Midterm Exam: NR574\/ NR 574 (2023\/2024 Latest Update) Acute Care Practicum Review | Week 1-4| Questions and Verified Answers| 100% Correct- Chamberlain<\/p>\n\n\n\n
Midterm Exam: NR574\/ NR 574 (2023\/2024
Latest Update) Acute Care Practicum Review
| Week 1-4| Questions and Verified Answers|
100% Correct- Chamberlain
Q: What is a TIPS procedure?
Answer:
The TIPS procedure bypasses a portion of the hepatic circulation by shunting blood flow from
the portal vein to the hepatic vein
-This reduces portal pressure and minimizes back pressure on the splanchnic organs. This also
decreases the likelihood of bleeding from the esophageal varies and reduces the amount of
ascites
*Hemorrhage is a significant risk during TIPS
Q: What is the treatment of choice for both type 1 and type 2 HRS?
Answer:
Liver transplant.
Q: What medications are used to tx type 2 HRS?
Answer:
vasoconstrictors (terlipressin, midodrine in combination with octriotide, norepinephrine)
combined with albumin.
Q: Bridge to transplant in Hepatorenal syndrome
Answer:
The combination of oc- treotide, midodrine, and albumin (triple therapy) is used to treat
hepatorenal syn- drome (HRS) often as a bridge to liver transplantation (LT).<\/p>\n\n\n\n
Q: Module ** Bridge to transplant**
Answer:
In clients who do not respond to medical therapy, are not candidates for TIPS but are candidates
for liver transplantation or recovery for their liver disease,
continuous renal replacement therapy can be utilized as a bridge to recovery or transplantation.
HRS clients typically do not tolerate hemodialysis well.
Q: Joaquin is a 22-year-old male who presents to the emergency department (ED) with a 1-
week history of headache, concentration difficulty, fatigue, nau- sea, and vague abdominal pain.
He became concerned this morning when
he noticed that the whites of his eyes appeared yellow. History is significant for epilepsy, which
he has had since childhood but is well-controlled with antiepileptic medication. There is no
known history of liver disease. Notable physical exam findings include scleral icterus,
generalized abdominal tender- ness, and new-onset ascites. Urine alcohol and drug screen were
negative. Labs reveal severe transaminitis, hyperbilirubinemia, hyperammonemia, and
coagulopathy. The most likely diagnosis is :
a. Cirrhosis
b. Acute liver failure c. Acute hepatitis A
d. Acute gastroenteritis
Answer:
Acute liver failure
Rationale: Acute liver failure is an abrupt onset of liver failure, characterized by hepatic
encephalopathy, jaundice, and coagulopathy in the absence of pre-existing liver disease which
has been present for less than 26 weeks. Joaquin’s symptoms are classic for that of acute liver
failure with antiepileptic medication as his biggest risk factor. For causes other than
acetaminophen toxicity, the onset of symptoms may be gradual and non-specific such as fatigue,
malaise, and changes in behavior or concentration. Asymptomatic jaundice and new-onset ascites
may also be present. Cirrhosis is a chronic disorder and is considered an end-stage liver disease.
Q: Chadwick presents to the ED following a suicide attempt. He reports swallowing
approximately 10,000 milligrams (mg) of acetaminophen 4-hours ago. An hour ago, he began to
develop generalized abdominal pain, nausea, and vomiting at which time he asked his brother to
take him to the hospital. Shortly after arrival, he becomes confused and agitated. Labs reveal
INR of 3.0, acute kidney injury (AKI) with creatinine 2.0, severe transaminitis, and lactic<\/p>\n\n\n\n
acidosis. Urine toxicology showed an acetaminophen level of 200 milligrams per kilogram.
Serum alcohol was negative. The AGACNP knows that the best initial treatment for Chadwick
is:
a. Administer fresh frozen plasma (FFP) to reverse the coagulopathy b. Consult nephrology to
begin hemodialysis
c. Administer N-acetylcysteine (Mucomyst)
d. Consult the liver transplant team
Answer:
Administer N-acetylcysteine (Mucomyst)
Rationale: All clients with ALF should receive N-acetylcysteine (NAC), regardless of its
etiology, upon admission as it has been shown to improve transplant-free recovery. In this case,
N-acetylcysteine is the treatment for acetaminophen toxicity. While the client has a
coagulopathy, there are no signs that Chadwick is actively bleeding. Consulting nephrology and
gastroenterology is important but adminis- tering Mucomyst is a higher priority. Consulting the
liver transplant team before administering or assessing response to treatment is inappropriate.
Continuous renal replacement therapy can be utilized as a bridge to recovery or transplantation.
HRS clients typically do not tolerate hemodialysis well.
Q: Rhabdomyolysis
Answer:
Rhabdomyolysis is a potentially life-threatening condition that occurs following skeletal muscle
injury.
-dissolution of striated muscle (caused by trauma, extreme exertion, or drug toxicity;
in severe cases renal failure can result)
Q: When the muscle injury occurs, what is released into the blood stream?-
Answer:
muscle fibers release large quantities of potassium, phosphate, creatinine kinase
(CK), and myoglobin, a small protein that binds oxygen, into the circulation.
-As an unbound protein, myoglobin is excreted by the kidneys but can precipitate and cause renal
tubular obstruction.
Q: What happens to myoglobin in Rhabdo?<\/p>\n\n\n\n
Answer:
myoglobin is release from skeletal muscle during injury.
it binds to oxygen
in excessive amount, as see with rhabdo, it is unbound.
when unbound it has to be excreted through the kidneys which can cause renal tubular
obstruction.
Q: Risk factors of Rhabdomyolysis
Answer:
Trauma, muscle compression, or ischemia
Heat-related causes
Infection with bacteria or viruses that can directly attack the muscle
Metabolic factors
Genetic factors
Medications that may cause direct myotoxicity Toxins which may cause indirect myotoxicity
Exertional activity
Nutritional supplements which contain substances that may induce muscle injury
Q: Subjective findings of Rhabdo (patient)
Answer:
muscle pain, dark urine and muscle weakness.
Other symptoms commonly associated with rhabdomyolysis can be nonspecific such as fever,
nausea, and vomiting, which developed over hours to days
Q: Physical exam findings in Rhabdo
Answer:
muscle tenderness soft tissue swelling
bruising
skin changes consistent with pressure necrosis muscle weakness
confusion, delirium, agitation anuria
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