Nur135 Gi2 - Nds And Cirrhosis

Front 1

Why would the ND
Imbalanced nutrition: less than body requirements
be an appropriate nursing diagnosis for hepatitis?

Back 1

it is related to the:
N/V/diarrhea/anorexia

Front 2

What type of diet do you want to provide for a patient with hepatitis?

Back 2

high calorie
high protein
high carb

LOW fat

Front 3

When (time of day) do you want to encourage your hepatitis patient to eat?

Back 3

Large meal in the morning (most likely to consume at this time)

then several small meals throughout the day

Front 4

What vitamins would be important to consider administering for a patient with hepatitis?

Back 4

C, B, K

Front 5

If a hepatitis patient has vomiting, what are you sure to monitor?

Back 5

fluid balance. monitor for dehydration. administer IV fluids, monitor i&o

Front 6

When do you want to administer an antiemetic to a hepatitis patient?

What is the most important drug to remember to AVOID in a patient with hepatitis (when you are considering antiemetics)?

Back 6

administer 1/2 hour before meals

avoid phenergen b/c of liver toxicity

Front 7

What are two drugs that are important antiemetics used for hepatitis?

Back 7

Compazine
Torecan

(act directly on the CTZ and the vomiting center...watch for adverse effects similar to anticholinergics: dry mouth..as well as sedative effects)

Front 8

Why is the ND
Impaired Skin Integrity
a possible diagnosis for a hepatitis patient?

Back 8

scratching from pruritus
(high levels of bilirubin bind to bile salts in skin causing them to be "itchy")

Front 9

What drug is administered for a hepatitis patient that is experiencing pruritus?

Back 9

Questran

(also Benadryl)

Front 10

Name independent nursing interventions for Impaired Skin Integrity r/t scratching from pruritus.

Back 10

Use cool showers
Provide diversional activities
Prevent dry skin - no ETOH products
Provide mittens to prevent injury to skin (cotton gloves)

Front 11

What is an important independent nursing intervention to initiate for activity intolerance/Fatigue in a patient with hepatitis?

Back 11

Promote bedrest with limited activities, BRP to decrease metabolic workload of liver

Front 12

Why is the ND
Ineffective Therapeutic regimen management
an appropriate diagnosis for a hepatitis patient?

Back 12

b/c the suggestion is that they stay out of work for 6-8 weeks...most can not do that

Front 13

Additional interventions or educational points to help a patient with hepatitis manage their state of "Ineffective therapeutic regimen management" might be.....

Back 13

Importance of:
-adequate rest
-adequate nutrition
-avoiding alcohol
-avoiding OTC meds that put strain on liver
-maintaining skin integrity
-keeping doctor appts (1 year of follow ups for LFTs)

Front 14

What is the difference between hepatitis and cirrhosis?

Back 14

Hepatitis is inflammed liver, but with cirrhosis, the liver is damaged and then replaced by scar tissue

Front 15

What is the onset of cirrhosis?

Back 15

chronic, progressive

Front 16

Although many different things can cause cirrhosis, a nursing student is happy to know that the results are the _________. The patho is consistent from one cause of cirrhosis to another.

Back 16

same

Front 17

What causes the decreased function of the liver with cirrhosis?

Back 17

inadequate blood flow from scar tissue which leads to poor cellular nutrition and hypoxia

Front 18

When the liver becomes filled with scar tissue and cirrhosis sets in, what is the "big" problem?

Back 18

liver is congested and stasis of blood happens.

portal hypertension

Front 19

The portal vein brings blood from where to where?

Back 19

from the GI organs to the liver

so if it is constricted, blood will back up into the GI organs

Front 20

List possible PC's of cirrhosis

Back 20

PC: ascites
PC: jaundice
PC: portal hypertension
PC: esophageal varices
PC: hepatic encephalopathy
PC: peripheral edema
PC: hepatorenal syndrome

Front 21

Why does jaundice occur in cirrhosis?

Back 21

b/c of impaired metabolism of bilirubin

Front 22

Why does ascites occur in cirrhosis?

Back 22

deficiency of plasma porteins and decrease in osmotic olloid pressure

(elevated BP in liver causes proteins to slip out and carry water with them into the peritoneal cavity)

Front 23

When the liver can not detoxify bacterial poisons, this leads to increased ammonia levels. This is the pathway for the PC: _______________

Back 23

hepatic encephalopathy

(although it is also caused by altered protein digestion (amino acids))

Front 24

What causes the increased bleeding tendencies for a patient with cirrhosis?

Back 24

inability to produce coagulants (prothrombin) and also thrombocytes

secondary to the splenomegaly

Front 25

What is the most common type of cirrhosis is called....

Back 25

Laennec's or alcoholic cirrhosis

Front 26

Although alcoholic cirrhosis is associated with alcohol, it is also directly connected to poor ____________.

Back 26

nutrition

(specifically protein malnutrition)

Front 27

Cardiac cirrhosis is caused from long standing ________ sided CHF.

Back 27

right

(right ventricle and right atria affected)

Front 28

Right sided heart failure means that the body can not pump the blood from....(where to where???).

This right sided heart failure causes blood to accumulate in the.....

Back 28

the body into the pulmonary system

systemic venous system (including the liver and GI organs)

Front 29

Three common causes of long standing R sided heart failure are:

1.
2.
3.

Back 29

1. cor pulmonale
2. restrictive pericarditis
3. tricuspid insufficiency

Front 30

Other than alcoholic and cardiac cirrhosis, there are two other TYPES of cirrhosis. Name them.

Back 30

Post necrotic
Biliary

Front 31

Describe the cause of post necrotic cirrhosis

Back 31

From chronic HBV or HCV

(it is a compliation of viral, toxic or idiopathic hepatitis)

Front 32

What causes biliary cirrhosis?

Back 32

bile flow obstruction within the liver or the biliary system

Front 33

The retained bile that is obstructed within the liver or in the biliary system causes....

Back 33

damage to the liver cells. (Not inflammation as in obstructive hepatitis, but actual damage, necrosis and scar tissue placement)

Front 34

What are the early signs of cirrhosis?

Back 34

enlarged tender liver

dull, aching pain in RUQ

weight loss, weakness, anorexia

diarrhea or constipation

vomiting

fever

dyspepsia (indigestion)

Front 35

What are the late signs of cirrhosis?

Back 35

edema
ascites
bleeding, bruising
esophageal varices, hemorrhoids
gastritis, anorexia, diarrhea
fetor hepaticus
caput medusae
jaundice
malnutriiton
peripheral neuropathy
anemia
asterixis, encephalopathy

Front 36

What is asterixis?

Back 36

flapping of arms due to high ammonia levels that crossed bbb into brain and now are causing hepatic encephalopathy

Front 37

What is fetor hepaticus?

Back 37

distinctive odor to the patient's breath due to increased ammonia levels from improperly metabolized amino acids

Front 38

Your patient with cirrhosis starts to have bloody stools. What exam to you expect to be ordered for this patient?

Back 38

esophagoscopy to r/o esophageal varices and gastric varices

Front 39

While waiting for the MD to evaluate your patient that has bloody stools, your patient begins to vomit large amounts of blood. What do you do?

Back 39

Call rapid response. Call MD. Prepare patient for transfer to the unit. Probable esophageal varices hemorrhage which is an emergency.

Front 40

You decide to check on your patient that had a hemorrhaging esophageal varice. You go to the unit and see that it appears this patient has an NG tube. What IS this tube and why is it being used?

Back 40

This is a sengstaken Blakemore tube. It has three purposes. It has an inflated balloon that compresses the varice temporarily. It is also used for gastric aspiration and saline lavage.

3 ports

PC on this device is mucosal ulcer due to increased pressure. Must relieve the balloon pressure occasionally

Front 41

You were promoted instantly when you identified the purpose of the NG tube for the patient with the esophageal varice. Now you have to take care of this patient. What drug would you be giving to this patient to produce generalized vasoconstriction (to control bleeding)?

Back 41

vasopressin

Front 42

Why would the MD order sclerotherapy for a patient with an esophageal varice?

Back 42

to reduce the risk of recurrent bleeding

to seal off the esophageal varice

(actual procedure is an injection that occludes the varice and causes sclerosis of the veins to decrease bleeding)

Front 43

What is a TIPS procedure?

Back 43

It is NOT a surgical procedure (this was noted 5 times during lecture)

It is a catheter that is inserted and redirects the blood flow to reduce pressure in the esophageal varice.

A temporary solution.

Front 44

What is your biggest "doorway" concern for a patient with the diagnosis of cirrhosis with esophageal varices?

Back 44

PC: shock

(you need to monitor the heck out of the vitals to assess for hemorrhage. watch the stools/emesis for blood)

Front 45

What are some situations/things that can contribute to a "break" or "bleeding" of an esophageal varice?

Back 45

non chewed food (piece of steak)

heavy lifting

GERD

alcohol

Front 46

What is the origin of esophageal varices?

Back 46

they ONLY come from portal hypertension

Front 47

Why are esophageal varices such a big deal?

Back 47

they are THE MOST LIFE threatening complication of cirrhosis

Front 48

During report you hear that your patient has so much fluid in her abdomen that she looks like she is 9 months pregnant. What does she HAVE? What interventions can YOU independently?

Back 48

Ascites. No real indepenent interventions....but you can:

low sodium diet, administer diuretics

Prepare for paracentesis

Know she might be getting a peritoneal venous shunt

Front 49

Where does a peritoneal venous shunt route fluid from?

from where to where?

Back 49

from abdominal cavity (duh, ASCITES) to jugular vein to superior vena cava BACK TO CIRCULATION

Front 50

What is your pre procedure prep for a paracentesis of the abdominal fluid in your ascites patient?

Back 50

informed consent
patient weight
assess VS for baseline
hav patient VOID to avoid bladder puncture
Position seated with feet supported

Front 51

What are the three CAUSES of ascites?

Back 51

leakage of fluid to the peritoneal cavity

hypoalbuminemai due to liver's inability to synthesize albumin

hyperaldosteronism due to liver's inability to make aldosterone...so sodium retention

Front 52

Although a patient with ASCITES will complain of having a distended stomach, the WEIRD complaint is....

Back 52

muscle weakness

Front 53

What diuretic is the most commonly given to a patient with ascites?

Back 53

Aldactone - it is potassium sparing