Understanding Medical Surgical Nursing Ch 33
Terms
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- hepatitis
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inflammation of cells of liver
usually caused by virus but may also be caused by drugs or bacteria
S/S: malaise - headache - anorexia - fever - RUQ pain - fatigue - vomiting - jaundice - hepatotoxic
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substance that is damaging to the liver
includes: Tylenol - aspirin - oral contraceptives - industrial chemicals - fulminant liver failure
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AKA acute liver failure
uncommon but serious complication of liver disease
up to 50% mortality rate
S/S: CNS dysfunction - rapid reduction in liver size - marked elevation in prothrombin time - encephalopathy
- central nervous system dysfunction
- cirrhosis
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chronic dx of liver associated w/fat infiltration & fibrotic tissue
S/S: malaise - anorexia - diarrhea - RUQ pain - icterus - jaundice - hepatorenal syndrome
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complication of liver failure
S/S: oliguria w/o detectable kidney damage - reduced GFR - urine output 200 mL or less daily - nearly total sodium retention - postnecrotic liver failure
- results from massive exposure to hepatotoxins or viral hepatitis
- biliary liver failure
- caused by chronic inflammation & obstruction of the gallbladder & bile ducts
- cardiac liver failure
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caused by chronic severe congestion of liver from heart failure
liver congestion causes death of liver cells from lack of nutrients & oxygen - ascites
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accumulation of serous fluid in abdominal cavity
accumulates primarily due to low production of albumin by failing liver - portal hypertension
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persistent BP elevation in portal circulation of abd
most serious result is bleeding esophageal varices (dilated veins) - varices
- dilated veins that tear easily from excessive pressure (coughing, lifting, etc)
- hepatic encephalopathy
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caused by accumulation of noxious substances in circulation
failing liver unable to make toxic substances water soluble for excretion
S/S: progressive confusion - asterixis - fetor hepaticus - fatigue - handwriting changes - asterixis
- flapping tremors in hands caused by toxins at peripheral nerves
- fetor hepaticus
- foul breath caused by metabolic end products related to sulfur
- transjugular intrahepatic portosystemic shunt (TIPS)
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shunt placed between portal and systemic venous systems
diverts venous blood around liver to vena cava - What are the medical goals for managing bleeding from esophageal varices? (four listed)
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1 Stop bleeding
2 Treat fluid volume deficit caused by bleeding
3 Prevent further fluid loss
4 Maintain fluid & electrolyte balance - What types of drugs are used to treat bleeding varices?
- vasoconstrictors
- List some dietary considerations for a pt w/liver failure.
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1 restrict protein intake
2 homogenized milk & eggs recommended
3 adequate carb intake necessary
4 fluid & sodium restricted if ascites present - The pt w/chronic liver failure is at risk for 1_____ from bleeding esophageal varices, gastrointestinal bleeding, & lack of 2_____ 2_____ 2_____.
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1 hemorrhage
2 blood clotting factors - Signs of possible organ transplant rejection include: (five)
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1 pulse greater than 100 bpm
2 temp greater than 101F
3 c/o of RUQ pain
4 increased jaundice
5 decrease in bile from T-tube or change in bile color - Symptoms of acute tissue rejection usually develop between the 1_____ and 2_____ postoperative days.
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1 fourth
2 tenth - cancer of the liver
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usually result of metastasis from primary cancer at distant location
increased risk for pts w/hx of chronic HBV, nutrional deficiencies, or exposure to hepatotoxins
S/S: encphalopathy - abnormal bleeding - jaundice - ascites - elevated serum alkaline phosphatase - pancreatitis
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inflammation of the pancreas
may be mild or severe - acute or chronic - acute pancreatitis
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caused by autodigestion
most commonly associated w/excessive alcohol consumption
S/S: dull abd pain - rigid abd - hypotension - respiratory distress - fever - dry mucous membranes - tachycardia - chronic pancreatitis
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chronic dx that replaces functioning pancreatic tissue w/fibrotic tissue due to inflammation
S/S: pattern of remissions /exacerbations over years - epigastric or LUQ pain - weight loss - anorexia - Dry, scaly skin or changes in skin pigment may indicate a deficiency in:
- vitamin A
- A pt complaining of bone pain may have a _____ _____ deficiency.
- vitamin D
- _____ _____ deficiency may be associated with anemia.
- Vitamin E
- Abnormal bruising or bleeding & prolonged clotting time indicate a deficiency of _____ _____.
- vitamin K
- cancer of the pancreas
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spread rapidly by direct extension to stomach, gallbladder, & duodenum
associated w/hi-fat diets, cigarettes, diabetes, alcohol, & chronic pancreatitis
S/S: weight loss - abdominal pain (worse at night) - anorexia - vomiting - weakness - feeling bloated after eating - pancreatectomy
- surgical removal of all or part of pancreas
- Relief of biliary obstruction can sometimes be accomplished by implanting a _____ or plastic tube in the common bile duct.
- stent
- cholecystitis
- inflammation of the gallbladder
- cholelithiasis
- gallstones
- cholangitis
- inflammation of the bile ducts
- choledocholithiasis
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gallstones in the common bile duct
S/S: sudden biliary colic onset - lasts 1 to 3 hrs - fever - nausea/vomiting - Medical management for an acute episode of cholecystitis centers on 1____ 1_____, prevention of 2_____, and maintenance of fluid and electrolyte balance. The analgesic agent most often ordered is meperidine hydrochloride because 3_____ 3_____ is believed
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1 pain control
2 infection
3 morphine sulfate - choledochoscopy
- use of endoscope to explore common bile duct & possibly remove stones found
- extracorporeal shock-wave lithotripsy (ESWL)
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use of shock waves as a noninvasive method to destroy stones in gallbladder or biliary ducts
usually used w/pts considered poor surgical candidates -
The pt w/altered thought processes r/t liver failure most likely has which of the following laboratory findings?
a. Low bilirubin
b. Low amylase
c. High hematocrit
d. High ammonia - d. High ammonia
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Jack, a pt w/chronic liver failure, has an episode of bleeding. Which of the following conditions placed Jack at risk for bleeding?
a. Portal hypertension
b. Low vitamin K
c. Elevated liver enzymes
d. High-fiber diet - b. Low vitamin K
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Most gallstones are composed of which of the following?
a. Lipase
b. Cholesterol
c. Sodium
d. Potassium - b. Cholesterol
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John develops jaundice & dark, amber-colored urine. Which of the following is the most likely cause?
a. Encephalopathy
b. Pancreatitis
c. Bile duct obstruction
d. Cholecystitis - c. Bile duct obstruction
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Jeff is a 26-yr-old health care worker who is diagnosed w/HCV. Which of the following questionis is most important to ask Jeff?
a. "Have you eaten any raw seafood recently?"
b. "Have you experienced a needle stick?"
c. - b. "Have you experienced a needle stick?"
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Jim, age 43, is admitted to your unit w/chronic pancreatitis. You recognize that an elevation in which diagnostic test indicates chronic pancreatitis?
a. Serum bilirubin
b. Serum calcium
c. Serum albumin
d. Serum amylase - d. Serum amylase
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In planning care for the newly admitted pt w/acute pancreatitis, you assign the highest priority to which pt outcome?
a. Pt expresses satisfaction w/pain control
b. Pt verbalizes understanding of meds for home
c. Pt increases activity tole - a. Pt expresses satisfaction w/pain control