Throwin' back pills
What pain meds should you expect to give a patient with a case of acute pancreatitis?
Fentanyl, Morphine, Hydromorphone; PCA pump is often preferred to allow the patient to be on top of their own pain management.
What imaging test in contraindicated for early pancreatitis patients?
Endoscopic Retrograde Cholangiopancreatography (ERCP); there is an increased risk of worsening the case of pancreatitis in early cases.
What are the metabolic disturbances for chronic kidney disease and what are their symptoms?
Waste product accumulation (increased urine nitrogen levels ---> N/V, lethargy, LOC changes), altered carb metabolism (patients with diabetes may require more insulin before diagnosis), elevated triglycerides
What is the primary symptom associated with a case of acute pancreatitis?
PAIN
What are the routes of transmission for each form of hepatitis?
Hep A and E are oral-fecal, and B-D are transmitted through infected blood by various means (sharing needles, unsafe sexual practices, etc)
Which of the following medications are known for causing toxic/ drug induced hepatitis?
NSAIDS
Thiazide diuretics
Statins
ARBs
1st gen antipsychotics
BONUS 300
List 3 specific drugs that are not in the following classes that are considered hepatotoxic
Thiazide diuretics and statins; while technically any drug that is processed by the liver can cause injury to the liver, the listed ones have a significantly higher risk.
BONUS
Tylenol
Methotrexate
Chloroform
Carbamazepin (tegretol)
What is the primary diagnostic procedure for choleithiasis?
RUQ ultrasound
What is the priority management goal for acute pancreatitis?
BONUS 300
What are the other five management goals for throughout the whole hospital stay?
Stabilize hemodynamic status; managing hemodynamic status is the top priority in acute pancreatitis because severe inflammation, third-spacing, and systemic complications can quickly lead to shock, organ failure, and death if not controlled early.
Adequate pain control, minimize pancreatic stimulation, psychosocial support, treat underlying cause, prevent complications
A kidney transplant recipient reports increasing fatigue, low-grade fever, and pain at the transplant site, one week post-transplant. What complications might this indicate?
This suggests possible acute rejection or infection.
Describe why acute pancreatitis is so dangerous.
Dead pancreatic tissue and toxins cause surrounding organs to fail, leading to widespread infection and organ failure.
A patient with chronic kidney disease (CKD) is prescribed epoetin alfa (Epogen). What is the primary purpose of this medication?
Epoetin alfa is a recombinant erythropoietin that stimulates red blood cell production.
Describe the four labs and their progression if applicable (if they peak at specific times) and why they're out of wack.
Serum amylase peaks in 1-2 days, stabilizes in 3-5 days
Serum lipase peaks in 1 day usually, stays elevated for 8-14 days; more specific for diagnosing pancreatitis
Elevated WBC due to inflammation of pancreas
Elevated blood sugar from impaired insulin production
What are the three management goals for damage control surgery?
Initial operation to control hemorrhage, ICU resuscitation to correct the trauma triad of death, and definitive restoration surgery or surgeries to help manage damage long term?
What are the clinical manifestations that are common between both acute and chronic hepatitis?
BONUS 200
What stage of hepatitis is the most infectious?
↓ sense of smell, ↓ appetite, Hepatomegaly, lymphadopathy, abd tenderness, sometimes splenomegaly, Pruritus, Malaise/Fatigue
BONUS
Period of maximum infectivity is when they are icteric (Jaundiced)
Describe the patho for glomerulonephritis.
An inflammation response occurs, usually after a group A strep infection, which results in the filtration process being impaired. Antigen-antibody complexes cause increased inflammation and permeability, resulting in increased tissue damage
A patient on hemodialysis develops hyperkalemia. Which medication would be MOST appropriate for immediate treatment of the hyperkalemia, and what is its mechanism of action?
For immediate treatment of acute hyperkalemia, intravenous insulin and dextrose (D50W) would be most appropriate.
Insulin promotes potassium uptake into cells, rapidly lowering serum potassium levels. D50W prevents hypoglycemia from the insulin administration.
What electrolyte imbalances are common with CKD?
BONUS 200
Describe the patho behind these electrolyte imbalances.
Hyperkalemia and hyper or hyponatremia
BONUS
↓ Potassium Excretion: The kidneys normally excrete excess K⁺, but in CKD, GFR is reduced, causing K⁺ retention.
Hyponatremia is more common due to fluid overload and impaired sodium handling.
Hypernatremia may occur in later stages due to an inability to excrete Na⁺.
A patient undergoing hemodialysis develops sudden hypotension, muscle cramps, and nausea during the treatment. What is the most likely cause of these symptoms?
These symptoms suggest rapid fluid removal during hemodialysis.
A patient on peritoneal dialysis (PD) reports cloudy dialysate output, abdominal pain, and fever. What is the likely diagnosis?
The suspected diagnosis is peritonitis.
Explain the patho for acute tubular necrosis.
An initial injury causes damage to endothelial cells that die, shed, leading to obstruction. This increases intratubular pressure and decreases GFR. The tubules become leaky, allowing filtrate to be reabsorbed instead of excreted, leading to increased oliguria, fluid overload, azotemia, and electrolyte imbalances.
A patient with end-stage renal disease (ESRD) on hemodialysis reports muscle weakness and palpitations. The ECG shows tall, peaked T waves and a widened QRS complex. Which intervention should the nurse implement first?
A. Administer IV calcium gluconate.
B. Encourage the patient to eat more potassium-rich foods.
C. Hold the patient’s scheduled sodium polystyrene sulfonate (Kayexalate).
D. Prepare for emergency hemodialysis.
The patient has severe hyperkalemia (tall, peaked T waves, widened QRS). IV calcium gluconate stabilizes cardiac membranes, preventing lethal dysrhythmias.
A patient with chronic kidney disease (CKD) has a serum phosphate level of 8.0 mg/dL (high). Which electrolyte imbalance is this patient MOST likely to also exhibit?
A. Hyperkalemia
B. Hypocalcemia
C. Hyponatremia
D. Hypermagnesemia
B. Hypocalcemia
Hyperphosphatemia (high phosphate) in CKD often leads to hypocalcemia (low calcium). The kidneys' impaired ability to activate vitamin D reduces calcium absorption from the gut. High phosphate also binds to calcium, making it unavailable.
A patient with renal calculi is experiencing severe flank pain. Which nursing intervention is the PRIORITY?
A. Administer prescribed antibiotics.
B. Encourage increased fluid intake.
C. Administer prescribed analgesics.
D. Monitor urine output.
C. Administer prescribed analgesics.
The priority intervention is to manage the patient's severe pain. Renal colic can be excruciating. While other options are important aspects of care (treating infection if present, fluid intake to promote stone passage), pain relief is paramount due to the intensity of the pain.
A patient in the oliguric phase of acute pancreatitis is developing metabolic acidosis. Which assessment finding is MOST indicative of this complication?
A. Hypoventilation
B. Kussmaul respirations
C. Elevated serum bicarbonate
D. Decreased serum potassium
B. Kussmaul respirations
Kussmaul respirations (deep, rapid breathing) are a compensatory mechanism for metabolic acidosis
Hepatic encephalopathy develops primarily due to the accumulation of which toxic substance in the blood?
A. Bilirubin
B. Ammonia
C. Lactate
D. Ketones
B. Ammonia
Hepatic encephalopathy is a neuropsychiatric syndrome resulting from the inability of the diseased liver to convert ammonia (a byproduct of protein metabolism) to urea.