Exam #5 (chp 58-59) Flashcards

Question

What are LATE assessment findings associated with advanced cirrhosis?

Answer 1

GI bleeding Jaundice Ascites Spontaneous bruising (All indicate poor liver function and complications of cirrhosis)

Answer 2

Jaundice (yellowing skin) or Icterus (yellowing sclera) Dry skin ; Rashes Petechiae or ecchymoses Warm BRIGHT RED palms Spider angiomas (vascular lesions on the nose, cheek, thorax, and shoulders) Ascites ; abdominal distention= measure ABDOMINAL GIRTH, measure in supine position, around largest diameter on exhalation. DAILY WTs Peripheral Edema- extremities and scrotum Vitamin deficiency (especially fat soluble D,E,A,K) Hepatomegaly (liver enlargement) Occult stools or emesis- FOBT or HEMA-CULT Fetor Hepaticus- fruity or musty distinctive breath odor (CLF/HE) Amenorrhea or Gynecomastia or Impotence Asterixis- "Hand flapping" course tremor, rapid nonrhythmic extensions and flexions of wrists and fingers Agitation ; insomnia ; emotional lability ; euphoria ; depression

Answer 3

A. Ecchymoses D. Jaundice E. Ankle Edema

Answer 4

ELEVATED: - AST/ALT and LDH (due to inflammation) - Alkaline phosphatase and GGT (caused by bile obstruction) - Bilirubin, present in the urine (urobilinogen) - Prolonged PT/INR (decreased prothrombin) - Ammonia (with advanced Liver disease) - Creatinine (with deteriorating kidney function) DECREASED: - Protein and Albumin (decreased synthesis by liver) - platelet count (thrombocytopenia) - RBCs and H&H (anemia) - WBCs - Hyponatremia (caused by ascites) Clay colored stools (cause bile obstruction & decreased bilirubin in urine)

Answer 5

Ultrasound of liver: 1st assessment suspected of liver disease to detect ascites, hepatomegaly, and splenomegaly X-ray: hepatomegaly, splenomegaly, massive ascites CT scan MRI Liver Biopsy- At risk for bleeding EGD- esophagogastroduodenoscopy of upper GI (complications: esophageal varices, stomach irritation, and ulceration ERCP- endoscopic retrograde cholangiopancreatography contrast dye into sphincter for stone removal and biopsies.

Answer 6

Excessive Fluid volume r/t third spacing Potential for hemorrhage r/t portal hypertension Potential for hepatic encephalopathy r/t shunting and increased ammonia

Answer 7

Prevent fluid accumulation- fluid restriction, treat ascites- paracentesis and diuretics- monitor DAILY WT, I/O, abd. Girth, peripheral edema, and electrolyte levels. (Loop diuretics- decreased K and Na) LASIX and SPIRONOLACTONE Prevent scratching/itching skin- use COOL water and minimal soap, use lotion ``` DIET: Low Sodium diet < 2gm, high carb. moderate fat, high protein. Vitamin supplements (with late stage cirrhosis) Banana Bag IVF (thiamine, folate, and multivitamins) ```

Answer 8

Hepatopulmonary syndrome is caused by excessive fluids caused by ascites Caused dyspnea, as result of intra-abdominal pressure, limiting thoracic expansion DO: -Auscultate lungs every 4-8hrs for crackles -Continuous Pulse Ox -Elevate HOB to 30 degrees, elevate feet = decreased ankle edema to relieve dyspnea - Assess BUN, H&H, protein, and electrolytes (Elevated BUN and hematocrit and decreased protein indicate hypovolemia)

Answer 9

Ensure Informed consent is received and answer any questions Obtain VS and Weight and have pt VOID BEFORE procedure Position with HOB elevated Measure the drainage- send fluid analysis Apply dressing to site and assess leakage Maintain bedrest and Weigh the pt POST-PROCEDURE

Answer 10

TIPS is a Transjugular Intrahepatic Portal-systemic Shunt Is a nonsurgical procedure used to control long-term ascites and to reduce variceal bleeding heavy IV sedation or general anesthesia needle through sheath on jugular vein and pushed through liver into the portal vein Balloon inflated, shunt to keep open. Doppler to assess blood flow through stent

Answer 11

D. The physician will likely remove 2-3 liters of fluid from my abdomen.

Answer 12

best outcome: pt expected to be free of bleeding. PREVENT bleed and infection: - screen for esophageal varices - nonselective Beta blocker: Propanolol (Inderal) - Prophylactic ABX on admission (infection is a common cause of AVB) If bleeding occurs: EMERGENCY -Vasoactive drugs: Vasopressin and Octreotide acetate (Sandostatin) -monitor VS q 1 hr, check coagulation studies (PT/INR, PTT and platelets)

Answer 13

Endocscopic Variceal Ligation (EVL): "banding" - apply a small "O" band at the base of the varices to decrease blood supply Endoscopic sclerotherapy (EST) aka injection therapy - inject sclerosing agent via a catheter, complication mucosal ulceration

Answer 14

Second endoscpoy or TIPS procedure if possible; if not: balloon tamponade and esophageal stents using a Sengstaken-Blakemore tube - place through the nose into stomach, balloon inflated, pressure to stop bleed - pt intubated and on ventilation - life threatening complications: aspiration, asphyxia, esophageal perforation.

Answer 15

goal: slowing or stopping accumulation of ammonia Diet changes: moderate protein and fats, simple carbs. -give brief, simple dietary do and dont Drug therapy: used sparingly (no opioids, sedatives, or barbiturates) Lactulose or lactitol: eleminate ammonia via stools, it is sweet, viscous, sticky liquid given PO or NG - desired laxative effect, 2-3 soft stools per day and decreased confusion - may report intestinal bloating and cramping - dehydration and hypokalemia for stools Nonabsorbable ABX: Neomtcin or rifaximin - broad spectrum for intestinal antiseptic- destroys normal flora, decreases protein breakdown and ammonia production. Maintenance dose PO or retention enema- potential kidney toxicity, do not use for pts with kidney disease. Metronidazole (Flagyl) - similar to neomycin, can cause peripheral neuropathy Vancomycin - long-term use can lead to resistance ASSESS: LOC and orientation frequently, asterixis (liver flapping) or fetor hepaticus (liver breath). thiamine supplements and benzos if at risk for alcohol withdrawal.

Answer 16

Optimize comfort, promote independence, support caregivers, prevent rehospitalization. End-stage may need hospice

Answer 17

Nutrition: - follow strict diet, low sodium - small frequent meals with supplement if needed. Drugs: - avoid fat soluble vitamins, iron, and niacin. - diuretics, may need K+ supplement - Med to reduce Acid Reflux - beta blocker (report weakness, irreg. HR, or dizziness) - lactulose to maintain 2-3 soft stools daily - avoid OTCs, including NSAIDs and TYLENOL - daily maintenance ABX if SBP Alcohol: -do not consume, seek supportive services

Answer 18

A. Encourage the client to eat a low-protein, high-carbohydrate diet.

Answer 19

Hepatitis is widespread inflammation of the liver cells. Viral hepatitis is most common. Edema can cause obstructive jaundice

Answer 20

Hepatitis C is an enveloped, single-stranded RNA virus, Transmitted blood to blood, incubation period is 7 weeks. -associated with cirrhosis and liver cancer Common causes: - illicit IV drug needle sharing - blood, blood products, or organ transplants - Needle stick injury - Unsanitary tattoo equipment NOT transmitted via common contact!! Advise NOT to share razors, toothbrushes, or earrings NO VACCINE FOR HEP C!!

Answer 21

- Use standard precautions - Use a needleless system, decrease presence of sharp instruments - Vaccinations, Hep B is a series of 3 injections - Prevent Hep B to prevent Hep D - Postexposure prevention of Hep A, seek medical attention immediately - Report all cases of hepatitis to local health department

Answer 22

- Maintain adequate sanitation and personal hygiene. - Wash your HANDS - Drink purified water or bottled water - Avoid foods prepared with tap water in undeveloped countries - Do NOT share personal items, linens, or eating utensils. - Do NOT share needles or piercings - Use a condom - Cover cuts/sores with bandage - If infected, NEVER donate blood, organs, or tissues.

Answer 23

``` The initial test: ELISA test (Enzyme-linked immunosorbent assay) for those suspected to be infected and screen for antibodies (detected within 4 weeks of infection) ``` Confirming test: RIBA (recombinant immunoblot assay) which is more specific in showing exposure to and development of antibodies than ELISA Additional test: OraQuick HCV rapid antibody test- approved by FDA in 2010, used for quick diagnosis as a point-of-care test.

Answer 24

``` ABD. PAIN Changes in skin or sclera (icterus) Arthralgia (joint pain) Myalgia (muscle pain) N/V/D/C Dark urine and clay-colored stools Fever Lethargy Malaise Pruritus (Itching) RUQ pain with jarring movements ```

Answer 25

Elevated AST/ALT Elevated Bilirubin Elevated Alkaline Phosphatase

Answer 26

Mind-body medicine - prayer - deep breathing - mediation To promote well-being and relieve tension and anxiety- promote health and improve Quality of life

Answer 27

Telaprevir (Incivek)-monitor CBC for anemia Boceprevir (Victrelis)- combo with HIV med, monitor Chem panel for kidney and liver function PegIFN/RBV (interferon/ribavirin)- given SubQ, cannot miss a dose!

Answer 28

Aimed at REST, is essential to reduce metabolic demand, promote regeneration, and increase blood supply. DIET: high carb, high calorie diet with moderate fats and proteins. SMALL FREQUENT MEALS, eat foods that are appealing Antiemetic to relieve nausea Community-based care: Primarily to PREVENT spread of infection, good hygiene and hand washing. EDUCATION is key.

Answer 29

``` AVOID OTC drugs, including Tylenol Avoid Alcohol Rest frequently, get adequate sleep Small frequent meals Avoid sex until antibody testing is negative Prevent transmission via MEDICATIONS ```

Answer 30

Fatty liver is caused by the accumulation of fats in and around the hepatic cells, may be caused by alcohol. Additional causes: - diabetes mellitus - obesity - elevated lipid profile LABS: elevated ALT and AST or normal ALT and elevated AST Pt is asymptomatic MRI, US, nuclear med to diagnose. Percutaneous biopsy to confirm. Intervention aimed to remove underlying cause of infiltration.

Answer 31

Most common organ to be injured Suspected with upper abdominal or lower chest trauma (steering wheel) OBSERVE for early signs of HYPOVOLEMIC SHOCK due to potential massive blood loss

Answer 32

``` RUQ pain with abd. Tenderness Abd distention and rigidity Guarding of the abdomen Increased abd pain with deep breathing or refers to the right shoulder (Kehr's sign) Hemorrhage or hypovolemic shock: -Hypotension -tachycardia -tachypnea -pallor -diaphoresis -cool, clammy skin -confusion or alter LOC -decreased Hematocrit ```

Answer 33

Chemotherapy and radiation therapy

Answer 34

Those with: - Severe cardiovascular instability - Severe respiratory disease - Metastatic tumors - Inability to follow instructions regarding drug therapy and self-management

Answer 35

Liver transplanted and preserved in solution for up to 8 hours. Transplant list ran by UNOS. Monitor for clinical manifestations of rejection: - tachycardia - fever - RUQ or flank pain - decreased bile pigment - increased jaundice - elevated bilirubin, ALT/AST, alkaline phosphatase - prolonged PT/INR DO: - Vaccines and Prophylactic ABX - Broad spectrum ABX during and after surgery - Monitor Temp and neuro status frequently - report clotting problems (bleeding) - immunosuppressants and anti-rejection med

Answer 36

Acute graft rejection: 4-10th post-op day - tachycardia, fever, RUQ or flank pain, diminished bile drainage or change in color of bile, increased jaundice - Prevent: Prophylactic immunosuppressants (cyclosporine) and anti-rejection meds Infection: occurs at any time -fever, foul smelling drainage Common infection- PNA, wound infection, UTI Opportunistic infection-develop after the 1st month, include: cytomegalovirus, mycobacterial or parasitic infections -Prevent: Prophylactic ABX and vaccinations. Frequent cultures, good hand hygiene, organism specific anti-infectives Hepatic Complications: (bile leakage, abscess, hepatic thrombosis) - decreased bile drainage, increased RUQ pain with distention and guarding, N/V, increased jaundice and Carly-colored stools. Increase bilirubin and transaminases - Prevent: t-tube in dependent position, secure to patient, empty frequently, record appearance and amount. May need surgery Acute Renal Failure: - caused by hypotension, ABX, cyclosporines, Acute liver failure, or hypothermia - Hypothermia Sx: shivering, hyperventilation, increased cardiac output, vasoconstriction, and alkalemia - early indicators of renal failure: changes in urine output, increased BUN and Cr, electrolyte imbalance - Prevent: monitor drug levels with nephrotoxic side effects, report early side effects immediately.

Answer 37

Liver, gallbladder (biliary system) and pancreas secrete enzymes to promote food digestion in the stomach and small intestine.

Answer 38

Cholecystitis is inflammation of the gallbladder, either acute or chronic.

Answer 39

Calculous Cholecystitis- most common - chemical irritation and inflammation result in gallstones (cholelithiasis) that cause obstruction (mostly cystic duct) - trapped bile is reabsorbed and causes irritation leading to ischemia and infection. May eventually perforate (can cause peritonitis) - Impaired motility causes stone formation by delaying bile emptying and causing stasis. Acalculous Cholecystitis: inflammation without gallstones, associated with bile stasis. (Decreased blood flow, anatomical problems, twists/kinks) Occurs in patients with: sepsis, severe trauma/burns, long term TPN, multiple organ failure, major surgery, hypovolemia.

Answer 40

Chronic Cholecystitis occurs with repeated obstruction of cystic duct. -gallbladder becomes fibrotic and contracted = decreased motility and absorption. Common complications: pancreatitis and cholangitis ``` Jaundice and icterus (sclera) Pruritus (itching) or burning sensation Clay colored stools Tea colored foamy urine (kidneys try to excrete bilirubin) Epigastric or vague upper abdominal pain pain with large meals N/V Dyspepsia (indigestion) Eructation (belching) Flatulence (gas) Abdominal fullness Rebound tenderness (Blumberg's sign) Fever Steatorrhea (fatty stools) ```

Answer 41

``` 4 F's: Female Forty Fat Fertile (Flatus) ``` ``` Pregnancy or obesity Athletes Rapid wt loss - affects normal absorption Crohn's disease, sickle cell Hormone replacement therapy ``` American Indian, Mexican American, or Caucasian are more likely to develop Cholecystitis

Answer 42

NO pain or fever Only Localized tenderness and acute confusion (delirium) Check O2 sat

Answer 43

Biliary colic is severe pain caused by obstruction of cystic duct caused by moving stones tachycardia Pallor Diaphoresis Prostration (extreme exhaustion) CALL RRT! Stay with pt and keep the HOB flat!

Answer 44

Increased fatty foods Increased calories Increased refined white carbs Decreased fiber S/Sx when these foods consumed: -gas, indigestion, belching, anorexia, N/V, abdominal pain or discomfort.

Answer 45

Increased WBCs (inflammation) Elevated Alkaline phosphatase, AST, and LDH Elevated Bilirubin If pancreas involved, elevated amylase and lipase X-ray: see calcified gallstones Ultrasound of RUQ: initial diagnostic test Hepatobiliary scan (HIDA scan)- decreased bile flow = disease with obstruction, NPO before procedure ``` ERCP MRI (contrast gadolinium does not contain iodine) ```

Answer 46

Tx of choice: laparoscopic cholecystectomy Short recovery time, inexpensive, less pain, minimal scaring

Answer 47

NPO diet if N/V occur IV fluids NG tube Acute pain: opioids: morphine or Dilaudid Ketorolac (Toradol) for mild to moderate pain (NSAID) Antiemetics for N/V IV ABX - depending on cause of Cholecystitis Bile acid dissolution: ursodiol (Actigall) and chenodiol (Chenodal) may be given for up to 2 years to dissolve or stabilize gallstones. - report diarrhea, vomiting, severe abd pain, especially if radiates to shoulders - take with food or milk Lithotripsy (extracorporeal shock wave lithotripsy) - used for normal weight, cholesterol based stones, and good gallbladder function. Lay on a water-filled pad, shock breaks up stones. Spasms occur- ursodeoxycholic acid (UDCA) used after procedure to dissolve remaining fragments.

Answer 48

Aka "Lap Chole" is the gold standard of Minimally Invasive Surgery - complications uncommon - death rate low - bile duct injuries are rare - recovery is quicker - pain less severe AMBULATE same day as surgery, review pain management, deep breathing, incision care, and leg exercises. IV ABX given immediately before or during surgery Air (carbon dioxide) 3-4 liters to inflate abdominal cavity, post-op will rise to chest and shoulders - elevated HOB, HEAT, void and early ambulation to get rid of air. Offer food and water when fully awake, monitor for N/V ASSESS O2 sat and deep breathing q 1 hour. -Given antiemetic PRN Maintain IV line Sterl-strips or adhesive comes off after 10 days Education: Ice and oral opioids for incisional pain. Bath or shower next day post-op. Rest for 24 hours then resume usual activities as tolerated. Avoid high fat foods- causes diarrhea and abd pain. Introduce fatty foods one at a time.

Answer 49

Open surgical procedure for severe biliary obstruction and to explore duct patency. Use has declined greatly JP drain to prevent fluid accumulation- Seriosanginous fluid and stained with bile for 24 hours after surgery- ABX to prevent infection. Post-op incisional pain: control with PCA pump, TCDB exercises, and incision splinting. Antiemetic for N/V- give early to prevent retching and decrease muscle strain. Post-op care for incision and surgical drain-- surgeon removes dressing and drain within 24 HR of surgery NPO until fully awake, advance to liquids then solid foods. Low fat diet, eat nutritious meals and avoid fatty foods. Document LOC, VS, pain, and signs of infection. Early ambulation and D/C home within 2 days.

Answer 50

Post cholecystectomy syndrome: severe Vomiting or Diarrhea with abdominal or epigastric pain for several weeks to months after surgery.

Answer 51

Acute pancreatitis is serious and life-threatening inflammation of the pancreas, caused by premature activation of excessive pancreatic enzymes that destroy ducal tissue and pancreatic cells, resulting in auto digestion and fibrosis of the pancreas. 4 processes: - lipolysis - proteolysis - necrosis of blood vessels - inflammation The majority of deaths in patients with acute pancreatitis result from irreversible shock.

Answer 52

jaundice occurs from swelling of the head of the pancreas Compression of bile duct by calculi (stones) Pancreatic shock (causes septic shock) Hemorrhage (necrotizing hemorrhagic pancreatitis [NHP]) Acute Kidney failure paralytic ileus Hypovolemic shock Acute Respiratory distress syndrome (ARDS) Decrease release of insulin Total distraction of the pancreas, leading to DM type 1. Left lung pleural effusion, atelectasis, and PNA Multiple organ failure Disseminated intravascular coagulation (DIC) DM type 2

Answer 53

B. report bile-colored drainage from the incision

Answer 54

C. Pneumonia

Answer 55

Result from trauma from surgical manipulation, or complication of diagnostic procedures Trauma-external source Pancreatic obstruction-tumor, cysts, abscess Metabolic disturbances-hyperlipemia, hyperparathyroidism, hypercalcemia Renal disturbances-failure or transplant Familial, inherited pancreatitis Penetrating gastric or duodenal ulcers Viral infections-coxsackievirus B and HIV Alcoholism Toxicity of drug-opioids, sulfonamide, thiazides, steroids, oral contraception Cigarette smoking Cystic Fibrosis Gallstones Abdominal surgery

Answer 56

Severe and consistent abdominal pain, mid-epigastric or LUQ Sudden onset and radiates to the back, left flank, or left shoulder. Intense boring, worse when lying in supine position, relief in Fetal position or sitting upright and bend forward. generalized jaundice Gray-blue discoloration of abdomen (Cullen's) or flanks (Grey Turner's) Absence of bowel sounds Abdominal tenderness, rigidity, and guarding with light palpation Palpable mass Pancreatic ascites- dull sound Respiratory Compromise Steatorrhea or clay-colored stools Wt loss Dark Urine Polyuria, polydipsia, polyphagia (DM) Assess: elevated temp, tachycardia, and decreased BP. Auscultate lung fields.

Answer 57

Elevated: - amylase - lipase - trypsin - elastase - glucose - Bilirubin - ALT/AST - leukocyte count (WBCs) - BUN and triglycerides - CRP present Decreased: - Calcium for 7-10 days, stay below 8 is poor prognosis - Magnesium - Potassium - platelets (thrombocytopenia) - Albumin (caused by cytokines)

Answer 58

Abdominal ultrasound- most sensitive to Dx CT scan- with contrast, more reliable imaging Abdominal X-ray: reveal gallstones ERCP: best Dx pancreatic stones

Answer 59

``` Priority: ABCs!! Provide Oxygen Control Pain Hydration with IVF - isotonic fluids NS or LR Replacement Ca and Mg via IV Foley catheter for accurate I/O ``` NG tube and suctioning for severely ill with continuous vomiting and biliary obstruction (due to paralytic ileus) -may need to be prolonged therapy, passing gas or BM is most reliable indicator of peristalsis return. Fasting and rest!! Withhold food and fluids (NPO) during acute period. Drug therapy: - Opioids via PCA (morphine or Dilaudid), IV or transdermal Fentanyl - ---NO Demerol, can cause seizures - H2 receptor antagonist (ranitidine [zantac]) - Proton pump inhibitor (omeprazole [prilosec]) - ABX for acute necrotizing pancreatitis. Frequent oral and nasal hygiene measures to keep mucosa moist, may have dry mouth manage anxiety and reduce pain. Daily weight Small frequent meals; moderate to high carbs, high protein, low fat meals. Bland foods, avoid caffeine (tea, cola, chocolate) and alcohol. Nutrition supplement as needed, and fat-soluble vitamins and minerals. Wound care and ADL assistance, activity to one floor. Support groups: AA and Al-Anon for family members

Answer 60

Chronic pancreatitis is a progressive, destructive disease of the pancreas that has remissions and exacerbations Alcoholism is primary risk factor for Chronic Calcifying Pancreatitis (CCP) (Predominant in men). - early: insoluble proteins plug pancreatic ducts and flow of pancreatic juices - late: ducts change and ulcerated, causes fibrosis. Introduction calcification and marked pancreatic destruction (necrosis). Organ is hard and firm. Chronic Obstructive Pancreatitis: inflammation, spasms, and obstruction of sphincter of Oddi, often gallstones Autoimmune Pancreatitis: chronic inflammation process in which immunoglobulins invade the pancreas. Can infiltrate the lungs and liver. Idiopathic and Hereditary Chronic Pancreatitis: SPINK1 and CFTR gene mutations

Answer 61

PERT- pancreatic enzyme replacement therapy: standard of care to prevent malnutrition, malabsorption, and excessive weight loss. - Pancrelipase: capsule or tablet containing amylase, lipase, and protease. - --do NOT chew or crush delayed capsules and enteric coating - --Take with all meals and snacks - --admin after antacids and H2 blockers If difficulty swallowing, pierce capsule and give with applesauce do NOT mix with protein-containing foods Wipe your lips after taking to prevent skin irritation Follow-up labs (can cause increased Uric acid levels) Record number of stools per day, if effective stools become less frequent and less fatty.

Answer 62

Avoid things that worse symptoms, i.e. Caffeine Avoid alcohol ingestion and nicotine Eat bland, low-fat, high-protein, and moderate-carb meals; avoid gastric stimulants (spices) Eat small meals and snacks high in calories (4000-6000calories/day) Take Pancreatic enzymes as prescribed with meals Rest frequently, restrict activity to one floor until regaining strength

Answer 63

C. Bacon | E. Fried potatoes

Answer 64

A pancreatic abscess is a serious complication of acute necrotizing pancreatitis. recurrence rate is high, purulent liquification of necrotic pancreas. Spiking temp, high to 104 degrees Drainage via percutaneous method or laparoscopy to prevent sepsis. ABX alone not effective. May require multiple drainage

Answer 65

AKA false cysts, do not have epithelial lining. Encapsulated saclike structures. Pseudocysts wall becomes inflamed, vascular, and fibrotic. Straw-colored or dark brown viscous fluid Risk factors: Acute pancreatitis, abdominal trauma, and chronic pancreatitis. Primary symptoms: Radiating epigastric pain to the back. Also abdominal fullness, N/V, and jaundice Complications: Hemorrhage, infection, Obstruction, Abscess, Fistula formation, and Pancreatic ascites. Interventions: Surgery if does not resolve within 6-8 weeks. Sump drainage tube to remove pancreatic secretions and exudate.

Answer 66

leading cause of cancer deaths, 5 year survival rates are low. Originate from epithelial cells of the pancreatic ducal system. Most often discovered in late stage and be a well-defined mass primary or metastasis from lungs, breasts, thyroid, kidney, or skin. treatment: Chemotherapy and radiation therapy. 5-FU. High dose opioids- morphine. Biliary stents Complete surgical resection Whipped procedure Symptoms: Jaundice, clay colored stools, dark urine, abdominal pain (dull, vague, radiates to back), wt loss, N/V/A, glucose intolerance, splenomegaly, gas, GI bleeding, ascites, leg or calf pain, weakness and fatigue.

Answer 67

``` Ca+ 9.0 - 10.5 K+ 3.5 - 5.0 Albumin 3.5 - 5.0 ALT 4 - 36 AST 0 - 35 Alkaline phosphatase 30 - 120 Bilirubin 0.3 - 1.0 Conjugated bilirubin 0.1 - 0.3 Unconjugated 0.2 - 0.8 Ammonia 10 - 80 Xylose 20 - 57 (60min) 30 - 58 (20min) Amylase 30 - 220. (Wendy 50-180) Lipase 0 - 160. (Wendy 31-186) Cholesterol <200 Carbohydrate antigen19-9: <37 Carcinoembryonic antigen <5 ```

Answer 68

``` Bright red blood (upper) coffee ground emesis (lower) Melena stools (dark, tarry) Decreased BP Weak peripheral pulses Confusion, vertigo, lightheaded Decreased H&H ```

Answer 69

Most common infection: H. Pylori -NSAIDs breakdown mucosal layers Most common reported complication: Indigestion (dyspepsia) - left of midline pain - aggravated by food consumption Pain occurs 1.5-3 hours after eating No eating before bed Foods to avoid- Onions, alcohol, caffeine, NSAIDs Tx: Proton Pump Inhibitors (Protonix, Prilosec, Nexium) -Protonix: use IV filter, and use separate line to admin -Prilosec: give PO 30 minutes before meals -Nexium: Don't stop abruptly to prevent rebound secretions. ABX for H. Pylori H2 Antagonist: Zantac, Pepcid, Axid Antacids (no wintergreen) give 1 HR before or 2 HR after meals & HS Pepto: do NOT give with ASA

Answer 70

Sharp, sudden, persistent, severe epigastricor abd pain | Bloody/black tarry stools or vomiting

Answer 71

PRIORITY: ABC's Provide O2 2 large bore IVs Monitor VS and Hematocrit Gastric lavage (NG tube) done by the physician

Answer 72

Occurs in the glands of the stomach, spreads via the lymphatic system-- carries tumor deposits to the lymph nodes. Risk factors: - infection with H. Pylori (#1) - pernicious anemia - gastric polyps - pickled foods - nitrates Treatment: Chemotherapy and radiation (causes N/V and bone marrow suppression- give Zofran) PREFERRED: Surgical resection of the tumor Metastasis- lymph nodes most common, Resection not available. Whipped procedure- very severe option. Monitor CBC, RBC, and WBC (leukopenia)

Answer 73

Small frequent meals Avoid drinks with meals Do not consume food that causes discomfort NO alcohol may need B12 injections (loss of intrinsic factor) Lie flat after meal to decrease motility

Answer 74

Grows rapidly, no aerosol layer to limit extension Spreads rapidly to the lymph nodes Risk factors: Smoking, alcohol, tobacco, gender (males), untreated GERD, pickled foods, obesity, genetic factors Assess: Dysphagia, Odynophagia (with cold liquids, painful swallowing), vomiting, halitosis, chronic hiccups Wt loss is concern for nutrition ``` Dx: Barrium Swallow (1st) esophageal ultrasound with aspiration to examine tissue EGD to inspect tissue and collect sample PET/CT scan identifying metastasis ``` Tx: Surgery, chemo or radiation Education: Remain upright after meals HOB >30 degrees to prevent reflux Semi soft foods and thickened liquids, TPN may be needed at first To promote swallowing: head forward in flexed position, place food at back of mouth, check for pocketed foods Fam Education: S/Sx of aspiration ``` Pre-op: no smoking 2-4 weeks prior to increase resp. Status Nutrition therapy Good oral care and dental visit TCDB + A Chest physiotherapy ``` ``` Post-op: AIRWAY, Respiratory care essential MIS procedure: less time to heal/short hospital stay, small incision Do not irrigate NG tube-physician does Mechanical ventilation Report weight loss of 5 lbs or more 6-8 small meals, give fluids between Caution: resp infection and hand washing Diarrhea occurs 20mins-2hrs after eating- give Imodium before Tube feeds at first Fatigue and weakness long lasting Avoid large crowds ```

Answer 75

Most common adenocarinoma from granular epithelial cells ``` Risks: >50 Personal or family Hx Crohn's Disease Ulcerative Cholitis 1st degree relative increase change by 3-4 X for this individual H. Pylori, Strep Bovis, HPV Long-term smoking Obesity, sedentary lifestyle Long, heavy alcohol consumption Hx: If personal Hx of breast, ovarian, and endometrial cancers = increased risk for!! ``` More common in African Americans, and their survival rate is lower ``` Education: Diagnostic screening Modify diet Stop smoking and drinking Encourage physical activity ``` Ask if change in bowel elimination Pt may report: fatigue, abdominal fullness, vague abd pain, and unintentional wt loss, rectal bleeding (later), changes in stool shape and size, small/micro spots of blood in stool (early), straining to pass stools, narrowing of stools, dull pain.

Answer 76

Labs: Decreased H&H Positive Occult blood Dx: Double contrast barium enema Colonoscopy Sigmoidoscopy Nursing Dx: R/F cancer metastasis Grieving r/t cancer Dx. Tx: Remove tumor radiation and chemotherapy ``` Interventions: Stool softeners Colostomy- 1st sign of acceptance is starting to watch colostomy cares -side lying in bed -no air rings or donuts -NO gas causing foods/drinks ``` 4-6wks to establish foods on a bowel pattern. Avoid moisturizing soaps- interfere with adhesive dressing

Answer 77

Yellow, green fluid drainage Functioning to produce BM in 2-3 days post op Pain is controlled with analgesics Absorbent dressing is placed post op (not a surgical dressing) JP drain in wound- Seriosangiuaous drainage

Answer 78

gas causing: Cauliflower, cucumber, mushrooms, peas, broccoli, beans, chewing gum, asparagus, cabbage, onions, spicy foods, and Brussels sprouts gas preventing: Crackers, toast, yogurt Odor preventing: Buttermilk, cranberry juice, parsley, yogurt

Exam #5 (chp 58-59) Flashcards

(102 cards)