Week 1: Endocrine, Hepatobiliary, Pancreas Flashcards
hyperpituitarism AKA ___________
acromegaly
hyperpituitarism AKA acromegaly - hypersecretion of:
growth hormone GH
hyperpituitarism AKA acromegaly
etiology:
congential, tumor
hyperpituitarism AKA acromegaly S&S:
& diagnostic test
acromegaly
large, thick _________, _________
_______________ syndrome
sleep apnea
_________ impairment
HTN
_________ disturbances
hyperglycemia
___________ cancer
Dx: ______________
acromegaly
large, thick hands and feet
carpal tunnel syndrome
sleep apnea
speech impairment
HTN
visual disturbances
hyperglycemia
colorecral cancer
Dx: OGTT [ingest 75g glucose]
hyperpituitarism AKA acromegaly nursing management
hypophysectomy [preferred surgical tx- removes pituitary gland]
Octreotide (sandostatin) [3x week subq; reduces GH]
Hypopituitarism - hyposecretion of
Pituitary hormones
Hypopituitarism etiology
____________
____________
____________
____________
congenital
infection
tumor
autoimmune
Hypopituitarism S&S
decreased ____________ [adults]
___________ [kids]
low ___________ [all]
decrease muscle & bone [adults]
dwarfism [kids]
low gonadotropins [all]
Hypopituitarism nursing management
hormone replacement therapy [lifelong]
surgery [if tumor]
SIADH is
syndrome inapporpriate antidiuretic hormone
syndrome inapporpriate antidiuretic hormone AKA SIADH is hypersecretion of
ADH
syndrome inapporpriate antidiuretic hormone AKA SIADH etiology
Diagnostic test?
__________
______ problems
medications
Dx: _____ urine specific gravity
_____ serum sodium
_____ serum osmolarity
cancers
CNS problems
medications
Dx: high urine specific gravity
low serum sodium
low serum osmolarity
syndrome inapporpriate antidiuretic hormone AKA SIADH S&S
______
________
weight _______
_____________ S&S
HTN
decreased ______ output
thirst
fatigue
weight gain
hyponatermia S&S
HTN
decreased urine output
syndrome inapporpriate antidiuretic hormone AKA SIADH RN management
VS
labs
I&O
restrict ________
assess _______ status
Meds: Demeclocycline, Tolvaptan, Conivapta, 3% NaCl
VS
labs
I&O
restrict fluids
assess neuro status
Meds: Demeclocycline, Tolvaptan, Conivapta, 3% NaCl
Diabetes Inspidus (DI)
hyposecretion of
ADH
Diabetes Inspidus (DI) etiology
conditions that ______________
tumor
removal of ______________
conditions that increase ICP
tumor
removal of pituitary gland
Diabetes Inspidus (DI) S&S
Diagnostic
_____________
____________
dehydration
hypotension
___________
confusion & lethargy (hypernatremia)
Dx: urine specific gravity _____
serum sodium _____
polyuria
polydipsia
dehydration
hypotension
tachycardia
confusion & lethargy (hypernatremia)
Dx: urine specific gravity low
serum sodium high
Diabetes Inspidus (DI) RN management
Vitals
I&O
Urine specific gravity
____________ acetate DDAVP
provide _______
assess neuro and cardiac status
Dextrose 5% in water
Vitals
I&O
Urine specific gravity
Desmopressin acetate DDAVP
provide fluids
assess neuro and cardiac status
Dextrose 5% in water
Hyperthyroidism AKA __________________
Grave’s Disease
Hyperthyroidism AKA Grave’s Disease
Etiology
Grave’s disease
_______ infection
Thyroiditis
Excessive ________
adenomas
Grave’s disease
viral infection
Thyroiditis
Excessive iodine
adenomas
Hyperthyroidism AKA Grave’s Disease
S&S
weight ______
_______ intolerance
HTN
____________ & palpitations
exophthalmos
diarrhea
diaphoresis
________ skin
fine tremors
irritability
mood swings
goiter
weight loss
heat intolerance
HTN
Tachycardia & palpitations
exophthalmos
diarrhea
diaphoresis
smooth skin
fine tremors
irritability
mood swings
goiter
Hyperthyroidism AKA Grave’s Disease
Nursing management
provide _____
quiet environment
inderal
high ________ diet
tylenol
Propyltiouracil/Tapazole
Avoid _________ rich food
manage diarrhea
_____ care
Thyroidectomy
provide rest
quiet environment
inderal
high cal/protein diet
tylenol
Propyltiouracil/Tapazole
Avoid iodine rich food
manage diarrhea
eye care
Thyroidectomy
Hyperthyroidism AKA Grave’s Disease
Thyroid storm
Extreme HTN
Tachy
Agitation
gever
Tx- PTU, Tapazole, Inderal, Tylenol
Hypothyroidism
Hyposecretion of
thyroid hormones
Hypothyroidism etiology
_________ deficiency
Hashimoto’s disease
Atrophy
radiation
thyroidectomy
aging
tumors
Amiodarone
iodine deficiency
Hashimoto’s disease
Atrophy
radiation
thyroidectomy
aging
tumors
Amiodarone
Hypothyroidism S&S
lethargy
__________
weakness
forgetfulness
paresthesia
weight _______
_______ intolerance
constipation
_____ hair and skin
___________ around eyes and face
bradycardia
MI
lethargy
fatigue
weakness
forgetfulness
paresthesia
weight gain
cold intolerance
constipation
dry hair and skin
puffiness around eyes and face
bradycardia
MI
Hypothyroidism
nursing management
VS
low____________ diet
manage constipation
warm environment
__________ replacement (synthroid)
Myxedema- hypothermia, hypotension, hypoventilation
VS
low cal, low cholestrol, low fat diet
manage constipation
warm environment
thyroid replacement (synthroid)
Myxedema- hypothermia, hypotension, hypoventilation
Hyperparathyroidism
hypersecretion of
PTH
Hyperparathyroidism etiology
________ failure
Hereditary
Renal failure
Hereditary
Hyperparathyroidism S&S
Fatigue
weakness
__________ pain
fractures
N/V
constipation
HTN
cardiac _____________
renal ________
Fatigue
weakness
skeletal pain
fractures
N/V
constipation
HTN
cardiac dysrhythmias
renal stones
Hyperparathyroidism nursing management
VS
Cardiac rhythm
I&O
strain urine
diuretic
Biphosphonate
Calcitonin
_____________ectomy
VS
Cardiac rhythm
I&O
strain urine
diuretic
Biphosphonate
Calcitonin
Parathyroidectomy
Hypoparathyroidism
hyposecretion of
PTH
Hypoparathyroidism etiology
tumor
removal of gland during thyroid surgery
Hypoparathyroidism S&S
hypo_________
tetany
____________ and tingling
muscle cramps
dysphagia
laryngospasms/_____________
Trousseau’s and Chvostek’s signs
Cardiac ____________
hypotension
anxiety
irritability
hypocalcemia
tetany
numbness and tingling
muscle cramps
dysphagia
laryngospasms/bronchospasms
Trousseau’s and Chvostek’s signs
Cardiac dysrhythmias
hypotension
anxiety
irritability
Hypoparathyroidism nursing management
VS
cardiac rhythm
monitor for S/S ____________
Calcium gluconate and phosphate binders
high _________
Vit D
low __________ diet
VS
cardiac rhythm
monitor for S/S hypocalcemia
Calcium gluconate and phosphate binders
high calcium
Vit D
low phosphate diet
Cushing’s syndrome
hypersecretion of
glucocorticoids & mineralocorticoids
Cushing’s syndrome etiology
pituitary tumor
steroid abuse
Cushing’s syndrome S&S
________ face
_______ gain
_______ -shaped figure (obesity in mid-section with small arms/legs)
acne
_________ hump
prone to infections
bruising, poor ________ healing
hyperglycemnia
osteoporosis
pendulous abdomen
HTN
moon face
weight gain
pear-shaped figure (obesity in mid-section with small arms/legs)
acne
buffalo hump
prone to infections
bruising, poor wound healing
hyperglycemnia
osteoporosis
pendulous abdomen
HTN
Cushing’s syndrome nursing management
VS, I&O
weight
labs (Na, K, Ca)
Monitor ___
______ care
meds to inhibit ________ hyperfunctioning
pituitary/adrenal _________
prevent infection
body image
low carb, low sodium, high __________ diet
VS, I&O
weight
labs (Na, K, Ca)
Monitor BG
skin care
meds to inhibit adrenal hyperfunctioning
pituitary/adrenal surgery
prevent infection
body image
low carb, low sodium, high protein diet
Hyperaldosteronism - _____ syndrome
Conn’s
Hyperaldosteronism etiology
overproduction of aldosterone usually caused by:
an adenoma
Hyperaldosteronism S&S
HTN
Hypernatremia
HA (head ache)
Hypokalemia
> > > muscle weakness
fatigue
dysrhythmias
metabolic alkalosis
Hyperaldosteronism nursing management
Adrenalectomy
low-Na diet
K+ sparing diuretics & supplements
antihypertensives
Pheochromocytoma
overproduction of
catecholamines
Pheochromocytoma etiology
usually caused by benign tumor of adrenal medulla
Pheochromocytoma S&S
Diagnostic
HTN
HA
Tachycardia
Palpitations
Dx- catecholamine level, CT, MRI
Pheochromocytoma nursing management
adrenalectomy
Antihypertensives [Doxazosin, Prazosin, Phenoxybenzamina]
Addison’s disease
hyposecrtion of
glucocorticoids & mineralocoricoids
Addison’s disease etiology
tumor, idiopathic
-decreased response to stress, decreased retention of sodium and water
Addison’s disease S&S
weight _______
_______ weakness
Low Na+, high K+ and BUN
hypo_________
dehydration
hypovolemia
hypotension
weight loss
muscle weakness
Low Na+, high K+ and BUN
hypoglycemia
dehydration
hypovolemia
hypotension
Addison’s disease nursing management
VS, I&O, labs (Na, K+, glucose)
hormone replacements
avoid strenuous activities & stress
high protein, high carb, increase sodium diet
Addison’s disease
Addisonian crisis-
hypotension
tachycardia
hyponatremia
hyperkalemia
hypoglycemia
vomiting
diarrhea
fever, confusion
Tx- vitals, I&O, neuro status, labs, IVF abx, IV sterpoids
Hepatitis
types
ABCDE
A, E - bowels
B, C, D - not from bowels, from body fluids
Hepatitis S&S
asymptomatic
malaise
myalgia (arthalgias)
_____ tenderness
weight _____
find ______ repugnant
loss of ______
HA
low grade fever
skin rashes
hepatomegaly
splenamegaly
___________
_____ urine
light or clay colored stool
pruritus
asymptomatic
malaise
myalgia (arthalgias)
RUQ tenderness
weight loss
find food repugnant
loss of smell
HA
low grade fever
skin rashes
hepatomegaly
splenamegaly
jaundice
dark urine
light or clay colored stool
pruritus
Hepatitis diagnostics
antibody/ antigen tests
LFTs
US
Hepatitis RN management
rest
adequate ____________
avoid________ detoxed by liver
notification of possible contacts
Vit B complex and K
IV glucose / enteral nutrition
avoid steroids
assess for jaundice
Drug therapy -
Hep B: Pegylated interferon
Hep C: DAAS
rest
adequate nutrition
avoid alc/drugs detoxed by liver
notification of possible contacts
Vit B complex and K
IV glucose / enteral nutrition
avoid steroids
assess for jaundice
Drug therapy -
Hep B: Pegylated interferon
Hep C: DAAS
Cirrhosis of the liver - end stage:
liver disease
Cirrhosis of the liver complications
Portal HTN
Esophageal/gastric varices
edema
ascites
hepatic encephalopathy
hepatorenal syndrome
Cirrhosis of the liver S&S
Cirrhosis of the liver Diagnostic
liver _________ tests
total protein
__________ levels
serum bilirubin
cholestrol levels
ammonia levels
prothrombin time
liver biopsy
liver enzyme tests
total protein
albumin levels
serum bilirubin
cholestrol levels
ammonia levels
prothrombin time
liver biopsy
Cirrhosis of the liver nursing management
Rest
B complex Vit
no ____
aspirin
acetaminophen
NSAIDS
low __________ diet
Monitor electrolytes
observe for bleeding disorders
Esophageal/Gastric varicies- B-B, Octreotide, Vasopressin, PRBC, balloon tamponade
Ascites- Fowlers, albumin, diuretics
Hepatic encephalopathy- check neuro, low protein, rifaximin, lactulose
Rest
B complex Vit
no alc
aspirin
acetaminophen
NSAIDS
low sodium diet
Monitor electrolytes
observe for bleeding disorders
Esophageal/Gastric varicies- B-B, Octreotide, Vasopressin, PRBC, balloon tamponade
Ascites- Fowlers, albumin, diuretics
Hepatic encephalopathy- check neuro, low protein, rifaximin, lactulose
Pancreatitis - inflammation of
pancreas (acute or chronic)
Pancreatitis etiology
gallstones
chronic alcohol use
Pancreatitis S&S
______ pain
NV
flushing
cyanosis
dyspnea
low-grade ______
leukocytosis
S/S hypocalcemia
DM
Steatorrhea
Grey turner’s sign & cullen’s sign
hypotension
tachycardia
shock
Abd pain
NV
flushing
cyanosis
dyspnea
low-grade fever
leukocytosis
S/S hypocalcemia
DM
Steatorrhea
Grey turner’s sign & cullen’s sign
hypotension
tachycardia
shock
Pancreatitis complications
atelactasis
pneumonia
ARDS
Pancreatitis diagnostic tests
lipase
amylase CT W/ contrast
LFTs
Increased triglyceride
Decreased calcium
Increased glucose
MRCP
ERCP
Pancreatitis nursing management
ABC
narcotics
IVF
antiemetics
NPO
NG suction
Bentyl
PPI
monitor labs - glucose/ ca+
insulin
IV calcium
gluconate
albumin
whipple procedure
Disorders of the biliary tract include:
Cholelithiasis
Cholesystitis
Cholelithiasis - __________________
Cholesystitis - ____________________
Cholelithiasis - stones in gallbladder (cholestrol)
Cholesystitis - inflammation of the gallbladder
Cholelithiasis
Cholesystitis
Risk factors
female (preg, oral contraceptives, estrogen)
40
obesity
DM
Native American
Cholelithiasis
Cholesystitis
S&S
biliary colic
R ________ pain
N/V
restlessness
tachycardia
diaphoresis
dark amber ______
clay or gray colored ________
pruritus
steatorrhea
bleeding
jaundice
fever, chills
intolerance to ________foods
biliary colic
R shoulder pain
N/V
restlessness
tachycardia
diaphoresis
dark amber urine
clay or gray colored stools
pruritus
steatorrhea
bleeding
jaundice
fever, chills
intolerance to fatty foods
Cholelithiasis
Cholesystitis
Dx; RN management
Dx: US, ERCP, WBC, LFTs, amylase, UA
Nursing
IVF
opioids
Abx
ng tube
antiemetics
NPO
fat soluble vitamins
anti___________
bile salts
diet- low _________
Papillotomy, ESWL, cholesysostomy
post-op care: watch for bleeding, R shoulder pain
sim’s position, ambulation
Dx: US, ERCP, WBC, LFTs, amylase, UA
Nursing
IVF
opioids
Abx
ng tube
antiemetics
NPO
fat soluble vitamins
anticholinergic
bile salts
diet- low sat. fat
Papillotomy, ESWL, cholesysostomy
post-op care: watch for bleeding, R shoulder pain
sim’s position, ambulation
ADH is also known as
vasopressin
BUN value
10-20 mg/dl
Creatinine value
0.5-1.2 mg/dl
Calcium levels
9-10.5 mg/dl
how to treat orthostastic hypotension
give fluids
Liver processes dead RBCS into
bilirubin
Liver transforms unconjugated bilirubin into
conjugated bilirubin
Vitamin K is important for
clotting factors
Albumin ________ fluid in blood vessels
retains
Hepatits means
Inflammation of liver
Liver transforms toxic ammonia into
urea
Hepatitis types
A - fecal-oral route
B - DNA virus percut.
C - RNA virus percut.
D - Delta virus; RNA; HBV; Percut.
E - fecal-oral route
ALT values
4-36 U/L
AST values
0-35 U/L
Total bilirubin values
0.3-1 mg/dl
Ammonia values
10-80 mcg/dl
Alkaline Phosphate values
30-120 U/L
Albumin values
3-5 g/dl
Drug therapy -
Hep B: ____________
Hep C: _________
Hep B: Pegylated interferon
Hep C: DAAS
thrombocytopenia is
low platelet
the spleen stores:
platelets, RBC, WBC
Leokopenia is
low WBC
Lipase values
0-160
Amylase values
60-120
whipple procedure [removing the head of the pancreas, the first part of the small intestine, the gallbladder and the bile duct]
watch for -
bleeding
hyperglycemia
bowel obstruction
Posterior Pituitary: releases
- Antidiuretic Hormone (ADH)
- Oxytocin
__________ Pituitary: releases
- Growth Hormone
- Thyroid Stimulating Hormone
- Adrenocorticotropin (ACTH)
- Prolactin
- Follicle-Stimulating Hormone
- Luteinizing Hormone
Anterior
Acromegaly: remember –megaly means ___________________
large, overgrowth
Which statement made by a 50-yr-old female patient indicates to the nurse that further assessment of thyroid function may be needed?
a. “I am so thirsty that I drink all day long.”
b. “I get up several times at night to urinate.”
c. “I feel a lump in my throat when I swallow.”
d. “I notice my breasts are always tender lately.
c. “I feel a lump in my throat when I swallow.”
Difficulty in swallowing can occur with a goiter. Nocturia is associated with diseases
such as diabetes, diabetes insipidus, or chronic kidney disease. Breast tenderness
would occur with excessive gonadal hormone levels. Thirst is a sign of disease such as
diabetes.
A 40-year-old patient with suspected acromegaly is seen at the clinic. To assist in making the diagnosis, which question should the nurse ask?
a. “Have you had a recent head injury?”
b. “Do you have to wear larger shoes now?”
c. “Is there a family history of acromegaly?”
d. “Are you experiencing tremors or anxiety?”
b. “Do you have to wear larger shoes now?”
Acromegaly causes an enlargement of the hands and feet. Head injury and family
history are not risk factors for acromegaly. Tremors and anxiety are not clinical
manifestations of acromegaly.
Which finding indicates to the nurse that demeclocycline is effective for a patient with
syndrome of inappropriate antidiuretic hormone (SIADH)?
a. Weight has increased.
b. Urinary output is increased.
c. Peripheral edema is increased.
d. Urine specific gravity is increased.
b. Urinary output is increased.
Demeclocycline blocks the action of antidiuretic hormone (ADH) on the renal tubules
and increases urine output. An increase in weight or an increase in urine specific
gravity indicates that the SIADH is not corrected. Peripheral edema does not occur
with SIADH. A sudden weight gain without edema is a common clinical manifestation of
this disorder.
Which problem should the nurse anticipate for a patient admitted to the hospital with diabetes insipidus?
a. Generalized edema
b. Fluid volume overload
c. Disturbed sleep pattern
d. Decreased gas exchange
c. Disturbed sleep pattern
Nocturia occurs because of the polyuria caused by diabetes insipidus. Edema, excess
fluid volume, and fluid retention are not expected.
A patient has just arrived on the unit after a thyroidectomy. Which action should the nurse take first?
a. Observe the dressing for bleeding.
b. Check the blood pressure and pulse.
c. Assess the patient’s respiratory effort.
d. Support the patient’s head with pillows.
c. Assess the patient’s respiratory effort.
Airway obstruction is a possible complication after thyroidectomy because of swelling
or bleeding at the site or tetany. The priority nursing action is to assess the airway.
The other actions are also part of the standard nursing care post thyroidectomy but
are not as high of a priority
Which information from a 70-yr-old patient during a health history indicates to the
nurse that the patient should be screened for hepatitis C?
a. The patient had a blood transfusion in 2005.
b. The patient used IV drugs about 20 years ago.
c. The patient frequently eats in fast-food restaurants.
d. The patient traveled to a country with poor sanitation.
b. The patient used IV drugs about 20 years ago.
Any patient with a history of IV drug use should be tested for hepatitis C. Blood
transfusions given after 1992 (when an antibody test for hepatitis C became available)
do not pose a risk for hepatitis C. Hepatitis C is not spread by the oral-fecal route and
therefore is not caused by contaminated food or by traveling in underdeveloped
countries.
Which focused data should the nurse assess after identifying 4+ pitting edema on a
patient who has cirrhosis?
a. Hemoglobin
b. Temperature
c. Activity level
d. Albumin level
d. Albumin level
The low oncotic pressure caused by hypoalbuminemia is a major pathophysiologic factor in the
development of edema. The other parameters are not directly associated with the patient’s edema.
How should the nurse prepare a patient with ascites for paracentesis?
a. Place the patient on NPO status.
b. Assist the patient to lie flat in bed.
c. Ask the patient to empty the bladder.
d. Position the patient on the right side.
c. Ask the patient to empty the bladder.
The patient should empty the bladder to decrease the risk of bladder perforation during the
procedure. The patient would be positioned in Fowler’s position and would not be able to lie flat without compromising breathing. Because no sedation is required for paracentesis, the patient does not need to be NPO.
A serum potassium level of 3.2 mEq/L (3.2 mmol/L) is reported for a patient with cirrhosis who has scheduled doses of spironolactone (Aldactone) and furosemide (Lasix) due. Which action should the nurse take?
a. Withhold both drugs.
b. Administer both drugs.
c. Administer the furosemide.
d. Administer the spironolactone
d. Administer the spironolactone
Spironolactone is a potassium-sparing diuretic and will help increase the patient’s potassium level. The furosemide will further decrease the patient’s potassium level and should be held until the nurse talks with the health care provider.
A patient is being treated for bleeding esophageal varices with balloon tamponade. Which nursing action will be included in the plan of care?
a. Instruct the patient to cough every hour.
b. Monitor the patient for shortness of breath.
c. Verify the position of the balloon every 4 hours.
d. Deflate the gastric balloon if the patient reports nausea.
b. Monitor the patient for shortness of breath.
The most common complication of balloon tamponade is aspiration pneumonia. In addition, if the gastric balloon ruptures, the esophageal balloon may slip upward and occlude the airway. Coughing increases the pressure on the varices and increases the risk for bleeding. Balloon position is verified after insertion and does not require further verification. Balloons may be deflated briefly every 8 to 12 hours to avoid tissue necrosis, but if only the gastric balloon is deflated, the esophageal balloon may occlude the airway. Balloons are not deflated for nausea.
Hyperthyroidism- Grave’s Disease
_____________ thyroid, increased ____________
Overreactive thyroid, increased metabolism
Hyperthyroidism- Grave’s Disease
Causes:
* ____________ disorder- Grave’s Disease
* Toxic goiter
* Excessive _______
* Pituitary _________
* Thyroid cancer
- Autoimmune disorder- Grave’s Disease
- Toxic goiter
- Excessive iodine
- Pituitary tumor
- Thyroid cancer
Hyperthyroidism- Grave’s Disease Management:
- Monitor VS
- Diet: High __________, high protein
- Provide ____ care- artificial tear, lubrication, eye patches at night
- Provide rest
- Radioactive ___________ (RAI Therapy)- destroys the thyroid gland
- No other cells in the body absorb iodine except the thyroid gland
- Will not harm other organs
- Take about 6 to 8 weeks to start working
- Most patient will then experience hypothyroidism & need to take thyroid replacement
medications
- Monitor VS
- Diet: High calorie, high protein
- Provide eye care- artificial tear, lubrication, eye patches at night
- Provide rest
- Radioactive Iodine (RAI Therapy)- destroys the thyroid gland
- No other cells in the body absorb iodine except the thyroid gland
- Will not harm other organs
- Take about 6 to 8 weeks to start working
- Most patient will then experience hypothyroidism & need to take thyroid replacement
medications
Hyperthyroidism- Grave’s Disease Common S/S:
- Everything ________ UP
- Weight loss
- Tachycardia
- HTN
- Diarrhea
- Nervousness
- ______________ (bulging eyes) immune system attacking muscles & fatty tissue around eyes= make them bulge & appear swollen
- Everything speeds UP
- Weight loss
- Tachycardia
- HTN
- Diarrhea
- Nervousness
- Exophthalmos (bulging eyes) immune system attacking muscles & fatty tissue around eyes= make them bulge & appear swollen
Hyperthyroidism- Grave’s Disease Pharmacology:
* Propylthiouracil & Methimazole (Tapazole)- Antithyroid= inhibit ___________________
thyroid hormone synthesis
Thyroid storm
[thyroid gland releases a large amount of thyroid hormone in a short amount of time]
is a medical emergency; causes include
*Trauma
*Infection
*Surgery
Reasons to have Thyroidectomy:
- Goiter causing tracheal __________
- __________ medication/therapy is not working
- Thyroid cancer
- Not a candidate for RAI Therapy
- Goiter causing tracheal compression
- Antithyroid medication/therapy is not working
- Thyroid cancer
- Not a candidate for RAI Therapy
Thyroidectomy
Pre-op:
* Monitor pt & establish a baseline
* Decrease ___________ of the gland- radiation or iodine therapy
* Medications- antithyroid med, Beta Blockers
* Post op teaching- pt knows what to expect and how to support after surgery
Pre-op:
* Monitor pt & establish a baseline
* Decrease vascularity of the gland- radiation or iodine therapy
* Medications- antithyroid med, Beta Blockers
* Post op teaching- pt knows what to expect and how to support after surgery
Thyroidectomy
Post-op:
* Helping with positions of comfort & making sure the neck does not get overextended
* Do not want to put stress on the suture line
* Monitor respiratory status
* Assess bleeding & drainage
* Limit talking
* Monitor labs (______) taking out thyroid AND parathyroid
* Hypocalcemia- numbness, tingling in hands, feet, & around mouth
* Monitor thyroid storm- manipulation of thyroid gland causes increase of thyroid hormone
in circulation, so immediate post op watch
* Trach kit & surgical suction at bedside- damage to laryngeal nerve, causing paralysis, pt
can’t breathe
- Helping with positions of comfort & making sure the neck does not get overextended
- Do not want to put stress on the suture line
- Monitor respiratory status
- Assess bleeding & drainage
- Limit talking
- Monitor labs (Ca++) taking out thyroid AND parathyroid
- Hypocalcemia- numbness, tingling in hands, feet, & around mouth
- Monitor thyroid storm- manipulation of thyroid gland causes increase of thyroid hormone
in circulation, so immediate post op watch - Trach kit & surgical suction at bedside- damage to laryngeal nerve, causing paralysis, pt
can’t breathe
Hypothyroidism- _________________
Hashimoto’s
Hypothyroidism- Hashimoto’s
Slowing of ______________
metabolic rate
Hypothyroidism- Hashimoto’s Causes:
- ___________deficiency- most common, since iodine is needed to synthesize thyroid hormone
- _____________ diseases- Hashimoto’s Disease (most common in U.S.), thyroid gland attacks itself= Atrophy of thyroid gland
- Treatments for Hyperthyroidism- Thyroidectomy or Radioactive Iodine
- HCPs did ”Too” good of job treating Hyperthyroidism
- Iodine deficiency- most common, since iodine is needed to synthesize thyroid hormone
- Autoimmune diseases- Hashimoto’s Disease (most common in U.S.), thyroid gland attacks itself= Atrophy of thyroid gland
- Treatments for Hyperthyroidism- Thyroidectomy or Radioactive Iodine
- HCPs did ”Too” good of job treating Hyperthyroidism
Hypothyroidism- Hashimoto’s s/s
- Everything ______ down
- Fatigue
- Weight gain
- Bradycardia
- _____________ - GI tract slows
- Decreased concentration/ Lethargy
- Everything SLOWS down
- Fatigue
- Weight gain
- Bradycardia
- Constipation- GI tract slows
- Decreased concentration/ Lethargy
Hypothyroidism- Hashimoto’s Management:
* Monitor VS
* Manage Diet: _____ calorie, low cholesterol, low fat, increase fiber & fluids
* Manage Symptoms
* Patient ______ - create warm environment
- Monitor VS
- Manage Diet: Low calorie, low cholesterol, low fat, increase fiber & fluids
- Manage Symptoms
- Patient cold- create warm environment
Hypothyroidism- Hashimoto’s
Pharmacology:
* _______________ (Synthroid)- synthetic form of thyroid hormone
* S/E: arrythmias
* Monitor cardiac function
* Note any chest pain
- Levothyroxine (Synthroid)- synthetic form of thyroid hormone
- S/E: arrythmias
- Monitor cardiac function
- Note any chest pain
____________ Coma - Gradual or sudden severe hypothyroidism
Myxedema
Myxedema Coma causes
- Infection
- Medications- opioids, tranquilizers, or barbiturates
- Exposure to severe coldness
- Trauma
- Infection
- Medications- opioids, tranquilizers, or barbiturates
- Exposure to severe coldness
- Trauma
Hyper VS Hypothyroidism
hyperpituitarism AKA acromegaly Causes:
- ___________ ___________ (adenoma)- usually small & benign, slow growing, presents with HA & visual problems
- Congenital
- Pituitary Tumor (adenoma)- usually small & benign, slow growing, presents with HA & visual problems
- Congenital
hyperpituitarism AKA acromegaly Common S/S:
- Skeletal ____________- large hands, feet, wide jaw
- Arthralgia- joint pain, Carpal Tunnel
- Organomegaly
- Skin changes- overgrowth of skin tissue (thick & leathery), oily, acne breakouts
- __________ resistance- Hyperglycemia- induced HTN
- Skeletal overgrowth- large hands, feet, wide jaw
- Arthralgia- joint pain, Carpal Tunnel
- Organomegaly
- Skin changes- overgrowth of skin tissue (thick & leathery), oily, acne breakouts
- Insulin resistance- Hyperglycemia- induced HTN
hyperpituitarism AKA acromegaly Psychosocial Concerns:
- Body image
- Encourage patient to express concerns, questions, and knowledge about their condition
- Ask open-ended questions
- Fatigue & sleep issues, depression
- Skin care: increased sweat, skin tags
- Provide emotional support- support groups?
- Body image
- Encourage patient to express concerns, questions, and knowledge about their condition
- Ask open-ended questions
- Fatigue & sleep issues, depression
- Skin care: increased sweat, skin tags
- Provide emotional support- support groups?
Transsphenoidal _________________
Surgical Removal of Pituitary Gland
Done for Hypo/Hyperpituitarism
Hypophysectomy
hyperpituitarism AKA acromegaly Management:
* Pharmacological- started to prevent over secretion of GH & manage symptoms
* Octreotide (Sandostain)- reduce GH, blocks GH reuptake in the body
* SQ injection 3x week
* Surgical removal- (Hypophysectomy) removal of pituitary gland
* Radiation- destroys tissue
* Encourage patient to express concerns and feelings related to disturbed body image
- Pharmacological- started to prevent over secretion of GH & manage symptoms
- Octreotide (Sandostain)- reduce GH, blocks GH reuptake in the body
- SQ injection 3x week
- Surgical removal- (Hypophysectomy) removal of pituitary gland
- Radiation- destroys tissue
- Encourage patient to express concerns and feelings related to disturbed body image
Transsphenoidal Hypophysectomy - Surgical Removal of Pituitary Gland
Procedure:
Trans ________ endoscopic approach
* Radiation is sometimes done prior to procedure to shrink the tumor or when someone is not a candidate for surgery
nasal
Syndrome of Inappropriate Antidiuretic Hormone (SIADH) - Hypersecretion of ADH
Causes:
* Malignancy- _______ Cell Lung Cancer
* _______ Injury- Severe Trauma, pituitary gland damaged
* ________ Infections of the Brain (Meningitis)
* Think about “S”
- Malignancy- Small Cell Lung Cancer
- Head Injury- Severe Trauma, pituitary gland damaged
- Sepsis Infections of the Brain (Meningitis)
- Think about “S”
Syndrome of Inappropriate Antidiuretic Hormone (SIADH) - Hypersecretion of ADH
Common S/S: *Body holding onto fluid
* _____________ Urine Output- Stops urination
* Weight _______ (not manifested as edema)
* Hypertension
* Electrolytes become diluted- specifically Hyponatremia (Low Sodium level <135)
* Nausea/Vomiting/HA
* Mental Status Changes- confusion, in severe cases Seizures
- Decreased Urine Output- Stops urination
- Weight Gain (not manifested as edema)
- Hypertension
- Electrolytes become diluted- specifically Hyponatremia (Low Sodium level <135)
- Nausea/Vomiting/HA
- Mental Status Changes- confusion, in severe cases Seizures
Syndrome of Inappropriate Antidiuretic Hormone (SIADH) - Hypersecretion of ADH
Diagnostics:
* Decrease serum ____
* __________ in urine specific gravity (>1.025)
- Decrease serum Na+
- Increase in urine specific gravity (>1.025)
Diabetes Insipidus (DI) - ____________ of ADH
Hyposecretion
Syndrome of Inappropriate Antidiuretic Hormone (SIADH) - Hypersecretion of ADH
Management:
* Monitor BP- circulating volume is increasing, holding fluids
* Tracking I&Os- determine severity
* Restrict Fluids (800mL to 1,000mL/day)- orally & through IV (give ice chips & gum if pt
complaining about dry mouth)
* Assess Neuro Status- Hyponatremia, MSC, seizures
* Environmental safety- injuries
* Sodium Replacement
* Diuretics- get rid of fluid
* Hypertonic Solution (3% sodium chloride)- Given in extreme cases
* Fluid pushed out of the cell to become secreted
* Na<120, done very slowly to prevent Osmotic Demyelination Syndrome
* Irreversible damage to neurons in the brain
- Monitor BP- circulating volume is increasing, holding fluids
- Tracking I&Os- determine severity
- Restrict Fluids (800mL to 1,000mL/day)- orally & through IV (give ice chips & gum if pt
complaining about dry mouth) - Assess Neuro Status- Hyponatremia, MSC, seizures
- Environmental safety- injuries
- Sodium Replacement
- Diuretics- get rid of fluid
- Hypertonic Solution (3% sodium chloride)- Given in extreme cases
- Fluid pushed out of the cell to become secreted
- Na<120, done very slowly to prevent Osmotic Demyelination Syndrome
- Irreversible damage to neurons in the brain
Syndrome of Inappropriate Antidiuretic Hormone (SIADH) - Hypersecretion of ADH
Pharmacology:
* Demeclocycline (__________)- reduces kidney’s collecting tubules responsiveness to ADH, blocks ADH from working
* Makes urine more dilute & now getting rid of fluids
Pharmacology:
* Demeclocycline (Antibiotic)- reduces kidney’s collecting tubules responsiveness to ADH, blocks ADH from working
* Makes urine more dilute & now getting rid of fluids
Diabetes Insipidus (DI) Causes:
- Tumor
- Medications- ________ (Mood stabilizer)
- Increased _____
- Removal of pituitary gland- not producing ADH anymore, kidneys not being told to keep fluids
- Tumor
- Medications- Lithium (Mood stabilizer)
- Increased ICP
- Removal of pituitary gland- not producing ADH anymore, kidneys not being told to keep fluids
Diabetes Insipidus (DI) Common S/S: *Body is giving away fluids
* _______ - increased urination, body not holding onto fluids
* __________- increased thirst, due to dehydration
* ___________- decreased circulating volume
* Tachycardia- compensate for decreased circulating volume due to dehydration
- Polyuria- increased urination, body not holding onto fluids
- Polydipsia- increased thirst, due to dehydration
- Hypotension- decreased circulating volume
- Tachycardia- compensate for decreased circulating volume due to dehydration
Diabetes Insipidus (DI) mnemonic
Dry Inside
Diabetes Insipidus (DI) Diagnostics:
* Increased serum ____ (Hypernatremia)
* ____________ urine specific gravity (<1.005)
- Increased serum Na+ (Hypernatremia)
- Decreased urine specific gravity (<1.005)
Diabetes Insipidus (DI) Management:
* Monitor HR (increased) & BP (decreased)
* Daily Weights
* Hypotonic Solutions (0.45% NaCl)
* Fluid pushed into the cells
* Na+> 145
* Assess neuro status (HA, seizures)
* Assess Cardiac Status
- Monitor HR (increased) & BP (decreased)
- Daily Weights
- Hypotonic Solutions (0.45% NaCl)
- Fluid pushed into the cells
- Na+> 145
- Assess neuro status (HA, seizures)
- Assess Cardiac Status
Diabetes Insipidus (DI) Pharmacology:
* ______________ (DDAVP)
* Synthetic hormone replacement of ADH
* Tells kidneys to stop secreting urine
* Key to know it’s working- Pt states “I slept so great last night, I haven’t slept through the night in forever”
* *used for nighttime bed wetting (Enuresis, will come up in Pediatrics)
- Desmopressin (DDAVP)
- Synthetic hormone replacement of ADH
- Tells kidneys to stop secreting urine
- Key to know it’s working- Pt states “I slept so great last night, I haven’t slept through the night in forever”
- *used for nighttime bed wetting (Enuresis, will come up in Pediatrics)
Addison’s Disease
mnemonic
*Absent steroids, Add “some steroids”
Addison’s Disease - Hyposecretion of glucocorticoids & mineralocorticoids
Causes:
* Tumor
* ___________ response- body starts attacking the adrenal glands
* Idiopathic- we don’t know why
- Tumor
- Autoimmune response- body starts attacking the adrenal glands
- Idiopathic- we don’t know why
Addison’s Disease - Hyposecretion of glucocorticoids & mineralocorticoids
Common S/S: *Decreased cortisol (glucose metabolism & stress) & Decreased aldosterone (regulate electrolytes)
* Weight loss
* Muscle weakness
* Fatigue
* Increased inflammation
* Hypovolemia/Hypotension
* Hypoglycemia
* Decreased Na+
* Increased K+
* Skin changes- hyperpigmentation due to high levels of ACTH
Common S/S: *Decreased cortisol (glucose metabolism & stress) & Decreased aldosterone (regulate electrolytes)
* Weight loss
* Muscle weakness
* Fatigue
* Increased inflammation
* Hypovolemia/Hypotension
* Hypoglycemia
* Decreased Na+
* Increased K+
* Skin changes- hyperpigmentation due to high levels of ACTH
Addison’s Disease - Hyposecretion of glucocorticoids & mineralocorticoids
Management:
* VS, I&Os
* Heart monitor- electrolyte imbalances impact muscle contractility
* Avoid stress- body is not producing glucocorticoids, can’t adapt to stressful situations
or fight illness
* Diet: High protein, high carbs, high Na+
* To supplement weight loss & low sodium levels associated with Addison’s
Management:
* VS, I&Os
* Heart monitor- electrolyte imbalances impact muscle contractility
* Avoid stress- body is not producing glucocorticoids, can’t adapt to stressful situations
or fight illness
* Diet: High protein, high carbs, high Na+
* To supplement weight loss & low sodium levels associated with Addison’s
Addisonian Crisis - Medical Emergency
Causes:
* Having Addison’s disease- in accident, have trauma, high stress situation, severe illness
* Stopping ________ abruptly
Causes:
* Having Addison’s disease- in accident, have trauma, high stress situation, severe illness
* Stopping steroids abruptly
Addison’s Disease - Hyposecretion of glucocorticoids & mineralocorticoids
Medications:
* Require lifelong hormone therapy
* Hydrocortisone (Cortef)- Both glucocorticoid & mineralocorticoid properties
* PO given 2/3xday, larger dose given in the AM because that reflects circadian
rhythms in hormone secretion
* Fludrocortisone- mineralocorticoid properties, helps body hold onto sodium
Medications:
* Require lifelong hormone therapy
* Hydrocortisone (Cortef)- Both glucocorticoid & mineralocorticoid properties
* PO given 2/3xday, larger dose given in the AM because that reflects circadian
rhythms in hormone secretion
* Fludrocortisone- mineralocorticoid properties, helps body hold onto sodium
Addisonian Crisis - Medical Emergency
Treatment:
* IV steroids (hydrocortisone) most readily available for the body to utilize
* IV fluids- to correct hypotension
* Rest- decrease stress
*Must taper steroids, so adrenal glands can start producing hormones again
Treatment:
* IV steroids (hydrocortisone) most readily available for the body to utilize
* IV fluids- to correct hypotension
* Rest- decrease stress
*Must taper steroids, so adrenal glands can start producing hormones again
Addisonian Crisis - Medical Emergency
Common S/S:
* Hypotension
* Hyperkalemia
* Hypoglycemia
* Severe HA
Common S/S:
* Hypotension
* Hyperkalemia
* Hypoglycemia
* Severe HA
Cushing’s Syndrome - Hypersecretion of glucocorticoids & mineralocorticoids
Causes:
* Chronic Steroid use (Prednisone)
* Pituitary of Adrenal tumor/adenoma (benign)
* Secretes extra ACTH stimulating release of more cortisol
Causes:
* Chronic Steroid use (Prednisone)
* Pituitary of Adrenal tumor/adenoma (benign)
* Secretes extra ACTH stimulating release of more cortisol
Cushing’s Syndrome - Hypersecretion of glucocorticoids & mineralocorticoids
Common S/S: *due to excess levels of corticosteroids
* Weight gain
* Moon Face
* HTN
* Hyperglycemia –glucose intolerance r/t induced insulin resistance/ increased gluconeogenesis
* Increase Na+ (Body holding onto it because of excess hormones)
* Decrease K+ (Body getting rid of it)
* Prone to infection, Poor wound healing, Bruises easily
* GI distress
Common S/S: *due to excess levels of corticosteroids
* Weight gain
* Moon Face
* HTN
* Hyperglycemia –glucose intolerance r/t induced insulin resistance/ increased gluconeogenesis
* Increase Na+ (Body holding onto it because of excess hormones)
* Decrease K+ (Body getting rid of it)
* Prone to infection, Poor wound healing, Bruises easily
* GI distress
Cushing’s Syndrome - Hypersecretion of glucocorticoids & mineralocorticoids
Mnemonic CUSH
Hypoparathyroidism - _________ levels are low
Calcium
Cushing’s Syndrome - Hypersecretion of glucocorticoids & mineralocorticoids
Management:
* Monitor VS & Blood sugar
* Prevent infections, good skin care
* Diet: low carb, low sodium, high protein
* Surgical removal of tumor
* Taper corticosteroids
* Educate: once hormone levels regulated, they should not suffer from S/S
Management:
* Monitor VS & Blood sugar
* Prevent infections, good skin care
* Diet: low carb, low sodium, high protein
* Surgical removal of tumor
* Taper corticosteroids
* Educate: once hormone levels regulated, they should not suffer from S/S
Pheochromocytoma - Hypersecretion of Norepinephrine & Epinephrine
Diagnostics:
* Check for catecholamines in blood & urine
* Imaging- checking for tumor since that is the common cause
Management:
* Removal of adrenal gland- Adrenalectomy
* Giving Antihypertensives for BP
* Decrease any stress- we don’t want more catecholamines released
* No stimulants (Coffee or smoking)
Diagnostics:
* Check for catecholamines in blood & urine
* Imaging- checking for tumor since that is the common cause
Management:
* Removal of adrenal gland- Adrenalectomy
* Giving Antihypertensives for BP
* Decrease any stress- we don’t want more catecholamines released
* No stimulants (Coffee or smoking)
Pheochromocytoma - Hypersecretion of Norepinephrine & Epinephrine
Causes:
* Benign Tumor of the __________
Common S/S:
* HTN
* HA
* Tachycardia
* Palpitations
* Classic Triad: Pounding HA, Tachy, & Sweating
Causes:
* Benign Tumor of the Medulla
Common S/S:
* HTN
* HA
* Tachycardia
* Palpitations
* Classic Triad: Pounding HA, Tachy, & Sweating
Hypoparathyroidism
Causes:
* Removal of thyroid gland
* Tumor
* Heavy metal poisoning
Causes:
* Removal of thyroid gland
* Tumor
* Heavy metal poisoning
Hypoparathyroidism
Common of S/S:
* Hypocalcemia
* Tetany
* Muscle spasm
* Bronchospasm
* Hypotension
* Dysphagia
* Anxiety
* Cardiac dysrhythmias
* Seizures
Common of S/S:
* Hypocalcemia
* Tetany
* Muscle spasm
* Bronchospasm
* Hypotension
* Dysphagia
* Anxiety
* Cardiac dysrhythmias
* Seizures
Hyperparathyroidism - Calcium levels are ______
high
Hypoparathyroidism
Management:
* Hypocalcemia tests:
* Check ___________sign-facial muscles contract when lightly tap facial nerve in front of the ear
* Trousseau’s sign- hand spasm with inflation of blood pressure cuff
* Monitor cardiac function
* Administer calcium gluconate & phosphate binders
* Diet: High calcium, High vitamin D, & Low phosphate
* Seizure precautions- bed level low, seizure pads, close to nursing station, working suction
Management:
* Hypocalcemia tests:
* Check Chvostek’s sign-facial muscles contract when lightly tap facial nerve in front of the ear
* Trousseau’s sign- hand spasm with inflation of blood pressure cuff
* Monitor cardiac function
* Administer calcium gluconate & phosphate binders
* Diet: High calcium, High vitamin D, & Low phosphate
* Seizure precautions- bed level low, seizure pads, close to nursing station, working suction
Hyperparathyroidism
Causes:
* Tumor
* Kidney disease
Causes:
* Tumor
* Kidney disease
Hyperparathyroidism
Common S/S:
* Hypercalcemia- calcium pulled from the bones
* Fatigue
* Weakness
* Skeletal muscle pain
* Fractures- bones weak
* Constipation
* HTN
* Renal stone- calcium deposits formed in kidneys
* N/V
* Cardiac Dysrhythmias
Common S/S:
* Hypercalcemia- calcium pulled from the bones
* Fatigue
* Weakness
* Skeletal muscle pain
* Fractures- bones weak
* Constipation
* HTN
* Renal stone- calcium deposits formed in kidneys
* N/V
* Cardiac Dysrhythmias
Hyperparathyroidism
Management:
* Monitor cardiac function
* Strain urine- check for stones
* Administer diuretics (Lasix)- increase urinary excretion of calcium
* Calcitonin- synthetic hormone, slows bone loss & maintain normal calcium levels in blood
* Possible parathyroidectomy
* Same interventions & considerations as when a pt has a thyroidectomy
Management:
* Monitor cardiac function
* Strain urine- check for stones
* Administer diuretics (Lasix)- increase urinary excretion of calcium
* Calcitonin- synthetic hormone, slows bone loss & maintain normal calcium levels in blood
* Possible parathyroidectomy
* Same interventions & considerations as when a pt has a thyroidectomy
LIVER - Main Job: Filters _________ coming from the digestive tract.
blood
________________ Vein - main vessel of portal venous system which drains blood from: GI
Tract, Gallbladder, Pancreas, Spleen and to the liver.
Hepatic Portal
Hepatitis
Inflammation of the liver
Hepatitis
Patho:
Caused by: viruses, bacteria, or toxic substances
o Viral variations present with same S/S, we have to do blood tests to see which type pt. has
o Toxic Hepatitis, usually d/t OD with OTC drugs, most commonly, Tylenol OD
* Acute (1-6 months) and chronic (6+ months) phase
* Lab Tests: Liver f(x) tests will be elevated.
o ALT: Normal: 4-36
o AST: Normal: 0-35
o Both of these are normally present in the blood at low levels, but elevated levels indicate damaged, injured liver
Patho:
Caused by: viruses, bacteria, or toxic substances
o Viral variations present with same S/S, we have to do blood tests to see which type pt. has
o Toxic Hepatitis, usually d/t OD with OTC drugs, most commonly, Tylenol OD
* Acute (1-6 months) and chronic (6+ months) phase
* Lab Tests: Liver f(x) tests will be elevated.
o ALT: Normal: 4-36
o AST: Normal: 0-35
o Both of these are normally present in the blood at low levels, but elevated levels indicate damaged, injured liver
Hepatitis S/S (sometimes pts can be asymptomatic)
* Fatigue
* RUQ pain/tenderness
* jaundiceà occurs because the liver can’t break down the bilirubin, and it will build up in
the blood. This causes the yellow tint we see.
* dark urineà also d/t excess bilirubin. The kidneys need to pick up the slack and excrete the
excess bilirubin, tinting the urine darker
* clay colored stoolà Bilirubin gives stool our normal color, so without it stool is lighter
* Hepatomegaly/Splenomegaly
* Weight Loss
- Fatigue
- RUQ pain/tenderness
- jaundiceà occurs because the liver can’t break down the bilirubin, and it will build up in
the blood. This causes the yellow tint we see. - dark urineà also d/t excess bilirubin. The kidneys need to pick up the slack and excrete the
excess bilirubin, tinting the urine darker - clay colored stoolà Bilirubin gives stool our normal color, so without it stool is lighter
- Hepatomegaly/Splenomegaly
- Weight Loss
**ALT & AST are enzymes found in the liver that helps metabolize _________ .
proteins
When the liver is damaged, ALT & AST is released into the bloodstream and levels __________.
increase
Hepatitis
Diagnostic Tests
- LFTs (Liver Function Tests)
- Urinalysis
- Antibody/Antigen Test (To test viral infection)
Nursing Management
- Adequate Nutrition
- Rest (allow the liver to regenerate and repair, liver is the only organ that can do that)
- Avoid Alcohol and Drugs detoxified by Liver
- Notification of possible contacts (for hepatitis infection)
- Assess for Jaundice
- Avoid Steroids
- Pegylated interferon and DAAS (Direct Acting Antivirals) for Hepatitis
o This drug suppresses the viral replication and prevent complications during acute hepatitis
Diagnostic Tests
- LFTs (Liver Function Tests)
- Urinalysis
- Antibody/Antigen Test (To test viral infection)
Nursing Management
- Adequate Nutrition
- Rest (allow the liver to regenerate and repair, liver is the only organ that can do that)
- Avoid Alcohol and Drugs detoxified by Liver
- Notification of possible contacts (for hepatitis infection)
- Assess for Jaundice
- Avoid Steroids
- Pegylated interferon and DAAS (Direct Acting Antivirals) for Hepatitis
o This drug suppresses the viral replication and prevent complications during acute hepatitis
- _____ is commonly spread from mother to baby
HBV
- Chronic Hepatitis ___ is the most common reason pts experience liver failure and need a
transplant in the USA
C
Cirrhosis:
End-stage of liver disease
Cirrhosis
Causes/Patho:
o Chronic hepatitis (Type C)
o excessive ETOH
o Nonalcoholic steatohepatitis (NASH) or Nonalcoholic fatty liver disease (NAFLD)
§ Lipids are deposited in the liver, and result in fatty liver tissue.
Related to obesity
o biliary obstruction
§ ducts aren’t draining properlyà so waste, such as bile, is backing up
in the liver instead of draining out. Usually caused by a cyst or tumor
Causes/Patho:
o Chronic hepatitis (Type C)
o excessive ETOH
o Nonalcoholic steatohepatitis (NASH) or Nonalcoholic fatty liver disease (NAFLD)
§ Lipids are deposited in the liver, and result in fatty liver tissue.
Related to obesity
o biliary obstruction
§ ducts aren’t draining properlyà so waste, such as bile, is backing up
in the liver instead of draining out. Usually caused by a cyst or tumor
Cirrhosis
Labs:
↑ AST, ALT, LDH, alkaline phosphate, bilirubin & ammonia
↓ Albumin and protein (These decrease because a healthy liver typically
creates these, and the malfunctioning liver is not working as well)
→ PT/INR prolonged times (because the liver is struggling to create clotting factors)
Diagnostic:
o Liver biopsy (best way to confirm cirrhosis in a suspected pt)
o Fibroscan (liver ultrasound that can measure scarring and fatty tissue)
Labs:
↑ AST, ALT, LDH, alkaline phosphate, bilirubin & ammonia
↓ Albumin and protein (These decrease because a healthy liver typically
creates these, and the malfunctioning liver is not working as well)
→ PT/INR prolonged times (because the liver is struggling to create clotting factors)
Diagnostic:
o Liver biopsy (best way to confirm cirrhosis in a suspected pt)
o Fibroscan (liver ultrasound that can measure scarring and fatty tissue)
Cirrhosis can develop from any __________ liver disease (usually 10+ years).
Liver cells are so badly destroyed, they can’t ___________ a scar tissue and nodules form
Cirrhosis can develop from any chronic liver disease (usually 10+ years).
Liver cells are so badly destroyed, they can’t regenerate a scar tissue and nodules form
Cirrhosis S/S:
o Early:
-fatigue
-enlarged liver
- abdominal pain
o Late:
-jaundice
-edema § ascites
-skin lesions
-bleeding
-peripheral neuropathy
o Early:
-fatigue
-enlarged liver
- abdominal pain
o Late:
-jaundice
-edema § ascites
-skin lesions
-bleeding
-peripheral neuropathy
Cirrhosis
Monitor:
o I/O, daily weights
o Electrolytes K+ especially will be impacted by a malfunctioning liver
o blood counts
Nursing Management:
- Rest
- No Alcohol, Aspirin, Acetaminophen and NSAIDs
- Low Sodium Diet
- Monitor for fluid imbalances
- Observe bleeding disorders
Monitor:
o I/O, daily weights
o Electrolytes K+ especially will be impacted by a malfunctioning liver
o blood counts
Nursing Management:
- Rest
- No Alcohol, Aspirin, Acetaminophen and NSAIDs
- Low Sodium Diet
- Monitor for fluid imbalances
- Observe bleeding disorders
Cirrhosis Complications:
- _________ Hypertension
o Splenomegaly
o Ascites
o Varices - Hepatic Encephalopathy
o Due to build up of ammonia in circulation
o Ammonia crosses the blood brain barrier and produces toxic neuro effects (impaired thinking, asterixis, seizures, etc.) - Hepatorenal Syndrome
o When liver failure causes renal failure. Rare, but fatal. Due to renal vasoconstriction due to decreased arterial blood volume
- Portal Hypertension
o Splenomegaly
o Ascites
o Varices - Hepatic Encephalopathy
o Due to build up of ammonia in circulation
o Ammonia crosses the blood brain barrier and produces toxic neuro effects (impaired thinking, asterixis, seizures, etc.) - Hepatorenal Syndrome
o When liver failure causes renal failure. Rare, but fatal. Due to renal vasoconstriction due to decreased arterial blood volume
Portal HTN
Complication of cirrhosis; ___________ of blood flow going IN and OUT of the liver through the portal vein
Obstruction
Ascites - accumulation of serous fluid in the _________________
abdominal cavity
Ascites
Patho: __________ > Portal Hypertension > Excess fluid released intoperitoneal cavity
Cirrhosis
Ascites S/S:
* Abdominal __________
* Weight gain
* Umbilical eversion
* Abdominal striae (stretch marks)
* S/S of ____________ > why? Because so much fluid is accumulating in the abdominal cavity
o dry tongue & skin
o sunken eyeballs
o muscle weakness
o decreased urine output
- Abdominal distention
- Weight gain
- Umbilical eversion
- Abdominal striae (stretch marks)
- S/S of dehydration > why? Because so much fluid is accumulating in the abdominal cavity
o dry tongue & skin
o sunken eyeballs
o muscle weakness
o decreased urine output
Management of Ascites
o low _________ diet > help prevent the retention of fluid (remember water follows sodium)
o Diuretics > must closely monitor electrolytes (pt. will already be hypokalemic)
o ____________ : withdraw fluid from abdominal cavity. Sterile procedure preformed by physician at the bedside.
Pre Procedure:
o Consent form signed
o Pt has voided pre procedure
o Weight and measure abd. girth pre and post procedure
o Positioning pt high-fowler or lateral side-lying
Post Procedure:
o Assess for bleeding (poor clotting response with liver pts), fluid leak, bladder trauma
o Assess for S/S of hypovolemia (tachycardia, hypotension) post- procedure
o low sodium diet > help prevent the retention of fluid (remember water follows sodium)
o Diuretics > must closely monitor electrolytes (pt. will already be hypokalemic)
o Paracentesis: withdraw fluid from abdominal cavity. Sterile procedure preformed by physician at the bedside.
Pre Procedure:
o Consent form signed
o Pt has voided pre procedure
o Weight and measure abd. girth pre and post procedure
o Positioning pt high-fowler or lateral side-lying
Post Procedure:
o Assess for bleeding (poor clotting response with liver pts), fluid leak, bladder trauma
o Assess for S/S of hypovolemia (tachycardia, hypotension) post- procedure
PANCREAS
Exocrine Job: Aid in __________
* The pancreas secretes enzymes that are deposited into the small intestine, where
they are activated and used to further ____________ our food.
Exocrine Job: Aid in digestion
* The pancreas secretes enzymes that are deposited into the small intestine, where
they are activated and used to further breakdown our food.
_______________ - Nonbacterial inflammation that occurs when pancreatic enzyme secretion builds up and begins to digest the organ itself
Pancreatitis
GALLBLADDER
* Stores & secretes _____
* Bile helps to break up ______
* When food enters the SI, gallbladder is stimulated to contract and secrete bile into SI
- Stores & secretes BILE
- Bile helps to break up fats
- When food enters the SI, gallbladder is stimulated to contract and secrete bile into SI
Treatment of Varices
Goal: prevent rupture/bleeding
Screening: Esophagogastroduodenoscopy (EGD)
- Small scope travels down esophagus to look for varices
Medications: _____________ (nadolol or propranolol) used to decrease BP and thus portal pressure
Treatment of Varices
Goal: prevent rupture/bleeding
Screening: Esophagogastroduodenoscopy (EGD)
- Small scope travels down esophagus to look for varices
Medications: Beta-blockers (nadolol or propranolol) used to decrease BP and thus portal pressure
Hepatic Encephalopathy
Goal: Reduce ammonia formation
Medications:
* Lactulose: binds to ammonia and traps it, then it’s eliminated in feces. > Pt needs to be having bowel movements for this med to work! > Important to check K⁺ (problem is that K+ also binds to the drug)
- Antibiotic: ex: rifazimin. > Can prevent the absorption of gut-derived neurotoxins like ammonia. Aka decreases formation of ammonia in the gut.
Hepatic Encephalopathy
Nursing management:
- Monitor bowel movements
- Prevent and control gastric bleeding
- Lower _________ intake
(Protein in the diet) + (blood in the GI tract) = protein formation in the GI. > Protein formation leads to an increased ammonia level in the body > bad
- Monitor bowel movements
- Prevent and control gastric bleeding
- Lower protein intake
Cholelithiasis: Excess of cholesterol, bilirubin or bile salts that crystalizes in the gall bladder to form ____________. Common and __________usually (unless stone migrates to duct= obstruction)
Cholecystitis: An _____________ of the gallbladder occurs. Often due to gallstones in gallbladder.
Cholelithiasis: Excess of cholesterol, bilirubin or bile salts that crystalizes in the gall bladder to form gall stones. Common and harmless usually (unless stone migrates to duct= obstruction)
Cholecystitis: An infection of the gallbladder occurs. Often due to gallstones in gallbladder.
Cholelithiasis & Cholecystitis Risk Factors:
women, obesity, aging, family history, high cholesterol, pregnancy
women, obesity, aging, family history, high cholesterol, pregnancy
