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?

<p>Circulatory collapse (C)</p> Signup and view all the answers

What is a common early sign of hepatic encephalopathy?

<p>Altered mental status (B)</p> Signup and view all the answers

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

<p>Active immunity (C)</p> Signup and view all the answers

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

<p>Liver (B)</p> Signup and view all the answers

What is a primary risk factor for contracting Hepatitis B?

<p>Close contact with infected individuals (A)</p> Signup and view all the answers

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

<p>Endoscopic Retrograde Cholangiopancreatography (ERCP) (A)</p> Signup and view all the answers

What is a common symptom that gallstones can produce?

<p>Epigastric distress and fullness (B)</p> Signup and view all the answers

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

<p>Sitting upright or using a heating pad may relieve discomfort. (B)</p> Signup and view all the answers

Which of the following is a cause of pancreatitis?

<p>Gallstones (B)</p> Signup and view all the answers

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

<p>NPO (nothing by mouth) (B)</p> Signup and view all the answers

Which symptom is associated with jaundice and gallstones?

<p>Steatorrhea and gray-colored stools (C)</p> Signup and view all the answers

What is a potential complication of cholecystectomy that requires monitoring?

<p>Peritonitis (B)</p> Signup and view all the answers

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

<p>Elevated cholesterol levels (C)</p> Signup and view all the answers

What is a characteristic feature of compensated cirrhosis?

<p>Normal functioning liver despite damage (D)</p> Signup and view all the answers

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

<p>Purple or red splotches on the skin (C)</p> Signup and view all the answers

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

<p>Avoid high-fat foods and heavy meals (C)</p> Signup and view all the answers

Which laboratory result would indicate liver dysfunction in a patient?

<p>Increased ammonia levels (A)</p> Signup and view all the answers

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

<p>Hepatic encephalopathy (A)</p> Signup and view all the answers

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

<p>Small, frequent meals (A)</p> Signup and view all the answers

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

<p>Semi-fowler's position (A)</p> Signup and view all the answers

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

<p>To minimize complications from bile salt irritation. (D)</p> Signup and view all the answers

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

<p>Glaucoma (C)</p> Signup and view all the answers

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

<p>Pilocarpine (A), Carbachol (B)</p> Signup and view all the answers

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

<p>Bronchospasm (A)</p> Signup and view all the answers

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

<p>Retinal detachment (B)</p> Signup and view all the answers

What is the pathophysiological cause of Meniere's disease?

<p>Increased inner ear fluid (B)</p> Signup and view all the answers

What is the primary focus of palliative care?

<p>Symptom management and psychosocial/spiritual support (D)</p> Signup and view all the answers

Which of the following is a goal of palliative care?

<p>Assist with informed decision making (A)</p> Signup and view all the answers

What distinguishes hospice care from general palliative care?

<p>Focus on comfort at the end of life (A)</p> Signup and view all the answers

When should a palliative care consult team be called?

<p>When managing chronic conditions or new conditions needing symptom management (A)</p> Signup and view all the answers

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

<p>Cold and clammy skin in peripheral areas (B)</p> Signup and view all the answers

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

<p>Increased heart rate greater than 150 (A)</p> Signup and view all the answers

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

<p>Vasopressors after ensuring adequate fluid resuscitation (D)</p> Signup and view all the answers

What condition is NOT a recognized cause of shock?

<p>Anemia (B)</p> Signup and view all the answers

What characterizes multiple organ dysfunction syndrome (MODS)?

<p>At least two or more organs failing (A)</p> Signup and view all the answers

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

<p>Morphine (C)</p> Signup and view all the answers

What are common symptoms associated with cardiogenic shock?

<p>Tachycardia and hypotension (D)</p> Signup and view all the answers

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

<p>Controlling the underlying cause and improving cardiac function (B)</p> Signup and view all the answers

Which symptom does NOT indicate worsening metabolic acidosis?

<p>Increased urine output (D)</p> Signup and view all the answers

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

<p>Controlling the initiating event and promoting adequate organ perfusion (C)</p> Signup and view all the answers

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

<p>12-lead ECG and hemodynamic markers (D)</p> Signup and view all the answers

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

<p>Decreased cardiac output and pulmonary edema (D)</p> Signup and view all the answers

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

<p>Blurry vision (B)</p> Signup and view all the answers

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

<p>Loss of vision in the center of the eye (A)</p> Signup and view all the answers

What is a critical aspect of managing retinal detachment?

<p>Immediate surgical intervention (B)</p> Signup and view all the answers

What is the primary goal of treatment for glaucoma?

<p>Reduce intraocular pressure (C)</p> Signup and view all the answers

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

<p>Meniere's disease (B)</p> Signup and view all the answers

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

<p>Hyperglycemia (A)</p> Signup and view all the answers

What is the primary cause of cardiogenic shock?

<p>Myocardial infarction (D)</p> Signup and view all the answers

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

<p>Continuous hemodynamic monitoring (C)</p> Signup and view all the answers

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

<p>Arrhythmias (B)</p> Signup and view all the answers

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

<p>Pulmonary congestion (C)</p> Signup and view all the answers

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

<p>Endoscopic Retrograde Cholangiopancreatography (ERCP) (D)</p> Signup and view all the answers

What symptom is commonly associated with the presence of gallstones?

<p>Vague pain in the right upper quadrant (B)</p> Signup and view all the answers

What is an important management strategy for patients experiencing MODS?

<p>Providing nutritional support (A)</p> Signup and view all the answers

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

<p>Anuria (D)</p> Signup and view all the answers

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

<p>Peritonitis (D)</p> Signup and view all the answers

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

<p>Severe headache (A)</p> Signup and view all the answers

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

<p>Severe abdominal pain (C)</p> Signup and view all the answers

What physical examination finding can suggest gallstones?

<p>Referred pain to the right shoulder (A)</p> Signup and view all the answers

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

<p>Using a heating pad for relief (A)</p> Signup and view all the answers

Which factor is NOT considered a common cause of pancreatitis?

<p>Obesity (D)</p> Signup and view all the answers

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

<p>Low-fat diet (C)</p> Signup and view all the answers

What does compensated cirrhosis indicate about liver function?

<p>The liver is damaged but still performs essential tasks moderately well. (C)</p> Signup and view all the answers

Which symptom is commonly associated with decompensated cirrhosis?

<p>Clubbing (C)</p> Signup and view all the answers

What dietary changes should patients with cirrhosis focus on?

<p>Low sodium, moderate protein, high calorie, small frequent meals (C)</p> Signup and view all the answers

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

<p>Implement regular skin care and use lotion to minimize irritation. (B)</p> Signup and view all the answers

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

<p>Purpura or spontaneous bruising (B)</p> Signup and view all the answers

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

<p>Avoid heavy meals and alcohol consumption. (C)</p> Signup and view all the answers

Which laboratory test result is typically seen in decompensated cirrhosis?

<p>Increased AST/ALT (B)</p> Signup and view all the answers

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

<p>Semi-fowler's position (D)</p> Signup and view all the answers

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

<p>Diabetes Mellitus (C)</p> Signup and view all the answers

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

<p>Nausea and vomiting (C)</p> Signup and view all the answers

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

<p>Maintain skin integrity (B)</p> Signup and view all the answers

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

<p>No children or pregnant women should visit (C)</p> Signup and view all the answers

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

<p>Internal radiation therapy (C)</p> Signup and view all the answers

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

<p>Pancytopenia (A)</p> Signup and view all the answers

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

<p>Viscous lidocaine (D)</p> Signup and view all the answers

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

<p>High genetic predisposition (B)</p> Signup and view all the answers

What is the primary focus of hospice care?

<p>Quality of life and comfort at the end-of-life (C)</p> Signup and view all the answers

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

<p>Progressive stage (D)</p> Signup and view all the answers

What is NOT an objective of palliative care?

<p>Providing curative treatment options (B)</p> Signup and view all the answers

Which symptom is associated with the compensatory stage of shock?

<p>Cold and clammy skin with central warming (D)</p> Signup and view all the answers

What is a defining characteristic of irreversible shock?

<p>Permanent organ damage despite treatment (B)</p> Signup and view all the answers

What does the palliative care consult team assist with?

<p>Discussing goals of care and symptom management (B)</p> Signup and view all the answers

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

<p>Stable chronic condition with no changes (B)</p> Signup and view all the answers

What goal does palliative care NOT typically support for patients?

<p>Focusing solely on end-of-life preparations (D)</p> Signup and view all the answers

Flashcards

Gallstones: Diagnosis

Diagnosed using ERCP (Endoscopic Retrograde Cholangiopancreatography), ultrasound, cholangiogram, laparoscopy, and blood tests (cholesterol, pancreatic enzymes, liver function tests).

Gallstones: Symptoms

Symptoms can vary from no symptoms to severe pain, radiating to the back/shoulder, nausea, vomiting, jaundice, itching (pruritus), and changes in bowel movements. May include vitamin deficiencies (A, D, E, K).

ERCP (Endoscopic Retrograde Cholangiopancreatography)

Endoscopic procedure visualizing the biliary system (gallbladder and bile ducts) using a camera. Pre-procedure fasting is necessary, and patients receive sedation.

Pancreatitis: Cause

Obstruction of pancreatic ducts, leading to the backs of digestive enzymes into the pancreas and causing inflammation. Common causes: gallstones, alcohol abuse, malnutrition.

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Pancreatitis: Symptoms

Severe abdominal pain (often radiating to the back), tenderness, nausea, vomiting, fever, jaundice, and potential confusion. Abdomen may be rigid or show discoloration (ecchymosis).

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Laparoscopic Cholecystectomy

Surgical removal of the gallbladder, typically using minimally invasive laparoscopic techniques.

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Pancreatitis: Treatment

NPO (nothing by mouth), NGT (nasogastric tube) for stomach decompression, and pain management focus are crucial aspects.

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Post-op Cholecystectomy Care

Monitor for complications (bleeding/infection), vital signs, and provide education on low-fat diet, pain management, and activity.

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Monitor for Amylase and Lipase

Tracking the levels of enzymes that help diagnose potential pancreatic issues.

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Semi-Fowler's Position

A patient position that improves breathing by lessening pressure on the diaphragm.

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Cirrhosis (Compensated)

Liver damage with continued relatively normal liver function.

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Cirrhosis (Decompensated)

Liver damage where function is significantly impaired.

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Cirrhosis Assessment Labs

Blood tests (like AST/ALT, Ammonia, and PTT) and albumin to evaluate liver function and possible problems.

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Cirrhosis Nursing Management

Managing skin care, nutritional needs (low sodium, moderate protein, high calories), and complications of cirrhosis (like bleeding, fluid buildup).

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Cirrhosis Nutritional Support

Providing adequate nutrients through small, frequent meals with a focus on low sodium, moderate protein, and high calories, possibly with enteral or parenteral nutrition if needed.

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Discharge Teaching for Liver Disease

Instructing patients on avoiding high-fat foods, heavy meals, and alcohol, as well as teaching through the "teach-back" method.

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TIPS Procedure

A procedure to treat ascites by creating a shunt between the portal vein and the hepatic vein.

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Hepatic Encephalopathy Cause

Ammonia buildup due to severe liver damage or failure.

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Hepatic Encephalopathy Symptoms

Mental status changes, motor disturbances, mood swings, asterixis, and fector hepaticus (bad breath).

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Hepatic Encephalopathy Treatment

Lactulose to trap and eliminate ammonia via stool, monitored for side effects.

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Hepatitis B Transmission

Spread through blood, saliva, semen, vaginal secretions via broken skin/mucous membranes.

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Hepatitis B Risk Factors

Close contact with carriers, hemodialysis, and frequent exposure to blood/body fluids.

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Liver Disease Coagulation

Most blood clotting factors are produced in the liver.

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Hepatitis B Immunity

Active immunity (vaccine) and passive immunity (immune globulin) available.

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Palliative Care

A philosophy and system of care for individuals with serious, life-limiting illnesses, focusing on managing symptoms and providing psychosocial and spiritual support.

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Hospice Care

A specific type of palliative care that focuses on comfort care at the end of life. It emphasizes quality of life and realistic preparation for death.

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Palliative Care Goals

Identify the patient and family's goals of care, assist with informed decision making, and facilitate quality symptom management.

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When to Call Palliative Care

Contact palliative care for chronic or new conditions, discussions about goals of care, and symptom management in outpatient settings.

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Shock: Compensatory Stage

The initial stage of shock, where the body attempts to compensate for reduced blood flow. Symptoms include normal blood pressure, tachycardia, tachypnea, and cool extremities with warm central body temperature.

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Shock: Progressive Stage

The decompensating stage of shock, where the body's compensatory mechanisms fail. Symptoms include hypotension, increased heart rate, rapid and shallow breathing, crackles, and declining mental status.

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Shock: Irreversible Stage

The final stage of shock, where organ damage is extensive and recovery is unlikely. This stage is marked by multiple organ dysfunction and death.

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Shock: Causes

Shock can be caused by various factors, including hypovolemia, cardiac dysfunction, sepsis, anaphylaxis, and neurogenic impairment.

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Glaucoma

Increased pressure in the eye due to problems draining fluid (aqueous humor) or overproduction of this fluid. Can lead to vision loss and blindness if untreated.

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Glaucoma: Treatment

Aims to reduce pressure in the eye to prevent optic nerve damage. Uses medications like miotics (pilocarpine, carbachol) to constrict pupils and improve fluid drainage or drugs like acetazolamide and timolol to reduce fluid production.

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Macular Degeneration

A condition that gradually damages the center of the eye (macula), leading to blurry vision and potential blindness.

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Retinal Detachment

An emergency condition where the layers of the retina separate, allowing fluid to seep between them. This can cause vision loss and needs immediate medical attention.

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Meniere's Disease

Caused by an excessive amount of fluid in the inner ear, leading to symptoms like dizziness, ringing in the ears (tinnitus), and hearing loss.

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What is MODS?

Multiple Organ Dysfunction Syndrome (MODS) is a life-threatening condition where two or more organs fail simultaneously.

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What are common signs of MODS?

Common signs of MODS include dyspnea, respiratory failure, hyperglycemia, increased BUN (blood urea nitrogen), and other organ-specific symptoms.

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What are some key management strategies for MODS?

Managing MODS involves early detection, controlling the initiating event, supporting organ function, providing nutrition, and maximizing patient comfort.

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Cardiogenic Shock

Cardiogenic shock occurs when the heart fails to pump efficiently, even with adequate blood volume. This leads to reduced oxygen delivery to the heart and tissues.

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What are some common symptoms of Cardiogenic Shock?

Symptoms of cardiogenic shock include tachycardia, hypotension, oliguria, cool clammy skin, and tachypnea.

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What is the primary goal in managing Cardiogenic Shock?

The primary goal in cardiogenic shock management is to reduce further myocardial damage, preserve healthy myocardium, and improve cardiac function.

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What are some key medications used to manage Cardiogenic Shock?

Key medications used in cardiogenic shock include morphine, oxygen, dobutamine, aspirin, nitroglycerin, dopamine, and norepinephrine. Careful monitoring for arrhythmias is essential.

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What is the importance of delegation in the management of these conditions?

Delegation is crucial for managing complex, critically ill patients as it allows nurses to prioritize tasks and optimize patient care.

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Gallstones: Cause

Gallstones form when cholesterol or bilirubin crystals build up and harden in the gallbladder.

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Biliary Colic

Severe pain in the upper right abdomen that radiates to the back or right shoulder, often triggered by eating fatty foods.

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Decompression for Pancreatitis

A nasogastric (NG) tube is inserted to decompress the stomach and remove bile, preventing ulcers.

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Decompensated Cirrhosis

A severe stage of liver disease where the liver can no longer perform its essential functions effectively.

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Cirrhosis: Nutritional Needs

Patients with cirrhosis should follow a diet low in sodium, moderate in protein, and high in calories, with small, frequent meals.

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Cirrhosis: Potential Complications

Cirrhosis can lead to complications like bleeding, hepatic encephalopathy (brain damage), and fluid buildup (ascites).

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Cirrhosis: Education

Patients with cirrhosis should be educated on avoiding alcohol, preventing infections, and following a healthy diet.

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Monitor: Amylase and Lipase

These enzymes are monitored to assess pancreatic health and identify potential pancreatitis.

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Monitor: VS, I's and O's

Vital signs (VS), intake and output (I&O) are closely monitored for signs of fluid and electrolyte imbalances, particularly in patients with liver or pancreatic diseases.

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Improve Breathing in Liver/Pancreatic Patients

Positioning patients in semi-Fowler's position helps ease breathing by decreasing pressure on the diaphragm.

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Goals of Palliative Care

Palliative care aims to identify patient and family goals, facilitate informed decision-making, and manage symptoms.

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Shock

A life-threatening condition where the body's tissues and organs are not getting enough oxygen due to inadequate blood flow.

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Compensatory Stage of Shock

The initial stage of shock where the body attempts to compensate for reduced blood flow. Symptoms include normal blood pressure, increased heart rate, and rapid breathing.

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Progressive Stage of Shock

The decompensating stage of shock where the body's compensatory mechanisms fail. Symptoms include low blood pressure, rapid heart rate, and shallow breathing.

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Causes of Shock

Shock can be caused by various factors, including low blood volume, heart problems, infection, allergic reaction, and nervous system issues.

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Irreversible Stage of Shock

The final stage of shock where organ damage is extensive and recovery is unlikely.

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Liver Dysfunction & Coagulation

Damaged liver (cirrhosis, hepatitis, tumor) can't produce enough clotting factors, leading to bleeding risks.

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Cancer: External Radiation Therapy

High-energy rays target cancer cells, but can also harm healthy ones. Requires precise positioning and skin care.

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What are common side effects of external radiation?

Nausea, vomiting, gastritis, and mouth sores (stomatitis) are common side effects, especially when targeting the abdomen.

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Internal Radiation Therapy (Brachytherapy)

Radiation source placed inside the body, either for a short, high dose or a long, low dose.

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What are the safety rules for patients receiving brachytherapy?

Patients are radioactive, so visitors are limited, especially children or pregnant women. Wear dosimeter badges for safety.

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Cancer & Lab Values

Cancer impacts all cell lines, leading to low blood cell counts (pancytopenia). Medications like filgrastim can help.

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Palliative Care vs Hospice

Palliative care focuses on managing symptoms and providing support for any serious illness. Hospice care is specialized for end-of-life care.

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What is the goal of palliative care?

To determine the patient and family's goals of care, provide informed decision-making support, and manage symptoms.

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Acoustic Neuroma

A slow-growing, non-cancerous tumor on the eighth cranial nerve (vestibulocochlear nerve), which controls hearing and balance.

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MODS: What is it?

Multiple Organ Dysfunction Syndrome (MODS) is a serious condition where two or more organs fail at the same time.

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MODS: Common Signs

Some common signs of MODS are trouble breathing, respiratory failure, high blood sugar, and high BUN (a measure of kidney function).

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MODS: Management

Managing MODS involves early detection, controlling the initial problem, supporting organ function, providing nutrition, and making the patient comfortable.

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Cardiogenic Shock: What is it?

Cardiogenic shock occurs when the heart fails to pump blood effectively, even though there is enough blood volume. This leads to reduced oxygen delivery to the heart and other tissues.

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Cardiogenic Shock: Common Symptoms

Common symptoms include fast heart rate, low blood pressure, decreased urine output, cool and clammy skin, and rapid breathing.

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Cardiogenic Shock: Goal of Management

The main goal is to minimize further heart damage, protect healthy heart tissue, and improve the heart's function.

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Cardiogenic Shock: Medications

Common medications include morphine, oxygen, dobutamine, aspirin, nitroglycerin, dopamine, and norepinephrine. Careful monitoring for heart rhythm problems is essential.

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Delegation in Critical Care

Delegation is a key skill in managing complex and critical patients, allowing nurses to prioritize tasks and optimize patient care.

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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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