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i'm stil liver dsrdr
Pancreas Jam
| Question | Answer |
|---|---|
| Degenerative disorder of the liver from generalized cellular damage. | cirrhosis |
| parenchyma degenerates. Lobules are infiltrated with fat. Restriction of blood flow Hepatomegaly and liver contraction. | pathophysiology |
| what happens in cirrhosis | Disturbances in digestion and metabolism. Reduced protein synthesis. Defects in blood coagulation. Defects in fluid/electrolyte balance. |
| ascites | Ascites-accumulation of third spaced fluid and albumin in the abdomen. |
| Destruction Inflammation Fibrotic regeneration Hepatic insufficiency | stages of liver cirrhosis progression |
| types of cirrhosis | Laennec’s, Post necrotic, Biliary Primary, Biliary Secondary, Cardiac |
| :) Laennec's | Laennec’s – ETOH abuse/protein deficiency. |
| Post necrotic | Post necrotic – post viral/toxin damage |
| Biliary Primary | destruction of bile ducts |
| Biliary Secondary | chronic bile retention after obstruction or infection of the major extra- or intrahepatic bile ducts |
| Cardiac | increased portal hypertension r/t R sided CHF. |
| s/s cirrhosis | Anorexia Nausea & vomiting Indigestion Diarrhea or constipation Abdominal pain Tissue wasting Weight loss Peripheral edema Abdominal distention Dyspnea Splenomegaly Bleeding |
| early subjective symptoms of /cirrhosis | -N&V -Loss of appetite -Fatigue -dyspepsia |
| late subjective symptoms of cirrhosis | More intense -Dyspnea -Severe fatigue |
| early objective signs of cirrhosis | Anemia -Fever -Jaundice Weight loss |
| late objective signs of cirrhosis | Epistaxis -Ascites -Coagulopathy, hemorrhage Disorientation |
| Diagnostic labs | Elevated liver enzymes. Decreased serum albumin. Elevated ammonia. Decreased glucose. Abnormal CBC. Prolonged PT. Abnormal urinalysis. |
| dx findings | ERCP - Endoscopic Retrograde Cholangiopancreatography Esophagoscopy with barium Scans and Biopsy Ultrasound Paracentesis-fluid from peritoneum |
| jaundice | Yellowish discolation of tissues caused by abnormally high level of bilirubin in blood |
| more clinical manifestations for cirrhosis?... really> | Clay colored stools. Deep orange color urine Visible jaundice(eyes, skin) |
| med mgmg | Decrease buildup of fluids HOB elevated 500-1000cc fluid/1-2g Sodium restriction Daily weights Strict I&O’s |
| more med mgm | Diuretics Aldactone{ Na+,CL-; K+} Lasix Hydrodiuril Na+ poor albumin infusions |
| strategy becomes prophylaxis of further damage... how | Eliminate ETOH Monitor liver function(labs) for drug toxicty Calorie/carbs diet[Vit K,C, folic acid] Fat/Na+; protein restriction (only in acute hepatic encephalopathy) Banana bag! |
| pot complications | Abdominal organ perforation Wound infection Bladder puncture |
| paracentesis 12 steps | My name is_______ and I am addicted to paracentesis. I will:Position-High Fowlers Fluid removal 30-90 min!!! Monitor patient for hypovolemia and electrolyte imbalance Monitor for bleeding/drainage No more than 1-1.5L of fluid prevents sudden hypotn |
| Leveen | One way valve moving fluid from peritoneal cavity to superior vena cava |
| complications | Hemodilution Pulmonary edema/CHF Wound infection, peritonitis, septicema Occlusion of shunt by thrombus |
| prevention of bleeding | -Vitamin K - vasopressin (sometimes -FFP used with NTG, why? |
| prevent complications | v |
| -Airway-aspiration/bleeding risk -IV x2 large bore(18G) -Vasopressin: Potent vasoconstrictor into Vena Cava or IV -Gastric Lavage -Sengstaken-Blakemore tube -Surgical shunting-around the liver | med emergent mgmg |
| hepatic encephalopathy | CNS manifestation of liver failure often leads to coma or death. Liver is unable to breakdown ammonia and it accumulates in the blood. Ammonia crosses blood-brain barrier; interferes w/neurotransmission, brain metabolism. |
| S/S HE | inappropriate behavior, disorientation, flapping tremors (Asterixis ), twitching extremities stupor, coma |
| therapy goal | Reduce blood ammonia levels. Reduction of protein in diet. Lactulose Give antibiotics Maintain Fluids/Electrolytes |
| nursing interventions | Monitor for hemorrhage Monitor fluids/electrolytes Provide appropriate; adequate nutrition Provide meticulous skin care Monitor mental status changes & report Teach & assess understanding of contributing factors(ETOH) |
| heap of tits | May be acute or chronic. Seven types(A,B,C,D,E,F & G). Distinguished by their mode of transmission and incubation period. |
| Hep C | 2 weeks-6 months incub. Transmission via needle sticks; blood transfusions |
| Hep B | Serum(old name) 28-160 days incub. Contact w/ blood &body fluids |
| Hep A | A Most common. 10-40 days incub. Direct contact of fecal content via H20 &food |
| clinical subjective m/b | General Malaise -Headaches/Chills -Photophobia -RUQ discomfort; N&V -Diarrhea & Constipation -Pruritis |
| clinical objective m/b | Jaundice -Pruritis -Dark, amber urine -Clay-colored stools -Hepatomegaly w/lymphadenopathy -Weight loss -Rhinitis |
| HEP A: incubus | Most common. 10-40 days incub. Direct contact of fecal content via H20 &food |
| HEP B In que | B Serum(old name) 28-160 days incub. Contact w/ blood &body fluids |
| HEP C ink | C 2 weeks-6 months incub. Transmission via needle sticks; blood transfusions |
| HEP D incubation | D(Delta) Contact of blood/body fluids 2-10 weeks incub. May progress to cirrhosis/ Chronic hepatitis |
| HEP E Nintendo Cube | E(Enteric non A/non B) 15-64 days incub. Fecal contamination of H20-poor sanitation & H20 quality |
| clinical diagnosis | Bilirubin, LFT’s Prolonged PT Leukopenia & Hypoglycemia Serum examined for HAA(A,B,C,D,G) Electron microscope for Hepatitis F No available test for Hep E |
| TX of hepatitis | No specific treatment other than supportive for S/S Prevention of transmission Bedrest for several weeks No ETOH x 1 year! Avoid sedatives Low Fat/High Carb w/vitamin supplement(C,B,K) |
| Hep A vaccine | Children 2 – 18 years: 0.5ml IM (pediatric formulation, repeated 6 – 12 months later. Adults: 1 ml IM, followed by 1 ml IM 6 – 18 months later (adult dose form) |
| Hep A vaccine contradictions | Hypersensitivity to alum Hypersensitivity to 2-phenoxyethanol Acute febrile illness (pediatrics) |
| Hep A S/E | Local soreness Headache |
| Hep B vaccine | 3 doses of 1 ml IM, given at 0, 1 – 2, and 4 – 6 months. |
| Hep B contraindications | Anaphylactic allergy to yeast |
| Hep B S/E | Local soreness |
| prevention of hepatitis | Good sanitation & personal hygiene Effective sterilization procedures Careful screening of food handlers/blood products |
| nursing interventions for hepatitis | Ensure rest Maintain adequate nutrition Provide fluids Skin care Prevent further transmission STANDARD PRECAUTIONS Teach/assess understanding of modes of transmission, prevention, S&S Patient education Prognosis |
| Hep A | A-Recovery high Mortality: 0.5% |
| Hep B | B-Most serious forms of hepatitis; Long-term health effects Mortality: 10% |
| Hep C | C-Progresses to Hepatitis, Cirrhosis,Liver CA, Death |
| Hep D | D-High mortality rate Progress to cirrhosis Chronic Hepatitis |
| Hep E | E-Mortality rate 10% in pregnant women, otherwise not fatal |
| Hep F & G | F&G-Uncertain; often coexists with others |
Created by:
redhawk101
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