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NURS 3512 acute & chronic > Week 6 Cholecystitis/pancreatitis/hepatitis/cirrohsis > Flashcards

Week 6 Cholecystitis/pancreatitis/hepatitis/cirrohsis Flashcards

1
Q

What are the symptoms of both acute and chronic Cholecystitis?

A
  1. Sometimes none
  2. Abd pain
  3. N&V
  4. Dyspepsia, eructation, flatulence
  5. Rebound tenderness (blumberg’s sign)
  6. Fever
  7. Jaunice/ clay-coloured stool/dark urine
  8. Steatorrhea (fatty poops)
  9. Biliary colic
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2
Q

What are some non-surgical interventions for cholecystitis?

A
  1. no fatty foods - high fibre
  2. Antiemetics for N&V
  3. IV fluids if dehydrated
  4. hydropmorph or morphine for acute pain
  5. Ketorolac/NSAIDS for mild to mod pain (watch bleeding)
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3
Q

What are non-surgical interventions for gall bladder stone management?

A
  1. ESWL - shock wave lithotripsy
  2. Percutatneous Transhepatic catheter (drain) -it’s a stent that diverts bile around the duct
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4
Q

What two conditions is Percutatneous Transhepatic catheter (drain) -(it’s a stent that diverts bile around the duct), most typically used?

A
  1. cancers
  2. chronic cholecystitis
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5
Q

What is the gold standard for surgical interventions for cholecystectomy?

A

Lacproscopic cholecystectomy (Lap Chole)

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6
Q

What is the difference in hospital discharge between Lap chole or open chole?

A

Lap chole - discharge same day
Open chole- discharge 1-2 days after

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7
Q

What are the 3 things we need to give/monitor in someone with open chole that is different than lap chole?

A
  1. Antibiotics to prevent infection
  2. Assess surgical site
  3. Jackson Pratt drain- JP drain (bulb drain) - patient usually goes home with this
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8
Q

What are the symptoms of acute pancreatitis?

A

boring/tunneling pain
severe abd pain
weight loss
jaundice
tender
rigid abdomen
decreased/absent bowel sounds
grey/blue flanks

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9
Q

What are the symptoms of chronic pancreatitis?

A
  1. gnawing/burning
  2. episodes of abd pain
  3. ascites
  4. LUQ mass
  5. Steatorrhea
  6. Weight loss
  7. Jaundice
  8. Dark urine
  9. DM
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10
Q

What are the complications of pancreatitis?

A
  1. Jaundice
  2. intermittent hyperglycemia
  3. multisystem organ failure
  4. Coagulation defects
  5. Shock
  6. Paralytic ileus
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11
Q

Where does pancreatitis pain start and move to?

A

starts left upper quad then to back and sometimes left shoulder

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12
Q

What 3 drugs types are used in acute pancreatitis?

A
  1. Opioids (maybe PCA)
  2. Ranitidine and PPI to lower gastric secretions
  3. Antibiotics if inflammation is really severe for acute necrotizing
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13
Q

How many hours do we want to have someone NPO min with acute pancreatitis?

A

24-48 hours

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14
Q

What kind of oral care does someone with pancreatitis need?

A

brush teeth and swishes (NPO)

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15
Q

If someone is very ill with pancreatitis how do we avoid further pancreas inflammation?

A

NG to low suction them

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16
Q

What is preferred in someone with acute pancreatitis? IV TPN or jejunal tube feed?

A

jejunal tube feed after 1-2 days NPO

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17
Q

Do we give someone with acute pancreatitis food right away or wait?

A

wait- gradually resume food

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18
Q

What lab are we most concerned about in acute pancreatitis and why?

A

calcium
hypocalcemia
b/c calcium binds to free acids

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19
Q

What sign do we see if someone is experiencing hypocalcemia?

A

muscle twitching (tetany)

20
Q

What do we do with someone experiencing hypocalcemia?

A

calcium

21
Q

Why do we monitor resp. status for someone with acute pancreatitis?

A

because pancreatic enzymes and juices impact the diaphragm. swelling, edema, pain b/c patient can’t take deep breaths

22
Q

What 3 things do we monitor for in someone with acute pancreatitis?

A
  1. Respiratory status
  2. hypocalcemia
  3. daily weights b/c poor nutrition
23
Q

What 3 drugs do we give to people with chronic pancreatitis?

A
  1. opioids and non-opioid analgesics
  2. Ranitadine and PPI
  3. Pancreatic enzymes (d/t loss of funtion of the pancreas)
24
Q

What are the 4 nutritional interventions for someone with chronic pancreatitis?

A
  1. TPN or jejunostomy (if cal need can’t be kept up with)
  2. 4000-6000 cal/day
  3. avoid high fat foods
  4. alcohol cessation
25
Q

What are early signs of Cirrhosis?

A

Fatigue
maybe weight change
maybe N&V
pain

26
Q

What are the symptoms of later stage cirrhosis?

A
  1. jaundice
  2. dry/itchy skin
  3. rashes
  4. purpuric lesions
  5. vascular lesions
  6. ascites/edema
  7. blood in stool/emesis
  8. fetor hepaticus
  9. neuro changes
  10. asterixis
27
Q

How do we know our interventions for liver cirrhosis are working?

A
  1. decrease in ascites and edema
  2. BP- adequate circulatory volume
28
Q

What are the 4 interventions we need to do for someone with liver cirrhosis?

A
  1. manage fluid volume - avoid fluid overload
  2. Manage bleeding
  3. Prevent & manage confusion
  4. Manage pruritis
29
Q

What are the 5 possible interventions to help someone manage fluid volume with liver cirrhosis?

A
  1. Low Na diet
  2. Vitamin suppliments
  3. Diuretics
  4. Paracentesis if respiratory distress
  5. monitor peritonitis - IV antibiotics if needed
  6. TIPS - transhepatic portal-systemic shunt procedure - portal & hepatic vein shunt reduces pressure in portal vein = reduces pressure/ascities
30
Q

What are the 7 interventions to help manage bleeding in someone with liver cirrhosis?

A
  1. watch for esophageal varices
  2. Betablockers - lower BP
  3. Treat infections
  4. Avoid straining
  5. Vasocative drugs like octreotide
  6. Endoscopic therapies
  7. TIPS procedure
31
Q

What are the 2 ways we help prevent and manage confusion in liver cirrhosis?

A
  1. Neuro assessment - baseline & trends
  2. Monitor ammonia levels
32
Q

How do we manage ammonia levels?

A
  1. moderate protein intake
  2. Drugs used sparingly so we don’t mask decrease in LOC
  3. lactulose to decrease ammonia levels (PO or NG)
    - need 2-3 soft stools to lower confusion
    - hypokalemia & dehydration risk
  4. monitor for asterixis and fetor hepaticus
33
Q

What are 5 interventions to manage pruritis from liver cirrhosis?

A
  1. avoid warm temps
  2. Moisturize skin
  3. Avoid irritants
  4. Cool compresses
  5. corticosterioid creams - sertraline (SSRI tricks the brain that you are not itchy)
34
Q

What do we teach patients about living at home with Cirrhosis?

A
  1. bathroom access is important d/t lactulose
  2. Sleeping position d/t ascities
  3. Nutrition & drug therapy
  4. ETOH abstinence
  5. family monitor for encephalopathy
  6. Avoid hepatotoxic meds like tylenol
  7. Liver transplant possibility
  8. discuss end of life plans
35
Q

Where is viral hepatitis felt on the body?

A

Upper right quadrant pain

36
Q

What are the complications of viral hepatitis?

A
  1. depression
  2. polyarthritis
  3. myalgia
  4. Renal insufficiency
  5. Cognitive impairment
  6. Heart disease
37
Q

What are the 2 goals for viral hepatitis?

A
  1. promote nutrition
  2. Manage fatigue
38
Q

What diet should someone with viral hepatitis have?

A

high carb and calories
moderate fat & protein
small frequent meals
high calorie snacks
supplimental vitamins

39
Q

Why do people with viral hepatitis become fatigued?

A

infection and decreased metabolic energy production

encourage periods of rest and activity

40
Q

What device is used for acute pancreatitis and why?

A

NG Gomco suction machine
to reduce gastric secretions and reduce pain

41
Q

What intervention is used in ascites (Liver cirrhosis) and why?

A

Paracentesis
to remove excess fluid and decrease symptoms

42
Q

What do we use for nutritional management in someone with chronic pancreatitis and why?

A

TPN
to bypass the GI tract and reduce secreations from the pancreas to give that area a rest

43
Q

What device is used post surgery after an open cholecystectormy and why?

A

JP drain
to drain fluid accumulation

44
Q

What procedure is done for GERD and why?

A

nissen fundoplication
it acts as a belt to strengthen the LES and prevent acid reflux

45
Q

What procedure is done for esophageal cancer and why?

A

Esophageal dilation
to dilate a constricted esophagus
nutritional management

NURS 3512 acute & chronic (29 decks)

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