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Diseases & Meds
Nur 270 Final Exam Material
Question | Answer |
---|---|
Cirrhosis s/sy | R?T stage disease anorexia GI Upset, wt loss abd fullness, abd pain weakness, fatigue, malaise anemia, bleeding low grade fever, infection jaundice, pruritis, hepatomegaly hypoglycemia, hypokalemia, edema |
Portal HTN s/sy | varices, altered LOC, dyspnea encephalopathy, hepatomegaly, ascities caput medusa hyperplenism palmar erythema jaundice, spider telangiectasia gynocomastia varices |
Hepatic Encephalopathy: Stage 1 | inappropriate behavior personality changes euphoria depression confusion slurred speech |
Hepatic Encephalopathy: Stage 2 | drowsiness lethargy incontinence asterixes (hand flapping) |
Hepatic Encephalopathy: Stage 3 | supor disoriented incoherent speech |
Hepatic Encephalopathy: Stage 4 | coma |
Cirrhosis: Stage A | compensated--not too sick |
Cirrhosis: Stage B | beginning to decompensated; complications beginning to appear |
Cirrhosis: Stage C | decompensated--end stage |
Cirrhosis: Diagnostic Testing | Lab Liver Bx CT Scan Hepatobillliary Scan Hepatoportography MRI NH3 15-45 mg/dl conventional |
Cirrhosis: Lab Variances | low WBC low RBC low platelet counts elevated serum billirubin elevated liver enzymes low serum albumin prolonged clotting time low clotting factors |
Liver Biopsy | Consent check PT/PTT bleeding time platelet count position w/ right side down after post procedure: s/s of bleeding/shock, Vitals, H/H |
Corticosteroids | +/- azathioprine for autoimmune |
Interferon | w/ viral hepatitis |
Lactulose | lowers pH of colon inhibits diffusion of ammonia from colon to blood increases water content of stools laxative effect |
Neomycin | 2nd line drug destroys intestinal floral that breakdown protein to ammonia risk of nephrotoxicity and ototoxicity w/ longterm use |
Metronidazole (flagyl) | 2nd line drug avoid alcohol (antabuse effect) |
Aldactone | potassium-sparing dieuretic |
Ritalin | used for chronic fatigue |
Esophageal Varices: RX | life threatening--ABCs bleeding soft diet pharmacological rx temp. balloon tamponade of varices endoscopic sclerotherapy variceal ligation or banding Transjugular intrahepaticportacaval shut surgery (TIPS) portal systemic shunt surgery blood tran |
Vasoactive agents | safer than ballon tamponade Examples: glypressin, samatostatin, octreotide, vasopressin w/NTG reduces azygos blood flow Bolus of 50 mcg followed by 50 mcg/hr infusion x 5 days |
Octreotide | used in place of vasopression & NTG; safer and fewer SEs |
Vasopressin | "Vascular-press" SE: chest pain, stimulate severe clotting factors anti-deuretic effects monitor for increased clotting |
Hepatic Coma: RX | safety protein--no aggressive protein restriction pt can tolerate 1 to 1.5g of protein/day remove nitrogenous load from intestine lactulose, neomycin (short term, flagyl don't stop lactulose bc pt is having diarrhea |
Colorectal Cancer: RIsk Factors | age, family hx, ethnic background (Jews) IBD or polyps high fat &/or low fiber diet inadequate fruits and veggies smoking high etoh consumption obesity physical inactivity long-term insulin use night shift work |
Hereditary Nonpolyposiscolorectal Cancer (HNPCC): Amsterdam Criteria | At least 3 relatives have CRC 2 successive generations are involved 1 of these relatives had CA younger than 50 at least 2 of the people are 1st degree relatives |
Bethesda Criteria | determines if pt with CRC should have CA tested for microsatelite instability (MSI) |
Hereditary Nonpolyposiscolorectal Cancer (HNPCC): Bethesda Criteria | person younger than 50 person with another CA asso. w. HNPCC 1st degree rel. not dx with Pt younger than 60 & CA has certain charac. w/ MSI 1st degree relative dx w. non-CRC often seen w. HNPCC pt has >2 2nd degree relatives who have HNPCC related t |
Familial Adenomatous polyposis (FAP) | 1% of all polyps 100s-1000 of polyps avg age of onset 15 100% lifetime risk of CRC Segmoidoscopy q2yrs from 10-40, q 3-5 yrs if polyps: subottal colectomy w/ IAA FAP associated CAs--thyroid, brain, liver |