Hepatobiliary
What liver diseases can you get vaccines for?
Which one is the leading cause for end-stage liver disease?
Hep A/Hep B.
Hep C.
Your patient is not a candidate for surgery to remove gallstones. What is the next option?
Extracorporeal shock wave lithotripsy.
Private room (immunocompromised)
What type of AKI is associated with decreased urine output and pain with urination?
POSTrenal obstruction
This type of shock is an umbrella term for neurogenic, anaphylactic, and septic shock.
DISTRIBUTIVE shock
What are the three most common complications associated with Cirrhosis?
- Hepatic Encephalopathy
- Ascites
- Portal Hypertension
What type of device will be needed in addition to someone who went through an open cholecystectomy?
JP drain.
Your patient comes in with SIADH, what is your PRIORITY intervention?
Chronic kidney disease.
It affects all bodily systems.
Which stage of shock is when you see MODS?
What is your first medication you would give for portal hypertension?
* Bonus: What are the 2 main contraindications for the med?
Beta blockers (Propanolol) to decrease HR/BP.
HR < 60
BP < 100 (systolic)
Patient comes in with unrelenting pain from R side that radiates to their back and is worse when laying down. What might you suspect they have? What are your Nursing Interventions?
ACUTE pancreatitis
- Control pain first with IV. PCA pump (patient-controlled anesthesia)
- Patient needs to be placed NPO
- May need NG tube to decrease gastric secretion
With DI, what are you teaching your patient upon discharge?
- Call 911 for an increase in weight 2.2 lbs/day or 5lbs/week
- Teach S/S of water toxicity (fluid overload)
- Teach about polyuria or polydipsia
- Headache is first sign of dehydration
What are some advantages of peritoneal dialysis?
- easy to learn
- can be done at home
- no machine needed
- greater freedom for patient
- Oxygen
- Fluids
- Elevate feet
- Look for bleeding
- Administer vasoconstrictors/inotropes
- Check pulse, pulse pressure
Name 5 things you would do to intervene in an esophageal varices rupture.
1) Turn on side
2) O2
3) IV access (fluids and blood)
4) Meds (Vasopressors)
5) Minnesota tube
How are labs affected in someone with CHRONIC pancreatitis?
- Amylase?
- Lipase?
- Serum Bilirubin?
- Serum glucose?
Normal/mild increase amylase
Normal/mild increase lipase
Increased serum bilirubin
Increased serum glucose
- Hypoglycemia
- Hyponatremia (#1 sign of adrenal deficiency!)
- Hypovolemia
- HYPERkalemia
- Weight loss
- Bronze skin
What are your nursing considerations for a patient who comes in with an AV fistula?
- Assess for adequate circulation
- Do not take BP in arm with fistula
- No blood draw/IV's in arm with fistula
- Palpate for thrills, auscultate for bruits
- Hypertensives should NOT be given
- Hold meds 1 hr BEFORE hemodialysis
Your patient with an infected laceration to the arm comes in with cool, pale skin, RR 22, HR 128, Temp at 102.4 F, BP 104/68, and lactic acid at 10 mg/dL. What are your priority interventions?
- Oxygen
- Culture
- Broad spectrum antibiotics
- Fluids
What are the main medication therapies for these conditions?
- Ascites
- Portal hypertension
- Portal hypertension with bleeding (varices)
- Hepatic encephalopathy
- Diuretics (spironolactone, furosemide)
- Beta blockers
- Vasopressors
- Lactulose
Educate your patient with chronic pancreatitis on how to take Pancrealipase (PERT).
- Extended release needs to be swallowed WHOLE
- Need to drink with a full glass of water
- Do NOT take with protein
- Administer AFTER antacid
- Wipe mouth after
For DKA, what S/S are you noticing?
What are your concerns?
- Kussmaul respirations
- Fruity breath
- Nausea
- 3 P's
Concerned about metabolic acidosis and HYPERkalemia
In CKD, what will your lab values be doing? High/Low
- Creatinine
- BUN
- Sodium
- Potassium
- Phosphorous
- Magnesium
- Calcium
- HgB
- Hct
- Osmolarity
- Creatinine INCREASED
- BUN INCREASED
- Sodium NORMAL/INCREASED/DECREASED
- Potassium INCREASED
- Phosphorous INCREASED
- Magnesium INCREASED
- Calcium DECREASED
- HgB DECREASED
- Hct DECREASED
- Osmolarity INCREASED
Your patient with comes in with a STEMI and is now showing a MAP of 52, BP of 90/54, HR 122, JVD, and cool, clammy skin. What are your nursing interventions?
Cardiogenic shock. Administer ONMA, use fluids sparingly!