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MCAI-FINALS--8
Liver
| Question | Answer |
|---|---|
| s/s of increase billirubin levels? | yellow tissues, skin, sclera, tea colored urine, bright sunshiny. |
| People with liver problem? | jaundice, mostly babies (increase in bilirubin) |
| what causes liver problem? | billiary system gets impacted |
| what is hemolytic jaundice? | liver overwhelmed, can not breakdown the RBC. |
| what are the causes of hemolytic jaundice? | Sickle cell crisis., xtransfusion reaction, hemolytic anemia. |
| what are different types of jaundice? | hemolytic, hepatocellular, and obstructive jaundice. |
| what is hepatocellular jaundice? | hepatocytes (liver cell) damage, liver unable to conjugate or excrete bilirubin from blood, increased conjugate and unconjugate biliruubin levels , excreted in urine (increase level of bilirubin). |
| whate are the causes of hepatocellular jaundice? | hepatitis, cirrhosis, cancer |
| unconjugated (indirect) | not water soluble. |
| conjugated (direct) | make brown color of stool. |
| conjugation process is interrupted | clay color stool. |
| lab for dx liver problem | total bilirubin, indirect and indirect level |
| what is obstructive jaundice? | decreased or obstruced flow through liver or biliary duct., intrahepatic, extrahepatic, |
| s/s of obstructive jaundice. | clay colored stool, elevated urine bilirubin, serum bilirubin elevated. |
| what intrahepatic | problem is outside the liver but inside the biliary system (gallblader or duct system freeway going to liver) , canaliculi, fibrosisor liver's bile ducts, swelling, (more on vessels problem) |
| what is extrahepatic? | common bile duct obstruction d/t stone, strictures, sclerosing cholangitis, pancreatic CA. |
| what is Hepa A and E | oral exposure to bacerial problem cause liver inflammation (food and water contaminated). |
| what is Hepa B and C | sexualy xmitted, shared needles, recaping used needles, bodily fluid (sweat, tears, breast milk, urine, saliva etc. |
| What vaccine for hepatitis? | HBV, immune globulin (IG) |
| what is Hepa C? | xmitted shared needles, revalent IV drug abusers, sexual xmitted. |
| what is Hepa D? | cannot survive on own, HBV reduce risk, weak virus, blood borne |
| what is hepa G? | weak virus, Xmitted blood, sexual xmitted, coexist with HBV, HCV, or HIV, bloodborne |
| what is the key to hepatitis? | prevention. |
| What hint that could possible tell that pt has HBV and HCV? | if pt is IV Drug abuse (IVDA) |
| Teaching for Hepa patients | isolate bathroom, good hygiene, test partner too d/t unprotected sex. |
| Hepatitis complications? | fulminant hepatic failure, chronic hepatitis, Cirrhosis, Hepatocellular carcinoma |
| What is fulminant hepatic failure? | acute type of liver failure, happens rapidly, associated with hepatic encephalopathy. Cause by taking drugs and drink alcohol. (acetaminophen, isoniazid, halothan, sulfa drugs, NSAIDS) accumulates toxics. |
| What is chronic hepatitis? | HBV, HBC - risk:pt start feeling better, they stop taking precaution. , |
| what is cirrhosis? | (autoimmune disease) chronic liver disease can be stop be can not be reverse., attributed to ETOH , HBV HCV. Destruction of liver parenchymal cell |
| what is hepatocellular carcinoma? | attributed to HBV HCV lead to cancer. |
| What can be done to pt with liver failure ? | liver can not be treated, so we can only treat the symptoms. Liver can not be healthy again. What kind of med they can take or avoid? Good education, can't take tylenol. If metabolize problem, antbx med may have to change. |
| True or false. HBV live longer than HIV outside the body? | TRUE |
| How can we dx hepatitis? | lab serum antibodies, LFT, albumin, serum bilirubin, Coagulant test (PT/INR) |
| Why do we need albumin test for liver related dx? | to see malnutrition problem. Folic acid, thiamin, |
| Why do we need PT/INR test for liver related dx? | liver damage may cause pt of bleeding. |
| How can RN manage pt with hepatitis? | nutrition, rest, banana bag (for jaundice pt, IV LR with types of multivitamin they need ), avoid alcohol, medications ( antiemetics, benadryl, reduce viral load/replication (interferon, ribavirin) |
| What are the non pharmacology tx fo hepatitis pt? | milk thistle, licorice root, ginger root |
| what does milk thistle do for hepatitis pt? | promote hepatocyte growth and reduce liver inflammation |
| what does licorice root do for hepatitis pt? | anti-inflammatory and antiviral properties (long term use not recommended) |
| what does ginger root do for hepatitis pt? | it is antiemetic. |
| what will happen to liver cell with cirrhosis? | Poor cellular nutrition and hypoxia, inadequate blood going to liver, scar tissue formation. |
| What are the complication of liver cell regeneration? | regenerative leads, new tissue are not functional. to abnormal blood vessel and bile duct struc. |
| Causes of cirrhosis | alcoholic, fatty diet, liver scar tissue, post necrotic tissue, cv-R side failure, billiary problem |
| s/s of cirrhosis | GI Symptoms and enlarge liver and spleen, jaundice, spider angiomas, hematologic disorder, endocrine disorder(gynocomastia-man w/ large breast d/t hormonal problem), peripheral neuropathy (hand/feet swollen d/t vit deficciency). |
| what are the complication s of cirrhosis? | portal hypertension with esophageal varices, gastric varices, peripheral edema, ascites, hepatic encephalopathy, and hepatorenal syndrome. |
| what is the major complication of cirrhosis | portal hypertension |
| what is portal hypertension | increased venous presure in the portal circulation. |
| What will happen if there is portal hypertension? | all veins connected to portal will back up.The portal veins are connected into liver, stomach (gastric varices), esophagus, spleen (splenomegally), anus(hemorroid), inferior vena cava (peripheral edema and ascites,3rd spacing),) |
| what are cirrhosis lab test? | LFT, Albumin test (nutrition test), serum bilirubin, cholecterol level, prothrombin levels, liver biopsy. |
| What will happen if blood is not going back to the heart d/t liver failure | cardiac output will increase |
| What will happen if there is a fluid leaking in the peripheral or ascites? | if blood cant get through the liver and then can't deliver the blood back to the heart, the vessels will start to leak out, protein leaks out – osmotic pressure pulls fluid out and fluid ends up in the periphery or peritoneal cavity (albumin leaks out). |
| What will happen if liver can't break down amonia into urea? | amonia stick on the blood. Elevate amonia level--> (change LOC -->COMA.) |
| How to manage liver failure? | Na restrict, diuretics, paracentesis, fluid restric, 25% albumin, peritoneovenous shunt, bleeding mgmt, TIPS procedure, medications. |
| what happened to albuminuria | too much protein in the urine. |
| what is the liver abnormal process from breaking down of protein into the urine. | normally, in the intestine protein break--> ammonia, then liver breaks ammonia --> urea. If there is a problem with liver, ammonia goes out to urine. |
| what is hepatic encephalopathy | high level of amonia causing problem with LOC and also COMA |
| what is hepatorenal syndrome | liver failure often times go to kidney failure. (d/t portal HTN, left cardiac ventricle do not deliver blood to kidney). Elevated serum creatine. |
| liver failure and kidney failure problem s/s | urine will be very dark (tea color) |
| Ascites management: | Na restriction, diuretics, and fluid removal (peritoneovenous shunt) |
| what is peritoneovenous shunt? | is a surgical procedure that provides continuous reinfusion of ascitic fluid into the venous system. The goal is to decrease Na and water. |
| esophageal and gastric varices management: | avoidance of bleeding and hemorrhage. Pt should avoid ingesting alcohol, aspirin, NSAIDs and irritating food, respiratory infection treat early and control cough. |
| What RN should do in case there is variceal bleeding? | stabilize pt, manage airway, IV thherapy maybe blood xfusion. |
| hepatic encephalopathy mgmt: | reduction of amonia formation (lactulose and antibx). Control GI bleeding, |
| what creates osmotic pressure in the blood stream | Salt Pour Albumin (25% Albumin ) by IV |
| gold standard management for cirrhosis pt. | Transjagular Intrahepatic Portosystemic Shunt (TIPS) portal bypass. |
| Nursing consideration for cirrhosis pt. | meds, no ambulation d/t H.ammonia level, s/s of bleeding, interpret lab, fluid mgmt (Na), treat tx, skin care, benadryl , I/O monitor, monitor urine, monitor size/complication abdomen (breathing problem), hob, turn on side, support men testicle d/t edema |
| causes of pancreatitis | billiary tract disease, alcoholism, gallblader disease, also associated with hyper TG, trauma, viral , cysts, abscesses , sx |
| s/s pancreatitis | abd pain (acute, severe, aggravated by eating), flushing, cyanosis, dyspnea (SOB), N/V, low fever, leukocytosis,jaundice, decrease bowel sounds, abd distention/rigidity, adventitious breath sounds |
| Complications of pancreatitis | pseudocyst, abscesses, pulmonary (pleural effusion, atelectasis, pneumonia), CV (hypotention, hypocalcemia) |
| what is pseudocyst? | cyst, fluid filled, around the pancrease, w/ contaminant/necrotic (toxic) product, if burst, peritonitis. |
| effect disease process of pancreatitis to calcium level? | low level of calcium, cause tremor, involuntary movement of muscle. |
| management of pancreatitis pt. | npo till s/s subside, etoh tx program, hemodynamic stability (monitor bp, monitor labs, respiratory status, S/S hypocalcemia, pain control, pulmunary system, antibx |
| what are the dx test for pancreatitis ? | serum amylase and lipase, LFT, WBC, Glucose monitoring, HLD, Ca level, Ultrasound, X-rays, ERCP, MRI |
| what are the lab reading of pt with pancreatitis? | elevated (serum amylase, serum lipase, Urinary amylase, Blood glucose, Serum TG) and low serum calcium |
| What is the normal range of Amylase | Amylase 53 - 123 units/L |
| What is the normal range of Lipase | Lipase 10 - 150 units/L |
| what are gallbladder disorders? | cholelithiasis, cholecystitis, and cholecystectomy |
| what are the causes? | pain resolve on its own, fatty good, spicy food, stones fill up gallblader (can cause perforation of gallbladder call edemphysematous cholecystitis), duct block |
| what are the s/s of gallblader disorder? | dyspepsia (n/v), bloating/abd distention, moderate to sever pain -radiating to back and shoulder, fever, diarrhea, jaundice, leukocytosis, dietary consideration. |
| complication of gallbladder disorder? | peritonitis |
| RN Dx for gallbladder disorder? | Ultrasound, ERCP, lab test, bilirubin est, LFT, Serum amylase (elevated because of involvement of the pancrease) |
| toradol, ketorlec | pain control for gallblader disorder and refered pain |
| how RN manage gallblader disorder? | pain control, antbx, fluid and electrolyte balance, treate tx, endoscopic mgmt, ESWL, low fat diet, sx, meds |
Created by:
rt-study
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