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