GI (exam three - complex)

how can hepatic failure be prevented following acute trauma or injury to the liver?

how can hepatic failure be prevented following acute trauma or injury to the liver?

treat the cause of injury and allow liver time to regenerate (i.e. stop drinking, treat cancer)

a patient reports to the ED reporting light colored stools and dark urine - what do you suspect?

liver impairment

your patient in liver failure calls you into the room to report that their urine in dark brown - what would you inform the patient about this?

this is normal - bilirubin as collecting in the urine rather than expelled in the stool

during a morning assessment, your patient in liver failure showing new confusion and disorientation - what is causing these symptoms?

the build up of ammonium in the body (the liver normally clears this)

where are common places to assess for jaundice in African American patients?

under the tongue or hard pallet

what can be given to sterilize the GI tract and decrease the effect of high circulating ammonia?

antibiotics

what are important nursing considerations associated with the treatment of liver failure?

prevention of bleeding, manage complications

where are common locations for an individual in liver failure to experience bleeding?

lower GI tract, gums

why is a patient in liver failure at an increased risk for bleeding?

the liver is not producing clotting factors

what is a common way to temporary relieve the discomfort associated with ascites?

paracentesis

how does albumin work to treat ascites?

it pulls fluid back into the intravascular space

when would you give lactulose to a patient in hepatic failure?

when they develop hepatic encephalopathy

how does lactulose work in treating hepatic encephalopathy?

flushes out the GI tract (removes ammonia)

a nurse extends a patients arm and then dorsiflexes the wrist - why are they doing this?

to check the ammonia level

what is the expected response after extending the arm and dorsiflexing the wrist if the patient’s ammonia is still to high?

a flapping motion or tremor

what is an expected side effect of lactulose administration?

diarrhea

what medication is giving to hepatic failure patients to help clear out bacterial flora to prevent ammonia build up?

neomycin

musty breath, asterixis, and apraxia are all signs of -

hepatic encephalopathy

flapping tremors in the arms and hands in a hepatic failure patient is called?

asterixis

a hepatic patient is having difficulty writing and moving a pen left to right - what is this?

apraxia

hepatorenal syndrome is caused by what physiological response?

systemic arterial vasodilation

what causes vasodilation which leads to the renal vasoconstriction that causes hepatorenal syndrome?

portal hypertension

how do you treat hepatorenal syndrome?

liver transplantation

why are you worried about your patients nutrition when they have hepatorenal syndrome?

they have anorexia

what is a common medication treatment to help increase blood flow to the kidneys during hepatorenal syndrome?

vasoconstrictors

what is a surgical intervention that could be made to treat hepatorenal syndrome?

transjugular intrahepatic postsystemic shunt (TIPS)

what does a TIPS procedure do?

reduces portal hypertension

what is a priority nursing consideration associated with liver failure?

impaired skin integrity

what is a common complication of portal hypertension?

esophageal varices

your liver failure patient calls you into the room because she is vomiting bright red blood - what do you suspect?

esophageal varices

what is your immediate action when treating someone with liver failure who has ruptured esophageal varices?

blackmoore tube

what do you want to assess when a patient has a blakemore tube placed?

airway

is hepatitis A acute or chronic?

acute

what decreases the incidence of hepatitis A?

vaccination

what does the presence of IgM indicated?

acute hepatitis A infection

what does the presence of IGG indicate?

past hepatitis A infection

how is hepatitis B transmitted?

blood-borne

is hepatitis B acute or chronic?

both

what can help decrease incidence of hepatitis B?

vaccination

what establishes a diagnosis of hepatitis B?

the presence of hepatitis B surface antigen

what does the presence of HBsAg after six months of initial hepatitis B infection?

carrier state or chronic hepatitis

what does the presence of anti-HBs indicate following a hepatitis infection?

immunity to hepatitis B

what are common symptoms of hepatitis C?

it can be asymptomatic or have mild symptoms

what complications can hepatitis C cause?

cirrhosis, liver failure

what does hepatitis D require to replicate?

hepatitis B

what is the most common way to transmit hepatitis E?

contained drinking water

patient presents with nausea/vomiting, fatigue, muscle/joint pain, and right upper quadrant pain - what do you suspect?

acute hepatitis infection

your patient presents with a decreased sense of smell, reports finding food repugnant, and has a distaste for cigarettes - what do you suspect?

incubation of hepatitis

what would you expect to find upon assessment of a patient experiencing acute hepatitis A infection?

hepatomegaly, lymphadenopathy, splenomegaly

what is the phase of hepatitis infection that begins as jaundice is disappearing?

convalescent phase

how long can the convalescent phase be?

weeks to months

what are common symptoms during the convalescent phase?

malaise and fatigability

if your patients splenomegaly subsides but their hepatomegaly persists - what does this indicate?

movement into the convalescent phase

what increases a person’s risk for developing chronic HBV?

infection at birth or during childhood

spider angiomas and palmar erythema are skin manifestations of -

chronic hepatitis

what should you educate a patient on avoiding during an acute or chronic hepatitis episode?

avoiding alcohol and drugs detoxified by the liver

what supportive drug therapy can be given to a patient with a hepatitis infection?

antihistamines and antiemetics

what does drug therapy try to do when treating hepatitis?

decreasing viral load, liver enzymes, and rate of disease progression

what dietary changes need to be change during the acute phase of a hepatitis infection?

increased calories

what dietary changes should you recommend for someone with hepatitis?

avoiding carbonated beverages and very hot/cold foods