liver

58問 • 2年前

問題一覧

What does the liver do?

Removes harmful substances from the blood, Makes protien and clotting factors, Amonia conversion, Metabolize medication, Vitamin and iron storage, Metabolize glucose, lipid, fat and protein, Produces biles to aid digestion

What happens when the liver fails?

Nodular growth=cirrhosis when liver can’t filter toxins reach the brain and damage the nervous system= encephalopathy fluid retention and peripheral edema

What can cause the liver to fail?

Hepatitis, Inherited metabolic disorders, Alcohol, Drugs, NASH non- alcoholic steatohepatitis fatty liver, Immune disorders, Excess vitamin A, Cholestatic disorders

Wide spread inflammation of liver cells acute or chronic?

Hepatitis

Complications of hepatitis are fulminant hepatitis and chronic hepatitis. Select the statements true of fulminant hepatitis.

Failure of liver cells to regenerate, Progression of nectrotic process (advanced), Often fatal

Complications of hepatitis are fulminant hepatitis and chronic hepatitis. Select statements true of chronic hepatitis.

Liver inflammation lasting linger than 6 months, Usually occurs due to HBV or HCV may occur with HBV+ HDV, May lead to cirrhosis and liver cancer

Select hepatitis prevention.

Vaccine, Infection control practices

Select assessment data: HISTORY for hepatitis.

Very comprehensive, Travel to another country, Recent ingestion of shellfish, Secual practices with whom/unprotected, Illicit drugs use IV, Body piercing/tattooing, Healthcare worker/child care/correctional facility/ Long term care, Blood/blood products prior to 1992, History of alcohol use, Living conditions

Select subjective/objective data for hepatitis.

Abdominal pain, Changes in skin or sclera yellowing, Changes in color of urine (dark) or stool, Arthralgia (joint, pain) myalgia (muscle pain), Fever, Lethargy, Malaise, N/V, Puritis

Select interventions for promoting nutrition with hepatitis

High carb and calories with moderate amount of fat and protein High protein= ammonia= encephalopathy, Small frequent meals, Highh calorie snacks, Supplemental vitamins, Food preferences

Select interventions for fatigue with hepatitis.

Resting the inflamed liver, Alternate periods of rest with activity, Self care and ambulation activities as tolerated

Select interventions for reducing potential for infection with hepatitis.

Teach pt and caregivers about importance of handwashing, Teach about any isolation precautions, Restrict visitors with active infections, Monitor for development of fever/⬆️WBC& report to physician

Select the drug interventions for hepatitis.

Anti-emetics very important, Anti virals for HBV&HCV, Integrative therapies, Teach pt to avoid all OTC meds unless

Select statements true of fatty liver disease

Caused by accumulation of fats around the hepatic cells, 2 types non-alcoholic fatty liver disease (NALFD) non-alcoholic steatohepatitis (NASH), Causes: Diabetetes, obesity, elevated lipid profile, genetics

Select assessment data for fatty liver disease.

Many pts asymptomatic for most part, Diagnostics: Elevated ALT/AST or normal ALT/⬆️ AST, MRI/Ultrasound, Biopsy

Select interventions for fatty liver disease.

Weight loss, Glucose control, Lipid lowering agents, Monitor liver function

Fatty liver disease leads to what?

Cirrhosis

Select statements true to cirrhosis.

Extensive irresversible scarring of the liver, Caused by chronic reaction to hepatic inflammation and necrosis, Widespread fibrotic changes lead to change in cellular regulation, Inflammation> destruction of hepatocytes, Tissue becomes modular> nodules block file ducts and blood and lymph flow, Early stage: liver is enlarged, firm and hard, Later stage: liver shrinks in size> ⬇️liver function

Select statements true to post necrotic cirrhosis.

Usually follows acute viral hepatitis, but may due to industrial chemical hepatotoxins, Massive lose of liver cells, with irregular patterns of regenerating cells, 75% die of complications within five years

Select statements true to Laennec’s (alcoholic) cirrhosis.

Chronic alcohol abuse, Also known as Laennec’s or micronudular cirrhosis, Small nodule form as a result of presistence of offending agent, Prognosis depends of presence of complicates and continued abuse

Select statements true to biliary cirrhosis.

Occurs secondary to chronic biliary obstruction or autoimmune disease, Bile flow is ⬇️with concurrent cell damage to hepatocytes around bile ductules, Treatment aim is to relieve mechanical obstruction, Also known as cholestatic

Select statements true to compensated cirrhosis (a complication of cirrhosis).

Liver is scarred and cellular regulation impaired, Can still perform essential functions, No major symptoms

Select statements true to decompensated cirrhosis (a complication of cirrhosis).

Portal hypertension, Coagulation defects, Ascites and esophageal varices, Jaundice, Portal systemic encephthalopathy> hepatic coma, Hepatorenal syndrome, Spontaneous bacterial pertitonitis

Select statements true of portal hypertension.

Persistent ⬆️in pressure in portal vein, ⬆️ resistance/ obstruction of blood flow through the portal vein and branches, Blood seeks collateral circulation, Backflow of blood to splee causes splenomegaly, Persistant venous dilation: esophagus, stomach, intestines, abdomen, and rectum.

Select statements true to ascites

Third space shift hypovolemia and edema, Free fluid within peritoneal cavity-Caused by ⬆️hydrostatic pressure from portal HTN- Fluid flows from the vascular system into the abdomen. Distended abdomen!

Select statements true to esophageal varices.

Results from portal HTN, Back up of blood from liver enters esophageal and gastric veins, Varices occur when esophageal veins become distended

Select statements true to esophageal varices

Life threatening/ Medical emergency, Hematemsis, Melena, Can occur spontaneously with no precipitating symptoms

Select statements true of biliary obstruction in order!

Production of bile in the liver is ⬇️, Prevents the absorption of fat-soluble vitamins (K), Insuffcient quantity of clotting factors produced (susceptible to bleeding and bruising, Genetic disposition primary biliary cirrhosis (PBC)

Select statements true to Jaundice.

Yellow pigmentation of the sclera, skin and deeper tissues caused by excessive accumulation of bile pigments in blood., Billirubin (bile pigment) a product of RBC breakdown is deposited in the skin and excreted in the urine when present in blood in excessive amounts (hyperbilirubinemia), Total bilirubin 0.3-1.1 mg/dl

Select statements true to hepatocellular jaundice.

Develops because the liver cannot metabolize billirubin, ⬆️indirect (unconjugated) and direct (conjugated) bilirubin levels, Excessive circulating bilirubin levels due to impaired uptake of bilirubin from the blood

Select statements true of intrahepatic obstructive jaundice.

Edema fibrosis or scarring of the hepatic bile channels and bile ducts which interferes with normal bile and bilirubin excretion., Increased direct bilirubin levels

Select statements true to hemolytic jaundice.

Results from impaired bilirubin uptake die to excessive RBC destruction (sickle cell, transfusion reactions), Caused by transfusion reaction, hemolytic anemia, sickle cell crisis, Increased indirect and normal direct levels

Select statements true to hepatic encephalopathy.

Exact cause unknown, Cognitive syndrome, Results from liver failure and cirrhosis, Early S/S: sleep disturbances, mood disturbances, mental status changes, speech problems, Later S/S altered LOC, impaired thinking processes, neuromuscular problems

What can cause hepatic encephalopathy in a person with cirrhosis?

High protien diet, Infection, Hypovolemia (⬇️fluid volume), Hypokalemia (⬇️serum K+), Constipation, GI bleeding, Drugs

Select statements true to hepatorenal syndrome.

Oliguria (sudden ⬇️ in urinary flow), ⬆️BUN& Creatinine, ⬇️sodium excretion, Increased urine osmoality

Select statements true to spontaneous bacterial peritonitis.

Very advanced liver disease, Low concentrations of proteins, Symptoms: fever, chills, alterations in comfort (abdomen)

Select the history assessment data for other complications of cirrhosis.

Exposure to alcohol and drugs (how much, how often, when, which routes), Needlestick injuries, Sexual history and orientation, Family history of alcoholism or liver disease, Work history (Healthcare, police officer, EMT), History of hepatitis, biliary tract disorders, viral infections, blood transfusions, lipid profile, autoimmune disorders

Select objective data of other complications of cirrhosis.

Fatigue, Weight changes, anorexia, N/V, Abdominal tenderness, Jaundice, Dry skin/ rashes, Purpuric lesions (petechiae or echymoses), Asterixes (hand flapping), Warm red palms, Spider angiomas, Ascites, Peripheral edema of extremities, Vitamin deficiencies esp fat soluble (A,D,E,K), Hepatomegaly, Blood in stool or vomit, Amenorrhea, Gynecomastia/ impotence

Select diagnostics for other complications of cirrhosis.

AST, ALT, LDH ⬆️initially, Alkaline phosphatase increased d/t biliary obstruction, Total serum bilirubin ⬆️, Ammonia levels ⬆️, Serum creatinine ⬆️, Total serum albumin ⬇️, PT/INR prolonged, PLT count ⬇️, ⬇️ RBC, HGB,HCT, ⬇️serum sodium, Imaging: Ultrasound of liver, x-ray, MRI-can reveal mass lesions, CAT scan, Liver biopsy, EGD, ERCP

Select interventions for managing fluid volume (Ascites)

Monitor:F&E, I&O, abdominal girth, peripheral edema, Nutrtion therapy: low sodium diet, Vitamin supplements, Drug therapy: Diuretics/K+ replacement, Furosemide (lasix), spirnolactone (aldactone)

Select statements true to ERCP procedure.

Endoscopic retrograde cholangiopancreatography, Used to diagnose and treat problems in the liver gallbladder, bile ducts, and pancreas

Select planning/interventions for paracentesis.

Explain the procedure and answer pt questions, Obtain VS including weight before procedure, Ask pt to void before procedure to prevent injury to bladder!, Position pt in bed with HOB elevated, Measure the drainage record accurately document characteristics, Label and send fluid for lab testing, After catheter removed apply a dressing to the site assess for leakage, Maintian rest per protocol, Take VS and weigh pt after and document

Select statement true to hepatopulmonary syndrome.

S/S: Dyspnea, adventituous lung sounds, Interventions: HOB elevated, feet elevated, weigh pt daily, monitor O2 sat.

Select interventions for managing a hemorrhage.

Drug therapy: Beta blocker propranolol and abx, Endoscopic therapies: ligation of bleeding veins via endoscopic variceal ligation EVL and endoscopic sclerotherapy (EST) injection sclerotherapy, Rescue therapies: balloon tamponade transjugular intrahepatic portal shunt (TIPS)

Select the different drug and nutrition therpies for managing hepatic encephalopathy.

Nutrion: High carb, moderate fat, high protein foods, Restrict opioids sedatives and barbiturates, Medications to reduce ammonia levels LACTULOS, lactilol, Non-absorbable antibiotics- neomycin sulfate or rifaximin

Select statements true of liver trauma.

Most common injury, Multiple lacerations, simple lacerations, Avulsions (tear),Crush injuries

Select assessment data for liver trauma.

Early signs of hypovolemic shock: hypotension, tachycardia, tachypenia, pallor, diaphoresis, cool clammy skin confusion or other changes in mental status, Hematoma: RUQ pain abdominal pain, abdominal tenderness, guarding, distention, rigidity, Diagnostics: Ultrasound or CT scan

Select interventions for liver trauma.

Blood products, Massive volume infusion, Srugery

Cirrhois is a risk factor for developing liver cancer the most ____ type of cancer.

Fatal

Select true statements of liver cancer.

Tumors may be metastatic, Tumor may be hepatocellular

Select assessment data for liver cancer

EARLY SYMPTOMS: Weight loss/ anorexia, weakness abdominal discomfort RUQ pain, Jaudice, Bleeding, Ascites, Edema

Select diagnostics for liver cancer.

⬆️Alpha fetal protein (AFP), Alkaline phosphate a tumor marker, Ultrasound/ CAT scan with contrast

Select interventions for liver cancer.

Surgical resection/liver transplant, TACE= Transarterial chemoilzation, SIRT= Selected internal radiation therapy, Hepatic artery embolization, Cryotherapy, Chemotherapy, Palliative, End-of-life, Hospice services

Select when liver transplantation is considered.

End stage liver disease, Acute liver failure

Select what make someone not a candidate for liver transplant.

Severe cardiovascular instability, Sever respiratory disease, Metastatic tumors, Inability to follow instructions regarding self management and drug therapy

Select post-op complications of liver transplantation.

Graft rejection, Infection, Bleeding

Select what is triple therapy for peptic ulcer disease PUD.

2 antibiotics, PPI

Select what is the triple therapy for GERD.

Antacids, H2 blockers, PPIs

Health assessment questions

ユーザ名非公開 · 15問 · 2年前

Health assessment questions