ah 2 exam 2 GI, Obesity, liver,
Cholecystitis complications + intervention
-weight loss due to pain -nausea -inflammation -high fiber, low fat diet -small frequent meals - nonsurgical management - meds -lithotripsy: sound waves to break up gallstones
pancreatic cancer
-aggressive, few symptoms until cancer advance -abdominal pain, weight loss, diarrhea, and jaundice -tx has limited results -low survival rates -localized radiation and therapy -biliary stent insertion (palliative, for pain)
post op bariatric care
-airway management -monitor obstructive sleep apnea -pressure between skinfolds -reintroduction of nutrition -abdominal binder -position in semi fowlers -O2 monitoring -sequential compression and/or heparin -skin assessment -absorbent padding -removal or urinary catheter within 24 hrs -ambulate -monitor abdominal girth daily -6 small feedings, prevent dehydration -s/s dumping syndrome - abdominal pain, diaphoresis, tachycardia, n/v edu -exercise regimen -increase protein -routine labs for malnutrition
cirrhosis head to assessment + labs
-ascites -jaundices -upper GI bleed -anemia labs -AST, ALT, LDH -alkaline phosphatase -GGT (enzyme -serum protein, albumin imagining -xray ct mri dx -liver US -EGD -ECRP
GI assessment hx
-changes in appetite, weight, stook -pain -age, gender, culture -GI disorder sx -meds, herbs, supplements -smoking -travel -nutrion -alcohol, caffeine
pancreatic pseudocyst
-collection of tissue and fluids that forms on your pancreas -usually form as result of hard blow or inflammation to abdomen complicationss -hemorrhage -infection -bowel obstruction -abscess -fistula formation -pancreatic ascites -may resolve spontaneously -surgical intervention after 6 weeks
liver transplantation
-end stage liver disease or acute liver failure -considerations: lifestyle changes, comorbidities -complications: rejection, bleeding, organ failure
hepatitis assessment
-exposure -chemical exposure -alcohol, drugs, herbal -travel, sexual, needlestick, drug use, military service -family hx of liver disease physical -abdominal pain -changes in skin or sclera (icterus) -joint pain or myalgia (joint, muscle) -diarrhea/ constipation -change in color of urine or stool -fever -lethargy -n/v -pruritus' (itching)
cirrhosis risk factors
-hepatitis c leading cause of liver disease, liver cancer, and liver related death -B and D common worldwide -alcohol use excessive and prolonged -non alcohol fatty liver disease 1/10 Americans
Cholecystitis
-inflammation of gallbladder -gall stones trapped causing back up of bile chronic -recurring attacks of milt o mod pain -s/s - upper abdomen pain, no fever acute -sudden attack of mod to sever pain -upper abdomen pain -fever -need to go to OR- cholecystectomy role of diet -fatty and fried foods predispose pt dx -US -HIDA scan- check bile is moving through body in normal way, slower -ERCP - can tx while performing -MRCP - MRI
abdominal exam
-inspection, auscultate, palpate -do not palpate if appendicitis or abdominal aneurysm -HCP percusses
GI dx assessment
-labs: serum -urine -stool (gFOBT, FIT) -CT, EGC imaging -xrays -double contrast barium enema CT scan or MRI
pancreatic abscess
-most serious complication of pancreatitis -always fatal if untreated -high fever -blood culture for sepsis tx -percutaneous drainage -antibiotic tx
chronic pancreatitis
-progressive destructive disease of pancreas, remission and exacerbations -leaking enzymes from inflammation, pancreas gets digested
acute pancreatitis
-sudden inflammation mild or life threatening -alcohol and gallstones cause -severe abdominal pain with radiation to the back -weight loss due to inability to injest food and absorb nutrients labs -amylase, lipase, CBC imagine -US, CT complications -hypovolemia -hemorrhage -acute kidney failure -paralytic ileus -hypovolemic or septic shock -pleural effusion -respiratory distress syndrome -pneumonia -multisystem organ failure -DIC -DM (manage blood sugar) tx -IV fluids -NPO while acute -opioids
Cirrhosis
-untreated hepatitis -widespread fibrotic scarred bands of connective tissue -inflammation destroy liver cells -liver becomes nodular, blood and lymph flow impaired compensated -cirrhosis but no symptoms decompensated -widespread dysfunction -portal HTN -ascites and esophageal varices -coagulation defects -jaundice excess bilirubin (leads to neurologic defects) -PSE with hepatic coma (ammonia build up in body, decline in neuro) -spontaneous bacterial peritonitis -major complication - GI bleed
hepatitis complications + pt teaching
-weight loss due to inflammation of liver -fatigue due to decrease metabolic energy production -promote nutrition -address fatigue -infection prevention
After abdominal surgery, which question should the nurse ask the patient to determine whether peristaltic movement is returning? A."Have you passed flatus?" B."Are you hungry" C."Do you have any nausea?" D."Is your pain level manageable?"
ANS: A Evidence indicates that the patient's report of passing flatus is the best indicator of whether peristaltic movement is returning after surgery.
Which does the nurse recognize as the primary reason for a higher incidence of liver cancer in the United States? A.Incidence of hepatitis C B.Incidence of HIV infection C.Incidence of illicit drug use D.Incidence of hepatitis A
ANS: A In the United States and worldwide, the incidence of liver cancer is increasing because there is an increase in cases of hepatitis C (HCV).
When the patient is asked about pain, he says that it is intense and continuous. He states that sometimes when he curls up in a fetal position the pain eases. Which medication does the nurse recognize that will provide the most comprehensive pain relief at this time? A.PCA morphine sulfate B.IM fentanyl (Sublimaze) C.PCA meperidine (Demerol) D.Oral hydromorphone (Dilaudid)
ANS: A Meperidine is not a good choice because it can cause seizures, especially in older adults. While hydromorphone is a good choice with acute pancreatitis pain, IV is the best route. Fentanyl is a good alternative, but the route chosen should be IV or transdermal. Another option is epidural analgesia.
A 59-year-old patient with a history of alcohol abuse spanning 15 years has been diagnosed with cirrhosis. The patient will be undergoing abdominal paracentesis today. Which assessment finding alerts the nurse that the paracentesis has been successful? A.Decrease in post-procedure weight B.No residual obtained during procedure C.Substantial decrease in blood pressure D.Immediate sensation of a need to urinate
ANS: A Weight should decrease as fluid is drained from the abdominal cavity. A substantial decrease in blood pressure can indicate shock. Residual should be obtained during the procedure. The patient should not feel a sensation or need to urinate, because a primary safety measure is to have the patient void right before the procedure to avoid injury to the bladder during the procedure.
A 68-year-old patient presents to the ED the day after Thanksgiving, stating that he has "eaten and drunk quite a bit." He states that about 1 hour ago he experienced a sudden onset of pain in the left upper quadrant that radiates to his left flank. He rates the pain as an 8 on a 0-to-10 scale. The patient is admitted with acute pancreatitis. Which laboratory finding corroborates the diagnosis of acute pancreatitis? A.Serum lipase, 150 U/L B.Serum amylase, 200 U/L C.Serum glucose, 80 mg/dL D.White blood cells (WBCs), 6000 mcL
ANS: B A serum amylase of 200 U/L is elevated (normal range is approximately 23 to 85 U/L). Lipase normal range is 0-160 U/L; WBC normal range is 4800 to 10,800 ccm; and glucose normal range is 82 to 110 mg/dL. Amylase, lipase, WBC, and glucose are often higher than normal in patients with acute pancreatitis.
What is the priority nursing intervention in the management of a patient with decompensated cirrhosis? A.Limiting protein intake B.Managing nausea and vomiting C.Monitoring fluid intake and output D.Elevating the head of bed >30 degrees
ANS: B Decompensated cirrhosis has multiple complications. However, bleeding esophageal varices can present a life-threatening emergency. Preventing nausea and vomiting is an important intervention in the management of esophageal varices. Monitoring protein, fluid balance, and patient positioning are also important interventions in the care of the patient with end-stage liver disease.
A patient with chronic cholecystitis reports pruritus, clay-colored stools, and voiding dark, frothy urine. Which laboratory analysis is a priority in the nurse's assessment of this patient? A.Lipase level B.Total bilirubin C.Liver function tests D.White blood cell count
ANS: B Excess circulating bilirubin present with chronic cholecystitis is responsible for pruritus and changes in stool and urine color. Cholecystitis is associated with several risks including hepatic disease, pancreatitis, and peritonitis. Monitoring liver function, pancreatic laboratory values, and white blood cell counts is also very important.
When administering a new GI medication to an older patient, the nurse anticipates what? A.A higher-than-normal dose may be needed. B.Close monitoring is needed because toxic levels may develop. C.Older adults always require a lower-than-normal dose than younger patients. D.Nausea and vomiting may develop rapidly and are common side effects in older adults.
ANS: B The older patient should be monitored closely for adverse effects of all medications, even those administered in normal doses, because toxic levels can develop rapidly. Medications should never be increased to greater-than-normal levels because age-related changes in the liver and intestinal absorption may cause development of toxic drug levels. The patient also should not receive drug doses that are lower than normal. Nausea and vomiting in response to medication are not expected side effects of a patient's use of prescribed medication in appropriate dosages.
The patient's assessment reveals yellowish coloration of skin and sclerae. Which laboratory values does the nurse anticipate? A.Increased urine bilirubin, decreased direct bilirubin B.Increased direct bilirubin, increased indirect bilirubin C.Decreased direct bilirubin, increased indirect bilirubin D.Increased direct bilirubin, decreased indirect bilirubin
ANS: B When a patient's skin is jaundiced, laboratory values of indirect and direct bilirubin are increased. Urine bilirubin is also increased. Urobilinogen in stool is normal to decreased, but in urine it is normal to increased.
In preparing to care for the patient, which conditions does the nurse recognize as potential complications of acute pancreatitis? (Select all that apply.) A.Strep throat B.Pleural effusion C.Diabetes mellitus D.Pancreatic infection E.Acute kidney failure
ANS: B, C, D, E All, with the exception of strep throat, are potential complications of acute pancreatitis.
When a complete assessment of this patient is performed, what other signs and symptoms does the nurse expect? (Select all that apply.) A.Muscle twitching B.Dry skin with rash C.Personality changes D.Peripheral dependent edema E.Ecchymosis, spider angiomas
ANS: B, D, E Personality changes and muscle twitching are findings that may be seen when the patient with cirrhosis develops portal-systemic encephalopathy. Additional manifestations that may be found on assessment include palmar erythema, clubbing of fingernails, and fixed flexion of fingers
Which assessment finding requires immediate nursing intervention in a patient with severe ascites? A.Confusion B.Temperature 38.2º C C.Tachycardia, rate 110 beats/min D.Shallow respirations, rate 32 breaths/min
ANS: D Ascites can increase abdominal distention, which interferes with lung expansion and compromises ventilation and oxygenation. Risk for infection, fluid displacement, and confusion are also assessment variables requiring monitoring in a patient with ascites.
Which patient statement alerts the nurse to perform a thorough GI history and focused assessent? A."I don't like the taste of spicy foods." B."I got dentures four years ago." C."I experience occasional constipation." D."I take ibuprofen three times daily for arthritis."
ANS: D Large amounts of aspirin or other nonsteroidal antiinflammatory drugs (NSAIDs) such as ibuprofen can predispose the patient to peptic ulcer disease and GI bleeding.
Which patient is more likely to develop gallstones? A.45-year-old Caucasian female with a family history of gallstones B.55-year-old African-American male with a history of diabetes mellitus C.62-year-old Hispanic/Latino female with a history of irritable bowel syndrome D.60-year-old obese, American-Indian female with a history of diabetes mellitus
ANS: D Risk factors for developing gallstones include female gender, obesity, family history of gallstones, diabetes mellitus, American-Indian and Caucasian descent, rapid change in weight, and advanced age. More risk factors increase the likelihood of developing gallstones.
hepatitis labs
ELEVATED -ALT/AST -bilirubin -serologic markers -PT/INR -WBC -liver enzymes -blood test -liver biopsy
The patient is being discharged to home. What patient teaching will the nurse provide regarding when the patient should notify the health care provider?
The patient should be instructed to notify the health care provider if acute abdominal pain occurs. Also, jaundice, clay-colored stools, or dark urine should be reported, because these are signs of biliary tract disease that may indicate complications as the disease progresses.
gastric restriction Roux-en-Y sleeve gastrectomy duodenal switch
adjustable banded gastroplast - band around upper portion of stomach -laproscopic -frequent follow -risk of erosion Roux-en-Y -small intestine brought to -malabsorption -small frequent meals -vitamin edu -dumping syndrome, undigested food in small intestines causing tachycardia, nausea vomiting sleeve gastrectomy -route of intestines not changed -no carbonated bevs duodenal switch -sleeve gastrectomy and bypass -pt with very high BMI
cholecystectomy
laparoscopic -complications uncommon -quicker recovery -less pain - traditional for rupture
Hepatitis
s/s -RUQ discomfort -N/V - anorexia, weight loss -fever, chills -jaundice -dark urine -potential exposure tx -rest -activty -nutrition -hydration dx -presence of antibody/antigen in serum AE -transmission through fecal and oral route -vaccine for A, not E B, D -transmission blood, semen, saliva -D is a super infection -vaccine avail for B, not D C -transmission blood semen -easily transmitted -no vaccine -most common
cirrhosis tx
surgical resection, liver transplantation palliative care -TACE: transcatheter arterial chemoembolization -selective internal radiation therapy
