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81 Cards in this Set
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- Back
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lactulose is ordered to treat high ammonia levels, how can nurse be sure this is effective treatment
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lactulose is titrated to ammonia levels
desired 2-3 soft stools per day < 2 not effective >3 at risk for dehydration |
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2 treatments for hepatic encephalopathy
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neomycin & lactulose
neomycin destorys bacteria in gut that prodcues ammonia |
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biggest concern for hepatic encephalpathy patient
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SAFETY
FVO- portal hypertension - 3rd spacing - decreased allbumin - ascites FVD - lactulose |
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patient safety related to bleeding tendencies in liver disease
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monitor pt
ecchymosis espohg varcies care esphagogastric tube if used |
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in case of acute resp arrest with the use of esophagogastric tube -- the nrse must
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immediately deflate balloon and remove tube to bag patient --- if occulded remove it
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purpose of esphogogastric tube
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balloon stops esph varcial bleeds
remove immediately if resp arrest occurs AIRWAY IS PRIORITY |
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decreased albumin leads to
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ascites - 3rd spacing
ankle edema monitor |
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way to monitor ascites girth
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mark belly and measure on exhalation
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paracentesis is done for
***pt at risk for? *** important teaching? |
to drain fluid from peritoneal cavity - ascites
1 hour post procedure - pt at risk hypovolemia bedrest - check bp often and maintain bedrest |
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dietary teaching for liver patient
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low protein - less ammonia produced
high cho - nutritional status for healing low sodium - fvo - prevent fluid retention (portal htn) |
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what type of restriction is liver pt on?
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fluid restriction, low sodium diet, want to prevent fvo
fluids cannot pass thru liver |
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what is hepatitis
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liver inflammation
viral-- poor hygiene, poor food prep, iv drug use, unprotected sex non viral - exposure drugs or chemicals |
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acute vs chronic hepatitis
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acute - rid of virus within blood stream in 6 months or less from tiime of infection
chronic - person has acute hep episode and virus remains in body for more 6 months |
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transmission of hepatitis occurs
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hep A & E - bowel oral/fecal route, sewage, contaminated water
Hep B - body fluids Hep C - blood, body fluids, circulation |
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3 phases of hepatitis
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pre-icteric (prodromal)
icteric (clinical) post icteric (convalescent) |
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pre icteric phase of hepatitis
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just p transmission
anorexia, nausea, vomiting RUQ pain hepatomegaly/lymphdenopathy |
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***********difference btw cirrohsis and hepatitis
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both have hepatomegaly but only hep has lymphadenopathy
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icteric phase of hepatitis
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last 2-4 weeks
a/n/v liver tenderness - inflammation along with enlargement alterations in bilirubin -- cant get of liver so comes out thru skin JAUNDICE JAUNDICE JAUNDICE |
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post icteric phase of hep
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jaundice disappears, 2-4 months
mailase, easily fatigued, relapes are common |
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chronic persistent hep
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asymptomatic,
precusor to cirrhosis or liver cancer |
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*************
an infection that persist more than 6 months indicate a |
chronic condition
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nsg implications r/t medications to treat LIVER disorders
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antiemetics
--compazine -prochlorperazine - not commonly used hepato-toxic not used in hepatitis patients b/c hepatotoxic |
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what med is not used in hepatitis patients
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compazine - antiemetic - hepatotoxic
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bile acid sequestraints are used for what
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hepatitis patients to control itching and jaundice
allows more bile to go out into stools forces liver to produce for bile salts, converts cholesterol into bile - which lowers levels of cholesterol questran, colestid |
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a new treatmetn for hep c patients
original use side effects potential complication |
virazole (ribavirin) originally designed for resp conditions in children RSV
effective in erradicating hep c virus in more than 1/2 patients side effects - hemolysis (bd healthy blood cells, before end of cell life) anemia |
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ways to help pt combat fatigue
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assist unlicensed staff to help patient with ADLs
schedule activities following rest between |
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teaching needs of hepatitis patient?
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hep prevention
hep A - good hygiene and health IG give to food handlers and patrons vaccination if spendign time in high risk areas Hep B - vaccination, use PPEs, know sex partners, tattoo/piercing |
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hepatitis is a reportable illness to
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CDC
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public health considerations of a patient dx with hepatitis
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has pt handled food prep?
patient contacts been notificed of illness? is a food or water source of suspected point of origin for infection? |
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nutritional and fluid balance for hepatitis patients
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high calorie, high carb diet
low fat, moederate protein (high protein can cause addt'l symptoms) no protein is recommended b/c its necessary for synthesis of albumin and normal healing vitamin supplemtns avoid supplements maintain iv hydration ANTIEMTICS - PRN no compazine - hepatotoxic vitamins PARC protein, vit a, riboflavin, vit c |
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**********PARC - vitamins need for hep patient
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protein, vit A, riboflavin, vit C
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kidneys are protected by
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ribs, muscle, fasica, peritoneal fat, renal capsule
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adrenal glands sit on
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top of kidneys
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******what substance maintains sodium homeostasis by cuasing reabsorption of sodium from kidney.
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aldosterone
adrenals |
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urine formation begins in
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renal cortex
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basic working unit of kidney -- purpose of that unit
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nephron - 1 miilion per kidney, fliters blood to form urine, excrete toxins and wastes
types neprhons cortical- juxamedullary - glomerulus |
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blood passes thru ____ wastes and particles are filtered out into a liquid filtrate
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glomerulus
blood cells are too large to pass out thru glom wall and return to general circulation |
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___ determines amount of water reabsorption by altering permability
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ADH
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renal flow --
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aorta -- renal A -- 2 capillary beds -- 1200 cc hr
afferenet arteriole - brings blood in efferent - takes blood from glomerulus |
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3 step process of urine formation ************
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1. glomerular filration
2. tubular reabsorption 3. tubular secretion substances are filtered, reabsorbed, and excreted by kidneys sodium chloride bicarb potassium glucose urea creatinine uric acid |
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GFR of plasma normally equals
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125 ml/minute
180 L/day due to reabsorption - only 1 cc minute -- forms urine |
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excretion of waste products
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1. urea (major waste product of protein metabolism)
2. creatinine 3. phosphates 4. sulfate 5. uric acid (waste products of purine metab) 6. drug metabolites |
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persistent ___________ in the first indicator of kidney disease ****************
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proteinuria
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elevated levels of BUN are suggestive of ________
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renal disease
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acute vs chr onic renal failure
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acute - sudden, rapid onset in renal fux, accum metabolic waste, pt eventually returns normal fux
chronic - irreversible damage |
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azotemia
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excess amt of nitrogen compounds in blood
untreated azotemia leads to ARF increased BUN and CREAT no other symptoms |
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uremia
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azotemia with physical manifestations
fatigue, anorexia, n/v, prutius NEURO DEFICITS --- BBB |
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pre renal azotemia
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high nitrogen in blood
before kidney, decreased renal perfusion(blood flow) correlates with decreased glom filtration rate BUN & CRET comes down ex. hypovolemia dehydration |
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intra renal azotemia (intrinsic)
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nephrotoxic agents or disease damages nephron
toxic - cant function ex. gentamicin with increased BUN and cret - do not give |
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post renal azotemia
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after kidney - obstruction of kidney outflow creates increased back prssure to kidney
ex. stricture, stone |
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3 stages of ARF -
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onset, oliguric, diuretic, recovery
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onset stage ARF
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3-21 days
precip event, onset oliguria non-symptomatic, slight increase BUN & cret dehydration, stone, Gent |
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oliguric stage ARF
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8-15 days
onset oliguria -- urine output 100-400ml/24 hrs (normal output 720cc/24hrs) increased output dilute urine - not concentrated - LOW SPECIFIC GRAVITY clinical manifest: due to FVO------- HTN wt gain tachyc edema JVD ekg changes respiratory changes - sob, crackles -- retaining fluid due to decreased output toxins: a/n/v ammonia odor on breath - breath of death HA -- r/t htn minor neuro deficits - r/t htn serum hypocalemia -- converse to serum phosphorus levels increased BUN & cret |
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diuretic stage ARF
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1-6 weeks p onset oliguiric
prompt onset urine flow output up to 10L (10,000ml/24hrs) trend of improvment in BUN levels volumes of urine c no diuretics |
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recovery stage ARF
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trend improvement BUN '(sufficient levels) may never return to preillness levels
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treatment for hyperkalemia in renal failure
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kayexelate, regular insulin drip, calicum gluconate, and/or dialysis
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treatment for hypernatremia in renal failure
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diuretics until no longer responsive, dialysis, fluid restriction, sodium restriction
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common complication of ARF is anemia -- why
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kidney is only natural production of erythropoetin (red blood cell production)
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ARF is leading cause of death in
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hospitalized patients -- often cause dehydration
24 hr totals of I&O not balanced and go unnoticed |
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FVO in oliguric stage interventions
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sodium restriction 60-90 mEq (2gm/day)
potassium restriction 40-70 mEq/day (2 gm/day) fluid restriction urine volume/24 hrs plus 500 ml |
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early sign of CRF
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polyuria
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stage 1 CRF the GFR is
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greater than or equal to 90
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stage 2 CRD the GFR is
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60-89
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stage 3 CRD the GFR is
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30-58
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stage 4 CRD the GFR is
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15-29
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what lab study is most accurate indicator of renal failure
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creatinine 0.6-2.1 males
females 0.5-1.1 |
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metabolic acidosis mainifests in CRF because
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kidney cannot excrete extra acid -- and there is a bicarb deficit
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man made materials are dangerous to patient b/c
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they are more prone to clots - such as in synthetic graft for dialysis
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a temporary subcutaneous access devices is used for HD in the case of ****************8
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emergency use in case of hyperkalemia in acute renal failure
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Hemodialysis HD Assessment
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dry weight before and after HD
bp every 15 mins/signs hypovolemia clotting times -- heparin Bun, Cr, electrolytes, HH patency access site complications |
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a patient on dialysis is experiencing dysequilibrium syndrome (vertigo) what is the cause of htis
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patient is losing too much fluid and not enough blood is getting to brain - poor perfusion
tx - slow or stop dialysis infuse hypertonic saline, albumin or mannitol |
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peritoneal dialysis advantages over HD
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no blood loss, no vascular access required, less expensive
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steps of peritioneal dialysis
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1. fill 2 L within 10 mins - via gravity
2. dwell 4-10 hrs hypertonic solution - diffusion and osmosis btw patients blood and peritoneal cavity 3. drain 15-30 mins effluent should be color less or straw colored |
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important assessments for peritioneal dialysis
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glucose checks - takes 24-72 hours for maltose to clear from body
VS Weight - in AM prior to treatment inspect and measure effluent assess for complications |
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bleeding returned in effluent with peritoneal dialysis is...
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only normal with first couple treatments, persistent or new blood indicates active intraperitoneal bleeding
check BP and Hct |
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blood sugar coverage is required with peritoneal dialysis..why
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up to 100-150 g of glucose is absorbed each day: hyperglycemia
beta cell exhaustion - type 2 DM |
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kidney transplant will
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give pt full kidney function back
call heal chrnoic renal failure open nephrectomy - d/c 4-7 days restrictions 6-8 weeks lap nephrecotomy d/c 2-4 days restrictions 4-6 weeks |
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goal of post op kidney transplant regarding renal function is
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creatinine less than 1.4mg/dl
hct should fall no more than 3-6 pts |
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a kidney transplant recipent will be _____ for rest of their life
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immunosuppressed
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within 24 hrs post op nephrectomy the nurse should anticipate *********************
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large amounts of urine production - 1 liter/day
urine output should be replaced 1cc/1cc to prevent dehydration and restrict blood flow to graft sudden decrease in urine output is MAJOR concern and crititcal assessmetn |
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35.List and explain the 6 links to “Chain of Infection”.
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a.Infectious agent- causative agent
b.Reservoir-Place where microbe can survive, and multiply c.Exit pathways- way an infectious agent is able to leave d.Means of transmission- Any mode e.Entry pathway- How agent enters a host. f.Susceptible host- decreased ability to resist infection. |
