Pancreas, Liver, Biliary and Respiratory exam
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| Describe biliary cirrhosis | bile flow is obstructed and is retained in the liver causing inflammation, fibrosis, and regenerative nodules to form
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| what nutrition issue is common in alcoholics? | malnutrition
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| Describe posthepatic or postnecrotic cirrhosis | chronic hepatitis B or C and unknown cause leads to liver shrinkage and nodule formation with extensive liver cell loss and fibrosis
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| What is the cause of cardiac cirrhosis? | from long standing right-sided CHF
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| what are early clinical manifestations of cirrhosis? | liver enlargement and tenderness, dull ache in RUQ, weight loss, weakness, anorexia, N & V, diarrhea, or constipation
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| What are late manifestations of Cirrhosis? | impaired metabolism causing bleeding, ascites, gynecomastia in men, infertility in women, jaundice, neurologic changes, peripheral edema, anemia, low WBC and platelets, and skin lesions
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| what diagnostic studies are used to diagnose Cirrhosis? | abdominal ultrasound- eval. liver size and ascites, upper endoscopy- diagnose and treat esophageal varices, and liver biopsy
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| what is treatment for ascites? | paracentesis
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| what is treatment for esophageal varices? | control bleeding with vasoconstrictive meds, restore hemodynamic stability, upper endoscopy to treat varices with banding or sclerotherapy, and balloon tamponade
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| nursing care for patient with cirrhosis | health promotion with education about alcohol and drug abuse, avoid substances toxic to liver, encourage patient to participate in disease management
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| Nursing diagnoses for Cirrhosis | excess fluid volume r/t fluid retention, disturbed thought processes/risk for injury, ineffective breathing pattern r/t pressure on diaphragm, impaired skin integrity: bile deposits = severe pruritis, and imbalanced nutrition: less than body requirments
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| define Pancreatitis | inflammation of pancreas characterized by release of pancreatic enzymes into pancreatic tissue itself leading to hemmorhage and necrosis
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| clinical manifestations of Pancreatitis | abrupt onset of continuous severe epigastric and LUQ abdominal pain, N & V, abdominal distention and rigidity, decreased Bowel sounds, fever, mild jaundice, hypotension, tachycardia/pnea, cold/clammy skin
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| what is cullen's sign? | bluish-black discoloration around the umbilicus. Takes 24-48 hrs to appear. Sign of acute pancreatitis.
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| what is turner's sign? | bruising of the flanks (side). Predicts severe attack of pancreatitis.
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| what does it indicate if both Cullen's and Turner's signs are present? | indicative of pancreatic necrosis with retroperitoneal or intraabdominal bleeding
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| what are complications of Pancreatitis? | acute tubular necrosis and renal failure = 24 hrs post. pleural effusion, atelectasis, and pneumonia. shock. local- pancreatic necrosis, abcess, pseudocysts, and pancreatic ascites
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| Nursing care for patient with Pancreatitis? | eliminate cause, pain management, treatment of malabsorption/malnutrition, reduce pancreatic secretions
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| diagnostic studies for pancreatitis? | ultrasound - look for gallstones, mass, pseudocyst. Spiral CT scan, MRI, endoscopic ultrasound - examine pancreatic enlargement, necrosis, and fluid collections.
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| treatment of pancreatitis? | NPO, hydration, pain control, prevent complications, minimize pancreatic stimulation. lipase supplements - decrease steatorrhea, and H2 blockers and octeotide to suppress pancreatic secretions
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| gallstones form because... | abnormal bile composition, biliary stasis, and inflammation of gallbladder
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| cholelithiasis is... | formation of stones (calculi) within gallbladder or biliary duct system
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| what is cholecystitis? | inflammation of gallbladder
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| what is cholangitis? | inflammation of biliary ducts
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| Clinical manifestations of cholelithiasis: | may be asymptomatic. epigastric fullness after meals, biliary colic, steady pain in RUQ, N & V, jaudice-if there is obstruction of common bile duct. Clay colored stools, dark amber urine, steatorrhea,& pruritis
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| complications of cholecystitis | empyema (collection of infected fluid w/in gallbladder), gangrene with perforation leading to peritonitis, abcess formation, pancreatitis, liver damage, obstruction
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| manifestations of acute cholecystitis: | flatus, anorexia, fever with chills, n & v, biliary colic
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| collaborative care of gallbladder disorders: | treatment of symptoms, surgical removal of gallstones and possibly gallbladder
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| diagnostic tests for gallbladder disorders: | serum bilirubin, CBC - elevation WBC, serum amylase and lipase, ultrasound of gallbladder, gallbladder scan, and oral cholecystogram
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| treatment of choice for gallbladder disorders: | laparoscopic cholecystectomy
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| explain portal hypertension | structural changes in the liver causes compression and destruction of the portal and hepatic veins and sinusoids. these changes cause obstruction to normal blood flow through the portal system, thus resulting in portal hypertension
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| what are esophageal varices? | complex of tortuous veins at the lower end of the esophagus, enlarged and swollen as a result of portal hypertension
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| what is hepatic encephalopathy? | blood is shunted past the liver or the liver is unable to convert ammonia to urea and so large amounts of ammonia remain in the circulation
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| what is a pseudocyst? | a cavity continuous with or surrounding the outside of the pancreas. it is filled with necrotic products and liquid secretions, such as plasma, pancreatic enzymes, and inflammatory exudates.
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| what happens in a cholecystectomy?? | removal of gallbladder
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| what type of diet should someone with cholelithiasis and cholecystitis have? | low-fat (decreases stimulation of gallbladder)
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| what would be a teaching plan for someone with pancreatitis? | eliminate alcohol intake, restriction of fats, no caffeine, avoid crash dieting and bingeing, recognize s/s of infection and observe stools
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| what are risk factors for cholecystitis? | female, fat, forty, fertile, fair
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| t-tube care should encompass... | maintain bile drainage and observe functioning
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| hemolytic jaundice is caused by... | lysis of red blood cells thus increasing bilirubin
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| nursing interventions and teaching for post-nasal surgery... | no nose blowing, no heavy lifting, change drip pad, assess respiratory status, pain management, observe for bleeding, infection and edema
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| amantadine and rimantadine work on what type of influenza? | A
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| zanamivir and oseltamivir work on what type of influenza? | A and B
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| basic preventions to take to prevent spread of flu | wash hands frequently, sneeze into elbow, if sick - stay home a week until fever gone for 24 hrs, fluids, avoid hand-to-face contact, vaccination before exposure
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| signs and symptoms of pneumothorax: | dyspnea, tachycardia, diminished or absent breath sounds on affected side, and anxiety
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| example of a cause of closed pneumothorax | rib fracture puncturing lung
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| open pneumothorax causes: | gunshot, stabbing, car accident, any accident that causes air into pleural cavity
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| in xrays what are the black areas? | air
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| in xrays what are the dark areas? | fatty soft tissue
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| in xrays what are the light areas? | water and fluids or normal soft tissue
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| in xrays what are the white areas? | bone or calcified soft tissue
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| in xrays what are the completely white areas? | metal or contrast media
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| what is the silhouette effect in xrays? | discrete lines when there is a difference in density between two adjacent groups. example bone and soft tissue.
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| what is the carina? | the last tracheal cartilage and point of bifurcation of the trachea
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| on an xray, a mediastinal shift is indicative of what type of pneumothorax? | tension
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| what does it mean by "pulsus paradoxus" | blood pressure decreasing on inspiration and increasing on expiration
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| chronic bronchitis | inflammation with excessive tracheobronchial secretions and chronic cough (s/s for 3 months of year for 2 consecutive years)
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| what occurs in emphysema? | hyperinflation of alveoli, destruction of alveolar walls as a result of inflammation (loss of elasticity), loss of lung elasticity, and dead air space
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| what is the number one risk factor for COPD besides aging population? | SMOKING
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| common signs of COPD | dyspnea, wheezing, and chronic cough
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| complications of COPD: | respiratory failure/acidosis, cor pulmonale - pulmonary htn, polycythemia
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| treatment for COPD: | bronchodilators, stop smoking, inhaled corticosteroids, pulmonary rehabilitation, oxygen, and surgery
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| mast cell stabilizers inhibit the release of ... | histamine
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| anticholinergics help with what nasal symptom? | rhinnorhea
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| Flu symptoms include: | fever, headache, extreme tiredness, dry cough, sore throat, runny or stuffy nose, muscle aches and some stomach symptoms
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| what are the three types of influenza? | A,B,C
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| the influenza vaccine protects against which type of influenza? | A & B
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| pathophysiology of sinusitis | blockage of discharge, bacteria grow
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| what causes obstructive apnea? | collapse of posterior airway
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| central apnea is usually related to which disorder? | heart disease
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| what is sleep apnea? | breathing suddenly stops repeatedly during sleep
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| what is pneumonia? | acute inflammation of lung caused by microorganism
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| what is the collaborative care for patients with pneumonia? | antibiotic/antiviral therapy, oxygen for hypoxemia, analgesics for chest pain, antipyretics, influenza vaccine, pneumonococcal vaccine, fluid intake at least 3 L per day, calorie intake at least 1500ml per day
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| pulmonary tuberculosis is a disease that... | is a highly contagious disease that is caused by slow growing mycobacterium tuberculosis bacillus
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| TB is transmitted primarily via | inhalation from airborne droplet nuclei, requires prolonged close exposure to someone infected
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| signs and symptoms of TB | dry cough, then hemoptysis (blood in sputum), anorexia, weight loss, chest pain with coughing
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| which TB drug causes urine, tears, and sweat to become orange?? | Rifampin
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| which TB med causes yellow-dark brown urine? | Isoniazid
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| what occurs in flail chest? | paradoxical respiration - opposite sucked in during respiration
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| explain the procedure: Thoracentesis | physician draws pleural fluid using a needle and local anesthetic. therapeutic - relieves pressure. diagnostic - test fluid.
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| Cause of primary pulmonary hypertension | unknown
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| Cause of secondary pulmonary hypertension | complication of heart or lung disease (ex COPD)
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| what is treatment for pulmonary hypertension? | similar to heart failure - oxygen, fluid restriction, diuretics, rest, vasodilators, anticoagulants. SECONDARY - treat underlying cause.
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| what is Cor Pulmonale? | pulmonary heart disease - right ventricular enlargement.
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| what is treatment for Cor Pulmonale? | O2, bed rest, NA restriction, diuretics, and digitalis to strengthen heart
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| what are nursing assessments for patient on pleural drainage system? | Observe pt. Vitals frequently (esp. RR). Assess breath sounds. Assess insertion site for subq emphysema. observe color/odor of drainage(>100cc must be reported)
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| where should drains be in relation to the patient? | Lower to ensure gravity flow
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| what should you never do with a chest drainage tube? | Clamp and milk/strip
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| what is subcutaneous emphysema? | the collection of air in the tissues just under the skin that causes swelling.
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| if patient has air in pleural space, and the air enters from the collection compartment, what might you see in the second compartment? | bubbling in the water
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| what does continuous bubbling mean? | there is a leak in the drainage system or tubing
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| what does tidaling mean? | water will rise upon inspiration and fall upon expiration. opposite occurs with positive pressure mechanical vent.
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| placement of pleural chest tube? (hemothorax) | 4-6th intercostal space at midaxillary line
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| placement of pleural chest tube? (pneumothorax) | 2-3rd intercostal space at midclavicular line
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| what is hemothorax? | collection of blood in pleural space
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| what is Chylothorax? | accumulation of lymphatic fluid in pleural space
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| pleural effusion should not exceed... | 250ml
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| what is pleural effusion? | accumulation of fluid in intrapleural space
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| what is empyema? | pleural effusion containing pus
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| what is low flow? | gas flow not sufficient to meet total inspiratory demands
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| what is high flow? | sufficient gas flow for total inspiratory needs
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| simple mask can provide how much Oxygen? | 35-60% inspired oxygen
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| partial rebreather mask can provide.. | 35-70% inspired oxygen
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| nonrebreather mask allows how much rebreathing | NONE - designed for HF but used for LF
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| venturi mask uses what flow rate | High flow rate
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| respiratory acidosis (abgs) | ph < 7.35 and PCo2 > 45
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| respiratory alkalosis (abgs) | ph > 7.45 and PCO2 < 35
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| metabolic acidosis (abgs) | bicarb < 22 and ph <7.35
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| metabolic alkalosis (abgs) | bicarb > 26 and ph > 7.45
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| normal PaO2 level | 80-100 mm Hg
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| normal SaO2 level | 95 - 100% oxygen
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| Fully compensated the Ph will be.. | within normal range
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| in partial and uncompensated ph will be... | outside normal range
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| when PaCO2 and Ph move in same direction it indicates that a-b disorder is primarily... | metabolic
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| when ph and PaCO2 move in opposite directions it indicates the ABGs are primarily... | respiratory
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