final med portion Flashcards
(92 cards)
1
Q
function of the liver
A
- metabolism (medications, alcohol)
- detoxification
- production of proteins (plasma proteins, coagulation factors, albumin)
- bile production (what aids us in digesting fats so we can absorb vitamins)
2
Q
what are some causes of liver dysfunction?
A
- vital infections (hep B & C)
- alcohol abuse
- non alcoholic fatty liver disease –> obesity –> fat accumulation in the liver
- autoimmune conditions
- toxins & medications (tylenol/alcohol OD or misuse)
3
Q
acute liver failure
A
rapid deterioration of the liver function resulting in encephalopathy and coagulopathy in persons with no known hx of liver disease
4
Q
most common cause of acute liver failure
A
medications in combination with alcohol
5
Q
clinical manifestations of acute liver failure
A
jaundice, coagulation abnormalities, encephalopathy, changes in cognitive function
6
Q
liver cirrhosis
A
chronic inflammation of the liver which leads to scar tissue development
7
Q
S/S of cirrhosis
A
- peripheral edema
- ascites
- anorexia
- dyspepsia
- SOB
- jaundice
- pruritus
- pale “clay” stool
- pain
- splenomegaly
8
Q
hepatic encephalopathy
A
neuropsychiatric condition of advanced liver disease
neurotoxic levels of ammonia d/t it crossing the blood-brain barrier which causes an altered LOC, inappropriate behaviour, concentration difficulties
9
Q
nursing management for encephalopathy
A
lactulose to reduce ammonia levels and expel ammonia from the colon (ensure a regular bowel regimen)
rifaximin used if lactulose unsuccessful alone
10
Q
esophageal varices
A
enlarged and swollen veins at the lower end of the esophagus d/t portal hypertension
at risk of bleeding = EMERGENCY
11
Q
ascites
A
accumulation of serous fluid in the peritoneal cavity d/t low albumin levels
management: sodium restriction, diuretics, fluid removal (paracentesis drain)
12
Q
medications for hepatic dysfunction
A
- lactulose (to reduce ammonia)
- rifaximin (antibiotic for hepatic encephalopathy)
- diuretics (decrease fluid)
- beta-blockers (decrease portal htn)
13
Q
what meds should pts with hepatic dysfunction avoid?
A
ASA, NSAIDS, sedatives, alcohol
14
Q
what should we be monitoring for pts with hepatic dysfunction?
A
- labs (albumin, ammonia, urea, clotting factors, LFTs, CBCs, ETOH level)
- ins & outs
- CIWA
- LOC
- nutrition
- daily weights
15
Q
pancreatitis
A
inflammation and necrosis of the pancreas –> autodigestion and leakage of enzymes
- severe pain
16
Q
causes of pancreatitis
A
- gallstones (middle aged women)
- alcohol use disorder (men)
Others: trauma, viral infection, penetrating duodenal ulcer, cysts, abscesses, cystic fibrosis, medications, metabolic disease
17
Q
S/S of pancreatitis
A
- RUQ or LUQ epigastric pain which radiates to back
- tender/distended abdomen
- pale, diaphoretic
- nausea/vomiting
- diarrhea
18
Q
what are the main systemic complications of acute pancreatitis?
A
cardiovascular & pulmonary (hypotension, tachycardia, pleural effusion, atelectasis, pneumonia, acute respiratory distress)
pulmonary complications due to passage of exudate containing pancreatic enzymes from peritoneal cavity through lymph channels
19
Q
primary diagnostic tests for pancreatitis
A
- serum amylase (3x normal level)
- serum lipase
- increase in liver enzymes, triglycerides, glucose, bilirubin and low calcium levels
20
Q
nursing interventions for pancreatitis
A
keep pt NPO to reduce pancreatic secretion
urgent ERCP may be performed
monitor glucs
21
Q
hepatitis A
A
transmitted by fecal-oral route
no specific tx, rarely leads to hepatic failure
22
Q
hepatitis B
A
transmitted through exposure to contaminated blood or body fluids
vaccine preventable
23
Q
hepatitis C
A
transmitted through blood or bodily fluids (primarily percutaneously)
24
Q
hepatitis D
A
extremely low prevalence
typically acquired at the same time as HBV
25
hepatitis E
transmitted through fecal-oral route most commonly through contaminated water
26
peritonitis
inflammation of the peritoneal cavity
27
inflammatory bowel disease
autoimmune disease that refers to Crohn's disease and ulcerative colitis
characterized by idiopathic inflammation and ulceration
28
3 characteristics of the etiology of inflammatory bowel disease
1. genetics
2. altered dysregulated immune response
3. altered response to gut microorganisms
29
ulcerative colitis
inflammation and ulceration of the rectum and colon
inflammation is diffuse and involves mucosa and submucosa with alternate periods of exacerbation and remission
disease begins in rectum and spreads proximally along the colon in a CONTINUOUS fashion
30
clinical manifestations of ulcerative colitis
- bloody diarrhea (multiple BMs/day)
- abdominal pain
- fever, malaise, anorexia (when severe)
31
how is ulcerative colitis diagnosed?
BW: CBC, serum electrolytes, serum protein
sigmoidoscope, colonoscopy
32
nursing management for ulcerative colitis
1. rest the bowels
2. control the inflammation
3. manage fluids & nutrition
4. manage pt stress
5. symptom relief (corticosteroids, sulphasalazine)
33
Crohn's disease
chronic inflammation of any part of the GI tract from mouth to anus (most commonly in terminal ileum and colon)
skip lesions
(15-30 yrs, higher in women, Jewish & upper middle class urban populations)
34
clinical manifestations of Crohn's disease
insidious onset with nonspecific symptoms
diarrhea (non-bloody), abdominal pain
35
how is Crohn's disease diagnosed?
1. lab work (electrolyte imbalances)
2. barium studies
3. endoscopic studies
36
nursing management for Crohn's disease
- sulphasalazine (when large intestine is involved)
- corticosteroid therapy
- immunosuppressive agents (when corticosteroids fail)
- metronidazole (used to treat Crohn's of the perianal area)
37
role of the thyroid
regulates metabolism, digestion, temperature, growth/development, thoughts/feelings, energy levels
38
thyroid hormones
pituitary gland --> TSH --> T3/T4
39
hypothyroidism
underactive thyroid gland (HIGH TSH, LOW T4)
everything is LOW and SLOW
mostly affects middle aged women
40
main causes of hypothyroidism
1. hashimotos disease (immune system attacks the thyroid)
2. iodine deficiency
3. pituitary gland tumour
41
clinical manifestations of hypothyroidism
fatigue, lethargy, impaired memory, somnolence, depression, low exercise tolerance, weight gain, anemia, constipation, hair loss, weight gain
42
worst case scenario of hypothyroidism
MYXEDEMA COMA
medical emergency
unresponsive, appears like respiratory failure, bradycardic, low blood glucose
43
how do we treat hypothyroidism
synthroid (levothyroxine)
44
hyperthyroidism
overactive thyroid gland (LOW TSH, HIGH T4)
everything is in OVERDRIVE
45
main causes of hyperthyroidism
1. graves disease (protruding eyeballs, frail, thin)
2. toxic goiter
3. increased iodine
4. thyroiditis
46
clinical manifestations of hyperthyroidism
goiter, abnormal eye appearance, weight loss, increased nervousness, confusion, agitation
47
worst case scenario of hyperthyroidism
THYROID STORM
medical emergency
severe tachycardia, heart failure, shock, hyperthermia, abdominal pain, restlessness, diarrhea, vomiting, coma
48
reatment for hyperthyroidism
1. PTW or tapazole (decreases production)
2. thyroidectomy (afterwards will need to take synthroid)
3. radioactive tx (pill that destroys thyroid tissue and hyperactive cells)
4. beta-blockers
5. dietary changes (avoid seafood, dairy, eggs)
49
goitre
abnormal growth of the thyroid gland
can be nodular or diffuse
can occur with hyper or hypothyroidism
50
tuberculosis
infectious disease caused by mycobacterium tuberculosis most often affecting the lungs but can be disseminated throughout the body
51
pathophysiology of tuberculosis
bacteria multiply and attack the lungs and other parts of the body (eg. lymph nodes)
from the lungs the bacteria move through the blood/lymphatic system to different parts of the body
52
who is most at risk for tuberculosis?
- low socioeconomic groups
- residing in overcrowded institutions
- immigrants and indigenous peoples
- smoking or air pollution
- people with chronic conditions
- people unvaxxed against TB
- immunocompromised pts
53
how is tuberculosis transmitted?
airborne droplets, can remain airborne for hours
gets stuck in the lungs/mucus lining
54
extrapulmonary tuberculosis
infection outside of the lungs
(kidneys, bones, lymph nodes, genitals)
55
S/S of ACTIVE TB
- frequent cough with sputum
- chest pain
- fever
- weight loss
- night sweats
- anorexia
symptoms are vague and often mild therefore, it is easy to unintentionally spread
can lead to abdominal pain, joint pain, pallor, anemia if gone systemic
56
latent TB
NO SYMPTOMS, NOT CONTAGIOUS
can live in granulomas and can lay dormant in macrophages and immune cells
when immune system decreases then TB becomes active
57
what is a granuloma?
masses of granulation tissue in which monocytes trap the mycobacteria within
58
how do you diagnose tuberculosis?
1. TB skin test (looking for induration, assessed 48-72 hrs after injection)
2. chest x-ray (looking for irregular patches in the lungs)
3. sputum sample (AFB test; 3 samples on different days in the AM)
59
how do you treat tuberculosis?
95% curable rate
- antibiotics (streptomycin)
MUST TAKE WHOLE COURSE 4-6 MONTHS
- DOTS (Direct Observation Therapy Short Course) done by public health authorities (watch pt swallow all meds and assessing tx adherence)
60
is tuberculosis a reportable disease?
YES, must be reported to the public health authority
61
tuberculosis prevention
BCG (Bacille Calmette Guerin) vaccine
62
HIV
human immunodeficiency virus
attacks the immune system
63
pathophysiology of HIV
HIV infects CD4 cells (WBCs) --> replicate --> destroy --> weakens the immune system = opportunistic infections & malignancies
64
who is at risk for HIV
1. healthcare workers
2. indigenous population
3. sex workers
65
how is HIV transmitted?
through blood and bodily fluids
(blood transfusion/needle stick; unprotected sex*; breast milk)
*most common
66
does every exposure to HIV indicate an infection?
not necessarily
depends on:
- amount of virus in the blood
- frequency and duration
- volume of fluid
- immune system of the host
67
what are the three stages of HIV?
1. ACUTE
2. EARLY CHRONIC
3. SYMPTOMATIC
4. AIDS (LATE)
68
Acute (initial) stage of HIV
within a few weeks post infection, increased amount of virus in the blood
- flu like symptoms (lethargy, malaise, fever, sore throat, fatigue)
- usually the body can fight it off
- may not test positive right away
69
Early chronic stage of HIV
prolonged period (10-12) years of LOW HIV in the blood
- few clinical symptoms (immune system constantly compensating)
- transmissible to other people
70
Symptomatic stage of HIV
CD4 counts fall below 500 *
- night sweats, fever, weight loss, more susceptible to opportunistic infections, lack of immunity
71
Late stage of HIV = AIDS
CD4 counts less than 200 *
- increased viral load, decreased T cells
- development of one opportunistic infection
72
what are some common opportunistic infections associated with AIDS?
candidiasis, Kaposi's sarcoma, tuberculosis, pneumonia, herpes simplex virus, neurological complications
73
where can you get tested for HIV?
- hospital
- sexual health clinics
- primary care clinics
74
what are the diagnostic tests for HIV?
1. self-administration testing (rapid test)
2. EAI: Enzyme Immuno Acid Test (antibody/antigen test)
3. NAT: Nucleic Acid Test (looks for virus in blood)
4. Western blot test
75
treatment for HIV
antiretroviral load therapy (decreases the viral load in the body)
* requires strict medication adherence
76
what are the nationally reportable STI's in Canada, and where do you report?
gonorrhea, syphilis, and chlamydia
must be reported to the Communicable Disease Division in each province or territory
77
gonorrhea
bacterial infection spread through direct physical contact with an infected host
S/S: greenish-yellow purulent urethral/anal discharge develops 2-5 days after infection, swollen testicles, vaginal discharge, dysuria, menstrual changes, frequency of urination
78
effect on babies being born to a mother with gonorrhea
newborns can develop gonorrhea during delivery, if left untreated babies can develop permanent blindness
79
nursing management for gonorrhea
- all sexual contacts must be examined and treated as well
- pt should abstain from sexual intercourse and alcohol during tx
- pts also treated for chlamydial infection
- ceftriaxone and azithromycin is preferred tx
80
syphilis
bacterial infection thought to enter through very small breaks in the skin or mucous membranes with contact with infectious indurated lesion
can affect many tissues in the body
81
S/S of syphilis
primary chancre (painless indurate lesion)
secondary (flu like symptoms; symmetrical rash that begins on the trunk and involves palms and soles; weight loss; alopecia)
late (gummas - chronic destructive lesions)
82
risk of pregnancy and syphilis
high risk for miscarriage, still birth or death of a newborn
83
nursing management for syphilis
penicillin G (tx of choice)
- all sexual contacts in last 90 days be treated
84
chlamydia
bacterial infection transmitted during penetrative sexual intervourse
high prevalence of asymptomatic infections
85
S/S of chlamydia
"silent disease"
urethritis, epididymitis, proctitis, purulent discharge, edematous area, pain with intercourse, menstrual abnormalities
86
pregnancy and chlamydia
baby may be born premature, have eye infections or develop pneumonia
87
nursing management for chlamydia
- rule out gonorrhea
- doxycycline or azithromycin with erythromycin or ofloxacin used as alternative tx regimen
88
HSV
herpes simplex virus
non-reportable
virus enters through mucous membranes or breaks in the skin during contact with an infected person
HSV-1: above the waist
HSV-2: below the waist
89
S/S of HSV
burning, itching, tingling at site of inoculation
small, vesicular painless lesions and when ruptured form shallow, moist ulcerations
they then crust over
90
pregnancy and HSV
high risk of transmission of genital herpes to the newborn
typically an indication for a C-section delivery if an active genital lesion is present
91
treatment for HSV
- encourage symptomatic treatment
- keep lesions dry and clean
- antiviral agents
92
