Adult Health 2 Exam 3
What are the 4 things that make up the criteria to match donor to recipients?
1. Matching blood type 2. HLA typing (goal match as many of 6 as possible) 3. Panel of reactive antibodies (PRA) - used to determine LIKELIHOOD of reactivity to potential donor 4. Crossmatch - used to determine the EXISTENCE of antibodies in a particular donor
The nurse cares for a patient with Addison's disease who was involved in a MVA and is hospitalized for a fracture of the right femur. Which patient info is the most important to report to the HCP? A. BP change from 128/80 to 90/50 B. Development of a 1st degree block on the EKG C. Report of right femur pain of 7/10 D. Vesicular breath sounds auscultated over lung tissue
A BP change from 128/80 to 90/50 Patient is at risk for Addisonian crisis which can lead to shock, B and C are not life-threatening. D is expected. Physical manifestations of Addisonian Crisis are hypotension (possibly severe enough to cause shock), tachycardia, dehydration, hyperglycemia...PROFOUND SHOCK (looks like sepsis)
This patient wants to limit protein intake as able....
A patient with liver cirrhosis
What is pheochromocytoma?
A rare condition caused by an adrenal medulla tumor which causes an excess of catecholamines (epinephrine and norepinephrine)
Which conditions may cause pancreatitis? Select all that apply A. Gallstones B. Cystic fibrosis C. Alcohol abuse D. Isoniazid therapy E. Food contamination
A, B, C Pancreatitis is an inflammation of the pancreas. Gallstones and alcohol abuse are the causes of acute pancreatitis, while cystic fibrosis can cause chronic pancreatitis.
A hospitalized patient with acute pancreatitis has nausea, vomiting, epigastric pain and tachycardia. Labs shows elevated serum lipase levels. Which interventions would the nurse anticipate being prescribed for the pt? SATA A. Administer hydromorphone IV PRN for pain B. Administer IV fluids C. Insert a NG tube for suction D. Maintain pt in a supine position, with head of the bed flat E. Provide small frequent high-carb and high-calorie meals
A, B, C Patient should be flexed with knees up to relieve pain and side-lying with elevated HOB. Patient would be NPO to inhibit stimulation of pancreatic enzymes.
What are the manifestations of acute pancreatitis? SATA A. Severe, deep, piercing abdominal pain that is continuous B. Hypotension C. Grey Turner's Sign D. Steatorrhea E. Cullen's Sign F. Pain that is intermittent to constant G. Fever
A, B, C, E, G D and F are signs in Chronic Pancreatitis
The clinic nurse is taking VS on a patient who reports being fatigued every day and gaining weight lately despite not eating much. The nurse should also ask about which symptoms? SATA A. Cold intolerance B. constipation C. fever D. Menstrual irregularity E. Night sweats F. tachycardia
A, B, D These are signs of hypothyroidism. System effects are characterized by a slowing of the body processes (HYPO IS LOW AND SLOW). Symptoms include: decreased appetite, weight gain, constipation, distended abdomen, enlarged scaly tongue, cold skin, decreased sweating, arthralgia, lethargy, and anemia.
What are some manifestations of Ulcerative Colitis? SATA A. bloody diarrhea B. LLQ pain that is relieved with emptying bowel C. RLQ pain that is worse with food D. colicky abdominal pain E. nonbloody diarrhea F. cramping
A, B, D, F
ABCDE primary assessment of abdominal trauma?
A- airway B- breathing C- circulation (are they losing blood??? 40% BV loss is LIFE THREATENING) D- disability E- exposure
What patient is at greatest risk for developing colon polyps and colorectal cancer and should have a screening colonoscopy every three to four years? A. A patient with acromegaly B. A patient with prolactinomas C. A patient with hypopituitarism D. A patient with pituitary infarctions
A. A patient with acromegaly
Which laboratory value would the nurse expect to be decreased for a patient with acute pancreatitis? A. Calcium B. Serum lipase C. Serum amylase D. Serum triglycerides
A. Calcium Hypocalcemia is a complication of acute pancreatitis, which is characterized by decreased levels of calcium. Therefore decreased serum calcium is an abnormal finding in acute pancreatitis. Serum lipase, serum amylase, and serum triglycerides are ELEVATED in patients with acute pancreatitis.
Which clinical manifestation is seen with Addison's disease? A. Delusions B. Hypokalemia C. Hyperglycemia D. Truncal obesity
A. Delusions Addison's disease occurs due to the hypofunction of adrenal cortex. This hypofunction manifests as delusions, which occur due to decreased levels of glucocorticoids. Hypokalemia, hyperglycemia, and truncal obesity are clinical manifestations of Cushing syndrome that occur due to hyperfunction of the adrenal cortex.
Activity intolerance in a patient with hypothyroidism is related to which side effect? A. Fatigue B. Diarrhea C. Weight loss D. Nervousness
A. Fatigue Activity intolerance in a patient with hypothyroidism is related to weakness and fatigue. Patients with hyperthyroidism, not hypothyroidism, experience weight loss, diarrhea, and nervousness.
A nurse completes an assessment and notes that a patient's thyroid gland is enlarged. With which condition is this finding consistent? A. Goiter B. Fibroma C. Thyrotoxicosis D. Hyperthyroidism
A. Goiter Thyroid abnormalities consist of three basic forms: goiter (enlarged thyroid gland), hypothyroidism, and hyperthyroidism.
A patient with acute pancreatitis reports severe abdominal pain. Which medication would the nurse anticipate administering to alleviate the pain? A. Morphine B. Omeprazole C. Pancrelipase D. Acetazolamide
A. Morphine Morphine is an opioid analgesic that relieves acute, severe pain. Omeprazole is an antacid that decreases gastric acid secretion. Pancrelipase is a synthetic product used for pancreatic enzyme replacement in patients with chronic pancreatitis. Acetazolamide is a diuretic and is not effective in relieving pain.
Increased pressure in the abdominal cavity that can be caused by bleeding or visceral edema is what? What is the assessment finding? Measurement?
Abdominal compartment syndrome Assessment finding - decrease venous return, CO, & perfusion to kidneys Measurement - normal is 0 to 5 mmHg
What are the 8 labels on the last image in the Pancreas Disorders PowerPoint?
Abdominal pain PPI Chronic alcohol use Nausea/Vomiting NG Tube Gallstone or biliary obstruction Imaging for confirmation
A patient with too little cortisol and/or aldosterone presents to the ED with joint pain, irritability, hyperpigmentation on the skin, and salt cravings. What does this patient most likely have?
Addison's Disease (Think...they need to ADD SALT (and ADD cortisol/aldosterone)
A patient presented to the ED with burning abdominal pain after eating, rebound tenderness, and stated they vomited coffee-ground-like material at home. What does this patient most likely have?
An upper GI bleed Pain onset as related to eating may indicate location of ulcer Rebound tenderness or involuntary guarding is indicative of peritoneal irritation
What would you want to teach a patient with liver cirrhosis?
Avoid NSAIDs & tylenol, eliminate or limit alcohol intake, and reduce sodium intake
A patient with primary hypothyroidism has been taking levothyroxine for years. Labs today are showing high levels of TSH. Which statement by the nurse to the patient is appropriate? A. A new prescription will likely be issued for a decreased dose of levothyroxine B. Dosages of levothyroxine may need to be increased to improve TSH levels C. Levothyroxine should be held, and the TSH levels will be reassessed in 3mo D. Start taking your levothyroxine with a dietary fiber or calcium to increase effectiveness
B In hypothyroidism the thyroid cannot produce enough T3 and T4, and TSH is high. Levothyroxine should reduce TSH via neg feedback. Levothyroxine should never be stopped abruptly and it has to be taken on an empty stomach.
The ED nurse cares for a patient admitted with a diagnosis of HHS. The nurse understands which characteristics are commonly associated with this complication? SATA A. abdominal pain B. blood glucose level >600mg/dL C. history of type 2 DM D. Kussmaul respirations E. Neurological manifestations
B, C, E Hyperglycemia hyperosmolar state (HHS) is characterized by uncontrolled hyperglycemia (>600 mg/dL) that induces hyperosmolar state and dehydration without significant ketoacidosis. It is more common in patients with type 2 DM. Patients with HHS may have a wide variety of focal.global neuro changes present. (Might think it's a stroke until glucose levels are checked)
The nurse cares for a patient admitted to the hospital due to confusion. The patient has a non-metastatic lung mass and a diagnosis of SIADH. Which action(s) should the nurse expect to implement? SATA A. Fluid bolus normal saline B. Fluid restriction C. Salt restriction in the diet D. Seizure precautions E. Strict record of I/O
B, D, E Confusion is a sign of hypoNa+ and can lead to seizure
Which clinical manifestations would the nurse assess in a patient with hyperthyroidism? SATA A. Enlarged, scaly tongue B. A positive bruit upon auscultation of the thyroid gland C. Dry, thick, inelastic, and cold skin D. A goiter E. Clubbing of the fingers
B, D, E In a pt with hyperthyroidism, auscultation of the thyroid gland reveals bruits and palpation of the thyroid gland reveals goiter, and the nurse may observe the acropachy (clubbing of the digits). Enlarged, scaly tongue and dry, thick, inelastic, and cold skin are observed in patients with hypothyroidism.
Which laboratory results would confirm overt hyperthyroidism? SATA A. Elevated TSH level B. Elevated T3 level C. Low free t4 level D. Elevated free T4 level E. Low TSH level
B, D, E Low T4 levels and elevated TSH levels are found with hypothyroidism
Which syndrome would be suspected in a patient with Addison's disease and other endocrine conditions? A. Hashimoto's thyroiditis B. Autoimmune polyglandular syndrome C. Multiple endocrine neoplasia D. Syndrome of inappropriate antidiuretic hormone (SIADH)
B. Autoimmune polyglandular syndrome Addison's disease is an autoimmune disorder caused by the destruction of adrenal tissue by antibodies. When it occurs along with other endocrine disorders. Addison's disease
Which term is used for the substance made of cholesterol crystals and calcium salts found in a patient with pancreatitis? A. Apraxia B. Biliary sludge C. Biliary atresia D. Pancreatic abscess
B. Biliary sludge Mixture seen in patients with bile salts.
Which finding for a patient with pancreatitis is termed Grey Turner's sign? A. Jaundice of the sclera B. Bluish discoloration of the flank area C. Bluish discoloration of the periumbilical area D. Left abdominal pain that occurs with movement
B. Bluish discoloration of the flank area The Grey Turner's sign includes a bluish discoloration, or ecchymosis, on the left or right flank area, the result of internal bleeding caused by pancreatitis.
The nurse prepares to administer a dose of radioactive iodine to a 39yo patient with Grave's disease. Which action is most important for the nurse to take? A. Ask the patient when her last menstrual cycle occurred B. Confirm pregnancy test is negative C. Obtain a baseline assessment of the mouth and throat D. Teach the patient the S/S of hypothyroidism
B. Confirm pregnancy test is negative Radioactive Iodine Therapy (RAI) is the treatment of choice for most nonpregnant adults. It damages or destroys thyroid tissue. Delayed response of up to 3 months. Treated with antithyroid drugs and B-Blocker before and during first 3 months of RAI
The nurse discovers a bluish discoloration of the periumbilical area on a patient who has been admitted with severe pancreatitis. How would the nurse document this finding? A. Asterixis B. Cullen's sign C. Spider angioma D. Grey Turner's sign
B. Cullen's sign Bluish discoloration of the periumbilical region is called Cullen's sign and can result from seepage of blood-stained exudate from the pancreas, which may occur in severe pancreatitis. Asterixis refers to tremors, which begin upon stretching the wrist. Spider angioma dilate blood vessel with a red center that branches out; it is a manifestation of cirrhosis. Grey Turner's sign is a bluish discoloration of the flank region.
Which effect may be observed if large amounts of endogenous corticosteroids are released into systemic circulation during surgery on a patient with Cushing syndrome? A. Fatigue B. Infections C. Delusions D. Hypotension
B. Infections A patient may become susceptible to infections if the endogenous corticosteroid levels are high during surgery. Fatigue and delusions may not occur due to elevated corticosteroids. Hypertension, not hypotension, is observed due to increased levels of corticosteroids.
The results of a urinalysis in a patient with abdominal trauma indicated blood in the urine. The nurse identifies that the finding may be indicative of which condition? A. Peritonitis B. Kidney damage C. Diaphragm rupture D. Abdominal compartment syndrome
B. Kidney damage Loss of bowel sounds indicated peritonitis. The presence of bowel sounds near the chest indicates diaphragm rupture. Abdominal hypertension indicated abdominal compartment syndrome.
Which intervention would the nurse expect to include in the plan of care for a patient with acute pancreatitis who has recurrent vomiting? A. Immediate enteral feeding to prevent malnutrition B. Nasogastric (NG) suction and NPO status C. Initiate early prophylactic antibiotic therapy to prevent infection D. Administer acetaminophen (Tylenol) every four hours for pain relief
B. Nasogastric (NG) suction and NPO status Initial treatment with acute pancreatitis will include an NG tube if there is vomiting and NPO status to decrease pancreatic enzyme stimulation and allow the pancreas to rest and heal. Enteral feedings will be used only for the patient with severe acute pancreatitis in whom oral intake is not resumed. Antibiotic therapy is needed only with acute necrotizing pancreatitis and signs of infection. The pain will be treated with IV morphine because of the NPO status.
A patient who had surgery for the treatment of acromegaly asked about the possibility of becoming pregnant. The nurse's response would be based on which physiologic factor? A. There will be a decrease in thyroid hormone. B. There will be a permanent loss of hormones. C. There is a loss of antidiuretic hormone (ADH). D. There will be increased levels of corticosteroids.
B. There will be a permanent loss of hormones. Surgery for acromegaly may result in permanent loss or deficiencies in follicle-stimulating hormone and luteinizing hormone, which leads to decreased fertility. Hypothyroidism occurs when a patient is deficient in TSH and is generally observed in radiation therapy. Loss of ADH is seen in patients with transient DI. Cushing syndrome results from increased levels of corticosteroids.
Why is pain with acute pancreatitis worsened with eating?
Because of the increased enzymes
Hep C transmission method
Blood
Hep B transmission method
Body fluids
Why would a patient with acute pancreatitis have toxemia?
Build up of lipase and amylase in the blood
A pt with ascites due to cirrhosis has increasing SOB and abdominal pain. The HCP requests that the nurse prepare the pt for paracentesis. Which nursing actions would be implemented prior to the procedure? SATA A. Educate the pt about the procedure and obtain informed consent B. Initiate NPO status 6h prior to the procedure C. Obtain baseline VS, abdominal circumference and weight D. Place pt high fowler or as upright as possible E. Request that the pt empty the bladder
C, D, E Consent is necessary but it is the HCP who will educate. B is not required.
The nurse practicing in and out-patient clinic cares for a patient recently diagnosed with hyperthyroidism. Which diet-related teaching should the nurse add to the patient's plan of care? SATA A. Emphasize the importance of low-carbohydrate diet B. Encourage the patient to increase high-fiber foods in the diet C. Include meals and snacks high in protein content D. Teach avoidance of caffeine-containing liquids E. Teach the patient about consumption of high-calorie diet of 4000-5000cal/day
C, D, E Patients with hyperthyroidism have an increased appetite, weight loss, and diarrhea. Nutritional therapy includes high-calorie diet (4000-5000 cal/day), 6 full meals/day with snacks, protein intake 1-2 g/kg ideal body weight, increased carbohydrate intake, avoid highly seasoned high-fiber diet foods, and avoid caffeine.
The nurse provides discharge education for a patient who underwent surgery for Chron's disease. The nurse provides information about which early symptoms of bowel obstruction? Select all that apply. A. Constipation B. Decreased flatus C. Colicky abdominal pain D. Nausea and vomiting E. Abdominal distention
C, D, E The patient should be watchful for symptoms such as colicky abdominal pain, nausea and vomiting, and abdominal distention. These are symptoms of bowel obstruction. Constipation and decreased flatus occur later.
A patient presented to the ED with abdominal pain, a palpable epigastric mass, and vomiting. What does the patient most likely have? A. Tumor B. Hernia C. Pancreatic pseudocyst D. Bloating
C. This is a collection of tissue debris, fluid, pancreatic enzymes, and inflammatory exudates seen in Acute Pancreatitis.
Which disease is treated with corticosteroidal hormonal therapy? A. Thyrotoxicosis B. Nephrotic syndrome C. Adrenal insufficiency D. Rheumatoid arthritis
C. Adrenal insufficiency The mainstay treatment of adrenal insufficiency is lifelong hormone therapy with glucocorticoids and mineralocorticoids.
The nurse documents Grey Turner's sign in the medical record of a patient diagnosed with acute pancreatitis. Which assessment finding prompted this? A. Blood in the vomitus B. Splinting of the abdominal wall C. Ecchymosis around the flanks D. Ecchymosis around the umbilicus
C. Ecchymosis around the flanks The flank is the region below the last rib and the hip. Grey Turner's sign is ecchymosis around the flanks, which may mean retroperitoneal hemorrhage. Blood in the vomitus is called hematemesis. Splinting of the abdominal wall is typically seen in patients with peritonitis. Ecchymosis around the umbilicus is Cullen's sign; this may also be a sign of retroperitoneal bleeding common to acute pancreatitis.
Which physiologic condition is consistent with mild pancreatitis? A. Pancreatic failure B. Pancreatic necrosis C. Edematous pancreas D. Sepsis of the pancreas
C. Edematous pancreas Mild pancreatitis is manifested by edema. The severe form of pancreatitis is manifested by organ failure, necrosis, and sepsis of the pancreas.
Which physiologic factor is related to the development of Cushing syndrome? A. Liver dysfunction B. Chronic renal failue C. Excessive secretion of adrenocorticosteroid hormones D. Decreased secretion of adrenocorticosteroid hormones
C. Excessive secretion of adrenocorticosteroid hormones Cushing syndrome results from excessive secretion of adrenocorticosteroid hormones, usually caused by pituitary gland tumors or carcinoma of the adrenal glands. It is also the result of excessive steroid intake for other medical conditions or nonmedical use (e.g. sports). Cushing syndrome is not directly related to liver function or renal failure. It is caused by excessive, not decreased, amounts of adrenocorticosteroid hormones.
Which clinical manifestation is a classic finding in Graves' disease? A. Gingivitis B. Cretinism C. Exophthalmos D. Muscular dystrophy
C. Exophthalmos Exophthalmos is the protrusion of eyeballs from the orbit; it results from increased fat deposits and fluid in orbital tissues. It is a classical clinical manifestation in Graves' disease.
Which symptom would the nurse assess in a patient with acromegaly? A. Fatigue B. Loss of smell C. Increase in shoe size D. Decreased peripheral vision
C. Increase in shoe size Acromegaly is a rare condition characterized by overproduction of growth hormone. Excess secretion of GH results in overgrowth of soft tissues and bones in the hands, feet, and face. Evaluation of physical changes such as increase in shoe size is important because they are gradual and slow; hence, the pt may not identify them.
The nurse reviews a patient's medical record and notes a diagnosis of abdominal compartment syndrome. Which event caused this complication to occur? A. Increased venous return B. Increased cardiac output C. Increased abdominal pressure D. Increased perfusion to kidneys
C. Increased abdominal pressure The patient with abdominal compartment syndrome experiences excessively high pressure in the abdomen. Increased abdominal pressure results in decreased venous return, cardiac output, and perfusion to the kidneys.
A patient is admitted to the emergency department with signs of blunt trauma. The nurse identifies that which type of event may have caused the patient's injuries? A. Gunshot B. Stabbing C. Motor vehicle accident D. Shrapnel
C. Motor vehicle accident Blunt trauma often occurs with MVAs, direct blows, and falls. It may not be obvious because it does not leave an open wound.
Where is abdominal pain located with acute pancreatitis? A. left lower quadrant to umbilicus B. right upper quadrant to mid-epigastric C. left upper quadrant to mid-epigastric D. right lower quadrant to umbilicus
C. left upper quadrant to mid-epigastric it may also radiate to the back
How does acute pancreatitis occur?
Caused by a spillage of pancreatic enzymes into surrounding tissues and these enzymes cause auto-digestion and severe pain (the enzymes that are supposed to break down food are essentially breaking down the pancreas itself)
Name two purine synthesis antagonists (suppress T & B cell) used as immunosuppressive therapies in recipients of organ transplants
CellCept (mycophenolate mofetil) and Imuran (azathioprine)
Which medication will NEVER be given alone in immunosuppressive therapy? & what will it be in combination with?
CellCept (mycophenolate mofetil) in combination with Prograf or Sandimmune
What is the first symptom seen in hepatic encephalopathy and what is this the result of?
Change in mental status Result of build up of ammonia
A patient is admitted to the ICU with a suspected pheochromocytoma. The pt VS are temp. 99.6F, BP 200/110, HR 110/min, RR 20/min. The patient is sweating profusely and reports a severe HA. Which prescription should the nurse implement 1st? A. Draw labs to assess electrolyte panel B. Give acetaminophen 650mg PO as needed for HA C. Place a fan in the patient's room D. Start nitroprusside infusion at 0.5mcg/kg/min
D Patient is in hypertensive crisis ad should be addressed 1st with a vasodilator
The nurse prepares to administer IV albumin to a patient with severe liver disease who has a low serum albumin level of 1.5g/dL. Which characteristic finding associated with hypoalbuminemia should the nurse anticipate assessing? A. Altered mental status B. Easily bruising C. Loss of body hair D. Pitting edema
D a, b, and c are s/s of liver disease but not hypoalbuminemia
The nurse is speaking to a patient who takes desmopressin nasal spray for DI. Which statement by the patient is most important for the nurse to report to the HCP? A. I am tired of restricting my fluids but I know I need to B. I feel like I am beginning to get sick with a cold C. I have been getting a lot of nasal pain with this spray D. I have recently started to experience frequent headaches
D HA, mental status change and weakness are early signs of hyponatremia, all others are to be reported but are not as urgent
Which characteristic is seen in syndrome of inappropriate antidiuretic hormone secretion (SIADH)? A. Polyuria B. Serum hyperosmolality C. Dilutional hypernatremia D. Fluid retention
D. Excess ADH increases fluid retention and causes decreased serum osmolality. The GFR increases, & Na levels decline, causing dilutional hyponatremia.
What disorder is characterized by fat pads on the back of the neck, and increased abdominal girth, a "buffalo hump," and a "moon" face? A. Acromegaly B. Conn's disease C. Graves' disease D. Cushing syndrome
D. Cushing syndrome Caused by excessive secretion of adrenocorticotrophic hormone. Wt gain is the most common feature.
A patient is admitted to the emergency department after a MVA. Assessment findings include facial trauma, a fractured pelvis, and a large piece of glass impaled in the abdomen. Which is the priority nursing action? A. Inserting a nasogastric tube B. Removing the impaled piece of glass C. Inserting an indwelling urinary catheter D. Ensuring a patent airway
D. Ensuring a patent airway The first step after receiving any patient after a MVA is to ensure a patent airway and to ensure that the patient is breathing. NG tube can be inserted if there is no facial trauma. Any impaled object should be stabilized with a bulky dressing - but should not be removed - in order to prevent further injury and bleeding. If the patient has sustained a fractured pelvis, inserting a urinary catheter is not advised.
Which condition correlates with SIADH after a head injury? A. Decreased antidiuretic hormone (ADH) B. Excessive urine output C. Increased serum osmolality D. Increased intravascular volume
D. Increased intravascular volume SIADH is characterized by an overproduction of ADH, which disrupts the fluid and electrolyte balance. Increased intravascular volume is one of the characteristic features of SIADH. Decreased ADH, excessive urine output and increased serum osmolality are the features of DI.
A patient reports severe abdominal pain, nausea, and vomiting. The nurse palpates a mass in a patient's upper abdomen. Laboratory reports show the white blood cell (WBC) count as 12,000 cells/uL. The nurse would anticipate that the patient will be treated for which condition? A. Pseudocyst B. Cullen's sign C. Spider angioma D. Pancreatic abscess
D. Pancreatic abscess A normal count of WBC is 4500 to 10000 cells/uL. The lab report reveals an increased WBC count, which indicates that the patient has leukocytosis. Abdominal mass, abdominal pain, nausea, vomiting, and leukocytosis are manifestations of pancreatic abscess. Therefore the healthcare provider suspects that the patient has pancreatic abscess. Though pseudocyst have the same manifestations as those of pancreatic abscess, the laboratory findings of pseudocysts include elevated serum amylase rather than increased WBC. Cullen's sign is manifested by discoloration of the abdominal wall and the periumbilical region. Spider angioma is a manifestation of liver cirrhosis, wherein the patient has a dilated blood vessel with a red center that branches like a spider web.
Which statement is true about pheochromocytoma? A. The primary tx is drug therapy B. An attack is provoked by antiepileptic medications C. Decreased levels of epinephrine and norepinephrine D. Severe pounding headaches and profuse sweating are clinical features
D. Severe pounding headaches and profuse sweating are clinical features The primary treatment is surgery! The attack is provoked by many drugs including antihypertensives, opioids, radiologic contrast media, and antidepressants, not antiepileptic medications. Epinephrine and norepinephrine levels rise in patients with pheochromocytoma.
What are the 3 causes of cirrhosis? (80% of the liver transplant list dx includes these)
Hepatitis C Alcohol-associated liver disease Nonalcohol-associated liver disease
What is hepatitis and what is it most commonly caused by?
Inflammation of the liver most commonly caused by a virus
Most effective way to diagnosis cirrhosis?
Liver biopsy but first one used and most sensitive is abdominal ultrasound
Ascites and caput medusae is presented in....?
Liver cirrhosis
Elevated serum bilirubin is a poor prognosis in which disease?
Liver cirrhosis
Jaundice, hepatic encephalopathy, fatigue, spider angiomata, and splenomegaly are symptoms seen in ________?
Liver cirrhosis
Explain graft-versus-host disease.
Occurs when an immunocompetent patient receives immunocompetent cells/tissue (may begin 7 to 30 days post transplant) Most common in hematopoietic stem cell transplants Skin develop blisters to desquamation (separations and shedding of epidermis), jaundice, diarrhea, abdominal pain, GI bleeding, and malabsorption
What is the primary goal in managing liver cirrhosis? and why would this be?
Prevention of bleeding due to varices, esophageal and gastric
Name two calcineurin inhibitors used as immunosuppressive therapies in recipients of organ transplants
Prograf (tracolimus) and Sandimmune (cyclosporine)
What is the treatment for gall stone pancreatitis? Pancreatic pseudocyst or abscess?
Removal of the gall stone (possibly gall bladder Catheter drainage
What is the most dangerous immediate effect in pheochromocytoma?
Severe hypertension
What is the priority goal of care for a patient with acute pancreatitis & what will you do?
The primary goal is relief of pain and I will administer IV morphine with antispasmodic
As a nurse, why would you use a nasogastric tube to low intermittent wall suction (LIWS) in a patient with acute pancreatitis? And when is this typically done?
To reduce stomach emptying into the duodenum and reduce vomiting, typically done prior to gallstone removal
As a nurse, you are taking care of a patient who is NPO (can only have ice chips/sips of water), has two large bore IVs, on fluid resuscitation, and receiving a transfusion of blood. What does this patient have, and what are some medications they might be on?
Upper GI bleed PPI for acid suppression Anticoagulants and antiplatelets Prokinetics (erythromycin or Reglan given prior to endoscopy)
Hep D transmission method
blood borne, commonly transmitted with Hep B
affects any area of the GI tract
chron's disease
Hep E transmission method
oral-fecal
Hep A transmission method
oral-fecal route (food & water)
What does an increase of serum lipase indicate?
pancreatitis
affects colon
ulcerative colitis
