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Sem 2 Ch 6 Gallbladder, Exocrine Pancreatic Disorder


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Lexie Rae Negron


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Transmitted in the same way as hepatitis B; it appears as a coinfection with hep B
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Hepatitis D

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Sem 2 Ch 6 Gallbladder, Exocrine Pancreatic Disorder - Marcador

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Sem 2 Ch 6 Gallbladder, Exocrine Pancreatic Disorder - Detalles

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Is seen frequently as a coinfection with hep C; it spreads through bloodborne exposure. Has been found in some blood donors and can be transmitted by transfusion
Hepatitis G *Transmission occurs through contaminated injectable drugs; contaminated blood, organs, or tissues; or unsafe methods of tattooing or body piercing
The 5 yr survival rate for liver cancer depends on what?
Extent of cancer when diagnosed, localized liver cancer survival rate is approx 31%
Rarely hepatitis is caused by bacteria such as
Streptococci, Salmonellae, or Escherichia Coli
Patient with Cirrhosis of the liver, you want to evaluate
Percentage of meals being eaten, weight loss, how patient responds to care, keeping pt as comfortable as possible is the goal
What does the American Cancer Society ACS estimate that primary liver cancer will be diagnose?
In more than 40,000 ppl in the year 2017 more than 29,000 men and more than 11,000 women *Newly diagnosed cases is estimated that almost 30,000 will die from the disease
What is the type of primary liver cancer seen the most?
Frequently, Hepatocellular Carcinoma; the other primary tumors are Cholangiomas or Biliary duct Carcinomas
What are the high risk factors for primary liver cancer?
Cirrhosis of the liver and infection with either Hep C or Hep B
More than 4 mill ppl in US are infected with Hep B or Hep C and risk factors such as
Increasing age, obesity, type 2 diabetes, male gender, Cirrhosis, and hepatotoxins are some factors tied to liver cancer
Most patients with Cirrhosis require what kind of diet?
Well balanced, moderate, high protein, high carb diet with adequate vitamins *Impending liver failure, protein and fluids are restricted, sodium restriction is frequently necessary which can make providing a palatable diet more difficult; Provide frequent oral hygiene and a pleasant environment to help patient increase food intake
Because of pruritus, malnutrition, and edema, what are patients with Cirrhosis prone to having?
Skin lesions and pressure sores *Initiate preventative nursing interventions to avoid impairment of skin integrity such as alternating pressure air mattress, frequent turning, and back rubs
What must the patient with Cirrhosis understand?
Need to get adequate rest and avoiding infections *Turning pt q 2 hrs and providing ROM help avoid infection and Thrombophlebitis
What may palpation reveal?
Enlarged nodular liver
A type of brain damage caused by liver disease and consequent ammonia intoxication
Hepatic Encephalopathy *Thought to result from a damaged liver being unable to metabolize substances that can be toxic to the brain such as ammonia
What are the S&S of a patient with Hepatic Encephalopathy?
Progress from inappropriate behavior, disorientation Asterixis [a clinical sign that describes the inability to maintain sustained posture with subsequent brief, shock-like, involuntary movements] Twitching of the extremities to stupor; unresponsiveness from which a person can be aroused only by vigorous, physical stimulation and coma
What is the treatment of pt with Hepatic Encephalopathy?
Supportive care to prevent further damage to the liver
In the past a low protein diet often was prescribed for pts with Cirrhosis because it was thought to
Decrease amount of ammonia produced in the intestine. current belief is that protein should not be restricted because these pts often have existing malnutrition
What may be prescribed to decrease bowel's pH from 7 to 5?
Lactulose which may decrease production of ammonia by bacteria within the bowel
How can Lactulose be administered?
Orally, as retention enema, or via nasogastric tube *Also functions as a cathartic, lactulose traps ammonia in the gut and the drug's laxative effect expels the ammonia from the colon
Antibiotics such as neomycin are poorly absorbed form the GI tract are given
Orally or Rectally *Because this drug may cause renal toxicity and hearing impairment, Lactulose is preferred
What results in the ammonia production?
Bacterial action on protein in feces
A complex of longitudinal, torturous veins at the lower end of the esophagus
Esophageal Varices *Enlarge and become edematous as the result of portal hypertension; susceptible to ulceration and hemorrhage avoiding this is a main goal treatment
What causes Varices to rupture?
Anything that increases abdominal venous pressure, coughing, sneezing, vomiting, or the Valsalva maneuver *Rupture may occur slowly over several days or suddenly and without pain
Endoscopy may be performed to identify varices or to rule out bleeding from other sources, Endoscopic therapies include
Scleropathy [ the injection of chemicals used to cause inflammation] Fibrosis and destruction of the vessels causing the bleeding Ligation of varices
What is the hormone vasopressin VP used for?
Administered intravenously or directly into the superior vena cava to decrease or stop the hemorrhaging *VP produces vasoconstriction of the vessels dreases portal blood flow and decreases portal hypertension
What does NTG Nitroglycerin do?
Current drug therapy is a combination of VP and NTG, NTG reduces the detrimental effects of VP which include decreased coronary blood flow and increased BP
Therapeutic management of a ruptured esophageal varix is an emergency what must be maintained?
Patient's airway, bleeding varix controlled, and IV lines established for fluids and blood replacement as needed
Why should VP be avoided or used cautiously in older adults?
Because of risk of cardiac ischemia which is restriction in blood supply to the heart *If VP drip does not stop or control bleeding, a Sengstaken Blakemore tube with openings at tip may be inserted This tube is passed through nose and balloon in stomach to press against bleeding vessels and control the hemorrhage
When would a Gastric Lavage be performed?
To remove any swallowed blood from stomach; iced isotonic saline solutions for lavage to facilitate vasoconstriction, endoscopic sclerotherapy may be used to stop the bleeding or band ligation
Severity of fluid retention from ascites and edema determines treatment, initially pt is placed on Bed rest, monitoring of I & O and restrictions on amount of fluid of
500ml to 1000ml/day and sodium of 1000 to 2000 mg a day consumed. *Diuretic therapy may be added if diet does not control ascites and edema; Spironolactone at 100 to 400 mg a day may be used to obtained desired diuresis
Salt poor albumin may be administered in an attempt to restore what?
Plasma volume if the intravascular volume is decreased significantly
What are subjective data in early stages of Cirrhosis?
Patient's description of flu like symptoms, loss of appetite, nausea and vomiting, general weakness and fatigue, indigestion, abnormal bowel movements constipation and or diarrhea
What is the most commonly affected in anatomic area?
Epigastric region or right upper quadrant of the abdomen
Pruritus results form what?
Accumulation of bile salts under the skin, resulting in Jaundice
Collection of objective data in early stages of Cirrhosis includes observing
Low hemoglobin,fever, weight loss and jaundice which is yellow discoloration of skin mucous membranes and sclera of the eyes caused by greater than normal amounts of bilirubin in the serum
Collection of objective data in the later stages includes
Noting Epistaxis, purpura, hematuria, spider angiomas and bleeding gums
Late symptoms of Cirrhosis may include what?
Ascites, hematologic disorders, splenic enlargement and hemorrhage from esophageal varices or other distended GI veins
What can increased ammonia levels in the brain cause in patients?
Mentally disorientation, display abnormal behaviors and speech patterns
What can relieve ascites and also provide fluid for laboratory examination?
Paracentesis, a procedure in which fluid is withdrawn from the abdominal cavity
What are used to diagnose Cirrhosis?
Visualization through ERCP [ Endoscopic retrograde cholangiopancreatography ], to detect common bile duct obstruction, Esophagoscopy, scans and biopsy of the liver
What to avoid and eliminate to cause further damage to the liver such as Cirrhosis?
Alcoholm hepatotoxins or environmental exposure etc, diet therapy is aimed at correcting malnutrition, well balanced diet high in calories 2500/3000 calories/day 75 mg of protein per day, low fat low sodium 1000mg to 2000mg a day *Additional vitamins and folic acid usually meets needs with cirrhosis and improves deficiencies
In most instances, portal hypertension that is caused by cirrhosis is irreversible; this increased pressure causes
Ascites which is an accumulation of fluid and albumin in the peritoneal cavity
When the damaged liver cannot metabolize protein in the usual manner, protein intake may result in an elevation of
Blood ammonia levels *Protein must be present in adequate amounts to create colloidal osmotic pressure and attract the fluid to pass back into the blood vessels after it escapes in the capillaries
What stimulates kidneys to retain sodium and water?
Fluid leaving the blood and circulating volume decreases, receptors in brain signal the adrenal cortex to increase secretion of aldosterone