Exam week 13

osteoarthritis (OA) vs rheumatoid arthritis (RA)

Degenerative disease vs autoimmune disease Cartilage loss vs inflamed synovium Asymmetrical vs symmetrical AM stiffness lasting less than 30 mins. vs AM stiffness lasting more than 30 mins.

chronic pancreatitis

Progressive, destructive disease of the exocrine pancreas, fibrosis that causes permanent dysfunction; long term alcohol usage is the main cause of this

Anterior Pituatary Hormones

The hypothalamus controls the release of this -secretes 6 hormones 1. GH- Growth Hormone (somatotropin)- bone growth, insulin growth factors 2. FSH- Follicle Stimulating Hormone- 3. LH-Leutenizing Hormone- stimulates ovulation & progesterone in women & testosterone secretion in men 4. TSH-Thyroid Stimulating Hormone 5. ACTH-Adrenocorticotropic Hormone- Stimulates adrenal cortex to released cortisol & other glucocorticoids TROPIC HORMONE 6. Prolactin- millk 7. Melanocyte stimulating Hormone

tensile strength

because of molecular configuration, collagen has great tensile strength

The late manifestations of cirrhosis are related to liver failure and

portal hypertension.

Kupffer cells

removing bacteria, debris, parasites, old RBCs (remember this because this plays a role with bilirubin)

systematic lupus erythematosus (SLE)

"Great imitator" because of capacity to affect many body systems (musculoskeletal, skin, cardiovascular, lungs, kidneys, CNS, RBC and platelets) -autoantibodies against self molecules found in plasma, cytoplasm, or surface of cells -Arthralgia and Arthritis - most common manifestations - autoimmune disease -The most common form of lupus—it's what most people mean when they refer to "lupus." Systemic lupus can be mild or severe.

Signs and Symptoms of Cirrhosis

"The Liver is Scarred" Tremors of hands (asterixis: hand-flapping due to increased toxins in the blood) Hepatic foetor or "fetor hepaticus": very late in the disease and is a pungent, sweet, musty smell. Eye and skin yellowing (jaundice) Loss of appetite (spleen pushing on stomach...feel full) Increased Bilirubin (skin and urine....jaundice) and ammonia Varices (esophagus and gastric...at risk for bleeding...watching for activities that can increase rupture: coughing, vomiting, drinking ETOH, constipation) Edema in legs (low albumin and congestion of hepatic veins) Reduced platelets and WBCs (bleeding and infection risk) Itchy skin (toxins the blood) Spider angiomas (chest) (increased estrogen in the blood) Splenomegaly (low platelets and WBCs), stool clay colored (no bilirubin in the stool...should be there not in the urine or blood) Confusion or coma (high toxin and ammonia level) Ascites (low albumin and venous congestion) Redness on the palms of the hands (increased estrogen in the blood) Renal failure (hepatorenal syndrome) Enlarged breast in men (decrease metabolism of estrogen so there is more in the blood) Deficient on vitamins (B12, A, C, D, E, K and iron) (no longer able to store and have bile to help absorb these fat soluble vitamins)

Paget's disease of bone

-2nd most common bone disease after osteoporosis -excessive bone turnover -paromyxovirus is viral infection that triggers development in genetically predisposed -kyphosis, bowed femur, tibia , fibula, waddling gait, pain, headache, tinnitus, vertigo

acute pancreatitis

-Autodigestion of pancreas by pancreatic enzymes -epigastric abdominal pain radiating to back -elevated serum amylase and lipase (higher specificity) -can lead to DIC, ARDS (pancreas enzymes digest lung tissue) -hypocalcemia (Ca++ collects into pancreating calcium soap deposits) -alcohol abuse and gallstones account for 70% of cases

Graves disease

-an autoimmune disorder that is caused by hyperthyroidism and is characterized by goiter and/or exophthalmos -disease associated with HLA-DR3 & HLA-B8 -common in women (20-40 years old)

rheumatoid arthritis (RA)

-chronic systemic disease characterized by autoimmune inflammatory changes in the connective tissue throughout the body -joint involvement is symmetric and polyarticular -ESP &CRP elevated -Rheumatoid nodules develops

rheumatoid arthritis manifestations

-fatigue, weakness, anorexia -rheumatoid nodules, splenomegaly, lymphadenopathy, pleural effusion, pericarditis, nephropathy, vasculitis, ulnar deviation -swan neck deformity- hyperextension of the peripheral interphalangeal and partial flexion of the distal interphalangeal joint The patient will have soft, tender, warm, and swollen joints. They will feel very tired (this leads them to be inactive) and have a fever. **Hallmark signs: RA affects the same joint bilaterally. Stiffness and pain will be worst in the mornings (>30 minutes of stiffness) or after long periods of inactivity and all types of joints can be affected.

Myxedema

-severe hypothyroidism -treated by replacement therapy with synthetic preparations of T3 or T4

You're providing an in-service to new nurse graduates about esophageal varices in patients with cirrhosis. You ask the graduates to list activities that should be avoided by a patient with this condition. Which activities listed are correct: Select all that apply A. Excessive coughing B. Sleeping on the back C. Drinking juice D. Alcohol consumption E. Straining during a bowel movement F. Vomiting

A. Excessive coughing D. Alcohol consumption E. Straining during a bowel movement F. Vomiting The answers are A, D, E, and F. Esophageal varices are dilated vessels that are connected from the throat to the stomach. They can become enlarged due to portal hypertension in cirrhosis and can rupture (this is a medical emergency). The patient should avoid activities that could rupture these vessels, such as excessive cough, vomiting, drinking alcohol, and constipation (straining increases thoracic pressure.)

Your patient with cirrhosis has severe splenomegaly. As the nurse, you will make it a priority to monitor the patient for signs and symptoms of? Select all that apply: A. Thrombocytopenia B. Vision changes C. Increased PT/INR D. Leukopenia

A. Thrombocytopenia C. Increased PT/INR D. Leukopenia The answers are A, C, and D. A patient with an enlarged spleen (splenomegaly) due to cirrhosis can experience thrombocytopenia (low platelet count), increased PT/INR (means it takes the patient a long time to stop bleeding), and leukopenia (low white blood cells). The spleen stores platelets and WBCs. An enlarged spleen can develop due to portal hypertension, which causes the platelets and WBCs to become stuck inside the spleen due to the increased pressure in the hepatic vein (hence lowering the count and the body's access to these important cells for survival).

During a routine health check-up visit, a patient states, "I've been experiencing severe pain and stiffness in my joints lately." As the nurse, you will ask the patient what questions to assess for other possible signs and symptoms of rheumatoid arthritis? Select-all-that-apply: A. "Does the pain and stiffness tend to be the worst before bedtime?" B. "Are you experiencing fatigue and fever as well?" C. "Is your pain and stiffness symmetrical on the body?" D. "Is your pain and stiffness aggravated by extreme temperature changes?"

B. "Are you experiencing fatigue and fever as well?" C. "Is your pain and stiffness symmetrical on the body?" The answers are B and C. Patients with RA will experience pain and stiffness in the morning (for more than 30 minutes) not bedtime. It is common for patients to have a fever and be fatigued...remember RA affects the whole body not just the joints. It will also affect the same joints on the opposite side of the body. Therefore, if the right wrist is inflamed, painful, and stiff the left wrist will be as well. RA is NOT aggravated by extreme temperatures. This is found in osteoarthritis.

A patient who received treatment for pancreatitis is being discharged home. You're providing diet teaching to the patient. Which statement by the patient requires immediate re-education about the diet restrictions? A. "It will be hard but I will eat a diet low in fat and avoid greasy foods." B. "It is very important I limit my alcohol intake to no more than 2-3 glasses of wine a week." C. "I will concentrate on eating complex carbohydrates rather than refined carbohydrates." D. "I will purchase foods that are high in protein."

B. "It is very important I limit my alcohol intake to no more than 2-3 glasses of wine a week." A patient with pancreatitis should AVOID any amount of alcohol because of its effects on the pancreas. Remember alcohol is a cause of both acute and chronic pancreatitis. All the other options are correct.

A patient with late-stage cirrhosis develops portal hypertension. Which of the following options below are complications that can develop from this condition? Select all that apply: A. Increase albumin levels B. Ascites C. Splenomegaly D. Fluid volume deficient E. Esophageal varices

B. Ascites C. Splenomegaly E. Esophageal varices The answer are B, C, and E. Portal Hypertension is where the portal vein becomes narrow due to scar tissue in the liver, which is restricting the flow of blood to the liver. Therefore, pressure becomes increased in the portal vein and affects the organs connected via the vein to the liver. The patient may experience ascites, enlarged spleen "splenomegaly", and esophageal varices etc.

You are receiving shift report on a patient with cirrhosis. The nurse tells you the patient's bilirubin levels are very high. Based on this, what assessment findings may you expect to find during your head-to-toe assessment? Select all that apply: A. Frothy light-colored urine B. Dark brown urine C. Yellowing of the sclera D. Dark brown stool E. Jaundice of the skin F. Bluish mucous membranes

B. Dark brown urine C. Yellowing of the sclera E. Jaundice of the skin The answers are B, C, and E. High bilirubin levels are because the hepatocytes are no longer able to properly conjugate the bilirubin because they are damaged. This causes bilirubin to leak into the blood and urine (rather than entering the bile and being excreted in the stool). Therefore, the bilirubin stays in the blood and will enter the urine. This will cause the patient to experience yellowing of the skin, sclera of the eyes, and mucous membranes ("jaundice") and have dark brown urine. The stools would be CLAY-COLORED not dark brown (remember bilirubin normally gives stool it brown color but it will be absent).

Which patient below is at MOST risk for CHRONIC pancreatitis? A. A 25 year old female with a family history of gallstones. B. A 35 year old male who reports social drinking of alcohol. C. A 15 year old female with cystic fibrosis. D. A 66 year old female with stomach cancer.

C. A 15 year old female with cystic fibrosis. Patients in options A and B are at slight risk for ACUTE pancreatitis not chronic. Remember the main causes of ACUTE pancreatitis are gallstones and alcohol consumption. In option C, the patient with cystic fibrosis is at MAJOR risk for CHRONIC pancreatitis because they are lacking the protein CFTR which plays a role in the movement of chloride ions to help balance salt and water in the epithelial cells that line the ducts of the pancreas. There is a decreased production of bicarbonate secretion by the epithelial cells. Therefore, this leads to thick mucus in the pancreatic ducts that can lead to blockage of the pancreatic ducts which can cause the digestive enzymes to activate and damage the pancreas. Overtime, the pancreas will experience fibrosis of the pancreas' tissue and will no longer produce digestive enzyme to help with food digestion.

Which of the following is NOT a role of the liver? A. Removing hormones from the body B. Producing bile C. Absorbing water D. Producing albumin

C. Absorbing water The liver does not absorb water. The intestines are responsible for this function.

You're caring for a 45-year-old patient who is admitted with suspected acute pancreatitis. The patient reports having extreme mid-epigastric pain that radiates to the back. The patient states the pain started last night after eating fast food. As the nurse, you know the two most common causes of acute pancreatitis are: A. High cholesterol and alcohol abuse B. History of diabetes and smoking C. Pancreatic cancer and obesity D. Gallstones and alcohol abuse

D. Gallstones and alcohol abuse Main causes of acute pancreatitis are gallstones and alcohol consumption. Heavy, long-term alcohol abuse is the main cause of CHRONIC pancreatitis.

acromegaly

Dysregulated growth hormone (GH) hypersecretion is usually caused by a GH-secreting pituitary adenoma and leads to it. — a disorder of disproportionate skeletal, tissue, and organ growth. High GH and IGF1 levels lead to comorbidities including arthritis, facial changes, prognathism, and glucose intolerance

Which condition is NOT a known cause of cirrhosis? A. Obesity B. Alcohol consumption C. Blockage of the bile duct D. Hepatitis C E. All are known causes of cirrhosis

E. All are known causes of cirrhosis

Hepatocytes

Hepatocytes: does most of the work of the liver by performing bile production, metabolism, storage, conjugating bilirubin, and detoxification.

During your morning assessment of a patient with cirrhosis, you note the patient is disoriented to person and place. In addition while assessing the upper extremities, the patient's hands demonstrate a flapping motion. What lab result would explain these abnormal assessment findings?

Increased ammonia level Based on the assessment findings and the fact the patient has cirrhosis, the patient is experiencing hepatic encephalopathy. This is due to the buildup of toxins in the blood, specifically ammonia. The flapping motion of the hands is called "asterixis". Therefore, an increased ammonia level would confirm these abnormal assessment findings.

systemic lupus erythematosus

It can cause your immune system to attack joints, causing pain and arthritis. When joints become inflamed, it causes pain and long-term damage. Lupus arthritis can occasionally affect large joints, like knees and hips, but more commonly affects smaller joints, like in the hands and wrists.

Cirrhosis

It's a liver disease where liver cells become extremely damaged due to long term/severe damage. This leads to the damaged cells being replaced with fibrous tissue, hence, scarring of the liver. The hepatocytes are damaged and CAN'T do this so the hepatocytes leak bilirubin in the blood (rather than it is entering the bile to leave the body in stool) and the levels increase in the blood and present in the urine. Therefore the patient will have yellowing of the skin, sclera, mucous membranes, dark urine along with clay-colored stool... JAUNDICE! Diagnosed: Liver biopsy Labs: liver enzymes (albumin), platelet levels, PT/INR, hepatitis B or C, bilirubin levels

________ reside in the liver and help remove bacteria, debris, and old red blood cells.

Kupffer cells Kupffer cells perform this function and are one of the two types of cells found in the liver lobules (the functional units of the liver). These cells play a role in helping the hepatocytes turn parts of the old red blood cells into bilirubin.

Esophageal varices

are a life-threatening complication of cirrhosis related to the risk of rupturing and producing a massive amount of hemorrhage. The remaining options are not life threatening.

Kupffer cells

are found in the sinosoids of the liver, and remove and phagocytose old and defective blood cells, bacteria and other foreign material from the portal blood as it flows through the sinusoid

Prodromal

early symptoms that may indicate the onset of a condition or disease -a vague sense of malaise, mild fever, myalgia, headache and fatigue

Cushing disease/syndrome

excess cortisol or an ACTH-secreting tumor, causing an excess of cortisol -protruding abdomen -buffalo humps (fat pads) -loss of diurnal pattern of cortisol secretion

Hepatitis A is spread by

fecal-oral route

The liver receives it blood supply from two sources. One of these sources is called the _________________, which is a vessel network that delivers blood _____________ in nutrients but ________ in oxygen.

hepatic portal vein, high, low The majority of the blood flow to the liver comes from the hepatic portal vein. This vessel network delivers blood HIGH in nutrients (lipids, proteins, carbs etc.) from organs that aid in the digestion of food, but the blood is POOR in oxygen. The organs connected to the hepatic portal vein are: small/large intestine, pancreas, spleen, stomach. Rich oxygenated blood comes from the hepatic artery to the liver.

Osteoarthritis

the degenerative joint disease commonly associated with aging or wear and tear on the joints -joint pain, the crackling of joints (audible crepitus), joint locking most affected joints- hips, knees, lumbar, cervical spine, proximal and distal joints of hands - asymmetric

Hypothyroidism

weight gain, coarse dry, brittle hair, pallor, large tongue, periorbital edema, puffy face, deep coarse voice, slow pulse, constipation, muscle weakness, peripheral edema

What causes Cirrhosis?

· Viral Infection: Hepatitis C*, B · Alcohol Consumption: Heavy amount* · Too much fat collecting in the liver (nonalcoholic): obese, hyperlipidemia, diabetics · Problems with bile duct (carries bile from liver to small intestine): bile stays in liver and damages cells · Autoimmune