Med Surg Review Chapters 35 36 37

Hepatitis: Liver inflamm, due to viral/bacterial infect, drugs, alcohol & or chemicals. S/S vary from NONE to SEVERE.include, liver function loss, prejaundice stage @ 2weeks after exposure to virus and lasts 1 week (flu like symptoms) malaise, fever, headache, RUQ pain, N/V, diarrhea/constipation, dark urine, jaundice, enlarged liver. Recovery can be as long as 1 year. Hep A- HOW oral-fecal, seafood, eating utensilsS/S fatigue/anorexia/malaise/ n/v, pale stools, dark urine, RUQ painAT RISK Military or day care & travelers VACCINE YES Hep B- HOW Body fluids S/S same as above with abd pain, rashes, muscle aches or NO S/S AT RISK COs, Healthcare wrkrs, IV drug users, gay men, transplant or dialysis pts VACCINE YES Hep C- HOW transfusions, IV drug use, unprotected sex S/S same as HEP B but less severe AT RISK SAME AS HEP B VACCINE NO Liver Function Test ALBUMIN- Decreased b/c of impaired protein synthesis, edema & ascites may result AMMONIA- ^ b/c liver cant metab protein, adds to hepatic encephalopathy BILIRUBIN- ^ b/c liver cant make bile PROTHROMBIN TIME- Prolonged, liver cant make pro-thrombin, bleeds easily ALT: released with death of liver cells, shows liver damage AST: Found in liver & <3, elevates & released with liver cell death ALP: Found in liver & Bone, elevates with liver damage

Acute Liver Failure commonly due to Tylenol (acetaminophen) OD, S/S: fatigue, GI upset & Diarrhea later jaundice, bleeding, abdomen distention, can suddenly lapse into illness resulting in coma ( reduction in liver size & enzymes, ^ in ALT AST BILIRUBIN PT Decrease in K+ & Glucose

Cirrhosis S/S: Not initially, as impairment begins, anorexia, N/V, Wt loss, & fatigue, jaundice, liver enlarged, tender & firm C- Clotting defects H- Hepatorenal syndrome E- Encephalopathy A-Ascites P-Portal HTN

Portal HTN: causes esophageal varices, coughing/lifting/straining may cause tearing of esophageal varices TX for Varices: Octreotide-ligation/banding- Vit K & antibiotics Ascites- FL retention in abd (peritoneal cavity) TX: Diuretics, Na+ & FL restriction (800100ml/day) & albumin infusions, removal of fl can be done Hepatic Encephalopathy- restrict dietary protein, S/S Asterixis, Fector hepaticus,liver dysfunction, abd pain, anorexia, N/V, itchy, RUQ pain, jaundice, light stools, ascites, ecchymosis, GI bleed, confusions TX & RX for ^: lactulose-neomycin-& the protein restriction Liver Transplant Candidate: Pts suffering from: End stage liver failure, cirrhosis, hep, biliary disease, meta disorders & hepatic vein obstruction NOT CANCER PTS S/S of rejection: P^ 100, T^ 101, RUQ PAIN, Jaundice, decrease of bile in T Tube or change in bile color

LIVER CANCER S/S: encephalopathy, abnormal bleed, Jaundice & ascites DX: Biopsy + Ultrasound most pts die within 6 mos of DX

Acute Pancreatitis: due to xcess alcohol use, gallstones & bile duct inflamm can contribute S/S very Ill, abd pain, guarding, rigid abd, hypotension, shock, resp distress, low grade T, dry mucous mbr, tachycardia (eating makes pain worse) Turners sign = purplish flank area Cullens sign = purplish around umbilicous Lab test = serum amylase & lipase ( X-Ray, CT & US tests are done as well)

Chronic Pancreatitis: when acute teach about alcohol affects, usually occure at age 4560, Men-due to alcohol Women- due to biliary disease READ CAREPLAN Page 798-99 Pancreas Cancer- Dx tests = serum alkaline/phosphatase/glucose & bilirubin lvls elevate, Carcinoembryonic antigen may be ordered, ERCP can be done, CT & US, Biopsy Therapeutic measures include: (depending on stage of cancer) early aimed at curing later on aimed at making comfortable and managing s/s, surgery is usually done, whipple procedure (removal of the head of the pancreas) Cholelithiasis- pooling/stasis of bile within gallbladder Biliary Colic: epigastric pain cause by above

Cholecystectomy: Gallbladder removal, diet high protein low to no fat, encourage wt loss, after surgery if fatty foods are consumed they should be introduced slowly into the diet avoid gassy foods T- Tube after surgery is: inserted into the common duct to ensure bile drainage is not obstructed (500 to 1000mL) Outpatient surgery is done via laparoscope (camera into umbilicus) 4 sm. Puncture wounds are made discharged within the 24hrs if traditional removal is done patients are hospitalized for 2-3 days Chap 36 Kidneys- 2 of them =) Nephrons = 1 million (decrease with age), blood vessels, Glomerular filtration (read page 813) The kidneys: regulate- blood vol. composition & pressure, electrolyte balance, acid base balance, erythropoietin, tissue FL, & Activates Vit D Table 36.1 Hormones & Function Aldosterone: Reabsorption of Na+ and excretes K+ Antidiuretic Hormone: Promotes H2o reabsorption Parathyroid Hormone: Reasborption of Ca+ Excretion of Phosphate

Urine Characteristics Amount: 1000-2000mL/day Color: straw or amber Gravity: 1.002-1.035 PH: 4.6 8.0 (6.0 is avg) 95% water remainder is nitrogenous waste Creatinine clearance- 85 135 mL/min IVP- x-ray of renal tissue / ureters / bladder after I.V. dye is given Renal biopsy- Analysis the tissue, CT done first to locate tissue Arteriogram- looks at bld vessels, femoral artery is pierced and cath threaded upward contrast is injected (dye) BUN- 8-20 mg/dL Creatinine- 0.6- 1.5mL/dL In Urine normal to have protein (persistent is a s/s of renal disease)/RBCs/WBCs(but too much is a s/s of infection NOT NORMAL? Glucose/Ketones/Bilirubin/Nitrate/ Read what the bad/negative or deviations from these test may indicate i.e cancer? Uti? Incontinence? Pg 823-27 Importance of Lung sounds: too much FL can hear crackles/wheeze new onset should be reported Edema: again FL retention assess degree & location of edema in renal disease edema can be generalized Daily wts: this is the best way to check FL balance, weight @ same time each day Intake/Output: Renal disease? Done every 8-12 hours or more often if not stable Should be measuring ea. Void accuracy is vital b/c meds may be given based on the #s recorded. LOOK @ FIG 36.3 pg 816 Types of incontinence Stress: <50ml, cough/sneeze/laugh common in women, in men associated with prostatectomy & radiation Urge: strong need to void do kegels Functional: due to memory/ physical/environmental/elderly Overflow: over distention of bladder dribbling of urine Total: due to surgery/malformation/trauma may need bladder training

Indwelling Care:Box 36.3 page 833 UTIs: dysuria, urgency, frequency, nocturia, hematuria, back pain, cloudy foul smell, wbcs in urine Dx test: culture, ^ sedimentation rate Therapeutic measures: ABT, FLs Complications: Pyelonephritis, Urosepsis, Chronic kidney disease Hydronephrosis: distention of the renal pelvis/calices due to untreated uti or obstruction Bladder Cancer common s/s hematuria, cigarettes put one at risk, pollution, dyes, leather (pg 848) Dx test: urinalysis, cytoscopy & biopsy, IVP Urinary diversion: page: 849 figure 37.5 a-b-c Polycystic Kidney Disease: hereditary, multiple cysts, dull heaviness in flank, hematuria Diabetic Nephropathy: due to DM, long term complication of DM. S/S microalbuminuria leading to proteinuria HTN accelerates the renal damage, urine output decreases, toxic waste increase Therapeutic measures: control blood glucose lvls & B/P Glomerulonephritis: caused by Group A strep, read pg 853 table 37.6