N317-Nutrition and Hepatobiliary Know this Statements

Hep a transmission

fecal oral

Hep B/c/d transmission

Blood and bodliy fluids

Hep e transmission

Fecal oral

Acute hep is

a/e

chronic hep

b/c/d

What is acute hep

inflammation of the liver lasting less than 6 months

what is chronic hep

ongoing inflammation of the liver cells and can be a complication of acute

Hep D co infection

HBV

Hep a way of contracting

Contaminated water and food, shellfish, and water contaminated with infected stool

hep b way of contracting

unprotected sex, infected mother, contact with infected blood, substance use

hep c way of contracting

unprotected sex, contact with infected blood, organ transplants, substance use disorder, and contaminated needle sticks or tattoo equipment

hep d way of contracting

unprotected sex and substance use disorder

hep e way of contracting

exposure to food and water contaminated with fecal waste.  

When do you see manifestations in hep

In the prodromal phase, this is when it is highly transmissible during this phase

What are the symptoms of hep in prodromal

There is no weight or symptoms during the incubation, or the symptoms resemble flu like illness.  

What are safe practices related to needles when caring for any client with hep

Aseptic technique for preparation and administration of parenteral meds. Sterile single-use disposable needles and syringes for each injection. Single dose vials whenever possible. Needless systems or safety caps.  

After hep liver biopsy what position do you put the patient

right side lying for 2-4 HR to apply pressure so there is no complication of bleeding

Hep prodromal phase

is flu-like symptoms and highly transmissible

Hep icteric phase

is the onset of jaundice and develops 1-2 weeks after the prodromal phase and persists for 2-6 weeks.

Hep recovery phase

begins as jaundice resolves, lasting several weeks.  

Hep interferon alfa 2B medcationmedication

This is a protein with antiviral, immunosuppressant, and anticancer effects. Prescribed for chronic viral hepatitis. Chronic is B/C/D.  

Bariatric surgeries position for dumping syndrome

Laying down

Bariatric surgeries position for maintain airway after surgery

semi fowler

Bariatric surgeries post op nursing considerations

Monitor for risk for developing atelectasis, thromboemboli, skin fold breakdown, incisional hernia, and peritonitis. Monitor bowel sounds.  

Bariatric surgeries procedures

Restrictive and malabsorptive

Restrictive procedures include

decreased capacity of the stomach. Gastric banding adjustable band, vertical band is a small pouch with staples, sleeve.

Malabsorptive procedures include

decreased capacity with malabsorption created from bypassing part of SMI. rouzenY-diversion with duodenal switch. Robotic assistant can be open or laparoscopic

Enteral feedings standard formula

Whole proteins (milk, meat, eggs) protein isolates

Require intact GI tract, provide 1-2 cal.ml

Enteral feeds hydrolyzed formulas

Nutrients hydrolyzed or partially broken down

Require intact GI tract 1-2 cal/ml

Continuous infusion method

Given over 24 hr period rate continuous

Cyclic feeding

Over 8-20 hr usually during sleeping

Often transition from total EN to oral intake

Obesity overweight

BMI 25-29.9

Obesity class 1

30-34.9

Obesity class 2

35-39.9

Obesity class 3

40 or greater

Obesity intragastric balloon therapy

gas filled or saline filled balloon placed in the stomach during endoscopic procedure

Obesity surgeries

restrictive, gastric banding, vertical banded, sleeve gastrectomy, Roux-en-Y (RNYGB), robotic assisted surgery

Obesity medication hydrogel pill

adjunt device to diet and exercise for weight loss for clients with BMI 25-40

Obesity med administered

Subcutaneous injection into fatty tissue so ABD, thigh, upper arm

Cholecystitis Diet and nutrition

(low-fat diet begin this once you are able to tolerate a clear liquid diet and advanced per medical staff, avoid fried/fatty meats/full-fat dairy products/greasy foods)

Pancreatitis  risk factor

gallstones

Pancreatitis lab values

increase blood glucose

Pancreatitis nursing care

monitor for fever, tachycardia and hypotension

Pancreatitis NG

gastric decompression

Pancreatitis meds

prescribed analgesics

Pancreatitis position for patient to lay

side lying with knees drawn up/flexed or semi fowler

Pancreatitis fluids

IV, oral or tube feedings

Pancreatitis output monitor

ng tube, urine, emesis, drains

Cholecystitis patho

Gallstones obstruct the cystic duct, preventing bile from leaving the gallbladder. The trapped bile causes inflammation, swelling, pain, and may lead to infection

Cholecystitis diet

low fat and high fiber

Pancreatitis risk factor

biliary tract diesease

Pancreatitis nursing care

Position for comfort. Monitor respiratory and vitals. Administer IV fluids. Monitor bowel sounds. Provide medication

Pancreatitis pt should be

NPO

Refeeding Syndrome nursing care

check for gastric residual volume is signifcant to determine if there is delayed gastric emptying. can lead to increase risk for aspriation.

Refeeding Syndrome preventative monitoring

crucial to avoid refeeding syndrome

Hepatic Encephalopathy cirrhosis risk factor

Excessive Alcohol Consumption, Obesity, Non-Alcoholic Fatty Liver Disease, Viral Hepatitis

What to monitor in a client with worsening Cirrhosis before encephalopathy is diagnosed:

Shortness of Breath, Ascites Progression, Peripheral Edema, Increased confusion, Increased Ammonia Levels 

Hepatic Encephalopathy expected findings

asterixis which is flapping tremors

Hepatic Encephalopathy lab values

Ammonia Levels: 15-45 ug/dL expected range

Hepatic Encephalopathy medication

Lactulose: non-absorbable sugar: lowers ammonia levels by increasing bowel movements

Hepatic Encephalopathy diet

low protein

Hepatitis A expected findings

Dark-colored urine, Abdominal pain, Clay-colored stools, Fatigue, Jaundice, Weight loss, Pruritus, N/V, Malaise

Hepatitis A safety

 Use standard precautions (never recap needle by hand, activate safety features, dispose in sharps container immediately, wear PPE, perform hand hygiene before and after, report any stick injury immediately)

hep a medication

Interferon (a protein with antiviral, immunosuppressant, and anti-cancer effects, used mainly with chronic)

Enteral Nutrition type of feedings

continous infusion and cyclic feeding

continous infusion

Formula is administered over a 24-hr period; the rate is continuous; infusion pumps help ensure consistent flow rates.

cyclic feeding

Administered over 8-20 hrs, often during sleeping hours, often transitioned from total EN to oral intake

Enteral Nutrition intra phase check residual volume because

used to determine how well the stomach is emptying and if the feeding is being tolerated) (If significant residual is left, it can indicate delayed gastric emptying, poor GI motility, and obstruction

Hep C risk

needle stick injuries and tattos/piercings with contaminated equipment

Malnutrition risk

older adulthood, dysphagia which is difficult swallowing, reduced taste and smell

Malnutrition expected findings

Unintentional weight loss

BMI less than 18.5 kg/m²

Muscle wasting

Weakness and fatigue

Poor wound healing

Dry, flaky skin

Brittle nails

Frequent infections

Confusion or disorientation

Reduced activity tolerance

Malnutrition lab test

albumin 3.5-5, low levels may indicate protein deficiency

Pancreatitis, acute or chronic risk factor

gallstones

Pancreatitis, acute or chronic lab values

increased serum glucose

Pancreatitis, acute or chronic patient care for NPO

frequent oral care

Pancreatitis, acute or chronic therapeutic procedures

NG tube for gastric decompression

Cirrhosis risk factors

diabetes

Cirrhosis lab values

decrease hemoglobin and hematocrit. Increase ammonia levels

Obesity medication

Liraglutide and semaglutide

Liraglutide and semaglutide medication administration

Liraglutide once daily subcutaneous and semaglutide once weekly subcutaneous

Hydrogel pill education

Oral med, particles in the stomach absorb water and expand into a gel. Gel takes up space. Pt feels fuller. Gel broken down and eliminated through GI

What is intragastric balloon therapy and how is it performed?

Endoscope pass through mouth to stomach, deflate ballon is inserted, balloon filled with saline or gas, remain in stomach for several months, later removed endoscopically

What are post-op nursing considerations for patients who have had bariatric surgery? What should be monitored? (Think first 24 hours post-op monitoring)

airway/resp, anastomotic leak, Prevent DVT/PE, fluid status, gi function, diet, dumping syndrome, nutrition, ng tube

Refeeding syndrome abnormal

Abd pain/bowel changes, confusion/difficulty breathing, fatigue/heart palpitations, muscle pain/weakness, swelling/fluid retention

What are assessment questions the nurse should ask for a client diagnosed with hepatitis A?

recent travel, contaminated food/water, infected person, N/V/fatigue, jaundive/dark UA/clay stool

What is interferon alfa prescribed for?

hep b/c

Risk Factors of Hep A?

Transmitted fecal-oral; Ingestion of contaminated food or water, contact with infected stool, and fecal-oral route person to person contact or by contaminated food.

Risk Factors of Hep C?

Transmitted by blood; Substance abuse disorder, blood/blood products, contaminated needle sticks, sexual contact.

In what phase of hepatitis are patients most infectious?

Prodromal (Pre-icteric) phase.

Nursing care to monitor in a patient with Cirrhosis?

Monitor for skin breakdown, prevent pressure injuries, wash skin with cold water and apply lotion to decrease itching. Monitor for fluid excess, monitor I&O, daily weights, and assess peripheral edema.

Dangerous Complication in Cirrhosis patients?

 Hepatic encephalopathy- clients poorly function liver