1
Q
Conditions that would put someone at risk for ARDS
A
- sepsis
- FVO
- Shock
- trauma,
- neurological injuries
- burns
- DIC
- Drug/alcohol abuse
- aspiration
- inhalation of toxic substances
- PNA
- Severe trauma
- Massive transfusions
- Cigarette smoking
- Cardiopulmonary bypass
- Pneumonectomy
- PE
2
Q
List clinical manifestations for ARDS
A
- Tachypnea: earliest sign, can begin from 1-96hr after initial insult
- Dyspnea
- Decreased breath sounds
- Deteriorating ABG
- Refractory Hypoxemia
- Decreased pulmonary compliance
- Pulmonary infiltrates
3
Q
Earliest sign of ARDS
A
Tachypnea
4
Q
The following are S/S of what?
-Absent or markly decreased breath sounds
-Cyanosis
Decreased chest expansion unilaterally
-Dyspnea
-Hypotension
-Sharp chest pain
-Subcutaneous
-emphysema AEB crepitus on palpation
-Sucking sound with open chest wound
-Tachycardia
-Tachypnea
A
Pneumothorax
5
Q
Complications of ARDS
A
- Barotrauma
- Renal failure
- MODS
- VAP
6
Q
All of the following are S/S of what?
Fever
Leukocytosis
Increased respiratory effort
Prulent secretions
Sputum cultures will show infection
A
VAP
7
Q
How to prevent barotrauma
A
Careful application of tidal volume and PEEP to prevent
8
Q
How to prevent VAP
A
Regular mouth care
Suctioning
Change vent circuit per hospital protocol
Use sterile water for humidification
9
Q
Acute onset of less than 7 days, refractory hypoxemia, and bilat infiltrates ruling out cardiac pulmonary edema as a cause. Classified by severity with PaO2/FIO2 Ratio. Three phases: Exudative, proliferative, and fibrotic. Can be caused by sepsis, FVO, shock, trauma, neurological injuries, burns, DIC, drug use, aspiration, and inhalation of toxic substances
A
ARDS
10
Q
Positioning/activity for a vented patient
A
- Prone
- Elevate HOB
- Q2 turn
- ROM exercises
- “Good lung down”
11
Q
Nursing interventions for infection prevention for a vented patient
A
- Handwashing
- Monitoring/care of central lines
- Foley cath care
- Mouth care
12
Q
Central line care
A
- Maintenance of strict sterile technique on insertion is key to infection prevention
- Routine monitoring for redness or drainage at the insertion site
dressing changes per hospital protocol - IV tubing changes per hospital protocol
- evaluation of the continued need
13
Q
Mouth care for a vented patient
A
mouth care every 2 hours. Use chlorhexidine
14
Q
Expected VS for a patient with ARDS
A
tachycardia, tachypnea, hypotension, hypoxemia
15
Q
How often should a neuro assesment be done on a patient with ARDS
A
At least every 1-2 hrs
16
Q
Expected lung sounds for a patient with ARDS Initially
A
Crackles
17
Q
As ARDS progresses what kind of lung sounds can you expect?
A
diminished
18
Q
An early sign of poor tissue perfusion
A
Decreased urine OP
19
Q
Expected initial ABG for a patient with ARDS
A
Respiratory alkalosis
20
Q
Expected ABG for a patient with ARDS as it progresses
A
Respiratory acidosis
21
Q
If treatment for ARDS is not working and condition continues to worsen what does the ABG look like?
A
Metabolic acidosis
22
Q
What does the CHXR of a patient with ARDS look like?
A
- Ground glass
- Snow
23
Q
Why does a patient with ARDS have to have their ECG monitored?
A
Hypoxemia can lead to dysrythmias
24
Q
List causes of a high pressure alarm on a mechanical ventilator
A
- Mucous plug or increased seretions
- Patient biting ETT
- Pneumothorax
- Pt anxious and fighting the vent
- Kink in the tubing
- Water collecting in vent tubing
25
If a patient on a vent has a mucus plug or increased secretions what needs to be done to correct it
Suction is needed
26
You have a patient on a vent: the high-pressure alarm goes off, you notice their chest has an a symmetrical rise, and decreased breath sounds on the right side. What do you suspect? What should you do ASAP?
Pneumothorax
call the MD
27
You have a vented patient who is axious and fighting the ventilator. What should be done?
Assess pt, provide emotional support, and reevaluate sedation/analgesic as needed
28
If you notice water accumulating in your patients vent tubing what should you do?
Empty water from ventilator tubing
29
Causes of low presure alarms on a ventilator
* Cuff leak
* Leak in the ventilator circut
* Patient stops breathing in the pressure support modes or SIMV
30
What needs to be done if you suspect a cuff leak on a vented patient
Assess of cuff leak, check cuff pressure, and call for respiratory, call MD
31
You suspect a leak in the ventilator circut. What should you do?
Assess all connections and tubing
32
Acute onset of less than 7 days, refractory hypoxemia, and bilat infiltrates ruling out cardiac pulmonary edema as a cause. Classified by severity with PaO2/FIO2 Ratio.
ARDS
33
# What phase of ARDS is this?
Occurs within 24-48 hrs after injury. Fluid moved from capillaries to interstitial space to alveoli. Protein moves from vascular space. All leads to pulmonary edema which causes V/Q mismatch
Exudative
34
# The following are S/S of what phase of ARDS
- Hyperventilation
- Tachycardia
- CHXR: Bilat infiltrates or pulmonary edema
- V/Q Mismatch
- Respiratory Alkalosis
Exudative
35
List S/S of the exudative phase of ARDS
Hyperventilation
Tachycardia
CHXR: Bilat infiltrates or pulmonary edema
V/Q Mismatch
Respiratory Alkalosis
36
# What phase of ARDS is this?
V/Q Mismatch worsens>pulmonary HTN occurs>R-sided heart failure>Fibrotic changes occur in lungs which cause lungs to become “stiff” and “noncompliant” which increases work of breathing
Proliferative
37
# The following are all S/S of what phase of ARDS?
- Hypercarbia
- Refractory Hypoxiemia
- Lung Compliance deteriorates
- If pt is vented inspiratory pressures rise d/t decreased lung compliance which requires more pressure
- Increasing PaCO2
Proliferative
38
List S/S of proliferative phase of ARDS
- Hypercarbia
- Refractory Hypoxiemia
- Lung Compliance deteriorates
- If pt is vented inspiratory pressures rise d/t decreased lung compliance which requires more pressure
- Increasing PaCO2
39
# What phase of ARDS is this?
Fibrosis and scarring severely impair gas exchange and lung compliance. Pulmonary HTN worsens, R-sided heart failure worsens Decreased L-sided heart pre-load
Fibrotic
40
# The following are S/S of what phase of ARDS
- Hypotension
- Decreased cardiac output
- Severe V/Q Mismatch
- Diffusion defects
- Intrapulmonary shunting
- Refractory hypoxemia
- Tissue hypoxemia
- Lactic acidosis
Fibrotic
41
List S/S of the fibrotic phase of ARDS
- Hypotension
- Decreased cardiac output
- Severe V/Q Mismatch
- Diffusion defects
- Intrapulmonary shunting
- Refractory hypoxemia
- Tissue hypoxemia
- Lactic acidosis
42
To maximumize patient comfort during mechanical ventilation; Respiratory effort and patient–ventilator synchrony must be optimized to avoid barotrauma. What can be done to acheive this for a patiet with ARDS?
Administer paralytic agents, analgesics, and sedative medications as ordered
43
Medications used to augment cardiac output for an ARDS pt
Inotropic agents
44
What kinds of medications may be necessary to support blood pressure in a patient with ARDS?
Vasoactive
45
Why are abx used in the treatment of ARDS patients?
They treat the cause of ARDS so that it can resolve
46
________ allows for better oxygenation and alveolar recruitment by having the “good” side down. This increases the recruitment of collapsed posterior alveolar units and reduces the V/Q mismatch via gravity as blood flow is directed to the better-aerated anterior portion of the lungs.
Proning
47
__________ allows for better lung expansion and reduces the risk of aspiration.
Elevating HOB
48
Positioning methods for a patient with ARDS
* Prone position
* Elevate HOB
* Frequent position changes
* ROM exercises
49
______________ are necessary in the sedated or medically paralyzed bed-bound patient to preserve limb functioning and decrease contracture
Range-of-motion (ROM) exercises
50
The number one nursing intervention for infection prevention
Hand washing
51
____________ are a significant source of infection. Maintenance of strict sterile technique on insertion is key to infection prevention. Routine monitoring for redness or drainage at the insertion site, dressing changes per hospital protocol, tubing changes per hospital protocol, and evaluation of the continued need.
Monitoring and care of central IV lines:
52
____________ Increased risk for iatrogenic infections such as urinary tract infection requires routine care and evaluation of necessity of continued use
Foley catheter care
53
Infection prevention measures for patiets with ARDS
* Hand washing
* Foley cath care
* Monitoring and care of central IV lines
* Diligent mouth care
54
This may develop secondary to changes in pressure in the chest cavity and is associated with positive-pressure modalities of mechanical ventilation. Because the delivered breaths are “pushed” into the lungs via positive-pressure ventilations, the pressure in the chest cavity increases
Hypotension
55
How to treat a patient who is on a vent and has hypotension
| three things
* Fluids ordered by the HCP to correct the hypotension
* ventilator settings need to be adjusted.
* Sedatives or opioids need to be adjusted
56
# What complication associated with mechanical ventilation is this?
potential complication because the normal defenses of the upper and lower respiratory systems are bypassed. The ETT or the tracheostomy tube can become a direct source to the lungs because both increase the risk of introduction
Infection
57
This occurs d/t the increased positive pressure applied to the lungs, which can cause alveolar rupture. Overdistention of the alveoli can lead to an excessive amount of air entering into the pleural space, causing a tension pneumothorax
Barotrauma
58
____________ of gastric secretions and pulmonary secretions is a potential complication because the natural defense of the epiglottis is bypassed when an artificial airway is in place
aspiration
59
a serious healthcare-associated infection resulting in high morbidity, high mortality, and high costs of treatment. Aspiration of oropharyngeal or gastric fluids is presumed to be an essential step in the development of this, and it typically develops 48 hrs or more after endotracheal intubation
Ventilatior-associated pnemonia
or
VAP
60
How to prevent aspiration
Elevate HOB 30 degrees
61
How to prevent a VAP
1. minimizing sedation, including daily spontaneous breathing trials (SBTs) for patients without contraindications.
2. facilitating early exercise and mobilization.
3. using ETTs w/ secretion drainage ports for patients requiring greater than 48 to 72 hrs of intubation.
4. elevating the HOB 30 to 45 degrees.
5. changing the ventilator circuit only when visibly soiled or malfunctioning
62
Reduces the risk of aspiration and clears the airways of secretions for a vented patient
Clear airway secretions with suctioning, CPT, frequent position changes, and increasing activity
63
Medications that reduce gastric acidity have been shown to protect patients from developing peptic ulcer disease and gastrointestinal bleeding in a vented patient
Peptic ulcer disease prophylaxis
64
What is a "sedation vacation"
Done daily. Holding sedation to determine pt's potential for readiness to wean from vent
65
# The following are S/S of what?
* malnutrition
* 10% loss of body mass
* reduced respiratory muscle strength
Inadequate nutrition
66
How long after mechanical ventilation should enteral or parenteral feedings be initiated?
48-72 hrs
67
Prefered method of enteral feedings for vented patients?
NG Tube
68
To prevent aspiration, when a patient is recieving enteral feedings what should be done?
Elevate HOB 30 degrees
Turn off feedings when supine
69
Complication associated with parenteral nutrition
Infection at IV site
70
What will happen if hydration for a vented patient is inadequate?
* Decreased CV output & BP Decreased
* decreased perfusion to organs
71
If an ARDS patient is given too much fluid what will happen?
ARDS will worsen
72
Causes of ARDS
* Sepsis
* FVO
* Shock
* Trauma
* Neuro injuries
* Burns
* DIC
* Drug use
* Aspiration
* Inhalation of toxic substances
73
# The following are S/S of what?
* Abd pain
* Irritability
* Pruritus
* Malaise/fatigue
* Fever
* n/V
* Jaundice
* Elevated liver enzymes
* Decreased appetite/anorexia
| General
Hepatitis
74
INFLAMMATION OF THE LIVER THAT IMPAIRS THE ABILITY TO DETOXIFY SUBSTANCES,PRODUCE PROTEINS AND CLOTTING FACTORS, STORE VITAMINS , FATS AND SUGARS.
Hepatitis
75
List S/S of hepatitis
| general
* Abd pain
* Irritability
* Pruritus
* Malaise/fatigue
* Fever
* n/V
* Jaundice
* Elevated liver enzymes
* Decreased appetite/anorexia
76
Dark amber urine, clay colored stools, and jaundice is caused by what?
Increased Bili
77
HEPATITIS
| What does it stand for
HANDWASHING STRICT
EAT A LOW FAT & HIGH CARBS
PERSONAL HYGIENE PRODUCTS NOT SHARED
ACTIVITY CONSERVATION (REST)
TOXIC SUBSTANCES AVOIDED
INDIVIDUAL BATHROOM
Testing results
Interferon (sub q)
Small but frequent meals
78
Medications that increase the risk for hepatitis
* Statins
* Anabolic steroid
* Azathioprine
* Methotrexate
* Isoniazid
* Valproic acid
* Tetracyclines
* Phenytoin
* Acetaminophen
79
Toxic substances that increase the risk of hepatitis
* Industrial chemicals
* Carbon tetrachloride
* Phosphorus
* Mushrooms
80
How long should someone with hepatitis abstain from sex?
Until they are negative for antibodies
81
Risk factors for Hepatitis
Autoimmune disorders
Alcoholism
Contaminated food, water
Infected blood
Sexual contact with body fluids
82
Complications of hepatitis
Chronic hepatitis
Cirrhosis
Liver Cancer
Liver failure
83
Nursing dx for Hepatitis
* Activity intolerance
* Acute pain
* Altered nutrition
* Altered thought process
* Knowledge deficit
84
Most common form of hepatitis in children
Hepatitis A
85
Which kinds of hepatitis have a vaccine
A &B
86
How and when is the Hepatitis B vaccine given
series of three injections:
1. at birth before leaving hospital
2. at least 4 weeks after 1st injection
3. at least 8 weeks after 2nd injection but no earlier than 24 weeks of age and at least 16 weeks after initial dose
87
Contraindications to the hep B vaccine
Do not give to preemies
Do not give if previous allergic reaction to Hep B injection
88
How and when is the Hepatitis A vaccine given
series of 2 injections:
1. at 12-15 months initial dose
2. at 18-33 months or 6-18 months after initial dose.
89
What kind of diet does a child with hepatitis need to follow
Low-fat, well-balanced diet
90
After changing a childs diaper with hepatitis what needs to be done?
Disinfect diaper changing surfaces thoroughly with bleach solution
91
How long should enteric precautions be utilized with a hepatitis patients?
at least 1 week after jaundice appears
92
When caring for a patient with hepatitis, when would you notify the provider
neurological status change, bleeding occurs, or fluid retention
93
Medications used to treat Hep B
* tenofovir, entecavir, lamivudine, telbivudine. All oral agents are given once a day for 1 year or longer.
* IMs = interferon - alpha several times a week ( 6-12 months), pegyalted interferon weekly Inj ( 6-12m )
94
Medication used to treat Hep C
* pegylated interferons ribavirin, peginterferon with ribavirin, interferon with ribavirin.
* Interferon therapy last 12-8 months, ribavirin therapy last 48 weeks
* Harvoni ( sofosbuvir + ledipasvir )= polymerase inhibitor 8-12 weeks of ttmt.
95
Oral medications used to treat Hep B, how long are they taken?
tenofovir, entecavir, lamivudine, telbivudine
Given once a day for one year
96
IM medications used to treat Hep B and how long they are given
* interferon - alpha several times a week ( 6-12 months)
* pegyalted interferon weekly Inj ( 6-12m )
97
What kind of hepatitis is a polymerase inhibitor given and for how long?
Hep C, 8-12 wks
98
To treat Hep C how long is interferon therapy and ribavirin therapy?
Interferon: 12-8 months
Ribavirin: 48 wks
99
What kind of diet should someone with hepatitis follow
high carb, high calorie, moderate fat and moderate protein diet, small - frequent meals.
100
How to promote hepatic rest and regeneration of tissue
◦ Avoid alcohol
◦ Limit physical activity
101
Expected labs in a patient with hepatitis
* AST / ALT will be elevated
* Bilirubin will be elevated
* Ammonia will be elevated
102
# What type of hepatitis is this?
* Acute only
* Transmission: fecal oral-food and water
* dx with +IgM & IgG
* treated with supportive therapy and rest
* Has a vaccine
Hep A
103
# What type of hepatitis is this?
* Acute & chronic
* Transmission: Body fluids - Birth, sex, childbirth, IV drug use, blood
* Dx: +HBsAG & Anti-HB
* Treatment: Acute-supportive therapy & rest chronic-Antivirals
* Has a vaccine
Hep B
104
# What type of Hepatitis is this?
* Acute & Chronic
* Transmission: Body fluids - IV drug use
* Dx: +Anti-HCV
* Treatment: antivirals, liver transplant
* No vaccine
Hep C
105
# What type of hepatitis is this?
* Acute & Chronic
* Transmission: only occurs if pt has hep B
* Dx: +HDAg & Anti-HDV
* Treatment: Antivirals & Interferon
* No vaccine
Hep D
106
# What type of hepatitis is this?
* Acute only
* Transmission: Fecal & oral - Food & water (uncooked meats, 3rd world countries)
* Dx: Anti-HEV
* Treatment: Support therapy & rest
* No vaccine
Hep E
107
Medications used to treat hepatitis
* Antivirals
* Pegylated interferon injections
* Immunizations
* Antiemetics
108
How to definitively diagnose NAFLD
Liver biopsy
109
S/S of liver transplant rejection
when do they occur?
RUQ pain, fever, tachycardia , changes in bile, jaundice
4-10 days
110
How to treat & reduce the reisk of rejection after a liver transplant
Immunosupressive therapy
111
Pre-op for a liver biopsy
Explain the procedure
Witness informed consent
Ensure client fasts starting at midnight
Administer medications as prescribed
112
Post op for a liver biopsy
Post op Assist the client to a r sided lying position and maintain for federal hrs Monitor vital signs Assess for abd pain / bleeding from site / manifestations of pneumothorax * Pneumothorax s/s – dyspnea, cyanosis, restlessness. Sometimes with 5-10 lbs sandbag over the biopsy site to prevent further bleeding A change in the patient’s level of consciousness or a decrease in blood pressure and increase in heart rate after a liver biopsy may indicate severe bleeding associated with the procedure, and the nurse should immediately notify the healthcare provider.
113
If a patient is at an increased risk for bleeding what should be done post liver biopsy
5-10 lbs sandbag over the biopsy site to prevent further bleeding
114
What S/S would cause the nurse to call the MD immediately after a liver biopsy and why?
change in the patient’s level of consciousness or a decrease in blood pressure and increase in heart rate after a liver biopsy may indicate severe bleeding associated with the procedure, and the nurse should immediately notify the healthcare provider.
115
S/S of Cirrhosis
SHOB
Jaundice
Increased abd girth
Abd pain and bloating
Enlarged spleen
Elevated liver enzymes
Increased risk of bleeding
Thrombocytopenia
Prolonged pt
Hemorrhoids
Elevated ammonia levels
Change in LOC
Changes in motor function
Hyponatremia
Asterixis
116
List S/S of Cirrhosis
SHOB
Jaundice
Increased abd girth
Abd pain and bloating
Enlarged spleen
Elevated liver enzymes
Increased risk of bleeding
Thrombocytopenia
Prolonged pt
Hemorrhoids
Elevated ammonia levels
Change in LOC
Changes in motor function
Hyponatremia
Asterixis
117
alcoholic cirrhosis, chronic hep B & C infections
Laënnec’s cirrhosis
118
caused by chronic biliary obstruction or autoimmune disorder
Biliary cirrhosis
119
caused by viral hepatitis (medications or toxins)
* Post necrotic cirrhosis
120
Tmnt for ascites in cirrhosis patients
2g/day Na restriction and administration of diuretics such as spironolactone and furosemide.
121
Tmnt for ascites in ESRD patients
paracentesis (invasive procedure to remove fluid)-Monitor closely for hypotension
122
Portal HTN can cause what?
* Esophageal varicies
* enlarged spleen
* hemmorids
123
Tmnt for esophageal varices
* Sclerotherapy
* sengstaken – blakemore tube (if uncontrolled)
* Endoscopic banding
124
procedure used to shrink veins
sclerotherapy
125
procedure in which a tube is inserted through GI tract through nose to provide compression and traction in the esophagus
sengstaken – blakemore tube
126
How is portal HTN treated?
Symptom managment
Beta blockers
127
ecchymosis
bruising
128
epistaxis
nosebleed
129
S/S of bleeding
ecchymosis, epistaxis, and petechia
130
How to treat coagulopathies
admin vitamin K, blood products, FFP, folic acid PRN
Implement bleeding precautions
131
# The following are S/S of what?
* Impaired mentation
* decreased LOC
* confusion
* somnolence
* changes in motor function
* restlessness
* seizures
* insomnia
Hepatic encephalopathy
132
How to treat hepatic encephalopathy
* avoid protein overload, decrease bacterial production of ammonia, correcting fluid and electrolyte imbalance.
o Small frequent meals to prevent protein overload
o Neomycin and lactulose to prevent production of ammonia.
o Neomycin and lactulose cause diarrhea which alters fluid and electrolytes. To correct this pt will receive vitamins A,B Complex, C, and K, as well as folic acid
133
How to treat hepatorenal syndrome
Liver transplant
134
# The following are S/S of what?
* Fever
* ABD pain
* encephalopathy
* acute hemodynamic decompensation
Spontaneous bacterial peritonitis
135
How to diagnose spontaneous bacterial peritonitis
diagnostic paracentesis and culture of ascitic fluid. Culture is usually positive for E.coli, strep, or klebsiella pneumonia
136
How to treat spontaneous bacterial peritonitis
short course of antibiotics, some patients are treated for prolonged periods of time
137
# What stage of encephalopathy is this?
slurred speech, tremors, lethargy, asterixis , impaired handwriting
Stage 1
138
# what stage of encephalopathy is this?
confusion, difficult to awake, increased tendon reflexes, rigid extremities
stage 3
139
# what stage of encephalopathy is this?
drowsiness, disorientation, mood swings, asterixis, fever hepaticus
stage 2
140
# What stage of encephalopathy is this?
coma, non responsive to painful stimuli
Stage 4
141
Expected respiratory assessment for a pt is cirrhosis/liver failure
deceased breath sounds and increased RR can indicate pulmonary fluid overload
142
Expected vital sigsn for a cirrhosis/liver failure pt's
bp may be elevated d/t FVO
143
Nursing interventions/actions for Cirrhosis/liver failure
Administer diuretics
Administer electrolyte replacement such as potassium
Administer magnesium/ phosphate as needed
Restrict protein/ sodium/fluid intake
Elevate HOB and legs to helps respiratory status and prevent ascites
Administer blood products and fresh frozen plasma as ordered
Promote rest periods between activities.
144
Complications related to cirrhosis
* Ascites
* Portal HTN
* Esophageal varicies
* Coagulopathies
* Hepatic encephalopathy
* Hyponatreamia
* Hepatorenal syndrome
* Spontaneous bacterial peritonitis
145
patient teaching for cirrhosis
Abstain from alcohol
Consult with provider prior to taking any OTC or herbal supplements
Follow diet guidelines
Educate about medications metabolized by the liver (Tylenol)
Seek routine care – monitor labs and progression of disease
Minimize the risk of bleeding (bleeding precautions)
146
Dietary guidelines for cirrhosis/liver failure patients
o High calorie , moderate fat
o Low sodium , low protein
o Small frequent meals
o Nutritional supplements drinks or shakes and daily multivitamin
o Fluid intake restrictions if blood sodium is low
147
Dx testing for cirrhosis
Used to Determine if there are abnormalities in the liver
CT
148
Dx testing for Cirrhosis/Liver failure
Endoscope used to visualize the GI tract from the esophagus to the duodenum to evaluate for esophageal varices or bleeding
EGD
149
Dx testing for cirrhosis/liver failure
combines endoscopy and fluoroscopy to dx, treat, causes of obstruction in biliary tree
ERCP
150
Dx testing for cirrhosis/liver failure
contrast is injected into bile duct of liver to visualize the biliary tract and identify obstruction
Percutaneous transhepatic cholangiography
151
Lab tests for cirrhosis
o Liver enzymes ( AST, ALT, ALP)-elevated
o Albumin-decreased
o Ptt, PT/inr -prolonged
o Platelets-decreased
o Bilirubin-elevated
o Ammonia-elevated
152
Is reversible , pancreatic enzymes given to aid in digestion of a fats and proteins taken with meals
Acute Pancreatitis
153
# The following are S/S of what?
LUQ EPIGASTRIC PAIN
ABD FULLNESS (GAS, BLOATING )
HICCUPS, INDIGESTION
FEVER
TACHYCardia
Hypotension
Elevated serum lipase, amylase, and glucose values
Hypocalcemia
Steatorrhea, clay-colored stools
Hypovolemia
Hypoxia
Pleural effusion
Clinical manifestations of Adult Respiratory Distress Syndrome (ARDS)
Multiple organ dysfunction
Acute pancreatitis
154
# The following are S/S of what?
Upper abd pain that spreads to back
Pain worse after overeating or ETOH consumption
Weight loss/anorexia
Pale or gray colored stools
Steatorrhea
Pain increasing with ETOH consumption and over eating
N|V|D
Constipation
Flatulence
Elevated amylase, lipase, serum bili, alkaline phosphatase, and blood glucose
Chronic pancreatitis
155
S/S of pancreatic cancer
Pain
Jaundice
Anorexia
Fatigue
Weight loss
Vague non-specific epigastric pain
156
Expected abd assessment for a patient with pancreatitis
rebound tenderness, muscle guarding, or rigid abdominal muscles.
157
bruising noted on the flank due to leaking of exudate stained with blood into the flank area
Bulletblue Turner’s sign
158
bruising around the umbilicus. Bruising in these areas indicates hemorrhage, severe inflammation, and tissue damage.
Cullen’s sign
159
hand spasms with inflation of the blood pressure cuff 20 mm Hg above the patient’s systolic blood pressure (SBP) for 3 to 5 minutes.
Presence indicates hypocalcemia
Trousseau sign
160
facial twitching. Tapping the skin over the facial nerve anterior to the external auditory meatus produces ipsilateral contraction of the facial muscles occurs.
Chvostek sign
presence inndicates hypocalcemia
161
If the heart, lungs, or kidneys are involved in acute pancreatits what needs to be done and why?
Patient needs to be managed in the ICU d/t the risk for hypovolemic shock, pulmonary compromise, renal failure, and GI bleeding
162
Positioning for a patient with acute pancreatitis
Semi-fowler or fetal position to decrease secretion and pain
163
Expected vitals for a patient with acute pancreatitis
Fever
Tachycardia
Hypoxia
164
Expected labs for acute pancreatitis patients
* Lipase, bili, glucose, ALT, AST, WBC, and amylase-elevated
* Calcium, albumin-decreased
165
Vital signs that are considered abnormal for Acute pancreatitis, what does it indicates and what needs to be done?
* Hypotension & Tachycardia
* Indicates elevated third-spacing volume
* IV fluid resuscitation is required
166
IV abx are give to patients with acute pancreatitis to treat what?
necrotizing pancreatitis
167
How to dx necrotizing pancreatitis
CT shows air and gas surrounding the pancreas
168
If NG tube is indicated for any type of panceratitis what is the suction set to?
Low intmt suction
169
Irreversible!! Not given pancreatic enzymes
Chronic pancreatitis
170
Expected vitals for a patient with chronic pancreatitis
* Tachycardia
* Tachypnea
* Hypertension
171
Expected labs for a patient with chronic pancreatitis
* Glucose, amylasem lipase, bili, and alkaline phosphate-elevated
172
Nursing actions/interventions for chronic pancreatitis
Administer pancreatic enzymes
Provide GI prophylaxis-Histamine blockers, PPI’s
Provide rest and a calm environment
Implement pain relief-administer opioids initially then non-opioids when pain is less intense
Collaborate with dietitian to ensure adequate nutrition-low fat diet
Teach to limit fat in diet, avoid alcohol, do not chew pancreatic enzymes, avoid irritating foods (coffee & caffeine, refer to AA
173
Nursing actions/interventions for pancreatic cancer
* Provide IV fluids
* NGT low intmt suction
* Never manipulate NGT
* Administer insulin, analgesics, and antiemetics as ordered
* Encourage incentive spirometer, cough and deep braething
* Offer nutritional suppluments
174
Treatment for acute Pancreatitis
* OPOID ANALGESICS
* ANTICHOLINERGICS
* HISTAMINE BLOCKERS
* PPI’S
* PANCREATIC ENZYMES
* ANTIBIOTIC THERAPY
* ENCOURAGE DEEP BREATH COUGH
* NPO
* IV FLUIDS
* ICU LEVEL OF CARE IF OTHER ORGANS ARE INVOLVED
* TREAT CAUSE OF PANCREATITIS
175
Treatment for chronic pancreatitis
* PAIN MANAGEMENT
* IVF
* ELECTROLYTE MANAGEMENT
* NUTRITIONAL SUPPORT
* INSULIN THERAPY
* PANCREATIC ENZYME REPLACEMENT THERAPY (PERT)
176
Treatment for pancreatic cancer
Megestrol acetate or megace can be given as an appetite stimulant
CHEMOTHERAPY
RADIATION
SURGICAL
177
HEAD OF THE PANCREAS , DUODENUM , GALLBLADDER , AND BILE DUCT ARE REMOVED
Whipple
178
If a patient stops breathing in pressure support mode or SIMV what needs to be done?
Assess patient, notify healthcare provider
179
Type 1 ARF
Hypoxemic; PaO2 <60mmHg
180
Type 2 ARF
Hypercapnic PaCO2 >50 mmHg
181
NUR 213
flashcards
Decks in class (29)
# Cards
-
Fluid and Electroytes lecture98
-
Tissue Integrity/Burns lecture112
-
Dialysis and Kidney transplants lecture70
-
ABG Refresher :)17
-
Unit one exam130
-
Unit one practice questions48
-
ARD/ARF104
-
Mechanical Ventilation87
-
Cirrhosis47
-
Hepatitis38
-
Pancreatitis67
-
Unit 2 exam181
-
CV System review50
-
Unit 3 exam60
-
EKG Rhythms111
-
Perfusion - Study guide 331
-
CV Disease - Exam 378
-
Cardiogenic & Septic Shock - Exam 322
-
Central Line care - exam 314
-
Medications - exam 347
-
CHD - Exam 324
-
Mobility: Spinal cord injuries & guillain Barre syndrome78
-
Cranial nerve pop quiz13
-
Unit 4 exam90
-
Emergency management, violence, PTSD, Communication - Unit 4 exam56
-
SCI & GBS Unit 4 exam58
-
Medications - Unit 4 exam40
-
Types of Shock - Unit 415
-
FINAL1
