Hepatitis
Which ones have vaccines and which have immune globulins?
AE are fecal/oral, BC are blood/bodily fluid, and D is B
AB have vaccines, ABE have immune globulins
Normal daily amount of alcohol for men and women.
Men = up to 80g or 2 drinks
Women = up to 60 grams or 1 drink
True/False: Men are more at risk for pancreatitis.
What are gallstones made of?
Cholesterol, bilirubin, and calcium
What is the most common cause of cholecystitis?
Cholelithiasis- the stones block outflow of bile causing inflammation
Three major signs of hepatic encephalopathy?
Mental status change, fetor hepaticus and asterixis
Portal hypertension is a complication of ________ and a primary factor in the development of ___________.
liver cirrhosis and ascites
the high pressure causes fluid leakage into the abdomen and the liver is unable to metabolize aldosterone so fluid continually builds
Dietary changes for acute pancreatitis and why.
What should the nurse be monitoring frequently?
NPO + NG suction!! To allow for bowel rest and prevent further release of pancreatic enzymes.
Monitor blood sugars to watch for hyperglycemia
What is ursodeoxycholic acid and what teaching is needed?
Gallstone dissolving medication used to avoid surgery. Takes 6-12 MONTHS to work, no longer than 2 years. Take with meals.
Symptoms of cholecystitis?
RUQ pain radiating to the right shoulder, abdomen rigidity, indigestion + gas, N/V, low-grade fever, and chills
Day to day nursing care of a patient with hepatitis.
Bed rest
Standard precautions, contact if incontinent
Diet: low fat, high carb calorie and protein
Teaching on NO ALCOHOL
What are the four complications of late stage cirrhosis?
Portal HTN
Esophageal Varices
Ascites
Hepatic Encephalopathy
What is the cardinal symptom of pancreatitis?
Abd pain radiating to back unrelieved by vomiting or antacids
What is the gold standard to diagnosing gallstones and what does the nurse need to educate on?
Ultrasound
NPO after midnight
Post-cholecystectomy education
May drive in 3-4 days, no lifting over 5lbs for one week, and may eat a normal diet
WATCH FOR BLEEDING AND INFECTION
Which medications should be avoided/limited to prevent drug-induced hepatitis?
NSAIDS: ibuprofen, naproxen, and voltaren
Acetaminophen
Amoxicillin
Valporic Acid
Ketoconazole
What is a TIPS procedures and what are the main risks?
Shunt for portal hypertension
1. Hypotension from fluid pull-off too quick
2. Peritonitis
3. Kinked Tubing-change positions/Dr. may replace
4. FLuid leak-apply dressing, apply collection bag
Which labs are most important in pancreatitis?
Amylase, lipase, WBC, albumin, and caclium
All increased except for albumin and calcium
Nursing care of a patient with cholelithiasis needs to know.
Low fowlers
NG suction + NPO for bowel rest until bowel sounds return then low fat, high carb
Pain management
Most common complication of children with gallbladder disease?
Pancreatitis
Name the top three important liver function tests and their normal values.
Extra: Normal Bilirubin and PT
ALT: 8-40
AST: 10-40
GTT/GTTP: 0-30
Bilirubin: 0-2 and PT: 12-16 seconds
What medications are given in the case of an esophageal variceal rupture?
Vasopressin, nitroglycerin, and octreocide IV to decrease bleeding
Propanolol to decrease portal pressure
What four signs should the nurse monitor in a patient with acute pancreatitis?
Turner's- bruising around flank
Cullen's- mottling around belly button
Chvostek-twitching with cheek palpation
Trousseau- contracted T-shape wrist with BP cuff
Risk factors
CF, DM, rapid weight loss, estrogen, pregnancy, hypothyroidism, obesity, sedentary lifestyle, 40 yo, and women
What procedure provides direct visualization of the pancreas and gallbladder?
What does a nurse need to know?
ERCP
Endoscopy with multiple position changes
NPO prior and will be sedated. Observe for OVERsedation, CNS depression, and gagging/vomiting. Must have return of gag reflex before eating post-op.