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NSG 430 - Critical Care > T13: Hepatitis & Acute Liver Failure > Flashcards

T13: Hepatitis & Acute Liver Failure Flashcards

(56 cards)

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1
Q

hepatitis

A

inflammation of the liver

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2
Q

causes of hepatitis

A

viral, ALCOHOL, medications (hepatotoxic), fatty liver disease

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3
Q

liver is the only organ in the body that can

A

regenerate

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4
Q

how do we help to regenerate the liver

A

adequate nutrition and rest

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5
Q

Hepatitis A (HAV)
Transmission

A

-Most commonly fecal-oral route-comtaminated water or food

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6
Q

prevention of hepatitis A (HAV)

A

through strict handwashing, stool and needle precautions, HEPATITIS A VACCINE (two doses)

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7
Q

Hepatitis B (HBV) Transmission

A

-Through direct contact with blood or body fluids of infected person

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8
Q

prevention of hepatitis b (HBV)

A

o strict hand washing, screening blood, needle precautions, avoiding sexual contact with anyone who is Hep B positive, HEPATITIS B VACCINE

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9
Q

Hepatitis C (HCV) transmission

A

primarily through blood (IV drug use, high risk-sex behavior, dialysis, blood transfusion before 1992, perinatal)

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10
Q

prevention of hepatitis C

A

strict hand washing, needle precautions, screening of blood, NO VACCINE

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11
Q

which type of hepatitis does NOT have a vaccine

A

Hepatitis C

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12
Q

hepatits clinical manifestations: preicteric stage

A
  • Flu-like symptoms (malaise, fatigue, anorexia, N/V, diarrhea, myalgias (muscle aches), arthralgias (joint pain)
  • Rash: IMPORTANT TO TEACH HOW TO SCRATCH WITH KNUCKLES
  • RUQ tenderness (caused by liver inflammation)
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13
Q

hepatits clinical manifestations: icteric stage

A

-Appearance of jaundice (elevated bilirubin levels)
· Look at sclera and palms/bottom of feet
· Palmar erythema
-DARK/TEA COLORED URINE
-CLAY COLORED STOOLS
-Pruritis

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14
Q

pruritis interventions

A

· Use cholestyramine or hydroxyzine, lotions, soft, or old linen, temperature control, short nails; rub with knuckles

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15
Q

hepatits clinical manifestations: posticteric stage

A
  • Jaundice, urine, and stool color return to normal
  • Energy increases and pain subsides
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16
Q

diagnostics for hepatitis

A

-Elevated bilirubin, gamma GT, AST, ALT
-Prolonged PT and INR
-Leukopenia, transient neutropenia, lymphocytosis
-Blood test for hepatitis associated antigen A, B, C, D
-Liver biopsy

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17
Q

Total bilirubin

A

0.3-1.0 mg/dL

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18
Q

interprofessional care for hepatitis

A

o Adequate nutrition
- IV GLUCOSE OR ENTERAL NUTRITION
-Small frequent meals, use measures to stimulate appetite (mouth care, antiemetics, attractively served meals)
o Rest (degree and strictness varies)
o AVOID alcohol intake and drugs detoxified by liver
o HOB elevated

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19
Q

what drug can be used for hep C infection

A

interferion

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20
Q

Hepatic encephalopathy

A

potentially life-threatening spectrum of neurologic, psychiatric, and motor disturbances (results from liver’s inability to remove toxins)

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21
Q

clinical manifestations of hepatic encephalopathy

A

-lethargic, personality changes
-cannot write well
-asterixis
-Fetor hepaticus (musty, sweet odor of patient’s breath; rotten eggs + garlic)

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22
Q

Asterixis

A

aka Liver Flap, a flapping tremor of the hands. When the client extends the arms & hands in front of the body, the hands rapidly flex & extend.

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23
Q

What causes hepatic encephalopathy?

Study These Flashcards
A

accumulation of ammonia that gets into the brain

24
Q

what do we give for hepatic encephalopathy to get rid of ammonia

25
Lactulose
ammonia binds to the stool and patients gets diarrhea, so we are worried about F&E imbalances
26
manifestations of chronic hepatitis
· Coagulation problems o Easy bruising and bleeding · Skin manifestations o Spider angiomas, palmar erythema, and gynecomastia. Some patients have splenomegaly, hepatomegaly, or cervical lymph node enlargement
27
cirrosis
end-stage disease liver "scarring"
28
clinical manifestations of cirrosis
- Skin: jaundice (decreased ability to remove bilirubin), palmar erythema (red area that blanches with pressure), pruritus, spider angioma - Neuro: asterixis (flapping tremor), portal-systemic encephalopathy - Respiratory: dyspnea, hyperventilation, hypoxemia - Ascites - Clay-colored stools - Esophageal varices - Hematologic: thrombocytopenia, anemia, leukopenia, coagulation disorders
29
treatment of hematologic conditions of cirrosis (thrombocytopenia, anemia, leukopenia, coagulation disorders)
Platelets, FFP, RBCs
30
why do patients get peripheral neuropathy with cirrosis
due to dietary deficiencies of thiamine, folic acid, and cobalamin-vitamin B12
31
cor pulmonale
right ventricular hypertrophy and heart failure DUE TO pulmonary hypertension
32
portal hypertension
characterized by increased venous pressure in the portal circulation, splenomegaly, large collateral veins, ascites, and gastric and esophageal varices.
33
TRANSJUGULAR INTRAHEPATIC PORTOSYSTEMIC SHUNT (TIPS)
· used to alleviate ascites that does not respond to diuretics; a nonsurgical procedure in which a tract (shunt) between the systemic and portal venous systems is created to redirect portal blood flow.
34
ascites
accumulation of fluid in the peritoneal cavity
35
treatment for ascites
diuretics (spironolactone, furosemide, triamterene) and paracentesis o Limit sodium
36
procedure for ascites
paracentesis
37
paracentesis
needle into the abdomen to pull fluid off
38
what should the patient do before a paracentesis
void
39
what color should the fluid be from a paracentesis
pale yellow
40
post care paracentesis
§ Patient voids immediately before § High Fowler's position or sitting on side of bed § Monitor for hypovolemia and electrolyte imbalances § Monitor BP and heart rate § Monitor dressing for bleeding/leakage
41
peripheral edema
occurs as in the lower extremities and presacral area
42
treatment for peripheral edema
exogenous albumin
43
esophageal varicies
dilates and tortuous veins in the submucosa of the esophagus that are fragile, thin-walled distended esophageal veins that become irritated and rupture
44
what should you avoid with esophageal varicies
alcohol, aspirin, NSAIDs
45
how to screen for esophageal varices
endoscopy
46
if bleeding occurs with esohageal varicies what should be done
stabilize patient, manage airway, prive IV therapy and blood products -band ligation -sclerotherapy -balloon tamponade
47
band ligation
placement of a small rubber band (elastic O-ring) around the base of the varix (enlarged vein)
48
sclerotherapy
involves injection of a sclerosing solution into the swollen veins through an injection needle that is placed through the endoscope
49
balloon tamponade
mechanical compression of varices
50
SAFETY ALERT for balloon tamponade
· Label each lumen to avoid confusion. · Secure the tube to prevent movement of the tube which could result in occlusion of the airway. · Deflate balloons for 5 minutes every 8 to 12 hours per institutional policy to prevent tissue necrosis.
51
Portal systemic encephalopathy
end-stage hepatic failure characterized by altered level of consciousness, neuro symptoms, impaired thinking
52
jaundice
occurs because liver is unable to metabolize bilirubin
53
hepatorenal syndrome
progressive renal failure associated with hepatic failure · Characterized by a sudden decreased in UO, elevated BUN and CRE
54
treatment for hepatorenal syndrome
liver transplant
55
care for cirrosis
o Rest o Administration of b-complex vitamins o Avoid alcohol o Minimize/avoid aspirin, acetaminophen, and NSAIDs o Diet for patient without complications - High in calories (3000 cal/day) - ↑ Carbohydrate - Moderate to low fat - Protein supplements for protein-calorie malnutrition - Low-sodium diet for patient with ascites and edema - Seasonings to make food more palatable
56
liver cancer treatment
CHEMOTHERAPY o Triple pronged approach -Immunosuppressive therapy o Corticosteroids, Cyclosporine/tacrolimus, Azathiprine, Hepatitis-antiviral therapy

NSG 430 - Critical Care (42 decks)

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