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Nurs 136- MCA II > Week 1: Endocrine, Hepatobiliary, Pancreas > Flashcards

Week 1: Endocrine, Hepatobiliary, Pancreas Flashcards

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1
Q

hyperpituitarism AKA ___________

A

acromegaly

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2
Q

hyperpituitarism AKA acromegaly - hypersecretion of:

A

growth hormone GH

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3
Q

hyperpituitarism AKA acromegaly

etiology:

A

congential, tumor

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4
Q

hyperpituitarism AKA acromegaly S&S:

& diagnostic test

acromegaly
large, thick _________, _________
_______________ syndrome
sleep apnea
_________ impairment
HTN
_________ disturbances
hyperglycemia
___________ cancer

Dx: ______________

A

acromegaly
large, thick hands and feet
carpal tunnel syndrome
sleep apnea
speech impairment
HTN
visual disturbances
hyperglycemia
colorecral cancer

Dx: OGTT [ingest 75g glucose]

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5
Q

hyperpituitarism AKA acromegaly nursing management

A

hypophysectomy [preferred surgical tx- removes pituitary gland]

Octreotide (sandostatin) [3x week subq; reduces GH]

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6
Q

Hypopituitarism - hyposecretion of

A

Pituitary hormones

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6
Q

Hypopituitarism etiology

____________
____________
____________
____________

A

congenital
infection
tumor
autoimmune

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7
Q

Hypopituitarism S&S

decreased ____________ [adults]
___________ [kids]
low ___________ [all]

A

decrease muscle & bone [adults]
dwarfism [kids]
low gonadotropins [all]

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8
Q

Hypopituitarism nursing management

A

hormone replacement therapy [lifelong]
surgery [if tumor]

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9
Q

SIADH is

A

syndrome inapporpriate antidiuretic hormone

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10
Q

syndrome inapporpriate antidiuretic hormone AKA SIADH is hypersecretion of

A

ADH

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11
Q

syndrome inapporpriate antidiuretic hormone AKA SIADH etiology

Diagnostic test?

__________
______ problems
medications

Dx: _____ urine specific gravity
_____ serum sodium
_____ serum osmolarity

A

cancers
CNS problems
medications

Dx: high urine specific gravity
low serum sodium
low serum osmolarity

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12
Q

syndrome inapporpriate antidiuretic hormone AKA SIADH S&S

______
________
weight _______
_____________ S&S
HTN
decreased ______ output

A

thirst
fatigue
weight gain
hyponatermia S&S
HTN
decreased urine output

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13
Q

syndrome inapporpriate antidiuretic hormone AKA SIADH RN management

VS
labs
I&O
restrict ________
assess _______ status
Meds: Demeclocycline, Tolvaptan, Conivapta, 3% NaCl

A

VS
labs
I&O
restrict fluids
assess neuro status
Meds: Demeclocycline, Tolvaptan, Conivapta, 3% NaCl

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14
Q

Diabetes Inspidus (DI)

hyposecretion of

A

ADH

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15
Q

Diabetes Inspidus (DI) etiology

conditions that ______________
tumor
removal of ______________

A

conditions that increase ICP
tumor
removal of pituitary gland

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16
Q

Diabetes Inspidus (DI) S&S

Diagnostic

_____________
____________
dehydration
hypotension
___________
confusion & lethargy (hypernatremia)

Dx: urine specific gravity _____
serum sodium _____

A

polyuria
polydipsia
dehydration
hypotension
tachycardia
confusion & lethargy (hypernatremia)

Dx: urine specific gravity low
serum sodium high

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17
Q

Diabetes Inspidus (DI) RN management

Vitals
I&O
Urine specific gravity
____________ acetate DDAVP
provide _______
assess neuro and cardiac status
Dextrose 5% in water

A

Vitals
I&O
Urine specific gravity
Desmopressin acetate DDAVP
provide fluids
assess neuro and cardiac status
Dextrose 5% in water

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18
Q

Hyperthyroidism AKA __________________

A

Grave’s Disease

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19
Q

Hyperthyroidism AKA Grave’s Disease
Etiology

Grave’s disease
_______ infection
Thyroiditis
Excessive ________
adenomas

A

Grave’s disease
viral infection
Thyroiditis
Excessive iodine
adenomas

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20
Q

Hyperthyroidism AKA Grave’s Disease
S&S

weight ______
_______ intolerance
HTN
____________ & palpitations
exophthalmos
diarrhea
diaphoresis
________ skin
fine tremors
irritability
mood swings
goiter

A

weight loss
heat intolerance
HTN
Tachycardia & palpitations
exophthalmos
diarrhea
diaphoresis
smooth skin
fine tremors
irritability
mood swings
goiter

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21
Q

Hyperthyroidism AKA Grave’s Disease
Nursing management

provide _____
quiet environment
inderal
high ________ diet
tylenol
Propyltiouracil/Tapazole
Avoid _________ rich food
manage diarrhea
_____ care
Thyroidectomy

A

provide rest
quiet environment
inderal
high cal/protein diet
tylenol
Propyltiouracil/Tapazole
Avoid iodine rich food
manage diarrhea
eye care
Thyroidectomy

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22
Q

Hyperthyroidism AKA Grave’s Disease
Thyroid storm

A

Extreme HTN
Tachy
Agitation
gever

Tx- PTU, Tapazole, Inderal, Tylenol

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23
Q

Hypothyroidism

Hyposecretion of

A

thyroid hormones

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24
Hypothyroidism etiology _________ deficiency Hashimoto's disease Atrophy radiation thyroidectomy aging tumors Amiodarone
iodine deficiency Hashimoto's disease Atrophy radiation thyroidectomy aging tumors Amiodarone
25
Hypothyroidism S&S lethargy __________ weakness forgetfulness paresthesia weight _______ _______ intolerance constipation _____ hair and skin ___________ around eyes and face bradycardia MI
lethargy fatigue weakness forgetfulness paresthesia weight gain cold intolerance constipation dry hair and skin puffiness around eyes and face bradycardia MI
26
Hypothyroidism nursing management VS low____________ diet manage constipation warm environment __________ replacement (synthroid) Myxedema- hypothermia, hypotension, hypoventilation
VS low cal, low cholestrol, low fat diet manage constipation warm environment thyroid replacement (synthroid) Myxedema- hypothermia, hypotension, hypoventilation
27
Hyperparathyroidism hypersecretion of
PTH
28
Hyperparathyroidism etiology ________ failure Hereditary
Renal failure Hereditary
29
Hyperparathyroidism S&S Fatigue weakness __________ pain fractures N/V constipation HTN cardiac _____________ renal ________
Fatigue weakness skeletal pain fractures N/V constipation HTN cardiac dysrhythmias renal stones
30
Hyperparathyroidism nursing management VS Cardiac rhythm I&O strain urine diuretic Biphosphonate Calcitonin _____________ectomy
VS Cardiac rhythm I&O strain urine diuretic Biphosphonate Calcitonin Parathyroidectomy
31
Hypoparathyroidism hyposecretion of
PTH
32
Hypoparathyroidism etiology
tumor removal of gland during thyroid surgery
33
Hypoparathyroidism S&S hypo_________ tetany ____________ and tingling muscle cramps dysphagia laryngospasms/_____________ Trousseau's and Chvostek's signs Cardiac ____________ hypotension anxiety irritability
hypocalcemia tetany numbness and tingling muscle cramps dysphagia laryngospasms/bronchospasms Trousseau's and Chvostek's signs Cardiac dysrhythmias hypotension anxiety irritability
34
Hypoparathyroidism nursing management VS cardiac rhythm monitor for S/S ____________ Calcium gluconate and phosphate binders high _________ Vit D low __________ diet
VS cardiac rhythm monitor for S/S hypocalcemia Calcium gluconate and phosphate binders high calcium Vit D low phosphate diet
35
Cushing's syndrome hypersecretion of
glucocorticoids & mineralocorticoids
36
Cushing's syndrome etiology
pituitary tumor steroid abuse
37
Cushing's syndrome S&S ________ face _______ gain _______ -shaped figure (obesity in mid-section with small arms/legs) acne _________ hump prone to infections bruising, poor ________ healing hyperglycemnia osteoporosis pendulous abdomen HTN
moon face weight gain pear-shaped figure (obesity in mid-section with small arms/legs) acne buffalo hump prone to infections bruising, poor wound healing hyperglycemnia osteoporosis pendulous abdomen HTN
38
Cushing's syndrome nursing management VS, I&O weight labs (Na, K, Ca) Monitor ___ ______ care meds to inhibit ________ hyperfunctioning pituitary/adrenal _________ prevent infection body image low carb, low sodium, high __________ diet
VS, I&O weight labs (Na, K, Ca) Monitor BG skin care meds to inhibit adrenal hyperfunctioning pituitary/adrenal surgery prevent infection body image low carb, low sodium, high protein diet
39
Hyperaldosteronism - _____ syndrome
Conn's
40
Hyperaldosteronism etiology overproduction of aldosterone usually caused by:
an adenoma
41
Hyperaldosteronism S&S
HTN Hypernatremia HA (head ache) Hypokalemia >>> muscle weakness fatigue dysrhythmias metabolic alkalosis
42
Hyperaldosteronism nursing management
Adrenalectomy low-Na diet K+ sparing diuretics & supplements antihypertensives
43
Pheochromocytoma overproduction of
catecholamines
44
Pheochromocytoma etiology
usually caused by benign tumor of adrenal medulla
45
Pheochromocytoma S&S Diagnostic
HTN HA Tachycardia Palpitations Dx- catecholamine level, CT, MRI
46
Pheochromocytoma nursing management
adrenalectomy Antihypertensives [Doxazosin, Prazosin, Phenoxybenzamina]
47
Addison's disease hyposecrtion of
glucocorticoids & mineralocoricoids
48
Addison's disease etiology
tumor, idiopathic -decreased response to stress, decreased retention of sodium and water
49
Addison's disease S&S weight _______ _______ weakness Low Na+, high K+ and BUN hypo_________ dehydration hypovolemia hypotension
weight loss muscle weakness Low Na+, high K+ and BUN hypoglycemia dehydration hypovolemia hypotension
50
Addison's disease nursing management
VS, I&O, labs (Na, K+, glucose) hormone replacements avoid strenuous activities & stress high protein, high carb, increase sodium diet
51
Addison's disease Addisonian crisis-
hypotension tachycardia hyponatremia hyperkalemia hypoglycemia vomiting diarrhea fever, confusion Tx- vitals, I&O, neuro status, labs, IVF abx, IV sterpoids
52
Hepatitis types
ABCDE A, E - bowels B, C, D - not from bowels, from body fluids
53
Hepatitis S&S asymptomatic malaise myalgia (arthalgias) _____ tenderness weight _____ find ______ repugnant loss of ______ HA low grade fever skin rashes hepatomegaly splenamegaly ___________ _____ urine light or clay colored stool pruritus
asymptomatic malaise myalgia (arthalgias) RUQ tenderness weight loss find food repugnant loss of smell HA low grade fever skin rashes hepatomegaly splenamegaly jaundice dark urine light or clay colored stool pruritus
54
Hepatitis diagnostics
antibody/ antigen tests LFTs US
55
Hepatitis RN management rest adequate ____________ avoid________ detoxed by liver notification of possible contacts Vit B complex and K IV glucose / enteral nutrition avoid steroids assess for jaundice Drug therapy - Hep B: Pegylated interferon Hep C: DAAS
rest adequate nutrition avoid alc/drugs detoxed by liver notification of possible contacts Vit B complex and K IV glucose / enteral nutrition avoid steroids assess for jaundice Drug therapy - Hep B: Pegylated interferon Hep C: DAAS
56
Cirrhosis of the liver - end stage:
liver disease
57
Cirrhosis of the liver complications
Portal HTN Esophageal/gastric varices edema ascites hepatic encephalopathy hepatorenal syndrome
58
Cirrhosis of the liver S&S
59
Cirrhosis of the liver Diagnostic liver _________ tests total protein __________ levels serum bilirubin cholestrol levels ammonia levels prothrombin time liver biopsy
liver enzyme tests total protein albumin levels serum bilirubin cholestrol levels ammonia levels prothrombin time liver biopsy
60
Cirrhosis of the liver nursing management Rest B complex Vit no ____ aspirin acetaminophen NSAIDS low __________ diet Monitor electrolytes observe for bleeding disorders Esophageal/Gastric varicies- B-B, Octreotide, Vasopressin, PRBC, balloon tamponade Ascites- Fowlers, albumin, diuretics Hepatic encephalopathy- check neuro, low protein, rifaximin, lactulose
Rest B complex Vit no alc aspirin acetaminophen NSAIDS low sodium diet Monitor electrolytes observe for bleeding disorders Esophageal/Gastric varicies- B-B, Octreotide, Vasopressin, PRBC, balloon tamponade Ascites- Fowlers, albumin, diuretics Hepatic encephalopathy- check neuro, low protein, rifaximin, lactulose
61
Pancreatitis - inflammation of
pancreas (acute or chronic)
62
Pancreatitis etiology
gallstones chronic alcohol use
63
Pancreatitis S&S ______ pain NV flushing cyanosis dyspnea low-grade ______ leukocytosis S/S hypocalcemia DM Steatorrhea Grey turner's sign & cullen's sign hypotension tachycardia shock
Abd pain NV flushing cyanosis dyspnea low-grade fever leukocytosis S/S hypocalcemia DM Steatorrhea Grey turner's sign & cullen's sign hypotension tachycardia shock
64
Pancreatitis complications
atelactasis pneumonia ARDS
65
Pancreatitis diagnostic tests
lipase amylase CT W/ contrast LFTs Increased triglyceride Decreased calcium Increased glucose MRCP ERCP
66
Pancreatitis nursing management
ABC narcotics IVF antiemetics NPO NG suction Bentyl PPI monitor labs - glucose/ ca+ insulin IV calcium gluconate albumin whipple procedure
67
Disorders of the biliary tract include:
Cholelithiasis Cholesystitis
68
Cholelithiasis - __________________ Cholesystitis - ____________________
Cholelithiasis - stones in gallbladder (cholestrol) Cholesystitis - inflammation of the gallbladder
69
Cholelithiasis Cholesystitis Risk factors
female (preg, oral contraceptives, estrogen) 40 obesity DM Native American
70
Cholelithiasis Cholesystitis S&S biliary colic R ________ pain N/V restlessness tachycardia diaphoresis dark amber ______ clay or gray colored ________ pruritus steatorrhea bleeding jaundice fever, chills intolerance to ________foods
biliary colic R shoulder pain N/V restlessness tachycardia diaphoresis dark amber urine clay or gray colored stools pruritus steatorrhea bleeding jaundice fever, chills intolerance to fatty foods
71
Cholelithiasis Cholesystitis Dx; RN management Dx: US, ERCP, WBC, LFTs, amylase, UA Nursing IVF opioids Abx ng tube antiemetics NPO fat soluble vitamins anti___________ bile salts diet- low _________ Papillotomy, ESWL, cholesysostomy post-op care: watch for bleeding, R shoulder pain sim's position, ambulation
Dx: US, ERCP, WBC, LFTs, amylase, UA Nursing IVF opioids Abx ng tube antiemetics NPO fat soluble vitamins anticholinergic bile salts diet- low sat. fat Papillotomy, ESWL, cholesysostomy post-op care: watch for bleeding, R shoulder pain sim's position, ambulation
72
ADH is also known as
vasopressin
73
BUN value
10-20 mg/dl
74
Creatinine value
0.5-1.2 mg/dl
75
Calcium levels
9-10.5 mg/dl
76
how to treat orthostastic hypotension
give fluids
77
Liver processes dead RBCS into
bilirubin
78
Liver transforms unconjugated bilirubin into
conjugated bilirubin
79
Vitamin K is important for
clotting factors
80
Albumin ________ fluid in blood vessels
retains
81
Hepatits means
Inflammation of liver
82
Liver transforms toxic ammonia into
urea
83
Hepatitis types
A - fecal-oral route B - DNA virus percut. C - RNA virus percut. D - Delta virus; RNA; HBV; Percut. E - fecal-oral route
84
ALT values
4-36 U/L
85
AST values
0-35 U/L
86
Total bilirubin values
0.3-1 mg/dl
87
Ammonia values
10-80 mcg/dl
88
Alkaline Phosphate values
30-120 U/L
89
Albumin values
3-5 g/dl
90
Drug therapy - Hep B: ____________ Hep C: _________
Hep B: Pegylated interferon Hep C: DAAS
91
thrombocytopenia is
low platelet
92
the spleen stores:
platelets, RBC, WBC
93
Leokopenia is
low WBC
93
Lipase values
0-160
94
Amylase values
60-120
95
whipple procedure [removing the head of the pancreas, the first part of the small intestine, the gallbladder and the bile duct] watch for -
bleeding hyperglycemia bowel obstruction
96
Posterior Pituitary: releases
* Antidiuretic Hormone (ADH) * Oxytocin
97
__________ Pituitary: releases * Growth Hormone * Thyroid Stimulating Hormone * Adrenocorticotropin (ACTH) * Prolactin * Follicle-Stimulating Hormone * Luteinizing Hormone
Anterior
98
Acromegaly: remember –megaly means ___________________
large, overgrowth
99
Which statement made by a 50-yr-old female patient indicates to the nurse that further assessment of thyroid function may be needed? a. “I am so thirsty that I drink all day long.” b. “I get up several times at night to urinate.” c. “I feel a lump in my throat when I swallow.” d. “I notice my breasts are always tender lately.
c. “I feel a lump in my throat when I swallow.” Difficulty in swallowing can occur with a goiter. Nocturia is associated with diseases such as diabetes, diabetes insipidus, or chronic kidney disease. Breast tenderness would occur with excessive gonadal hormone levels. Thirst is a sign of disease such as diabetes.
100
A 40-year-old patient with suspected acromegaly is seen at the clinic. To assist in making the diagnosis, which question should the nurse ask? a. “Have you had a recent head injury?” b. “Do you have to wear larger shoes now?” c. “Is there a family history of acromegaly?” d. “Are you experiencing tremors or anxiety?”
b. “Do you have to wear larger shoes now?” Acromegaly causes an enlargement of the hands and feet. Head injury and family history are not risk factors for acromegaly. Tremors and anxiety are not clinical manifestations of acromegaly.
101
Which finding indicates to the nurse that demeclocycline is effective for a patient with syndrome of inappropriate antidiuretic hormone (SIADH)? a. Weight has increased. b. Urinary output is increased. c. Peripheral edema is increased. d. Urine specific gravity is increased.
b. Urinary output is increased. Demeclocycline blocks the action of antidiuretic hormone (ADH) on the renal tubules and increases urine output. An increase in weight or an increase in urine specific gravity indicates that the SIADH is not corrected. Peripheral edema does not occur with SIADH. A sudden weight gain without edema is a common clinical manifestation of this disorder.
102
Which problem should the nurse anticipate for a patient admitted to the hospital with diabetes insipidus? a. Generalized edema b. Fluid volume overload c. Disturbed sleep pattern d. Decreased gas exchange
c. Disturbed sleep pattern Nocturia occurs because of the polyuria caused by diabetes insipidus. Edema, excess fluid volume, and fluid retention are not expected.
103
A patient has just arrived on the unit after a thyroidectomy. Which action should the nurse take first? a. Observe the dressing for bleeding. b. Check the blood pressure and pulse. c. Assess the patient’s respiratory effort. d. Support the patient’s head with pillows.
c. Assess the patient’s respiratory effort. Airway obstruction is a possible complication after thyroidectomy because of swelling or bleeding at the site or tetany. The priority nursing action is to assess the airway. The other actions are also part of the standard nursing care post thyroidectomy but are not as high of a priority
104
Which information from a 70-yr-old patient during a health history indicates to the nurse that the patient should be screened for hepatitis C? a. The patient had a blood transfusion in 2005. b. The patient used IV drugs about 20 years ago. c. The patient frequently eats in fast-food restaurants. d. The patient traveled to a country with poor sanitation.
b. The patient used IV drugs about 20 years ago. Any patient with a history of IV drug use should be tested for hepatitis C. Blood transfusions given after 1992 (when an antibody test for hepatitis C became available) do not pose a risk for hepatitis C. Hepatitis C is not spread by the oral-fecal route and therefore is not caused by contaminated food or by traveling in underdeveloped countries.
105
Which focused data should the nurse assess after identifying 4+ pitting edema on a patient who has cirrhosis? a. Hemoglobin b. Temperature c. Activity level d. Albumin level
d. Albumin level The low oncotic pressure caused by hypoalbuminemia is a major pathophysiologic factor in the development of edema. The other parameters are not directly associated with the patient’s edema.
106
How should the nurse prepare a patient with ascites for paracentesis? a. Place the patient on NPO status. b. Assist the patient to lie flat in bed. c. Ask the patient to empty the bladder. d. Position the patient on the right side.
c. Ask the patient to empty the bladder. The patient should empty the bladder to decrease the risk of bladder perforation during the procedure. The patient would be positioned in Fowler’s position and would not be able to lie flat without compromising breathing. Because no sedation is required for paracentesis, the patient does not need to be NPO.
107
A serum potassium level of 3.2 mEq/L (3.2 mmol/L) is reported for a patient with cirrhosis who has scheduled doses of spironolactone (Aldactone) and furosemide (Lasix) due. Which action should the nurse take? a. Withhold both drugs. b. Administer both drugs. c. Administer the furosemide. d. Administer the spironolactone
d. Administer the spironolactone Spironolactone is a potassium-sparing diuretic and will help increase the patient’s potassium level. The furosemide will further decrease the patient’s potassium level and should be held until the nurse talks with the health care provider.
108
A patient is being treated for bleeding esophageal varices with balloon tamponade. Which nursing action will be included in the plan of care? a. Instruct the patient to cough every hour. b. Monitor the patient for shortness of breath. c. Verify the position of the balloon every 4 hours. d. Deflate the gastric balloon if the patient reports nausea.
b. Monitor the patient for shortness of breath. The most common complication of balloon tamponade is aspiration pneumonia. In addition, if the gastric balloon ruptures, the esophageal balloon may slip upward and occlude the airway. Coughing increases the pressure on the varices and increases the risk for bleeding. Balloon position is verified after insertion and does not require further verification. Balloons may be deflated briefly every 8 to 12 hours to avoid tissue necrosis, but if only the gastric balloon is deflated, the esophageal balloon may occlude the airway. Balloons are not deflated for nausea.
109
Hyperthyroidism- Grave’s Disease _____________ thyroid, increased ____________
Overreactive thyroid, increased metabolism
110
Hyperthyroidism- Grave’s Disease Causes: * ____________ disorder- Grave’s Disease * Toxic goiter * Excessive _______ * Pituitary _________ * Thyroid cancer
* Autoimmune disorder- Grave’s Disease * Toxic goiter * Excessive iodine * Pituitary tumor * Thyroid cancer
111
Hyperthyroidism- Grave’s Disease Management: * Monitor VS * Diet: High __________, high protein * Provide ____ care- artificial tear, lubrication, eye patches at night * Provide rest * Radioactive ___________ (RAI Therapy)- destroys the thyroid gland * No other cells in the body absorb iodine except the thyroid gland * Will not harm other organs * Take about 6 to 8 weeks to start working * Most patient will then experience hypothyroidism & need to take thyroid replacement medications
* Monitor VS * Diet: High calorie, high protein * Provide eye care- artificial tear, lubrication, eye patches at night * Provide rest * Radioactive Iodine (RAI Therapy)- destroys the thyroid gland * No other cells in the body absorb iodine except the thyroid gland * Will not harm other organs * Take about 6 to 8 weeks to start working * Most patient will then experience hypothyroidism & need to take thyroid replacement medications
111
Hyperthyroidism- Grave’s Disease Common S/S: * Everything ________ UP * Weight loss * Tachycardia * HTN * Diarrhea * Nervousness * ______________ (bulging eyes) immune system attacking muscles & fatty tissue around eyes= make them bulge & appear swollen
* Everything speeds UP * Weight loss * Tachycardia * HTN * Diarrhea * Nervousness * Exophthalmos (bulging eyes) immune system attacking muscles & fatty tissue around eyes= make them bulge & appear swollen
112
Hyperthyroidism- Grave’s Disease Pharmacology: * Propylthiouracil & Methimazole (Tapazole)- Antithyroid= inhibit ___________________
thyroid hormone synthesis
113
Thyroid storm [thyroid gland releases a large amount of thyroid hormone in a short amount of time] is a medical emergency; causes include
*Trauma *Infection *Surgery
114
Reasons to have Thyroidectomy: 1. Goiter causing tracheal __________ 2. __________ medication/therapy is not working 3. Thyroid cancer 4. Not a candidate for RAI Therapy
1. Goiter causing tracheal compression 2. Antithyroid medication/therapy is not working 3. Thyroid cancer 4. Not a candidate for RAI Therapy
115
Thyroidectomy Pre-op: * Monitor pt & establish a baseline * Decrease ___________ of the gland- radiation or iodine therapy * Medications- antithyroid med, Beta Blockers * Post op teaching- pt knows what to expect and how to support after surgery
Pre-op: * Monitor pt & establish a baseline * Decrease vascularity of the gland- radiation or iodine therapy * Medications- antithyroid med, Beta Blockers * Post op teaching- pt knows what to expect and how to support after surgery
116
Thyroidectomy Post-op: * Helping with positions of comfort & making sure the neck does not get overextended * Do not want to put stress on the suture line * Monitor respiratory status * Assess bleeding & drainage * Limit talking * Monitor labs (______) taking out thyroid AND parathyroid * Hypocalcemia- numbness, tingling in hands, feet, & around mouth * Monitor thyroid storm- manipulation of thyroid gland causes increase of thyroid hormone in circulation, so immediate post op watch * Trach kit & surgical suction at bedside- damage to laryngeal nerve, causing paralysis, pt can’t breathe
* Helping with positions of comfort & making sure the neck does not get overextended * Do not want to put stress on the suture line * Monitor respiratory status * Assess bleeding & drainage * Limit talking * Monitor labs (Ca++) taking out thyroid AND parathyroid * Hypocalcemia- numbness, tingling in hands, feet, & around mouth * Monitor thyroid storm- manipulation of thyroid gland causes increase of thyroid hormone in circulation, so immediate post op watch * Trach kit & surgical suction at bedside- damage to laryngeal nerve, causing paralysis, pt can’t breathe
117
Hypothyroidism- _________________
Hashimoto’s
118
Hypothyroidism- Hashimoto’s Slowing of ______________
metabolic rate
119
Hypothyroidism- Hashimoto’s Causes: * ___________deficiency- most common, since iodine is needed to synthesize thyroid hormone * _____________ diseases- Hashimoto’s Disease (most common in U.S.), thyroid gland attacks itself= Atrophy of thyroid gland * Treatments for Hyperthyroidism- Thyroidectomy or Radioactive Iodine * HCPs did ”Too” good of job treating Hyperthyroidism
* Iodine deficiency- most common, since iodine is needed to synthesize thyroid hormone * Autoimmune diseases- Hashimoto’s Disease (most common in U.S.), thyroid gland attacks itself= Atrophy of thyroid gland * Treatments for Hyperthyroidism- Thyroidectomy or Radioactive Iodine * HCPs did ”Too” good of job treating Hyperthyroidism
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Hypothyroidism- Hashimoto’s s/s * Everything ______ down * Fatigue * Weight gain * Bradycardia * _____________ - GI tract slows * Decreased concentration/ Lethargy
* Everything SLOWS down * Fatigue * Weight gain * Bradycardia * Constipation- GI tract slows * Decreased concentration/ Lethargy
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Hypothyroidism- Hashimoto’s Management: * Monitor VS * Manage Diet: _____ calorie, low cholesterol, low fat, increase fiber & fluids * Manage Symptoms * Patient ______ - create warm environment
* Monitor VS * Manage Diet: Low calorie, low cholesterol, low fat, increase fiber & fluids * Manage Symptoms * Patient cold- create warm environment
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Hypothyroidism- Hashimoto’s Pharmacology: * _______________ (Synthroid)- synthetic form of thyroid hormone * S/E: arrythmias * Monitor cardiac function * Note any chest pain
* Levothyroxine (Synthroid)- synthetic form of thyroid hormone * S/E: arrythmias * Monitor cardiac function * Note any chest pain
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____________ Coma - Gradual or sudden severe hypothyroidism
Myxedema
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Myxedema Coma causes * Infection * Medications- opioids, tranquilizers, or barbiturates * Exposure to severe coldness * Trauma
* Infection * Medications- opioids, tranquilizers, or barbiturates * Exposure to severe coldness * Trauma
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Hyper VS Hypothyroidism
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hyperpituitarism AKA acromegaly Causes: * ___________ ___________ (adenoma)- usually small & benign, slow growing, presents with HA & visual problems * Congenital
* Pituitary Tumor (adenoma)- usually small & benign, slow growing, presents with HA & visual problems * Congenital
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hyperpituitarism AKA acromegaly Common S/S: * Skeletal ____________- large hands, feet, wide jaw * Arthralgia- joint pain, Carpal Tunnel * Organomegaly * Skin changes- overgrowth of skin tissue (thick & leathery), oily, acne breakouts * __________ resistance- Hyperglycemia- induced HTN
* Skeletal overgrowth- large hands, feet, wide jaw * Arthralgia- joint pain, Carpal Tunnel * Organomegaly * Skin changes- overgrowth of skin tissue (thick & leathery), oily, acne breakouts * Insulin resistance- Hyperglycemia- induced HTN
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hyperpituitarism AKA acromegaly Psychosocial Concerns: * Body image * Encourage patient to express concerns, questions, and knowledge about their condition * Ask open-ended questions * Fatigue & sleep issues, depression * Skin care: increased sweat, skin tags * Provide emotional support- support groups?
* Body image * Encourage patient to express concerns, questions, and knowledge about their condition * Ask open-ended questions * Fatigue & sleep issues, depression * Skin care: increased sweat, skin tags * Provide emotional support- support groups?
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Transsphenoidal _________________ Surgical Removal of Pituitary Gland Done for Hypo/Hyperpituitarism
Hypophysectomy
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hyperpituitarism AKA acromegaly Management: * Pharmacological- started to prevent over secretion of GH & manage symptoms * Octreotide (Sandostain)- reduce GH, blocks GH reuptake in the body * SQ injection 3x week * Surgical removal- (Hypophysectomy) removal of pituitary gland * Radiation- destroys tissue * Encourage patient to express concerns and feelings related to disturbed body image
* Pharmacological- started to prevent over secretion of GH & manage symptoms * Octreotide (Sandostain)- reduce GH, blocks GH reuptake in the body * SQ injection 3x week * Surgical removal- (Hypophysectomy) removal of pituitary gland * Radiation- destroys tissue * Encourage patient to express concerns and feelings related to disturbed body image
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Transsphenoidal Hypophysectomy - Surgical Removal of Pituitary Gland Procedure: Trans ________ endoscopic approach * Radiation is sometimes done prior to procedure to shrink the tumor or when someone is not a candidate for surgery
nasal
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Syndrome of Inappropriate Antidiuretic Hormone (SIADH) - Hypersecretion of ADH Causes: * Malignancy- _______ Cell Lung Cancer * _______ Injury- Severe Trauma, pituitary gland damaged * ________ Infections of the Brain (Meningitis) * Think about “S”
* Malignancy- Small Cell Lung Cancer * Head Injury- Severe Trauma, pituitary gland damaged * Sepsis Infections of the Brain (Meningitis) * Think about “S”
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Syndrome of Inappropriate Antidiuretic Hormone (SIADH) - Hypersecretion of ADH Common S/S: *Body holding onto fluid * _____________ Urine Output- Stops urination * Weight _______ (not manifested as edema) * Hypertension * Electrolytes become diluted- specifically Hyponatremia (Low Sodium level <135) * Nausea/Vomiting/HA * Mental Status Changes- confusion, in severe cases Seizures
* Decreased Urine Output- Stops urination * Weight Gain (not manifested as edema) * Hypertension * Electrolytes become diluted- specifically Hyponatremia (Low Sodium level <135) * Nausea/Vomiting/HA * Mental Status Changes- confusion, in severe cases Seizures
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Syndrome of Inappropriate Antidiuretic Hormone (SIADH) - Hypersecretion of ADH Diagnostics: * Decrease serum ____ * __________ in urine specific gravity (>1.025)
* Decrease serum Na+ * Increase in urine specific gravity (>1.025)
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Diabetes Insipidus (DI) - ____________ of ADH
Hyposecretion
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Syndrome of Inappropriate Antidiuretic Hormone (SIADH) - Hypersecretion of ADH Management: * Monitor BP- circulating volume is increasing, holding fluids * Tracking I&Os- determine severity * Restrict Fluids (800mL to 1,000mL/day)- orally & through IV (give ice chips & gum if pt complaining about dry mouth) * Assess Neuro Status- Hyponatremia, MSC, seizures * Environmental safety- injuries * Sodium Replacement * Diuretics- get rid of fluid * Hypertonic Solution (3% sodium chloride)- Given in extreme cases * Fluid pushed out of the cell to become secreted * Na<120, done very slowly to prevent Osmotic Demyelination Syndrome * Irreversible damage to neurons in the brain
* Monitor BP- circulating volume is increasing, holding fluids * Tracking I&Os- determine severity * Restrict Fluids (800mL to 1,000mL/day)- orally & through IV (give ice chips & gum if pt complaining about dry mouth) * Assess Neuro Status- Hyponatremia, MSC, seizures * Environmental safety- injuries * Sodium Replacement * Diuretics- get rid of fluid * Hypertonic Solution (3% sodium chloride)- Given in extreme cases * Fluid pushed out of the cell to become secreted * Na<120, done very slowly to prevent Osmotic Demyelination Syndrome * Irreversible damage to neurons in the brain
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Syndrome of Inappropriate Antidiuretic Hormone (SIADH) - Hypersecretion of ADH Pharmacology: * Demeclocycline (__________)- reduces kidney’s collecting tubules responsiveness to ADH, blocks ADH from working * Makes urine more dilute & now getting rid of fluids
Pharmacology: * Demeclocycline (Antibiotic)- reduces kidney’s collecting tubules responsiveness to ADH, blocks ADH from working * Makes urine more dilute & now getting rid of fluids
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Diabetes Insipidus (DI) Causes: * Tumor * Medications- ________ (Mood stabilizer) * Increased _____ * Removal of pituitary gland- not producing ADH anymore, kidneys not being told to keep fluids
* Tumor * Medications- Lithium (Mood stabilizer) * Increased ICP * Removal of pituitary gland- not producing ADH anymore, kidneys not being told to keep fluids
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Diabetes Insipidus (DI) Common S/S: *Body is giving away fluids * _______ - increased urination, body not holding onto fluids * __________- increased thirst, due to dehydration * ___________- decreased circulating volume * Tachycardia- compensate for decreased circulating volume due to dehydration
* Polyuria- increased urination, body not holding onto fluids * Polydipsia- increased thirst, due to dehydration * Hypotension- decreased circulating volume * Tachycardia- compensate for decreased circulating volume due to dehydration
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Diabetes Insipidus (DI) mnemonic
Dry Inside
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Diabetes Insipidus (DI) Diagnostics: * Increased serum ____ (Hypernatremia) * ____________ urine specific gravity (<1.005)
* Increased serum Na+ (Hypernatremia) * Decreased urine specific gravity (<1.005)
140
Diabetes Insipidus (DI) Management: * Monitor HR (increased) & BP (decreased) * Daily Weights * Hypotonic Solutions (0.45% NaCl) * Fluid pushed into the cells * Na+> 145 * Assess neuro status (HA, seizures) * Assess Cardiac Status
* Monitor HR (increased) & BP (decreased) * Daily Weights * Hypotonic Solutions (0.45% NaCl) * Fluid pushed into the cells * Na+> 145 * Assess neuro status (HA, seizures) * Assess Cardiac Status
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Diabetes Insipidus (DI) Pharmacology: * ______________ (DDAVP) * Synthetic hormone replacement of ADH * Tells kidneys to stop secreting urine * Key to know it’s working- Pt states “I slept so great last night, I haven’t slept through the night in forever” * *used for nighttime bed wetting (Enuresis, will come up in Pediatrics)
* Desmopressin (DDAVP) * Synthetic hormone replacement of ADH * Tells kidneys to stop secreting urine * Key to know it’s working- Pt states “I slept so great last night, I haven’t slept through the night in forever” * *used for nighttime bed wetting (Enuresis, will come up in Pediatrics)
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Addison’s Disease mnemonic
*Absent steroids, Add “some steroids”
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Addison’s Disease - Hyposecretion of glucocorticoids & mineralocorticoids Causes: * Tumor * ___________ response- body starts attacking the adrenal glands * Idiopathic- we don’t know why
* Tumor * Autoimmune response- body starts attacking the adrenal glands * Idiopathic- we don’t know why
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Addison’s Disease - Hyposecretion of glucocorticoids & mineralocorticoids Common S/S: *Decreased cortisol (glucose metabolism & stress) & Decreased aldosterone (regulate electrolytes) * Weight loss * Muscle weakness * Fatigue * Increased inflammation * Hypovolemia/Hypotension * Hypoglycemia * Decreased Na+ * Increased K+ * Skin changes- hyperpigmentation due to high levels of ACTH
Common S/S: *Decreased cortisol (glucose metabolism & stress) & Decreased aldosterone (regulate electrolytes) * Weight loss * Muscle weakness * Fatigue * Increased inflammation * Hypovolemia/Hypotension * Hypoglycemia * Decreased Na+ * Increased K+ * Skin changes- hyperpigmentation due to high levels of ACTH
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Addison’s Disease - Hyposecretion of glucocorticoids & mineralocorticoids Management: * VS, I&Os * Heart monitor- electrolyte imbalances impact muscle contractility * Avoid stress- body is not producing glucocorticoids, can’t adapt to stressful situations or fight illness * Diet: High protein, high carbs, high Na+ * To supplement weight loss & low sodium levels associated with Addison’s
Management: * VS, I&Os * Heart monitor- electrolyte imbalances impact muscle contractility * Avoid stress- body is not producing glucocorticoids, can’t adapt to stressful situations or fight illness * Diet: High protein, high carbs, high Na+ * To supplement weight loss & low sodium levels associated with Addison’s
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Addisonian Crisis - Medical Emergency Causes: * Having Addison’s disease- in accident, have trauma, high stress situation, severe illness * Stopping ________ abruptly
Causes: * Having Addison’s disease- in accident, have trauma, high stress situation, severe illness * Stopping steroids abruptly
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Addison’s Disease - Hyposecretion of glucocorticoids & mineralocorticoids Medications: * Require lifelong hormone therapy * Hydrocortisone (Cortef)- Both glucocorticoid & mineralocorticoid properties * PO given 2/3xday, larger dose given in the AM because that reflects circadian rhythms in hormone secretion * Fludrocortisone- mineralocorticoid properties, helps body hold onto sodium
Medications: * Require lifelong hormone therapy * Hydrocortisone (Cortef)- Both glucocorticoid & mineralocorticoid properties * PO given 2/3xday, larger dose given in the AM because that reflects circadian rhythms in hormone secretion * Fludrocortisone- mineralocorticoid properties, helps body hold onto sodium
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Addisonian Crisis - Medical Emergency Treatment: * IV steroids (hydrocortisone) most readily available for the body to utilize * IV fluids- to correct hypotension * Rest- decrease stress *Must taper steroids, so adrenal glands can start producing hormones again
Treatment: * IV steroids (hydrocortisone) most readily available for the body to utilize * IV fluids- to correct hypotension * Rest- decrease stress *Must taper steroids, so adrenal glands can start producing hormones again
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Addisonian Crisis - Medical Emergency Common S/S: * Hypotension * Hyperkalemia * Hypoglycemia * Severe HA
Common S/S: * Hypotension * Hyperkalemia * Hypoglycemia * Severe HA
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Cushing’s Syndrome - Hypersecretion of glucocorticoids & mineralocorticoids Causes: * Chronic Steroid use (Prednisone) * Pituitary of Adrenal tumor/adenoma (benign) * Secretes extra ACTH stimulating release of more cortisol
Causes: * Chronic Steroid use (Prednisone) * Pituitary of Adrenal tumor/adenoma (benign) * Secretes extra ACTH stimulating release of more cortisol
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Cushing’s Syndrome - Hypersecretion of glucocorticoids & mineralocorticoids Common S/S: *due to excess levels of corticosteroids * Weight gain * Moon Face * HTN * Hyperglycemia –glucose intolerance r/t induced insulin resistance/ increased gluconeogenesis * Increase Na+ (Body holding onto it because of excess hormones) * Decrease K+ (Body getting rid of it) * Prone to infection, Poor wound healing, Bruises easily * GI distress
Common S/S: *due to excess levels of corticosteroids * Weight gain * Moon Face * HTN * Hyperglycemia –glucose intolerance r/t induced insulin resistance/ increased gluconeogenesis * Increase Na+ (Body holding onto it because of excess hormones) * Decrease K+ (Body getting rid of it) * Prone to infection, Poor wound healing, Bruises easily * GI distress
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Cushing’s Syndrome - Hypersecretion of glucocorticoids & mineralocorticoids Mnemonic CUSH
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Hypoparathyroidism - _________ levels are low
Calcium
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Cushing’s Syndrome - Hypersecretion of glucocorticoids & mineralocorticoids Management: * Monitor VS & Blood sugar * Prevent infections, good skin care * Diet: low carb, low sodium, high protein * Surgical removal of tumor * Taper corticosteroids * Educate: once hormone levels regulated, they should not suffer from S/S
Management: * Monitor VS & Blood sugar * Prevent infections, good skin care * Diet: low carb, low sodium, high protein * Surgical removal of tumor * Taper corticosteroids * Educate: once hormone levels regulated, they should not suffer from S/S
150
Pheochromocytoma - Hypersecretion of Norepinephrine & Epinephrine Diagnostics: * Check for catecholamines in blood & urine * Imaging- checking for tumor since that is the common cause Management: * Removal of adrenal gland- Adrenalectomy * Giving Antihypertensives for BP * Decrease any stress- we don’t want more catecholamines released * No stimulants (Coffee or smoking)
Diagnostics: * Check for catecholamines in blood & urine * Imaging- checking for tumor since that is the common cause Management: * Removal of adrenal gland- Adrenalectomy * Giving Antihypertensives for BP * Decrease any stress- we don’t want more catecholamines released * No stimulants (Coffee or smoking)
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Pheochromocytoma - Hypersecretion of Norepinephrine & Epinephrine Causes: * Benign Tumor of the __________ Common S/S: * HTN * HA * Tachycardia * Palpitations * Classic Triad: Pounding HA, Tachy, & Sweating
Causes: * Benign Tumor of the Medulla Common S/S: * HTN * HA * Tachycardia * Palpitations * Classic Triad: Pounding HA, Tachy, & Sweating
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Hypoparathyroidism Causes: * Removal of thyroid gland * Tumor * Heavy metal poisoning
Causes: * Removal of thyroid gland * Tumor * Heavy metal poisoning
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Hypoparathyroidism Common of S/S: * Hypocalcemia * Tetany * Muscle spasm * Bronchospasm * Hypotension * Dysphagia * Anxiety * Cardiac dysrhythmias * Seizures
Common of S/S: * Hypocalcemia * Tetany * Muscle spasm * Bronchospasm * Hypotension * Dysphagia * Anxiety * Cardiac dysrhythmias * Seizures
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Hyperparathyroidism - Calcium levels are ______
high
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Hypoparathyroidism Management: * Hypocalcemia tests: * Check ___________sign-facial muscles contract when lightly tap facial nerve in front of the ear * Trousseau's sign- hand spasm with inflation of blood pressure cuff * Monitor cardiac function * Administer calcium gluconate & phosphate binders * Diet: High calcium, High vitamin D, & Low phosphate * Seizure precautions- bed level low, seizure pads, close to nursing station, working suction
Management: * Hypocalcemia tests: * Check Chvostek’s sign-facial muscles contract when lightly tap facial nerve in front of the ear * Trousseau's sign- hand spasm with inflation of blood pressure cuff * Monitor cardiac function * Administer calcium gluconate & phosphate binders * Diet: High calcium, High vitamin D, & Low phosphate * Seizure precautions- bed level low, seizure pads, close to nursing station, working suction
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Hyperparathyroidism Causes: * Tumor * Kidney disease
Causes: * Tumor * Kidney disease
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Hyperparathyroidism Common S/S: * Hypercalcemia- calcium pulled from the bones * Fatigue * Weakness * Skeletal muscle pain * Fractures- bones weak * Constipation * HTN * Renal stone- calcium deposits formed in kidneys * N/V * Cardiac Dysrhythmias
Common S/S: * Hypercalcemia- calcium pulled from the bones * Fatigue * Weakness * Skeletal muscle pain * Fractures- bones weak * Constipation * HTN * Renal stone- calcium deposits formed in kidneys * N/V * Cardiac Dysrhythmias
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Hyperparathyroidism Management: * Monitor cardiac function * Strain urine- check for stones * Administer diuretics (Lasix)- increase urinary excretion of calcium * Calcitonin- synthetic hormone, slows bone loss & maintain normal calcium levels in blood * Possible parathyroidectomy * Same interventions & considerations as when a pt has a thyroidectomy
Management: * Monitor cardiac function * Strain urine- check for stones * Administer diuretics (Lasix)- increase urinary excretion of calcium * Calcitonin- synthetic hormone, slows bone loss & maintain normal calcium levels in blood * Possible parathyroidectomy * Same interventions & considerations as when a pt has a thyroidectomy
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LIVER - Main Job: Filters _________ coming from the digestive tract.
blood
157
________________ Vein - main vessel of portal venous system which drains blood from: GI Tract, Gallbladder, Pancreas, Spleen and to the liver.
Hepatic Portal
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Hepatitis
Inflammation of the liver
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Hepatitis Patho: Caused by: viruses, bacteria, or toxic substances o Viral variations present with same S/S, we have to do blood tests to see which type pt. has o Toxic Hepatitis, usually d/t OD with OTC drugs, most commonly, Tylenol OD * Acute (1-6 months) and chronic (6+ months) phase * Lab Tests: Liver f(x) tests will be elevated. o ALT: Normal: 4-36 o AST: Normal: 0-35 o Both of these are normally present in the blood at low levels, but elevated levels indicate damaged, injured liver
Patho: Caused by: viruses, bacteria, or toxic substances o Viral variations present with same S/S, we have to do blood tests to see which type pt. has o Toxic Hepatitis, usually d/t OD with OTC drugs, most commonly, Tylenol OD * Acute (1-6 months) and chronic (6+ months) phase * Lab Tests: Liver f(x) tests will be elevated. o ALT: Normal: 4-36 o AST: Normal: 0-35 o Both of these are normally present in the blood at low levels, but elevated levels indicate damaged, injured liver
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Hepatitis S/S (sometimes pts can be asymptomatic) * Fatigue * RUQ pain/tenderness * jaundiceà occurs because the liver can’t break down the bilirubin, and it will build up in the blood. This causes the yellow tint we see. * dark urineà also d/t excess bilirubin. The kidneys need to pick up the slack and excrete the excess bilirubin, tinting the urine darker * clay colored stoolà Bilirubin gives stool our normal color, so without it stool is lighter * Hepatomegaly/Splenomegaly * Weight Loss
* Fatigue * RUQ pain/tenderness * jaundiceà occurs because the liver can’t break down the bilirubin, and it will build up in the blood. This causes the yellow tint we see. * dark urineà also d/t excess bilirubin. The kidneys need to pick up the slack and excrete the excess bilirubin, tinting the urine darker * clay colored stoolà Bilirubin gives stool our normal color, so without it stool is lighter * Hepatomegaly/Splenomegaly * Weight Loss
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**ALT & AST are enzymes found in the liver that helps metabolize _________ .
proteins
162
When the liver is damaged, ALT & AST is released into the bloodstream and levels __________.
increase
163
Hepatitis Diagnostic Tests - LFTs (Liver Function Tests) - Urinalysis - Antibody/Antigen Test (To test viral infection) Nursing Management - Adequate Nutrition - Rest (allow the liver to regenerate and repair, liver is the only organ that can do that) - Avoid Alcohol and Drugs detoxified by Liver - Notification of possible contacts (for hepatitis infection) - Assess for Jaundice - Avoid Steroids - Pegylated interferon and DAAS (Direct Acting Antivirals) for Hepatitis o This drug suppresses the viral replication and prevent complications during acute hepatitis
Diagnostic Tests - LFTs (Liver Function Tests) - Urinalysis - Antibody/Antigen Test (To test viral infection) Nursing Management - Adequate Nutrition - Rest (allow the liver to regenerate and repair, liver is the only organ that can do that) - Avoid Alcohol and Drugs detoxified by Liver - Notification of possible contacts (for hepatitis infection) - Assess for Jaundice - Avoid Steroids - Pegylated interferon and DAAS (Direct Acting Antivirals) for Hepatitis o This drug suppresses the viral replication and prevent complications during acute hepatitis
164
* _____ is commonly spread from mother to baby
HBV
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* Chronic Hepatitis ___ is the most common reason pts experience liver failure and need a transplant in the USA
C
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Cirrhosis:
End-stage of liver disease
167
Cirrhosis Causes/Patho: o Chronic hepatitis (Type C) o excessive ETOH o Nonalcoholic steatohepatitis (NASH) or Nonalcoholic fatty liver disease (NAFLD) § Lipids are deposited in the liver, and result in fatty liver tissue. Related to obesity o biliary obstruction § ducts aren’t draining properlyà so waste, such as bile, is backing up in the liver instead of draining out. Usually caused by a cyst or tumor
Causes/Patho: o Chronic hepatitis (Type C) o excessive ETOH o Nonalcoholic steatohepatitis (NASH) or Nonalcoholic fatty liver disease (NAFLD) § Lipids are deposited in the liver, and result in fatty liver tissue. Related to obesity o biliary obstruction § ducts aren’t draining properlyà so waste, such as bile, is backing up in the liver instead of draining out. Usually caused by a cyst or tumor
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Cirrhosis Labs: ↑ AST, ALT, LDH, alkaline phosphate, bilirubin & ammonia ↓ Albumin and protein (These decrease because a healthy liver typically creates these, and the malfunctioning liver is not working as well) → PT/INR prolonged times (because the liver is struggling to create clotting factors) Diagnostic: o Liver biopsy (best way to confirm cirrhosis in a suspected pt) o Fibroscan (liver ultrasound that can measure scarring and fatty tissue)
Labs: ↑ AST, ALT, LDH, alkaline phosphate, bilirubin & ammonia ↓ Albumin and protein (These decrease because a healthy liver typically creates these, and the malfunctioning liver is not working as well) → PT/INR prolonged times (because the liver is struggling to create clotting factors) Diagnostic: o Liver biopsy (best way to confirm cirrhosis in a suspected pt) o Fibroscan (liver ultrasound that can measure scarring and fatty tissue)
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Cirrhosis can develop from any __________ liver disease (usually 10+ years). Liver cells are so badly destroyed, they can’t ___________ a scar tissue and nodules form
Cirrhosis can develop from any chronic liver disease (usually 10+ years). Liver cells are so badly destroyed, they can’t regenerate a scar tissue and nodules form
169
Cirrhosis S/S: o Early: -fatigue -enlarged liver - abdominal pain o Late: -jaundice -edema § ascites -skin lesions -bleeding -peripheral neuropathy
o Early: -fatigue -enlarged liver - abdominal pain o Late: -jaundice -edema § ascites -skin lesions -bleeding -peripheral neuropathy
170
Cirrhosis Monitor: o I/O, daily weights o Electrolytes K+ especially will be impacted by a malfunctioning liver o blood counts Nursing Management: - Rest - No Alcohol, Aspirin, Acetaminophen and NSAIDs - Low Sodium Diet - Monitor for fluid imbalances - Observe bleeding disorders
Monitor: o I/O, daily weights o Electrolytes K+ especially will be impacted by a malfunctioning liver o blood counts Nursing Management: - Rest - No Alcohol, Aspirin, Acetaminophen and NSAIDs - Low Sodium Diet - Monitor for fluid imbalances - Observe bleeding disorders
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Cirrhosis Complications: * _________ Hypertension o Splenomegaly o Ascites o Varices * Hepatic Encephalopathy o Due to build up of ammonia in circulation o Ammonia crosses the blood brain barrier and produces toxic neuro effects (impaired thinking, asterixis, seizures, etc.) * Hepatorenal Syndrome o When liver failure causes renal failure. Rare, but fatal. Due to renal vasoconstriction due to decreased arterial blood volume
* Portal Hypertension o Splenomegaly o Ascites o Varices * Hepatic Encephalopathy o Due to build up of ammonia in circulation o Ammonia crosses the blood brain barrier and produces toxic neuro effects (impaired thinking, asterixis, seizures, etc.) * Hepatorenal Syndrome o When liver failure causes renal failure. Rare, but fatal. Due to renal vasoconstriction due to decreased arterial blood volume
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Portal HTN Complication of cirrhosis; ___________ of blood flow going IN and OUT of the liver through the portal vein
Obstruction
173
Ascites - accumulation of serous fluid in the _________________
abdominal cavity
174
Ascites Patho: __________ > Portal Hypertension > Excess fluid released intoperitoneal cavity
Cirrhosis
175
Ascites S/S: * Abdominal __________ * Weight gain * Umbilical eversion * Abdominal striae (stretch marks) * S/S of ____________ > why? Because so much fluid is accumulating in the abdominal cavity o dry tongue & skin o sunken eyeballs o muscle weakness o decreased urine output
* Abdominal distention * Weight gain * Umbilical eversion * Abdominal striae (stretch marks) * S/S of dehydration > why? Because so much fluid is accumulating in the abdominal cavity o dry tongue & skin o sunken eyeballs o muscle weakness o decreased urine output
176
Management of Ascites o low _________ diet > help prevent the retention of fluid (remember water follows sodium) o Diuretics > must closely monitor electrolytes (pt. will already be hypokalemic) o ____________ : withdraw fluid from abdominal cavity. Sterile procedure preformed by physician at the bedside. Pre Procedure: o Consent form signed o Pt has voided pre procedure o Weight and measure abd. girth pre and post procedure o Positioning pt high-fowler or lateral side-lying Post Procedure: o Assess for bleeding (poor clotting response with liver pts), fluid leak, bladder trauma o Assess for S/S of hypovolemia (tachycardia, hypotension) post- procedure
o low sodium diet > help prevent the retention of fluid (remember water follows sodium) o Diuretics > must closely monitor electrolytes (pt. will already be hypokalemic) o Paracentesis: withdraw fluid from abdominal cavity. Sterile procedure preformed by physician at the bedside. Pre Procedure: o Consent form signed o Pt has voided pre procedure o Weight and measure abd. girth pre and post procedure o Positioning pt high-fowler or lateral side-lying Post Procedure: o Assess for bleeding (poor clotting response with liver pts), fluid leak, bladder trauma o Assess for S/S of hypovolemia (tachycardia, hypotension) post- procedure
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PANCREAS Exocrine Job: Aid in __________ * The pancreas secretes enzymes that are deposited into the small intestine, where they are activated and used to further ____________ our food.
Exocrine Job: Aid in digestion * The pancreas secretes enzymes that are deposited into the small intestine, where they are activated and used to further breakdown our food.
178
_______________ - Nonbacterial inflammation that occurs when pancreatic enzyme secretion builds up and begins to digest the organ itself
Pancreatitis
179
GALLBLADDER * Stores & secretes _____ * Bile helps to break up ______ * When food enters the SI, gallbladder is stimulated to contract and secrete bile into SI
* Stores & secretes BILE * Bile helps to break up fats * When food enters the SI, gallbladder is stimulated to contract and secrete bile into SI
180
Treatment of Varices Goal: prevent rupture/bleeding Screening: Esophagogastroduodenoscopy (EGD) - Small scope travels down esophagus to look for varices Medications: _____________ (nadolol or propranolol) used to decrease BP and thus portal pressure
Treatment of Varices Goal: prevent rupture/bleeding Screening: Esophagogastroduodenoscopy (EGD) - Small scope travels down esophagus to look for varices Medications: Beta-blockers (nadolol or propranolol) used to decrease BP and thus portal pressure
181
Hepatic Encephalopathy Goal: Reduce ammonia formation Medications: * Lactulose: binds to ammonia and traps it, then it’s eliminated in feces. > Pt needs to be having bowel movements for this med to work! > Important to check K⁺ (problem is that K+ also binds to the drug) * Antibiotic: ex: rifazimin. > Can prevent the absorption of gut-derived neurotoxins like ammonia. Aka decreases formation of ammonia in the gut.
182
Hepatic Encephalopathy Nursing management: - Monitor bowel movements - Prevent and control gastric bleeding - Lower _________ intake (Protein in the diet) + (blood in the GI tract) = protein formation in the GI. > Protein formation leads to an increased ammonia level in the body > bad
- Monitor bowel movements - Prevent and control gastric bleeding - Lower protein intake
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Cholelithiasis: Excess of cholesterol, bilirubin or bile salts that crystalizes in the gall bladder to form ____________. Common and __________usually (unless stone migrates to duct= obstruction) Cholecystitis: An _____________ of the gallbladder occurs. Often due to gallstones in gallbladder.
Cholelithiasis: Excess of cholesterol, bilirubin or bile salts that crystalizes in the gall bladder to form gall stones. Common and harmless usually (unless stone migrates to duct= obstruction) Cholecystitis: An infection of the gallbladder occurs. Often due to gallstones in gallbladder.
184
Cholelithiasis & Cholecystitis Risk Factors: women, obesity, aging, family history, high cholesterol, pregnancy
women, obesity, aging, family history, high cholesterol, pregnancy

Nurs 136- MCA II (12 decks)

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