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Exam 4
Hepatitis/Cirrhosis/Pancreatitis/Renal/Endocrine
| Question | Answer |
|---|---|
| Hepatitis Incubation period | asymptomatic |
| Hepatitis Prodromal phase | mild flu-like symptoms, malaise, body aches, N&V |
| Hepatitis Icteric Phase | Jaundice, dry, itchy skin, RUQ pain, N&V, fatigue |
| Hepatitis Convalescent phase | Acute Hepatitis will begin to resolve and patient symptoms will improve |
| Hepatitis A | Acute Hepatitis; oral-fecal route caused by contaminated food/water |
| Hepatitis B | Can be acute (< 3 months) or chronic; spread via blood or sexual intercourse |
| Hepatitis C | Chronic and ends with liver failure; spread via blood/body fluids; leading cause of liver transplants |
| Hepatitis D | occurs ONLY concurrently with Hepatitis B; spread via blood/body fluids |
| Hepatitis E | Acute Hepatitis; oral-fecal route; primarily spread from contaminated water |
| Chronic Hepatitis | Hep B, D, or C: RUQ pain, fatigue, hepatomegaly. Leads to cirrhosis, liver cancer, and transplants |
| Fulminant Hepatitis | Rapidly progressing form; leads to liver failure within 3 weeks |
| Toxic Hepatitis | Caused by drug and alcohol use rather than a virus |
| Hepatobiliary Hepatitis | Caused by bile duct blockage rather than a virus |
| Manifestations of Hepatitis | Fatigue, muscle and joint pain, RUQ pain, hepatomegaly, jaundice, dry itchy skin, weight loss and anorexia, clay-colored stoll, bilirubin present in urine |
| Diagnosing Hepatitis | Liver Function Tests: elevated ALT, AST, and serum bilirubin. Viral antigen test & Liver biopsy |
| How long does the Icteric Phase of acute hepatitis last | 2-6 weeks |
| Medications for treating Hepatitis | Antiemetics, Antivirals, Immunomodulators, and Corticosteroids |
| Considerations for antiviral drugs | Epivir-HBV & Hepsera: RENAL TOXIC: monitor I&O's and risk of infection |
| Considerations for Immunomodulating drugs | Interferon & Ribavirin: Interferon is ONLY given IM or SQ |
| Diet considerations with Hepatitis | small frequent meals high in carbs & calories; low in fat. Lots of fluids and no alcohol |
| Preventing the spread of Hepatitis | Education on prevention & Vaccines for Hep A & B |
| Causes of liver cirrhosis | drugs & alcohol, biliary duct obstruction, severe R-sided heart failure & HTN |
| Pathophysiology of Cirrhosis | inflammation --> fibrous scar tissue --> decreased blood flow --> hypoxia --> cell damage --> nodular formation |
| Early manifestations of cirrhosis | hepatomegaly, fever, weight loss, RUQ pain, N,V |
| Later manifestations of cirrhosis | Jaundice, altered mental status, edema, leukocytopenia, esophageal varices |
| Portal HTN | Increased pressure in the portal vein due to reduced perfusion in the liver |
| Esophageal Varices | complex enlarged veins at the base of the esophagus causing increased risk of bleeding *life threatening |
| Cause of peripheral edema and ascites in cirrhosis patients | increased aldosterone & decreased albumin--> Na and H2O retention --> edema and ascites |
| Hepatic encephalopathy | ammonia accumulates in the body (the liver cannot turn ammonia into urea for excretion) and causes cerebral edema and altered mental status |
| Diet considerations for cirrhosis patients | Low Protein (body cannot convert protein byproduct into urea) |
| Early signs of hepatic encephalopathy | euphoria, depression, memory loss, and slowed speach |
| Late signs of hepatic encephalopathy | hyperventilation, hypothermia, asterixis (fine tremors of hands), coma |
| Hepatorenal Syndrome (HRS) | decreased perfusion to the kidneys commonly following diuretics, bleeding, or pancreatitis leads to acute renal failure and oliguria |
| Diagnosing cirrhosis | ultrasound, xray, biopsy (bleeding risk but needed for staging), liver function tests |
| Labs of the cirrhosis patient | elevated liver function tests (AST, ALT), watch albumin & protein levels, monitor ammonia levels, perform coagulation study (low clotting factors) |
| Meds for treating Cirrhosis | diuretics (edema), beta blockers (portal HTN), iron & folic acid & Vitamin K (risk of bleeding), antacids (esophageal varices), *Lactulose & Neomycin (excrete ammonia; encephalopathy) |
| Decreasing blood ammonia levels | Low protein diet & Lactulose & Neomycin |
| Managing Cirrhosis | Diet (low salt & protein), medications (HTN, edema, ammonia), prevent bleeding; symptom management (paracentesis to decrease ascites) |
| Treating Esophageal Varices | antacids: if bleeding: AIRWAY, vasopressor, blood, & Vitamin K; *NTG balloon puts pressure to stop the bleeding and decrease risk of aspiration |
| Esophageal Tamponade | due to esophageal varices the esophagus fills with blood causing risk of aspiration; use a NTG tube to provide pressure on the bleeding |
| Function of the pancreas | secrete digestive enzymes & produce insulin |
| Acute Pancreatitis | pancreatic duct obstruction (gall stone or inflammation) causes enzyme reflux and cell damage |
| Necrotizing Hemorrhagic Pancreatitis | Acute form; enzyme reflux causing necrosis of the blood vessels and inflammation. Risk of rupture & bleeding. Life-threatening |
| Signs of Acute Pancreatitis | sudden onset, severe RUQ pain radiating to back; N&V, decreased bowel sounds, tachycardia, jaundice, Turner's sign, & Cullen's sign |
| Turner's Sign | bruising in the flank area (Pancreatitis) |
| Cullen's Sign | bruising around the umbilicus (Pancreatitis) |
| Diagnosing Acute Pancreatitis | ERCP (scope of GI system), Xray, ultrasound (gall stones), CT, biopsy |
| Labs with Acute Pancreatitis | elevated liver enzymes, elevated ESR (inflammation), CBC (anemia) |
| Manifestations of Acute Pancreatitis | dehydration, inflammation, jaundice, edema, Hypoactive or Absent Bowel Sounds, abdominal pain (RUQ to back) |
| Chronic Pancreatitis | progressive destruction of pancreas; common causes include alcoholism and cystic fibrosis; occurs with remission and exacerbations |
| Manifestations of Chronic Pancreatitis | RUQ & LUQ pain, weight loss, N&V, gas, Steatorrhea (fatty stools) |
| Diet for patients with chronic pancreatitis | High protein, High calorie, Low fat diet |
| Treating Chronic Pancreatitis | During exacerbations: NPO, PCA pump, NG to suction, bowel rest, steroids (tx inflammation), IV fluids (lactated ringers), albumin (tx low protein), Dopamine (tx low BP & edema) |
| Pancreatic Abscess | life-threatening; causes fever & pain, if it ruptures infection will spread & bleeding. MUST be drained AND treated with antibiotics |
| Whipple procedure | remove part of the pancreas & small intestine, and gall bladder; reconnect duct, pancreas, and small intestine to work more efficiently |
| Pre-op interventions: Whipple | NPO, NG to suction, TPN started |
| Renal Labs | BUN/Creatinine, B:C ratio, GFR, BMP (Na, K, Ca, Ph) RBC (anemia), UA |
| Use of contrast dye with renal patients | CT contrast dye is renal toxic and can send the patient into renal failure. |
| Acute Renal Failure | rapid decline in renal function commonly caused by Ischemia. |
| Azotemia | nitrogen waste products present in the blood (measured with BUN) |
| BMP of acute renal failure | Hyperkalemia (peaked T wave, muscle spasms, fatigue), Hypocalcemia (tetany, trusseu's, chektevak's), Hyponatremia (confusion) |
| Pre-Renal Acute Renal Failure | Results from decreased blood flow to kidneys (hypovolemia, ischemia) |
| Intrinsic Acute Renal Failure | Damage within the kidney causing decreased function (infection, injury, glomerulonephritis) |
| Post-Renal Acute Renal Failure | Obstruction preventing renal drainage (stones, inflammation, prostate issues) |
| Acute Tubular Necrosis | destruction of renal tube epithelial cells causing decline in renal function; caused from ischemia (dead cells clog the kidneys) |
| Stages of Acute Renal Failure | Initiation (asymptomatic), Maintenance (edema, oliguria, decreased GFR, metabolic acidosis, hyperkalemia, hypocalcemia, anemia, confusion), Recovery (gradual improvement) |
| Manifestations of Acute Renal Failure (Maintenance) | decreased GFR, Metabolic acidosis, Hyperkalemia, Hypocalcemia, Hyponatremia, confusion, peaked T waves, tetany, edema, oliguria, anemia, fluid retention |
| Diagnosing Acute Renal Failure | BUN/Creatinine, GFR, UA, BMP, renal ultrasound |
| Treating Acute Renal Failure | Fluid challenge, Dopamine (small doses causing renal dilation), ACE-inhibitors (vasodilation), Dextrose & Insulin or Kayelxelate (tx hyperkalemia), Calcium, Aluminum Hydroxide (binds phosphorous) |
| Diet considerations for renal patients | low sodium, possible fluid restriction |
| Chronic Kidney Disease | kidneys cannot excrete wastes lasting more than 3 months; common causes: diabetes, HTN, nephron damage |
| Manifestations of Chronic Kidney Disease | uremia, fatigue, confusion, hematuria, proteinuria, hyperkalemia, hypocalcemia, chronic metabolic acidosis, HTN, edema, and anemia |
| Diagnosing Chronic Kidney Disease | UA, BUN/Cr, GFR, BMP, ultrasound & biopsy |
| Treating Chronic Kidney Disease | diuretics, fluid restriction, Ace-inhibitors, Sodium Bicarb (tx acidosis), Dialysis |
| Dialysis considerations | dialysis cannot pull off phosphorous. Use Phosflo to bind phosphorous in the blood. Dialysis will be 3-4 times a week lasting 3-4 hours each time. |
| Hemodialysis | cleans the blood with a machine using a blood bath with semi-permeable membrane. Complications: bleeding & hypotension. Accessed via fistula. |
| Continuous Renal Replacement therapy (CRRT) | slow version of hemodialysis for ICU patients who cannot tolerate abrupt fluid balance changes. |
| Considerations for fistulas and subclavian dialysis lines | they are loaded with anticoagulants (Do Not Flush), No BP or IV on affected arm. |
| Peritoneal Dialysis | Patient does at home by instilling fluid into abdominal cavity and draining off waste later. Complications: fluid is high in dextrose (risk of hyperglycemia and INFECTION) |
| Ambulatory versus Cyclic Peritoneal Dialysis | ambulatory: fluid in the morning and drain about 6 hours later; cyclic: fluid before bed, machine drains off through the night. |
| Manifestations of Hyperthyroidism | increased appetite, weight loss, heat intolerance, insomnia, palpations, hair loss, sweating, goiter, blurred vision |
| Labs with Hyperthyroidism & Graves Disease | TSH will be low and T3 & T4 will be really HIGH |
| Graves Disease | autoimmune disorder that binds TSH causing thyroid hyperfunction |
| Manifestations of Graves Disease | Goiter, Proptosis (bulging eyes), exophthalmos (fluid around eyes), pretibial myxedema (nodules on tibia) |
| Causes of Hyperthyroidism | Tumor, Pituitary malfunctions, Thyroiditis |
| Symptoms of Thyroid Crisis | High fever, Tachycardia, Systolic HTN, N&V, Confusion (altered mental status), and Cardiac Complications |
| Diagnosing Hyperthyroidism | TSH will be low; T3/T4 will be high |
| Treating Hyperthyroidism | Medications (antithyroid meds), radioactive iodine, surgery |
| Considerations with radioactive iodine for hyperthyroidism | destroys partial thyroid cells; pre-medicate with potassium iodine to slow thyroid function. (Potassium Iodine: no shellfish allergy, increases bleeding) |
| Antithyroid Medications | Tapazole & PTU: increases risk of bleeding; takes 12 weeks to kick in |
| Thyroidectomy | subtotal or total removal of the thyroid; treat with thyroid replacement hormone afterwards |
| Nursing interventions for hyperthyroidism | cool environment, protect eyes (sunglasses and eye drops), daily weight, high protein and carb diet |
| Primary vs Secondary Hypothyroidism | Primary: defect or loss of thyroid function; Secondary: problem with pituitary secretions or peripheral absorption |
| Manifestations of Hypothyroidism | Goiter, fluid retention, weight gain, constipation, dry skin, edema, bradycardia, Low Sodium, confusion, depression |
| Causes of Hypothyroidism | iodine deficiency, Hashimoto's Thyroiditis |
| Hashimoto's Thyroiditis | autoimmune disorder where the body attacks its own thyroid cells |
| Myxedema Coma | life threatening complication of untreated hypothyroidism. Hypoglycemia, Hyponatremia, Metabolic acidosis, cardiovascular problems leading to coma |
| Treating Hypothyroidism | thyroid hormone replacement: Synthroid (take on empty stomach with glass of water) |
| Hyperparathyroidism | increased PTH disorder primarily affecting bones and kidneys and causing high calcium levels |
| Primary, Secondary, Tertiary Hyperparathyroidism | Primary: PTH and calcium imbalance; Secondary: chronic low calcium leads to increase PTH; Tertiary: body is insensitive to serum calcium usually from chronic kidney disease |
| Manifestations of Hyperparathyroidism | bone fracturs, muscle weakness & atrophy, altered renal function, Metabolic acidosis, arrhythmia, kidney stone formation, constipation, and peptic ulcers. |
| Diagnosing Hyperparathyroidism | rule out other causes of Hypercalcemia |
| Treating Hyperparathyroidism | GOAL: decrease calcium; Aredia, Fosamax & Zometa (reduces calcium reabsorption), Calcitonin (given IM/SQ to reduce plasma calcium) fluids, and staying active |
| Hypoparathyroidism | Low PTH due to damage or removal or parathyroid glands causing hypocalcemia and hyperphosphatemia |
| Manifestations of Hypoparathyroidism | numbness & tingling, tetany, trusseu's & chvostek's sign, arrhythmias, psychosis, increased intracranial pressure |
| Treating Hypoparathyroidism | IV calcium gluconate, supplemental calcium and vitamin D |
| Cushing's Syndrome | excessive circulating cortisol (ACTH) caused from cancerous tumors, benign secreting tumors, small-cell lung cancer, or long-term corticosteroid therapy |
| Manifestations of Cushing's | weakness, osteoporosis, thin skin, striae, mood swings, HTN, peptic ulcers, Hypokalemia, Hypernatremia, slow wound healing, moon face, easy bruising, buffalo hump, hyperglycemia |
| Diagnosing Cushing's | Plasma cortisol levels, plasma ACTH, 24h urine |
| Medications for treating Cushing's Disease | Mitotane (suppress adrenals), Aminogluthemide, Ketoconazole (inhibit cortisol synthesis) & Somatostatin (depresses ACTH) |
| Treating Cushing's Disease | surgery to remove adrenals, pituitary, or tumors, radiation if cancerous, medications for management |
| Addison's Disease | Results from Adrenal Insufficiency; caused from pituitary tumors, trauma, sepsis, sudden stopping of cortisol medications, or autoimmune process |
| Manifestations of Addison's Disease | slow wound healing, postural HTN, lethargy, confusion, mood swings, N,V&D, Hyperkalemia, Hypoglycemia, Hyponatremia, loss of blood volume due to aldosterone deficiency causing excess sodium and water loss |
| Diagnosing Addison's Disease | Serum cortisol (low), blood glucose (low), Plasma ACTH (high/low), Potassium (high), BUN (high), CT scan |
| Addison's Crisis | life-threatening: Hypotension, Fever, Severe V&D, Shock and Coma |
| Treating Addison's Disease | Coritcosteroid and Mineralcorticoid replacement therapy (Cortef & Florinef) |
| SIADH (inappropriate ADH Secretion) | Posterior Pituitary Disorder caused by tumor, head trauma or water retention causing excessive release of ADH |
| Manifestations of SIADH | Water retention, increased & diluted blood volume, weight gain with no edema, Hyponatremia, Hyperkalemia |
| Treating SIADH | Diuretics, Sodium replacement, treat hyperkalemia (insulin & dextrose or kaylexelate), fluid restriction, *Declomycin (creates urine flow) |
| Diabetes Insipidus | Low ADH levels & renal system becomes insensitive to ADH absorption |
| Manifestations of Diabetes Insipidus | LARGE amounts of DILUTE URINE, Polyuria, Polydipsia, Dehydration, Hypernatremia, Hyperosmolarity of the blood with dilute urine |
| Treating Diabetes Insipidus | IV Hypotonic solutions, Increase fluids, Replace ADH hormone, correct underlying issue (renal/pituitary gland damage) |
Created by:
jperrault9941
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