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level: Level 1

Questions and Answers List

level questions: Level 1

QuestionAnswer
Mortality from Cirrhosis occurs more frequently amongAfrican Americans than other ethnic groups
Primary Hepatic cancer has a higher incidence among African Americans, Asian Americans, and Inuit [Eskimos] thanAmong White Americans
Pancreatic cancer occurs more frequently amongAfrican Americans and Asian Americans than among White Americans
The incidence of Cholelithiasis increases with aging; closely observe older adults with histories of this disease for changes in the color ofUrine and stool or other s&s of gallbladder problems
As the body ages, the number and size of hepatic cells decrease which results in an overall reducedSize and weight of the liver *Liver also has decreased ability to regenerate after injury or from hepatotoxic injury; detoxification of substances is delayed
Older adults have a decrease in what?Protein synthesis in the liver and possible changes in the production of enzymes that assist in the metabolism of drugs, particularly anticonvulsants, psychotropics and oral anticoagulants
Be alert to the S&S of drug toxicity because decreased metabolism in the liver can causeAccumulation of the drugs
When does output of Pancreatic secretions steadily decline?After the age 40 but related problems with absorption cannot be documented
The Pancreas exhibits ductal hyperplasia and fibrosis with aging but these changes are not necessarilyAssociated with altered functioning
Disorders of the Biliary system are common in the US, the two most common conditions areCholecystitis [ inflammation of the bladder ] and Cholelithiasis [ presence of gallstones in gallbladder *More commonly seen in women than men *Native Americans *White Americans *African Americans *Obese ppl, pregnant women,ppl with diabetes or use birth control
Cholecystitis can be caused by an obstruction,Gallstone, Nonfunctioning gallbladder, or tumor
The exact stone formation in gallbladder is not known, but altered lipid metabolism and female sex hormones play aRole in the disease; Stones usually occur in multiples but can occur singly
What happens when there is an obstruction caused by gallstones? or a tumor prevents bile from leaving the gallbladder?The trapped bile acts as an irritant, causing inflammatory cells to infiltrate the gallbladder wall after 3-4 days *A typical inflammatory response occurs and the gallbladder becomes enlarged and edematous
When Cholecystitis disease is severe enough, the gallbladder may becomeGangrenous, rupture, and spread infection to the hepatic duct and liver
What are the clinical manifestations with Cholecystitis?Condition may be acute with sudden onset of indigestion, nausea and vomiting, severe colicky pain in upper right quadrant of the abdomen. *Pain may be referred to the right shoulder and scapula; pain resulting from Cholecystitis sometimes is mistaken for a cardiac problem because of pain that is felt in epigastric region and radiating to the back
If Cholecystitis is chronic, the patient usually has had several milderAttacks of pain and history of fat intolerance. When gallstones move through the biliary ducts, the patient often complains of pain being intensified
Excess formation of gases in the stomach or intestineFlatulence
The pain of acute Cholecystitis is abrupt in onset, reaches peak intensity quickly and remains at that level for2 to 4 hrs
What kind of symptoms may patients experience with Cholecystitis?Increased heart and respiratory rates and become diaphoretic [sweaty] leading them to think they are having a heart attack *These symptoms decrease or are absent in patients with chronic Cholecystitis
Stools that contain fatSteatorrhea
What meds are commonly used for pain for the gallbladder disease?Meperidine [Demerol] and Ketorolac
What are Nursing interventions for patient potential for harm or damage to the body related to poor nutrition and prolonged clotting times?Assist weakened pt with activities Encourage use of electric razor and soft toothbrush
What are Nursing interventions for patient with insufficient nutrition related to anorexia, nausea, vomiting and altered metabolism of nutrients by the liver?Provide diet high in Carbohydrates and low in fats Encourage total fluid intake of 2500-3000 mL daily Monitor I&O and daily weight Document COCA of stool/urine Aminister antiemetics as ordered, support and understanding Promote adequate rest
Has become a practical therapeutic option for many people with end stage liver disease, generally improving their quality of lifeLiver transplantation
What are indications for liver transplantation include?Congenital biliary abnormalities, inborn errors of metabolism, hepatic malignancy [confined to liver], sclerosing cholangitis, and chronic end stage liver disease
What is the leading indication for liver transplantation?Liver disease related to chronic viral hepatitis
Liver transplants are not recommended for patients with widespreadMalignant disease
Approximately 16,000 pp; waiting for liver transplants at present, only approx6000 transplants are performed annually
What are major postoperative complications?Rejection and Infection *Liver candidates must go through a rigorous presurgery screening *Liver seems to be less susceptible t rejection than the kidney
A live donor only donates a portion of liver to the recipient, within weeks the recipient and theDonor's liver will grow to the size the body needs *Donor faces potential risks such as liver and biliary problems, postoperative infection, and common postoperative complications
What is the most common complications for the recipient of a liver transplant?Rejection of the new liver tissue and infection
What has been used and been a major factor in improving the success rate of liver transplantation?Use of Cyclosporine, an effective immunosuppressant drug *It does not cause bone marrow suppression and does not impede wound healing
What other immunosuppressants are used in combination with other immunosuppressive agents to reduce rejection of liver?Azathioprine [ Imuran ] Corticosteroids Tacrolimus [Prograf] Mycophenolate mofetil [ Cellcept ] Interleukin 2 receptor antagonists Simulect and Zinbryta
Patients who have liver disease secondary to viral hepatitis often experience reinfection of theTransplanted liver with hepatitis B or C
Approx 20% to 30% of patients develop Cirrhosis of the transplanted liver by theFifth year posttransplantation Approx 75% of patients survive more than 5 yrs after transplantation
What are the postoperative nursing care for liver transplant?Assessing neurologic status, monitoring for signs of hemorrhage, preventing pulmonary complications, monitoring drainage, electrolyte levels and urinary output, monitoring S&S of infection and rejection
What are common respiratory problems associated with liver transplant?Pneumonia, Atelectasis [collapsed lung], and pleural effusions *Patient should use measures such as coughing, deep breathing, incentive spirometry, and repositioning to prevent these complications
First 2 months after surgery are critical, and a critical aspect of nursing intervention after liver transplant isMonitoring for infection *Fever may be the only sign of infection *Infection can be viral, fungal or bacterial
Care of the patient with viral hepatitis includesEnsuring rest, maintaining adequate nutrition, providing fluids and caring for the skin
What does drug therapy for Chronic hepatitis B focus on?Decreasing the viral load, decreasing rate of disease progression, and monitoring for detection of drug resistant HBV
Drugs that are considered first line treatment for chronic HBV includePegylated interferon alfa [PEG-IFN-a], ETV and TDF
Combination of PEG-IFN-a, ETV, and TDF therapy eradicates the virus more effectively thanMonotherapy *Therapy that uses one type of treatment, such as radiation therapy or surgery alone, to treat a certain disease or condition. In drug therapy, monotherapy refers to the use of a single drug to treat a disease or condition.
Half of all liver recipients are HCV positive, most transplanted livers eventually becomeInfected with HCV but recipients can increase quantity and quality of life by avoiding risky behaviors *A virus that causes hepatitis (inflammation of the liver).
Patient is not allowed alcohol for at least 1 yr and may need supportive care; most patients tolerateSmall frequent meals of low fat high carb diet, if becomes dehydrated, IV fluids are given with addition of: Vitamin C for healing Vitamin B to assist damaged liver's inability to absorb fat soluble vitamins Vitamin K to combat prolonged coagulation time
What do you give to people who have been in direct contact with a person with Hepatitis AGamma Globulin or Immune Serum Globulin as soon as possible *during the infectious period [2 weeks before and 1 week after onset of symptoms]
A dose of 0.1 to 0.2 mL/kg of body weight, given Intramuscularly is effective in preventingHepatitis A in 80% to 90% of cases *At present, 3 vaccines are used to prevent hepatitis A: Havrix and Vaqta
How long do you use Enteric precautions?7 days after the onset of Hepatitis A *Ues standard precautions for all patients
Maintaining standard precautions while exposed to blood and body fluids such as saliva, semen, and vaginal secretions is essential to prevent the transmission ofHepatitis B
What helps prevent the spread of Hepatitis A?Proper personal hygiene, good sanitation, and hep A vaccine
What prevents the spread of all bloodborne pathogenic diseases?Following standard precautions
What do primary immunization for Hepatitis A consist of?A single dose administered intramuscularly in the deltoid muscle *Booster is recommended between 6 and 12 months after the primary dose to ensure adequate antibody titers and long-term protection
How long does the primary immunization for Hep A provide immunity for?30 days after a single dose
Until routine vaccination of children is feasible, ppl who are at risk for infection should be vaccinated for hep A ppl at risk such as:People traveling to countries where hep A is endemic Sexually active homosexual and bisexual men Patients with chronic liver disease Injecting drug users Ppl risk for occupational infection those who work with hep A in research lab settings
Individuals who have been exposed to HBV via a needle puncture or sexual contact should be protected withHepatitis B Immune Globulin *A dose is administered intramuscularly as quickly after exposure as possible; dose is repeated 1 month later
People identified as being at high risk for developing Hepatitis B should be vaccinated, these ppl include:All health care personnel High risk lifestyles drug users, tattoo recipients, homosexual men, prostitutes Infants born to mothers who test positive for hep B surface antigen Hemodialysis patients Individuals sharing household with an infected person
Hepatitis B, C, D, and G are all spread throughBlood transfusions *Blood used should be screened for elevated ALT
What does the protection program consist of?Three vaccines *Initial vaccination *Vaccination 1 month later *Third vaccine 6 months after the first injection *Hepatitis B vaccine has been shown to provide protection for 3-5 years in approx 90% of the people treated
Spreads by direct contact through the oral-fecal route, usually by food or water contaminated with feces. The incidence of infection in the US has decreased significantly because of availability of the hep A vaccine. Ppl traveling outside US should avoid untreated water sources and uncooked foodHepatitis A
Transmitted by contaminated serum via blood transfusion, contaminated needles and instruments, needlesticks, illicit intravenous 'iv drug use, and by direct contact with body fluids form infected ppl such as bresk milk and sexual contactHepatitis B *an ever increasing risk comes from improper disposal of used needles and syringes sharing toothbrushes razor blades or personal items with infected person leads to exposure
Transmitted through needlesticks, blood transfusions, illicit IV drug use, and unidentified means. Also can be transmitted by sharing contaminated straws used for snorting cocaineHepatitis C HCV *In the past, hep C could not be detected in banked blood, so it was transmitted more easily through transfusion. The advent of routine blood screening in 1992 greatly reduced the number of cases of transfusion related hep C