Unit 4

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Questions and Answers

What is the primary purpose of using a Transjugular intrahepatic portosystemic shunt (TIPS)?

To alleviate ascites (correct)

To facilitate liver transplant

To treat hypertension

To manage liver cancer

Which medication is primarily used to manage excess ammonia in hepatic encephalopathy patients?

Lactulose (correct)

Antifibrotics

Famotidine

Spironolactone

What lab test is most indicative of hepatic encephalopathy?

Complete blood count

Liver function tests

Serum ammonia levels (correct)

Coagulation profile

Which of the following is a potential complication of TIPS?

Circulatory collapse Signup and view all the answers

What is a common early sign of hepatic encephalopathy?

Altered mental status Signup and view all the answers

What type of immunity is provided by the Hepatitis B vaccine?

Active immunity Signup and view all the answers

Which of the following substances is critical for the synthesis of blood coagulation factors?

Liver Signup and view all the answers

What is a primary risk factor for contracting Hepatitis B?

Close contact with infected individuals Signup and view all the answers

Which diagnostic procedure uses fiberoptic technology to visualize the biliary system?

Endoscopic Retrograde Cholangiopancreatography (ERCP) Signup and view all the answers

What is a common symptom that gallstones can produce?

Epigastric distress and fullness Signup and view all the answers

What is a potential post-operative teaching point for a patient who has undergone a laparoscopic cholecystectomy?

Sitting upright or using a heating pad may relieve discomfort. Signup and view all the answers

Which of the following is a cause of pancreatitis?

Gallstones Signup and view all the answers

In the management of pancreatitis, what is a common initial dietary recommendation?

NPO (nothing by mouth) Signup and view all the answers

Which symptom is associated with jaundice and gallstones?

Steatorrhea and gray-colored stools Signup and view all the answers

What is a potential complication of cholecystectomy that requires monitoring?

Peritonitis Signup and view all the answers

What could indicate the presence of gallstones based on liver function tests (LFTs)?

Elevated cholesterol levels Signup and view all the answers

What is a characteristic feature of compensated cirrhosis?

Normal functioning liver despite damage Signup and view all the answers

Which of the following signs and symptoms are associated with decompensated cirrhosis?

Purple or red splotches on the skin Signup and view all the answers

What is the recommended lifestyle change for patients with liver issues regarding dietary habits?

Avoid high-fat foods and heavy meals Signup and view all the answers

Which laboratory result would indicate liver dysfunction in a patient?

Increased ammonia levels Signup and view all the answers

What is a common complication that nursing management should focus on for patients with cirrhosis?

Hepatic encephalopathy Signup and view all the answers

Which of the following interventions can help improve nutritional status in patients with cirrhosis?

Small, frequent meals Signup and view all the answers

To reduce pressure on the diaphragm for improved breathing, patients should be positioned in which way?

Semi-fowler's position Signup and view all the answers

What role does skin care play in the management of patients with cirrhosis?

To minimize complications from bile salt irritation. Signup and view all the answers

What condition is characterized by increased intraocular pressure due to inadequate drainage or overproduction of aqueous humor?

Glaucoma Signup and view all the answers

Which medication is used to constrict pupils and improve the outflow of aqueous humor in glaucoma treatment?

Pilocarpine Signup and view all the answers

What is a common side effect of beta blockers used in the treatment of glaucoma?

Bronchospasm Signup and view all the answers

In which condition does fluid seep between the layers of the retina, leading to detachment?

Retinal detachment Signup and view all the answers

What is the pathophysiological cause of Meniere's disease?

Increased inner ear fluid Signup and view all the answers

What is the primary focus of palliative care?

Symptom management and psychosocial/spiritual support Signup and view all the answers

Which of the following is a goal of palliative care?

Assist with informed decision making Signup and view all the answers

What distinguishes hospice care from general palliative care?

Focus on comfort at the end of life Signup and view all the answers

When should a palliative care consult team be called?

When managing chronic conditions or new conditions needing symptom management Signup and view all the answers

What is a characteristic symptom during the compensatory stage of shock?

Cold and clammy skin in peripheral areas Signup and view all the answers

Which of the following signs and symptoms is associated with the progressive stage of shock?

Increased heart rate greater than 150 Signup and view all the answers

What is an essential treatment measure in the progressive stage of shock?

Vasopressors after ensuring adequate fluid resuscitation Signup and view all the answers

What condition is NOT a recognized cause of shock?

Anemia Signup and view all the answers

What characterizes multiple organ dysfunction syndrome (MODS)?

At least two or more organs failing Signup and view all the answers

Which medication is primarily indicated to manage pain and anxiety in cardiogenic shock?

Morphine Signup and view all the answers

What are common symptoms associated with cardiogenic shock?

Tachycardia and hypotension Signup and view all the answers

What is a critical aspect of the management for preventing further myocardial damage?

Controlling the underlying cause and improving cardiac function Signup and view all the answers

Which symptom does NOT indicate worsening metabolic acidosis?

Increased urine output Signup and view all the answers

In cases of MODS, which of the following management strategies is crucial?

Controlling the initiating event and promoting adequate organ perfusion Signup and view all the answers

What should be continuously monitored to assess treatment efficacy in cardiogenic shock?

12-lead ECG and hemodynamic markers Signup and view all the answers

Which of the following represents potential complications of pulmonary dysfunction in metabolic acidosis?

Decreased cardiac output and pulmonary edema Signup and view all the answers

What is a common side effect associated with the use of carbonic anhydrase inhibitors for treating glaucoma?

Blurry vision Signup and view all the answers

Which of the following describes the primary pathophysiological aspect of macular degeneration?

Loss of vision in the center of the eye Signup and view all the answers

What is a critical aspect of managing retinal detachment?

Immediate surgical intervention Signup and view all the answers

What is the primary goal of treatment for glaucoma?

Reduce intraocular pressure Signup and view all the answers

What condition is primarily associated with an increased amount of fluid in the inner ear?

Meniere's disease Signup and view all the answers

Which of the following is a primary symptom indicating the presence of multiple organ dysfunction syndrome (MODS)?

Hyperglycemia Signup and view all the answers

What is the primary cause of cardiogenic shock?

Myocardial infarction Signup and view all the answers

Which treatment is considered essential in the management of cardiogenic shock?

Continuous hemodynamic monitoring Signup and view all the answers

What should be monitored closely when administering medications like nitroglycerin and dobutamine in cardiogenic shock?

Arrhythmias Signup and view all the answers

In the context of cardiogenic shock, what is a potential outcome of decreased stroke volume and cardiac output?

Pulmonary congestion Signup and view all the answers

Which diagnostic test employs fiberoptic technology to visualize the biliary system?

Endoscopic Retrograde Cholangiopancreatography (ERCP) Signup and view all the answers

What symptom is commonly associated with the presence of gallstones?

Vague pain in the right upper quadrant Signup and view all the answers

What is an important management strategy for patients experiencing MODS?

Providing nutritional support Signup and view all the answers

What is a critical sign that may indicate renal involvement in multiple organ dysfunction syndrome?

Anuria Signup and view all the answers

What is a primary complication to monitor after a laparoscopic cholecystectomy?

Peritonitis Signup and view all the answers

Which symptom is least likely to be associated with worsening metabolic acidosis?

Severe headache Signup and view all the answers

What is the primary symptom of pancreatitis that differentiates it from gallbladder issues?

Severe abdominal pain Signup and view all the answers

What physical examination finding can suggest gallstones?

Referred pain to the right shoulder Signup and view all the answers

Which treatment is commonly recommended post laparoscopic cholecystectomy to ease discomfort?

Using a heating pad for relief Signup and view all the answers

Which factor is NOT considered a common cause of pancreatitis?

Obesity Signup and view all the answers

What dietary change is often recommended during the management of pancreatitis?

Low-fat diet Signup and view all the answers

What does compensated cirrhosis indicate about liver function?

The liver is damaged but still performs essential tasks moderately well. Signup and view all the answers

Which symptom is commonly associated with decompensated cirrhosis?

Clubbing Signup and view all the answers

What dietary changes should patients with cirrhosis focus on?

Low sodium, moderate protein, high calorie, small frequent meals Signup and view all the answers

What is a critical nursing management task for patients experiencing skin breakdown due to cirrhosis?

Implement regular skin care and use lotion to minimize irritation. Signup and view all the answers

Which assessment finding would indicate a need for immediate intervention in a cirrhosis patient?

Purpura or spontaneous bruising Signup and view all the answers

Which of the following is part of the education/discharge teaching for a patient with pancreatitis?

Avoid heavy meals and alcohol consumption. Signup and view all the answers

Which laboratory test result is typically seen in decompensated cirrhosis?

Increased AST/ALT Signup and view all the answers

What patient positioning is recommended to improve breathing in patients with cirrhosis?

Semi-fowler's position Signup and view all the answers

Which condition is NOT typically associated with liver dysfunction leading to reduced coagulation factors?

Diabetes Mellitus Signup and view all the answers

What is a common side effect of external radiation therapy to the abdomen?

Nausea and vomiting Signup and view all the answers

What specific care should be taken to maintain during external radiation therapy?

Maintain skin integrity Signup and view all the answers

Which of the following is an important precaution for a patient undergoing internal radiation therapy?

No children or pregnant women should visit Signup and view all the answers

What type of cancer treatment involves high doses of radiation for a short period of time?

Internal radiation therapy Signup and view all the answers

What is a common lab finding associated with cancer that reflects a decrease in blood cells?

Pancytopenia Signup and view all the answers

Which of the following medications is commonly used to manage symptoms of stomatitis in cancer patients?

Viscous lidocaine Signup and view all the answers

Which of the following is a risk factor for developing cancer?

High genetic predisposition Signup and view all the answers

What is the primary focus of hospice care?

Quality of life and comfort at the end-of-life Signup and view all the answers

During which stage of shock would you expect to find hypotension and increased heart rate greater than 150?

Progressive stage Signup and view all the answers

What is NOT an objective of palliative care?

Providing curative treatment options Signup and view all the answers

Which symptom is associated with the compensatory stage of shock?

Cold and clammy skin with central warming Signup and view all the answers

What is a defining characteristic of irreversible shock?

Permanent organ damage despite treatment Signup and view all the answers

What does the palliative care consult team assist with?

Discussing goals of care and symptom management Signup and view all the answers

Which symptom is least likely to indicate the need for a palliative care consult?

Stable chronic condition with no changes Signup and view all the answers

What goal does palliative care NOT typically support for patients?

Focusing solely on end-of-life preparations Signup and view all the answers

Study Notes

Gallstones

Diagnosis (Dx): Endoscopic Retrograde Cholangiopancreatography (ERCP) visualizes the biliary system, including gallbladder and biliary ducts. NPO (nothing by mouth) several hours before, with moderate sedation.
Tests: Ultrasound, cholangiogram, laparoscopy, cholesterol levels (elevated), pancreatic enzymes (amylase and lipase), liver function tests (LFTs).
Symptoms (S/s): Gallstones can be silent or cause mild gastrointestinal symptoms. Epigastric distress, fullness, abdominal distension, right upper quadrant (RUQ) pain, radiating to the back/right shoulder. Biliary colic (pain, nausea, and vomiting after a large meal). Jaundice and itching (pruritus), changes in urine or stool color (steatorrhea, or gray-colored stool). Vitamin deficiencies (vitamins A, D, E, and K).
Physical exam: Referred pain to the right shoulder.
Treatment (Tx): Laparoscopic cholecystectomy.

Pancreatitis

Teaching: Upright posture (sitting or standing) helps. Heating pads are helpful. Splinting (using a pillow) supports the abdomen during coughing and breathing. If right shoulder or scapular pain occurs, use a heating pad (15-20 minutes hourly). Post-op: monitor for bleeding/infection, vital signs, and low-fat diet. Avoid high fat foods, heavy meals, alcohol.
Causes: Gallstones, alcohol abuse, malnutrition.
Symptoms (S/s): Severe abdominal pain, abdominal tenderness, back pain, decreased peristalsis, nausea and vomiting (N/V), fever, jaundice, mental confusion, rigid or board-like abdomen, ecchymosis (bruising) in the flank area, and agitation.

Cirrhosis

Compensated: Liver is damaged but functioning well. Symptoms may include abdominal pain, ankle swelling, firm liver, excessive gas, indigestion, and spider-like blood vessels.
Decompensated: Liver cannot function well. Symptoms may include purpura (easy bruising), ascites, clubbing of fingers, muscle wasting, weakness, jaundice, weight loss, and low blood pressure.
Assessment/dx: Labs (increased AST/ALT, ammonia, prolonged PTT, decreased albumin. Ultrasound, CT, MRI, liver scans.
Treatment/Care: Skin care, rest, nutritional support (low sodium, moderate protein, high calories, small frequent meals), hydration, prevention of complications (bleeding, hepatic encephalopathy, fluid imbalance).

Hepatitis B

Transmission: Blood, saliva, semen, vaginal secretions through broken mucous membranes.
Risk Factors: Close contact with carriers, blood transfusions, hemodialysis, frequent exposure to blood.
Immunity: Vaccination, Immune Globulin (for exposure).

Liver Disease

Pathophysiology: Liver synthesizes blood-clotting factors. Liver dysfunction reduces clotting factors.
Symptoms (S/s): May experience minor bleeding or significant bleeding after surgery/trauma.

Cancer

External Radiation Therapy: Exact positioning is essential, shields are used to protect healthy tissue.
Internal Radiation Therapy (Brachytherapy): High dose radiation for a short period or low dose over a longer period. The radiation source is placed within the patient.

Shock

Stages: Compensatory (initial) vs. Progressive.
Compensatory: Normal blood pressure, increased heart rate and breathing rate, cool clammy skin.
Progressive: Decreased blood pressure, rapid and shallow breathing, low heart rate, confusion, metabolic acidosis, jaundice.

Irreversible MODS

Symptoms: Worsening metabolic acidosis, pulmonary dysfunction leads to respiratory arrest and cardiac arrest (tachypnea, rapid shallow respirations, crackles, atelectasis, pulmonary edema, cool clammy skin, petechiae).
Treatment: Early detection, control of initial event, promotion of adequate organ perfusion, nutritional support, maximum comfort.

Cardiogenic Shock

Pathophysiology: Heart cannot effectively pump blood, despite adequate blood volume. Reduced oxygen supply to organs and tissues.
Symptoms (S/s): Tachycardia, hypotension, oliguria (<30 mL/hr), cool clammy skin, and tachypnea.
Treatment: fluids, mechanical assistance (intubation), 12-lead electrocardiogram, medications.

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Description

This quiz covers key concepts related to gallstones and pancreatitis, including diagnosis, symptoms, physical exams, and treatment options. It highlights important diagnostic tests like ERCP and ultrasound, as well as the significance of managing symptoms and potential complications. Test your knowledge on these common gastrointestinal conditions.