Pharmacology
Unintentional Tylenol Overdose
Lactulose use, action, and routes
Cirrhosis, Hepatic Encephalopathy
Acidifies intestine to ionize ammonia and excrete it through stool
PO, PR, NG (liquid medication)
General treatment for Hepatitis
Rest, supportive treatment (it's a virus)
Cirrhosis Diet
High calorie, mod-low fat, increased carbs, protein supp, low Na (with ascites/edema), B Vitamins
(T/F) UAPs can assist with placement of braces and prostheses
True
Steroids must be tapered to avoid this
Adrenal crisis (severe hypotension/shock, hypoglycemia, hyponatremia, hyperkalemia, weakness, confusion, lethargy, coma, n/v, abdominal pain)
Class, action and use of Rifaximin
Class: Antibiotic
Action: reduce ammonia production by eliminating ammonia-producing colonic bacteria
Use: Tx or prevention of HE in ESRD
Precautions for Hep A, Hep B and Hep C
Hep A: contact
Hep B and C: Standard
Most common causes of cirrhosis
Alcohol, chronic Hep C, NASH
(T/F) LPNs can receive a verbal order from the provider
False
Absorption (how it reaches bloodstream), Distribution (movement of medication to tissues), Metabolism (liver), Excretion (kidneys)
Class and use of spironolactone
Class: potassium-sparing diuretic (aldosterone antagonist)
Use: Cirrhosis of liver with ascites; fluid retention
This complication is most likely to occur from Hep C
Cirrhosis
Also: liver failure/cancer, portal HTN, varices, peripheral edema and ascites
This is the most life-threatening complication of Cirrhosis (and why)
Esophageal Varices d/t inadequate clotting factors and Vitamin K
(T/F) It is appropriate for the RN to teach the patient about a new medical diagnosis
True- The provider gives the actual diagnosis.
Extra: LPN can reinforce RN's initial teaching after
Steroid administration routes ("extra points" for examples of each route)
Inhaled (fluticasone), eye drops, PO (prednisone), IM (emergency kits for Addison's patients), IV (methylprednisolone), Topical (hydrocortisone cream)
** Bonus Question **
What is oncotic pressure?
Force exerted by proteins in blood plasma that draws fluid back into capillaries from the surrounding tissues
Timeframes for giving Immunoglobulin for Hep A vs Hep B
Hep A: within 2 weeks of exposure
Hep B: within 24 hours
Increase or decrease in these VS with cirrhosis: BP, HR, RR, T, 02, Pain
(T/F) The UAP can place the patient's nasal cannula in their nares
True- the UAP can not turn on/off the actual oxygen
Steroid Diet
Low Na, high protein (wound healing, suppress appetite), high Ca (risk of osteoporosis), high K (steroids cause hypokalemia), decreased simple carbs (risk of hyperglycemia)
Purpose of administering IV Serum Albumin
ESLD - to help pull fluid out of pleural spaces
Who else should get the immunoglobulin for Hep A vs Hep B
Hep A: household, daycare
Hep B: newborns if mom is positive, needle sticks, sexual exposure (check titers to determine immunity)
The four main symptoms a patient would come to the hospital when they have Cirrhosis (and what caused them)
Mental status changes (HE)
SOB (ascites)
GI Bleed (varices)
AKI (hepatorenal syndrome)
The five rights of Delegation
Right task, right circumstance, right person, right direction/communication, right supervision/evaluation