Med-Surg Exam 13
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What is the name of the dx test that is a scan that usually uses contrast dye and takes multiple cross-section images?
CT abdomen test
What dx test detects tumors, abscesses, inflammation, perforation, bleeding, aneurysms, and calculi?
CT Abdomen test
What should you ask the pt before using contrast dye?
allergies to iodine or shellfish?
What are the most common reasons for ostomies to be performed?
- culerative colitis
- Crohn's disease
- birth defects
What is the type of ostomy that is an internal pouch constructed from the ileum and then end of the ileum is intussescepted to form a one-way nipple valve?
pouch ileostomy AKA Kock pouch
How is a pouch ileostomy drained?
collects in pouch, drained by catheter that is inserted though the stoma (pressure of full pouch forces the nipple valve to close)
What is the pro and con of a pouch ileostomy?
- pro: low possibility of leakage of mucus/fecal material/gas
- con: higher risk of valve failure
An _______ _______ takes 2 surgeries- one for colectomy/ileostomy and creation of reservoir, then one for closure of the ileostomy a few months later; usually continent within 3 to 6 months.
What is the pre-care for a pt who is getting a liver biopsy?
- obtain cell sample to rule out CA, cirrhosis, hepatitis
- check PT level- high risk for hemorrhage; Dr. may oder vitamin K
- NPO; consent
- type and crossmatch in case need blood
- baseline VS
- pt voids
- review breathing instructions with pt
What is the post-care for a pt who is getting a liver biopsy?
- keep pt on right side with folded blanket against the site for a few hours; BR for 24 hours.
- monitor VS
What is a HIDA scan?
- hydroxyiminodiacetic acid
- NM test: IV radioactive substance given/taken up by bile; flows where bile goes, then scanner passes over area of the gallbladder.
- evaluates GB function/obstruction/bile leak
What liver/GB dx test involves a low fat meal the evening before the test (4 pm); then 2 hours later, radiopaque iodine dye taken.
can be done w/IV dye given immediately before the test
May give high-fat meal and repeat x-rays to check GB function
GB series/ IV cholangiogram
What liver/GB test (NM) involves a contrast being introduced into hepatic circulation, then x-rays taken to assess vessels and flow through them?
Portal venography/hepatic arteriography
What liver/GB test (NM) involves the pt given an IV radioisotope, then a scan of the liver that evaluates liver size, shape; also tumors, abscesses?
What liver/GB test involves a peritoneal tap to drain ascitic fluid from the pt's abdominal cavity for dx and tx purposes; sterile procedure done at the bedside?
What are some complications?
- Complications: peritonitis, bleeding, hypovolemic shock
What liver/GB test involves inserting a scope though the mouth into the duodenum, then a small cannula directed into the common bile and pancreatic ducts?
Contrast is injected, x-rays are taken
Can also be used for retrieval of stones in common bile duct, bx & dx tumors/cysts, or to dialate strictures
ERCP Endoscopic retrograde cholangiopancreatography
What liver/GB test involves using high frequency sound waves that are passed into the body and recarded as they are reflected via the use of conductive gel & transducer.
Useful in dx of tumors, cirrhosis
NOP with bowel prep; allows better view
What is the chronic, progressive, degenerative disease in which liver damage is followed by scarring and development of excessive fibrous connective tissue?
What is the nursing care that should be performed with a pt with cirrhosis?
- nutritional care
- fluid/electrolyte balance
- monitor VS/neuro checks
- monitor lab results
- monitor BMs
- skin care
- emotional support
_________ _________ _________ AKA _________is due to an elevated serum ammonial level. What are some s/s?
- prtal systemic encephalopathy; hepatic coma
- s/s: lethargy, drowsiness, confusion, eventual stupor to coma,...
What is the main goal when treating a person in a hepatic coma?
you want to lower ammonial levels
_________ is the term for fluid in the peritoneal cavity secondary to portal HTN, aldosterone overproduction, and decreased albumin production.
When removing fluid from the peritoneal cavity in a person with ascites, why should you only remove a few liters at a time?
may cause shock if you remove too much too quickly
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