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N370: Hepatobiliary
Interventions, Medications & Treatment pt. 1
| Intervention | Problem |
|---|---|
| Lose healthy weight in a supervised setting | To decrease the risk for cholelithiasis, one thing we can do regarding the weight is ________. |
| Oral Cholecystogram | To diagnose Cholelithiasis, we utilize USN, endoscopy, ERCP, and ________ (looks at flow of gallbladder; patient takes IODINE-CONTAINING TABS BY MOUTH for one or two nights in a row - to check to flow/metabolization) |
| Procedural; topical anesthetic; ensure return of gag reflex; aspiration | During ERCP, patients will only undergo _______ sedation so we administer _____ anesthesia spray to numb the gag reflex, this means that we have to ______ before continuing PO fluids b/c it's an _______ risk. |
| Gag reflex return; airway damage d/t scope; scraping (esp the ducts b/c they're very narrow) -> swelling -> inflammation (i.e. Pancreatitis/Cholecystitis) | ______, ______, and ________ are safety implications for ERCP. |
| Pain management (opioids); stone retrieval (ERCP); oral dissolution therapy (actigall & lithotripsy) | Cholelithiasis management includes ______, ______, and _______. |
| Opioids | We use _____ for cholelithiasis pain management to reduce pain and dec GI motility b/c cramping/contraction causes pain too. |
| Actigall | For oral dissolution therapy (dissolves stones through PO meds) in the management of cholelithiasis, the most common is ______ which dissolves stones. But not highly efficient so surgery is still our first line. |
| ERCP | ______ is the most effective cholelithiasis management. |
| NPO; IV fluids; cholecystectomy; T-tube | Interventions for cholecystitis are: ____ (to dec bladder contraction) + _____ (for euvolemia), _____ if N/V (also known as "bowel rest", ______ if stable; _____ insertion if no resolution (promotes patency) |
| ABX; analgesics; anticholinergics; antispasmodics | Medications for cholecystitis are: ____ (for bacterial etiology), ______ (opiate controversy to dec GI motility), _____ (to avoid rest & digest, dec acid, dec pain), _______ (dec GI spasms and pain, dec smooth muscle tone); 2 3 4 - dec peristalsis |
| IV AXB; emergency GB decompression; ERCP; PTC | Cholangitis treatment entails ______, ________ (to manipulate and take out gallstones BUT only if GB is NOT inflamed to avoid perforation), ____, & _____; surgery is NOT done if case is not serious b/c mortality's 20-60% |
| Laparoscopic "lap choley"; laparotic "open choley" | ______ is a minimally invasive removal of GB while _____ is the traditional large incision. |
| Lap choley | ______ is done outpatient, minimally invasive multiple stab wounds -> less bleeding, fewer post-op complications esp resp, less pain |
| Open choley; splinting; T-tube | ______ is done in the hospital; prevent post-op complications (pulmonary/atelectasis, DVT, pain, skin breakdown, bleeding); encourage _____ when coughing, etc, TCDB and ambulate NPO, NGT, antiemetics + placement of ______; no heavy lifting |
| Blood; dark yellow-greenish; reposition pt; call MD | For T-tubes, we EXPECT to see some pink tinged _____ & _________ drainage; it should decrease, if not, try _______ first then try to flush to check for patency -> if still not working, ______ for possible obstruction |
| Cloudy/purulent; frank; ecchymosis; green leakage | For T-tubes, we DO NOT EXPECT infection, it's ______ when u hold it up to the light, ______ blood, _____ on activity, _____ on incision |
| Obstruction; infection | Self-care management education is important for T-tubes. _____ (supersaturated bile -> turns into stones -> clogs tube) & _____ (cloudy malodorous drainage) are reportable conditions; dark urine, clay stools & jaundice |
| T-tube | Patients with ______ placed should be educated about medications, wound care, avoidance of ETOH for 2 months, no lifting > 20lbs for 10 days to avoid dehisence, and LOW-FAT diet d/t poor synthesization. |
| High in cholesterol; gas-forming vegetables | Foods to avoid for Cholecystitis and Cholelithiasis are ______ & ______. |
| Opioids; stop stimulation of GB; IV fluids; small frequent low-fat meals | Management of BILIARY DISORDERS: pain/anxiety management using _____ to dec pain and peristalsis, stop ____ of ____ (NPO/low fat diet, NGT w/ N/V, acid suppression, antiemetics), ______ if NPO, ______ meals, oral dissolution, chem dissolution into T tube |
| Ascites | Tx for ______ is conservative unless ventilation/mobility is impaired, Na+ restrictions, diuretics, PARACENTESIS, IV COLLOIDS, shunting. |
| HYPOvolemia; breathing issues and atelectasis | During paracentesis, look out for fluid redistribution post-paracentesis can cause _______ symptoms! (Draining fluid without albumin, body compensates by pushing more to peritoneal space from ECV); look out for _____ d/t pressure |
| Tapped (removed) | During paracentesis, document how much fluid was "______" by MD |
| Protect airway; falls; lactulose; titrate; neomycin sulfate & xifaxan | For hep. encephalopathy, we have to _______ (aspiration risk), minimize injury d/t _____, _____ PRECAUTIONS!!!, administer _____ (PO/NGT/Enema) (pulls water & ammonia out -> EXPECT DIARRHEA -> _____ based on # of BM) + _____ & _____ (AXB to dec gut flora) |
| Lactulose; neomycin sulfate & xifaxan | ______ is used to dec already high ammonia levels in hepatic encephalopathy, while ______ prevents ammonia from inc. |
| TIPS | ______ is the insertion of a tube into the liver via the jugular vein to reduce portal HTN; stent opens it up -> risk for bleeding! watch out for ecchymosis - NOT tender) |
| Bleeding (liver's highly vascular), infection, organ rejection | What do we monitor in liver transplant? |
| Seizure precautions, gradual withdrawal so we might administer alcohol from time to time | What do we do if pt has severe CIWA score (>20) and actively withdrawing? |
| Check mentation (encephalopathy); stool & urine characteristics; labs (AST, ALT, Alk phos, protein=immunoglobs, in INR); monitor for complications of cirrhosis if progressing; MINIMIZE PROTEIN INTAKE; educate on self-care, transmission, prevention | What are the interventions for hepatitis pts? |
Created by:
yortiz
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