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