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exam 4 Flashcards

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1
Q

9 functions of liver

A

Bile formation and excretion

Metabolism of bilirubin (a by-product of breakdown of old RBCs)

Production of protein for blood plasma
(albumin) - albumin holds water in vascular space

Metabolism of carbohydrates, proteins, and fats

Conversion of ammonia to urea – ammonia

comes from breakdown of protein

Coagulation and anticoagulation

Metabolic detoxification

Metabolizing medications

Storage of minerals and vitamins

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2
Q

heptocytes

A

functional cell of the liver, secretes bile, performs metabolic functions

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3
Q

sinusoids

A

specialized vascular beds
lined with Kupffer cells
very permeable endothelium

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4
Q

kupffer cells

A

phagocytic
detoxify toxins
Produce vasoactive mediators

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5
Q

severity of alc withdrawal symptoms

A

are dose and time dependent

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6
Q

3 things that cause more serious alc withdrawal

A

Previous withdrawal, liver dysfunction, and other substance use

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7
Q

1st Q to ask when assessing alc withdrawal

A

when was the last drink

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8
Q

s/s of alc withdrawal and when do they start
- 4 early signs
- 5 moderate
- 5 severe

A

Symptoms: start 6-12 hours after last drink

Psychomotor agitation
Anxiety
Autonomic hyperactivity (tachycardia, sweating, HTN, fever) (EARLY SIGNS)
Increased hand tremor
Insomnia
Nausea or vomiting
hallucinations (severe)
Tonic-clonic seizures (severe)
delirium tremens(severe)
fluid, electrolyte imbalances (severe)
wernick-korsakoff syndrome (severe)

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9
Q

CIWA assessment cateogries 8

A

Nausea and vomiting
Tremor
Sweating
Anxiety
Agitation
Headache
Disorientation
Tactile, visual, and auditory disturbances

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10
Q

gold standard of tx for alc withdrawal

A

benzos (lorazepam)

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11
Q

how is blood supplied to the liver

A

most blood comes from GI tract via portal vein

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12
Q

who is at higher risk of seizures

A

people with previous hx of withdrawal

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13
Q

if pt having seizures, nurse should 4

A

implement seizure precautions ,
one-to-one observation,
monitor fluid and electrolyte status, and glucose monitoring.

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14
Q

when do hallucinations start to occur

A

12-24 hours

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15
Q

what 2 symptoms distinguish delirium tremens

A

disorientation and global confusion

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16
Q

nurse actions for alc withdrawal 4

A

Monitoring vital signs,

pulse oximetry

Assessment using the CIWA Scale q 4

Administration of (benzodiazepines) based on ciwa

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17
Q

how do benzos work

A

increases GABA = mimics depressive effects

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18
Q

therapeutic goal of benzo use

A

light somnolence (patient sleeps when not stimulated but is easily arousable).

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19
Q

Treatment of AWS Seizures, DTs and Refractory DTs vs AWS and what is goal

A

infusion of benzos + phenobarbital + BB
goal: reduce autonomic activity

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20
Q

wernickes encephalopathy

A

confusion, abnormal gait, and paralysis of eyes muscles caused by nutritional deficiency (especially thiamine (vitamin B1) deficiency) and NOT caused by AWS.

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21
Q

korsakoff syndrome

A

selective memory disturbances and amnesia that occurs commonly in AWS and with Wernicke’s encephalopathy.

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22
Q

how to treat wernicke korsakoff

A

thiamine for 3 days through IV infusion

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23
Q

how does nurse maintain and monitor fluid and electrolyte levels 9

what do electrolyte imbalances cause

A

weight
vital signs
I&O
BUN
creatinine
electrolytes (low K+, Mg, Phosp)
skin and mucous
edema
lung sounds

DYSRHYTHMIAS

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24
Q

all patients should have what consult

A

nutritonist

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25
nurse action to counteract hypoglycemia
thiamine then IV glucose (cannot do glucose by itself)
26
most common cause of acute liver failure
alcohol
27
5 questions to assess in overdose
#1 question:Intent – is the ingestion intentional or unintentional? If an attempt to commit suicide, suicide precautions and a psychiatric consultation are indicated. Dose Pattern – single or repeated Time of ingestion Coingestants
28
labs to monitor in acetaminophen overdose 6
ABGS -ph creatinine - bc renal damage Pt/inr - rises 24-72 hours after ingestion bilirubin actaminophen levels ASt/alt - greater than 1000 is toxicity
29
acetaminophen antidote
N-acetylcysteine (NAC)/Mucomyst
30
N-acetylcysteine (NAC)/Mucomyst when to give how to give how it works
give 8-12 hours after ingestion to reduce hepatic injury if alert and oriented can give orally It limits formation/accumulation of toxic metabolite,
31
digoxin antidote
digibind
32
MgSo4 antidote
Ca gluconate
33
heparin antidote
protamine sulfate
34
warfarin(coumadin) antidote
Vit K
35
iron lead antidote
chelation
36
Lavage 3
insertion tube with Nacl within 2-4 hours Contraindicated in ingestion of caustic agents, sharp objects.
37
high priority in overdose is
AIRWAY
38
when to give activated charcoal
1 hour of ingestion
39
cirrhosis leads to
portal hypertension -> ascites
40
ascites development
hypoalbuminemia -> leakage from plasma from the lymph -> Changes in capillary permeability and hydrostatic/oncotic pressure gradients Release of nitric oxide causes vasodilation of the splenic artery, -> decreasing SVR and MAP, -> activating the renin-angiotensin-aldosterone (RASS holds onto water and salt), -> SNS and ADH causing water and sodium retention, the inability to excrete water causes dilutional hyponatremia, and renal blood flow is reduced resulting in hypoperfusion and decreased GFR.
41
8 assesments for ascites
For shifting dullness in the abdomen with percussion For peripheral edema (often pitting in the legs and feet) Daily weight and I&O For difficulty breathing and lung sounds Abdominal discomfort and pain For skin breakdown and jaundice Orthostatic vital signs
42
5 tx of ascites
alcohol abstinence Sodium restriction of 2000 mg/day Diuretic therapy Fluid restriction Paracentesis
43
nursing resp for paracentesis
BEFORE (time-out), reassure the patient, maintain sterile field monitor hemodynamic status, infuse albumin to replace protein as ordered. AFTER monitor hemodynamics assess for pain, assess fluid withdrawn and process any specimens, maintain I&O, monitor dressing for leaking, monitor for complications.
44
most serious complications of cirrhosis and portal hypertension.
bleeding varices - results from collateral circulation that develops to bypass the abnormally high pressure in the portal system
45
assesment focus for bleeding varices 3***
hemodynamic status fluid volume status. somatostatin prophylactic antibiotics for 7 days
46
somatostatin
a hormone that inhibits vasodilator hormones and decreases portal pressure. Administered by IV bolus dose, followed by a continuous infusion for 3-5 days. – assess H and H
47
endoscopic therapy
for bleeding varices tx - sclerosing or banding to ligate the vessel. - repeated every 2-4 weeks until varices are eliminated - surveillance every 6-12 months.
48
TIPS
done to treat repeated or uncontrolled variceal bleeding. A stent placed to decrease portal pressure thus reducing re-bleeding and formation of ascites.
49
if someone has balloon tamponade what should be at bedside
scissors to cut balloon
50
hepatic encephalopathy
is neuropsychiatric manifestations from ammonia resulting from a disturbance in the CNS because of liver failure. s/s confusion to coma
51
5 treatment for hepatic encephalopathy
Assessment of neurological status Maintenance of the patient’s airway and preventing aspiration Maintaining safety by preventing falls Administration of lactulose or oral antibiotics (rifaximin). TEMP restriction of protein intake from veg sources
52
6 long term effects of burns
Temp regulation Increased susceptibility to UV injury (wear sunscreen) Decreased vitamin D synthesis (need vit D supplement/need osteoporosis screening younger) Hypermetabolic state- increased HR and temp (need increased nutritional needs) Prolonged immunosuppression PTSD, anxiety etc
53
percents of body burn
Head and neck – 9% Arms – each 9% Anterior and posterior trunk – 36% Anterior and posterior legs – each 18% Perineum – 1%
54
burn that extends to subcut, muscle or bone
4th
55
superficial/1st degree
epidural only Skin is pink to red in color and slightly edematous. These burns heal in 3-6 days. TBSA not used painful.
56
superficial 2nd degree
epidermis and part of dermis bright red in color, moist, with fluid-filled blisters increased sensation and pain 21 days little scaring
57
deep 2nd degree
involve the epidermis + entire dermis. white/waxy, capillary refill is decreased. less pain and decreased sensation. 3 weeks scarring
58
full thickness/3rd degree burns
all layers Wound color ranges no capillary refill wound is dry, firm, leathery no sensation to pressure, no pain need skin grafting.
59
major burn area percent
>20%
60
which burns for which zones
Zone of inflamm: superficial Zone of stasis: superificial or deep 2nd Zone of coag: 3rd
61
most common cardiac change with burns
hypovolemic burn shock.
62
2 components of burn shock
The cellular component results from damage to cells in the burn itself. The CV component=Release of inflammatory mediators suppress myocardial contraction systemic edema -> massive decrease in circulating blood-> hyperviscosity of blood (can lead to dvt) ->and slowed capillary circulation
63
critical nursing function for burn shock
fluid and electrolytes!!!
64
gold standard for fluid monitoring after first 24 hours
urine output
65
burn resuscitation fluid is successful when
0.5-1.0 mL/kg/ HOUR achieved after 2 hours of maintence fluids
66
fluid resuscitation required when
burns involving > 20% TBSA
67
fluid amount resucitation determined by
The Parkland Formula is commonly used: (4 mL/kg) * % of TBSA burned administered in the first 24 hours. After the first 24 hours, fluids are given at a maintenance rate with urine output guiding replacement
68
preferred fluid for resuscitation
Lactated Ringer’s solution
69
Burns that extend around the circumference of the neck, chest, abdomen, and extremities (think tourniquet) are at risk for
compartment syndrome
70
For patients with burns around the abdomen,
bladder pressure (measured through the indwelling urinary catheter WITH A PRESSURE SENSOR) to measure intra-abdominal pressure (> 30 mmHg indicate abdominal hypertension)
71
tx for compartment syndrome
escharotomy
72
what is escharotomy
provider uses a scalpel or electrocautery to cut through the eschar, releasing tension and permitting blood flow to the area.
73
nurse responsibilties for escharotomy
sterile guaze for 24 hours monitoring for blood loss/edema
74
if Patients with singed scalp or facial hair, changes in the mucosal lining of the oropharynx, including presence of soot, hoarseness, edema, or blisters
evaluate for inhalation injury
75
monitoring resp function include 6
vital signs, ABGs, lung sounds, chest x-ray, bronchoscopy carboxyhemoglobin levels.
76
respiratory support interventions 4
elevating the HOB, turning and repositioning, administration of humidified O2, suctioning as needed.
77
intervention for inhalation injury
Early intubation NG/OG tube- to decompress the stomach/ enteral nutrition.
78
patient with suspected CO poisoning
high-flow O2 at 90-100% or hyperbaric O2 therapy.
79
GI changes in burns 6
hypermetabolic state Urea and creatinine levels in urine increase. Body weight drops quickly. Delayed healing, muscle wasting bone loss
80
GI assessments in burns 4
bowel sounds, bowel movements, presence of nausea/vomiting, abdominal distention and tightness (remember abdominal compartment syndrome)
81
lab values 3 and other assessments 2 to monitor for blood loss from ulcers
h and h nitrogen- 24 hour urine collection gluoce checks I and O dly weights
82
renal chnages in burn 4
GFR decreased urine output decreased BUN and Cr rise dark brown urine
83
how to monitor urine output for burns
catheter
84
foundation of burn wound management
early exicision to remove eschar and debris
85
how long are dressings on burns
3 days
86
silver sulfadiazine
topical medication for bacteria Application is painless does not penetrate eschar. If a rash occurs, the medication is discontinued
87
madenide acetate
bacterial cream NOT ANTI FUNGAL penetrates eschar and application can be painful. MONITOR FOR FUNGAL INFECTION discontinuing if a rash develops.
88
portal vein supplies
75% of blood flow and 50% of oxygen from nutrient-rich blood in the entire GI tract

CCN (9 decks)

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