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72 Cards in this Set
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- Back
- 3rd side (hint)
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What does serum bilirubin measure? |
Testing for blood bilirubin provides information for the diagnosis and evaluation of liver diease, biliary obstruction,and hemolytic anemia. |
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When is jaundice visible? |
When the total serum bilirubin level exceeds 2.5 mg/dL |
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Serum Bilirubin test: Nursing Intervention |
- NPO until after the blood specimen is drawn. - inform pt of blood draws and what test is being performed. - monitor venipuncture site for bleeding. |
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Liver enzymes test |
AST (asparate aminotransferase) adult 0- 35 units/L ALT child 4- 36 units/l LDH Normal LDH levels range from 140 units per liter (U/L) to 280 U/L or 2.34 mkat/L to 4.68 mkat/L. Alkaline phosphatase adult 30- 120 units/L Gct males and females older than age 45 years:8 to 38 units/L Female younger than age 45 yrs :5 to 27 units/L |
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What liver enzyme is elevated in myocardial infarction, hepatitis, cirrhosis, hepatic necrosis, hepatic tumor, acute pancreatitis, and acute hemolytic anemia. |
AST (asparate aminotransferase) |
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What liver enzymes levels are elevated in hepatic necrosis, hepatic tumor, cirrhosis? |
AST, ALT, GCT. |
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Liver Enzymes Test: nursing interventions |
- monitor the venipuncture site for bleeding |
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The normal values for serum protein test |
Total protein 6.4- 8.3 g/dL Albumin 3.5- 5g/dL Globulin 2.3- 3.4 g/dL Albumin/globulin 1.2- 2.2g/dL |
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Which protein's low level is a sign of liver diease. |
Albumin |
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Serum Protein Test: nursing intervention |
Monitor venipuncture site |
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The nurse assists a health care provider in performing a liver biopsy. After the biopsy, the nurse should place the client in which position? 1. Prone 2. Supine 3. A left side-lying position with a small pillow or folded towel under the puncture site 4. A right side-lying position with a small pillow or folded towel under the puncture site |
4. |
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Oral cholecystography nursing intervention |
-To prevent allergic reaction the nurse determine whether the pt is allergic to iodine - administer 6 tablets one every 5 minutes beginning after the evening meals. - pt is put on npo starting midnight. |
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The client is scheduled to have an intravenous cholangiogram. Before the procedure, the nurse should assess the patient for A)Shellfish allergies B) Reactions to blood transfusions C) Gallbladder disease D)Egg allergies |
You guys should know this. A) shellfish allergies |
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T- tube cholangiography |
A t-tube cholangiogram is a special x-ray procedure that is done with contrast media (x-ray dye) to visualize the bile ducts after the removal of the gallbladder. The bile ducts drain bile from the liver into the duodenum (first part of the small bowel). |
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When is a t- tube cholangiography performed? |
To diagnosed retained ductal stones after surgery in a patient who had undergone a Cholecystectomy and a common bile duct exploration to demonstrate good flow of contrast into the duodenum. |
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Before performing T- tube cholangiography ensure the patient is not allergic to? |
Iodine |
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Nursing Intervention for t- tube cholangiography |
-Npo at midnight - administer a cleansing enema on the morning of the examination - after surgery of is protected from sepsis by connecting the t- tube to a sterile closed- drainage system - cover the t- tube tract site with a sterile dressing to prevent pathogen from entering the ductal system. |
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HIDA scan is a diagnostic test which uses |
radiolabeled dye taken up by hepatocytes, excreted into biliary tract
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Ultrasonography (ultrasound,echogram) |
A |
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Gallbladder scanning |
Assure patient only a minimal amount of radioactive isotope is used |
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Another name for radionuclide? |
Radioisotope liver scanning which is a procedure used to outline and detect structural changes of the liver. |
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Nursing Intervention: radioisotope liver scanning |
- npo status at midnight - inform pt only a trace amount of isotopes are used. |
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Indications for serum ammonia |
Used to support the diagnosis of severe liver disease (fulminant hepatitis or cirrhosis) Used in the diagnosis and follow-up of hepatic encephalopathy |
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10-80 mcg/dL |
What are the normal values for serum ammonia? |
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Drugs that may cause increased ammonia levels include |
Alcohol Barbituates Diuretics Narcotics Parenteral nutrition (TPN) |
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Drugs that may cause decreased ammonia levels include |
Broad spectrum antibiotics Lactobacillus Lactulose levapoda Potassium (K) salts |
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Hepatitis causes |
Viruses Bacteria Alcohol ingestion Drugs |
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Nursing Intervention for hepatitis |
- use standard precautions - wear gloves when handling body fluid or blood |
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Serum amylase test |
Normal lab values 60- 120 Simonyi units/dL Or 30- 220 units/L |
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Rationale for serum amylase test |
Quickly diagnose pancreatitis in its early stages |
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Serum Amylase Test Nursing Intervention |
Note on the lab whether the patient is receiving intravenous dextrose or any other medications since these can cause a false- negative result |
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Urine Amylase Test |
Levels of Amylase stay elevated for 7 - 10 days after the onset of pancreatitis. It's useful in detecting pancreatitis late in the disease course |
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Nursing intervention |
Record exact time of beginning and end of collection, keep specimen on ice or refrigerated |
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Serum Lipase test |
Elevated in acute pancreatitis. The Lipase levels rise 4 to 48 hours after the onset of pancreatitis. Lipase peaks later and remains elevated longer than Amylase it's useful in diagnosing acute pancreatitis later in the course of the diease. |
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Ultrasonography of the pancreas |
A |
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How do I know the T-tube is working effectively? |
Observe stool color |
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The advantages of Laparoscopic cholecystectomy are |
•Complications are not common.•The death rate is very low.•Bile duct injuries are rare.•Patient recovery is quicker.•Postoperative pain is less severe.*often called a "lap chole |
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Early symptoms of Cancer of the Gallbladder are |
Anorexia, weight loss, nausea, vomiting, general malaise, jaundice, hepatosplenomegaly; chronic, progressively severe epigastric or right upper quadrant painPoor prognosis |
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What are systemic signs of cirrhosis? |
ascites hepaticus jaundice altered mental status/hepatic encephalpathy splenomegaly |
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Diagnostic test for cirrhosis |
ALT AST LDH GOT Protein levels Prothrombin time Ercp |
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Endoscopic retrograde cholangiopancreatography of the pancreatic ducts nursing intervention |
Before ExplainINFORMED CONSENT NPO at midnightAdmin of appropriate meds (midazolam (versed), atropine)
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ERCP rationale |
Dye is injected for radiographic visualization of the common bile duct and pancreatic duct. Evaluate obstructive jaundice Remove biliary stone Place biliary and pancreatic ducts stents to bypass obstruction Indicate presence of tumor. |
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ERCP nursing intervention |
Withhold food and fluid for 8 hrs before examination - obtain patient signature on a consent form - - assess proyhrombin time and inr before the procedure Patient must lie completely motionless on a hard xray table for 1 or 2 hrs. - keep patient on boo status until gag reflex return |
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The most common complication of ERCP IS? |
Pancreatitis |
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What is the cause of cirrhosis of the liver? |
Scar tissue replaces healthy liver tissue and partially blocks the flow of blood through the liver. The most common causes of cirrhosis in the United States are chronic hepatitis C, alcohol-related liver disease, nonalcoholic fatty liver disease (NAFLD) and nonalcoholic steatohepatitis (NASH), and chronic hepatitis B. |
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Second biliary cirrhosis is caused by |
Chronic biliary tree obstruction from gallstones, chronic pancreatic, a tumor, cystic fibrosis or biliary atresia |
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The stages of the liver |
Destruction Inflammation Fibrotic regeneration And hepatic insufficiency |
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Ascites is the result of |
Portal hypertension Hypoalbuminemia Hyperaldosteronism |
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Early stages of cirrhosis |
Firmness over the liver Generalized weakness Malaise Vague flulike symptoms |
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Later stages of cirrhosis |
Upset stomach Ascites Jaundice Malaise Spider telangiectasis |
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What are the two main complications of cirrhosis? |
Fluid retention and esophageal varices |
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Prophylactic treatment of cirrhosis |
Beta blockers |
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What is a complication of cirrhosis? |
Hepatic encephalopathy |
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Liver carcinoma mimics what other liver condition? |
Cirrhosis |
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Hepatitis a |
likely to contract hepatitis A from contaminated food or water or from close contact with someone who's infected. Fecal- oral |
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Hepatitis b |
The virus is passed from person to person through blood, semen or other body fluids. Common ways HBV is transmitted include: Sexual contact. |
Both b and c :needle sticks, blood, body fluids and vaccine |
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Hepatitis c |
is usually spread when blood from a person infected with the Hepatitis C virus enters the body of someone who is not infected. Today, most people become infected with the Hepatitis C virus by sharing needles or other equipment to inject drugs. |
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Hepatitis d |
. Hepatitis D body fluid occurs with hep b |
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Hepatitis e |
Hepatitis E body fluids. Occurs with hep c |
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Hepatitis g |
by infected blood or blood products |
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Cancer of the pancreas |
5- 12 months survival rate |
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Jaundice is caused due to: A)Excess of uric acid in the blood b)Excess of hemoglobin in the blood c)Excess of bilirubin in the blood d)Excess of potassium in the blood |
C |
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Liver transplantation med to prevent rejection |
Cyclosporine (common) Azathioprine Corticosteroids Tacrolimus (common) |
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Liver transplantation nursing intervention |
Assess neurologic status Moniter vital signs Monitor lab values Pulmonary toileting Prevent infection |
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What is cirrhosis? |
A chronic, degenerative disease of the liver in which the lives become covered with fibrous (scar) tissue. |
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Parenchyma |
The functional tissue of an organ oppose to supporting or connective tissue. |
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Postnecrotic cirrhosis |
Is caused by viral hepatitis Exposure to hepatotoxins Infection |
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Primary biliary cirrhosis |
Occurs most often in women and results from destruction of the bile ducts due to inflammation. |
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Second biliary cirrhosis |
Is caused by chronic biliary tree obstruction from gallstones, chronic pancreatitis, a tumor, cystic fibrosis, or biliary atresia |
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Atresia |
The absence of or underdevelopment of biliary structures that is congenital in nature . |
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Cardiac cirrhosis |
Results from long-standing , severe right sided heart failure in patient with cor pulmonale, constrictive pericarditis and tricuspid insufficiency |
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Nonalcholic fatty liver disease |
I'm taking a break watching Hart to hart |
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