Nclex Ch04 U02-08: Liver And Pancreas Problems

Front 1

What is compensated cirrhosis?

Back 1

when the liver is heavily scarred, but it can still perform many important fxns

Front 2

What is compensated cirrhosis?

Back 2

when the liver is heavily scarred, but it can still perform many important fxns

Front 3

S&S of compensated cirrhosis?

Back 3

1. vascular spiders
2. ankle edema
3. indigestion
4. flatulence
5. ab pain
6. enlarged liver

Front 4

What is decompensated cirrhosis?

Back 4

liver is extensively scarred and unable to fxn properly

Front 5

S&S of decompensated cirrhosis?

Back 5

1. ascites
2. jaundice
3. weight LOSS
4. purpura
5. epistaxis

Front 6

Which biliary changes occur w/ cirrhosis? (3)

Back 6

1. jaundice, pruritis
2. DARK URINE, CLAY-COLORED STOOLS
3. increased ab girth

Front 7

3 circulatory changes that occur w/ cirrhosis?

Back 7

1. esophageal varices
2. hematemesis
3. hemorrhage

Front 8

List the digestive disturbances that occur w/ cirrhosis

Back 8

1. indigestion, dyspepsia
2. flatulence, C, D
3. anorexia, weight LOSS
4. N, V

Front 9

What is the phys of cirrhosis?

Back 9

the replacement of normal liver tissue w/ widespread fibrosis and NODULE formation

Front 10

3 types of cirrhosis?

Back 10

1. alcoholic cirrhosis
2. biliary cirrhosis
3. postnecrotic cirrhosis

Front 11

What is the cause of alcoholic cirrhosis?

Back 11

alcoholism & poor nutrition

Front 12

What is the cause of biliary cirrhosis?

Back 12

chronic biliary obstruction and infection

Front 13

What is the cause of postnecrotic cirrhosis?

Back 13

result of previous viral hepatitis

Front 14

List 4 complications a/w cirrhosis.

Back 14

1. portal HTN w/ esophageal varices
2. peripheral edema & ascites
3. hepatic encephalopathy (coma)
4. hepatorenal syndrome

Front 15

Where is the impact of portal HTN most likely found?

Back 15

dilated tortuous veins usually in the submucosa of the lower esophagus

Front 16

What is the leading cause of death in pt w/ cirrhosis?

Back 16

hemorrhage from rupture of the esophageal varices r/t portal HTN

Front 17

What is ascites/?

Back 17

accumulation of serous fluid in peritoneal and abdominal cavity

Front 18

What is peripheral edema and ascites a/w?

Back 18

1. dehydration
2. HYPOkalemia

Front 19

What is the cause of hepatic encephalopathy?

Back 19

accumulation of AMMONIA and other toxic metabolites in the blood

Front 20

S&S of hepatic encephalopathy?

Back 20

1. change in level of consciousness
2. jaundice
**may lead to COMA

Front 21

Signs of impending coma? (3)

Back 21

1. not AxO x3
2. asterixis (flapping of hand when arm extended and hand held upward (dorsiflexed)

Front 22

What is the cause of postnecrotic cirrhosis?

Back 22

result of previous viral hepatitis

Front 23

What is hepatorenal syndrome and what are S&S? 2

Back 23

functional renal failure-

1. azotemia
2. ascites

Front 24

List 4 complications a/w cirrhosis.

Back 24

1. portal HTN w/ esophageal varices
2. peripheral edema & ascites
3. hepatic encephalopathy (coma)
4. hepatorenal syndrome

Front 25

Where is the impact of portal HTN most likely found?

Back 25

dilated tortuous veins usually in the submucosa of the lower esophagus

Front 26

What is the leading cause of death in pt w/ cirrhosis?

Back 26

hemorrhage from rupture of the esophageal varices r/t portal HTN

Front 27

What is ascites/?

Back 27

accumulation of serous fluid in peritoneal and abdominal cavity

Front 28

What is peripheral edema and ascites a/w?

Back 28

1. dehydration
2. HYPOkalemia

Front 29

What is the cause of hepatic encephalopathy?

Back 29

accumulation of AMMONIA and other toxic metabolites in the blood

Front 30

S&S of hepatic encephalopathy?

Back 30

1. change in level of consciousness
2. jaundice
**may lead to COMA

Front 31

Signs of impending coma? (3)

Back 31

1. not AxO x3
2. asterixis (flapping of hand when arm extended and hand held upward (dorsiflexed)

Front 32

What is hepatorenal syndrome and what are S&S? 2

Back 32

functional renal failure-

1. azotemia
2. ascites

Front 33

How to relieve portal HTN?

Back 33

shunts

Front 34

Nutrition for pt w/ early stages of cirrhosis?

Back 34

HIGH PROTEIN
HIGH CARB
VIT B COMPLEX SUPPLEMENT

Front 35

Nutrition for pt/ w/ advanced cirrhosis?

Back 35

FIBER, PROTEIN, FAT AND SODIUM RESTRICTIONS!!!

HIGH CALORIE
HIGH PROTEIN (W/ GOOD BIO VALUE)

Front 36

3 additional nutrition requirements for cirrhosis pts?

Back 36

1. small, frequent feedings
2. fluid restriction
3. avoid alcohol

Front 37

What should you monitor for in pt w/ cirrhosis?

Back 37

1. signs of bleeding (give blood products if necessary)
2. VS (for shock)
3. ab girth
4. daily wt
5. skin integrity (AVOID strong soaps)
6. assess degree of jaundice
7. promote REST
8. promote resp fxn

Front 38

3 ways to prevent bleeding in a pt w/ cirrhosis?

Back 38

1. electric razor
2. soft toothbrush
3. P to site after venipuncture

Front 39

How do you reduce ascites?

Back 39

1. sodium & fluid restrictions
2. diuretics

Front 40

6 invasive tx for bleeding esophageal varices?

Back 40

1. balloon tamponade
2. endoscopic sclerotherapy
3. room temp saline lavage
4. esophageal banding therapy
5. TIPS: transjugular intrahepatic postsystemic shunting
6. surgical bypass

Front 41

What tubes can you use for balloon tamponade?

Back 41

1. Sengstaken-Blakemore tube
2. Minnesota tube

Front 42

What are the 3 fxns of the 3 lumens of the Sengstaken-Blakemore tube?

Back 42

1. gastric inflation balloon
2. gastric aspiration (cxt to sxn)
3. esophageal inflation balloon

*deflate these sequentially, beginning w/ the esophageal one

Front 43

Complications a/w balloon tamponade? 4

Back 43

1. necrosis of nose, stomach mucosa, or esophagus
2. asphyxiation

Front 44

What is endoscopic sclerotherapy?

Back 44

injection of sclerosing agent into the esophagus, causing varices to become fibrotic

Front 45

Which meds can be given to tx bleeding esophageal varices?

Back 45

vasopressin
propanolol IV or interarterial
IV octreotide (sandostatin)

fxn: temp lowers the portal pressure by constricting the splenic artery

Front 46

What is esophageal banding therapy?

Back 46

modified endoscope w/ rubber band passed into the esophagus, varices are banded

Front 47

How do you tx hepatic encephalopathy?

Back 47

1. bedrest
2. meds:
Lactulose
Neomycin

Front 48

S&S of Jaundice? (4)

Back 48

Jaundice:
1. yellow or greenish-yellow skin & sclerae r/t high bilirubin conc in blood
2. DARK URINE
3. CLAY-COLORED stool
4. pruritis

Front 49

What is hemolytic jaundice?

Back 49

jaundice caused by destruction of great number of blood cells, which leads to high conc of bilirubin that exceeds liver's ability to excrete it

Front 50

3 causes of hemolytic jaundice?

Back 50

hemolytic jaundice:
1. hemolytic transfusion rxns
2. hemolytic anemia
3. sickle-cell crisis

Front 51

What is intrahepatic jaundice?

Back 51

jaundice due to obstructed flow of bile through the liver or biliary duct system

Front 52

2 causes of intrahepatic jaundice?

Back 52

1. cirrhosis
2. hepatitis

Front 53

What is extrahepatic jaundice?

Back 53

jaundice due to obstructed flow of bile through the liver or biliary duct system

Front 54

3 causes of extrahepatic jaundice?

Back 54

1. cholelithiasis
2. tumors
3. med side effects
-phenothiazine
-antithyroids
-sulfonamides
-TCAs
-androgens, estrogens

Front 55

How do you relieve jaundice?

Back 55

tx the underlying cause

Front 56

How do you tx pruritis? (5)

Back 56

1. antihistamines
2. baking soda or Keri baths
3. keep nails trimmed and clean (teach to rub w/ knuckles, not nails)
4. soft, old linen
5. moderate T

Front 57

What is Reye's Syndrome (RS)?

Back 57

acute metabolic encephalopathy of childhood that causes hepatic dysfxn

Front 58

What are the causes of RS? (2)

Back 58

1. asprin w/ a viral illness
2. a/w viruses (esp URI, gastroenteritis)

Front 59

S&S of RS? 3

Back 59

1. fever
2. increased ICP
3. decreased LOC, coma
4. decreased hepatic fxn

Front 60

How do you dx RS?

Back 60

liver biopsy

Front 61

What should you monitor in a pt w/ RS?

Back 61

1. neuro checks
2. hydration and electrolytes w/ IV
3. ET tube and respirator may be needed
4. CVP or Swan-Ganz catheter

Front 62

What is cholecytitis?

Back 62

inflammation of the gallbladder

Front 63

What is cholelithiasis?

Back 63

presence of STONES in the gallbladder

Front 64

Risk factors for cholelithiasis/cholecystitis? 8

Back 64

1. obesity
2. sedentary life
3. women (esp multips)
4. 40+ y/o
5. preg
6. family hx
7. hypothyroidism
8. increased serum cholesterol

Front 65

Where is pain located in pt w/ cholecystitis/cholelithiasis?

Back 65

severe pain in the upper right quadrant of badomen, radiating to back and right shoulder (biliary colic)

Front 66

S&S of cholecystitis/cholelithiasis? 7)

Back 66

1. intolerance to fatty foods
2. indigestion
3. N,V,flatus, eructation
4. high T
5. leukocytosis
6. diaphoresis
7. DARK URINE & CLAY COLORED STOOLS

Front 67

4 interventions for cholecystitis/cholelithiasis?

Back 67

1. rest
2. IVF
3. NG suction
4. meds: Ab, analgesics

Front 68

What type of diet should a pt w/ cholecystitis/cholelithiasis be on?

Back 68

LOW FAT LIQUIDS: powdered supplements high in protein, carbs stirred into skim milk

NO fried foods, pork, cheese, alcohol

Front 69

2 types of surgeries to remove the gallbladder?

Back 69

1. laparoscopic laser cholecystectomy
2. traditional cholecystectomy

Front 70

What is a laparoscopic laser cholecystectomy?

Back 70

removal of the gallbladder by a laser through a laparoscope

4 small puncture holes made in ab

Front 71

Pre-op care before a laparoscopic laser cholecystectomy?

Back 71

NPO

Front 72

Postop care for pt s/p laparoscopic laser cholecystectomy? 3

Back 72

1. monitor for bleeding
2. resume normal activity in 1 wk
3. low-fat diet for several wks

Front 73

What is a traditional cholecystectomy?

Back 73

removal of gallbladder through high abdom incision

Front 74

What should you give if prothrombin time is low before a traditional cholecystectomy?

Back 74

1. Vitamin K
2. blood transfusions

Front 75

Which supplements would aid in healing and prevent liver damage?

Back 75

1. glucose
2. protein hydrolysates

Front 76

What must you insert prior to a traditional cholecystectomy?

Back 76

NGT

Front 77

Which tube must you monitor s/p traditional cholecystectomy?

Back 77

T tube (inserted to ensure drainage of bile from common bile duct until edema in area diminishes)

*keep T-tube drainage bag below the level of the gallbladder

Front 78

Which position should a pt s/p a traditional cholecystectomy be in?

Back 78

semi-fowler's

Front 79

How should you monitor for jaundice s/p a traditional cholecystectomy?

Back 79

1. yellow sclerae
2. stools that don't change from light to dark after removal of T tube

Front 80

What type of diet should a pt be on s/p a traditional cholecystectomy?

Back 80

HIGH CARB
HIGH PROTEIN

LOW fat

Front 81

What is acute pancreatitis?

Back 81

acute inflammation of pancrease, brought about by digestion of the organ by ENZYMES IT PRODUCES, esp TRYPSIN

Front 82

What is chronic pancreatitis?

Back 82

progressive, chronic fibrosis and inflammation of the pancreas, w/ obstruction of its ducts and destruction of its secreting cells

Front 83

Risk factors for pancreatitis? (5)

Back 83

1. alcoholism
2. infection
3. trauma
4. mumps complication
5. meds
-BCPs
-corticosteroids
-thiazide diuretics

Front 84

Describe the pain in r/t pancreatitis?

Back 84

ab pain, N, V 24-48 hr after a heavy meal or alcohol

pain is relieved w/ position change

Front 85

3 S&S of pancreatitis?

Back 85

1. hypOtension
2. acute renal failure
3. GREY-BLUE discoloration in FLANK and around umbilicus

Front 86

Meds to tx pancreatitis? 4

Back 86

1. abs
2. opioids (avoid meperidine r/t tox)
3. his-blockers
4. PPIs

Front 87

Which position should a pt w/ pancreatitis be in?

Back 87

semi-fowler's

Front 88

Resp care for a pt w/ pancreatitis?

Back 88

1. ABG
2. humidified oxygen
3. intubation
4. ventilaiton
5. C&DB q2h

Front 89

Goals for pt w/ pancreatitis?

Back 89

1. NPO, gastric decompression
2. F&E
3. monitor for shock and HYPERglycemia

Front 90

Diet for pt w/ pancreatitis?

Back 90

TPN

Front 91

long term tx for pancreatitis?

Back 91

1. avoid alcohol and caffeine
2. low fat, bland diet
3. small, frequent meals