exam 3 N3416

Hepatic encephalopathy

Caused by liver cirrhosis use special diuretic to rid body lactulose to reduce serum ammonia levels. Goal: get 2-3 stools daily

clinical manifestations of cushings

Moon face Buffalo Hump Emotional disturbances Osteoporosis Obesity Abdominal Striae Muscle Weakness Amenorrhea Hypertension Adrenal tumor (disease) Thin, wrinkled skin Petechiae, Purpura Skin ulcers

Interventions for SIADH

loop diuretics vasopressin seizure precaution.

steroid issues

Addison disease: HYPO client must ADD on STONES S/S: extreme fatigue, dehydration, hypotension, shock, cyanosis, confusion, hyperpigmentation. Cushing syndrome: HYPER Client has CUSHION of STEROIDS AROUND THEM Client has CUSHION of STEROIDS AROUND THEM Commonly caused by long-term, high-dose use of the cortisol-like glucocorticoids

vasopressin + somatostatin + octreotide

Are used to decrease bleeding of esophageal varices

SIADH

HYPER too much ADH causes water retention low urine output fluid overload (hypervolemia) hypertension tachycardia hyponatremia

diabetes insipidus

HYPO S/S opposite of SIADH orthostatic hypotension

liver cancer

Hepatitis B= major cause hepatitis C= 3rd cause and most common reason for liver transplant. RN interventions: liver function test increase risk for surgery palliative care radiation therapy chemo percutaneous biliary drainage.

thyroid cancer

Tx: thyroidectomy, followed by hypocalcemia (chvosteks, trousseaus, circum-oral tingling) Caused by: occurs more in women, younger than 50 yo, exposure to radiation in infancy in childhood.

Acute and chronic cholecystitis

abdominal pain may radiate to R shoulder Acute: not as severe, no long duration. Caused by gallstones or by some type of trauma elevated bilirubin treatment: biliary acid (UDCA) Chronic: cell destruction, recurring attacks of pain

acute and chronic pancreatitis

acute: relieved quickly chronic: intermittent or constant slowly destroys pancreas S/S: severe upper abdominal and back pain, vomiting

liver failure

associated to diet, alcohol use and infection increased risk for bleeding thrombin and vitamin K OTC use: Tylenol, aleve.

ascites

edema in the abdominal cavity measure abdominal girth daily weights Jacquie's story (abdominal tapped to get fluid pulled from the abdomin

drug induced hepatitis

increased AST(ALT is viral) non viral, hepatitis G,GB

peritonitis

inflammation of the peritoneum associated with liver cirrhosis

how do you treat esophageal varices

occlude internal bleeding--> tamponade. vasopressin, somatostatin and ocreot to decrease bleeding

Hepatocellular carcinoma

primary liver cancer, primary liver tumors S/S: mild or severely ill lack of appetite nausea malaise fever chills

Octreotide (Sandostatin)

surpasses anterior pituitary gland and decreases GH levels. Used to treat excess GH

esophageal varices

swollen, varicose veins at the lower end of the esophagus

portal hypertension

the elevation of blood pressure within the portal venous system causes esophageal varices ascites HTN