Week 3: Accessory GI Disorders Flashcards
(160 cards)
1
Q
what is hepatic portal vein?
A
the hepatic portal vein brings blood from he stomach, intestines, spleen, and pancreas directly to the liver. This blood contains products of digestions.
2
Q
what is hepatic portal circulation?
A
tributaries from small intestine and portions of large intestine, stomach and pancreas - superior mesenteric vein,
tributaries from portions of stomach, pancreas and large intestine - spleenic vein
both lead to hepatic portal vein
hepatic portal vein to liver - hepatic veins to inferior vena cava - heart - abdominal aorta - proper hepatic artery back to liver !
3
Q
what is the summary of liver functions? (Hint - D.M.P.M.P.P.P.E)
A
Destroy - Destroy bacteria in the portal blood
Metabolize - Metabolize drugs, hormones, and toxins
Produce- Produce fatty acids, triglycerides, cholesterol, and lipoproteins (ie. HDL and LDL)
Maintain - Maintain blood glucose
Produce - produce urea
Produce - clotting proteins, albumin, angiotensinogen, IGF
Produce - Produce bile salts
Excrete - Excrete bilirubin in the bile
4
Q
what are kupffer cells made of?
A
macrophages!
5
Q
true or false: blood from the GI tract (containing bacteria, endotoxins and microbes blows tot he liver where kupffer cells work to clean the blood
A
true
6
Q
what does liver metabolize? be more specific..
A
nutrients - fats carbohydrates and proteins
7
Q
select all that apply: Liver helps break down proteins to be used for energy
Liver produces bile which emulsifies fat, allowing for lower absorption
helps the body safely manage ammonia levels that are a toxic by- product of protein metabolism. It does this by converting ammonia into urea to be excreted by the kidneys
A
second one wrong - better absorption
8
Q
liver helps regulate blood sugars by being involved in 3 processes, what are they?
A
glycogenesis, glycogenolysis and gluconeogenesis
9
Q
true or false regarding fat metabolism in the liver: fats are broken down to fatty acids and glycerol - bile allows h20 and fat to mix allowing absorption to occur
A
true
10
Q
true or false regarding protein metabolism in the liver: its broken down into amino acids - which contains nitrogen (excreted by urea). the metabolism creates ammonium which is toxic
A
truuuu
11
Q
what important component that it known for osmotic pressure does liver produce?
A
albumin!!
12
Q
true or false regarding albumin: Maintains oncotic pressure in the vascular system
Transports substances in the blood stream by binding to them (drugs, lipids, toxins, hormones)
A
true
13
Q
what is oncotic pressure?
A
this is the pressure that pulls water back into the bloodstream from the surrounding tissues
14
Q
what is metabolic detoxification?
A
Alters medications, hormones, and other chemicals to make them less toxic
- “First Pass Metabolism” or “First Pass Effect”
- Diminishes reabsorption and facilitates excretion
- Prevents accumulation of side effects
15
Q
what are some examples of hormones and chemicals - metabolic detoxification?
A
Examples of hormones: aldosterone, estrogen, testosterone
Examples of chemicals: alcohol, barbiturates
16
Q
is the hematologic function synthesizes most clotting factors ?
A
yes of courseeeee munch
17
Q
what vitamin is fat soluble vitamin required to
synthesize clotting factors ? also the absorption relies on bile production in the liver ?
A
vitamin K - recall its the antidote for warfarin (because its necessary for clotting)
18
Q
true or false: not have a functional liver - no absorption of vitamin K - no proper clotting
A
true
19
Q
clotting cascade refers to …
A
intrinsic and extrinsic factors
20
Q
what is bilirubin?
A
yellowish substance that forms in the blood when red blood cells break down. It’s a waste product that is produced during the normal process of red blood cell metabolism.
21
Q
what is bilirubin a key component of ?
A
bile
22
Q
true or false: Bilirubin is a byproduct of the destruction of aged red blood cells
A
true
23
Q
what is bilirubin connected to ? think skin…
A
jaundice !!
24
Q
what is the origin of bilirubin?
A
rbcs
25
select all that is true: Once RBC are destroyed, they become bilirubin which needs to be removed from the body
* It needs to be processed or “conjugated” by the liver which makes it water soluble and allows it to be excreted in the bile
all true
26
what is conjugated bilirubin or direct ?
processed by the liver
27
what is unconjugated bilirubin or free bilirubin?
not processed by liver though unconjugated bilirubin combines with glucuronic acid to become conjugated bilirubin (soluble)
28
true or false: Once in the large intestine, bacteria converts bilirubin into stercobilinogen and urobilinogen
* Stercobilinogen gives feces its brown color
both true
29
what gives stool its brown colour?
Stercobilinogen - converted bilirubin by bacteria
30
Viral hepatitis : what is this ?
widespread inflammation and infection of the liver tissue
31
what are the three most common viral agents that cause hepatitis ?
hepatitis A ( AV ) virus , Hepatitis B virus ( HBV) and hepatitis C virus ( HCV)
32
Viral hepatitis : other hepatitis agents that cause viral hepatitis
hepatitis D virus, Epstein barr cytomegalovirus, herpes simple, rubella, and yellow fever
33
true or false. Liver damage is mediated by cytotoxic cytokines and natural killer cells that destroy infected hepatocytes.
true
34
viral hepatitis results from in...?
liver cell necrosis an inflammation which can obstruct the flow of bile
35
liver cells often can regenerate?
true
36
true or false. Viral hepatitis some individuals are carriers and complete asymptomatic ?
true
37
Viral hepatic can be acute or chronic ? and if chronic how can it affect the individual?
it can be acute or chronic, and if chronic viral hepatitis infection can cause chronic inflammation and lead to scaring, eventually progressing to cirrhosis
38
THE ABC"S of viral hepatitis
define what hepatitis A
define the transmission, worldwide incidence and prevention and treatment
hep a is ingestion of contaminated food and water, or direct contact with an infected person
** does not cause chronic liver disease is rarely fatal
39
THE ABC"S of viral hepatitis
define what hepatitis B
define the transmission, worldwide incidence and prevention and treatment
hep b is contact with infected blood and bodily fluids, mother to child transmission, and unprotected sex
** billion infected, chronic infection can lead to liver cancer or cirrhosis
prevention includes:
- vaccination
-blood screening
-protected sex
treatment t:
-nucleotide/nucleotide analogues
-pegylated interferon
40
THE ABC"S of viral hepatitis
define what hepatitis C
define the transmission, worldwide incidence and prevention and treatment
Hep c : - unsafe injection practice
- infected blood or organ transfer
** infected, chronic infection can lead to lvier cancer or cirrhosis
prevention include :
- blood screening
-protected sex
-no sharing needles
treatment : pegylated interferon and ribavarin
41
What is this describing : this can be passed into mouth and poor hygiene, hand washing can be used as a mechanism to avoid this.Can rarely cause liver failure
hep a
42
what are the clinical manifestations of hepatitis viruses ( explain each one )
right upper quadrant pain --> liver enlargement due to inflammatory process
general symptoms ( fatigue, arthralgia, malaise, anorexia, fever ) --> underlying inflammatory process, infection
( the body is trying to fight that infection )
Jaundice---> inflammation and necrosis changes structures of lvier, cna obstruct flow of bile causing blockage ( yellow of sclera, lgiht coloured stool, dark yellow urine, pruritus
43
true or false. the clinical manifestations for hepatitis viruses , range of manifestations from absence of symptoms to liver failure
true
44
Chronic Viral hepatitis :what are the characteristics
Hep B and Hep c infections can result in chronic infections
they are often asymptomatic
increase risk of developing liver cancer
45
what are chronic viral hepatitis progress to ?
can progress to liver scarring, liver cirrhosis and liver failure
46
What does NAFLD stand for ?
non alcoholic fatty liver disease ( this is not associated with drinking alcohol )
47
what does nafld ranges from ?
ranges from a simple fatty liver ( no liver inflammation ) to severe liver scarring and cirrhosis ( NASH )
48
True or false. NAFLD this is an accumulation of fat in the liver cells?
what does this refer to as
true
this is referred to as hepatitis steatosis
49
what does NAFLD associated with ?
obesity and type 2 diabetes
50
nafld. true or false. 75% of obese individuals will develop simple fatty liver → 25% of those will develop NASH (Non-Alcoholic Steatohepatitis)
true
51
NAFLD is often symptomatic and can be detected right away ?
false! this is often asymptomatic and is undetected for years
52
Toxic & Drug induced hepatitis : characteristics
Agents producing toxic hepatitis are generally systemic poisons or are those converted in the liver to toxic metabolites
examples l carbon tetrachloride, gold compounds, acetaminophen, alcohol
53
Toxic & Drug Induced
Hepatitis :
liver necrosis generally occurs within how many days?
2 to 3 days of acute exposure to a toxic substance
54
what is this describing: irreversible inflammatory and fibrotic liver disease
liver cirrhosis
55
what are the diseases that lead to liver cirrhosis
viral hepatitis ( B and C) , NAFLD , toxic/drug induced hepatitis , autoimmune disorders
56
what is the leading cause of liver cirrhosis ?
excessive alcohol intake
57
how is liver cirrhosis characterized
Characterized by fibrosis (scar tissue) and conversion of
normal liver architecture to abnormal nodules
58
the regeneration process of ______ is disorganized meaning that liver can regenerate but not withstand
liver cirrhosis
59
during liver cirrhosis the liver is deceased but can still perform ?
true
60
describe how the connective tissue is having liver cirrhosis and the blood flow
new fibrous ct , is different from the normal lobule structure leading to irregular size and shape
due to inadequate blood flow t the liver and scar tissue, the liver becomes hypotonic and received poor nutrition, leading to hepatocyte dysfunction
61
complications of cirrhosis
portal hypertension
varices
ascites and edema
hepatic encephalopathy
coagulopathy and anemia
biliary obstruction
hepatorenal syndrome
spontaneous bacterial peritonitis
62
portal hypertension : what can it lead to
structural changes in the liver lead to compressed and damaged veins, which impeded blood flow
63
How does portal hypertension create venous pressure ( increase )
The hepatic portal vein which brings blood from the stomach, intestines, pancreas, and spleen to the liver is now obstructed creating an increase in venous pressure
64
portal hypertension:what are the signs of bleeding and excessive bruising
blood back flows into the spleen, causing splenomegaly, thrombocytopenia ( due to trapping of platelets ) and trapping of WBC's
65
portal hypertension : what does the body create ?
the body creates collateral circulation or new veins to bypass the liver ( varices )
66
varices are what type of veins ?
veins that directly connect to general circulation
67
this is distended and tortuous collateral veins
varices
68
Varices are :... name the characteristics
where is it commonly formed ?
can lead to ?
fragile and do not tolerate high pressure
commonly formed in the lower esophagus ( esophageal varcies ) abdominal wall( gastric varices), and rectum (hemorrhoidal varices)
Can lead to hematemesis or melena
69
esophageal varicosities commonly rupture creating a life threatening GI bleed, is this a common fact ?
yes
70
Varices have a high risk of bleeding, can you explain why ?
risk of bleeding because of that red blood cells and low platelets
71
ascites & edema, how does this form?
ascites is accumulation of fluid in the peritoneal or abdominal cavity
72
how does Ascites & Edema develop ?
* Portal Hypertension
* Increased flow of hepatic lymph
* Decreased serum colloidal oncotic pressure
* Hyperaldosteronism
* Impaired water excretion
73
ascites and edema signs and symptoms
abdominal distention,
dehydration (sunken eyeballs, dry skin, dry
tongue), hypokalemia
74
Recall the normal functions of the liver:
*Synthesis of Albumin and
Metabolism of steroids
75
an individual with ascites or edema would be hypervolemic or hypo?
it would be hypovolemic because their circulatory does not have access to that fluid and the fluid is sitting in that intersial space
76
Hepatic encephalopathy : in liver cirrhosis, the process of converting ammonia to urea is impacted for 2 reasons
what are they ?
1: ammonia rich blood being shunted past the liver via collateral veins
2: dysfunctional hepatocytes cannot convert the ammonia to Urea
77
this leads to high levels of ammonia in the blood which is neurotoxic
hepatic encephalpathy
78
what are the clinical mani. for hepatic encephalopathy
range from sleep disturbances to coma ( anxiety, personality, confusion, difficulty performing )
79
what are the characteristics symptoms of hepatic encephalopathy ?
asterixis ( flapping tremors )
80
what can a pateint develop when they have hepatc encephalopathy
fector hepaticus ( smell like a rotten egg )
81
other manifestations of cirrhosis
jaundice
infections
hepatorenal syndrome
hormonal imbalances
drug toxicity
82
other manifestations of cirrhosis: describe each one : jaundice
infections
Jaundice: Hepatic jaundice can occur due to damage of liver cells and intrahepatic cholestasis
Infections: Portal-systemic shunts (collateral circulation) created as a result of portal hypertension allow ingested bacteria to bypass the liver
83
other manifestations of cirrhosis: describe each one : Hepatorenal Syndrome & Hormonal imbalances:
Hepatorenal Syndrome: Sudden decrease in urinary output, elevated BUN and Creatinine levels, Increased urine osmolality.
Hormonal imbalances: Impaired breakdown of steroid hormones (for example, aldosterone, estrogen, and testosterone) can cause water/Na+ retention, testicular atrophy, gynecomastia, amenorrhea, spider angiomas, palmar erythema, and abnormal hair growth
84
other manifestations of cirrhosis : drug toxicity
impaired hepatocyte function can result in impaired clearance of drugs. This can cause elevated levels of drugs or metabolite sin the blood and can have toxic effects
85
cirrhosis of the liver : run down of what it contributes as a negative factor in our body
neurological
gastrointestinal
reproductive
integumentary
hematological
cardiovascular
86
what undergoes the neurological and reproductive that cirrhosis of the liver affects
neurological :
hepatic encephalopathy
peripheral neuropathy
asterixis
reproductive = amenorrhea
testicular atrophy
gynecomastia ( male ) impotence
87
what undergoes the integumentary and hemotological that cirrhosis of the liver affects
integumentary : jaundice
spider angioma
palmar erythema
petechiae
caput meduase
haematological :
anemia
thrombocytopenia
leukopenia
coagulation
splenomegaly
88
what undergoes the metabollic and cardio that cirrhosis of the liver affects
metabollic
hypokalemia
hyponatremia
hypoalbuminemia
cardio
fluid retention
peripheral edema
ascites
89
what undergoes the gastrontestinal that cirrhosis of the liver affects
anorexia
dyspepsia
n and v
change in bowel habits
dull abd pain
fetor hepaticus
esophageal and gastric varices
hematemesis
hemorrhoidal varices
congestive gastritis
90
The gallbladder- physiology review
the biliary system secretes enzymes and substances that remote digestion in the small intestine
gallbladder stores and concentrates bile which is produced by the liver, bile helps us absorb fat within 30 mins of eating cytokinin prompts the the g.b to contract.
91
what are the biliary organs?
pancreas, gallbladder, and the liver
92
disorders of the gallbladder
cholelithiasis ( calculi )
what are the risk factors?
1. female
2. fertile
3. forty
4. fat
93
women in there 40s are a risk factor of cholelithiasis ( calculi ) define why it is a risk factor ?
women multiparous--> 40 years old increased BMI estrogen
94
what is this describing : gallbladder stones, they become enlarged, this is too much cholesterol or bilirubin in the bile ( overly contracted )
cholelithiasis ( calculi )
95
disorders of the gallbladder inflammation ( cholecystitis ) : can be acute, what are the 2 types
1. calculous
2. acalculous
96
briefly describe what calculous and acalculous mean
calculous = this is common with stones
acalculous = occurs without the presence of gallstones regularly not filling or emptying
Could be from starvation or hypovolemic
97
what is this describing : when the obstruction occurs the gallbladder becomes distended and inflamed ( leads into necrosis and die )
swollen mucosa
98
clinical manifestations : disorders of the gallbladder
pain
indigestion
n and v
fever
jaundice
99
why is pain and indigestion occurring during the disorders of the gallbladder
our body is trying to get rid of it ( severe pain ) biliary colic
indigestion - tenderness , abdominal guarding
100
why is n and v and fever occurring during the disorders of the gallbladder
people with dyspepsis ( heartburn, burping ) farting
fever - white blood is increased
101
what is bilirubin responsible for?
- byproduct of the destruction of aged red blood cells
- it is a key component of bile!!!!
102
what is in the spleen and liver that breaks down old red blood cells?
macrophages
103
what is required for the emulsification and absorption of fat in the intestinal tract ?
bile
104
true of false: bile is made up of bile salts, cholesterol, bilirubin, electrolytes, and water
true
105
what is this: dark green brown colour thats produced in the liver and stored in the gallbladder
bile
106
what are the disorders of the liver ?
viral hepatitis
non-alcoholic fatty liver disease and non-alcoholic steatohepatitis (advanced version of NAFLD)
toxic and drug induced hepatitis
liver cirrhosis
107
select all that is true regarding jaundice:
* Many liver disorders result in Jaundice – also called hyperbilirubinemia
* Symptom resulting from elevated bile
* Causes yellow discoloration – can be visible on the skin,
sclera of the eye, and soft palate
may also cause pruritis
second one false: bilirubin
108
what are the three types of jaudice?
1. prehepatic
2. hepatic
3. posthepatic
109
what is prehepatic jaundice?
results from increase bilirubin BEFORE reaching liver
overproduction of the unconjugated bilirubin
usually from excessive hemolysis - break down of RBC
liver cant conjugate the bilirubin fast enough because of increased load
caused by: hemolytic jaundice of newborn, blood transfusion reaction
110
what stage of jaundice is this describing?
increase bilirubin before reaching liver
prehepatic
111
what type of jaundice is this caused by: hemolytic jaundice of newborn, blood transfusion reaction
prehepatic
112
what kind of jaundice is this describing?
increased unconjugated bilirubin
decreased hematocrit
normal liver enzymes
urine will appear normal (amber)
prehepatic
113
what is hepatic jaundice?
* Results from liver’s inability to take up, conjugate, or excrete bilirubin
* Damaged hepatocytes lead to leakage of bilirubin
* A diseased liver can result in both elevated conjugated and unconjugated bilirubin because:
1. Hepatocytes struggle to conjugate bilirubin
2. Conjugated bilirubin leaks from the cells
114
what is conjugated or direct bilirubin?
conjugated or direct bilirubin is water soluble and can be excreted in the urine
115
recall: what is indirect bilirubin?
unconjugated or indirect bilirubin is not water soluble and cannot be excreted in the urine
116
true or false; Liver diseases such as hepatitis and cirrhosis cause hepatic jaundice
true
117
what is hepatic jaundice characterized as?
* increased conjugated and unconjugated bilirubin
* elevated liver enzymes
* Urine will be dark in color due to increased conjugated bilirubin (water soluble)
118
what is post hepatic jaundice?
Caused by failure of bile to reach the duodenum
* Usually from cholestasis (obstruction of bile flow through the liver)
* Could be from intrahepatic (inside liver) or extrahepatic (outside liver) causes
* Swelling or fibrosis of liver and bile ducts (intrahepatic)
* Common bile duct stone, gall stones, pancreatic cancer (extrahepatic
119
what is post hepatic jaundice characterized by?
* Elevated conjugated
* Elevated blood cholesterol.
* Dark colored urine (increased conjugated bilirubin).
* Pale colored feces; steatorrhea (decreased urobilinogen and stercobilin).
* Accumulation of bile salts in the blood and depositing in the skin (puritis).
* Vitamin K deficiency.
120
what is the details of pancreatic islets? (what is it made up of)
alpha cells - glucagon
beta cells - insulin
somatostatin
pp-cells - pancreatic polypeptide
ghrelin cells
121
what are the pancreatic enzymes function?
trypsin, chymotrysin
amylase
lipase
Trypsin-digestion of proteins
Chymotrypsin-digestion of proteins
Amylase-digestion of carbohydrates
Lipase-digestion of fats
122
what is a disorder of the pancreas?
acute pancreatitis
123
what does this describe?
Acute inflammation of the pancreas
Abnormal activation of digestive enzymes within the pancreas
acute pancreatitis
124
true or false: acute pancreatitis main causes are:
1. Gallbladder Stones
2. Alcohol Use
3. Genetics
4. Medications
5. Viruses
6. Hypercalcemia
7. High Triglyceride levels
8. Trauma/Procedures
true
125
what is lipolysis? (happens in pancreas)
the enzyme lipase causes fat necrosis of pancreatic cells
126
what is this describing? premature activation of the enzymes - essentially digesting itself
acute pancreatitis
127
what is this describing? the enzyme lipase causes fat necrosis of pancreatic cells
Lipolysis
128
what is proteolysis? (happen in pancreas)
break down of proteins can lead to thrombosis and gangrene
129
what happens what theres necrosis of blood vessels?
enzymes will dissolve elastic fibers of the pancreatic blood vessels causing bleeding
130
release of more enzymes that cause ...
Vasodilation and increased vascular permeability
131
what happens in the pancreas (acute pancreatitis) with inflammatory mediators?
damage will lead to leukocytes
132
what are some clinical manifestations of acute pancreatitis?
pain
N/V
jaundice
hemorrhage
fever
pancreatic enzymes in blood
hypocalcemia
hyperglycemia
hypovolemia
pulmonary complications
khyperkalemia
133
go more in depth with pain in terms of acute pancreatitis?
left upper quadrant, mid epigastric area – radiating to the back, left flank, or left shoulder
134
clin mani can be n/v due to ...
inflammation leads to abdominal distension and slowed GI motility
135
what is hemorrhage a clinical mani in acute pancreatitis
break down of blood vessels
136
true of false: fever is a clinical manifestations of acute pancreatitis due to inflammation
true
137
why is hyperglycemia a clinical manifestation of AP?
destruction of beta cells
138
why can their be pancreatic enzymes in the blood for AP?
increased serum amylase and lipase
139
hypocalcemia in AP is due to...
breakdown of fats ! releases free fatty acids that bind to calcium in blood, causes low serum calcium
140
hypovolemia in AP can be found because
increased permeability, vasodilation, loss of fluid from vascular space
141
why is pulmonary complications sometimes a symptom in AP
inflammatory cytokines and enzymes in blood stream cause inflammation of lungs and alveoli, ARDS - acute resp distress syndrome
142
is hypokalemia sometimes a sign in AP?
no its hyperkalemia - cells/tissue death leads to release of intracellular potassium into blood stream, causes elevated serum potassium levels
143
this is multiple causes of pancytopenia
low RBC, WBC, and Platelets) in cirrhosis
144
portal hypertension leads to what ?
it leads to splenomegaly ( enlarged spleen ) where rbc, wbc, and platelets are trapped
145
true or false. an enlarged spleen reduces the amount of circulating platelets and red blood cells?
true
146
true or false. would a dysfunctional liver unable to produce clotting factors?
true
147
a dysfunctional; liver is unable to excrete bile which is required for what ?
this is required for vitamin k absorption ( fat soluble vitamin )
148
esophageal varices can lead to bleeding and risk for what ?
hemorrage
149
the pancreas endocrine function and exocrine function explain it briefly
endocrine function : maintains the blood glucose levels through the release of beta cells and alpha cells
exocrine function : they have inactive forms until they are needed for digestion--> protects the pancreas from the enzymes so it doesn't auto digest it self
150
what are the pancreatic enzymes ? and explain briefly what it does in the exocrine funtions
pancreatic enzymes:
lipase, amylase, trypsin, an chymotropsin
trypin - digestion of proteins
chymotypsin- digestion of proteins
amylase- digestion of carbohydrates
lipase- digestion of fats
they becpme activated when they are rleased into the duodenem
151
what works together to break down fats carbohydrates?
bile and pancreatic enzymes
152
True or false. when you eat food and reaches your stomach pancreatic juices are release into the pancreatic duct and then they travel to ampulla to vader and duodenem during the exocrine function process.
true
153
DRUG CARD: Beta blockers ( non selective ): Propranolol
MOA
Indications
adverse effects
therapeutic effects
propanolol ( inderal)
MOA: blocks cardiac beta 1 and beta 2 adnergic receptors
- blocks renal beta 1 receptors
-ultimately reduces heart rate, force of contrction, suppresses renin secretion, and reduces CO
indications : HTN, angina, heart failire, cardiac dysrhythmias, myocardial infraction
- portal HTN
therapeutic effect: lower blood pressure in the large veins by slowing heart rate and widening vessels--> reduces risk of bleeding varices
154
DRUG CARD: Beta blockers ( non selective ): Propranolol
nursing considerations
precautions
nursing considerations:
assess hr prior administrattion, hold med if hr is low
do not administer if pt has more than 1st degree av block
* Monitor for early signs of heart failure (shortness of breath after mild exertion or lying flat, edema, weight gain, coughing at night)
* Withdraw medication slowly (wean the drug), do not abruptly discontinue. Monitor for heart rate, chest pain, blood pressure, and palpitations
* Monitor respiratory rate, 02 saturation, and work of breathing. Do not administer to someone with asthma or obstructive pulmonary diseases
155
DRUG CARD: Beta blockers ( non selective ): Propranolol
precautions
Severe Allergies→ Any allergies resulting in anaphylaxis
* *Epinephrine* activates Beta 1 receptors in heart and Beta 2 receptors in the
lungs, if the receptors are blocked, epinephrine may not work
* Diabetes→1. blocks Beta 2 receptors in muscle and liver which are responsible for glycogenolysis when we need glycogen to convert to glucose (which we need for hypoglycemia) 2. blocks Beta 1 receptors which give early warning signs of hypoglycemia (tachycardia, tremors, perspiration)
* Cardiac/Respiratory Disorders→can exacerbate heart failure, AV blocks, sinus bradycardia, asthma, and bronchospasm
156
DRUG CARD : Albumin 25% (HSA)
* Blood product, plasma volume expander
* Intravenous Injection
* Used to restore and maintain circulating blood volume
* Expands plasma volume by withdrawing fluid from interstitial spaces
* Administered after ascites fluid removed (post paracentesis)
157
DRUG CARD : Albumin 25% (HSA) adverse effects and contra.
Adverse Reactions
* Hypervolemia (circulatory overload)
* Hypersensitivity
Contraindications
* Patients at risk for volume overload (renal insufficiency, heart failure, severe anemia) * Hypersensitivity
158
DRUG CARD : Albumin 25% (HSA)
Nursing Considerations
Monitor for allergic reaction – stop immediately if showing signs of reaction
* Electrolyte imbalances as fluids shift → monitor blood work
* Fluid Overload→monitor for signs of heart failure, pulmonary edema, and hypertension →check vital signs, headache, edema, jugular venous distention, assess lung (crackles) and heart sounds (extra heart sounds), urine output, work of breathing
159
true or false: hep A, B and C can lead to liver cirrhosis
false; only B and C
160
the nurse should recognize that a GI bleed is a common trigger for _____
h.e
