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GI, Pancreatitis, Cirrhosis

Terms in this set (29)

Why is albumin administration sometimes indicated for patients undergoing paracentesis?
The liver is not making albumin, fluid shifts from vasculature to abdominal cavity, fluid is drained in paracentesis and albumin is replaced to keep fluid in veins Recommended for >5L removal to prevent fluid shift
Recognize the maximum adult dose of acetaminophen over a 24-hour period.
4 grams
What electrolyte imbalance is most likely to increase risk for hepatic encephalopathy?
Low K increased ammonia production
Why is the ammonia level in the bloodstream often elevated in a patient with hepatic failure?
Ammonia is cleared by the liver (ammonia to urea). As liver fxn decreases, ammonia level increases
Why is a patient with pancreatitis at risk for hypocalcemia?
The PTH feedback loop does not work so Ca is not absorbed in the gut and Ca is not released from the bones, also endotoxins present and Ca is stuck in necrotic tissue
Why might a patient with acute pancreatitis need rapid fluid resuscitation in the first 24 hours of admission?
They leak fluid into the perineal space causing FVD and renal insufficiency, they also have frequent vomiting and probable gastric suctioning Needed to prevent shock and perfuse the pancrease
Why might magnesium be prescribed for an alcoholic patient with a myocardial infarction admitted to an Emergency Department?
Low mag is present from excessive vomiting and is worsened with cardiac insufficiency
What is secondary hyperaldosteronism?
The increase in aldosterone synthesis due to poor renal perfusion from decreased cardiac output or increased systemic pressure in liver failure. Kidneys think the lack of flow is hypovolemia and release aldosterone to raise systemic volume
Name imbalances likely to be caused by the inappropriate use of tap water enemas:
Hyponatremia
Name imbalances likely to be caused by the inappropriate use of hypertonic sodium phosphate enemas or laxatives
Hyperphosphatemia
Hypernatremia
Name imbalances likely to be caused by the inappropriate use of Milk of Magnesia
Hypermagnesemia?
Name imbalances likely to be caused by the inappropriate use of Magnesium Citrate laxative
Hypermagnesemia?
Name imbalances likely to be caused by purging after eating
metabolic alkalosis
hypokalemia
hypomagnesemia
Name imbalances likely to be caused by diuretics to lose weight
FVD
hypokalemia
Name imbalances likely to be caused by laxatives to lose weight
metabolic acidosis
FVD
Why are patients with pancreatitis at risk for hypocalcemia?
Endotoxins
faulty PTH release
Ca trapped in necrotic tissue
Why are patients with pancreatitis at risk for Low PaO2?
Poor ventilation due to pain & plural effusion (water on lungs)
Why are patients with pancreatitis at risk for severe FVD?
Shift of fluid into intraperitoneal space
Sequestration of fluid can amount up to 40% of the circulating blood volume
Vomiting and gastric suction
How would a nurse assess for adequate fluid replacement in a patient with early severe pancreatitis?
a. HR < 120
b. MAP between 65 to 85 mm Hg
c. UO > 0.5 to 1 ml/kg/hr *
d. Reduction in Hct (goal 35 to 44%)
e. BUN especially important (level at time of admission and during first 24 hrs predicts mortality)
What is the danger of too little fluid resuscitation in patient with pancreatitis?
a. Hinders perfusion and oxygenation of pancreas (necrosis)
b. ATN
What is the danger of too aggressive fluid resuscitation in patients with pancreatitis?
a. Cardiopulmonary decompensation
b. Abdominal compartment syndrome
What factors contribute to the development of abdominal compartment syndrome in patients with pancreatitis?
Associated with significant visceral edema from:
1. pancreatic ascites
2. paralytic ileus
3. Massive fluid resuscitation
Why is it important to test blood glucose in patients with acute pancreatitis?
Hyperglycemia possible:
i. Decreased insulin release
ii. Increased gluconeogenesis
iii. Parenteral glucose-containing fluids
What should nurses teach patients about the safe use of acetaminophen?
Warn about potential for severe liver damage associated with exceeding maximum daily dose or taking three or more alcoholic drinks a day while taking acetaminophen
What is the significance of secondary hyperaldosteronism in patients with cirrhosis of the liver?
a. FVE
b. Hyponatremia superimposed on total body excess of fluid
When is albumin administration indicated during the use of abdominal paracentesis?
Greater than 5 L should be done simultaneously with plasma volume expansion
Name several precipitators of encephalopathy in liver failure patients
a. GI bleeding
b. High protein intake
c. Constipation
d. Dehydration
e. Infection
f. Hypoxia
g. Sedatives/tranquilizers
h. Hypokalemic metabolic alkalosis
Why is it important to prevent hypokalemia in a patient with liver failure?
a. Hypokalemia results in increased ammonia production
b. Associated metabolic alkalosis promotes movement of NH3 and other toxins into the brain
c. KCl replacement may reverse encephalopathy without any other therapy
How does a patient's hematocrit level distinguish between (a) hypovolemic pancreatitis without hemorrhage and (b)hemorrhagic pancreatitis?
Hemorrhagic = decreased hematocrit
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