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Exam 4

Hepatitis/Cirrhosis/Pancreatitis/Renal/Endocrine

QuestionAnswer
Hepatitis Incubation period asymptomatic
Hepatitis Prodromal phase mild flu-like symptoms, malaise, body aches, N&V
Hepatitis Icteric Phase Jaundice, dry, itchy skin, RUQ pain, N&V, fatigue
Hepatitis Convalescent phase Acute Hepatitis will begin to resolve and patient symptoms will improve
Hepatitis A Acute Hepatitis; oral-fecal route caused by contaminated food/water
Hepatitis B Can be acute (< 3 months) or chronic; spread via blood or sexual intercourse
Hepatitis C Chronic and ends with liver failure; spread via blood/body fluids; leading cause of liver transplants
Hepatitis D occurs ONLY concurrently with Hepatitis B; spread via blood/body fluids
Hepatitis E Acute Hepatitis; oral-fecal route; primarily spread from contaminated water
Chronic Hepatitis Hep B, D, or C: RUQ pain, fatigue, hepatomegaly. Leads to cirrhosis, liver cancer, and transplants
Fulminant Hepatitis Rapidly progressing form; leads to liver failure within 3 weeks
Toxic Hepatitis Caused by drug and alcohol use rather than a virus
Hepatobiliary Hepatitis Caused by bile duct blockage rather than a virus
Manifestations of Hepatitis Fatigue, muscle and joint pain, RUQ pain, hepatomegaly, jaundice, dry itchy skin, weight loss and anorexia, clay-colored stoll, bilirubin present in urine
Diagnosing Hepatitis Liver Function Tests: elevated ALT, AST, and serum bilirubin. Viral antigen test & Liver biopsy
How long does the Icteric Phase of acute hepatitis last 2-6 weeks
Medications for treating Hepatitis Antiemetics, Antivirals, Immunomodulators, and Corticosteroids
Considerations for antiviral drugs Epivir-HBV & Hepsera: RENAL TOXIC: monitor I&O's and risk of infection
Considerations for Immunomodulating drugs Interferon & Ribavirin: Interferon is ONLY given IM or SQ
Diet considerations with Hepatitis small frequent meals high in carbs & calories; low in fat. Lots of fluids and no alcohol
Preventing the spread of Hepatitis Education on prevention & Vaccines for Hep A & B
Causes of liver cirrhosis drugs & alcohol, biliary duct obstruction, severe R-sided heart failure & HTN
Pathophysiology of Cirrhosis inflammation --> fibrous scar tissue --> decreased blood flow --> hypoxia --> cell damage --> nodular formation
Early manifestations of cirrhosis hepatomegaly, fever, weight loss, RUQ pain, N,V
Later manifestations of cirrhosis Jaundice, altered mental status, edema, leukocytopenia, esophageal varices
Portal HTN Increased pressure in the portal vein due to reduced perfusion in the liver
Esophageal Varices complex enlarged veins at the base of the esophagus causing increased risk of bleeding *life threatening
Cause of peripheral edema and ascites in cirrhosis patients increased aldosterone & decreased albumin--> Na and H2O retention --> edema and ascites
Hepatic encephalopathy ammonia accumulates in the body (the liver cannot turn ammonia into urea for excretion) and causes cerebral edema and altered mental status
Diet considerations for cirrhosis patients Low Protein (body cannot convert protein byproduct into urea)
Early signs of hepatic encephalopathy euphoria, depression, memory loss, and slowed speach
Late signs of hepatic encephalopathy hyperventilation, hypothermia, asterixis (fine tremors of hands), coma
Hepatorenal Syndrome (HRS) decreased perfusion to the kidneys commonly following diuretics, bleeding, or pancreatitis leads to acute renal failure and oliguria
Diagnosing cirrhosis ultrasound, xray, biopsy (bleeding risk but needed for staging), liver function tests
Labs of the cirrhosis patient elevated liver function tests (AST, ALT), watch albumin & protein levels, monitor ammonia levels, perform coagulation study (low clotting factors)
Meds for treating Cirrhosis diuretics (edema), beta blockers (portal HTN), iron & folic acid & Vitamin K (risk of bleeding), antacids (esophageal varices), *Lactulose & Neomycin (excrete ammonia; encephalopathy)
Decreasing blood ammonia levels Low protein diet & Lactulose & Neomycin
Managing Cirrhosis Diet (low salt & protein), medications (HTN, edema, ammonia), prevent bleeding; symptom management (paracentesis to decrease ascites)
Treating Esophageal Varices antacids: if bleeding: AIRWAY, vasopressor, blood, & Vitamin K; *NTG balloon puts pressure to stop the bleeding and decrease risk of aspiration
Esophageal Tamponade due to esophageal varices the esophagus fills with blood causing risk of aspiration; use a NTG tube to provide pressure on the bleeding
Function of the pancreas secrete digestive enzymes & produce insulin
Acute Pancreatitis pancreatic duct obstruction (gall stone or inflammation) causes enzyme reflux and cell damage
Necrotizing Hemorrhagic Pancreatitis Acute form; enzyme reflux causing necrosis of the blood vessels and inflammation. Risk of rupture & bleeding. Life-threatening
Signs of Acute Pancreatitis sudden onset, severe RUQ pain radiating to back; N&V, decreased bowel sounds, tachycardia, jaundice, Turner's sign, & Cullen's sign
Turner's Sign bruising in the flank area (Pancreatitis)
Cullen's Sign bruising around the umbilicus (Pancreatitis)
Diagnosing Acute Pancreatitis ERCP (scope of GI system), Xray, ultrasound (gall stones), CT, biopsy
Labs with Acute Pancreatitis elevated liver enzymes, elevated ESR (inflammation), CBC (anemia)
Manifestations of Acute Pancreatitis dehydration, inflammation, jaundice, edema, Hypoactive or Absent Bowel Sounds, abdominal pain (RUQ to back)
Chronic Pancreatitis progressive destruction of pancreas; common causes include alcoholism and cystic fibrosis; occurs with remission and exacerbations
Manifestations of Chronic Pancreatitis RUQ & LUQ pain, weight loss, N&V, gas, Steatorrhea (fatty stools)
Diet for patients with chronic pancreatitis High protein, High calorie, Low fat diet
Treating Chronic Pancreatitis During exacerbations: NPO, PCA pump, NG to suction, bowel rest, steroids (tx inflammation), IV fluids (lactated ringers), albumin (tx low protein), Dopamine (tx low BP & edema)
Pancreatic Abscess life-threatening; causes fever & pain, if it ruptures infection will spread & bleeding. MUST be drained AND treated with antibiotics
Whipple procedure remove part of the pancreas & small intestine, and gall bladder; reconnect duct, pancreas, and small intestine to work more efficiently
Pre-op interventions: Whipple NPO, NG to suction, TPN started
Renal Labs BUN/Creatinine, B:C ratio, GFR, BMP (Na, K, Ca, Ph) RBC (anemia), UA
Use of contrast dye with renal patients CT contrast dye is renal toxic and can send the patient into renal failure.
Acute Renal Failure rapid decline in renal function commonly caused by Ischemia.
Azotemia nitrogen waste products present in the blood (measured with BUN)
BMP of acute renal failure Hyperkalemia (peaked T wave, muscle spasms, fatigue), Hypocalcemia (tetany, trusseu's, chektevak's), Hyponatremia (confusion)
Pre-Renal Acute Renal Failure Results from decreased blood flow to kidneys (hypovolemia, ischemia)
Intrinsic Acute Renal Failure Damage within the kidney causing decreased function (infection, injury, glomerulonephritis)
Post-Renal Acute Renal Failure Obstruction preventing renal drainage (stones, inflammation, prostate issues)
Acute Tubular Necrosis destruction of renal tube epithelial cells causing decline in renal function; caused from ischemia (dead cells clog the kidneys)
Stages of Acute Renal Failure Initiation (asymptomatic), Maintenance (edema, oliguria, decreased GFR, metabolic acidosis, hyperkalemia, hypocalcemia, anemia, confusion), Recovery (gradual improvement)
Manifestations of Acute Renal Failure (Maintenance) decreased GFR, Metabolic acidosis, Hyperkalemia, Hypocalcemia, Hyponatremia, confusion, peaked T waves, tetany, edema, oliguria, anemia, fluid retention
Diagnosing Acute Renal Failure BUN/Creatinine, GFR, UA, BMP, renal ultrasound
Treating Acute Renal Failure Fluid challenge, Dopamine (small doses causing renal dilation), ACE-inhibitors (vasodilation), Dextrose & Insulin or Kayelxelate (tx hyperkalemia), Calcium, Aluminum Hydroxide (binds phosphorous)
Diet considerations for renal patients low sodium, possible fluid restriction
Chronic Kidney Disease kidneys cannot excrete wastes lasting more than 3 months; common causes: diabetes, HTN, nephron damage
Manifestations of Chronic Kidney Disease uremia, fatigue, confusion, hematuria, proteinuria, hyperkalemia, hypocalcemia, chronic metabolic acidosis, HTN, edema, and anemia
Diagnosing Chronic Kidney Disease UA, BUN/Cr, GFR, BMP, ultrasound & biopsy
Treating Chronic Kidney Disease diuretics, fluid restriction, Ace-inhibitors, Sodium Bicarb (tx acidosis), Dialysis
Dialysis considerations dialysis cannot pull off phosphorous. Use Phosflo to bind phosphorous in the blood. Dialysis will be 3-4 times a week lasting 3-4 hours each time.
Hemodialysis cleans the blood with a machine using a blood bath with semi-permeable membrane. Complications: bleeding & hypotension. Accessed via fistula.
Continuous Renal Replacement therapy (CRRT) slow version of hemodialysis for ICU patients who cannot tolerate abrupt fluid balance changes.
Considerations for fistulas and subclavian dialysis lines they are loaded with anticoagulants (Do Not Flush), No BP or IV on affected arm.
Peritoneal Dialysis Patient does at home by instilling fluid into abdominal cavity and draining off waste later. Complications: fluid is high in dextrose (risk of hyperglycemia and INFECTION)
Ambulatory versus Cyclic Peritoneal Dialysis ambulatory: fluid in the morning and drain about 6 hours later; cyclic: fluid before bed, machine drains off through the night.
Manifestations of Hyperthyroidism increased appetite, weight loss, heat intolerance, insomnia, palpations, hair loss, sweating, goiter, blurred vision
Labs with Hyperthyroidism & Graves Disease TSH will be low and T3 & T4 will be really HIGH
Graves Disease autoimmune disorder that binds TSH causing thyroid hyperfunction
Manifestations of Graves Disease Goiter, Proptosis (bulging eyes), exophthalmos (fluid around eyes), pretibial myxedema (nodules on tibia)
Causes of Hyperthyroidism Tumor, Pituitary malfunctions, Thyroiditis
Symptoms of Thyroid Crisis High fever, Tachycardia, Systolic HTN, N&V, Confusion (altered mental status), and Cardiac Complications
Diagnosing Hyperthyroidism TSH will be low; T3/T4 will be high
Treating Hyperthyroidism Medications (antithyroid meds), radioactive iodine, surgery
Considerations with radioactive iodine for hyperthyroidism destroys partial thyroid cells; pre-medicate with potassium iodine to slow thyroid function. (Potassium Iodine: no shellfish allergy, increases bleeding)
Antithyroid Medications Tapazole & PTU: increases risk of bleeding; takes 12 weeks to kick in
Thyroidectomy subtotal or total removal of the thyroid; treat with thyroid replacement hormone afterwards
Nursing interventions for hyperthyroidism cool environment, protect eyes (sunglasses and eye drops), daily weight, high protein and carb diet
Primary vs Secondary Hypothyroidism Primary: defect or loss of thyroid function; Secondary: problem with pituitary secretions or peripheral absorption
Manifestations of Hypothyroidism Goiter, fluid retention, weight gain, constipation, dry skin, edema, bradycardia, Low Sodium, confusion, depression
Causes of Hypothyroidism iodine deficiency, Hashimoto's Thyroiditis
Hashimoto's Thyroiditis autoimmune disorder where the body attacks its own thyroid cells
Myxedema Coma life threatening complication of untreated hypothyroidism. Hypoglycemia, Hyponatremia, Metabolic acidosis, cardiovascular problems leading to coma
Treating Hypothyroidism thyroid hormone replacement: Synthroid (take on empty stomach with glass of water)
Hyperparathyroidism increased PTH disorder primarily affecting bones and kidneys and causing high calcium levels
Primary, Secondary, Tertiary Hyperparathyroidism Primary: PTH and calcium imbalance; Secondary: chronic low calcium leads to increase PTH; Tertiary: body is insensitive to serum calcium usually from chronic kidney disease
Manifestations of Hyperparathyroidism bone fracturs, muscle weakness & atrophy, altered renal function, Metabolic acidosis, arrhythmia, kidney stone formation, constipation, and peptic ulcers.
Diagnosing Hyperparathyroidism rule out other causes of Hypercalcemia
Treating Hyperparathyroidism GOAL: decrease calcium; Aredia, Fosamax & Zometa (reduces calcium reabsorption), Calcitonin (given IM/SQ to reduce plasma calcium) fluids, and staying active
Hypoparathyroidism Low PTH due to damage or removal or parathyroid glands causing hypocalcemia and hyperphosphatemia
Manifestations of Hypoparathyroidism numbness & tingling, tetany, trusseu's & chvostek's sign, arrhythmias, psychosis, increased intracranial pressure
Treating Hypoparathyroidism IV calcium gluconate, supplemental calcium and vitamin D
Cushing's Syndrome excessive circulating cortisol (ACTH) caused from cancerous tumors, benign secreting tumors, small-cell lung cancer, or long-term corticosteroid therapy
Manifestations of Cushing's weakness, osteoporosis, thin skin, striae, mood swings, HTN, peptic ulcers, Hypokalemia, Hypernatremia, slow wound healing, moon face, easy bruising, buffalo hump, hyperglycemia
Diagnosing Cushing's Plasma cortisol levels, plasma ACTH, 24h urine
Medications for treating Cushing's Disease Mitotane (suppress adrenals), Aminogluthemide, Ketoconazole (inhibit cortisol synthesis) & Somatostatin (depresses ACTH)
Treating Cushing's Disease surgery to remove adrenals, pituitary, or tumors, radiation if cancerous, medications for management
Addison's Disease Results from Adrenal Insufficiency; caused from pituitary tumors, trauma, sepsis, sudden stopping of cortisol medications, or autoimmune process
Manifestations of Addison's Disease slow wound healing, postural HTN, lethargy, confusion, mood swings, N,V&D, Hyperkalemia, Hypoglycemia, Hyponatremia, loss of blood volume due to aldosterone deficiency causing excess sodium and water loss
Diagnosing Addison's Disease Serum cortisol (low), blood glucose (low), Plasma ACTH (high/low), Potassium (high), BUN (high), CT scan
Addison's Crisis life-threatening: Hypotension, Fever, Severe V&D, Shock and Coma
Treating Addison's Disease Coritcosteroid and Mineralcorticoid replacement therapy (Cortef & Florinef)
SIADH (inappropriate ADH Secretion) Posterior Pituitary Disorder caused by tumor, head trauma or water retention causing excessive release of ADH
Manifestations of SIADH Water retention, increased & diluted blood volume, weight gain with no edema, Hyponatremia, Hyperkalemia
Treating SIADH Diuretics, Sodium replacement, treat hyperkalemia (insulin & dextrose or kaylexelate), fluid restriction, *Declomycin (creates urine flow)
Diabetes Insipidus Low ADH levels & renal system becomes insensitive to ADH absorption
Manifestations of Diabetes Insipidus LARGE amounts of DILUTE URINE, Polyuria, Polydipsia, Dehydration, Hypernatremia, Hyperosmolarity of the blood with dilute urine
Treating Diabetes Insipidus IV Hypotonic solutions, Increase fluids, Replace ADH hormone, correct underlying issue (renal/pituitary gland damage)
Created by: jperrault9941