NUR 460 Study Guide 2 - Pancreas, Liver Cancer, Esophageal Varices
NUR 460 Study Guide 2 - Pancreas, Liver Cancer, Esophageal Varices 460
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This 5 page Study Guide was uploaded by ndp33 on Thursday July 28, 2016. The Study Guide belongs to 460 at Niagara University taught by in Summer 2016. Since its upload, it has received 13 views. For similar materials see Nursing Concepts IV: Health of Maturing Adults / Chronic Disease in Nursing and Health Sciences at Niagara University.
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Date Created: 07/28/16
Pancreatic Pancreatic cancer- nursing interventions, Nursing management -General post op care -promotion of comfort -ICU post op -Fluid and blood replacement -Vented -Major high risk surgery, pt critically ill Note: Risk factors for pancreatic cancer include: - smoking, -chemical exposure -high fat, -meat diet, -DM, -chronic pancreatitis, -heredity -sites of lesions: head, body or tail of pancrease -METS liver, lung, bones, peritoneal cavity -medical treatment: chemotherapy, radiation (limited) surgery: if in head and localized, resection -treatment may be palliative surgery often not possible d/t late dx Pancreatic cancer- s/sx, pain, jaundice, weight loss, pain more severe at night Pancreatic cancer- post op considerations pancreatitis- risk factors Causes: -long-term alcohol use -blunt abdominal trauma - peptic ulcer disease -meds diuretics oral contraceptics corticosteroids -bacterial/viral infectioncomplication of the mumps virus Note: pancreatitis is a severe disorder that can cause death Dx: -Hx of abdominal pain -Known risk factors - Serum amylase and lipase rise 3x nl within 24 hrs Urinary amylase elevated -WBC-elevated -Hypocalcemia -Hyperglycemia -glucosuria -X-ray of abd chest differentiate from other disorders w/ sim symptoms -U/S &CT increase diameter of the pancreas, cysts, abscesses -HGB, HCT Monitor for bleeding - Peracentesis Increased levels of pancreatic enzymes -Stool samples Bulky, pale, fatty Acute vs. Chronic pancreatitis Acute pancreatitis -the pancreatic duct becomes obstructed and enzymes back up into the pancreatic duct, causing auto digestion and inflammation of the pancreas -acute pancreatitis does not usu lead to chronic pancreatitis Chronic pancreatitis -a progressive inflammatory disorder w/ destruction of the pancreas. Cells are replaced by fibrous tissue, and pressure within the pancreas increases. -Mechanical obstruction of the pancreatic and common bile ducts and destruction of the secreting cells of the pancreas occur Manifestations of Acute Pancreatitis -Severe abdominal pain -Pt appears acutely ill - Abdominal guarding -N/V -Fever, jaundice, confusion, and agitation may occur -Ecchymosis in the blank or umbilical area may occur -May develop respiratory distress, hypoxia, renal failure, hypovolemia, and shock Manifestations of chronic pancreatitis -recurrent attacks of severe abdominal and back pain -weight loss -steatorrhea Liver Liver cancer -s/sx- early -Pain, a dull continuous ache in RUQ, epigastrium or back -weight loss, loss of strength, anorexia, or anemia may occur -jaundice if bile ducts occluded, ascites if obstructed portal veins Note: primary liver tumors few cancers originate in liver usu associated w/ hep B and C hepatocellular carcinoma (HCC) -liver metastasis liver is a frequent site of metastatic cancer Nonsurgical management of liver cancer: -underlying cirrhosis, which is prevalent in patients with liver cancer, which increases risks of surgery -major effects of nonsurgical therapy may be palliative -radiation therapy, chemo therapy -percutaneous biliary drainage -other nonsurgical treatments Surgical Management of liver cancer: -treatment of choice for HCC if confined to one lobe and liver function is adequate -liver has regenerative capacity lobectomy cryosurgery liver transplant Dx test for liver Liver function studies -serum aminotransferase: AST, ALT, GGT, GGTP, LDH elevated w/ liver dmg, alcohol abuse, liver failure -serum protein studies altered levels in chronic hepatitis, edema, ascites, cirrhosis, obstructive jaundice, viral hepatitis -pigment studies: direct and indirect serum bilirubin, urine bilirubin, and urine bilirubin and urobilinogen measure the ability of the liver to secret bilirubin abnormal results with liver and biliary tract disorders -prothrombin time prolonged in liver disease -serum alkaline phosphatase made in bones, liver, kidneys, intestines- excreted through the liver alterations indicate biliary tract obstruction -serum ammonia elevated in liver failure -cholesterol elevated with biliary obstruction, decreased in liver disease Additional Diagnostic Studies -liver biopsy determines changes in liver tissue - ultrasonography presence of masses, changes in size --CT/MRI hepatic neoplasms, cyst, abscesses, hematomas may differentiate b/t obstructive and non-obst jaundice -ERCP visualize biliary structures via endo - cholangiogram to visualize gallbladder and bile duct Esophageal varicies -dx, -endoscopy to id the bleeding site U/S, CT Esophageal varicies -s/sx -hematemesis, -melana, - general deterioration, -shock
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