Adult Health Nursing: GI, Hepatic, Pancreatic, Oncologic, and Infectious Disorders Review

Comprehensive practice flashcards covering hepatic pathophysiology, acute pancreatitis, oncologic emergencies, multidrug-resistant organisms, HIV/AIDS clinical care, and acute gastrointestinal disorders based on lecture notes.

What metabolic detoxification process is compromised in liver failure, leading to elevated serum ammonia levels?

The liver's ability to convert toxic ammonia ($NH_3$), produced by protein metabolism, into urea is lost, causing hyperammonemia and hepatic encephalopathy.

What are the three components of the Hepatitis B Triple Panel and what does a positive result for each indicate?

1. HBsAg (Hepatitis B Surface Antigen): Detects current acute or chronic infection.\n2. anti-HBs (Hepatitis B Surface Antibody): Indicates immunity from past recovery or vaccination.\n3. Total anti-HBc (Hepatitis B Core Antibody): Shows prior or ongoing exposure (with IgM anti-HBc used specifically for acute infection).

How do the clinical presentations and progression rates of Hepatitis A, B, and C differ?

Hepatitis A is transmitted via the fecal-oral route, has an acute onset with flu-like symptoms, and has a vaccine; Hepatitis B is transmitted through blood/body fluids, has a slow onset with more severe symptoms, and has a vaccine; Hepatitis C is transmitted percutaneously, is often asymptomatic or mild initially, causes liver damage $15\text{--}20\text{ years}$ post-infection, is curable with direct-acting antivirals, and has no available vaccine.

What clinical manifestations characterize the icteric phase of acute viral hepatitis?

Jaundice, dark urine (due to bilirubin excretion), light or clay-colored stools (due to blocked bilirubin outflow), right upper quadrant pain, hepatomegaly, and elevated liver function tests (LFTs).

What dietary management and positioning guidelines are indicated for a patient with ascites undergoing a paracentesis?

Dietary sodium is restricted to $2\text{ g/day}$ with a high-carbohydrate intake. Prior to paracentesis, the patient sits upright with the head of the bed elevated and empties their bladder; post-procedure, they are positioned on their right side to splint the puncture site.

What is the primary pharmacological action of lactulose in the management of hepatic encephalopathy, and what is the therapeutic target?

Lactulose acidifies the colon and traps ammonia ($NH_3$) in the gut to facilitate its excretion; the therapeutic goal is to produce $2\text{ to }3$ soft stools per day.

What are the three criteria of the Atlanta Criteria used to diagnose acute pancreatitis, and how many are required?

A diagnosis requires meeting at least 2 out of 3 criteria:\n1. Clinical symptoms: Acute onset of severe, persistent, steady epigastric abdominal pain radiating to the back (partially relieved by sitting up or leaning forward).\n2. Biochemical markers: Serum lipase or amylase elevated to $\\ge 3$ times the upper limit of normal (ULN), with lipase preferred.\n3. Characteristic imaging: Diagnostic findings on contrast-enhanced CT (CECT) or MRI.

What two clinical skin signs indicate retroperitoneal hemorrhage in severe acute pancreatitis?

Grey Turner's sign (bluish ecchymosis of the flanks) and Cullen's sign (bluish ecchymosis in the periumbilical region).

How are Chvostek's sign and Trousseau's sign assessed, what condition do they indicate in pancreatitis, and what is the treatment?

Chvostek's sign is facial muscle contraction elicited by tapping the facial nerve anterior to the ear; Trousseau's sign is carpal spasm induced by inflating a blood pressure cuff above systolic pressure for several minutes. Both indicate hypocalcemia (tetany), treated with $10\%$ IV calcium gluconate.

Why do patients frequently experience shoulder pain following a laparoscopic cholecystectomy, and what nursing interventions relieve it?

Referred pain to the shoulder is caused by residual carbon dioxide ($CO_2$) gas irritating the phrenic nerve; it is managed with early ambulation, deep breathing, and analgesia.

What do the letters in the cancer early detection acronym CAUTION represent?

C = Change in bowel or bladder habits\nA = A sore that does not heal\nU = Unusual bleeding or discharge from any orifice\nT = Thickening or a lump in the breast or elsewhere\nI = Indigestion or difficulty in swallowing\nO = Obvious change in a wart or a mole\nN = Nagging cough or hoarseness

What absolute neutrophil count (ANC) values define neutropenia, the threshold to hold chemotherapy, and a medical emergency?

A patient is neutropenic with an ANC $< 1500/\\mu\text{L}$; chemotherapy is held if the ANC is $< 1000/\\mu\text{L}$; an ANC $< 500/\\mu\text{L}$ is a medical emergency requiring protective isolation and broad-spectrum antibiotics within $60\text{ minutes}$ if febrile.

What are the hallmark laboratory findings of Tumor Lysis Syndrome (TLS)?

Hyperuricemia, hyperphosphatemia, hyperkalemia, and hypocalcemia occurring within $24\text{ to }48\text{ hours}$ following the initiation of chemotherapy.

What type of radiation-induced skin reaction is illustrated, characterized by cellular sloughing, oozing of serous fluid, and exposed dermis?

Wet desquamation, which occurs as a cutaneous complication of radiation therapy.

According to the anatomical distribution diagram of breast cancer, which quadrant accounts for 50% of all breast malignancies?

The upper outer quadrant of the breast.

What post-mastectomy complication is illustrated in the patient's left arm, and what nursing measures are required to manage it?

Lymphedema; nursing management requires avoiding blood pressure measurements, injections, and venipunctures in the affected arm, elevating the arm above the heart, and performing isotonic exercises.

Why is alcohol-based hand sanitizer contraindicated for infection control in patients with Clostridioides difficile (C. diff)?

Alcohol-based hand rubs do not eradicate C. difficile spores; hand hygiene must be performed with soap and water to mechanically remove spores, along with contact precautions and sporicidal cleaning.

Which transmission-based precaution is assigned to Tuberculosis versus Bacterial Meningitis versus Vancomycin-resistant enterococci (VRE)?

Tuberculosis requires Airborne precautions; Bacterial meningitis requires Droplet precautions; VRE requires Contact precautions.

What specific laboratory and clinical criteria establish a diagnosis of Acquired Immune Deficiency Syndrome (AIDS) in a person with HIV?

An absolute CD4 count $< 200\text{ cells/mm}^3$ OR the presentation of an AIDS-defining illness (such as Pneumocystis jirovecii pneumonia [PJP], Kaposi sarcoma, esophageal candidiasis, or Mycobacterium avium complex [MAC]), regardless of CD4 count.

In human immunodeficiency virus (HIV) clinical management, what is the significance of the "Undetectable = Untransmittable" (U=U) standard?

A person with HIV who adheres to antiretroviral therapy (ART) and maintains an undetectable viral load ($< 200\text{ copies/mL}$) has effectively no risk of sexually transmitting HIV to partners.

What are the critical time frames for initiating and completing HIV Post-Exposure Prophylaxis (PEP)?

PEP must be initiated as soon as possible and within $72\text{ hours}$ of exposure, followed by full treatment adherence for a duration of $28\text{ days}$.

What structural and clinical distinctions differentiate Type 1 (Sliding) and Type 2 (Rolling/Paraesophageal) hiatal hernias?

Type 1 (Sliding) occurs when the gastroesophageal junction slips above the diaphragm into the thoracic cavity, frequently causing GERD. Type 2 (Rolling) occurs when the fundus rolls up through the diaphragm while the junction remains below, causing chest fullness, breathlessness, and risk of volvulus without typical reflux.

What cellular transformation occurs in Barrett's esophagus, and what is its clinical consequence?

The normal squamous epithelium of the lower esophagus is replaced by columnar metaplastic epithelium due to chronic acid exposure, creating a pre-cancerous condition that increases the risk of esophageal adenocarcinoma.

How do duodenal and gastric ulcers differ regarding the relationship between eating and epigastric pain?

Duodenal ulcer pain is aggravated by fasting and relieved by food intake; gastric ulcer pain typically worsens directly after eating.

What anatomical surface landmark is indicated, and what does acute tenderness here suggest?

McBurney's point (located halfway between the umbilicus and the right anterior superior iliac spine); tenderness and rebound pain here indicate acute appendicitis.

What are the major pathophysiological and clinical differences between Ulcerative Colitis and Crohn's Disease?

Ulcerative Colitis affects only the mucosa/submucosa continuously beginning in the rectum and moving upward through the colon, causing $10\text{ to }20$ bloody, mucus stools daily; Crohn's Disease is transmural (all layers), occurs anywhere from mouth to anus with skip lesions and a cobblestone pattern, causes $5\text{ to }6$ loose non-bloody stools daily, and frequently leads to strictures and fistulas.

What critical urine output threshold requires immediate notification of the healthcare provider in a patient with bowel obstruction?

A urine output of less than $0.5\text{ mL/kg/hour}$, which indicates inadequate renal perfusion and severe hypovolemia.

What safety infection control and metabolic monitoring requirements apply to Total Parenteral Nutrition (TPN)?

TPN bags must be discarded after $24\text{ hours}$, administered with a $0.22\,\mu\text{m}$ in-line Millipore filter, and patient blood glucose levels must be monitored every $4\text{ to }6\text{ hours}$.