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Principles III, Exam Two
Hepatobiliary slides 40-42, Pain slides 2-7
24
Nursing
Graduate
02/26/2010

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Cards

Term

What is the maximum volume that should be removed during a paracentesis of ascites?  How much weight loss does that yield?

 

Definition
Not to exceed 1 L/day, weight loss of 0.5 to 1 kg.
Term

How much albumin is lost with 1L of ascites?

 

How much albumin do we replace?

Definition

1L of ascites contains 10 grams of albumin.

 

Each liter of ascites removed must be replaced by 50 ml of 25% albumin.

Term
What is hepatobiliary disease usually associated with?
Definition
Stones that block the flow of bile.  Blockage can result in bile backup into the liver producing jaundice.  Other causes are strictures and tumors.
Term
What are the presenting s/s of patients with hepaobiliary disease?
Definition
Jaundice, dark urine, pale stools, and pruritis.
Term

What is the treatment for hepatobiliary disease if the cause is stones?

What is the obstruction is in the liver?

Definition
Surgical, unless the obstruction is in the liver, then it is usually medically managed.
Term
What are the symptoms of gallstones?
Definition
Sudden RUQ pain, fever, elevated WBC.
Term
If gallstones pass out of the gall badder, where might they end up?
Definition
They may pass through the common duct, producing jaundice, or they can obstruct the pancreatic duct.
Term

Acalculus cholecystitis can also occur.  In what pt populations is this common?

 

Is this type more or less severe?

Definition

Common in ICU pts and preggers.

 

This is more severe.

Term
A patient that has stones preventing the passage of bile into the guts may have an elevated PT.  Why? 
Definition
The inability of bile to pass into the intestines results in a vitamin K deficiency.  
Term
What types of drugs cause sphincter of Oddi spasms?  How do you treat it?
Definition

Narcotics, with morphine maybe being the worst.

 

Treatment: Narcan, glucagon, nitroglycerine, atropin/glycopyrolate

Term
If a drug is excreted through the bile, what impact will biliary obstruction have?
Definition
Prolonged action.
Term
What type of pain is protopathic, and what nerve fibers carry it?
Definition
Noxious, transmitted by high-threshold receptors and conducted by smaller, lightly myelinated (alpha delta) and unmyelinated C fibers.
Term
What stimulates epicritic pain?
Definition
Non-noxious stimuli--touch, pressure, proprioception, and temperature discrimination.  LOW THRESHOLD receptors, conducted by large myelinated nerve fibers.
Term

True or false:

 

Nociceptive pain is due to activation or sensitization of peripheral nociceptors which are specialized receptors that transduce noxious stimuli.

Definition
True
Term
Pain as a result of injury or acquired abnormality of peripheral or central neural structures is call ________?
Definition
Neuropathic
Term

What is the purpose of nociceptive pain?

 

What type of pain is acute pain?

Definition

To detect, localize, and limit tissue damage.

 

Acute pain is always nociceptive.

Term
What are the 4 physiologic processes involved in nociceptive pain?
Definition

1.  Transduction

2.  Transmission

3.  Modulation

4.  Perception

Term
Modulation can either inhibit or facilitate pain.  Where can this occur?
Definition
Peripherally at the nociceptor, in the spinal cord, or in the supraspinal structures.
Term
What results in the perception of pain?  Where does this occur?
Definition
Third order neurons located in the thalamus, that project to somatosensory areas I and II in the post-central gyrus and superior wall of the sylvian fissure?
Term
What are the 2 types of acute nociceptive pain?
Definition
Somatic and visceral
Term
Differentiate between superficial and deep somatic pain.
Definition
Superficial comes from the skin, mucous membranes, SQ.  Deep is from muscle, tendons, joints, or bones.
Term

What causes visceral pain?

How is visceral pain divided?

Definition

Visceral pain is due to disease or abnormal function of an organ or its covering, such as pleura, pericardium, or peritoneum.

1.  True visceral, driven by the ANS.  dull, diffuse, and midline

2.  Localized parietal--localized sharp or stabbing

3.  Referred parietal--sharp or stabbing pain referred to another site

4.  Referred visceral--dull, diffuse pain referred to another site.

Term

For each characteristic, state whether this primarily refers to acute or chronic pain.

 

1.  Dependence and tolerance to medication

2.  Psychological component

3.  Organic cause

4.  Environmental contributions and family involvement

5.  Insomnia

6.  Treatment goal is cure

7.  Depression

Definition

1.  Chronic

2.  Chronic

3.  Acute

4.  Chronic

5.  Chronic

6.  Acute

7.  Chronic

Term
What do many patients consider to be the most frightening aspect of surgery?
Definition
Post-op pain
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