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Complex II > Digestion & Metabolism Exam 3 > Flashcards

Digestion & Metabolism Exam 3 Flashcards

(63 cards)

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1
Q

What are the most common causes of drug-induced hepatitis?

A

Acetaminophen
statins
combining alcohol with these meds

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2
Q

What measures should you teach your patient about preventing drug-induced hepatitis?

A

no herbals (harmful to liver)
OTC meds

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3
Q

What are the clinical manifestations of acute hepatic failure?

A

fatigue
anorexia
constipation/diarrhea
chalky/oily stool
ascites
jaundice
hepatic encephalopathy (results in a coma)
Coagulation abnormalities

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4
Q

What diagnostics are used for acute hepatic failure?

A

ammonia level
drug screen
CT/MRI
increased PT & INR (bleeding)
increased bili
increased AST/ALT

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5
Q

What is the normal ammonia level?

A

15-45

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6
Q

What are the priority nursing interventions for acute hepatic failure?

A

neuro & ICP assessments
paracentesis (ascites)
liver transplant (only tx for acute liver failure)
monitor for new onset of restlessness, confusion, & deteriorating LOC
monitor airway, resp status, ET tube & oral airway
daily weights & abdominal girth
assess pain

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7
Q

What medications should be used for acute liver failure?

A

lactulose (decrease ammonia)
beta-blockers or vasoconstrictors (varices)
diuretics (ascites)
vit K (risk for bleeding)

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8
Q

What meds should you avoid with acute liver failure?

A

nephrotoxic meds (NSAIDs)
sedatives (harmful effects on mental status)

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9
Q

What are some potential complications of acute liver failure?

A

Portal HTN (esophageal varices)
renal failure
neurological deterioration
sepsis

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10
Q

What kind of diet should a patient with acute liver failure be on?

A

high carb
high protein (low w/ hepatic encephalopathy)
moderate fat
fluid restriction
possibly enteral feedings

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11
Q

What vitamins should pts with acute liver failure take?

A

thiamine
folate
B12
vit. A D E K (fat-soluble)

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12
Q

What is esophageal varices caused by?

A

portal vein hypertension

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13
Q

What are the clinical manifestations of esophageal varices?

A

hematemesis
melena
hypotension
tachycardia
decreased H & H

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14
Q

What is the #1 priority intervention for esophageal varices?

A

Control bleeding to prevent hemorrhage & hypovolemic shock

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15
Q

What are the nursing interventions for esophageal varices?

A

large-bore IV access
monitor for tachycardia and hypotension
watch for bleeding and H & H
educate pt on not straining (coughing, sneezing, alcohol, heavy lifting)

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16
Q

What medications are used to treat esophageal varices?

A

Beta-blockers: propranolol (vasodilates to decrease the risk of hemorrhage)
Octreotide (reduces bleeding/vasodilates)
Vasoconstrictors (if bleeding)

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17
Q

What treatment procedures are used for esophageal varices?

A

Banding
TIPS
Balloon Tamponade

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18
Q

What is the banding procedure?

A

Banding: places rubber band at the base of varices to stop bleeding during an upper endoscopy

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19
Q

What is the TIPS procedure?

A

TIPS: a catheter is placed in the liver b/w the portal & hepatic vein (helps relieve portal HTN)

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20
Q

What is a balloon tamponade?

A

EG tube w/ esophageal & gastric balloons are used to compress blood vessels in the esophagus & stomach

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21
Q

What does the upper GI tract contain? What causes acute hemorrhage?

A

esophagus: varices
stomach: gastric or duodenal-commonly caused by PUD, gastritis, tumors, esophagitis

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22
Q

What does the lower GI tract contain? What causes acute hemorrhage in that area?

A

Small & large intestine
rectum
anus
causes: diverticulosis, cancer, polyps, IBD, UC

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23
Q

What are the signs of an upper GI tract hemorrhage?

A

hematemesis: bloody vomit
melena: black tarry stool

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24
Q

What are the signs of a lower GI tract hemorrhage?

A

hematochezia: bright red bloody stool
abdominal pain

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25
What are the general signs if a GI tract hemorrhage?
cool/clammy skin restlessness cap refill >3 sec rigid abdomen s/sx of anemia
26
What are the s/sx that suggest hemodynamic compromise?
pallor fatigue chest pain (NOT GOOD) Palpitations dyspnea tachypnea/syncope Tachycardia postural changes
27
What diagnostics are used for a general GI tract hemorrhage?
CBC BUN blood type and crossmatch H. pylori stool sample
28
What diagnostics are used specifically for an upper GI hemorrhage?
upper endoscopy (EGD) NG tube
29
What diagnostics are used specifically for a lower GI hemorrhage?
Colonoscopy Endoscopy Abdominal CT, MRI, X-ray
30
What are the nursing interventions for an upper GI hemorrhage?
IV fluids transfusion if needed Antibiotics (metronidazole) PPIs to prevent recurrence and treat PUD
31
What are the nursing interventions for a lower GI hemorrhage?
IV fluids blood transfusion NPO during a bleeding episode and usually clear liquids after
32
What is the major complication of a GI tract hemorrhage? What are the S/SX?
Hypovolemic shock!! -chest pain -tachycardia and hypoTN - pallor -restlessness
33
What are the nursing actions for hypovolemic shock?
admin O2 and IVFs transfuse PRBCs needs to be in the ICU
34
What patients are eligible for a liver transplant?
end-stage liver disease chronic liver disease
35
Who is not eligible for a liver transplant?
severe cardiac or respiratory diseases Metastatic malignant liver cancer alcohol/substance use disorder
36
What are the nurse's actions pre-op for a liver transplant?
witness consent x-ray enema shower with chlorhexidine soap
37
What are the nurse's actions post-op for a liver transplant?
monitor VS neuro checks monitor for infection (fever, redness, drainage) rejection signs clotting
38
What should you educate your patient following a liver transplant?
They will take immunosuppressants for life
39
Why are patients with acute pancreatitis NPO?
Eating stimulates the release of amylase and lipase
40
What are the signs of acute pancreatitis?
10/10 epigastric pain radiating to the back and, left flank & shoulder pain worsens when lying down, the fetal position helps Turner's sign Cullen's sign Trousseau's sign Chvostek's sign tetany constipation/steatorrhea
41
What is turner's sign?
Ecchymosis on flanks (appears blue from the blood pooling)
42
What is Cullen's sign?
Bluish-gray discoloration around the belly button
43
What is trousseau's sign?
hand spasm when BP cuff is inflated
44
What is Chvostek's sign?
facial twitching when the facial nerve is tapped
45
What are the priority nursing interventions for acute pancreatitis?
ABCs rest the pancreas!! NPO!! consider TPN NG tube to empty the stomach so no more enzymes are released FLUIDS!!! monitor glucose (may need insulin)
46
What meds can be given to help w/ pancreatitis?
antiemetics to help w/ N/V antibiotics
47
What are the potential complications of acute pancreatitis?
hypovolemia pancreatic infection type 1 diabetes MODS
48
What is pyloric stenosis/intestinal obstruction?
an obstruction/hardening between the stomach & small intestine can be due to tumor's, hernias, impactions, diverticulitis
49
What are the s/sx of pyloric stenosis & intestinal obstruction?
projectile vomiting palpable olive size mass in RUQ abdominal pain & distention signs of dehydration hypoactive bowel sounds
50
What are the diagnostics for pyloric stenosis & intestinal obstruction?
ABGs: indicate metabolic alkalosis X-ray Endoscopy (cause of obstruction) CT scan (cause and exact location of the obstruction) ultrasound
51
What is diverticulitis?
Inflammation of the bowel where bacteria, food or fecal matter is trapped in the little pockets causing an infection
52
What is diverticulosis?
small pouches form in the intestinal wall but do not always lead to an infection
53
What are the clinical manifestations of diverticulitis and diverticulosis?
Diverticulosis is usually asymptomatic -constipation/straining could lead to herniation N/V LLQ pain fever/chills tachycardia
54
What are the priority actions for severe symptoms of diverticulitis?
NPO NG tube suctioning IV fluids IV antibiotics opioids for pain assess for s/sx of peritonitis
55
What should you educate your patient on regarding diverticulitis/diverticulosis?
NO popcorn, seeds, nuts clear liquid diet until symptoms subside, then progress to a low-fiber diet add fiber to the diet when solid foods are tolerated w/o side effects avoid alcohol and fatty foods
56
What is a bowel perforation?
puncture to the GI tract due to an ulcer, infection, or surgical procedure obstruction in the bowel causing contents to be released into the interstitial space and into the blood stream
57
What are the s/sx of bowel perforation?
severe epigastric pain across abd. abd. tender & rigid (boardlike/stiff) hypoactive bowel sounds hypoTN, tachycardia, fever, N/V
58
What are the nursing interventions for bowel perforation?
NPO and go to surgery monitor for peritonitis, infection and signs of sepsis
59
What is dumping syndrome?
A shift of fluid to the abd. which is triggered by rapid gastric emptying to high-carb ingestion -food is moving too fast to the small intestine
60
What are the s/sx of dumping syndrome?
symptoms can occur 10-90 min after eating feeling full weakness diaphoresis tachycardia hypoTN abd. cramps Late sign: hypoglycemia
61
What should you educate your patient on with dumping syndrome?
lie down after eating to delay gastric emptying eat small frequent meals (5-6) no liquids with meals (wait 30 min after meals)
62
What kind of diet should a patient with dumping syndrome be on?
high protein high fat low fiber low-moderate carb diet avoid milk & sugars
63
What medication can be given to help dumping syndrome?
Octreotide given SQ to help manage symptoms blocks gastric acid and pancreatic hormones

Complex II (6 decks)

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