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NURS 2514 > Week 7 - Assessment, Study Questions, Meds > Flashcards

Week 7 - Assessment, Study Questions, Meds Flashcards

1
Q

define ascites

A
  • increased amt of fluid in the peritoneal cavity
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2
Q

define bile

A
  • fluid responsible for digestion of food, absorption of fats & fat soluble vitamins, and stimulation of peristalsis
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3
Q

define cholecystitis

A
  • inflammation of the gall bladder
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4
Q

define cholelithiasis

A

condition in which there are stones present in the gall bladder

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5
Q

define cirrhosis

A
  • scarring of liver tissue which interferes w normal liver function & results in structural changes within the liver
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6
Q

define hepatic encephalopathy

A

complication of liver cirrhosis caused by ammonia in the brain

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7
Q

define splenomegaly

A

enlarged spleen

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8
Q

define hepatitis

A
  • inflammation of the liver
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9
Q

define portal HTN

A
  • increase in pressure in the portal vein caused by obstruction or congestion
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10
Q

define steatorrhea

A
  • fatty stools
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11
Q

define varices

A
  • dilation of a vein that is tortuous
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12
Q

what is the fnxn of the hepatic portal vein

A
  • moves blood from the spleen & GI tract to the liver
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13
Q

how is bilirubin formed

A
  • from the breakdown of hgb
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14
Q

conjugated bilirubin is called…

A
  • direct
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15
Q

unconjugated bilirubin is called..

A
  • indirect
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16
Q

what causes jaundice

A
  • increase in bilirubin lvls
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17
Q

what causes prehepatic jaundice? is direct or indirect high

A
  • when RBC are destroyed at high rates & the liver cannot conjugate fast enough
    = high unconjugated bilirubin
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18
Q

what causes hepatic jaundice? what is elevated

A
  • when bilirubin cannot be conjugated due to liver disease

- high unconj & conj

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19
Q

what should we ask during PMHx for a liver assessment (3)

A

about anything that can damage the liver

  • alcohol
  • meds (such as tyenol)
  • fatty foods
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20
Q

what assessment findings will we find in a pt with prehepatic jaundice (3)

A
  • elevated unconj
  • amber urine
  • normal stool
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21
Q

what assessment findings will we find in a pt with hepatic jaundice

A
  • elevated unconj & conj
  • elevated liver enzymes
  • dark urine
  • pale or N stool
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22
Q

what assessment findings will we find in a pt with post hepatic jaundice

A
  • elevated unconj & conj
  • elevated liver enzymes
  • dark urine
  • pale stool
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23
Q

what should we assess during inspection of a liver assessment

A
  • skin, mucous membranes, and eyes for jaundice
  • color of the urine
  • color of the stool
  • fat in the stool
  • melena (due to varices, bleeding disorders)
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24
Q

what is the normal liver span

A

6-12 cm

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25
Q

is the liver typically palpable?

A
  • no
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26
Q

what kind of palpation is used for liver palpation?

A
  • deep
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27
Q

what quadrant is the liver found? spleen?

A
  • liver = RUQ

- spleen = LUQ

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28
Q

what are 3 types of diagnostics for hepatitis

A
  • viral serological tests
  • serum liver enzymes
  • liver function tests
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29
Q

what is included under viral serological tests

A
  • measures the viral antibodies & antigens
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30
Q

what is included under liver enzymes tests

A
  • AST & ALT

- ALP (or ALK) and GGT

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31
Q

what do liver enzyme tests tell us

A
  • do not differentiate between different types of hepatitis

- but can determine the type of liver injury

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32
Q

what does elevated ALT and AST indicate

A
  • liver cell injury
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33
Q

what does elevated ALP and GGT indicate

A
  • bile duct injury
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34
Q

what is included under liver function tests

A
  • serum albumin
  • serum bilirubin
  • prothrombine time
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35
Q

deteriorating liver function is demonstrated by which liver function test findings

A
  • increased bilirubin
  • increased bleeding time
  • decreased albumin
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36
Q

what liver function test findings is present during mild acute viral hep? viral hep with detectable jaundice?

A
  • mild acute = normal albumin, bilirubin, and INR

- jaundice = elevated bilirubin

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37
Q

what viral serological tests are used for hep A

A

anti HAV IgM = indicates acute infection

anti HAV IgG = indicates past infection

38
Q

what viral serological tests are used for hep B (4)

A
  • HBsAg = hep B surface antigen
  • anti HBs = antibody towards HBsAG = indicates immunity
  • anti HBc = indicated infection
    HBV DNA
39
Q

what viral serological tests are used for hep C

A
  • anti HCV = indicates either past OR current exposure

- HCV RNA = will confirm if the disease is active or not

40
Q

list 4 causes of hepatitis

A
  • drugs
  • chemicals
  • viral infections
  • autoimmune diseases
41
Q

what are the 3 phases of hepatitis

A
  • pre-icterus or incubation period
  • icteric
  • convalescent or post icterus
42
Q

which 2 types of hep can cause chronic injury

A

hep B & C

43
Q

list causes of hep A (5)

A
  • contaminated water
  • contaiminated food
  • poor sanitation
  • pooor hygeine
  • crowded conditions
44
Q

list 5 causes of hep B and C

A
  • blood products
  • tattoos/body piercings
  • contaminated needles
  • IV drug users
  • sexual intercourse
45
Q

which 2 types of hep have a vaccine

A

A & B

46
Q

what is NAFLD

A
  • non alcoholic fatty liver disease
47
Q

what is NAFLD characterized by? what can it lead to?

A
  • characterized by hepatic steatosis

- can progress to inflammation & scarring = NASH

48
Q

list 3 complications of NAFLD

A
  • cirrhosis
  • cancer
  • liver failure
49
Q

list symptoms of NAFLD

A
  • most have none
  • fatigue, malaise
  • abdominal discomfort in RUQ
  • enlarged liver & spleen
50
Q

what are 4 complications of hepatitis

A
  • inflammation
  • fibrosis
  • cirrhosis
  • liver failure
51
Q

what labs might you order for cirrhosis

A
  • K, Na
  • INR/PT
  • liver enzymes
  • total bili
  • glucose
  • ammonia
52
Q

why might a pt with cirrhosis be on a low sodium diet

A
  • to prevent worsening of edema
53
Q

why might a pt with cirrhosis be on a high protein, high cal diet

A
  • damage to the liver = stops storing glucose
    = if dont eat for few hours, body will start using ur muscle for energy
    = muscle wasting & malnourishment
    = high protein & cal to avoid
54
Q

why might a pt with cirrhosis be SOB

A
  • due to ascites = decreased expansion of lungs
55
Q

what is a paracentesis

A
  • removal of fluid from the abdomin
56
Q

what is a risk associated with paracentesis in someone who has cirrhosis

A
  • risk of bleeding
57
Q

why is an endoscopy used for for someone w cirrhossi

A
  • to detect varices
58
Q

what are ways to assess for ascites

A
  • fluid wave
  • “outie” belly buttin
  • striae
  • inspect for distension
59
Q

describe how fluid wave works

A
  • firmly strike the left flank

- and then with ascites, you will feel a distinct tap on the right hand (on the other side of the stomach)

60
Q

what are signs of hepatic encephalopathy

A
  • starts w insomnia & confusion
  • progress to lethargy
  • then coma
61
Q

what is the function of the gall bladder

A
  • to concentrate & store bile

- then release it to the duodenom when needed

62
Q

what is the gall bladder & bile important for

A
  • fat breakdown
63
Q

what are 2 diagnostic studies for cholelithiasis

A
  • US

- ERCP

64
Q

what are the benefits of US for cholelithiasis diagnossi

A
  • 90-95% accurate

- useful for those allergic to contrast medium

65
Q

what is ERCP

A

Endoscopic Retrograde Cholangiopancreatography

- a specialized endoscopic technique

66
Q

what is ERCP good for

A

allows visualization of:

  • gallbladder
  • cystic duct
  • common hepatic duct
  • common bile duct
67
Q

what are signs of cholelithliasis (4)

A
  • RUQ
  • steatorrhea
  • NV
  • shoulder discomfort (due to referred pain)
68
Q

what sign indicated cholelithiasis

A
  • murphy’s sign
69
Q

what is murphy’s sign

A
  • ask pt to axhale
  • place hand below costal margin on R side at mid clavicular line
  • ask pt to inspire
70
Q

what indicates a positive murphy’s sign

A
  • if the pt stops breathing in & winces with a “catch” in breath
71
Q

what blood work findings might you find in a pt with cholelithiasis

A
  • increased WBC due to inflammation
  • increased bili (direct and indirect)
  • increased liver enzymes
72
Q

describe how an ERCP works

A
  • fibre-optic endoscope is inserted thru the mouth to the descending duodenom
  • then CBD and pancreatic ducts are cannulated
73
Q

what are risk associated with ERCP

A
  • perforation & bleeding
  • infection
  • pancreatitis (abdom pain, NV)
74
Q

what is tetany

A
  • a condition that is due to low blood calcium

- characterized by spasms of the hands & feet, cramps, spasm of the voicebox (larynx) and overactive neuro reflexes

75
Q

what 2 signs indicate hypocalcemia

A
  • Trousseau sign

- Chvosek sign

76
Q

what is trousseau’s sign

A
  • when a blood pressure cuff is inflated & it causes the flexion of the hand
77
Q

what is Chvosek’s sign

A
  • tapping of the cheek causes abnormal rxn of the facial nerve
78
Q

what 2 signs indicate pancreatitis

A

grey turner’s & cullen’s

79
Q

what is grey turner’s sign

A
  • bruising of the flank
80
Q

what is cullen’s signm

A
  • bruising around the belly button
81
Q

what type of pain is present in pancreatitis

A
  • LUQ or mid epigastric that radiates to the back

- sudden, deep, piercing, continuous

82
Q

what causes aggravation of pancreatitis pain

A
  • eating

- recumbent position

83
Q

why would you want to manage / avoid constipation in a pt with liver cirrhossi

A
  • want to prevent build up of ammonia
84
Q

what is palmar eythema ? what causes it?

A
  • redness of the palms

- rt estrogen

85
Q

what kind of laxative may be used for hepatic encephalopagthy?

A

lactulose

86
Q

what does lactulose do?

A
  • enhances intestinal excretion of ammonia
87
Q

what are 2 side effects of lactulose

A
  • cramping & flatulence
88
Q

what is propanolol

A
  • nonselective beta blockers
89
Q

what can propanolol be used for?

A
  • liver cirrhosis
90
Q

what are some side effects of propanolol

A
  • bronchospasms

- hypotension

NURS 2514 (75 decks)

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