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Flashcards in Exam 3 Deck (188):
1

Treatment for "sucking chest wound"

Covering the wound with occlusive dressing that is secured on three sides.

2

Open Pneumothorax

Air enters the pleural space through an opening in the chest wall.

3

Closed Pneumothorax

No associated external wound

4

Causes of closed pneumothorax

Rupture of small blebs on visceral pleura, injury to lungs from broken ribs, excessive pressure during ventilation, esophageal tear, laceration or puncture of lungs during subclavian catheter insertion

5

What do you do if the object that causes an open chest wound is still present?

Do not remove it until a physician is present. Stabilize the impaled object with a bulky dressing.

6

Tension Pneumothorax

A pneumothorax with rapid accumulation of air in the pleural space that can cause high intrapleural pressures

7

Results of a tension pneumothorax

Compression of the lung on the affected side and pressure on the heart and great vessels pushing them away from the affected side. As pressures increases, venous return is decreased and cardiac output falls.

8

Causes of tension pneumothorax

Open or closed pneumothorax; mechanical ventilation, resuscitative measures, chest tubes that are clamped or blocked,

9

Symptoms of a tension pneumthorax

dyspnea, chest pain radiating to the shoulder, tracheal deviation, decreased or absent breath sounds on the affected side, neck vein distention, and cyanosis.

10

Hemothorax

Accumulation of blood in the pleural space from an intecostal blood vessel, the internal mammary arter, lung, heart or great vessel.

11

Clyothorax

presence of lymphatic fluid in the pleural space.

12

Causes of clyothorax

The thoracic duct is disrupted traumatically or from malignancy and fills the pleural space.

13

Conservative treatment of clyothorax

chest drainage, bowel rest and paraenteral nutrition. Octreotide, surgery and pleurodesis.

14

Clinical manifestations of pneumothorax

Small mind tachycardia and dyspnea. If it occurs largely, respiratory distress may be present including shallow, rapid respirations, dyspnea, air hunger, oxygen desat, chest pain, cough with or without hemoptysis, no breath sounds. C-xray shows presence of air or fluid in pleural space and reduction of lung volume.

15

Management of tension pneumothorax

EMERGENCY!! Insert a arge bore needle into the anterior chest wall at the fourth or fifth intercostal space to release the trapped air. A chest tube is then inserted and connected to water-seal drainage.

16

Treatment for pneumothorax

Aspirate air/fluid with a large bore needle. (Thoracentesis). Insert a chest tube and attach a water-seal drainage. Repeated spontaneous may be surgically treated with pleurectomy, stapling, and pleurodesis.

17

Chest tubes used to do what?

Chest Tubes are inserted into the pleural space to remove air and fluid and to allow the lung to reexpand.

18

Chest Tube Insertion

Positioned seated on the edge of the bed with arms supported on a bedside table or supine with midaxillary area of the affected side exposed.
Chest x-ray is available to confirm the affected side.
Area is cleansed with an antiseptic solution.
Chest wall prepared with a local anesthetic and a small incision is made over a rib. The chest tube is advanced up and over the top of the rib to avoid intercostals nerves and blood vessels. For removal of air, a smaller tube (14F to 22F) is used and is directed anteriorly and superiorly as air rises. For removal of fluid, a larger tube (28F to 40F) is used and directed posteriorly and inferiorly. The chest tube is connected to a pleural drainage system. The incision is closed with sutures and the chest tube is secured. The wound is covered with a dressing. Some physicians prefer to seal the wound with petroleum gauze. Monitor patient for comfort levels, as insertion and presence of chest tube is painful.

19

Chest tube for air removal

A smaller tube (14F to 22F) is used and is directed anteriorly and superiorly as air rises

20

Chest tube for fluid removal

A larger tube (28F to 40F) is used and directed posteriorly and inferiorly

21

Intervention for disconnected chest tube

Reestablishment of the water seal system immediately and attachment of a new drainage system as soon as possible. Some hospitals immerse the tube in sterile water until system can be reestablished.

22

Chest tube removal procedure

Removed 24 hrs after being on gravity drainage and when the lungs are reexpanded and fluid drainage has ceased. Gather supplies and petroleum jelly dressing. Explain procedure, give pain meds 15 min before, cut suture, pt hold breath or bear down, remove tube, cover with dressing. Do CXR to evaluate for reaccumulation or pneumothorax.

23

Insufficient CO2 removal results in what

Hypercapnia

24

hypoxemia

a decrease in arterial O2 (PaO2) and saturation. (SaO2)

25

Hypercapnia produces what

an increase in arterial CO2. (PaCO2)

26

When does respiratory failure occur?

When one or both of the gas exchanging functions are inadequate....(transfer of O2 and CO2 between inhaled tidal volumes and circulating blood volume within the pulmonary capillary bed)

27

Two types of respiratory failure

Hypoxemic or hypercapnic

28

Primary problem with hypoxemic respiratory failure

inadequate O2 transfer between the alveoli and the pulmonary capillary bed.

29

Hypoxemic respiratory failure is defined as

PaO2 less than 60 mmHg when the patient is recieving an inspired O2 concentration of >60%.

30

Hypercapnic respiratory failure is defined as

PaCO2 greater than 48mmHg in combination with acidemia (arterial pH less than 7.35).

31

Four physiologic mechanisms that may cause hypoxemia and subsequent hypoxemic respiratory failure

1. mismatch between ventilation (V) and perfusion (Q), commonly referred to as V/Q mismatch
2. shunt
3. diffuse limitations
4. hypoventilation

32

In normal lungs, the volume of blood perfusing the lungs each minute is

4 to 5 L/ min

33

What is the V/Q mismatch?

MIsmatch between ventilation and perfusion. Examples of causes are pneumonia, atelectasis, asthma and pulmonary emboli. Normally VQ is 1:1.

34

Shunt

when blood exits the heart without having participated in gas exchange.

35

Anatomic shunt

when blood passes through an anatomic channel in the heart (ventricle septal defect) and bypasses the lungs

36

Intrapulmonary shunt

Occurs when blood flows through the pulmonary capillaries without participating in gas exchange.

37

When are intrapulmonary shunts seen>

In conditions in which the alveoli is filled with fluids, like in ARDS, pneumonia, and pulmonary edema.

38

Treatment for patients with shunts

Usually require mechanical ventilation and a high fraction of inspired O2 (FiO2) to improve gas exchange.

39

What is diffuse limitation

Occurs when gas exchange across the alveolar-capillary membrane is compromised by a process that thickens, damages, or destroys the membrane.

40

When does diffuse limitation cause hypoxemia

during exercise more than at rest because the blood moves more rapidly through the lungs which decreases the time for diffusion of O2 across the alveolar capillary membrane.

41

Classic sign of diffusion limitation

Hypoxemia that is present during exercise but not during rest.

42

What is alveolar hypoventilation

Generalized decrease in ventilation that results in an increase in PaCO2 and consequent decrease in PaO2.

43

Hypercapnic respiratory failure results from what

An imbalance between ventilatory supply and ventilatory demand.

44

When does hypercapnia occur

When ventilatory demand exceeds ventilatory supply and the PaCO2 cannot be sustained within normal limits.

45

Primary problem with hypercapnic respiratory failure

The inability of the respiratory system to remove sufficient CO2 to maintain a normal PaCO2.

46

Four groups that can cause a limitation in ventilatory supply

1. abnormalities of airways and alveoli
2. abnormalities of CNS
3. abnormalities of the chest wall
4. neuromuscular conditions

47

Failure of oxygen utilization primarily occurs when?

In septic shock. Adequate O2 may be deliveered to the body tissues, but imparied O2 extraction or diffuse limitation exists at the cellular level. This results in abnormally high amount of O2 returning in venous blood because its not extracted at the tissue level.

48

Normal PaO2

80 to 100 mmHg

49

When does hypoxemia occur

the amount of O2 in arterial blood is less than normal values

50

when does hypoxia occur

when the PaO2 falls sufficiently to cause signs and symptoms of inadequate oxygenation.

51

Normal IE ratio

Inspiratory to expiratory ratio is normally 1:2, meaning that expiration is twice as long as inspiration.

52

Oxygen Treatment for hypoxemia due to v/q mismatch

For V/Q mismatch, supplemental oxygen administered 1 to 3 L/min per nasal cannula, or 24% to 32 % by simple face mask or venturi mask should improve the PaO2 and SaO2.

53

Oxygen Treatment for hypoxemia secondary to intrapulmonary shunt

PPV, which provides O2 therapy and humidification, decreases the work of breathing, and reduces respiratory muscle fatigue. It also assists in opening collapsed airways and decreases shunt.

54

PPV is provided how?

via endotracheal tube or noninvasively by means of a tight fitting mask.

55

What levels of PaO2 and SaO2 must the selected O2 delivery system provide?

maintain PaO2 >= to 55 to 60mmHg and SaO2 >= to 90% at the lowest O2 concentration possible.

56

What will high concentrations of O2 cause?

It will replace nitrogen gas normally present in the alveoli, causing instability and atelectasis.

57

Oxygen treatment for patients with chronic hypercapnia (patients with COPD)

O2 through a low-flow device such as nasal cannula at 1 to 2 L/min or a venturi mask at 24% to 28%.

58

Performing augmented coughing, how to?

By placing the palm of your hand or hands on the patient's abdomen below the xiphoid process. As the patient ends a deep inspiration and begins and expiration, move your hand forcefully downward, increasing abdominal pressure and facilitating the cough.

59

Huff coughing

A series of coughs performed while saying the word "huff". It prevents the glottis from closing during the cough.

60

Staged cough

The patient assumes a sitting position, breaths three or four times in and out through the mouth, and coughs while bending forward and pressing a pillow inward against the diaphragm.

61

Mini-trach indications

Used to instill sterile normal saline solution to elicit a cough and to perform suctioning.

62

Mini-trach contraindications

Absent gag reflex, hx of aspiration, and the need for long-term mechanical ventilation.

63

Contraindications for NIPPV

patients with absent respirations, decreased LOC, high O2 requirements, facial trauma, hemodynamic instability

64

CPAP

Form of NIPPV in which constant positive pressure is delivered to the airway during inspiration and expiration

65

BIPAP

Bilevel positive airway pressure, a form of NIPPV in which different positive pressure levels are set for inspiration and expiration

66

Hemoglobin level that typically ensures adequate oxygen saturation of the hemoglobin

>= 9g/dL (90g/L)

67

What is ARDS

ARDS is a sudden and progressive form of acute respiratory failure in which the alveolar capillary membrane becomes damaged and more permeable to intravascular fluid.

68

Causes of ARDS

Sepsis, direct lung injury, Systemic inflammation response syndrome (SIRS), MODS, aspiration of gastric contents, viral or bacterial pneumonia, severe massive trauma, chest truama, embolism, inhalation of toxic substances, near drowning, o2 toxicity, radiation pneumonitis,

69

Pathophysiology of ARDS

Due to stimulation of the inflammatory and immune systems, which causes an attraction of neutrophils to the pulmonary interstitium. The neutrophils cause a release of mediators that produce changes in the lungs.

70

What does ascites result from?

(1) Protein shift into lymph space and lymphatic system cannot carry it off and they leak into cavity pulling additional fluid. (2) Hypoalbunemia (3) hyperaldosteronism causing an increase Na+ reabsortion

71

Treatment for ascites

Sodium restriction, diuretics, and fluid removal. Na+ to 2g/day or 250-500mg/day for severe. K+sparing diuretics in combo with loop diuretics. Paracentesis to remove fluids (temporary fix). Peritoneovenous shunt to reinfuse the ascitic fluid into venous system. TIPS

72

Complications of peritoneovenous shunts

thrombus formation, infection, fluid overload, DIC, variceal hemorrhage, shunt occlusion.

73

First step when variceal bleed occurs

Stabilize the patient and manage the airway. IV therapy is administered and may include blood products.

74

Drug therapy for varicial bleeds

Drug therapy includes Sandostatin, vasopressin, nitroglycerin, and beta blockers.

75

Prophylactic treatment for non bleeding variceal bleeds

Nonselective beta blockers (propanolol [Inderal])

76

Side effects of Vasopressin

decreased coronary blood flow, dysrhythmias, and increased BP.

77

What does vasopressin do?

produces vasoconstriction of arterial bed, decreases portal blood flow and decreases portal hypertension.

78

Why use nitroglycerin with variceal bleeds

reduces side effects of vasopressin while enhancing its beneficial effect.

79

Who should VP be used cautiously with

Older adult because of the risk of cardiac ischemia.

80

Safety alert for balloon inflation for gastric varices

Deflate balloon for 5 minutes every 8 to 12 hrs per policy to prevent necrosis.

81

What does the balloon tamponades do for gastro varicies

applies pressure to bleeding. Controls the hemorrhage by mechanical ventilation of the variciies.

82

Why give lactulose and neomycin for varicies

To prevent hepatic encephalopathy from breakdown of blood and the release of ammonia in the intestines

83

Why give antibiotics with ascites

To prevent bacterial infections.

84

What does propanolol do for long term management of varicial bleeds & what are risks

reduces portal venous pressure, and can be given to prevent recurrent GI bleeding. BUT it can cause hepatic encephalopathy because of reduced hepatic blood flow.

85

What is TIPS

Transjugular intrahepatic portosystemic shunt is a nonsurgical procedure in which a tract (shunt) between systemic and portal venous systems is creasted to redirect portal blood flow.

86

What does TIPS do

reduces portal venous pressure and decompresses the varicies, thus controlling bleeding.

87

Goal of treatment for hepatic encaphalopathy and how?

Reduce ammonia formation. With lactulose, anbx such as neopmycin sulfate or flagyl or vanc, catharics/enemas,

88

Lactulose does what therapeutically?

Traps the ammonia in the gut and excretes it from the colon.

89

Why give Anbx for hepatic encephalopathy

Reduces bacterial flora in colon (Bacterial action on protein in the feces results in ammonia production).

90

Nutritional therapy for cirrhosis

High in calories (3000/day), high carbs, mod to low fats, protein decrease, For ascites--low sodium (2g.day),

91

Why high carbs for patients with cirrhosis

to prevent hypoglycemia and catabolism

92

Foods high in sodium

Table salt, baking soda, baking powder, canned soups & vegetable, frozen foods, salted crackers, ships, nuts, smoked meats and fish, breads, olives, pickles, ketchup, beer, antacids, carbonated beverages,

93

Risk factors for cirrhosis

alcohol ingestion, malnutrition, hepatitis, biliary obstruction, obesity, right sided heart failure

94

Indications for paracentesis

Used to decrease the amount of fluid in the peritoneal cavity, like in ascites caused by cirrhosis.

95

Nursing care for paracentesis

Have the patient void prior to prevent puncture of the bladder. The patient sits on the side of the bed or is in high folwers position.
Patient Monitoring: Following the procedure, monitor the patient for signs of hypovolemia and electrolyte imbalances and check the dressing for bleeding and leakage.

96

Nursing care for dyspnea with ascites

Place in semi fowlers or fowlers position for maximal repiratory efficiency and use pillows ot support the arms and chest as they will increase comfortability and ability to breathe.

97

Hypokalemia is manifested....

cardiac dysrhythmias, hypotension, tachycardia, generalized muscle weakness

98

Water excess is manifested how

muscle cramping, weakness, lethargy, and confusion

99

Signs of varicies

hematemesis and melena.

100

What do you do if patient with cirrhosis has hematemesis

assess patient for hemorrhage, call physician and be ready to assist with treatment to control bleeding. Pt admitted to ICU and airway must be maintained

101

Balloon tamponade nursing care

Explain use of tube and how its inserted. Balloon should be checked for patentcy, Physician inserts thru nose or mouth, inflated with 250 ml air, retracted until resistance is met, tube secured at nostrils. Position verified by xray.

102

Saline lavage use

Used to prevent blood from degrading to ammonia.

103

Most common complication of balloon tamponade

Aspiration pneumonia

104

What do you do id the gastric balloon breaks or deflates?

Cut the tube or deflate the balloon. Keep scissors at bedside.

105

How to minimize regurgitation with balloon tamponade therapy

Oral and pharangeal suctioning and keeping in semi fowlers position

106

Assessment parameters and patho of pancreatitis

......

107

Treatment for pseudocysts

Internal drainage system procedure with an anastomosis between the pancreatic duct and the jejunum.

108

Two local complications of acute pancreatitis

Pseudocyst and abscess

109

Treatement for abscess of pancreas

Prompt surgical drainage to prevent sepsis.

110

What can trypsin activate?

Prothrombin and plasminogen causing pulmonary emboli, intravascular thrombi and DIC.

111

What drugs should be avoided with paralytic ileus

Atropine-like drugs

112

What do you monitor when IV lipids are ordered

Triglyceride levels

113

Diet for pancreatitis

NPO at first to reduce pancreatic secretions. Then enteral feedings via nasojejunal tube are initiated. WHen food is allowed, small frequent feedings. High in carbs. Abstain from alcohol. May be given supp fat-soluble vitamins

114

During feeding of pancreatitis patient and patient reports pain, as increasing abdominal girth or elevations in pancreatic enzymes, what is wrong?

Suspect intolerance to food

115

Signs of hypocalcemia

jerking, irritability muscular twitching, numbness or tingling around the lips and in finger, positive chvosteks signs and trousseaus sign.

116

What to treat hypocalcemia

calcium gluconate

117

Good position for pancreatitis

Flexing the trunk and drawing knees to abdomen may decrease pain. Side lying with head elevated 45 degrees decreases tension on abdomen and decrease pain.

118

When to take antacids

After meals or at bedtime.

119

What is the breakdown of heme

Bilirubin

120

If you have a buildup of bilirubin in the blood, what can it mean?

Producin too many RBCs or something wrong with the liver (not conjugating the bilirubin)

121

What will happen if biliruben isnt conjugated?

It will go to the blood. Causing jaundice

122

Who is NAFLD seen in?

Patient with metabolic syndrome, obese, rapid weight loss, strict diets. Statins for hyperlipidemia is hard on liver

123

CLinical manifestations of NAFLD

Usually asymptomatic. Increased ALT and AST.

124

Diagnosis for NAFLD is made how?

AST & ALT, liver biopsy

125

Liver biopsy risks

Risks of bleeding because the liver is involved in coagulation

126

Teaching about weight loss for NAFLD

Teach to lose weight slowly because rapid loss can cause liver failure

127

Palmar erythema and spider angiomas are the result of what

Due to an increase in estrogen because the liver can no longer metabolize steroid hormones.

128

What are palmar erythemas

red areas on the palm that blanches

129

What are spider angiomas

small dilated vessels that have the look of spider webs, seen on face

130

Portal hypertension can lead to what?

esophageal varicies

131

What is the esophageal balloon port on the Blake Moor Tube used for

WHen you inflate it, it tamponades/puts pressure on the vessel and stops bleeding

132

What is the gastric balloon port on the Blake Moor Tube used for

To put tension on the gastric sphincter which prevents regurgitation

133

What is the third (gastric) port at the end on the Blake Moor Tube used for

Used to decompress the stomach and remove fluids

134

Administering pancreatic enzymes

Give with fruit, do not give with protein

135

Signs of retroperitoneal bleed

Collins signs and grey turners signs

136

Drug therapy for chronic pancreatitis

Take pancreatic enzymes

137

Indications for ET Tube Intubation (5)

Indications for an ET tube intubation: upper airway obstruction, apnea, high risk for aspiration, inneffective clearance of secretions, and respiratory ditress.

138

Why insert a tracheotomy?

When the need for artificial airway is expected to be long term (14 days +)

139

What reduces the work of breathing?

A larger bore ET Tube because there is less airway resistance. It is easier to remove secretions and perform fiberoptic broncoscopy if needed.

140

When is Nasal ET tube used?

Nasal ET intubation is used when head and neck manipulation is risky.

141

What do you do to avoid a patient obstructing or biting down on an ET tube

Sedation with a bite block

142

What do you use to do mouth care with a patient with ET tube in place?

Pediatric oral sized products for brushing, suctioning, and cleaning.

143

Nasal intubation is contraindicated in what patients?

Patients with facial fractures, suspected fractures at the base of the skull and postoperative after cranial surgeries

144

nasal intubation has been linked with an increased incidence of what

increased incidence of sinus infections and VAP.

145

Patient undergoing intubation & ventilation will need to have what at bedside?

Patient undergoing intubation will need to have Ambu bag attached to O2, suctioning equipment at bedside and IV access.

146

Endotracheal intubation procedure

Obtain consent, explain procedure, get ambu bag with O2, suction & IV access, remove dentures, administer Versed, fentanyl, anectine (paralytic), atropine (reduce secretions), monitor O2 status, preoxygen with 100% O2 3-5 min before and in between attempts, attempts <30 sec, inflate cuff, confirm placement, connect to O2, secure, suction, bite block, portable x ray, record and mark at exit, ABGs within 25 minutes.

147

RSI is not indicated in who?

comatose or cardiac arrest

148

What is RSI

Rapid sequence intubation, rapid concurrent admin of a paralytic and sedative during emergency airway management to decrease aspiration, combativeness or injury to patient

149

Monitor ET tube placement how oftein

every 2 to 4 hrs

150

If ET tube is not placed properly,,,,what you do?

emergency, stay with patient, maintain airway, maintain ventilation, get assistance, ventilate with BMV and 100%.

151

Malpositioning of ET tube places them at risk of waht

Pneumothorax

152

To avoid ET tube cuff damagin the trachea....

To avoid the cuff damaging the trachea, inflate the cuff with air and measure and monitor the cuff pressure. Maintain cuff pressure at 30 to 25 mmHg. Measure Q8hrs.

153

What does it mean when adequate cuff pressure on the ET tube isnt maintained or larger volumes of air are needed to keep the cuff inflated

The cuff could be leaking or there could be tracheal dilation at the cuff site

154

What you do when adequate cuff pressure on the ET tube isnt maintained or larger volumes of air are needed to keep the cuff inflated

Notify physician to repositon and change the ET tube.

155

What is the best indicator of alveolar hyper/hypoventilation

PaCO2

156

Alveolar hyperventilation

Decreased PaCo2, increased pH indicated respiratory alkalosis

157

Alveolar hypoventilation

Increased PaCO2, decreased pH indicating respiratoryu acidosis

158

Decreased PaCo2, increased pH indicates what alkalosis

repiratory alkalosis or alveolar hyperventilation

159

Increased PaCO2, decreased pH indicates what

respiratory acidosis or Alveolar hypoventilation

160

Indications for suctioning ET tube (7)

visible secretions in tube, sudden onset of resp distress, suspected aspiration of secretions, increase in peak airway pressures, auscultations of adventitious breath sounds over trachea/bronchi, increase in RR and or sustained coughing, and sudden or gradual decrease in PaO2 and or SpO2

161

Closed suctioining technique for ET tube should be reserved for who

Should be used for patient requiring high levels of PEEP, high FiO2, bloody or infected pulmonary secretions, require frequent suctioning.

162

How do you tell if a patient doesnt tolerate ET tube suctioning well

If a patient doesn’t tolerate suctioning well, they will have decreased SpO2, increased or decreased BP, sustained coughing, and development of dysrthymias

163

What do you do if a patient doesnt tolerate suctioning well?

Stop the procedure, and manually hyperventilate with 100% O2. Limit each suction to <10 secs. Avoid excessive suctioning when severe bradycardia and hypoxemia.

164

What indicated mucosal damage has occured with ET tube suctioning

The presence of bloody streaks or tissue shreds in aspiratrd secretions may indicate mucosal damage has occured.

165

What helps in thining or removing secretion

dequately hydrate patient (oral or IV) and provide humidification of inspired gases may assist in thinning secretions. Do not instil normal saline. Postural drainage, percussion, and turning the patient Q2hrs may help move secretions into larger airways.

166

How often do you repositon and retape the ET tube

every 24 hrs or as needed

167

Signs of unplanned extubation

Signs of unplanned extubation is patient speaking, activation of low pressure ventilation alarm, absent or diminished breath sounds, respiratory distress, and gastric distention

168

Preventing unplanned extubation

You can prevent unplanned extubation by ensuring the ET tube is secured and observing and supporting ET tube during repositioning, procedures, and patient transfers. Provide sedation and analgesia and immobilizIng hands with restraints.

169

If unplanned extubation occurs, what do you do?

If unplanned extubation occurs, stay with patient and call for help. Maintain airway and support ventilation.

170

Normal Serum Amylase

30-122 U/L

171

Normal serum Lipase

31-186 U/L

172

Risk factors for developing NAFLD

obesity, DM, hypertriglyceridemia, severe weight loss, syndromes with insulin resistance

173

Cirrhosis can be caused by

alcohol intake, viral hepatitis, malnutrition, biliary obstruction, right sided heart failure,

174

Manifestations of cirrhosis

jaundice, skin lesions (spider agiomas), hematologic problems )thrombocytopenia, leukopenia, anemia, coag d/o), endocrine problems, peripheral neuropathy

175

a persistent increase in blood pressure in the portal venous system, is characterized by increased venous pressure in the portal circulation

Portal hypertension

176

, tortuous veins at the lower end of the esophagus, are the most life-threatening complication of cirrhosis.

Bleeding esophageal varicies

177

accumulation of serous fluid in the peritoneal or abdominal cavity, and may be accompanied by dehydration, hypokalemia, and peritonitis.

Ascites

178

characteristic symptom of hepatic encephalopathy

Asterixis (flapping tremors)

179

Diagnostic tests for cirrhosis

elevations in liver enzymes, decreased total protein, fat metabolism abnormalities, and positive liver biopsy.

180

Diet for cirrhosis

is high in calories (3000 cal/day) with high carbohydrate content and moderate to low-fat levels. Sodium restrictions are placed on the patient with ascites and edema.

181

Treatment for fulimant hepatic failure

liver transplant

182

Causes of fulimant hepatic failure

Acetaminophen with alcohol

183

Clinical manifestations of acute pancreatitis

Abdominal pain located in the left upper quadrant is the predominant symptom of acute pancreatitis. Other manifestations include nausea, vomiting, hypotension, tachycardia, and jaundice.

184

Nursing diagnosis for acute pancreatitis

acute pain, fluid volume deficit, imbalanced nutrition, and ineffective self-health management.

185

The pancreas becomes progressively destroyed as it is replaced with fibrotic tissue.

Chronic pancreatitis

186

Clinical manifestations of chronic pancreatitis

abdominal pain; symptoms of pancreatic insufficiency, including malabsorption with weight loss; constipation; mild jaundice with dark urine; steatorrhea; and diabetes mellitus.

187

Major concern with esophogeal balloon tamponade

Aspiration and choking on saliva. cannot use esophagus to swallow saliva

188

Airway obstruction or choking during esophageal balloon tamponade

cut balloon and pull it out.