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Pancreatitis, Cirrhosis, and Liver failureMedical-Surgical Nursing-7th edition

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How is ascites associated with cirrhosis treated?
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Sodium restriction (2q/day), if severe, 250-500 mg/day; Bed rest; Diuretics (spironolactone, Amiloride, Triamterene, furosemide); and Paracentesis or Peritoneovenous shunt.
What is the recommended diet for patients with cirrhosis?
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3,000 kcal/day; increased carbohydrates, low-moderate fat; decreased Na+; and Polycose can be used to provide adequate carbs.
What supportive measures are used during an acute variceal bleed?
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Fresh, frozen plasma and packed RBCs, albumin; Vitamin K; H2 blockers like Tagamet or Zantac; PPIs like Protonix; Lactulose and Neomycin (prevents encephalopathy); and ABX.
_______ is used to cause vasoconstriction which limits the amount of blood going to the liver, decreases portal hypertension and decreases pressure on varices.
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Octreotide
What are the treatments for a bleeding varices?
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Sandostatin, vasopressin, nitroglycerin, beta blockers, endoscopic sclerotherapy, ligation and shunt therapy.
_______ decreases ammonia formation by decreasing colon pH which discourages bacterial growth. It has a laxative effect.
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Lactulose (given orally, enema, and NG tube)
_______ is a non-surgical procedure where a shunt is created to redirect portal blood flow between the systemic and portal venous systems.
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Transjugular Intrahepatic Portosystemic Shunts (TIPS) (Placed in jugular and threaded thru the SVC and IVC to the hepatic vein and then to the portal vein).
What are signs and symptoms of endocrine problems caused by cirrhosis?
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Gynecomastia, loss of pubic/axillary hair, impotence, amenorrhea, older women: vaginal bleeding, and testicular atrophy.
A patient with esophageal varices should avoid...
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Alcohol, aspirin/acetaminophen, irritating food, and coughing.
What is given with vasopressin when treating a bleeding varices and why?
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Nitroglycerin (It decreases detrimental SE like increased BP, decreased heart rate and decreased coronary blood flow)
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The pressure of the balloon tamponade should be between _______.
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20-40 (placement confirmed via x-ray)
How is pain associated with pancreatitis treated?
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Morphine, nitroglycerin, papaverine, Dicyclomine, propantheline bromide, and side-lying, HOB at 45 degrees.
What is the typical clinical picture of a patient with acute pancreatitis?
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Abrupt onset of deep epigastric pain that radiates to the back (LUQ), n/v, abdominal distention, decreased or no bowel sounds, maybe a palpable pseudocyst, flushing, cyanosis and dyspnea.
What are the 3 phases of pancreatitis?
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1. Activation of trypsin leads to activation of pancreatic digestive enzymes. 2. Intrapancreatic inflammation. 3. Extrapancreatic inflammation.
What is the confirmatory tool to diagnose acute pancreatitis?
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CT scan
_______ causes hemorrhage and _______ causes fat necrosis in patients with acute pancreatitis.
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Elastase = hemorrhage; phospholipase A = fat necrosis
In more severe forms of acute pancreatitis, _______ is associated with poor clinical outcomes.
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negative nitrogen balance
_______ is a scale used to predict the severity of acute pancreatitis using parameters such as age, WBC count, hematocrit, and serum urea nitrogen in 48 hours.
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Ranson criteria
A pancreatic _______ results from extensive necrosis. It is a fluid filled sac in the pancreas.
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Abscess (*requires surgical drainage to prevent sepsis)
A pancreatic _______ is a cavity continuous with or surrounding the pancreas filled with necrotic products and liquid secretions.
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pseudocyst (*resolves on it's own within a few weeks)
C-reactive protein levels greater than _______ in the first 72 hours of an acute pancreatic attack suggests necrosis.
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150 mg/L
  
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