Med sure quiz # 5 liver, pancreas Flashcards Preview

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1

Referred Pain

  • Is often experience in a location different from its source.

  • To illustrate, pain from appendicitis is usually felt around umbilicus and is of the aching, cramping type. The pain impulses come from an inflamed appendix in the right lower quadrant of the abdomen, where sharp pain also may be experienced. 

  • Anginal pain is another type of referred pain. This it is caused by lack of blood flow to the heart muscle and may be experienced as pain in the jaw, arm, and neck, as well as in the chest. 

2

Metabolism

  • Glucose Metabolism The liver helps to maintain the blood glucose within a certain range. After a meal, excess glucose molecules are taken up by the liver, combined, and then stored as glycogen. This process is called glycogenesis. When the glucose level in the blood falls, the process is reversed by glycogenolysis and glucose molecules are returned to the blood. Gluconeogenesis is the third process by which the liver maintains blood glucose. Fats and protein are broken down in response to low blood glucose levels and the molecules are used to make new glucose. 

  • Protein Metabolism Some nonessential amino acids, plasma proteins (albumin and globulin), and clotting factors are synthesized in the liver. Another important liver function in relation to protein metabolism is conversion of ammonia to urea. Ammonia is a by-product of the metabolism of amino acids. If ammonia accumulates in the blood, it has toxic effects on the brain tissue. 

  • Lipid Metabolism The liver synthesizes lipids from glucose, pyruvic acid, acetic acid, and amino acid. It also synthesizes fatty acids, breaks down triglycerides, an synthesizes and breaks down cholesterol. 

     

3

Blood Coagulation

  • Normal blood coagulations (clotting) is a complex process. Two essential elements for coagulation, prothrombin and fibrinogen, are synthesized by the liver. 

4

Exocrine Function

  • The exocrine function of the pancreas is carried out by acinar tissue. Acinar tissue is composed of tiny grapelike clusters of cells that produce pancreatic fluid. Pancreatic fluid contains enzymes needed for the digestion of proteins, fats, and carbohydrates. It is secreted into the duodenum through the pancreatic duct. 

  • The pancreatic enzymes trypsin, amylase, and lipase acts on partially digested foods in the small intestine. Trypsin plays a role in the digestion of protein by breaking proteases and peptones into small polypeptides. Normally, trypsin is not activated until it enters the duodenum. Otherwise, it would digest the protein tissue of the pancreas itself. Amylase acts with intestinal enzymes to reduce starch, sucrose, and fructose to glucose, fructose, and galactose. Lipase acts on emulsified fats to yield fatty acids, glycerides, and glycerol.

5

Endocrine Function

  • The endocrine function of the pancreas is carried out by clusters of specialized cells scattered throughout the pancreas. These cells are called islet of Langerhans. The islets contain Alpha, Beta, Delta, and PP cells. Alpha cells produce and secrete glucagon. Beta cells produce and secrete insulin. Delta cells produce somatostatin, which inhibits the release of glucagon and insulin. PP cells secrete pancreatic polypeptides, a family of peptides known chiefly for their inhibitory functions. 

  • Glucagon is secreted when the blood glucose level falls. It stimulates the liver to convert glycogen into glucose. Insulin is secreted when the blood sugar rises, as after a meal. It stimulates the use of glucose by the cells so that a normal blood glucose level is maintained

6

Physical Examination

  • Head and Neck Inspection of the mouth determines the condition of the lips, teeth, gums, tongue, and mucous membranes. Describe caries, moisture, color, and lesions and note any unpleasant or unusual odors of the mouth. If the patient has dentures, examine the mouth with and without the dentures in place. Inspect the sclera of the eyes. Like the skin, the sclera may turn yellow with liver disease, a condition called scleral icterus. This sign is especially useful when jaundice cannot be seen elsewhere in dark-skinned people. 

7

Reduced Activity Tolerance and Potential for Complications of Immobility

  • Most patients with acute viral hepatitis are treated at home, so instructions about activity limitations or needed. The extent of activity limitation depends on the severity of the symptoms. Although the patient is asymptomatic, bed rest may be advised. Explain that rest allows deliver to heal by regenerating new cells to replace those damaged by hepatitis. Blank air activities to permit times when the patient is not disturbed. Offer diversions such as reading or television to combat boredom. 

  • Unless the patient has severe complications, complete bed rest is usually not necessary. If complete bed rest is ordered, the patient is at risk for complications of immobility. Inspect the skin for early signs of pressure (redness, especially over Bony prominences). If the patient is unable to turn in dependently, assist with turning at least every 2 hours. Moisturizing lotions protect the skin and help to relieve itching associated with jaundice. Teach the patient to cough and deep breathe every 2 hours to reduce the risk of pneumonia.  Gentle exercise of the legs promotes circulation and discourages the formation of thrombi. Discourage crossing of the legs. Inactivity tends to lead to constipation and may cause urinary stasis. Therefore, record bowel movements and urine output and describe any abnormal characteristics of stool and urine. 

8

Altered Body Image

  • The patient may be self-conscious about his or her appearance because of jaundice. Demonstrate acceptance of the patient and explain that the skin color usually returns to normal in 2-4 weeks. 

9

Complications (cirrhosis)

  • Portal Hypertension-The portal vein delivers blood from the intestines to the liver. changes in the liver with cirrhosis obstruct the flow of incoming blood, causing blood to back up in the portal system. high  portal pressure, or portal hypertension, causes collateral vessels to develop. Collateral vessels commonly form in the esophagus, the anterior abdominal wall, and the rectum. 

  • Hepatic Encephalopathy The failing liver is unable to detoxify ammonia, a breakdown product of protein metabolism. Excessive ammonia in the blood causes neurologic symptoms, including cognitive disturbances, declining level of consciousness, and changes in the neuromuscular function. If the condition is not reversed, the patient lapses into unconsciousness, referred to as hepatic coma. 

    Factors that may precipitate hepatic encephalopathy are infection, fluid and potassium depletion, GI bleeding, Constipation, and some drugs. 

10

Disorders of the Gallbladder

  • Gallbladder disease is one of the most common health problems in the United states. The two most common gallbladder disorders are cholecystitis and cholelithiasis. Carcinoma of the gallbladder occurs but is uncommon
  • Risk factors for Gallbladder disease include obesity, familial tendency, a sedentary lifestyle, and the use of estrogen or oral contraceptives. Women are at regular risk than men, especially women who have had multiple pregnancies. The “five Fs” are sometimes used to describe those at greatest risk for gallbladder disease: female, fat, fair, forty, and fertile. 

11

Patient Teaching – Cholelithiasis

  • You need to have a low-fat diet with supplementary fat-soluble vitamins (or as ordered by the physician). The dietitian will explain the details of the diet to you. 

  • Notify your physician of signs of bile duct obstruction: light stools, dark urine, jaundice, and itching. 

  • If you are taking bile salts, report gastric upset. 

  • Keep medical appointments to have blood drawn to monitor liver function. 

  • Do not rely on oral contraceptives; bile salts interfere with their effectiveness. 

12

Laparoscopic Cholecystectomy

After laparoscopic cholecystectomy, usual instructions include the following:

  • avoid fatty foods for several weeks. 
  • Remove the dressings and bathe or shower normally the next day. 
  • Notify the physician if redness, drainage, or pus from the incision is noted.
  • Report any signs of peritonitis: severe abdominal pain, chills and fever, and vomiting. 
  • A low-fat diet may be recommended for 4-6 weeks.
  •  In general, avoid heavy lifting for 4-6 weeks or as prescribed. Other activities, including sexual intercourse, can usually be resumed when you feel well enough.

13

Pancreatitis 

  • Inflammation of the pancreas
  • Can be acute or chronic
  • Often associated with alcoholism or obstruction of the pancreatic duct by gallstone. 
  • Other causes are viral infections, peptic ulcer disease, cysts, metabolic disorders, and trauma from external injury, surgery, or endoscopic procedures. 
  • High fat diet and cigarette smoking please roll as well. 
  • Chronic pancreatitis is associated with alcohol abuse but often develops independently chronic pancreatitis is sometimes associated with cancer of the duo denim and pancreas. 
  • Pancreatic enzymes are activated in the small intestine with pancreatitis they just of enzymes are activated by some mechanism that is not well understood and begin to digest pancreatic tissue fat and elastic tissue and blood vessels. Fluid may leak into the surrounding tissues. The effect of this escape fluid has been compared with an internal chemical burn and can be devastating. 

14

Cancer of the Pancreas

  • Cancer of the pancreas is extremely serious as it quickly spreads to the duodenum, stomach, spleen, and left adrenal gland. About 42,000 new cases are diagnosed each year in the United states. Only 24% of these people will survive for 1 year; 4% will be alive after five years. Among persons diagnosed early, about 17% are alive after five years. 

  • The risk factors for pancreatic cancer include chronic pancreatitis and smoking. Other probable risk factors are obesity, diabetes mellitus, a high fat diet, an exposure to certain toxic chemicals. Tumors may develop in the head, body, or tail of the pancreas. 

15

Patient Teaching Pancreatitis

  • Your prescribed diet (usually bland, high carbohydrate, low fat) will avoid stimulating your pancreas and will promote healing. 
  • At first, you may tolerate small, frequent meals better than large meals. 
  • Abstaining from alcohol and tobacco decreases your risk for recurrence. 
  • Community resources such as Alcoholics Anonymous can assist if it is hard for you to abstain from drinking alcohol. 

16

 Cholangiography

Test, Patient Preparation, Post Procedure Nursing Care

  • test- T Tube, IV, percutaneous transhepatic, surgical, magnetic resonance cholangiopancreatography. All provide images of hepatic and biliary duct to detect abnormalities. A contrast agent may be injected.
  • before-Dye precautions. Food and fluids should be withheld as ordered. The patient is usually NPO after midnight before the study. A laxative may be also ordered the night before. The test takes 4 to 6 hours. 
  • after-Die precautions. A fatty meal helps to illuminate die. If used after percutaneous transhepatic: geography, watch for signs of bleeding and respiratory distress. 

17

Endoscopic Retrograde Cholangiopancreatography

Test, Patient Preparation, Post Procedure Nursing Care

  • Endoscopic retrograde cholangiopancreatography visualize his pancreatic hepatic in common bile duct and ampulla of vater.
  • NPO for 6 - 8 hours or agency protocol. If ordered give the patient a sedative shortly before the examination. Dentures and eyewear will need to be removed. Inform the patient that the scope will not interfere with breathing. ERCP requires dye so implement general dye precautions, ask if patient is allergic to dye, iodine, or seafood. If yes inform radiology in advance
  • The patient should be NPO until the gag reflex returns. Monitor for signs of trauma; bleeding from the throat or rectum. Monitor for signs of perforation; fever, Domino distention, cramping pain, and vague discomfort. The patient may have belching or flat ones. Tell the patient that sore throat could be treated with warm Gargus or ice pack to the neck. The patient should contact the physician in the event of severe pain, fever, dyspnea, or hematemesis. 

18

PT and INR

prothromnin time and international normalized ratio

  • Prothrombin time and international normalized ratio, measures clotting ability. Prolonged with liver disease, vitamin K deficiency, anticoagulant therapy. 
  • Non-fasting. If patient is on warfarin, octane specimen before daily dose. Those may be adjusted pending test results. 
  • Monitor vina puncture site, apply pressure. Patient with liver disease may have prolonged clotting time. Check results; nurses should know these values; PT 11.0 to 14 seconds INR 0.8 to 1.1 seconds immediately report PT above 46 seconds or INR equal or greater than f5.

19

Types of Hepatitis – Key Features of Each Type of Viral Hepatitis

A, B, C, D, E – Transmission Route and Prevention

20

Medical Treatment (cirrhosis) 

  • The goal of medical treatment for cirrhosis or to limit deterioration of liver function and to prevent complications, but no specific medical treatment exist. 
  • Promote rest so that the liver can regenerate. 
  • The earlier the condition is diagnosed and measures are taken to promote healing, the better is the chance of recovery. 
  • Compensated cirrhosis is manage with treatment of any underlying diseases, avoidance of liver toxins, and monitoring four varises and liver cancer. 
  • If the patient is in liver failure, bedrest is usually ordered. 
  • Mount nutrition is common, and specific diet depends on individual patient factors. A diet high in calories, carbohydrates, and vitamins is typically ordered. 
  • In the past protein was restricted to prevent encephalopathy caused by accumulation of ammonia. 
  • Supplement of iron maybe order, the amount of fat allowed in the diet varies with the patient's condition. Anorexia is a frequent problem with cirrhosis small semi solid or liquid meals may be better received. Enteral feedings maybe needed to provide adequate nutrients. 
  • Other treatments maybe order to correct complications. IV fluids maybe need it for electrolyte in balance is anemia may require blood transfusions water and soda more likely to be restricted in patients with severe fluid retention. 
  • Cathartics and anabiotic's maybe used for encephalopathy. Beta adrenergic blockers such as propranolol may be prescribed to reduce portal pressure. 
  • Albumin dialysis for patients with liver failure. The blood is filtered through a system that removes toxins and return the blood to the body. I'll be man is used because many toxic molecules including Billy Rubin bind with it. 
  • The dialysis supports patient while the liver recovers or serves as a temporary treatment while waiting for liver transplant. 

21

Liver transplantation 

  • The only possible cure for end-stage liver disease is liver transplantation. 
  • Transplantation is also appropriate for patient with cancer that is confined to the liver and for patients with certain congenital disorders. 
  • Most liver is come from deceased donors, as the use of living donor is controversial because of risks of infection, bile leakage, death to the donor. 
  • When a living donor is available a lobe transplanted. 
  • Hepatitis see patients are given antiviral drugs pre-and post op. 
  • Transplant patients have ET tube, wound drainage devices, nasal gastric tube, and central line for total parenteral nutrition. Mechanical ventilation is also used initially. 
  • Nursing assessments focus on neurologic status, vital signs, central venous pressure, respiratory status, and indicators of bleeding. 
  • If stable the patient is moved out of specialized unit after three or four days. Continue to monitor vital signs, I and o, neurologic status. 
  • Postop care including assistance with turning, coughing and deep breathing, progressively activity.
  • Lifelong immunosuppressive therapy will be required to prevent rejection of the donor liver. 
  • Signs and symptoms of rejection or fever, anorexia, depression, vague abdominal pain, muscle aches, and joint paint. 

22

Pharmacology capsule

  • Rifampin, phenobarbital, ketoconazole, and Saint johns wort enhance metabolism of amino suppressant, making them less effective than increasing the risk of graft rejection. 

23

Signs and symptoms of pancreatitis

  • Abdominal pain severe sudden onset in the left upper quadrant or the epigastric region that radiates to the back. 
  • Severe vomiting, Flushing, sinuses, and dyspnea. 
  • Low grade fever. Tacky piña. Tachycardia, and hypotension. 
  • Tender and distended abdomen, absent bowel sounds may suggest an ileus. 
  • Chips and may damage blood vessels causing pancreatic hemorrhage and discoloration of the abdomen. 
  • Symptoms of chronic pancreatitis or similar to a cute butt up here as periodic attacks that become more and more frequent. In addition may develop diabetes and malabsorption with steatorrhea

24

Pancreatic complications 

  • Pseudo cyst, abscess, hypercalcemia, and pulmonary, cardiac, and renal complications. 
  • Pseudo cyst is a fluid filled pouch attached to the pancreas. Symptoms include abdominal pain, nausea, vomiting, and anorexia. 
  • Necrosis within the pancreas can lead to pancreatic abscess a fluid filled cavity in the pancreas symptoms are similar to those of pseudo cyst with a high fever. 
  • Hypocalcemia is caused by the action of fatty acids on calcium and increased loss of calcium in the urine.
  • Pulmonary complications or pneumonia and atelectasis. 
  • Pancreatic can be fatal in the early stage of acute pancreatitis cause of death is usually cardiovascular, Reno, or pulmonary failure. Later, sepsis and absences are the leading causes of death. 

25

Medical diagnoses of pancreatitis

  • Acute pancreatitis or elevated serum amylase, lipase, and urinary amylase levels.
  • Elevated WBC count serum lipid and glucose levels, decreased serum calcium level. 
  • Ultrasound an ERCP they revealed the presence of gallstones, cyst, or absences. 
  • Test include secretary stimulation test and fecal studies. Findings consistent with chronic pancreatitis or decrease volume and HCO3 concentration of pancreatic fluid, low serum trypsinogen and high fecal fat cotton.

26

Treatment of pancreatitis

  • NPO remove the stimulus for secretion of pancreatic fluid. 
  • If patient is vomiting or ileus is suspected nasogastric tube is inserted and connected to suction. 
  • I will forward our order to restore and maintain fluid balance. 
  • Blood or plasma expanders are given if the blood volume is low.
  • urine output is monitored and should be at least 40 ML per hour. 
  • Once food is permitted bland diet started high in carbs, low fat divided into frequent small meals. 
  • If oral cannot be tolerated nasal gastric or did you not feeding tube or TPN may be needed to provide adequate nutrients. 
  • Some doctors order prophylactic anabiotic's perry Tonio lavage or laprascopy is used to remove toxic fluid from the peritoneum. 
  • Drugs include analgesics, antispasmodic agents, anti-cholinergic agents, and gastric acid inhibitor's.
  • Opioids are avoided because they are thought to cause more spasms in the pancreatic duct. However the lauded or morphine is gaining favor because the pain relief last longer and spasms can be managed with anti-spasmodic drugs such as nitroglycerin. 
  • Anticholinergic decrease equations can also reduce spasm and pain.
  • For chronic pancreatitis acetaminophen, ibuprofen, or tramadol is trade initially if these non-opioid agents do not provide relief hydrocodone may be prescribed. 
  • Other options are endoscopic nerve block and dilation of ductal structures. 
  • Pancreatic enzymes to digest food may be taken with meals or snacks. 
  • Various surgical procedures may be indicated if gallstones are present for sphincterotomy followed by cholecystectomy may be done.
  • For abscesses and cyst or severe peritonitis the brain meant involves resection of necrotic tissue and irritation of the cavity to remove harmful fluid the procedure may be needed to be done more than once. 

27

Nursing care of the patient with pancreatitis

  • Watch for signs of hypovolemic shock; restlessness, tachycardia, tachypnea, hypotension, and decreased urinary output. 
  • Abdomen should be inspected for discoloration, distention, tenderness, and diminished bowel sounds. 
  • The flanks should be also examined for discoloration
  • in addition to the patient's mental status should be monitored.
  • Altered mental status may be result of metabolic and balances. Confusion and agitation may occur in the patient who abuses alcohol because of withdrawal.