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3910 Health Promotion & Caring: Client's with Health Challenges I > Week 11 Hepatic > Flashcards

Week 11 Hepatic Flashcards

1
Q

Liver Key Functions

A
  • Metabolism
  • Storage (carbs & fats)
  • Detoxification
  • Bile production
  • Clotting factors
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2
Q

Gallbladder

A
  • Associated with anything (chole)
  • Storage unit for bile
  • Can live without one
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3
Q

Bile

A
  • Dark green/yellow fluid
  • Produced by liver
  • Stored & concentrated in gallbladder
  • Makes stool brown & emesis yellow
  • Contains water, electrolytes, fatty acids, cholesterol, bile salts, bilibrubin
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4
Q

Exocrine

A
  • Amylase - CHO (carbs)
  • Trypsin - proteins
  • Lipase - fats
  • HCO3 - increase pH
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5
Q

Endocrine

A
  • Glucagon - increase blood glucose
  • Insulin - decrease blood glucose
  • Somatostatin - slightly increase blood glucose
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6
Q

Liver Stress

A

Causes inflammation which damages hepatocytes

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7
Q

Liver Necrosis

A

Causes poor perfusion which destroys hepatocytes

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8
Q

Liver Fibrosis & Scarring

A

Tissue is replaced & abnormal lobules are created
Irreversible

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9
Q

Hepatocyte Damage/Destruction

A
  • Can’t filter, store, absorb
  • Waste buildup
  • Increase pressure through CV system
  • Poor nutrition
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10
Q

Disrupted Liver Perfusion

A
  • Blood can’t move through hepatic vessels
  • Pressure increase in hepatic vessels
  • Pressure backs up into GI system
  • Results in varices, bleeding, ruptures
  • Fluid moves into extracellular space - edema ascites
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11
Q

Disrupted Production of Albumin

A
  • Fluid not retained in intravascular space
  • Fluid moves to extracellular space
  • Results in edema, ascites
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12
Q

Increased ALT & AST

A

Normal liver enzymes leak into blood from damaged cells

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13
Q

Increased Ammonia

A
  • Decreased filtration
  • Waste product, neruo changes, itchy skin, GI changes
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14
Q

Increased Bilirubin

A
  • Decreased filtration
  • Jaundice
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15
Q

Increased PT & Decreased Platelets

A
  • Decreased clotting factor production
  • Role of spleen
  • Bleeding
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16
Q

Decreased Hemoglobin & WBCs

A
  • Blood loss
  • Role of spleen
  • Bleeding & infection risk
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17
Q

Lipids

A
  • Fatty deposits
  • Atherosclerosis
  • Increased cholesterol
  • Increased LDLs
  • Decreased HDLs
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18
Q

Ascites

A

Abnormal buildup of fluid in peritoneal space

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19
Q

Ascites Causes

A
  • Hepatic portal hypertension
  • Increase aldosterone
  • Decrease albumin
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20
Q

Ascites S&S

A
  • Increase abdominal girth
  • Weight gain
  • Abdominal discomfort
  • SOB
  • Fluid/electrolyte imbalances
  • Umbilical herniation
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21
Q

Ascites Management

A
  • Nutritional therapy - low Na diet
  • Pharm therapy - diuretic, IV albumin
  • Paracentesis
  • Transjugular intrahepatic portosystemic shunt (TIPS)
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22
Q

Albumin 5% & 25% Major Uses

A
  • Volume expansion & diuresis
  • Ascites & bacterial peritonitis - 25%
  • Hepatorenal syndrome - 25%
  • Plasma exchange procedures - 5%
  • Edema management - most common
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23
Q

Paracentesis

A

Procedure to drain ascites fluid from abdomen

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24
Q

Norfloxacin

A
  • Antibiotic
  • Fluoroquinolone
  • Treat infection
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25
Q

Norfloxacin Side Effects

A
  • Headache
  • Nausea
26
Q

Norfloxacin Nursing Considerations

A
  • Adverse effects: tendon rupture, seizures
  • Take drug at same time everyday
27
Q

Transjugular Intrahepatic Portosystemic Shunt - TIPS

A
  • Treatment for ascites - frequent paracentesis
  • Tract creased between higher-pressure portal vein & low pressure hepatic vein
  • Increase portal venous pressure
  • Decrease ascites
28
Q

Esophageal Varices

A
  • Enlarged & additional veins with poor integrity in stomach & esophagus
  • GI bleeding risk
  • Can be emergency - size of bleed
29
Q

Esophageal Varices - Nursing Management

A
  • Monitor for S&S of GI hemorrhage
  • Administer clotting factors
  • Pharm therapy - beta blocker
  • Endoscopy & banding
  • TIPS
30
Q

Phytonadione - Vitamin K

A

Supports liver in generating clotting factors

31
Q

Phytonadione Side Effects

A

Decreased appetite

32
Q

Phytonadione Nursing Considerations

A
  • Avoid with anticoagulants, NSAIDs, ASA
  • IV admin for acute bleed
  • Oral admin with bile salts to increase uptake
33
Q

Esophageal Banding Therapy (Ligation)

A
  • Treats varices
  • Endoscope loaded with rubber bands wrap varices
34
Q

Hepatic Encephalopathy

A
  • Brain dysfunction caused by liver dysfunction
  • Depression of CNS
  • Neuro changes
35
Q

Hepatic Encephalopathy Causes

A
  • Elevated ammonia levels
  • Increased GABA
  • CNS depression
36
Q

Hepatic Encephalopathy S&S

A
  • Lethargy/confusion
  • Disturbed sleep (insomnia/sleepy during day)
  • Asterixis
  • Difficulty handwriting
  • Hyperactive deep tendon reflexes
  • Flaccidity
  • Coma
37
Q

Hepatic Encephalopathy Nursing Management

A
  • Lactulose
  • Antibiotics
  • Low protein diet (avoid animal products)
  • Monitor vitals, ammonia, resp depression
38
Q

Lactulose

A
  • Laxative
  • Sugar
  • Promotes elimination by pulling water into colon
  • Removes ammonia from GI by drawing into colon
39
Q

Lactulose Side Effects

A
  • Bloating
  • Cramping
  • Gas
  • Diarrhea
40
Q

Lactulose Nursing Considerations

A
  • Loose stools
  • Increase # of stools/day
41
Q

Rifaximin (Zaxine)

A
  • Antibiotic
  • Rifamycin
  • Breaks down bacteria in colon to prevent ammonia production
42
Q

Rifaximin Side Effects

A
  • Dizzy
  • Not absorbed well by body = few side effects
43
Q

Pancreatitis

A
  • Inflammation of pancreas
  • Acute or chronic
  • Can lead to autodigestion of the pancreas
44
Q

Pancreatitis Causes

A
  • Excessive EtOH use
  • Viral/bacterial infections - mumps
  • Gall stones obstruction of ampulla of vater
  • Trauma, tremors
  • Hypercalcemia, hyperchloesterolemia
  • Cystic fibrosis
45
Q

Pancreatitis Risk Factors

A
  • Mumps
  • Gull stones, tumours
  • Cystic fibrosis
  • Smoking, alcohol
46
Q

Pancreatitis Pain Assessment

A
  • LUQ mid epigastric - under rib
  • Can refer to back on left side
  • Pain worse when laying down
  • Pain better sitting up & bent forward
  • Pain can be worse with eating/drinking
47
Q

Cullen’s Sign

A
  • Bruising around umbilicus
48
Q

Grey Turner’s Sign

A

Bruising of flanks (between last rib & hip)

49
Q

Pancreatitis CV Assessment

A
  • Hemodynamic instability
  • Increase HR with pain
  • Decrease BP with dehydration & bleeding
50
Q

Pancreatitis Integ Assessment

A
  • Cullen’s sign
  • Grey Turners sign
51
Q

Pancreatitis Labs

A
  • Increase amylase & lipase
  • Increase glucose - no insulin production
52
Q

Opioids

A
  • Analgesics
  • Treat pain
53
Q

Opioids Side Effects

A
  • Drowsy
  • Dizzy
  • Pruritis
  • N&V
  • Constipation
54
Q

Opioids Nursing Considerations

A
  • Monitor RR
  • Increase OD risk with older age
  • Existing renal/hepatic dysfunction
55
Q

Cholecystitis

A
  • Inflammation of gall bladder
  • Can be complication of liver/pancreas dysfunction
56
Q

Cholecystitis Causes

A
  • 80% caused by gall stones
  • Bile flow obstruction
57
Q

Cholecystitis Risk Factors

A
  • Gall stones
  • Sickle cell disease
  • Smoking, alcohol, obesity
58
Q

Cholecystitis Pain Assessment

A
  • RUQ - under rib
  • Can refer to back right side
  • Lower part of scapula
  • Worse with eating/drinking
  • Constant or colicky
59
Q

Cholecystitis GI Assessment

A
  • Pain location, tenderness, guarding on palpation
  • N&V
  • Avoids deep breathing
60
Q

Cholecystitis Physical Assessment

A
  • Jaundice, pale stool, impaired vitamin absorption - liver
  • Fatty stools - pancreas
61
Q

Murphy’s Sign

A
  • Finding for acute cholecystitis
  • Ask client to take & hold deep breath
  • Palpate right subcostal area
  • Pain on inspiration when hand palpates gallbladder = positive
62
Q

Increased Bilirubin S/S

A
  • Clay colour stool
  • Jaundice

3910 Health Promotion & Caring: Client's with Health Challenges I (15 decks)

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