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314 Cards in this Set
- Front
- Back
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a break or excavation in the musocsal wall of the stomach, pylorus or duodenum
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PUD
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more occuring close to pylorus, FUNNEL SHAPED lesions extend into muscularis layer
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duodenal ulcer
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frequently called stress ulcers or erosive gastritis
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gastric ulcer
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medication to counteract effects of H.pylori
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nexium
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location of gastric ulcers
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antral region and lesser curvature
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gastric or duodenal? food burning and gnawing in the upper epigastrium
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gastric ulcer
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location of duodenal ulcers
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pyloric region
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duodenal ulcer: increased incidence in blood type ____
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O
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associated diseases common with duodenal ulcer
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ETOH cirrhosis, COPD, renal failure, chronic pancreatitis
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acid secretion: duodenal ulcer
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increased
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risk factors for duodenal ulcer
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a) O blood type
b) family Hx c) ETOH, COPD |
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Meds for PUD
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Prilosec, Zantac, H2 antagonist, Carafate
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diet for PUD
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small frequent meals; stop eating at 7pm
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tests for PUD
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endoscopy, Upper GI series,
EGD, H.pylori test (biopsy) |
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complications of PUD
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hemorrhage
perforation penetration pyloric obstruction |
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surgical interventions for PUD
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vagotomy
vagotomy w/ pyloroplasty subtotal gastrectomy billroth I billroth II |
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complications of billroth surgeries
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Dumping syndrome
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what is billroth I?
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removal of distal half of the stomach w/ anastomosis to the duodenum
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what is billroth II?
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removal of distal portion of the stomach w/ anastomosis to the proximal jejunum
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Etiology: uncommon malignancy, 2%
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Gastric Cancer
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site of gastric cancer
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antrum, pylorus and lesser curvature (better prognosis)
tumors in cardia or fundus (poorer prognosis) |
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2 types of gastric CA
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diffuse and intestinal
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what gastric ca is increased in females?
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diffuse type
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common age for gastric CA
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age 65 years and >
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risk factors for gastric ca
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high fat/sodium diet
high starch and fat diet low intake of fruits and veggies worked in metal and chemical factories chronic PUD, gastric ulcers, polyps, pernicious anemia, H.pylori family Hx and type A blood |
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s/s assessment for gastric ca
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weight loss
dyspepsia can't eat full meal change in eating habits decreased appetite, nausea chronic bleeding - guiac stools hx of h.pylori infection hx of smoking and etoh abuse |
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Dx gastric cancer
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upper GI series, endoscopy w/ bx and cytology studies, abd ultrasound
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Nsg intervention for gastric CA
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small freq. meals with vitamins
TPN pain control |
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surgical interventions for gastric ca
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gastric resection
Billroth I or II Total gastrectomy |
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what occurs after eating foods high in CHO/electrolytes (gastric ca pts)
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Dumping syndrome
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what happens when iron is lost and vitamin B12 increased?
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pernicious anemia
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goals for pt with gastric ca
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maintain ideal body weight
cope w/ anxiety communicate understanding of surgery demonstrate understanding of wound care Pt does not have p/o complications identify coping strategies for Dumping Syndrome |
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benign tumors of mouth
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lipomas, neurofibromas
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premalignant tumors of oral cavity
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leukoplakia
erythroplakia |
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what is leukoplakia
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precancerous yellow-white or grey lesions
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are red velvety appearing patch that indicates early squamous cell carcinoma
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erythroplakia
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second most common tumors in the lips = excessive exposure to sun, and fair skinned people
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basal cell carcinomas
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tiny flat squamous cells (malignant) ; most common type of oral cancers
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squamous cell carcinomas
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medical mgt of malignant tumors
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radiation (external beam)
interstitial radiation chemotherapy |
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involves implanting radioactive seeds used for small lesions
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interstitial radiation
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nsg interventions (malignant tumors)
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avoid oral irritants
freq. oral hygiene anti-emetics to prevent N/v small freq. meals soft tooth brush analgesics b4 eating gum, candy to relieve oral dryness |
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extensive procedure that removes sternocleeidomastoid muscle, tissue under the skin from jaw to clavicle
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radical neck dissection
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surgical mgt of oral tumors
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extensive tumors ---
a) removal of large part of tongue and lymph nodes b) mandibulectomy c) rad. neck dissection |
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nsg interventions of post op (malignant oral tumors)
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a) maintain airway
b) semi fowlers c) wound care (1/2 h202) d) trach -communication techniques e) TPN, oral supplements |
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nsg intervention for fractured jaw
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a) wire cutters at the bedside
b) entiemetic meds for n/v c) frequent mouth care w/ mouthwash |
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pulmonary complication in esophageal cancer
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tracheoesophageal fistulae
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s/s esophagus ca
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a) dysphagia
b) inc. salivation c) inc. mucous in back of throat d) regurgitation e) odynophagia (pain on swallowing) |
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special fiberoptic probe inserted to kill only cancer cells on esophageal ca pts
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photofrim
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nsg intervention (esophageal cancer)
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a) elevate HOB 30 deg
b) monitor CBC, chem 7 c) ca channel blockers to reduce spasms d) monitor for GERD e) no caffeine, no soda, no food 2-3 hours before bedtime |
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condition in which the cardiac sphincter becomes enlarged allowing part of the stomach to pass into the thoracic cavity
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hiatal hernia (diaphramatic hernia)
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hernia when upper stomach and gastroesophageal junction are displaced : occurs 90% of hernias ; occurs with position changes and increased peristalsis
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type I (sliding)
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the gastroesophageal junction stays below the diaphragm but all or part of the stomach pushes through the thorax
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type 2 (rolling)
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risk factors for hiatal hernia
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a) female
b) over 60 yrs old c) pregnancy or ascites d) obesity |
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s/s hiatal hernia
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a) heartburn 30-60 mins after meals
b) GERD c) odynophagia, dysphagia d) acid regurgitation (water brash) |
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tests for hiatal hernia
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xray
barium swallow and endoscopy |
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medical intervention (hiatal hernia)
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small meals
hob 30 deg or higher small feedings/day drink lots of fluids avoid extreme hot/cold foods lose weight avoid nsaids/tobacco administer meds such as antacids, H2 blockers, Reglan, propulsid |
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surgical interventions (hiatal hernia)
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nissen fundoplication
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involves the suturing of the fundus around the esophagus
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nissen fundoplication
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organ that stores bile
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gallbladder
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how much bile is stored in gb?
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600-800 ml /day
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gallbladder releases concentrated bile into __________ when stimulated by ____________
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CBD (common bile duct)
CCK (cholecystokinin) |
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inflammation of G/B wall
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cholecystitis
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is associated w/ gallstones in 90% of pts; caused by OBSTRUCTION of the CYSTIC DUCT by a stone
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acute cholecystitis
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G/B with pus
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empyema
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complications of cholecystitis
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septicemia
adhesions gangrene (if not removed in time) perforation abscess and fistula |
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the presence of gall stones
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cholelithiasis
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risk factors for G/B disease
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a) white americans
b) 5 Fs c) DM, obese, Crohn's, cirrhosis d) pima native women |
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classic 5 Fs
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a) female
b) fat c) forty d) fair e) fertile |
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cardinal symptom of cholelithiasis
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pain after indigestion of FAT, located RUQ, radiating to R shoulder
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formed by crystalline hardening of bile constituents
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gallstones
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nuclear scanning test to evaluate gallbladder function. It can find blockage in the tubes (bile ducts) that lead from the liver to the gallbladder and small intestine (duodenum)
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HIDA scan
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what happens when CBD is obstructed
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jaundice
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Dx methods for Gallstones
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HIDA scan
ultrasound |
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how are blood tests for gallstones
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unremarkable
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__________blocks CBD, causing backflow, which leads to ___________
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cholelithiasis / cholecystitis
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s/s of GB disease
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-hx of bloating, flatulence, belching
- pain RUQ, acute and peaks in 30mins - pain several days acute; vs several hrs in chronic - + murphy's sign -fever -mild jaundice -high WBC |
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dx of GB disease
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-biliary u/s
-thickening of g/b wall > 3mm -abd xray -labs show elevated Alk Phos, serum bilirubin |
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meds for gallstones
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antibiotics (ampicillin, ceph, aminoglycosides)
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surgical interventions (gallstones)
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cholecystectomy
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non surgical intervention (gallstones)
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ERCP - endoscopic retrograde cholangiopancreatography
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extracorporeal shock wave treatments for small stones, only for less than 4 stones
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lithotripsy
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may increase spasm of the sphincter of Oddi, therefore contraindicated
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morphine
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diet for gallstone pts
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-low fat diet
- less than 6 oz of meat per day - no fried foods |
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inflammation of the pancreas
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pancreatitis
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results in autodigestion of the pancreas by its own enzymes
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acute pancreatitis
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occurs when a stone migrates down to the ampulla of vater, causing diversion of bile into pancreatic duct
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biliary pancreatitis
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characteristics of bil.pancreatitis
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a) inflammation and edema
b) autodigestion c) fat necrosis d) hemmorhage |
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causes of pancreatitis
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a) alcohol
b) gallstones c) DM d) drugs other causes: hyperlipidemia, high estrogen admin, pancreatic trauma, drugs (azathioprine imuran, estrogens), duodenal obstructions, viral infections, cancer |
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pain begins after 12-24 hours of binge drinking (Dx?)
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alchohol related pancreatitis
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s/s pancreatitis
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-abd pain mid epigastrium, radiating to back
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labs for pancreatitis
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serum amylase
serum lipase WBC bloodsugar LFT to check cirrhosis |
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Dx for pancreatitis
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xray (possible left basilar atelectasis)
pleural effusion CT scan showing air in duodenal loop, transverse colon distension, pseudocyst, abscess |
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interventions for pancreatitis
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a)correct hypovolemia
b)NPO c) NG suction d) TPN support e) morphine for pain (usually PCA) |
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surgical intervention for pancreatitis
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a) subtotal pancreatectomy
b) Whipple's procedure |
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diet for pancreatitis
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no alcohol, tea, coffee, spicy foods
small frequent meals high in carbohydrates |
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post op care for pancreatitis
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a) maintain respiratory status
b) monitor for ARDS c) monitor drains, stents d) monitor loss of exocrine function e) replace pancreatic enzymes with meds |
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largest lymphoid organ in body
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spleen
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diseases of the spleen
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a) infectioius mono
b) malaria c) ITP d) splenomegaly |
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not performed in children less than 10 years due to risk of septicemia
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splenectomy
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inflammation of the stomach and intestinal tract that affects the small bowel
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gastroenteritis
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s/s of gastroenteritis
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abd pain
cramping N/v/d abd distention tenesmus borborygmi |
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invol spasmodic straining on defecation
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tenesmus
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hyperactivebowel sound
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borborygmi
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are referred to as "food poisoning"
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GI infections
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sources of gastroenteritis
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a) contaminated food or water
b) campylobacter c) E.coli 0157:H7 d) C. diff e) salmonella f) shigella |
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when travelling avoid ______________ (gastro)
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tap water
milk products raw seafood foods cannot be peeled or cooked |
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10% of clients infected w/ e.coli develop _______________
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HUS (hemolytic uremic syndrome)
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nsg interventions (gastroenteritis)
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a) ortho Vs
b) fluid replacement c) isolation d) labs Chem 7, CBC e) health teaching / risk factors |
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is indicated to maintain nutritional status and prevent malnutrition when client cannot be fed orally, tube feeing, or by IV infusion
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TPN
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refers to the glucose and AA acids on TPN feedings
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Hyperalimentation
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uses of TPN
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malabsorptive syndromes
motility disorters intestinal obstruction nutrition for prev. of malnutrition |
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s/s of intestinal obstruction
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severe persistent n/v
abd distention |
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composition of TPN iV bottle
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50% glucose in 500cc
8.5 % amino acids in 500 cc |
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each liter of TPN provides ______cal = _____g of nitrogen
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1000= 6
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ISOTONIC solution to provide fatty acids
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INTRALIPIDS
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where to administer TPN
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Central venous line (subclavian or jugular), PICC line
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tips on admin of TPN
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a) never add medication to bottle or IVPBs
b) administer w/ 1.5 micro filter c) intitiate slowly d) change IV tube q. 24 hours e) use IV pump f) change drsg. every 3-5 days g) monitor labs (CBC, BMP, PTT, chem 10) h) accucheck q.12 hrs |
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Complications with TPN
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a) penumothorax, air emboli
b) sepsis c) hyperglycemia d) fluid overload e) rebound hypoglycemia f) HHNS |
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risk factor for IBD
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family Hx
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aka regional enteritis
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chrons disease
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2 types of IBD
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Crohn's disease
Ulcerative colitis |
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chronic, relapsing disease commonly locates in terminal ileum and involves the entire thickness of the bowel wall
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Crohn's disease
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risk factors for Crohn's disease
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Whites and Jews
family Hx ages 20-30 |
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PATHOPYSIOLOGY:
reddish purple areas, edematous enlarged lymph nodes appear in the sub mucosa Peyer's patches in the intestines ulcerate, then fissures form, then small bowel becomes congested and thickened, lumen narrows |
Crohn's disease
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complications of Crohn's disease
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SBO
strictures perianal disease |
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S/S Crohn's disease
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diarrhea
soft-semi-liquid stools steatorrheic stools quiac stools malnutrition |
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body type of pts with crohn's disease with progressive malnutrition
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tall and skeletal
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GI disease that spans the ENTIRE LENGTH of the colon, and involves on the MUCOSA and SUBMUCOSA
Starts in the rectum and spreads upwards and involves most of the sigmoid and descending colon |
Ulcerative colitis
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develops in 5% of ppl with ulcerative colitis
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colon cancer
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pain site on ulcerative colitis
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LLQ
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characterized by lesions or small abscesses (inflammatory infiltrate) leading to purulent discharge from the bowel mucosa
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ulcerative colitis
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pathopysiology:
scarring from lesions fibrosis narrowing and thickening of colon shortening of colon |
ulcerative colitis
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PUS and blood in the colon; often leads to toxic megacolon
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ulcerative colitis
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s/s of ulcerative colitis
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rectal bleeding
n/v/d 20 stools / day bloody stools with pus borborygmi LLQ pain anorexia fever low HgB, HcT, hypokalemia |
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dx of ulcerative colitis
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colonoscopy w/ bx
cytology |
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meds for ulcerative colitis
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Loperamide (immodium)
Metamucil Azulfidine Mesalamine antispasmodics: Probanthine Aminosalicylates Corticosteroids Anticholinergics (cramps and diarrhea) Anti-infectives |
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nutritional support for Crohn's disease
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Vits ADEK
folate diet high on kcal high protein low fiber small freq. feedings |
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nutrition for Ulcerative Colitis
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tube feedings
TPN iron and B12 pain releif anti-anxiety meds (xanax, ativan) |
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surgery for ulcerative colitis
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total proctocolectomy
Koch Pouch continent ileal reservoir |
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colon and rectum are removed and anus is closed -- permanent ileostomy is created
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total proctolectomy
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surgery for Crohn's disease
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small bowel resection
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complications of short bowel resection
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Dumping syndrome
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inflammatory disease of the verniform appendix
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appendicitis
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most common cause of acute abd pain
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appendicitis
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s/s of appendicitis
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RLQ pain
rebound tenderness anorexia n/v low grade fever leukocytosis |
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surgical mgt. of appendicitis
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appendectomy
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site of rebound tenderness (appendicitis)
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McBurney's point
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caused by leakage of contents into peritoneum, such as bile, gastric contents, feces, intestinal juices, infectious organisms (gram -),
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Peritonitis
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pathopysiology= edema of tissue and exudation of fluids with hypermobility followed by PARALYTIC ILEUS
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Peritonitis
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s/s peritonitis
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diffuse pain then localizes, n/v, pallor, shock symptoms
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management of peritonitis
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fluid challenge
antibiotics n/g to suction pain mgmt monitor u/o watch for JVD |
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organisms on peritonitis
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E coli
Klebsiella Proteus Pseudomonas |
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outpouches with "swiss cheese" looking lesions on intestinal mucosa thru smooth muscle of colon wall
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dirverticulosis
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is the blockage fo the lumen of the bowel by mechanical obstruction
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intestinal obstruction
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pathopysiology: gas and air distend the bowel followed by pooling of gastric , biliary and pancreatic secretions
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intestinal obstruction
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s/s of intestinal obstruction
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increased bowel sounds above obstruction then absent
n/v acute cramping abd pain rigid abd hypovolemic shock septic shock fever leukocytosis |
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management of intestinal obstruction
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IV therapy
n/g suction measure abd girth u/o labs |
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occurs when tissue demand for o2 exceeds the supply
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intestinal infarction
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can occur in highly vascular systems - mesenteric artery, and results in decreased blood supply to intestines
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intestinal infarction
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occlusion of the superior mesenteric artery by embolism or a thrombus
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intestinal infarction
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s/s include cramping, abd pain, associated with n/v/d
abd distention, borborygmi, hypotension, shock, peritonitis |
intestinal infarction
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mngmgt of intestinal infarction
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IV fluids
NG surgical intervention |
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is a defect in the abdominal wall
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hernia
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type of hernia common among children
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umbilical hernia
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types of hernias
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inguinal
scrotal incisional umbilical |
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hernia wherein the sac bulging can be reduced or is intermittent
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reducible hernia
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hernia that contains trapped abdominal contents that are poorly drained
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incarcerated hernia
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causes necrosis of the the abd contents due to lack of blood supply --- clinical manifestations of abd obstruction
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strangulated hernia
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multiple non inflamed diverticula caused by outpouches of the intestinal mucosa thru the smooth muscle of colon wall
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diverticulosis (asymptomatic)
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occurs when the diverticula become inflamed
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diverticulitis (caused by food and bacteria)
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caused by increased muscular contractions in the colon
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diverticulosis
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caused by diets with decreased fiber leading to higher intrabdominal pressure during defecation
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diverticulosis -- itis
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risk factor for diverticu -losis/itis
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>40 years old with possible congenital predisposition
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asymptomatic, cramping abd pain in LLQ relieved w/ flatulence and BM
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diverticular disease
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s/s increased with ingestion of foods like popcorn, celery, fresh veggies, nuts
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diverticular disease
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prevention of diverticulosis
|
increased fiber diet
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prevention of diverticulitis
|
bowel rest
bed rest IV NPO CL diet bland residue diet (easier to digest) |
|
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130,000 people are diagnosed /year
1 in 17 persons in the US |
colorectal cancer
|
|
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56,000 die each year
|
colorectal cancer
|
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2nd most cause of death in adults
|
colorectal cancer
|
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11% of all cancer deaths
|
colorectal cancer
|
|
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risk factors (colorectal cancer)
|
40 yrs and over
men family hx of polyps familial adenomatous polyposis syndrome hx of ulcerative colitis smoking polyps or adenomas low fiber diet, hi-fat obese |
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95% are adenocarcinomas
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colorectal cancer
|
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a malignant tumor arising from a glandular organ
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adenocarcinomas
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a lesion that projects into the lumen of the bowel
|
polyp
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typically round and polypoid polyp
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sessile
|
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polyp that is elongated with stems
|
pedunculated
|
|
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recent "shift to right" seen in elderly
|
means that colon cancer is higher in the elderly
|
|
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survival rate: colon cancer
|
5 years: 90% localized and excised
8%: if cancer has metastasized |
|
|
how do malignant bowel tumors spread?
|
as direct extension to nearby organ
as lymphatic and hematogenous channel to liver by means of seeding, implanting into the peritoneal cavity |
|
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stages of colon cancer
|
TNM1 - ca is confined to bowel mucosa
TNM2 - ca extends into muscle, serosa and connective tissue TNM3 - ca penetrates the bowel wal and adheres/invades adjacent organs TNM4 - cancer metastasizes to distant organs |
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s/s colon cancer
|
- no early symptoms
-rectal bleeding; change in bowel habits, abd pain - wt loss -anemia -dark reddish brown stools |
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dx for colon cancer
|
guiac tests
CEA carcinoembryonic antigen 19-9 cancer antigen barium xray flexible fiberoptic colonoscopy |
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surgeries for colon cancer
|
colon resection
abdominal perineal resection colostomy (single/double barrel) |
|
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complications of colon cancer surgery
|
infection
fistula suture line leakage gen.peritonitis hemmorhage stomal necrosis retraction prolapse |
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meds for colon cancer pre-op
|
sulfonamides
neomycin cephalexin |
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pre-op for colon cancer pts
|
clear liquid diet 24-48 hrs prior
oral laxatives (Golytely) 24 hours prior enemas till clear (am/pm b4 surgery) psychosocial support |
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post op care for colon cancer pts
|
assess respiratory status, monitor drains, JP, ostomy and pain management
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nsg Dx for colon cancer Post op
|
pain: imbalanced nutrition less than body requirements, anticipatory grieving
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post op teaching for colon cancer pts
|
stoma management
wound infections ET nurse referral Ostomy association and ACS (Cancer society) |
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largest organ inside the body
|
liver
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|
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2.5% of body weight
|
liver
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|
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lies in upper right quad of abd just below diaphragm
|
liver
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liver receives ______% of cardiac output
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20
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hepatic artery supplies liver ____ of its blood
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1/3
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portal vein supplies the other ___ and carries deoxygenated blood
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2/3
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blood on small capillaries or sinusoids of the liver
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venous and arterial
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all blood in the liver drains into _____vein, into __________
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hepatic / inferior vena cava
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an increase in central venous pressure in the hepatic sinuses causes _________________
|
liver engorgement followed by blood vessels draining the GI organs
|
|
|
fibro elastic capsule covering the liver
|
Glisson capsule
|
|
|
separates the R and L lobes of the liver
|
falciform ligament
|
|
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in ______________, distention of the capsule causes pain, and lymphatics ooze fluid into the peritoneal space
|
liver disease
|
|
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smaller anatomic units of the the liver
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liver lobules
|
|
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functional cells of the liver capable of regrowth
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hepatocytes
|
|
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stores lipids including vit.A in the liver
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Lipocytes
|
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small capillaries of the liver
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sinusoids
|
|
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phagocytic liver cells that remove bacteria from blood
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Kupffer cells
|
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natural killer cells for tumor defense in the liver
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Pitt cells
|
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channel where bile is secreted and drained into common bile duct
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Bile canaliculi
|
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functions of the liver
|
regulates glucose and fatty acids
major storage organ for glycogen converts glucose to glycogen converts non CHO into glucose during periods of low CHO intake |
|
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separates the R and L lobes of the liver
|
falciform ligament
|
|
|
in ______________, distention of the capsule causes pain, and lymphatics ooze fluid into the peritoneal space
|
liver disease
|
|
|
smaller anatomic units of the the liver
|
liver lobules
|
|
|
functional cells of the liver capable of regrowth
|
hepatocytes
|
|
|
stores lipids including vit.A in the liver
|
Lipocytes
|
|
|
small capillaries of the liver
|
sinusoids
|
|
|
phagocytic liver cells that remove bacteria from blood
|
Kupffer cells
|
|
|
natural killer cells for tumor defense in the liver
|
Pitt cells
|
|
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channel where bile is secreted and drained into common bile duct
|
Bile canaliculi
|
|
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functions of the liver
|
regulates glucose and fatty acids
major storage organ for glycogen converts glucose to glycogen converts non CHO into glucose during periods of low CHO intake |
|
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forms most lipoprotein and involved in the synthesis of cholesterol and phospholipids
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liver
|
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organ involved in protein metabolism by deamination of amino acids
|
liver
|
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ammonia is converted to _______ and is excreted by kidneys and intestines
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urea
|
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in liver disease, ammonia accumulates into high levels leading to _________________
|
hepatic encephalopathy (coma)
|
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vascular and hematologic function of the liver
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stores large amount of blood and release blood in case of hemmorhage
|
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vitamin needed for clotting factors
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Vit K (fat soluble)
|
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plasma protein synthesized by liver; essential for maintaining plasma oncotic pressure
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Albumin
|
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happens when intravascular fluid moves into extravascular spaces
|
ascites and peripheral edema
|
|
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is defined by a liver span that exceeds normal limits
|
hepatomegaly
|
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what lowers position of liver
|
COPD, emphysema
|
|
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2 techniques for testing shifting of dullness in an ascitic abdomen
|
client supine - percuss flanks and mark where dullness turns to tympany
client supine (fluid wave test) - feel for ascites |
|
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or icterus; is yellow pigmentation of skin or sclera caused by excess bile in blood
|
jaundice
|
|
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common symptom of liver and biliary disease or excess destruction of RBCs
|
jaundice
|
|
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occurs when bilirubin level exceds 1.5 to 2 mg/dl
|
Jaundice
|
|
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normal bilirubin levels
|
0.4 to 1 mg/dl
|
|
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elevated bilirubin in blood (deposited in skin and excreted in urine)
|
hyperbilirubinemia
|
|
|
blocks the flow of bile into the intestine, and stool becomes clay colored
|
biliary obstruction
|
|
|
diseases that cause obstruction of the CBD include ________ and ________
|
gallstones and pancreatic tumors
|
|
|
Drugs that cause obstruction of normal bile flow thru liver :
|
chlorpromazine (thorazine)
estrogenic hormones halothane |
|
|
a normal, yellow to green pigment of bile and derived from the RBC breakdown,
|
biliriubin
|
|
|
not water soluble can't be filtered by kidneys, not excreted in urine; returns to the liver via bloodstream and becomes conjugated
|
indirect or unconjugated bilirubin
|
|
|
water soluble, increased levels may indicate obstructive jaundice (stones or tumors or intrahepatic)
|
conjugated bilirubin or direct bilirubin
|
|
|
etiology of jaundice
|
outside liver (results in unconjugated hyperbilirubinemia)
in liver or biliary tracts (results in conjugated hyperbilirubenemia) |
|
|
clinical manifestations of jaundice
|
yellow sclerae
yellow to orange skin clay colored feces tea colored urine pruritis fatigue and anorexia |
|
|
LAB tests for liver function
|
conj. serum bilirubin > 0.4
unconj. serum bili 0.2 to 0.8 mg/dl urine bilirubin: neg to 0.02 mg/dl urobilinogen : neg or <1.0 E units |
|
|
when direct bilirubin is more than 0.4 mg / dl ___________________
|
bile excretion is blocked
|
|
|
when unconj. serum bili is more than 0.8 ________________________
|
increased destruction or breakdown of RBCs
|
|
|
when Bili in urine is more than 0.02____________________
|
liver damage or biliary obstruction of conjugated bili; urine is dark amber
|
|
|
when urobilinogen is elevated:
|
early cirrhosis of liver, infectious hepatitis, erythroblastosis fetalis, infectious mono
|
|
|
when urobilinogen is dcreased
|
biliary obstruction , severe liver disease, ca of pancreas
|
|
|
alk phos level
|
40-136 u/L
|
|
|
enzyme produced mainly in liver and bone
|
alk.phos
|
|
|
causes for elevated alk phos
|
obstructive biliary disease, cirrhosis, hepatitis, leukemia, cancer of bone, breast and prostate cancer
antibiotics methyldopa IV albumin |
|
|
causes for cholesterol elevation
|
atherosclerosis
uncontrolled DM cirrhosis contraceptives phenothiazines vit. a & d dilantin |
|
|
ALT (SGPT) levels
|
10-35 u/L adults
|
|
|
enzyme, effective in Dx of hepatocellular destruction ; serum levels elev. before jaundice is present
|
ALT (SGPT) alanine aminotransferase
|
|
|
causes of ALT elev
|
viral hepatitis
cirrhosis ca of liver AMI acute ETOH intox |
|
|
drugs causing false + of ALT elev
|
antibiotics
narcotics Aldomet Dalmane oral contraceptives Heparin |
|
|
AST (SGOT) aspartate aminotransferase levels
|
8 - 38 u/L
|
|
|
enzyme found in heart and liver, elevation found in AMI or liver damage by 10x or more
|
AST (SGOT)
|
|
|
Ammonia levels
|
15-45 ug/dl
|
|
|
byproduct of protein metabolism and converted in liver to urea -- excreted by kidneys
|
ammonia
|
|
|
elevated ammonia means
|
hepatic failure
hepatic encephalopathy or coma sever CHF, TPN diuretics |
|
|
treatment to reduce NH4 levels
|
low protein diet
antibiotics MgSo4 Lactulose |
|
|
assessment for liver damage
|
HnP
PE liver tests CBC liver scan ABD pain fever dec. appetite wt. loss change in BM pruritis |
|
|
Nsg. Dx for Jaundiced client
|
impaired skin integrity r/t liver impairment aeb itchy skin sclera , etc.....
|
|
|
relieves itching in the jaundiced client
|
antihistamines and phenobarbital
emollient baths loose clothing cotton linens cool room |
|
|
Nsg Dx for yellowing skin and sclera
|
Body Image Disturbance r/t yellowing of skin and sclera
|
|
|
Nsg Interventions for Jaundice
|
Assist with hygiene
give reassurace (jaundice is temporary) Psychosocial support |
|
|
is a virus that weakens the body's immune system and ultimately leads to aids
|
HIV
|
|
|
ranks 4th leading cod worldwide
|
AIDS
|
|
|
preferred host cell for HIV virus
|
helper T cells
|
|
|
T cells are _______
|
WBC
|
|
|
transmission of HIV/AIDS
|
body fluids (sex, contaminated blood)
needles, ear piercing, tattooing, accupuncture, drugs infected mother during lactation |
|
|
stages of HIV
|
1st : exposure (mild flu symptoms)
2nd: ARC period, immune system grows weaker, opportunistic infections: s/s include 23 clinical conditions - fatigue, skin rashes, headache, noc sweats 3rd stage: end stage of HIV infection (low T cell count < 200 T lymphocyte/UI) |
|
|
Lab tests for HIV/AIDS
|
HIV 1-2 antibody
ELISA (enzyme linked immunosorbant assay) EIA (enzyme immunoassay) |
|
|
nutrition in HIV infection
|
healthy diet, high kcal
|
|
|
causes of nutrition loss in AIDS patients
|
anorexia
cancer diarrhea change in metab. due to fever medications malabsorption PEM - body wasting (protein energy malnutrition) Hyboalbuminemia - low amounts of protein in blood |
|
|
methods to improve appetite of AIDS patient
|
give meds after meals
offer soft foods avoid spicy, acidic and extreme hot/cold foods serve frequent small meals take adv. of "good days" |
|
|
benefits of HIV/AIDS medications
|
control HIV replication and mutation
delayed progression of AIDS decreased risk of drug toxicity increased survival with HIV |
|
|
common pneumonia for HIV AIDS patients
|
PCP pneumocystis carinii pneumonia
|
|
|
is an indication for Zidovudine
|
T cell count <500
|
|
|
is an indication for PCP prophylaxis
|
T cell count < 200
|
|
|
fungal infections for HIV/AIDS patients
|
candidiasis
|
|
|
oral esophageal meds for AIDS/HIV patients
|
clotrimazole troches (mycelex)
nystatin suspension fluconazole |
|
|
indicated for disseminated fungal disease on AIDS/HIV patients
|
Amphotericin B
|
|
|
what to eat to prevent fungal infections on HIV/AIDS patients
|
8 oz of yogurt
|
|
|
removal of distal half of the stomach w/ anastomosis to the duodenum
|
bilroth I
|
|
|
inflammation of the gastric or stomach mucosa
|
gastritis
|
|
|
antibiotics for h. pylori
|
amoxicillin
clarithromycin metronidazole tetracycline |
|
|
proton pump inhibitors
|
nexium
prevacid prilosec protonix acipHex |
|
|
an erosion that forms in the mucosal wall of the stomach, in the pylorus or the duodenum
|
peptic ulcer disease
|
|
|
________ulcers are common in pts with head injury and brain trauma
|
Cushing's ulcers
|
|
|
surgical procedures for PUD
|
Billroth I
Billroth II |
|
|
clinical manifestations of gallbladder disease
|
pain
jaundice changes in urine and stool color vitamin deficiency (ADEK) |
|
|
Lab findings for acute cholecystitis
|
elevated Alk Phos
eleveted serum bilirubin elevated WBC |
|
|
a procedure wherein a flexible fiberoptic endoscope is inserted through the esophagus to the descending duodenum for direct examination of the hepatobiliary system
|
ERCP - endoscopic retrograde cholangiopancreatography
|
|
|
fibrous tissue begins to replace the normal muscle and mucosal tissue of G/B; G/B loses ability to concentrate bile
|
Chronic Choleecystitis
|
|
|
results in autodigestion of the pancreas by its own enzymes
|
pancreatitis
|
|
|
when a stone migrates down to the ampulla of vater causing diversion of bile into pancreatic duct
|
Biliary pancreatitis
|
|
|
CT scan of a pancreatitis pt reveals ____________, _______ ,_____________, ______________
|
air in duodenal loop
distention of transverse colon pseudocyst abscess |
|
|
Labs checked on pancreatitis patient
|
Serum amylase
serum lipase wbc blood sugar Liver function tests |
|
|
xray of pancreatitis patient reveals_______,________
|
left basilar atelectasis
pleural effusion |
|
|
infarction
|
localized necrosis resulting from obstruction of the blood
|
