NUR 213 Test #3

Ascites S/S

- Dehydration - Decreased Urine Output - Hypokalemia - Swelling in the abdomen - Unexplained Wt Gain - Sense of fullness - Nausea and indigestion - SOB

Hepatic Encephalopathy Interventions

-Adequate fluid hydration, nutrition support -Maintain fluid and electrolyte balance -Lowering ammonia levels and patient safety

Septic Shock Treatment

-Antibiotics -Fluid resuscitation -Vasopressors -Hydrocortisone

Hypertrophic Cardiomyopathy Tx

-Antidysrhythmics -Betablockers -Calcium Channel Blockers -Surgical Excision of ventricular septum -Avoid strenuous activity and dehydration

Hep C Transmission

-Bodily fluids: infected blood, saliva, semen -Contaminated needles -Sexual Contact -Hemodialysis -Sharing razors or toothbrushes with an infected individual

Hepatic Encephalopathy S/S

-Changes in neurologic and mental responsiveness -Impaired consciousness -Inappropriate behavior -Ranging from sleep problems to trouble concentrating to deep coma -Asterixis: Hand flapping -Hyperventilation, hypothermia, tongue fasciculations, and grimacing and grasping reflexes -Fetor hepaticus: Musty, sweet odor of the patient's breath

Hep A Risk Factors

-Crowded conditions: nursing homes or daycare -Exposure to poor sanitation practices -Drug users: both injected and non injected drugs -Men who have sex with men -Persons traveling to developing countries

Hepatorenal Syndrome S/S

-Decrease in arterial blood volume -Sudden decrease in urine output -Elevated BUN and Creatinine -Decrease in urine sodium excretion -Increase in urine osmolarity -Intractable ascites (does not recede after paracentesis)

Cardiogenic Shock S/S

-Decrease pulse pressure -Decreased SV, CO -Increased SVR, CVP, and PAWP -Tachypnea -Crackles -Decreased urinary output -Pallor, cool, clammy, cyanosis -Decreased cerebral perfusion -Anxiety, confusion, agitation

Septic Shock S/S

-Decreased EF -Hyperventilation, crackles, respiratory alkalosis -Decreased urinary output -Warm flushed them cool mottled as progresses -Mental status changes -Anxiety -Coma late

Hepatorenal Syndrome Procedures/Tx

-Dialysis -Paracentesis -TIPS (Transjugular Intrahepatic Portosystemic Shunt) which redirects portal blood flow between vascular system and portal venous system -Peritoneovenous Shunt which is continuous reinfusion of ascitic fluid into venous system -Liver transplant

Hep D Risk Factors

-Drug users -People receiving hemodialysis -People who get blood transfusions -Health care personnel -Men who have sex with other men

Esophageal Varices Procedures/Tx

-Endoscopic or Surgical Procedures: Endoscopic injection(sclerotherapy), Endoscopic varceal litigation, Shunting procedures -NG tube or Balloon tamponade

Hep A Transmission

-Fecal-oral route -Person to person contact -Contaminated fruits or veggies, uncooked shellfish -Contaminated water or milk -Contamination of objects with stool -Poorly washed utensils

Hep E Transmission

-Fecal-oral route -Person-to-person contact -Parenteral -Contaminated fruits or vegetables -Uncooked shellfish -Contaminated water or milk -Poorly washed utensils

Restrictive Cardiomyopathy Tx

-HF management -Heart transplant -Avoid strenuous activity and dehydration

Dilated Cardiomyopathy Tx

-HF management: Diuretics, daily weight, I&Os, elevate HOB -Heart transplant: complication- rejection -LVAD -Implanted defibrillator

Esophageal Varices S/S

-Hematemesis -Melena -Ascites -Jaundice -Hepatomegaly and Splenomegaly -Dilated abdominal veins -Signs of shock

Hep B Risk Factors

-IV drug users -Long-term hemodialysis patients -Healthcare workers -Living with chronically HBV-infected people -Public safety workers -Blood product recipients -Men who have sex with men -Native Alaskans Pacific Islanders -Native Americans

Hep D Transmission

-Infected blood/body fluid -Contaminated needles -Sexual contact with the infected -Perinatal period -Hemodialysis -Sharing a razor or tooth brush with infected

Hep A Patho

-Inflammation or swelling of the liver from viruses, bacteria, exposure to medications and autoimmune diseases -Hep A is a short term infection and treatable in all cases

How might women present non traditional symptoms of an MI?

-Jaw pain -Indigestion -Abdominal pain/GI pain

Hepatic Encephalopathy Procedure/Tx

-Liver transplant in severe cases -Medications: Neomycin, Metronidazole to kill ammonia producing bacteria and Lactulose to inhibit ammonia production, and accelerate defecation

Portal Hypertension Interventions

-Monitor VS -Administer medication (ex: beta blockers) -Ensure pt elevates lower extremities -Ensure pt wears TED hose

Cardiomyopathy Tx

-Pacemaker -Cardiac rehab: exercise, diet, rest periods

Ascites Procedure/Tx

-Paracentesis is a Sterile procedure where a catheter used to withdraw fluid from abdominal cavity -A peritoneovenous shunt is a surgical procedure that provides continuous reinfusion of ascitic fluid into the venous system -TIPS: shunt to redirect portal blood flow when pt is unresponsive to diuretic therapy

Hep C Risk Factors

-Parenteral drug users -Clients receiving frequent transfusions -Health care personnel -Those born between 1945 and 1965 -Prisoners -High risk sexual behavior -Unprotected sex, multiple partners -Men who have sex with men

Hepatitis S/S

-RUQ pain -GI: N/V, Anorexia, Wt loss -Fever -Chills -Jaundice -Dark urine -History of potential exposure

Hep B S/S

-Rash -Angioedema (life threatening) -Fever -Jaundice (yellowing of the skin or sclera) -Fatigue -Loss of appetite -Flu-like symptoms -Hepatomegaly (enlarged liver) -Joint pain -Right upper quadrant tenderness.

Hepatorenal Syndrome Interventions

-Restrict sodium -Diurectics (potassium sparing) -Restrict NSAIDS -Albumin (helps maintain intravascular volume) -Avoid alcohol

Ascites Interventions

-Restrict sodium: 2g/day -Administer albumin: maintain intravascular volume -Administer potassium-sparing diuretic -Tolvaptan: hyponatremia -Preop for paracentesis: have pt void or insert catheter, obtain baseline vs and monitor, obtain weight, measure abdominal girth, baseline labs (CBC, electrolytes, coag), pt education -Postop: assess and compare to baseline, note any signs of hypovolemia, have pt sit on side of bed or in high fowler's, label and send fluid to lab, check dressing, give Iv fluids or albumin, measure and describe fluid, weigh pt, monitor I&Os, have pt maintain bedrest

Portal Hypertension S/S

-Splenomegaly -Varices -Fluid buildup (ascites, lungs, edema) -Malnutrition (weight loss, electrolyte imbalance) -Change in mental status

Hep A Prevention

-Strict handwashing -Clean surfaces well -Avoid contaminated food -Stool and needle precautions -Hep A vaccine -If in same house with someone with Hep A: clean bathroom, or use different bathroom

Hep C Prevention

-Strict handwashing -Needle precautions -Safety needle -Tattoo practices -Screening of blood donors -Patient safety: Do not share needles, wash your hands, safe sex practices

Hep B Prevention

-Strict handwashing -Vaccination against Hepatitis B -Avoiding intimate contact with infected individuals -Use only new, clean needles for tattoos, piercings or drug use -Hepatitis B Immune Globulin if exposed -Safe sex practices: condoms, abstinence, monogamy -Patient Safety: strict handwashing, avoid intimate contact with infected people, screening of blood donors

Hep D Prevention

-Strict handwashing -Screening blood donors -Testing all pregnant women -Hepatitis B vaccine -Safe sex practices -Needle precautions -Patient Safety: Strict handwashing, Do not share bathroom or prepare food, Avoid alcohol and OTC medications, Do not donate blood, Avoid crowds, Inform medical personnel of infection, Follow up appointments

Hep E Prevention

-Strict handwashing -Treatment of water supplies/sanitation measures -Maintaining quality standards for public water supplies -Establishing proper disposal systems for human feces -Patient Safety: High mortality rate in pregnant individuals, Fetal demise

Hep B Transmission

-Through blood or body fluid contact -Infected blood, saliva or semen -Use of contaminated needles -Sexual contact with someone infected with Hepatitis B -Hemodialysis -Sharing of razors or toothbrushes with an infected person

Hep E Risk Factors

-Travelers to countries that have a high incidence of hep A (India, Africa, Afghanistan) -Eating or drinking of food or water contaminated with the virus

Portal Hypertension Procedure/Tx

-Treatment is aimed at managing the complications of portal hypertension -Endoscopy and Medication can address bleeding concerns from varices -Oxygen, Dialysis, & Paracentesis could be other treatment options -Shunting Procedures: the action of opening the portal vein by placing a stent

Esophageal Varices Interventions

-Varices at risk for bleeding- reduce portal pressure, Nonselective β-blocker to reduce the risk of hemorrhage, Nadolol or propranolol -Instruct the client to avoid activities that initiate vasovagal responses: coughing, baring down with BM -Administering medications to induce vasoconstriction and reduce bleeding: Vasopression, Octreotide, Vit K, PPI (pantoprazole) -Stabilize airway, establish IV, Elevate HOB, Administer oxygen as prescribed, Maintain NPO status, Administer fluids, Administer blood transfusions or clotting factors -Monitor: vital signs, orthostatic hypotension, lung sounds, LOC, HGB/HCT

Cardiogenic Shock Treatment

-Vasopressors- Norepinephrine

A client is diagnosed as having the hepatitis B virus (HBV). The nurse reviews the client's health history for situations in which exposure may have occurred. Which event does the nurse determine is most likely the source of this infection? A. The client received a small tattoo on the arm 3 months ago. B. The client assisted in the emergency birth of a baby 2 weeks ago. C. The client worked for a month in an undeveloped area in a foreign country 4 months ago. D. The client attended an ecological conference in a large urban center 2 months ago.

A

A client with jaundice reports fatigue, abdominal pain, loss of appetite, dark urine, nausea, and vomiting. Which pathogen would the nurse associate with this client's clinical manifestations? A. Hepatitis C virus B. Candida albicans C. Varicella-zoster virus D. Cryptosporidium muris

A

Patient E.V, a 69 year old male with a history of alcoholic cirrhosis presents to the emergency room with an active episode of hematemesis. An Esophagogastroduodenoscopy (EGD) was completed and a diagnosis of esophageal varacies was determined to be the cause. Which interventions should the nurse prioritize in this patients plan of care? A. Administer oxygen, Instruct patient to avoid activities that will initiate vasovagal responses, Maintain NPO, NG Tube, Balloon Tamponade, Elevate HOB B. Administer antibiotics, Paracentesis, Administer NSAIDS for pain, Administer Diuretics, Assess reflexes, Instruct client to cough and deep breath

A

Select all interventions that are appropriate for ascites? A. Weigh client daily, Elevate head of bed to decrease SOB, Adminster Spironolactone, Provide supplemental vitamins B. Increase protein intake, Increase fluid and sodium intake, Weigh client every other day.

A

The nurse is caring for a client that is scheduled to have a percutaneous liver biopsy. Which assessment findings warrant the postponement of the procedure? A. Marked ascites, Hemoglobin of less than 9 g/dL (90 mmol/L) B. Hemosiderosis, Hepatic cirrhosis, Platelet count of 150,000/mm (150 × 10 /L)

A

The nurse is reviewing discharge plans with a client who is hospitalized with hepatitis A. The nurse concludes that the client understands preventive measures to reduce the risk of spreading the disease when the client makes which statement? A. "I should wash my hands frequently." B. "I should launder my clothes separately." C. "I should put used tissues in the garbage." D. "I should wear a mask when leaving the house."

A

The nurse provides education for a client about prophylactic measures that minimize the risk of contracting hepatitis B. Which actions would be included in the teaching plan? A. Screening of blood donors, Maintaining a monogamous sexual relationship B. Avoiding shellfish in the diet, Limiting hepatotoxic medication therapy, Preventing constipation

A

The nurse teaches a client who is concerned about hepatitis transmission routes. Which type of hepatitis spreads more frequently through food? A. A B. B C. C D. D

A

Which action would the nurse take when caring for a neonate that weights 1.8kg and whose birth parent is Hepatitis B negative? A. Administer HepB vaccine to the newborn 1 month after birth. B. Administer monovalent HepB vaccine to the newborn during discharge. C. Administer 0.5 mL of hepatitis B immune globulin (HBIG) within 12 hours of birth. D. Administer HepB vaccine and 0.5 mL of hepatitis B immune globulin (HBIG) within 12 hours of birth.

A

Which employment history is linked to the development of hepatitis A? A. Works at a plumbing business B. Works in a hemodialysis unit at a hospital C. Works as a dishwasher at a local restaurant D. Works at an occupational arsenic compound business

A

Which immunization protocol would the nurse follow when administering a hepatitis B vaccine to an infant whose birth parent is diagnosed HBsAg-positive during pregnancy? A. Hepatitis B immune globulin 0.5 mL is given along with the first dose of Hepatitis B vaccine. B. Hepatitis B immune globulin is given within a week after obtaining the birth parent's laboratory reports. C. Hepatitis B immune globulin is not administered because the first dose of Hepatitis B vaccine itself is sufficient. D. Hepatitis B immune globulin is not administered; however, the second dose of the hepatitis B vaccine is given after 1 month.

A

Which of the following are possible or expected signs of Hepatorenal Syndrome? A. Increased BUN and Creatinine, Intractable Ascites, Decreased Urine Sodium, Decreased Urine Output, Dark-colored Urine B. Increased Urine Sodium, Decreased BUN and Creatinine, Increased Urine Output

A

Which statement by the client recovering from an acute case of viral hepatitis indicates understanding of the discharge instructions presented by the nurse? A. "I will avoid alcohol because my liver is scarred and the alcohol causes more damage.", "I will eat four to seven small snacks or meals per day.", "I will eat foods high in carbohydrates but moderate in fats and proteins." B. "I will take acetaminophen for pain rather than aspirin.", "I will not have to use condoms during intercourse because I have beaten this."

A

Which statement indicates the patient understands the origin of hepatitis C? A. "You can catch it while you're getting a tattoo." B. "You're more likely to get it in crowded living conditions." C. "The disease is passed from person to person by casual contact." D. "People working at restaurants can give it to you if they don't wash their hands."

A

Which type of hepatitis develops into a chronic form of the disease? A. Hep B, Hep C, Hep D B. Hep A, Hep E

A

Which type of hepatitis is commonly spread by consuming contaminated food and water or by fecal contamination? A. Hep A, Hep E B. Hep B, Hep C, Hep D

A

Which type of hepatitis virus spreads through contaminated food and water? A. Hepatitis A virus B. Hepatitis B virus C. Hepatitis C virus D. Hepatitis D virus

A

Cirrhosis Complications: Portal Hypertension

A persistent increase in pressure in the portal vein that develops as a result of obstruction to flow.

Patient arrives to the emergency room with a history of cirrhosis. The patient is A&O x2 with jaundice and abdomen distention. The wife states that her husband has not acted himself, hyperventilating, not drinking, and he has a musty sweet odor to his breath. His labs show an ammonia level of 152. He is diagnosis with hepatic encephalopathy, what other precipitating factors would he present with? A. Dehydration B. Metabolic acidosis C. Diarrhea D. Metabolic alkalosis E. Hypokalemia F. Constipation

A, D, E, F

A client with jaundice associated with hepatitis expresses concern over the change in skin color. Which does the nurse explain is the cause of this color change? A. Stimulation of the liver to produce an excess quantity of bile pigments B. Inability of the liver to remove normal amounts of bilirubin from the blood C. Increased destruction of red blood cells during the acute phase of the disease D. Decreased prothrombin levels, leading to multiple sites of intradermal bleeding

B

The nurse educator of a college health course is discussing tattoos with the class. Which type of hepatitis associated with tattoos would the nurse include in the teaching plan? A. Hepatitis A B. Hepatitis C C. Hepatitis D D. Hepatitis E

B

The nurse is caring for a client who is positive for hepatitis A. Which precautions would the nurse take? A. Wear a gown when entering the client's room. B. Use gloves when removing the client's bedpan. C. Clean eating utensils with bleach after use. D. Wear a high-efficiency particulate air (HEPA) respirator when entering the client's room.

B

Which result would the nurse monitor in a client with acetaminophen overdose? A. Blood gas level B. Liver function tests C. Complete blood count D. Glycosylated hemoglobin

B

Which intervention would the nurse expect for a client who reports malaise, fever, and abdominal pain, and who is slightly jaundiced and reports to the nurse that he or she returned 2 days ago from a mission trip to a developing country where he or she lived and worked with the local population while implementing new water systems to provide access to safe water? A. Refer client for hepatitis B immune globulin administration. B. Obtain a QuantiFeron-TB blood test to assess for M. tuberculosis infection. C. Refer client for administration of immunoglobulin (IG) to prevent infection with hepatitis A. D. Discuss need to rest, drink plenty of fluids, and use nonsteroidal anti-inflammatory drugs (NSAIDS) regularly until symptoms subside.

C

What labs are expected to be elevated with MI?

Cardiac Biomarkers -Troponin: specific for MI, elevates 4-6 hours after MI, peak 10-24 hours -CKMB: indicates cardiac injury but not specific to MI, elevates 3-6 hours after MI, peak 12-24 hours

The nurse gives a client with hepatitis A information about untoward signs and symptoms related to the disease. The nurse instructs the client to contact the primary health care provider if the client develops which symptom? A. Fatigue B. Anorexia C. Yellow urine D. Clay-colored stools

D

When assessing a client with Hepatitis A, with which substance would the nurse be particularly careful, to prevent transmission of the disease? A. Urine B. Saliva C. Blood D. Fecal matter

D

Which response will be given by a nurse caring for a client with chronic hepatitis B who asks "Are there any medications to help me get rid of this problem?"? A. "Sedatives can be given to help you relax." B. "We can give you immune serum globulin." C. "Vitamin supplements are frequently helpful and hasten recovery." D. "There are medications to help reduce viral load and liver inflammation."

D

Which response would the nurse give to the parents of a child diagnosed with hepatitis A who express concern that other family members may contract hepatitis because they only have one bathroom? A. "I suggest you buy an individual commode seat to use exclusively for your child's bathroom needs." B. "Your child may use the bathroom, but you need to use disposable toilet seat covers." C. "You will need to clean the bathroom from top to bottom every time a family member uses it." D. "All family members, including your child, need to wash their hands after using the bathroom."

D

Septic Shock Complication

DIC MODS

What cardiomyopathy is associated with HF?

Dilated

What is used to determine Ejection Fraction?

Echocardiogram -Must be 55% or greater, pumped out of left ventricle

Cirrhosis Complications: Hepatic Encephalopathy

Failure in removal of toxins from the blood due to damage in the liver causing altered levels of consciousness.

Cirrhosis Complications: Esophageal Varices

Fragile, thin-walled, distended esophageal veins that become irritated and rupture. Lower end of the esophagus.

Restrictive Cardiomyopathy

Heart muscle scars, stiffens, or both

Hypertrophic Cardiomyopathy

Heart muscle thickens -Most common in athletes

Hep C Patho

Hep C is RNA virus that is bloodborne and can result in both acute illness and chronic infection.

Hep D Patho

Hepatitis D is an RNA virus that cannot survive on its own. You have to have Hepatitis B to be infected

Hep E Patho

Hepatitis E is an inflammation of the liver caused by infection with the hepatitis E virus (HEV). The virus is transmitted via the fecal-oral route, principally via contaminated water.

Septic Shock

Immune response (inflammation) initiates systemic vasodilation -Caused by an infection

Cirrhosis Complications: Hepatorenal Syndrome

Increased portal hypertension-the body will VASODILATE causing renal VASOCONSTRICTION which will lead to renal failure.

Hep B Patho

Inflammation of the liver caused by a virus, bacteria, exposure to any hepatotoxins, autoimmune diseases, or metabolic problems. This causes a large number of infected hepatocytes (liver cells) to be destroyed. Hepatitis B usually resolves without treatment and is more likely to cause chronic liver dysfunction.

Cirrhosis Complications: Ascites

Is the accumulation of fluid (excessive protein and water) into the abdominal cavity.

Why give Nitroglycercin for chest pain and MI?

It is a vasodilator and will increase blood flow -Side effects: headache, orthostatic hypotension, lower BP

What is the most common cause of cardiogenic shock?

MI

Cardiogenic Shock Complication

MODS

Dilated Cardiomyopathy

Pumping chambers enlarge

QUESTION #1: What complications of portal hypertension would the nurse expect to see in a patient who comes into the ER? A. Ascites, Peripheral Edema, Gastric Varices, Esophageal Varices B. Ptosis, Neuropathy QUESTION #2: What nursing interventions would be appropriate for these complications? A. Bolus 1000ml normal saline per provider order, Diet low in calcium and magnesium B. Maintain NPO status, Establish IV access, Paracentesis, Administer loop diuretics and spironalactone

Q #1: A Q# 2: B

What ECG reading is expected with MI?

ST segment elevation/depression

Cardiogenic Shock

Shock caused by inadequate function of the heart, or pump failure.

Cardiogenic Shock Vital Signs

Tachycardia Hypotension

Septic Shock Vital Signs

Tachycardia Hypotension Elevated temp

Why give stool softeners with and MI?

To avoid straining and vasovagal response

T or F: Is instructing family to learn CPR apart of cardiomyopathy management?

True

T or F: S3 and S4 sounds are a symptom of Dilated Cardiomyopathy?

True