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127 Cards in this Set
- Front
- Back
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Inflammation of the pancreas, can be acute or chronic
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Pancreatitis
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80% of cases are associated with alcoholism and biliary tract disease, alcohol triggers spasms of the sphincter of Oddi, which may obstruct enzyme flow into the SI
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Pancreatitis
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Chronic can lead to cancer of the duodenum or pancreas and they can develop diabetes
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Pancreatitis
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Which diagnositic test do they use to monitor for pancreatitis?
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ERCP, Serum amylase, and blood sugar will be over 200
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S/S of this disease includes: mid-epigastric pain that radiates to back and flank, pain is worse when lying supine or when eating, jaundice, eructation, distention, decreased bowel sounds, anorexia, N/V, low grade fever, increased pulse rapid shallow respirations, hypotension, malaise
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Pancreatitis
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What is the best position to be in for pancreatitis?
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Semi-fowlers, but they may be in the fetal position
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What is the diet used as an intervention for pancreatitis?
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Small frequent meals, bland, low fat, high protein, high carbs, avoid spicy foods, avoid caffeine, and avoid alcohol
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What are the drugs to give for pancreatitis?
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Antibiotics, antispasmotics, anticholenergics, also demerol
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Demerol is used instead of morphine because it is believed to cause spasms in the common bile duct.
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Why is demerol used instead of morphine?
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Define the word "liberal."
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Marked by generosity
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Is defined as failing of the liver to detoxify ammonia
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Hepatic Encephalopathy
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A breakdown product of protein metabolism
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Ammonia
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Neurologic symptoms, cognitive disturbances, declined consciousness, hepatic coma
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S/S of Hepatic Encephalopathy
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What is the most serious complication of Hepatic Encephalopathy
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Hepatic Coma
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What vitamin do you take for Hepatic Encephalopathy
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Vit B Complex
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This disorder lives in feces and is transmissions through the fecal oral route
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Hepatitis A
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You can get this disorder in shellfish
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Hepatitis A
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HAV is
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Hepatitis A
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Incubation period is between 5-50 days
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Hepatitis A
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You can get this disease from sexual or close person contact, fecal transmission
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Hepatitis A
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You can get this disease again even after you have had it once
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Hepatitis A
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There is a vaccine for both of these diseases
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Hepatitis A and B
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You can take IG when exposed to preven the disease
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Hepatitis A
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HBV
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Hepatitis B
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Has a carrier state
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Hepatitis B
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Transmitted through blood and body fluids, needle use is the primary transmission
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Hepatitis B
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Newborns my be infected before, during, or after birth, if their mother has it, 90-95% chance
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Hepatitis B
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Incubation period is 45-160 days
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Hepatitis B
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Can get a liver transplant
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Hepatitis B
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No drugs are available for these diseases
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Hepatitis B and A
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Chronic hepatitis be my be treated with
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Interferon
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If you are chronic for this disease you are at an increase risk for liver failure and liver cancer
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Hepatitis B
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Phases of Hepatitis
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Preicteric, Icteric, Posticteric
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S/S of this phase are: malaise, right upper quadrant abdominal pain, anorexia, nausea, vomiting, fever, arthralgia, urticaria
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Preicteric Phase
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Most infectious phase of Hepatitis
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Preicteric Phase
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This phase of hepatitis lase 1-21 days
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Preicteric Phase
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S/S of this phase include jaundice, clay colered stools, dark urine, puritis, prolonged clotting times, fatigue
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Icteric Phase
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This phase of hepatitis last 2-4 weeks
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Icteric Phase
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S/S of this phase of hepatitis include fatigue, malaise, hepatomegaly
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Posticteric Phase
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This phase of hepatitis last for several months
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Posticteric Phase
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When you are a carrier of this disease you may be asymptomatic, have a low grade fever, infection remains in blood, and you can transmit the disease
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Hepatitis
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What is the goal of drug therapy for hepatic encephalopathey
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To reduce the amount of ammonia produced in the digestive tract
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What is the source ammonia
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The action of bacteria on protein in the digestive tract
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What is the cathartic agent or laxative for in Hepatic Encephalopathy
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Lactulose
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What promotes elimination of ammonia from the colon and discourages bacterial growth by making the intestinal contents more acidic
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Lactulose
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What disease do you use mannitol for?
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Hepatic Encephalopathy
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What is mannitol?
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Osmotic Diuretic
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Neomycin Enema is used to do what in Hepatic Encephalopathy
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Eliminate ammonia
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This disorder is chronic, progressive disease of the liver and is characterized by degeneration with fatty infilltration of normal liver tissue, fibrotic bands
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Cirrhosis
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This disorder cause metabolic disturbances (protein), nodules, and scar tissue, obstructs the portal vein, and you cant make plasma proteins
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Cirrhosis
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The incidence of this disorder is in men, aged 40-60, most often but not always related to alcohol induced liver disease
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Cirrhosis
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Alcohol, drugs, poision, infection (viral), obstruction to bile flow, and right sided heart failure are all causes of this disorder
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Cirrhosis
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GI S/S of this disorder include: anorexia, dyspepsia, N/V, change in bowel habits, pain in RUQ, weight loss, fetor Hepaticus, ascites, clay-colored stools, melena, get infection easily
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Cirrhosis
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What is Fetor Hepaticus
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Liver breath is a fruity-musty odor
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Neuro S/S of this diorder include: hepatic encephalopathy, asterixis (liver flapping tumor)
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Cirrhosis
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Integumentary S/S of this disorder include: Jaundice, spider angioma (spider veins), palmar erythema
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Cirrhosis
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Cirrhosis affects aldosterone production this will affect (Metabolic System)
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Potassium and Sodium
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What is a S/S of Cirrhosis when it concerns the hematologic system
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Anemia, Thrombocytopenia, Leukopenia, Coagulation disorders, Splenomegaly
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When dealing with Cirrhosis whey do you check PT/PTT
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Because they have a tendency to bleed
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When dealing with Cirrhosis what drugs may they be on that will affect their PT/PTT
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Coumadin (PT) and Heparin (PTT)
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What is the syndrome associated with Cirrhosis and causes renal failure:
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Hepatorenal Syndrome
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What does portal hypertension have to do with Cirrhosis?
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This will cause esophageal varcies, and is caused by obstruction of the blood flow of incoming blood causing a back up in the protal system
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When you monitor BUN what is the normal range
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10-20
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NI for this disease include: Monitor bleeding, bed rest, monitor LOC, seziure precautions, monitor I/O, monitor BUN, well balanced diet with small-frequent meals, elevate HOB, keep IS around, check daily weight, and skin care
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Cirrhosis
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What vitamins and supplements do you give for Cirrhosis
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A, K, C B complex
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The diet for Cirrhosis should include:
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High carbs, vitamins with moderate to high protein and dietary supplements
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Why would you lower protein in the diet for Cirrhosis?
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The daily need is 60 g/day, this may need to be lowered if the patients blood ammonia which can cause hepatic encephalopathy
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Why would you need to restrict water and sodium in patients with Cirrhosis?
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Limit to 1500 ml/day and this is because of fluid retention or ascites
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Why do they use IG or immuno globulin?
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For people who are traveling out of the country for passive immunity, and it boost your antibodies, given within two weeks
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Meaning of percipitate
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To bring about abruptly
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What are the factors that may percipitate hepatic encephalopathy
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Infection, fluid-potassium depletion, GI bleeding, constipation and some drugs
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What are the 5 F's of Gallbladder disease?
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Female, fat, fair, forty and fertile or even flatulent
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When gallstones are present this is known as...
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Cholelithasis
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Cholelithiasis can cause inflammation of the gallbladder this is known as
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Cholecystitis
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What are the affects of fat in the gallbladder?
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The high concentration of cholesterol rises when stasis of bile exists causing gallstones, also a low fat diet is reccomened to decrease the incidence of acute symptoms
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Common S/S found in Cholecystitis are:
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Biliary colic, indigestion, jaundice, nausea, eructation, RUQ pain that may radiate to the shoulder. When the bile flow is obstructed the patient may have steatorrhea, jaundice, clay colored stools, an increase in WBS and a low grade fever. The S/S can last for hours/weeks and are worse with movement
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Surgery is an option for gallbladder disorders they include
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Laparoscopic, the most common method and this could turn into the Open Method, cholecystectomy, shock wave lithotripsy, endoscopic sphincterotomy
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Surgery info for gallbladder disorders include
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General anesthesia, shoulder pain, 4 small stab wounds, less pain and scaring, and they can generally go back to work in 3-5 days, could possibly develop peritionitis
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The Open Method for gallbladder surgery info:
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Includes a single incision, you will be able to palpate for gallstones, the gallbladder will be very fragile, may have a T tube inserted, possible drains, this could result in peritonitis
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This tube may be placed in the common bile duct to maintain bile flow until swelling in the duct subsides it is known as a
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T-tube
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Is it normal for the T-tube drainage, when returning from surgery, to be bloody and then drainage to become greenish brown
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Yes this is a normal finding!
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What is the nurses job when caring for a T-tube?
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To measure/record the amount of drainage and notify the Dr. if the drainage exceeds 1000 mL in 24 hours.
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What is the best position to put the patient in to allow for drainage when using a T-Tube?
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Low-Fowlers
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What is the reason for a Penrose drain...
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To divert fluids directly onto the wound dressings
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What disorder do you use a Penrose or Jackson-Pratt drains
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Gallbladder diseases and disorders: Cholelithiasis and Cholecystitis
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What drain is a passive drain that has a fluid collection device that keeps fluid away from the skin
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Jaskson-Pratt
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Post-Op Nursing responsibilities for Gallbladder include:
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Assess the T-tube, JP or Penrose drains, and NG tubes for drainage, TCDB, I/O, Ambulate, low fat diet for 4-6 weeks, no heavy lifting for 4-6 weeks, may begin clamping T-Tube 1-2 hours after meals, also they may need an acid base binder
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What is the acid base binder that patients with Gallbladder surgeries take?
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Cholestyramine-Questran
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What is Actigall?
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An oral bile salt, used to dissolve gallstones
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When is the only time Actigall is used?
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For patients with only small stones or those who are poor surgical risks
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This examination removes a small specimen of the liver tissue for examination, requires a signed consent
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Liver Biopsy
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For this examination you need to prep the patient by obtaining V/S and blood coagulation studies
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Liver Biopsy
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What are you looking for when you do a liver biopsy
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Hepatitis and Cirrhosis
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What are the complications for a liver biopsy
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Pneumothorax and hemorrhage, apply a pressure dressing
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What position do you put the patient in to do a liver biopsy
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Supine with right arem behind the head
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This tube is used in the Nasoenteric and is used to decompress the small intestine
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Miller-Abbott Tube
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This tube is characterized as a long double-lumen tube used to drain and decompress the small intestine, one lumen leads to a weighted balloon that is filled once it is in the stomach the second lumen is for irrigation and drainage
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Miller-Abbott Tube
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Tubes that are passed through the nose are called:
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Nasogastric, nasoduodenal, nasoenteric
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GI decompression is used for the relief of distenstion and
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remove gluid and gases that accumulate when GI motility is impaired
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Conditions that slow motility include:
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peritonitis, obstruction, and surgery
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What type of suction is used for single-lumen tubes
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Low and intermittent
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What type of suction is used four double-lumen tubes
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Low and continuous
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When the tube does not drain properly you can
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Change patient position, or rotate the tube or pull it out very slightly
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What is the amount of irrigation used for adults
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23-30 mLs
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(TUBES) When blood is present the drainage may be:
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Bright red, dark red, brown, black
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What is indicative of a stomach bleed in emesis?
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Coffee ground vomit
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What is used to stop bleeding in the stomach?
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Iced lavage
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When may the patient have N/V when concerning Gastric Decompression
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When distention is not relieved
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A nursing duty is to check for....when dealing with Gastric Decompression
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The return of peristalsis by hearing bowel sounds and flatus
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What are two NG tubes that can be used for feedins and Gastric Decompression
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Levin and Gastric Sump tubes
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What position do you put the patient in to do tube feedings?
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Fowler's, also keep the head and chest elevated for 30 minutes after the feeding is complete
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Methods to determine placement of the tube?
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CXR (inital placement), pH (during shift), Auscultating with air pumped in
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Wha tis the pH of the stomach?
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5 or less
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Do you always check the residual amount before a tube feeding? If, so do you replace the formula and why?
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Yes it is check to prevent overfilling of the stomach, yes you replace to prevent loss of e-lytes
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After a bolus tube feeding how much do you flush the tube with and with what substance
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30 mLs and water
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This type of feeding is delivered is specified intravals usually 200-300 mL over 30-45 minutes/feeding
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Bolus
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What is the diet for liver disease?
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Increase carbs, increase vitamins, moderate to high protein, small, semisolid or liquid meals
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This diagnostic test assesses liver function by measuring bilirubin in the blood
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Serum Bilirubin
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What are the normal values for a bilirubin serum
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0.2-1.0 mg/dL
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What are some other enzymes that can detect prolonged clotting time possibly caused by liver disease or vitamin K deficiency?
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PT and INR serum enzumes, AST and ALT
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What foods do you need to avoid when doing a serum bilirubin study
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Yellow foods 3-4 days before the test
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Some other labs for biliary disease include
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Serum (amylase and lipase), serum enzymes, cholesystogram, WBC's will be elevated, and ultrasonography
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What disorder is characterized by above 20% of the desired body weight
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Obesity
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What are the diseases you are at risk for when you are obese?
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Diabetes, hypertension, CAD, High cholesterol, post op complications, gynecological irregularities, gout, musculoskeletal problems, varicose veings, abdominal hernias
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Inorder to remove a tube must you have a drs order?
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Yes, a drs order is needed to remove a tube
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What are some general guidelines to remove a NG tube?
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No N/V and they must have bowel sounds in all four quadrants, clamp it several hours before removal, place towel over chest, turn off suction, remove tape, have patient deep breathe, pull out steadily, clean mouth and nose, doc, and measure and dispose of the drainage
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Where does the patient sit when irrigating a colostomy?
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On the toilet or infront of the toilet!
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