor vital signs  Assess for abd pain / bleeding from site / manifestations of pneumothorax * Pneumothorax s/s – dyspnea, cyanosis, restlessness.  Sometimes with 5-10 lbs sandbag over the biopsy site to prevent further bleeding  A change in the patient’s level of consciousness or a decrease in blood pressure and increase in heart rate after a liver biopsy may indicate severe bleeding associated with the procedure, and the nurse should immediately notify the healthcare provider.

113
Q

If a patient is at an increased risk for bleeding what should be done post liver biopsy

A

5-10 lbs sandbag over the biopsy site to prevent further bleeding

114
Q

What S/S would cause the nurse to call the MD immediately after a liver biopsy and why?

A

change in the patient’s level of consciousness or a decrease in blood pressure and increase in heart rate after a liver biopsy may indicate severe bleeding associated with the procedure, and the nurse should immediately notify the healthcare provider.

115
Q

S/S of Cirrhosis

A

 SHOB
 Jaundice
 Increased abd girth
 Abd pain and bloating
 Enlarged spleen
 Elevated liver enzymes
 Increased risk of bleeding
 Thrombocytopenia
 Prolonged pt
 Hemorrhoids
 Elevated ammonia levels
 Change in LOC
 Changes in motor function
 Hyponatremia
 Asterixis

116
Q

List S/S of Cirrhosis

A

 SHOB
 Jaundice
 Increased abd girth
 Abd pain and bloating
 Enlarged spleen
 Elevated liver enzymes
 Increased risk of bleeding
 Thrombocytopenia
 Prolonged pt
 Hemorrhoids
 Elevated ammonia levels
 Change in LOC
 Changes in motor function
 Hyponatremia
 Asterixis

117
Q

alcoholic cirrhosis, chronic hep B & C infections

A

Laënnec’s cirrhosis

118
Q

caused by chronic biliary obstruction or autoimmune disorder

A

Biliary cirrhosis

119
Q

caused by viral hepatitis (medications or toxins)

A
  • Post necrotic cirrhosis
120
Q

Tmnt for ascites in cirrhosis patients

A

2g/day Na restriction and administration of diuretics such as spironolactone and furosemide.

121
Q

Tmnt for ascites in ESRD patients

A

paracentesis (invasive procedure to remove fluid)-Monitor closely for hypotension

122
Q

Portal HTN can cause what?

A
  • Esophageal varicies
  • enlarged spleen
  • hemmorids
123
Q

Tmnt for esophageal varices

A
  • Sclerotherapy
  • sengstaken – blakemore tube (if uncontrolled)
  • Endoscopic banding
124
Q

procedure used to shrink veins

A

sclerotherapy

125
Q

procedure in which a tube is inserted through GI tract through nose to provide compression and traction in the esophagus

A

sengstaken – blakemore tube

126
Q

How is portal HTN treated?

A

Symptom managment
Beta blockers

127
Q

ecchymosis

A

bruising

128
Q

epistaxis

A

nosebleed

129
Q

S/S of bleeding

A

ecchymosis, epistaxis, and petechia

130
Q

How to treat coagulopathies

A

admin vitamin K, blood products, FFP, folic acid PRN
Implement bleeding precautions

131
Q

The following are S/S of what?

  • Impaired mentation
  • decreased LOC
  • confusion
  • somnolence
  • changes in motor function
  • restlessness
  • seizures
  • insomnia
A

Hepatic encephalopathy

132
Q

How to treat hepatic encephalopathy

A
  • avoid protein overload, decrease bacterial production of ammonia, correcting fluid and electrolyte imbalance.
    o Small frequent meals to prevent protein overload
    o Neomycin and lactulose to prevent production of ammonia.
    o Neomycin and lactulose cause diarrhea which alters fluid and electrolytes. To correct this pt will receive vitamins A,B Complex, C, and K, as well as folic acid
133
Q

How to treat hepatorenal syndrome

A

Liver transplant

134
Q

The following are S/S of what?

  • Fever
  • ABD pain
  • encephalopathy
  • acute hemodynamic decompensation
A

Spontaneous bacterial peritonitis

135
Q

How to diagnose spontaneous bacterial peritonitis

A

diagnostic paracentesis and culture of ascitic fluid. Culture is usually positive for E.coli, strep, or klebsiella pneumonia

136
Q

How to treat spontaneous bacterial peritonitis

A

short course of antibiotics, some patients are treated for prolonged periods of time

137
Q

What stage of encephalopathy is this?

slurred speech, tremors, lethargy, asterixis , impaired handwriting

A

Stage 1

138
Q

what stage of encephalopathy is this?

confusion, difficult to awake, increased tendon reflexes, rigid extremities

A

stage 3

139
Q

what stage of encephalopathy is this?

drowsiness, disorientation, mood swings, asterixis, fever hepaticus

A

stage 2

140
Q

What stage of encephalopathy is this?

coma, non responsive to painful stimuli

A

Stage 4

141
Q

Expected respiratory assessment for a pt is cirrhosis/liver failure

A

deceased breath sounds and increased RR can indicate pulmonary fluid overload

142
Q

Expected vital sigsn for a cirrhosis/liver failure pt’s

A

bp may be elevated d/t FVO

143
Q

Nursing interventions/actions for Cirrhosis/liver failure

A

 Administer diuretics
 Administer electrolyte replacement such as potassium
 Administer magnesium/ phosphate as needed
 Restrict protein/ sodium/fluid intake
 Elevate HOB and legs to helps respiratory status and prevent ascites
 Administer blood products and fresh frozen plasma as ordered
 Promote rest periods between activities.

144
Q

Complications related to cirrhosis

A
  • Ascites
  • Portal HTN
  • Esophageal varicies
  • Coagulopathies
  • Hepatic encephalopathy
  • Hyponatreamia
  • Hepatorenal syndrome
  • Spontaneous bacterial peritonitis
145
Q

patient teaching for cirrhosis

A

 Abstain from alcohol
 Consult with provider prior to taking any OTC or herbal supplements
 Follow diet guidelines
 Educate about medications metabolized by the liver (Tylenol)
 Seek routine care – monitor labs and progression of disease
 Minimize the risk of bleeding (bleeding precautions)

146
Q

Dietary guidelines for cirrhosis/liver failure patients

A

o High calorie , moderate fat
o Low sodium , low protein
o Small frequent meals
o Nutritional supplements drinks or shakes and daily multivitamin
o Fluid intake restrictions if blood sodium is low

147
Q

Dx testing for cirrhosis
Used to Determine if there are abnormalities in the liver

A

CT

148
Q

Dx testing for Cirrhosis/Liver failure
Endoscope used to visualize the GI tract from the esophagus to the duodenum to evaluate for esophageal varices or bleeding

A

EGD

149
Q

Dx testing for cirrhosis/liver failure
combines endoscopy and fluoroscopy to dx, treat, causes of obstruction in biliary tree

A

ERCP

150
Q

Dx testing for cirrhosis/liver failure
contrast is injected into bile duct of liver to visualize the biliary tract and identify obstruction

A

Percutaneous transhepatic cholangiography

151
Q

Lab tests for cirrhosis

A

o Liver enzymes ( AST, ALT, ALP)-elevated
o Albumin-decreased
o Ptt, PT/inr -prolonged
o Platelets-decreased
o Bilirubin-elevated
o Ammonia-elevated

152
Q

Is reversible , pancreatic enzymes given to aid in digestion of a fats and proteins taken with meals

A

Acute Pancreatitis

153
Q

The following are S/S of what?

 LUQ EPIGASTRIC PAIN
 ABD FULLNESS (GAS, BLOATING )
 HICCUPS, INDIGESTION
 FEVER
 TACHYCardia
 Hypotension
 Elevated serum lipase, amylase, and glucose values
 Hypocalcemia
 Steatorrhea, clay-colored stools
 Hypovolemia
 Hypoxia
 Pleural effusion
 Clinical manifestations of Adult Respiratory Distress Syndrome (ARDS)
 Multiple organ dysfunction

A

Acute pancreatitis

154
Q

The following are S/S of what?

 Upper abd pain that spreads to back
 Pain worse after overeating or ETOH consumption
 Weight loss/anorexia
 Pale or gray colored stools
 Steatorrhea
 Pain increasing with ETOH consumption and over eating
 N|V|D
 Constipation
 Flatulence
 Elevated amylase, lipase, serum bili, alkaline phosphatase, and blood glucose

A

Chronic pancreatitis

155
Q

S/S of pancreatic cancer

A

 Pain
 Jaundice
 Anorexia
 Fatigue
 Weight loss
 Vague non-specific epigastric pain

156
Q

Expected abd assessment for a patient with pancreatitis

A

rebound tenderness, muscle guarding, or rigid abdominal muscles.

157
Q

bruising noted on the flank due to leaking of exudate stained with blood into the flank area

A

Bulletblue Turner’s sign

158
Q

bruising around the umbilicus. Bruising in these areas indicates hemorrhage, severe inflammation, and tissue damage.

A

Cullen’s sign

159
Q

hand spasms with inflation of the blood pressure cuff 20 mm Hg above the patient’s systolic blood pressure (SBP) for 3 to 5 minutes.
Presence indicates hypocalcemia

A

Trousseau sign

160
Q

facial twitching. Tapping the skin over the facial nerve anterior to the external auditory meatus produces ipsilateral contraction of the facial muscles occurs.

A

Chvostek sign
presence inndicates hypocalcemia

161
Q

If the heart, lungs, or kidneys are involved in acute pancreatits what needs to be done and why?

A

Patient needs to be managed in the ICU d/t the risk for hypovolemic shock, pulmonary compromise, renal failure, and GI bleeding

162
Q

Positioning for a patient with acute pancreatitis

A

Semi-fowler or fetal position to decrease secretion and pain

163
Q

Expected vitals for a patient with acute pancreatitis

A

Fever
Tachycardia
Hypoxia

164
Q

Expected labs for acute pancreatitis patients

A
  • Lipase, bili, glucose, ALT, AST, WBC, and amylase-elevated
  • Calcium, albumin-decreased
165
Q

Vital signs that are considered abnormal for Acute pancreatitis, what does it indicates and what needs to be done?

A
  • Hypotension & Tachycardia
  • Indicates elevated third-spacing volume
  • IV fluid resuscitation is required
166
Q

IV abx are give to patients with acute pancreatitis to treat what?

A

necrotizing pancreatitis

167
Q

How to dx necrotizing pancreatitis

A

CT shows air and gas surrounding the pancreas

168
Q

If NG tube is indicated for any type of panceratitis what is the suction set to?

A

Low intmt suction

169
Q

Irreversible!! Not given pancreatic enzymes

A

Chronic pancreatitis

170
Q

Expected vitals for a patient with chronic pancreatitis

A
  • Tachycardia
  • Tachypnea
  • Hypertension
171
Q

Expected labs for a patient with chronic pancreatitis

A
  • Glucose, amylasem lipase, bili, and alkaline phosphate-elevated
172
Q

Nursing actions/interventions for chronic pancreatitis

A

 Administer pancreatic enzymes
 Provide GI prophylaxis-Histamine blockers, PPI’s
 Provide rest and a calm environment
 Implement pain relief-administer opioids initially then non-opioids when pain is less intense
 Collaborate with dietitian to ensure adequate nutrition-low fat diet
 Teach to limit fat in diet, avoid alcohol, do not chew pancreatic enzymes, avoid irritating foods (coffee & caffeine, refer to AA

173
Q

Nursing actions/interventions for pancreatic cancer

A
  • Provide IV fluids
  • NGT low intmt suction
  • Never manipulate NGT
  • Administer insulin, analgesics, and antiemetics as ordered
  • Encourage incentive spirometer, cough and deep braething
  • Offer nutritional suppluments
174
Q

Treatment for acute Pancreatitis

A
  • OPOID ANALGESICS
  • ANTICHOLINERGICS
  • HISTAMINE BLOCKERS
  • PPI’S
  • PANCREATIC ENZYMES
  • ANTIBIOTIC THERAPY
  • ENCOURAGE DEEP BREATH COUGH
  • NPO
  • IV FLUIDS
  • ICU LEVEL OF CARE IF OTHER ORGANS ARE INVOLVED
  • TREAT CAUSE OF PANCREATITIS
175
Q

Treatment for chronic pancreatitis

A
  • PAIN MANAGEMENT
  • IVF
  • ELECTROLYTE MANAGEMENT
  • NUTRITIONAL SUPPORT
  • INSULIN THERAPY
  • PANCREATIC ENZYME REPLACEMENT THERAPY (PERT)
176
Q

Treatment for pancreatic cancer

A

 Megestrol acetate or megace can be given as an appetite stimulant
 CHEMOTHERAPY
 RADIATION
 SURGICAL

177
Q

HEAD OF THE PANCREAS , DUODENUM , GALLBLADDER , AND BILE DUCT ARE REMOVED

A

Whipple

178
Q

If a patient stops breathing in pressure support mode or SIMV what needs to be done?

A

Assess patient, notify healthcare provider

179
Q

Type 1 ARF

A

Hypoxemic; PaO2 <60mmHg

180
Q

Type 2 ARF

A

Hypercapnic PaCO2 >50 mmHg

181
Q
A

NUR 213 (29 decks)

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