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N370: Hepatobiliary

Interventions, Medications & Treatment pt. 1

InterventionProblem
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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