Test 4

Which is an indicator of neurovascular compromise?

Capillary refill of more than 3 seconds

Which term refers to muscle tension being unchanged with muscle shortening and joint motion?term-65

Isotonic contraction

Which of the following medications would the nurse expect the physician to order for a client with cirrhosis who develops portal hypertension?

Kanamycin (Kantrex) For portal hypertension, a diuretic usually an aldosterone antagonist such as spironolactone (Aldactone) is ordered. Kanamycin (Kantrex) would be used to treat hepatic encephalopathy to destroy intestinal microorganisms and decrease ammonia production. Lactulose would be used to reduce serum ammonia concentration in a client with hepatic encephalopathy. Cyclosporine (Sandimmune) would be used to prevent graft rejection after a transplant.

How to we decrease Ammonia

Low protein diet

Metabolic Abnormalities

Many endocrine abnormalities occur R/T liver can't properly metabolize hormones -gyno -amenorrhea -testicular atrophy -pubic hair loss -menstrual irregularities -disturbed sexual function

Cirrhosis 3 types

-chronic; replacement of normal liver tissue with diffuse fibrosis that disrupts the anatomy & physiology of the liver. 1. Alcoholic ---most common, scar tissues surrounds the portal areas 2. Postnecrotic -broad bands of scar tissue--late manifestation of prior case of acute viral hepatitis 3. Biliary--much less common, scarring around the bile ducts, usually caused by chronic biliary obstruction & infection

Viral Hepatitis

-most common type 5 types A&E are transmitted via fecal oral route B,C,D blood

Lupus

-red butterfly rash on face

Osteoarthritis (OA)

A type of arthritis that occurs when flexible tissue at the ends of bones wears down. Single joint effected Causes: Age, repetition injury, heredity -Women more susceptible, Hispanic, AA Diagnosis: X-ray, Arthrocentesis, Arthroscopy, symptoms Treatment: meds, epidural injections, PT, rest, surgery

Liver Anatomy

4 Lobes Hepatocytes- liver cells Kupffer's Cells-phagocytes Hepatic Duct + cystic duct=common bile duct Sphincter of Oddi

How many days must local communities be prepared to act in insolation and provide competent care before Federal and or State resources become available?

5 Days

A client is suspected of having cirrhosis of the liver. What diagnostic procedure will the nurse prepare the client for in order to obtain a confirmed diagnosis?

A liver biopsy

Which is a circulatory indicator of peripheral neurovascular dysfunction?

Cool skin

A nurse is taking health history data from a client. Use of which of the following medications would especially alert the nurse to an increased risk of hepatic dysfunction and disease in this client? Select all that apply.

A. Acetaminophen B. Ketoconazole C. Valproic acid

Know the levels of PPE

A: SCBA vapor tight chemical resistant suit gloves and boots B: high level of SCBA, less skin and eye protection, chemical resistant suit C: air purified respirator, coverall with splash hood, chemical resistant gloves and boots D: typical work uniform

When reading a client's chart, the nurse notices that the client is documented to have paresthesia. The nurse plans care for a client with:?

Abnormal sensations

What intervention does the nurse anticipate providing for the patient with ascites that will help correct the decrease in effective arterial blood volume that leads to sodium retention?

Albumin infusion

A nurse is assessing a client who has a diagnosis of RA. Which of the following nonpharmacological interventions should the nurse suggest to the client to reduce pain?

Alternate application of heat and cold to the affected joints.

Considered the major culprit in encephalopathy development

Ammonia

What enzyme changes in acute Pancreatitis

Amylase

The nursing educator is reviewing the signs and symptoms of heat stroke with a group of nurses who provide care in a desert region. The educator should describe what sign or symptom?

Anhidrosis

A patient has had a laparoscopic cholecystectomy. The patient is now complaining of right shoulder pain. What should the nurse suggest to relieve the pain?

Application of heat 15 to 20 minutes each hour

The nurse completing a plan of care for a client with cirrhosis who has ascites and 4+ pitting edema of the feet and legs identifies a nursing diagnosis of risk for impaired skin integrity. Which nursing intervention is appropriate for this problem?

Arrange for a low air loss bed

Which is useful in identifying acute or chronic tears of the joint capsule or supporting ligaments of the knee, shoulder, ankle hip, or wrist?

Arthrography

The nurse is caring for a patient with cirrhosis of the liver and observes that the patient is having hand-flapping tremors. What does the nurse document this finding as?

Asterixis

Which of the following would the nurse expect to assess in a client with hepatic encephalopathy?

Asterixis

A nurse is creating a care plan for a patient with acute pancreatitis. The care plan includes reduced activity. What rationale for this intervention should be cited in the care plan?

Bed rest lowers the metabolic rate and reduces enzyme production.

Physical Injuries After Blast Events

Blast Lung Tympanic Membrane Rupture Abdominal and Head Injuries

Liver transplant immediate complications

Bleeding, infection, & rejection -post transplant Dietary changes: no alcohol, no salt, and weight management

Osteomyelitis

Bone infection, usually caused by bacteria -Most cases are caused by Staphylococcus aureus 70-80% Multiple modes of entry into bone. Symptoms: fever, pain, swelling soreness, warm to touch Treatment: Abx, drainage of abscess

Liver Fat metabolism

Breaks down fatty acids-ketones produced--usually in starvation or uncontrolled diabetes

Hepatic encephalopathy

CNS dysfunction frequently associated with elevated ammonia levels that produce changes in mental status, altered level of consciousness, and coma

What term refers to a grating or crackling sound or sensation?

Crepitus

Emergency operations plan Essential components

Data management strategy Demobilization response After-action report or corrective plan Plan for practice drills Anticipated resources MCI planning Education for all the above

The nurse working in the ED receives a call from the x-ray department communicating that the client the nurse is caring for has a fracture in the shaft of the tibia. The nurse tells the physician that the client's facture is in the_______

Diaphysis----which is primarily cortical bone.

Which of the following the are early manifestations of liver cancer?

Early manifestations of liver cancer include pain and continuous dull aching in the right upper quadrant epigastrium or back. Weight loss, anorexia, and anemia may occur. Jaundice is present only if the larger bile ducts are occluded by the pressure of malignant nodules in the hilum of the liver. Fever and vomiting are not associated manifestations.

Jaundice

Elevated level of bilirubin in blood from either bile duct obstruction or excessive RBC destruction -serum level >2.5mg/dL

What test should the nurse prepare the client for that will locate stones that have collected in the common bile duct?

Endoscopic retrograde cholangiopancreatography (ERCP)

A patient is receiving care in the intensive care unit for acute pancreatitis. The nurse is aware that pancreatic necrosis is a major cause of morbidity and mortality in patients with acute pancreatitis. Consequently, the nurse should assess for what signs or symptoms of this complication?

Fever, increased heart rate and decreased blood pressure

Ankylosing Spondylitis (AS)

Genetic cell marker HLA B27 Ankylosing: Fusing together Spondylitis: inflammation of the vertebrae. -painful, progressive, rheumatic disease, can effect other areas(eyes, heart, ribs). -inflammation, new bone develops ------->restricted movement, inflammation---fusing together of bone -More common in men, late teens and twenties Symptoms: slow/gradual onset back pain and stiffness over weeks or months. Early morning same that goes away with exercise

Liver Glucose Metabolism

Glucose to glycogen Gluconeogenesis -liver takes AA from protein breakdown or lactate produced by muscle movement and converts it into glucose in response to hypoglycemia

Emergency Operations Plan

Health care facilities are required by The Joint Commission to create a plan for emergency preparedness and to practice this plan twice a year essential components of the plan: Activation response Internal and external communication plan Plan for coordinated patient care Security plans Identification of external resources Plan for people management and traffic flow

Portal HTN

Increased BP in portal veins -most common cause is cirrhosis b/c scarred tissue blocks veins Main S/S gi bleed, hemoptysis, ascites, encephalopathy, lower platelets or WBCs

Jaundice types

Hepatocellular (hepatitis) -serum bilirubin and urine urobilinogen elevated, AST and ALT levels elevated indicating cellular necrosis Obstructive (bile duct) -flow goes back into the liver and reabsorbed in the blood; urine is deep orange and foamy, stool light or clay colored -AST, ALT and GGT moderately elevated, Bilirubin and alkaline phosphate elevated

A patients abdominal ultrasound indicates cholelithiasis. When the nurse is reviewing the patients laboratory studies, what finding is most closely associated with this diagnosis?

Increased bilirubin

Biological weapons: Anthrax

Incubation 1-6 days Skin contact, GI ingestion, inhalation Skin lesions, fever, n/v, abd pain, diarrhea Respiratory symptoms that mimic flu Treatment= PNC V, Erythrocin

A client is actively bleeding from esophageal varices. Which medication would the nurse most expect to be administered to this client?

Octreotide

The nurse is conducting a musculoskeletal assessment of a client in a nursing home. The client is unable to dorsiflex the right foot or extend the toes. The nurse evaluates this finding as an injury to which nerve?

Peroneal

A patient with chronic pancreatitis had a pancreaticojejunostomy created 3 months ago for relief of pain and to restore drainage of pancreatic secretions. The patient has come to the office for a routine postsurgical appointment. The patient is frustrated that the pain has not decreased. What is the most appropriate initial response by the nurse?

Pain relief occurs by 6 months in most patients who undergo this procedure, but some people experience a recurrence of their pain.

The nurse is teaching a client who was admitted to the hospital with an acute hepatic encephalopathy and ascites about an appropriate diet. Nurse Determines that the teaching has been effective when the client chooses which food choices from the menu?

Pancakes with butter and honey, and orange juice Explanation: teach clients to select a diet high in carbohydrates with protein intake consistent with liver function. The client should identify foods high in carbohydrates and within protein requirements (moderate to high protein in cirrhosis and hepatitis, low protein and hepatic failure) the client with acute hepatic encephalopathy is placed on a low protein diet to decrease ammonia concentration. The other choices are high in protein. Clients ascites indicates that a low sodium diet is needed, and the other choices are all high in sodium.

Pancreas

Secretes digestive enzymes Amylase digests Carbs Trypsin digests Protein Lipase digests Fats -Secretin stimulates bicarb secretion from pancreas -CCK stimulates release of secretin

Perfusion to the liver

Portal vein Hepatic Artery

The nurse is caring for a client with cirrhosis. Which assessment findings indicate that the client has deficient vitamin K absorption caused by this hepatic disease?

Purpura and petechiae

Which liver function study is used to show the size of the liver and hepatic blood flow and obstruction?

Radioisotope liver scan

The nurse is preparing a care plan for a client with hepatic cirrhosis. Which nursing diagnoses are appropriate? Select all that apply.

Risk for injury related to altered clotting mechanisms Disturbed body image related to changes in appearance, sexual dysfunction, and role function Activity intolerance related to fatigue, general debility, muscle wasting, and discomfort

What lab study indicates the rate of bone turnover?

Serum osteocalcin (bone GLA protein) indicated the rate of bone turnover. -healing process

What position do we place the patient for a Paracentesis surgery

Sitting up right, this facilitates pooling of flood for easier drainage.

A patient is brought to the ED by ambulance with a gunshot wound to the abdomen. The nurse knows that the most common hollow organ injured in this type of injury is what?

Small bowel

Dietary management Hepatitis

Small frequent meals, refrain from alcohol use for 6 months after recovery.

The nurse is concerned about potassium loss when a diuretic is prescribed for a patient with ascites and edema. What diuretic may be ordered that spares potassium and prevents hypokalemia?

Spironolactone (Aldactone)

What term refers to an injury to ligaments and other soft tissues surrounding a joint?

Sprain

A patient with severe chronic liver dysfunction comes to the clinic with bleeding of the gums and blood in the stool. What vitamin deficiency does the nurse suspect the patient may be experiencing?

Vitamin K deficiency

Pancreatitis Clinical Manifestations

Steatorrhea---foul smelling stool from high fat content

Rheumatoid Arthritis

Swollen inflamed Synovial membrane Immune system response promotes inflammation in the joints Progressive illness that has potential to cause joint destruction and functional disability. Can be genetics, viral response, injuries that occur. -May see an increase in Creatinine, erythrocyte count, ESR, hematocrit Medical management: no cure -goal is to reduce inflamm. maximize joint function, prevent joint destruction and deformity -ASA, corticosteroids -Methotrexate(DMARDS)--suppresses autoimmune response Splints, canes etc to support for ambulation

Gout: Metabolic Disorder

Systemic disease -build of uric acid in the joints Causes: diet high in rich foods (red meat, cream sauces, red wine) Foods high in purine Treatment: Anti-inflammatories -corticosteroids Diet: avoid alcohol, avoid rich food, drink water, exercise regularly

S(T)rain

Tendon

What has similar initial signs and symptoms of Anthrax infection

The Flu

The nurse is completing a morning assessment of a client with cirrhosis. Which information obtained by the nurse will be of most concern?

The client's hands flap back and forth when the arms are extended (Asterixis)

A nurse is caring for a client with cirrhosis. The nurse assesses the client at noon and discovers that the client is difficult to arouse and has an elevated serum ammonia level. The nurse should suspect which situation?

The client's hepatic function is decreasing.

Ammonia, the major etiologic factor in the development of encephalopathy, inhibits neurotransmission. Increased levels of ammonia are damaging to the body. The largest source of ammonia is from:

The digestion of dietary and blood proteins

A patient is scheduled for a diagnostic paracentesis, but when coagulation studies were reviewed, the nurse observed they were abnormal. How does the nurse anticipate the physician will proceed with the paracentesis?

The physician will use an ultrasound guided paracentesis

A nurse is caring for a patient who has been scheduled for endoscopic retrograde cholangiopancreatography (ERCP) the following day. When providing anticipatory guidance for this patient, the nurse should describe what aspect of this diagnostic procedure?

The use of moderate sedation

Disaster response levesl

Type 1 National Type 2 State Type 3 Metropolitan Type 4 City, county or fire district level Type 5 Local village or township

Which nerve is assessed when the nurse asks the client to spread all fingers?

Ulnar

Biological weapons: Smallpox

Virus, incubation 12 days Extremely contagious, spread by direct contact No known cure

A nurse is providing education to a client who is at risk for osteoporosis. Which of the following instructions should the nurse include?

Walk for 30 minutes four times per week.

Condition that indicates an overdose of Lactulose?

Watery diarrhea

In the presence of esophageal varices and an intact blakemore, how do keep the airway patent?

We provide oral and nares care

When do we report to a provider regarding Cirrhosis

When there is change in mental status

A student accepted into a nursing program must begin receiving the hepatitis B series of injections. The student asks when the next two injections should be administered. What is the best response by the instructor?

You must have the second one in 1 month and the third in 6 months

A client with end stage liver disease is scheduled to undergo a liver transplant. The client tells the nurse, "I am worried that my body will reject the liver." Which statement is the nurses best response to the client?

You will need to take a daily medication to prevent rejection of the transplanted liver. The new liver has a good chance of survival with the use of these drugs.

xenograft

a graft from another species

Ascites

abnormal accumulation of albumin-rich fluid in the abdomen

Liver Ammonia Conversion

by-product of AA gluconeogenesis or from bacteria in intestines is converted to urea for urine excretion

The nurse is caring for a client scheduled to have magnetic resonance imaging. The nurse contacts the health care provider to cancel the MRI when the nurse reads which element in the client's medical history?

cochlear implant

Sphincter of Oddi

controls the flow of bile into the small intestine

The nurse is creating a teaching plan about preventing osteoporosis for a 65 year old client. The nurse should include which topics in the teaching plan?

daily intake of 1000 IU vitamin D, increased consumption of fish, increased consumption of low-fat milk

Laparoscopy

examination of contents of abdomen using guided biopsy, determine cause of aseities; dx & stage tumors

Hepatic encephalopathy

hepatic insufficiency may leak to encephalopathy due to livers inability to detoxify toxic by-products of metabolism

Cirrhosis Compenstated

less sever, often vague s/s, may be incidental finding

Cirrhosis Decompensated

liver fails to synthesize proteins, clotting factors, & other substances, & presents with S/S of portal HTN---ascites, varices, & hepatic encephalopathy

liver protein metabolism

makes plasma proteins: albumin, alpha & beta globulins, clotting factors, transport proteins and most plasma lipoproteins Liver needs vit. K to be able to produce prothrombin and other clotting factors

A client who was recently diagnosed with carcinoma of the pancreas and is having a procedure in which the head of the pancreas is removed. In addition, the surgeon will remove the duodenum and stomach, redirecting the flow of secretions from the stomach, gallbladder, and pancreas into the middle section of the small intestine. What procedure is this client having performed?

radical pancreatoduodenectomy

The nurse is conducting a musculoskeletal assessment on a client documented to have rheumatoid arthritis. Which would the nurse anticipate finding when inspecting the client's fingers?

soft, subcutaneous nodules along the tendons

Liver Biopsy

to evaluate diffuse disorders Complications: peritonitis