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150 Test #4
Chronic test 4
| Question | Answer |
|---|---|
| Diseased liver | Bleeding Risk! |
| Metabolism | Chemical reactions that occur in body to produce & provide energy |
| Normal person-Tylenol limit | 4g/24hr |
| Lab tests for Hepatitis | LFT,PT, serum bilirubin, serum protein, serum ammonia |
| AST/ALT | 10-40 |
| PT | 12-16sec |
| Serum Bilirubin | 0-0.9mg/dl(over 1-jaundice) |
| Serum Protein | 6.0-8.4 |
| Serum Ammonia | 15-90 |
| Albumin | 3.5-5.5g/dl |
| Liver Biopsy-Nursing Responsibility | check labs/consent, per/post VS, instruct pt to inhale/exhale-hold breath, needle inserted btw 6th & 7th rib, position on R-pillow to costal margin, remain in position, avoid coughing/straining |
| Hepatitis A | fecal-oral, shellfish, mild flu-like sx |
| Hep A-Nursing Mgmt | prevention(handwashing), sm freq meals, 2,000-3,000cal/restrict fat, do not force feed, I&O, no alcohol, vaccine |
| Hepatitis B | blood-body fluids, incubation 1-6months, HCW high risk |
| Hep B Stats | >90% dev antibodies & recover, 10% carrier w/ liver damage & inflammation, 10% mortality |
| Hep B-active immunization | 2 common(Enerix-B and Recombinavax HB), series of 3 inj, IM in deltoid, all HCW & newborns |
| Hep B-Stage 1 | Pre-icteric; flu-like sx, arthralgia, rash, loss of appitite, abdominal pain |
| Hep B-Stage 2 | Icteric phase; elevated LFT’s, enlarged liver, spleen and lymph nodes, jaundice, light colored stools, dark urine |
| Hep B-Stage 3 | Recovery |
| Chronic HBV infection | Chronic carrier |
| Chronic carrier (HBV) | High risk for liver Ca |
| Hep B-Tx | minimize active inf, decrease liver inflammation, decrease Sx, Alpha-Interferon |
| Alpha-Interferon(Intron A) | Immunomodulator-antiviral/immune modulating activity, 5million units or 10million units 3/wk for 4-6months, remission in 1/3 of pts, SE: diarrhea, fever, chills, fatigue, late SE: bone marrow suppression |
| Hep B-Nursing Mgmt | bedrest, adequate nutrition(protein restriction), antacids/antiemetics, may need hospitalization & fluid mgmt, evaluation of other blood borne illnesses |
| Hep C | IV drug use/needlesticks, most common chronic blood-borne infection, blood trans & sexual contact, most common reason for liver transplant, 15-160day incubation, assoc w/ HIV, 40-59yrs/africian americans, often no signs/sx |
| Hep C-Pharm agents | Pegylated Interferon/Pegasys, Ribaviron/Rebetol, some pts may have complete recovery w/ drug combo, insulin resistance may effect-must check before HCV tx |
| Hep D | have to have B to get D, transmitted/manifests like B, likely progress to chronic active Hep & cirrhosis |
| Hep E | fecal-oral, contaminated H2O/poor sanitation/Asia, jaundice, incubation 15-65days |
| Hep G | similar to C, seen after transfusion, incubation 14-145days |
| Hepatitis-Nutritional Concerns | restrict protein, restrict fats, high carbs, low sodium, no ETOH, no acetaminophen |
| Hepatitis-associated conditions | jaundice, portal hypertension, ascites, paracentesis, hepatic encephalopathy |
| Jaundice | icterus, yellow-tinged or orange-yellow coloring of the skin/mucus membranes/sclerae, seen when bilirubin exceeds 2.5mg/dl, pruritus |
| Portal Hypertension | ^hepatic/portal BP due to obstructed blood flow thru liver, esophageal/gastric/hemorrhoidal varicosities, prone to rupture/may hemorrhage, ascites-accumulation of fluid in abd cavity |
| Ascites | ^abd girth/rapid wt gain, sodium/H2O reten- inability liver metab aldosterone, ^intravasc fl vol, decrease liver synthesis albu, fl from vasc system-peritoneal space, diet restrict(low sodium), trouble breathing, diuretics needed(Spironalactone/Aldactone) |
| Paracentesis | removal of fluid from peritoneal cavity, ultrasound to guide procedure, may remove several liters but generally will return, will improve breathing |
| Hepatic Encephalopathy | occurs w/ profound liver disease & accumulation of ammonia in blood, ammonia levels monitored(15-45ug/dL), may lead to hepatic coma, early sx include mental changes and confusion, lactulose/cephulac given to promote excretion of ammonia in stool |
| Parkinson’s Disease-Pathophysiology | decreased neurotransmitter: Dopamine, dopamine signals the body’s muscle control/coordination, cells in substantia nigra destroyed |
| Acetylcholine | excitatory |
| Dopamine | inhibitory |
| Parkinson’s Manifestations | gradual onset, dysphagia, drooling, risk of aspiration and choking |
| Parkinson’s-3 cardinal signs | tremor, rigidity, and bradykinesia |
| Parkinson’s-Most definitive | asymmetric onset, resting tremor, shake while walking |
| Parkinson’s-Lewy bodies | pathological lesions (like Alzheimer’s) found in PET scan |
| Parkinson’s-Pharmacologic therapy | Dopaminergic drugs-^levels of dopamine in a variety of ways |
| Levodopa/Larodopa | Most effective agent for tx of Parkinson’s, precursor to dopamine, ½ life 180 min, less effective over time/more pronounced side effects, SE: dyskinesias/motor fluctuations |
| Carbidopa/Lodosyn | Inhibits enzyme AADC, more levodopa reaches brain |
| Levadopa/Carbidopa(Sinemet) | Hallmark of therapy, controlled release, give w/ food but no high protein meals, store in tight/light resistant containers |
| Anticholinergic therapy-Benzotropine/Cogentin | rare, not w/ elderly, controls tremor & rigidity of Parkinson’s, SE: can’t see, can’t pee, can’t spit, can’t shit |
| Dopaminergic Agonists-Ropinirole/Requip | mimic dopamine, restless leg, often used w/ younger pts |
| MAO-B Inhibitors-Rasagiline/Azilect | ^ dopamine in brain, inhibit metabolism of dopamine by MAO-B, food/drug interactions-Tyramine(aged cheese, meat, chocolate)-Hypertensive Crisis! |
| Rheumatoid Arthritis-S&Sx | joint swelling, tenderness, erythema, warmth, decreased mobility, deformity |
| Diagnostic Labs-RA | Rheumatoid factor ^, ESR, CRP, ANA, |
| RA-Pharmacology | anti-inflammatants(CORTICOSTEROIDS), DMARDS(Disease Modifying Antirheumatic Drugs)-also w/ psoriasis |
| Adalimumab/Humira | RA-DMARD-injectable pen: stop change of joints, risk for infection, risk for other immunocompromised probs |
| Gout | big red painful toe, hyperuricemia-at risk: renal insufficiency, HCTZ diuretics, ^purine diet |
| Purine | turkey, pork roast, wine, shellfish, sardines, organ meats |
| Gout med-Allopurinol/Zyloprim | inhibit synthesis of purines, decrease uric acid levels, SE: rash, take w/ food to prevent GI irritation, ^ H2O intake |
| Myasthenia Gravis | autoimmune disease, S&Sx: diplopia(double vision), Ptosis(drooping eyelid), weakness ^ w/ activity-decreases w/ rest, difficulty speaking-chewing-aspiration, respiratory failure |
| MG-Diagnosis | Tensilon test: obvious ^ increase in strength after administration is + for MG |
| MG-Pharmacology | anticholinesterase agents, Neostigmine/Prostigmin, Pyridostigmine/Mestinon |
| MG-Prednisone | immune suppressing |
| MG-Principles of Therapy | dosages are ^ gradually, lowest possible dose/fewest adverse effects, reg scheduled doses-before meals(swallowing) |
| MG-Medical Emergencies | Myasthenic Crisis & Cholinergic Crisis, both characterized by respiratory difficultyrespiratory faiure |
| Myasthenic Crisis | due to infection, ^stress, not enough drugs on board, ^ muscle weakness & difficulty breathing,Tx: ^cholinergic agents |
| Cholinergic Crisis | drug overdose, excess stimulation of PNS, abdominal cramps, diarrhea, excessive oral secretions, difficulty breathing, muscle weakness |
| Cholinergic Crisis Implications/Tx | monitor heart rate, stop cholinergic agents, give anticholinergic-atropine, mechanical ventilation |
| Multiple Sclerosis | autoimmune, demyelination, scattered lesions, MRI reveals plaque lesions |
| MS-S &Sx | depends on amount of demyelination, fatigue, weakness, loss of balance, muscle spasticity, visual disturbances, depression |
| MS-Temperature | heat slows nerve conduction, aggravates sx-cool/cold ^ nerve conduction, improves sx |
| MS-Pharmacology | corticosteroids for acute exacerbations, interferon/Avonex, Baclofen/Lioresal for ROM |
| Systemic Lupus Erythematosus | diffuse connective tissue disorder, autoimmune, secondary to genetics, hormonal, environmental, chemical or med induced |
| SLE-S&Sx | fever, fatigue, weight loss, arthritis, pleurisy, pericarditis, skin rashes, all body systems may become infected |
| SLE-Manifestations | characteristic skin changes, butterfly rash, malar rash, red/purple/scaly, inflamed appearance |
| SLE-Pharmacology | Corticosteroids-mainstay of therapy, decrease tissue inflammation, topical for dermatologic therapy, oral low dose maintenance therapy, IV high dose for exacerbation |
| Corticsteroids-SE | glaucoma/cataracts, fluid retention, ^BP, mood swings, weight gain, hyperglycemia, ^risk infections, loss of calcium, cushingoid features |
| Amyotrophic Lateral Sclerosis | nerve cells slowly die, motor neurons in brain & spinal cord slowly die-all muscles that move body are affected-loss of: walking, speaking, swallowing, eating, breathing |
| ALS-S&Sx | 1st weakness of one leg, one arm, tongue, face…later-slow spread of weakness to other areas, muscles weaker, atrophy |
| ALS-Pharmacology | Riluzole/Rilutek, skeletal muscle relaxants-Baclofen/Lioresal |
| ALS-Mobility Loss | Hazards of immobility: bed sores/skin integ, wasting, contractures, osteoporosis, respire/pneumonia, risk for aspiration, DVT |
Created by:
neffielewis
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