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93 Cards in this Set

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before pt goes in for an Endoscoptic Retrograde Cholangiopancreatography (ERCP) exam, why do we want to check the bilirubin level?
before pt goes in for an Endoscoptic Retrograde Cholangiopancreatography (ERCP) exam, why do we want to check the bilirubin level?

we must have Billirubin test - if too high, the test is not done. The cannulization goes through the common bile duct may be obstructed and it may exacerbate the condition.

Test is not performed if bilirubin is > 3-4 mg/dL
because cannulization -> edema -> bile flow obstruction -> high bilirubin
If a pt with cirrhosis has high ammonia levels, what drugs do you give to reduce the ammonia levels?
If a pt with cirrhosis has high ammonia levels, what drugs do you give to reduce the ammonia levels?

-Lactulose
-Neomycin
Your pt has jaundice. He’s got acites. All of his liver function tests and bili are high (all elevated: AST, ADH, and ALT all elevated). What kind of condition do you think he has?
Your pt has jaundice. He’s got acites. All of his liver function tests and bili are high (all elevated: AST, ADH, and ALT all elevated). What kind of condition do you think he has?

-Hepatitis - viral infection - possible fever
Pt had a liver biopsy, what position are you going to put the pt in?
Pt going for liver biopsy pt will lie on Right side with pillow under right side to tampanade the bleeding.
Pt’s in liver failure what blood test will be decreased?
Pt’s in liver failure what blood test will be decreased?
• Cerum albuman
what is primary diagnostic indicator for pancreatic? and is it elevated or is it decreased?
what is primary diagnostic indicator for pancreatic? and is it elevated or is it decreased?

- lypaise

- elevated
liver failure, serum albumin should be up or down? And Why?
liver failure, serum albumin should be up or down? And Why?
- serum albumin level should be down
- why? liver unable to process protein
pt with cirrhosis, all lab tests show high: ammonia is high, ALT is high, seromonial is high, bilirubin is elevated.
What color is the patient?
what is the pt's mental status?
what do you worry about?
pt with cirrhosis, all lab tests show high: ammonia is high, ALT is high, seromonial is high, bilirubin is elevated.
What color is the patient?
what is the pt's mental status?
what do you worry about?

Yellow with jaundice
Confused
Bleeding
Before a liver biopsy, coagulation studies will be done what kind of labs should be run?
(PT, PTT, INR)
Before a liver study, we will do coagulation studies, why?
Before a liver study, we will do coagulation studies, why?

-Because he is prone to bleeding. They want to do coagulation studies.
What are your coagulation studies?
What are your coagulation studies?

-PT, PTT, INR
Pt has cirrhosis and ascites. With ascites, what system will the pt have problems with?
Pt has cirrhosis and ascites. With ascites, what system will the pt have problems with?

-Respiratory
Pt has Ascites and dr. decides to do a paracentesis, what position do you put the pt in?
Pt has Ascites and dr. decides to do a paracentesis, what position do you put the pt in?

- High fowlers
Prior to a paracentesis, what do you have the pt do? and why?
Prior to a paracentesis, what do you have the pt do?

- Void
- it can rupture the bladder
Pt had a parencintisis done & pt is being discharged, pt needs to let you know if he has a fever or abdominal pain, what is the abd pain due to?
Pt had a parencintisis done & pt is being discharged, pt needs to let Dr. know if he has a fever or abdominal pain, what is the abd pain due to?

- bleeding
pt discharge from parencintisis, how do you position pt?
pt discharge from parencintisis, how do you position pt?
- high Fowler's
- check VS
what is the most common risk for cirrhosis?
what is the most common risk for cirrhosis?

- alcoholism
before the parencintisis is done, what needs to be signed by the pt?
before the parencintisis is done, what needs to be signed by the pt?

-Informal consent
How long before a parencintisis is done do you check the vital signs?
How long before a parencintisis is done do you check the vital signs?

-10 min.
when assessing pt with cirrhosis to determine the amount of ascites, what do you check on a daily basis?
in assessing pt with cirrhosis to determine the amount of ascites, what do you check on a daily basis?

- abdominal girth
What signs would indicate to you that your pt with cirrhosis has a problem with vitamin D. and K absorption?
What signs would indicate to you that your pt with cirrhosis has a problem with vitamin D. and K absorption?

eccomosis (lg bursing), purpura (lil spot of purple)
Your Pt has hepatic alcohol cirrhosis, what is he at risk for?
Your Pt has hepatic alcohol cirrhosis, what is he at risk for?

- portal hypotension
Pt with hepatic cirrhosis w/ hx of alcoholism, esophageal varies what are you looking for - bleeding all over stool is back tarry and bright red emesis
Pt with hepatic cirrhosis w/ hx of alcoholism, esophageal varies what are you looking for - bleeding all over stool is back tarry and bright red emesis
in assessing pt with cirrhosis to determine the amount of ascites, what do you check on a daily basis?
in assessing pt with cirrhosis to determine the amount of ascites, what do you check on a daily basis?

- abd gerth
What signs would indicate to you that your pt with cirrhosis has a problem with vitamin D. and K absorption?
what signs would you find in a cirrhosis pt had deficiency in vita K -

eccomosis (lg bursing), purpura (lil spot of purple)
pt has hepatic alcohol cirrhosis he is at risk for?
pt has hepatic alcohol cirrhosis he is at risk for?

- portal hypotenson
Pt with hepatic cirrhosis w/ hx of alcoholism, esophageal varies what are you looking for?
Pt with hepatic cirrhosis w/ hx of alcoholism, esophageal varies what are you looking for

- melena bleeding all over stool is back tarry and bright red emesis.
pt w cirrhosis, what color are his stool normally? and what color is his urine normally?
pt w cirrhosis, what color are his stool normally? and what color is his urine normally?

- stool: clay colored
- urine: tea colored
pt has portal hypertension, what are the 2 problems with portal hypertension?
pt has portal hypertension, what are the 2 problems with portal hypertension?

- Esophageal Varices (due to back up of blood into the portal system putting pressure)
'
- ascites
if pt were having Esophageal Varices and they were bleeding, what kind of tube do you use?
if pt were having Esophageal Varices and they were bleeding, what kind of tube do you use?

- Blakemore tube (aka esophageal balloon) (its the one with the balloon and it puts pressure on the stomach)
Pt with esophageal Varices has come back from surgery, where they put in a portacava shunt, what is your nursing responsibility?
Pt with esophageal Varices has come back from surgery, where they put in a portacava shunt, what is your nursing responsibility?

- look for signs of bleeding on the incision site.
You’re planning dietary and fluid management for a pt with cirrhosis, who has a severely elevated ammonia level. What kind of a diet do we put him on?
You’re planning dietary and fluid management for a pt with cirrhosis, who has a severely elevated ammonia level. What kind of a diet do we put him on?

- Protein restriction, increase carbs and fats

(only restrict proteins when there is a high ammonia level)
In late stages of cirrhosis, what kind of diet will you put him on?
In late stages of cirrhosis, what kind of diet will you put him on?
- The answer is: “carbs” primarily, not fat. (She said there is an option to choose between fat and carbs, choose carbs)
Pt with hepatic disease and hepatic Encephalopathy, with high ammonia level and it affects the cerebrum and one of the things it causes is asterixis (flapping tremors). How do you check for asterixis?
Pt with hepatic disease and hepatic Encephalopathy, with high ammonia level and it affects the cerebrum and one of the things it causes is asterixis (flapping tremors). How do you check for asterixis?
-The pt’s wrist and fingers are observed to “flap” because of a brief, rapid relaxation of the wrist dorsiflexion
pt with cirrhosis and due to hepatic disfunction is deteriorating, what would indicate the condition is getting worse?
pt with cirrhosis and due to hepatic disfunction is deteriorating, what would indicate the condition is getting worse?
- his mental status/function
female pt with sudden flu symptoms, w/ elevated liver enzymes. blood test ast/alt elevated. What is her prob?
female pt with sudden flu symptoms, w/ elevated liver enzymes. blood test ast/alt elevated. What is her prob?

- Hepatitis
what kind of precautions with pt with HEP A?
what kind of precautions with pt with HEP A?

- gloves with contact procautions
When you are screening for blood donors, which hepatitis are they looking for?
When you are screening for blood donors, which hepatitis are they looking for?
- Hepatitis B
Most common way to develop hepatitis A?
Most common way to develop hepatitis A?

- common cause - contaminated seafood
pt known iv drug abuser, which HEP are you worried about?
pt known iv drug abuser, which HEP are you worried about?
- HEP B (iv drug abuser)
Contaminated needle sticks. Blood born.
Which type of HEP transmitted by blood transfusions?
Which type of HEP transmitted by blood transfusions?

- HEP C
what is the best way to prevent the spread of HEP A?
what is the best way to prevent the spread of HEP A?

- wash hands
What are the blood transmitted hepatitis’s? (what type of HEP associated with tattoos?)
What are the blood transmitted hepatitis’s? (what type of HEP associated with tattoos?)

- HEP B, C & D
Which hepatitis is transmitted via the oral-fecal route?
Which hepatitis is transmitted via the oral-fecal route?

-A & E
Can you ever get Hep D without Hep B?
Can you ever get Hep D without Hep B?
-no! You can’t get D without B. D never occurs on its own. You have to have B in order to get D. D & B are always together.
What are the common, early signs of hepatic inflammatory disorder/ hepatitis?
What are the common, early signs of hepatic inflammatory disorder/ hepatitis?
- Anorexia, nausea and vomiting.
What do you monitor to know if your pt with hepatitis condition is worsening?
What do you monitor to know if your pt with hepatitis condition is worsening?

- Mental status, monitor for drowsiness, difficulty to arouse or coma.
Pt with viral HEP asks you what kind of a diet they should eat?
Pt with viral HEP asks you what kind of a diet they should eat?

- high protein, carbs and fats Regular diet (don’t pick French fries, tortilla chips, cheese burger, maybe pick jello desert?)
pt who has a cholecystitis or cholelithiasis is going to have pain where? What is the quality of pain?
pt who has a cholecystitis or cholelithiasis is going to have pain where? What is the quality of pain?
- RUQ
- Colicky pain. Acute abdominal pain with intense spasmodic cramping that is caused by a stone in the cystic duct. Billiary spasming is what causes the colicky pain.
(FYI: fatty foods make the colicky pain worse)

An acute or chronic inflammation causing painful distention of the gallbladder
pt is sever pain ruq associated with nausea and vomiting, coliesesitisis/colielathytis
pt is sever pain ruq associated with nausea and vomiting, coliesesitisis/colielathytis

- pain why track is blocked by lithiasis (stones)
if your pt with coliesesitisis/colielathytis has a stone and it gets wedged in the biliary ducts somewhere, what color will their sclara be?
if your pt with coliesesitisis/colielathytis has a stone and it gets wedged in the biliary ducts somewhere, what color will their sclara be?
- yellow
-if it goes on long enough, then their skin will turn yellow
another word for yellow skin is?
another word for yellow skin is?

- jondis or ichteric
what are the ducts? billiary ducts are:
what are the ducts? billiary ducts are:

- cystict duct, hepatic duct, pancreatic duct, all go into the common bile duct all going to the duadinum.
pt has obstructive johndis (another way of saying obstruction in the biliary trace). pt. now has objected jaundice, what color is his stool? what color is his urine?
pt has obstructive johndis (another way of saying obstruction in the biliary trace). pt. now has objected jaundice, what color is his stool? what color is his urine?

- clay colored with tea colored pee
Why do we use a incentive spirometer for pt with chest or abd surguries? How will it prevent pt from getting pneumonia?
Why do we use a incentive spirometer for pt with chest or abd surguries? How will it prevent pt from getting pneumonia?
-Deep breathing
- pt with open cholecstecystectomy is at risk for pneumonia due to location of the abdominal incision
- any pt with abd or chest surgery, post surgery, nurse responsible - turn, cough, deep breath instead of syromiter - to avoid pneumonia
pt has severe upper abd. pain (on rt. side), she also has an elevated serum Amylase, what is that a sign of?
pt has severe upper abd. pain (on rt. side), she also has an elevated serum Amylase, what is that a sign of?

-sign of pancreatitis
-rise in enzyme indicates pancreatic duct obstruction or leak.
what is your primary nursing goal for a pt with pancreatitis?
what is your primary nursing goal for a pt with pancreatitis?

-Relieve pin
what medication should be prescribed to a pt with pancreatitis?
what medication should be prescribed to a pt with pancreatitis?

-anything without morphine. Just say no to morphine.

-Demerol / morphine sends sphincter of oddi into spasms
how do you help the pt to do these things?
how do you help the pt to do these things?

- med 30 min before, splint site
pt c/o sever upper abd pain, serums amylase elevated, what organ is a concerned
pt c/o sever upper abd pain, serums amylase elevated, what organ is a concerned
- pancreas
pancreatitis what is primary goal for nursing?
pancreatitis what is primary goal for nursing?

- relieve pain
pt acute pancreatitis giving med what position to be in?
pt acute pancreatitis giving med what position to be in?

- fetal position

-sitting up leaning forward relieves the pain.
what type of diet for pt with pancreatitis?
what type of diet for pt with pancreatitis?

- low fat / high carb
why would pt with pancreatitis be NPO initially (until pain subsides)?
why would pt with pancreatitis be NPO initially (until pain subsides)?

-to rest the pancrease to reduce the amount of digestive enzymes
-releive the pain
(u don’t want to stimulate the pancrease)
pt acute pancreatitis what position will relive the pt from the pain?
pt acute pancreatitis what position will relive the pt from the pain?

- sitting up & leaning forward relieves the pain.
What is the recomint position? what will this do to a pt with pancreatitis?
What is the recomint position? what will this do to a pt with pancreatitis?

- legs elevated, head 45 degree angle
- this position will worsen the pain
pancretitis my have a ngt placed why?
pancretitis my have a ngt placed why?

- suck out the digestive juices machine is on low intermittent setting
pt with pancretitis cant stands night time why?
pt with pancretitis cant stands night time why?
- increase in pain, put in semi Fowler's knees flexed
warm aveeno baths order with cancer of pancreas, why ?
warm aveeno baths order with cancer of pancreas, why ?

- relieves itching because of the jaundice (bile salts)
pt with cancer of pancreaese whipple procedure, what part of pancreas is removed?
pt with cancer of pancreaese whipple procedure, what part of pancreas is removed?

- head
pt with cancer of pancreas is apprehensive and restless, what nursing consideration be?
pt with cancer of pancreas is apprehensive and restless, what nursing consideration be?

- encourage him to express his concerns
pt safety ---- pt has distal pancreatectomy and spleectomy, sleepy but can answer ok VS within limits, before nurse leaves room -
pt safety ---- pt has distal pancreatectomy and spleectomy, sleepy but can answer ok VS within limits, before nurse leaves room - handrails up and bed lowest position
after pancreatic surgery, main reason for respirator infection is because of -
after pancreatic surgery, main reason for respirator infection is because of

- promixity of insision to diaphram
a new client admitted to hospital with anorexia, weight lost , lab shows elevation in ASC, ALT?
a new client admitted to hospital with anorexia, weight lost , lab shows elevation in ASC, ALT?
- liver
pt has cirrhosis. your looking at the lab tests and total bili is elevated, serum ammonia is elevated, alt is elevated and PT is prolonged. what do you expect to find?
pt has cirrhosis. your looking at the lab tests and total bili is elevated, serum ammonia is elevated, alt is elevated and PT is prolonged. what do you expect to find?

- juandice
- confused
- bleeding
your pt has hepatitis C. your going to have a liver biopsy.. before procedure what kind of lab tests do you expect to run?
your pt has hepatitis C. your going to have a liver biopsy.. before procedure what kind of lab tests do you expect to run?

- coagulation studies (risk for bleeding)
- PT PTT and INR
paracenthesis:
paracenthesis: take the fluid out of belly
in order to know if pt is properley pre-oped before paracenthesis. what do you do?
in order to know if pt is properley pre-oped before paracenthesis. what do you do?

- high fowlers

- take vitals within 10 mins of procedure

- informed consent
what signs would indicated to you that cirrhotic pt has a defiency in vitamin K?
what signs would indicated to you that cirrhotic pt has a defiency in vitamin K?

- bruising
- ecchymosis
- purpura
what can you do to tampondoff the bleeding?
what can you do to tampondoff the bleeding?

- blakemore tube
where does the blakemore tube do its job?
where does the blakemore tube do its job?
- down the esophagus into the stomach
after pancreatic surgery, the main reason they may develop a respiratory tract infection due to the type of surgery. why?
after pancreatic surgery, the main reason they may develop a respiratory tract infection due to the type of surgery. why?

- proximity to the incision of the diaphragm
your pt has has pancreatic cancer and .... what part of pancreas is removed?
your pt has has pancreatic cancer and .... what part of pancreas is removed?

- the head
pt. with cirrhosis, lab test showed bilirubin, serum ammonia and ALT are elevated; also PT(prothrombin time) is prolonged. What do you expect to find in your pt?
pt. with cirrhosis, lab test showed bilirubin, serum ammonia and ALT are elevated; also PT(prothrombin time) is prolonged. What do you expect to find in your pt, select all it apply

- jaundice

- confused (due to ammonia increased)

- bleeding

*** Prothrombin time (PT) is a blood test that measures the time it takes for the liquid portion (plasma) of your blood to clot
pt. has cirrhosis and ascites, what system is most important for you to monitor
pt. has cirrhosis and ascites, what system is most important for you to monitor

- respiratory status
pt. discharged from paracentesis procedure, what is your nurse teaching if pt develops fever or abd pain
pt. discharged from paracentesis procedure, what is your nurse teaching if pt develops fever or abd pain

- notify doctor

- abd pain due to internal bleeding

- fever due to infection
what is the most important daily check for pt. with cirrhosis?
what is the most important daily check for pt. with cirrhosis

- abdominal girth (distance around the abd) to see if it is increased
sign of vitamin K deficiency?
sign of vitamin K deficiency

- bruises

- ecchymosis (large purple bruise)

- purpura (purple color spot)
diet for pt. with alcoholic induced cirrhosis, has severe elevated ammonia level?
diet for pt. with alcoholic induced cirrhosis, has severe elevated ammonia level

- reduce protein (restricted)

- increase calories

- high carbohydrate

- high fat
what is asterixis?
what is asterixis?

- also called the flapping tremor or liver flap

- cause by high ammonia level

- is a tremor of the wrist when the wrist is extended (dorsiflexion)
what is the sign of elevated AST and ALT
what is the sign of elevated AST and ALT

- hepatitis
nursing responsibilities for abd post-surgery or any surgery? Why?
nursing responsibilities for abd post-surgery or any surgery?

- turn, cough, deep breathing (medicate pt. 30 minutes before)

- and incentive spirometer (measuring volume of air inspired and expired from lung)

why?

- prevent ammonia
what is the main reason for pt. with pancreatic surgery develop respiratory tract infection?
what is the main reason for pt. with pancreatic surgery develop respiratory tract infection?

- proximity to the incision of the diaphragm (due to the type and position of the surgery)