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Theory Exam 2
Problems of Hematological System

Normal Hgb
Male: 14-18
Female: 12-16
Normal Hct
Male: 42-52%
Female: 37-47%
Neutropenic
fever implies an
infection which
can lead to septic
shock which can
lead to death, so
these patients
need immediate
attention
visitors=
nurse and
family

Normal platelets
Thrombocytopenia- low number of platelets (under 150k)
150k-400k
o These paents are at risk for bleeding
o People at risk: chemotherapy paents, people on aspirin
o Symptoms: paents are asymptomac unl they start bleeding internally or
externally
 Nose bleeds (epistaxis)
 Bleeding from gums
 Petechiae on skin (emergent! = bleeding internally)
 Purpura (purpleish)
 Ecchymosis (bruising)
o Paent educaon: use so toothbrush, use electric razor rather than straight
razor, do not blow nose forcefully (dab nose), advise against
pedicures/manicures, nofy denst about thrombocytopenia, **limit
injecons** do not take NSAIDs (they cause GI bleeds)
o Paent who is bleeding (externally or internally) has low BP and high HR
o Treatment: platelet transfusion is an opon IF platelet count is under 10k
 If paent is bleeding and BP is lowering, you can give IV uids and
possibly give blood transfusion
 Priority queson: (1) stop bleeding and then (2) give IV uids
Neutropenia- low neutrophil count (a type of WBC)
o When you have an infecon, it can worsen quickly because you have a low
Normal
WBC
amount of WBC ghng o the infecon
5k-10k
o Risk Factors: immunosuppressed people (paents with HIV, organ transplant
paents, chemotherapy paents)
o Symptoms: These paents are asymptomac unless they get sick- keep an eye
out for “neutropenic fever (100.4+)” this is an issue and needs to be addressed
ASAP
 If paent has neutropenic fever, you do a blood culture ASAP
 Aer blood culture, THEN give anbiocs (anbiocs can alter results of
blood culture)
 Anbiocs should be started within one hour of doing blood culture
 Once you get blood culture results, then you can give specic anbioc
o Neutropenic precauons:
 isolaon (ideally) but can be in a room with another paent who has no
risk for infecon (paent with a bone fracture)
 Any visitors cannot be sick
 Visitors must wash hands before entering room
 Visitors must wear gown and mask
 Everything this paent eats must be fully cooked
 No fresh fruits or veggies (if paent wants an apple, they must eat apple
pie)
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No tap water, boled water only
No fresh owers in room
If paent is at home, have them avoid large crowds, public sengs/public
transportaon
Pancytopenia/ Aplasc Anemia-low amount of all cells in the body (RBC, WBC, platelets)
o Paent educaon: same as thrombocytopenia and neutropenia paents
 Risk for bleeding, risk for infecon- use the same precauons as
thrombocytopenia and neutropenia
o Treatment depends on the issue. If paent is bleeding, treat the bleeding. If
paent is sick, treat the illness.
Iron Deciency Anemia
o Causes: diet low in iron
 Iron rich foods: red meats, liver meats, muscle meats, organ meats
o People at risk: young people (their diet is usually poor and not rich in iron),
women in their reproducve years (losing blood in menses)/women who are
pregnant
o Symptoms: pallor, SOB, low h&h, fague
o Treatment: increasing iron in diet, iron supplements (ferrous sulfate)
 Take ferrous sulfate with absorbic acid (orange juice)
 Black tarry stools are normal when taking ferrous sulfate
 Take ferrous sulfate one hour before meals
 Do not take ferrous sulfate with calcium
Kidney failure can cause anemia!! Our kidneys produce Erythropoien which is a
hormone that is made in your kidneys and travels to your bones to nofy your bones
that there in a low RBC count. This makes your bones produce more RBC. However,
when you have kidney failure, Erythropoien is not made, and your bones don’t know to
make more RBC if there is a low amount. Epoen Alpha is the treatment for this!!!
Cobalamin Anemia/ Pernicious Anemia/ B-12 Deciency Anemia (all the same!)
o Two main causes: vegetarian/ vegan diet (this is because B12 is found in meat)
and lack of intrinsic factor (you need intrinsic factor to absorb B12)
o Treatment: for a vegetarian you would give supplements/changes in diet (leafy
green veggies). for someone who is not vegetarian/vegan but sll has a poor
diet, you would have them eat more meats like poultry, sh, and red meats.
treatment for someone who doesn’t have an intrinsic factor would be IM
injecons monthly or nasal spray
o Paents who have undergone Billroth I and Billroth II surgery are at risk for B12
deciency because they lose intrinsic factor during the surgery
o Symptoms: Beefy tongue, numbness/ngling in hands and feet*





iron helps create
hemoglobin and
hemoglobin carries
oxygen.
Low Iron= Low O2

Potential question: A patient who just had Billroth I surgery two weeks ago is now experiencing
numbness and tingling in their feet. What do you do?
Give them an injection of B12 OR nasal spray monthly
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

Folic Acid Deciency- folic acid is necessary to mature your RBC, if you have folic acid
deciency, your RBC never get to mature and die as baby cells
o People at risk: people with GI issues, people with poor diet, alcoholics, pregnant
women
o Treatment: supplements, increase diet with folic acid (avocado and orange juice,
peanuts)
Acquired Hemolyc Anemia- happens when there is a “forced” destrucon of your RBC.
example: you are having a blood transfusion and you are B+, but your nurse gives you Bblood. this will cause a destrucon of your RBCs.
Sickle Cell Anemia- a type of hemolyc anemia in which your RBCs are moon shaped
o A specic symptom seen in sickle cell anemia is jaundice because when RBCs are
destroyed, they release bilirubin. another symptom seen specially only in sickle
cell paents is enlargement of the spleen (splenomegaly) and liver
(hepatomegaly). paents with sickle cell also experience intense pain specically
during sickle cell crisis (aka vasocculsive crisis).
o People at risk: it is genec, you get it from your mother or father lol rip
o Risk factors for having a sickle cell crisis: infecon, decrease in oxygen, stress,
strenuous acvies, intense change in temperature
o Nursing management: treat the pain rst and treat it aggressively (morphine,
fentanyl). secondly, administer oxygen. third, administer IV uids. fourth, treat
the infecon. nally, have them rest!
o Paent educaon: avoid large crowds (to avoid infecon), avoid any sort of
injury, be fully vaccinated, do not go anywhere where altude is high, have them
stay hydrated (IV uids in hospital, oral uids at home), blood transfusion if H&H
get low
Potential question: A homeless man coming into the ED and claims he is in severe pain and
needs morphine. Upon further investigation you realize he has sickle cell anemia. Do you give
him the medication he is asking for?
YES! Believe the patient and give them strong medications (not just Tylenol/ Advil)

Potential question: A patient with sickle cell is asking where he should vacation for the summer.
He is between the Florida and Colorado. What do you advise for him?
Flordia. High altitude is bad for sickle cell patients!!!
Potential question: How does sickle cell affect parts of your body? Select all that apply.
Brain: Thrombosis or hemorrhage causing paralysis, sensory deficits, death
Lung: Acute chest syndrome; Pulmonary hypertension; Pneumonia
Liver and Gallbladder: Hepatomegaly; Gallstones
Kidney: Hematuria; Renal Failure
Bones and Joints: Hand-foot syndrome; Osteonecrosis
Eye: Hemorrhage; Retinal detachment; Blindness; Retinopathy
Heart: Heart Failure
1. Spleen: Splenic Atrophy (autosplenectomy)
Penis: Priapism
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Skin: Stasis ulcers of hands, ankles, and feet
Potential question: What medication is clinically beneficial in reducing the risk of having sickle
cell crisis in a patient with sickle cell anemia?
Hydroxyurea
Know this chart. There will be several select all that apply questions that ask which blood type
can give/receive from other blood types.
Tip: “Positive people attract both positive and negative people.” If you’re a positive blood type,
you can receive positive and negative blood. If you’re a negative person, you can only receive
form negative people.
Tip: O- is universal donor, they can give to anyone
Tip: AB+ is universal recipient, they can receive from anyone
 Blood Transfusion
o Before starng a blood transfusion, you want to get paents vitals*, do an assessment,
start an IV site, and do labs on paent (h&h, clong factors)
o When starng IV site, you aach a normal saline bag to dilute the blood. Regular saline
(0.9 sodium chloride) is the only thing that is compable when giving blood transfusions
o Get paent’s blood type (cross match) and get a consent form signed BEFORE going to
blood bank to get the blood
o Ask paent if they have had a blood transfusion before and if so, ask if they had any
negave reacons. Chances of having another negave reacon are increased
o You only have 30 minutes to start the infusion from the me you get the blood from the
blood bank
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If you pick up the blood and realize it will take you longer than 30 minutes to
start the infusion, then take the blood back to the bank
o Once you get the blood, you must verify with another RN that the blood type matches
o Infuse the blood within 4 hours (no longer because the blood will coagulate aer that)
o When you start the infusion, you want to stay with the paent for the rst 15 minutes of
the infusion because this is when the most reacons occur
o Get the paents vitals every 15 minutes for the rst hour of the transfusion to make sure
the paent isn’t having a bad reacon
 ATI, page 260 & 261 know the reacons and their symptoms!
 Hemolyc reacon, febrile reacon, allergic reacon, bacterial reacon,
circulatory overload
o No maer what kind of reacon that the paent is having, you must stop the transfusion
rst, treat them however they need to be treated, and then call the provider
o In circulatory overload, hypervolemia, high BP low HR, don’t need to stop transfusion
just need to slow it down
o If there is a reacon, you stop the transfusion, you would remove everything that was
used in the transfusion (IV site, tubing, bag) and collect a blood sample, and send
everything to the lab because it needs to be tested
The nurse should recognize urticaria and flushing as an indicator of an allergic transfusion
reaction. Other clinical manifestations include itching and signs of anaphylaxis with
bronchospasm.

Low-back pain, fever, and chills are manifestations of an acute hemolytic transfusion reaction.
The nurse should discontinue the transfusion and administer 0.9% sodium chloride through new
IV tubing.(immediate)
Febrile transfusion reaction- chills, increase in temperature, flushing, hypotension, tachycardia
Bacterial- wheezing, dyspnea, chest tightness, cyanosis, hypotension, and shock
Circulatory overload- crackles, dyspnea, cough, anxiety, JVD, tachycardia, and pulmonary
edema
Potential question: You are on a med surg floor and have just picked up a blood bag and need to
verify with someone that the blood matches. Who do you verify with?
A) The UAP who is also on the med surg oor
B) RN on the OB oor
C) CNA on the hemodialysis oor
Only RN can verify with you!!!
Gastrointestinal Issues
 Pepc Ulcer Disease (ulcer= erosion)
o Stomach/gastric ulcer
 Signs specic to gastric ulcer: food make it worse
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when you eat something, your stomach creates acid to break it down.
however, this acid irritates the ulcers and creates pain for the paent
 pain happens about 30m-1hr aer eang
 paents have weight loss because eang hurts them
 since they do not eat, they are malnourished
 hematemesis is more common in gastric ulcers (since it is higher up in
your GI tract)
o Duodenum ulcer
 Signs specic to duodenum ulcers: food make it beer
 since the duodenum ulcer is lower in the GI tract, the food moves
through the tract and “coats” over the ulcer (at this point, the food
has already buered with the acid in the stomach and there is no
irritaon)
 pain happens about 2-3hrs aer eang
 pain also occurs at night
 melena is more common in duodenal ulcers (since it is lower in GI
tract)
o Risk Factors for both: NSAIDs, h. pylori bacteria, stress, spicy/acidic foods, caeine,
alcohol
o Signs and Symptoms for both: hematemesis (voming blood), melena (dark, tarry
stool), dyspepsia (heart burn)
o Diagnoscs: endoscopies
 EGD (goes in through mouth and down esophageal into stomach)
 checks for gastric ulcers and gastris
 this will give denive diagnosis
 prior to doing EGD: must put paent NPO (about 6-8 hours before
procedure).
 during and aer EGD: monitor vitals unl sedaon is totally worn o
 post op: paents complain of sore throat (NORMAL)- give them ice
chips or lidocaine spray to help numb
 post op: they are NPO unl their gag reex is assessed
 monitor for pain and bleeding
 Colonoscopy (goes up the rectum to the intesnes)
 checks for GI bleeds
***Complicaons of Pepc Ulcer Disease
o Perforaon (rupture)- when ulcer ruptures, it releases gastric content into other
places which can lead to peritonis
 Signs and Symptoms of Peritonis- rigid, board-like abdomen
o GI Bleeds
Treatment (for Pepc Ulcers AND Gastris)
 Medicaons: PPIs (-prazole), H2 receptors (-dine), anbiocs (usually for h
pylori), antacids (-hydroxide), mucosal protectant (bismol salicylate,
sucralfate), DO NOT GIVE aspirin (salicylate) with mucosal protectant



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ATI book- page 328 & 329
take antacids 1-2 hours apart from other medicaons
take mucosal protectants 1 hour before meals
take PPIs once a day, prior to eang main meal- PPIS can lead to
fractures/cdi
 don’t take NSAIDs or alcohol
 vagotomy- surgery in which the vagus nerve (which smulates acid
producon) is cut to decrease the producon of acid
Paent Educaon: avoid spicy/acidic foods, avoid alcohol, avoid coee.





Possible question: This patient has been prescribed bismol salicylate and an antacid. How should
they follow their medication regimen?
Take bismol salicylate 1 hour before eating, and then take the antacid 1-2 hours after eating
Possible Question: how does bismol salicylate and sucralfate work?
It coats the lining of the wall to prevent h. pylori from binding to mucosal wall
The nurse should inform the client that famotidine is an H2-receptor antagonist that is prescribed
for the treatment of peptic ulcer disease to inhibit the secretion of gastric acid.
 Billroth I (Gastroduodenostomy) and Billroth II (Gastrojejunostomy)


Billroth I
o Paents are at higher risk for Cobalamin (B-12) deciency
o Paent educaon on increasing B-12 intake OR (if they’ve lost intrinsic factor)
then they need injecon
Billroth II
o Paents are at risk for dumping syndrome
o Dumping syndrome- when paent eats food, they almost immediately need to
use the restroom (“dumping” =poop)
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o Early Dumping Syndrome signs: signs occur 15-30 minutes aer eang. Signs are
feeling bloated, abdominal pain, hypotension, dizziness, diarrhea
o Late Dumping Syndrome (Postprandial Hypoglycemia) signs: Signs occur 3 hours
aer eang. Signs are sweaty, weak, dizzy, mental confusion
o Paent educaon for Dumping Syndrome: eat smaller/frequent meals, lay down
for 30 minutes aer eang, paents should not drink anything while eang (if
they drink something, it should be aer 30 minutes from eang), avoid sugary
foods/drinks, eat high protein/low ber/low carb meals, and bland/easy to digest
foods, avoid simple carbs and eat complex carbs
Possible Question: Which of the following foods should the patient choose after having a
Billroth I surgery?
White rice and bananas
 Gastris- inammaon of the lining of the stomach
o Symptoms of Acute Gastris: anorexia, nausea, and voming, feeling of fullness
o Acute Gastris can lead to Gastric Bleeding
 Main risk factor in Gastric Bleeding is alcohol (hemorrhage is associated
with alcohol use)
o Somemes hemorrhage is the only symptom that is present
o Symptoms of Chronic Gastris: increased risk for B12 (pernicious) anemia
o Treatment: NPO rst to rest their bowel, give IV uids, and give an-nausea meds
(-etron) (ondansetron)
 When taking o NPO, start with clear liquids and move your way up
 However, if paent is feeling nausea/voming again anyme while
they’re o NPO, put them right back on NPO
** Know page 914 in Lewis- Pre Op and Post Op for surgery**
Potential Question: After surgery you want the patient to ambulate early (to prevent DVT), you
also want to prevent risk of pneumonia (use incentive spirometer)
 GI Bleeds
o Symptoms: hematemesis, melena, occult bleeding
o Things that cause Upper GI Bleeds: Gastris, Pepc Ulcers, Esophageal Varices,
GERD
 If paent has GI Bleed, you want to insert an NG tube to clear out the
bleeding
 HOWEVER, do NOT insert NG tube IF paent has esophageal varices
because you don’t want to rupture them!!!
 If they are already bleeding, then you can insert NG tube
o Complicaons of GI Bleed: paents can go into hypovolemic shock
 Vital signs of someone who is bleeding: Low BP, High HR
o Signs: Pale, cool, clammy skin (diaphorec), fagues, dizziness, low H&H
 If these paents have lost a lot of blood, may give transfusion
o If paent is unconscious during GI Bleed, CAB (circulaon, airway breathing)
o If paent is conscious during GI Bleed, ABC (airway breathing circulaon)
 Peritonis
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o Rigid board-like abdomen
o Sharp pain that radiates into shoulder
o Diagnosis: check WBC count (WBC should be elevated), CT scan, ultrasound
This is because peritonis leads to infecon and WBC are elevated in
infecons
o Treatment: NPO!! Give anbiocs immediately!
o Treatment: Paracentesis procedure (must empty bladder rst to avoid puncture,
and make sure paent is sing up)
Appendicis
o Usually occurs in younger people (because they have a poor diet)
o Risk factors: young age (10-12), poor diet (low in ber, high in sugar/carbs), if
paent has an obstrucon to the opening of the appendix (can be from poop or
foreign bodies)
o Symptoms: Steady pain, abdominal cramping, pain at McBurney's point (LRQ),
low grade fever, rovsing sign (rebound pain at McBurney's point), paents usually
lying on their side
o If there is an immediate relief of pain, the appendix has ruptured and you need
to take paent to surgery asap
o Diagnosis: urinalyses to rule out UTI, pregnancy test to rule out ectopic
pregnancy
o Treatment:
 NPO asap! Eang can increase pain
 DO NOT GIVE NARCOTICS BEFORE DIAGNOSIS- you won’t be able to tell if
there is a rupture or not. Aer diagnosis, you can give some pain meds
while you sll monitor
 DO NOT APPLY HEAT
 DO NOT GIVE ENEMAS
o Complicaons: Peritonis!! Peritonis>infecon>sepsis>death


A fib- rapid heart rate. When your heart beats this fast, not enough blood is getting
out. Some of the blood that stays behind becomes stagnant and begins to coagulate.
SO, hardened clots that have formed in this process will accidentally shoot out while
the heart is beating so fast. This clot is what may travel to the brain and cause a
stroke. A FIB = EMBOLIC
Cerebral Vascular Accident (CVA) and Transient Ischemic Attack
(TIA)


Thrombotic- clot
forms on its own,
atherosclerosis,
“already there”
CVA]e
o Ischemic
 Thromboc- clot formaon
 Paents at risk: paents with hyperlipidemia and history of heart
disease (essenally, paents who have a diet high in fat)
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Embolic- parcles/debris break o from some part in your body and they
travel to your brain which causes blockage
 Paents at risk: paents with A b, paents on blood thinners
Hemorrhagic
 Intracerebral- bleeding within your brain (inside your actual brain)
 Subarachnoid- bleeding in intracranial area (between skull and brain)
 “Worst headache of my life” #1 SIGN OF
SUBARACHNOID/HEMORRHAGIC
 #1 Risk Factor for ANY hemorrhagic stroke: Hypertension!!!
NM Risk Factors: age (55+ when you turn 55, your chances doubles), gender
(more common in med, more women die), race/ethnicity more common in black
people, hereditary (family history)
M Risk Factors: hypertension, diabetes, high cholesterol levels (hyperlipidemia),
medicaon use (BC pills)
Warning Signs for Paent having Stroke:
 F- facial drooping
 A- arm weakness (have them raise their arm)
 S- speech diculty/slurred speech
 T-me

Embolic- particles
coming from
somewhere else that
create a blockage,
“makes its way
there”
o
o
o
o
Page 1336 Lewis figure 57.4, also know communication section
 Le sided stroke
o Aecng the le side of the brain
Only ischemic
o The le side of the brain controls logic/logical thinking, reading, speech
L =patients
L
stroke
get
o Le sided stroke eects right side of the body.
Left =
TPA!!!!!!!
TPALogic
breaks down  Right sided stroke
the clot to promote
o Aects the right side of the brain
blood flow!
o The right side of the brain controls impulses
o These paents are usually impulsive, have a short aenon span
o Le side of the body is aected.
 Communicaon secon
o Dysphagia- diculty swallowing
o Aphasia/Dysphasia- diculty communicang
o Hemianopia- loss of vision in right or le side of eyeball
o Recepve aphasia- loss of comprehension
o Expressive aphasia- inability to speak/communicate
o Global aphasia- total inability to communicate
o Dysarthria- problem with the muscular control of speech
 Diagnosis: aer you have assessed FAST, do CT scan! You need to know if you are dealing
with ischemic or hemorrhagic!
 Treatment:
o Ischemic: give TPA (ssue plasminogen acvator) (alteplase)
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There is certain criteria the paent must meet in order to receive TPA:
symptoms should have started 3-4.5 hour ago (if they started 5 hours ago,
they CANNOT receive TPA). Paents need to be screened beforehand for
pTT and INR. If paent has had a GI bleed or Head Trauma within the past
You can give aspirin to a
ischemic patient post3 months, they CANNOT receive TPA (Lewis, page 1340)
stoke but do not give to a
 TPA paents are at risk for bleeding, so once you have given TPA:
hemorrhagic stroke
patient
 you want to monitor for bleeding
 check their vitals (low BP, high HR is sign for bleeding)
 check their neuro status
 Carod endarterectomy- go through your neck and scrape o the clot
that is built up in carod artery
o Hemorrhagic: surgical intervenon
 Ancoagulants and platelet inhibitors are contraindicated in these
paents
Normal
 Main drug therapy: management of their hypertension
INR
 Metoprolol
0.8-1.1
 (-olol) drugs

Normal aPPT
30-40 sec
Normal PT
11-12 sec
Bleeding is a side effect of
TPA, patient needs to have
good pTT and INR to
receive TPA so they don’t
bleed out

Unilateral neglectone sided weakness.
Patient forgets about
their weak side
Nursing care:
o Paents placed on NPO immediately aer stroke
o When you have order to take o NPO, you must check gag reex before taking
them o
 If paent fails gag reex, you must keep them NPO and you must call
Speech Pathologist (they do a swallow study)
o Feed paent thick liquids when o NPO, you can add thickener to their liquids
o Paents tend to accumulate food in the weak side of their face so make sure you
check their mouth before giving next spoonful of food
o When paent is swallowing, they must tuck their chin into their chest
o Raise HOB 30 degrees or higher
o Have suconing on standby in event of aspiraon
o Promote independence!!
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lOMoARcPSD|9915992
Have paent feed themselves
Have paents take care of weak side (ex. Have paent drape their weak
arm over their lap when they are in a wheelchair)
 Encourage range of moon exercise
 Teach paent to dress their weak side rst and THEN strong side
 If paent has Hemianopia, place food on the side that the paent can
see. If they have RSH put on le side of the table in front of them
 If paent has Hemianopia, also encourage the paent to scan the room
when they walk in
 If approaching a paent with Hemianopia, approach them on the side
that they can see
Possible Question: You notice a family member caring for their loved one, a patient who just had
a stroke. Which of the following actions by the family member would cause for intervention?
You notice that the family member feeds the patient all their meals. (you want to promote
independence!!!)



TIA- “mini stroke,” a precursor to an ischemic stroke
o Signs and Symptoms: last less than an hour, temporary loss of vision, double
vision (diplopia) numbness/loss of sensaon in hands and feet, nnitus (ringing
in the ears), vergo
o Treatment: Aspirin
Possible Question: What topic should the nurse anticipate teaching a patient who had a brief
episode of tinnitus, diplopia, and dysarthria with no residual effects?
A. Cerebral aneurysm clipping
B. Heparin intravenous infusion
C. Oral low-dose aspirin therapy
D. Tissue plasminogen acvator (tPA)
A patient with carotid atherosclerosis asks the nurse to describe a carotid endarterectomy. Which
response by the nurse is accurate?
A. “The diseased poron of the artery is replaced with a synthec gra.”
B. “The obstrucng plaque is surgically removed from inside an artery in the neck.”
C. “A wire is threaded through an artery in the leg to the clots in the carod artery, and
clots are removed.”
D. “A catheter with a deated balloon is posioned at the narrow area, and the balloon
aens the plaque.”
Possible Question: A patient has a dysthymia, difficultly speaking, and arm weakness, which
stroke did he have?
Embolic stroke
Things that can cause damage to
ALT levels
Bilirubin
AST normal
levels
0-35
4-36
Ammonia
10-80
0.31-
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your liver: toxins (alcohol),
nephrotoxic medications
(Tylenol), hepatitis, cirrhosis
lOMoARcPSD|9915992
Biliary Issues

Hepatitis is the
inflammation
of the liver




Hepas A- has vaccine!
o Transmied through oral-fecal route
o Risk Factors: poor hand hygiene, food not being cooked thoroughly
o Paent Educaon: emphasize hand hygiene (especially aer using restroom and
before cooking), ensure food is being cooked thoroughly, advise to eat at
restaurants that are up-to-code on everything
Hepas B- has vaccine!
o Transmied through blood and bodily uids
o B = BABY (perinatal transmission!!!)
o Hep B is the only hep that can pass from mother to baby during birth
o JOINT PAIN
o Leads to cancer
Hepas C
o Transmied through blood and bodily uids
o Risk Factors: having unprotected sex, sharing/reusing needles (IV drug
use/taoos)
o Paent educaon: use protecon during sex, don’t share needles, get taoos
from legit places, don’t do sketchy IV drugs
o Because this does not have a vaccine, it is more likely to progress into cirrhosis
Signs and Symptoms of Hepas
o Jaundice is in both acute and chronic hepas
o Pain in upper right quadrant
o Clay colored stools
o Acute Hepas- lasts from 1-6 months
 its u-like symptoms (chills, fague, nausea, voming, diarrhea, lethargic)
o Chronic- caused by hep C, connuous, doesn’t ever get “healed”
Risk Factors: Having a Blood Transfusion before 1992
o Prior to 1992 literally no one was checking/tesng blood to make sure it was
clean??? So, some people got dirty/infected/bad blood yikes
If your liver was healthy and normal, your portal vein would
supply your liver with blood. However, because the liver is
rock hard in patients with Cirrhosis, there is pressure build up
in the portal vein. This is because the blood can’t get into the
liver and is backflowing into interstitial space. When the fluid
spills over into the interstitial space, this causes ascites

Ammonia is a side
product of protein
being metabolized.
Your liver is
supposed to get rid
of the ammonia. If
your liver is not
working, you have
ammonia build up.
Since ammonia can
cross the blood
brain barrier, your
neuro statis is
The pressure builds up in the portal vein
Cirrhosis- the scarring of the liver
also causes the veins in your esophagus to
o Your liver is damaged beyond repair
become enlarged- this is called esophageal
varices
o Number 1 cause is Alcoholism
o Number 2 cause is Hepas C
o Symptoms: Jaundice, portal hypertension, ascites, esophageal varices, hepac
encephalopathy
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Esophageal
varices are
ticking time
bombs to
bursting any
moment.
These are
what cause
upper GI
bleeds
lOMoARcPSD|9915992
Paent educaon on esophageal varices
 you do not want the paent to strain while they’re on the toiletthis can cause varices to rupture (give stool soeners!)
Ascites- fluid in
abdomen
 give anemecs if paent is nauseous because throwing up could
also cause the varices to rupture
 NO NG tube because you don’t want to rupture any varices.
However, if rupture has already happened, you can insert NG tube
to sucon out the blood
 Ascites: caused by low albumin level. Albumin helps keep blood and uid
inside your arteries. So if you don’t have albumin, all that uid leaks out
into intersal space
 Treatment for ascites: #1 diurecs!!! (to get rid of extra uid) and
THEN paracentesis
 Paracentesis procedure- 1) must empty bladder rst to avoid
puncture and 2) make sure paent is sing up during procedure
 Portal hypertension Treatment: give B Blockers
 Hepac encephalopathy: ammonia level increasing which causes paent
confusion, twitching extremies (asterixis), bizarre behavior
 Treat hepac encephalopathy by giving lactulose (it helps excrete
ammonia)
o Lactulose can cause hypokalemia because you’re pooping
so much to get rid of the ammonia
o Since paent’s lose potassium, you may want to put this
Albumin also
paent on an EKG
helps calcium
o Paent educaon for prevenng a Cirrhosis paent from developing Hepac
absorption. Low
albumin = low
Encephalopathy
calcium
 Diet low in protein
o Cirrhosis paents experience Hypocalcemia
 Trousseau's sign
 Chvostek's sign
o pTT and INR are prolonged in Cirrhosis paents
 paents do not have the clong factors to help stop bleeding
o Bilirubin is high in Cirrhosis paents
 Increased bilirubin can lead to pruritus (itching of the skin)
 You don’t want paent to scratch so you can give moisturizing cream, you
can give a cool moist cloth, and you should clip the paent’s nails
o Low sodium, low uid diet! We don’t want any uid retenon
o Quit drinking alcohol
o Other Nursing Care:
 Risk for bleeding, so toothbrush, electric razor, monitor stool for blood,
an-nausea meds to prevent throwing up, stool soeners to prevent
straining on toilet
*Ascites can become infecous and lead to peritonis

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*SPIDER ANGIOMAS IS A SYMPTOM OF CIRRHOSIS
Amylase and lipase are supposed to break
The greatest risk to the client who has cirrhosis of the liver is hemorrhagic
dueThey
to active when they
down fatshock
and carbs.
leave
the
pancreas,
However,
bleeding in the esophageal varices. Therefore, bloody stools is the priority nding to reportintoPancreatitis,
there is an obstruction/malfunction (alcohol
the provider
abuse) that doesn’t allow for these enzymes
Potenal Queson: How do you know the lactulose is working?
A. The paent stops being confused
B. The ammonia levels return to normal
to leave. Therefore, the enzymes activate
inside of the pancreas and eat at the pancreas
itself.
Amylase helps

break down fat
Pancreas
o Inammaon of pancreas
Lipase helps
o Amylase and lipase are used to measure pancreas funcon
break down
o Causes: alcohol abuse, gallstones, ERCP procedure
carbs
o Symptoms: pain (LUQ), pain can radiate to the shoulder/back
 Grey-turners: bruising on their side (their ank)
Pancreas creates insulin so broken
 Cullen’s sign: bruising on bellybuon
pancreas= hyperglycemia
o These paents can have decreased bowel sounds
o These paents can have hypocalcemia (check their calcium)
 Trousseau's sign
 Chvostek's sign
 Numbness/nging in hands and feet
o These paents can also have hyperglycemia (check their glucose)
o Nursing intervenons:
 NPO!!!! (You don’t want enzymes to eat at the pancreas which will
happen if they eat food)
 If they are on NPO for longer than 3 days, you switch them to TPN
 When giving TPN, you know it is working when the paent is
gaining weight, and there is would healing
 Complicaons of TPN- uid volume overload, and can have either
hyperglycemia or hypoglycemia
 Can give pain medicaon
 Can give insulin
o Diet for these paents when o NPO/TPN: high carb, high protein and low fat,
low sugar
o Complicaons: acute respiratory distress syndrome, pleural diusion, essenally
anything respiratory
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