NUR 201 GI Exam - Answer -Hgb & Hct are *decreased* due to interm...

NUR 201 GI Exam

• What are the labs associated with CRC?

Answer -Hgb & Hct are *decreased* due to intermittent bleeding associated with the tumor (may be the *first indication of a tumor* in some patients)

-if spread to liver, *liver enzymes are elevated*

-FOBT (if positive = GI bleeding)

-*CEA* elevated in CRC (tumor marker - may be elevated in other benign or malignant diseases & in smokers as well, so is *not a diagnosis*) (normal value = *<5 ng/mL*) ---> CEA often used to evaluate treatment effectiveness & to identify recurrence (repeat every year)

• How should albumin 20% be administered?

Answer for hypovolemic shock --> 1 mL/min

for normal blood volume --> 2-3 mL/min

*comes in grams, and is administered by gravity (drops/min)

• True or False

As ascites increases, pts complain of SOB

Answer true

• True or False 1 / 4

Esophageal varices are a life-threatening medical emergency; severe blood loss may occur and result in shock from hypovolemia

Answer true (anything that increases IAP or irritates the lining can increase risk for bleeding)

all patients with cirrhosis should be screened for then by *endoscopy* to detect them *before* they bleed

*propanolol to prevent bleeding*

• What is often the first clinical sign that a patient has liver dysfunction?

Answer -

thrombcytopenia

• Hepatic cell damage may lead to what common complications?

Answer -portal hypertension

---> *ascites* & esophageal varices --coagulation defects -jaundice

-portal-systemic encephalopathy w/ hepatic coma -hepatorenal syndrome -spontaneous bacterial peritonitis

• A patient can be prescribed Ketoralac for a maximum of

days for relief of pain associated with cholecystitis

Answer 10 days 2 / 4

• How does the aging process affect the expected findings with the *liver*?-

Answer -liver cells *decrease in number & size* which results in a *smaller* liver

-*decreased* enzyme activity* -*decreased* cholesterol synthesis -*DECREASED DRUG METABOLISM* = increased risk for toxicity (monitor for adverse effects)

• How does the aging process affect the *large intestine*?

Answer -*decreased* sensation to defecate (nerve impulse are dulled)

-peristalsis *decreases*

= constipation / impaction

(encourage increased fluids & high-fiber diet and encourage as much activity as tolerated)

• How does the aging process affect the *pancreas*?

Answer -duct changes (disten- tion/dilation)

-calcification of pancreatic vessels = *decreased lipase production* -*decreased lipase levels* = *decreased* fat absorption & *decreased* digestion ---> steatorrhea (fat in stools)

(encourage small, frequent feedings and assess for diarrhea)

• What is the pathway of bile from its originating organ to the exi

liver --> L& R hepatic ducts --> common hepatic duct --> cystic duct fr --> common bile duct --> pancreatic duct --> duodenum

(if sphincter to common bile duct is closed, it goes to gallbladder for *

• Which labs are *elevated* with hepatitis?

ting point?: -

om gallbladder storage*) 3 / 4

Answer

ALT, AST, CEA

• Which labs are *elevated* with cirrhosis?Which labs are *decreased*?

Answer *el- evated* = ALT, AST, alkaline phosphatase, CEA, ammonia

*serum albumin is decreased* but there is an increase in albumin in the abdominal cavity due to *ascites* (liver dysfunction = fluid shifts to abdominal cavity)

• Which labs are *elevated* with acute pancreatitis? Which labs are *de- creased*?

Answer *elevated* = serum amylase, serum lipase, carbohydrate antigen

*decreased* = calcium

• What are the 3 functions of the liver?

Answer

• metabolism

• storage
• drug detoxification

• True or False

Answer

15,000 mL/min of blood flows through the liver

Answer true (liver is vascular AF so needs to be protected from trauma --> aka ribs)

• If you have bleeding into the abdominal cavity, what signs might you expect to find?

Answer -gray turner's sign

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