1.
3rd spacing: results of ↓ albumin: → ↓ oncotic pressure → fluid into abd, extrem
Escapes vasc space into interstitium
2.
Ascites risk: • infection
• spontaneous peritonitis
3.
BMI parameters for bariatric surgery: • BMI ≥40 kg/m2 with no comorbidities
• BMI ≥35 kg/m2 with obesity-associated comorbidity
4.
Cholecystitis risk factors: • Women
• People older than 60 years
• American Indian, Mexican American, or Caucasian
• Obesity
• Rapid weight loss or prolonged fasting
• Women on hormone replacement therapy (HRT) or older birth control pills
• Family history of gallstones
• Prolonged total parenteral nutrition
• Crohn's disease
• Gastric bypass surgery
• Sickle cell anemia
• Glucose intolerance
5.
Conseq of ↓ bile prod in liver: ↓ absorption of fat-soluble vitamins (e.g., vitamin K) → ↓ clotting factors II, VII, IX, and X →o bleeding and easy bruising.
6.
Conseq of ↓ hepatic fxn: • Portal hypertension
• Ascites
• Bleeding esophageal varices
• Coagulation defects
• Jaundice
• Portal-systemic encephalopathy (PSE) with hepatic coma
• Hepatorenal syndrome
• Spontaneous bacterial peritonitis
7.
Conseq of portal HTN: • ascites
• esophageal varices
• caput medusae
• hemorrhoidsn
• splenomegaly
8.
Conseq/causes of pancreatic enzyme reflux into the gallbladder: →→inflamm
d/t:
• Sepsis
• Severe trauma or burns
• Long-term total parenteral nutrition
• Multi-system organ failure
• Major surgery (postoperatively)
• Hypovolemia
9.
Drugs for ascites: comb of diruetics: (Lasix) and spironolactone (Aldactone):
• Work differently
• Used for maintenance of sodium and potassium balance
• Furosemide causes potassium loss
• Spironolactone conserves potassium
10.
Duodenal ulcer sx: • Occ 1/5-3 hrs after meal
• Often occ @ nt
• Pain relieved by food ingestion
11.
Effect of aldosterone on 3rd spacing: Aldosterone pulls Na & water into vascular space in an effort to increase volume, but in this case, this just results in increased 3rd spacing
12.
First organs affected by hypovolemia: Heart → ↓ stretch → ↓ cardiac output
kidneys → ↓ perfusion ↓ GFR → ↑ renin → ↑ angiontensin I to angiotensin II to aldosterone
13.
Gastric ulcer sx: • Occ 30-60 min after meal
• Rarely occ @ nt
• ↑ pain w/food ingestion
14.
Lactulose axns: Binds ammonia in gut → ↓ ammonia (passed in stools) → improved consc, ↓ confusion, ↓ tremor
15.
Manif of hepatorenal syndrome (HRS): • A sudden decrease in urinary flow (<500 mL/24 hr) (oliguria)
• Elevated blood urea nitrogen and creatinine levels with abnormally decreased urine sodium excretion
• Increased urine osmolarity
16.
Most common complic/cause of death after bariatric surgery: Anastomotic leaks →→HCl, pancr enzyme, bile:
• Inc back, shoulder, abdominal pain
• Restlessnes
• Unexplained tachycardia
• Oliguria
17.
Order of giving blood products: 1. RBC's (to ↑ O2) - only give one unit at a time, so if there's a rxn know from which unit
2. FFP
3. Cryoppt
18.
Pancreatitis labs: • ↓↓ calcium and magnesium
• ↑↑ liver enzymes, bilirubin, WBC's
19.
Pancreatitis nursing axns: • NPO until pain free
• NG
• TPN
• Ø alc, smoking
• Monitor blood glucose, hydration, orthostatics, hypocalcemia, coag def, renal fxn, LL hypoventil
20.
Peak of alcohol w/dl: 48°-72° after last drink
21.
Portal HTN: Most common nursing dx: Excess Fluid Volume related to edema (portal hypertension).
22.
Priority concern after bariatric surgery: Airway mgmt
23.
Priority monitoring in PUD: Orthostatics:
• 20 mm Hg drop in systolic
• 10 mm Hg drop in diastolic
• Tachycardia
All suggest GI bleeding
24.
PUD causes: • H. pylori
• NSAID use
• Severe stress
• Hypersecretory states
25.
PUD meds: • Bismuth or PPI
• 2 ABX: flagyl + tetracycline, clarithromycin, amoxicillin
• Antacids: 1-3 hrs after meals, but 1 hr apart from other meds to avoid decr in their abs
• Sucralfate: 1 hr before meals
26.
Results of ↑ hydrostatic pressure in d/t liver scarring: Back pressure pushes fluid out into peritoneal space
27.
Signs of adv cirrhosis: • GI bleeding
• Jaundice
• Ascites
• Spontaneous bruising
28.
Signs of early cirrhosis: • Fatigue
• Significant change in weight
• GI symptoms
• Abdominal pain and liver tenderness (both of which may be ignored by the patient)
• Pruritus (itching)
29.
Signs of liver dysfunction/failure: • Obvious yellowing of the skin (jaundice) and sclerae (icterus)
• Dry skin
• Rashes
• Purpuric lesions, such as petechiae (round, pinpoint, red-purple lesions) or ecchymosis (large purple, blue, or yellow bruises)
• Warm and bright red palms of the hands (palmar erythema)
• Vascular lesions with a red center and radiating branches, known as "spider angiomas" (telangiectases, spider nevi, or vascular spiders), on the nose, cheeks, upper thorax, and shoulders
• Peripheral dependent edema of the extremities and sacrum
• Clubbing of nails
• Fixed flexion of fingers
30.
What leads to portal-systemic encephalopathy: • High-protein diet
• Infections
• Hypovolemia (deficient fluid volume)
• Hypokalemia (deficient serum potassium)
• Constipation
• GI bleeding (causes a large protein load in the intestines)
• Drugs (e.g., hypnotics, opioids, sedatives, analgesics, diuretics)
• After paracentesis or shunting procedures.
