Disclaimer: This document is designed to help guide your study and help you focus on topics
that we find to be some of the most important information that was covered in the material for
the exam. This is not all of the information that will be on the exam, so please do not expect this
to be the only information covered on the exam.
Topics for exam 3:
GI:
TPN indications, maintenance, risk factors, possible complications
o Indications
o Maintenance
o Hung at night.
o Must use filter, if using filter, lipids must be connected distal to the filter.
o Must be verified with another RN.
o Bag & tubing must be changed every 24 hours even if bag is not empty.
o No other medications or fluids should be infused in the line being used
for TPN
o Monitor glucose & electrolytes
o If TPN unavailable for a patient who has been receiving TPN, hang D10 so
that they do not become hypoglycemic
o Start slowly with TPN & gradually increase to goal rate
o When discontinuing TPN ensure that it is weaned off instead of suddenly
stopped
o Risk factors
o TBD
o Complications
o Hyperglycemia
o Hypoglycemia
o Infection
o Fluid shifts
Risk factors, pathophysiology, manifestations, lab values, diagnostics, pharmacological
treatments, nursing care, nutrition, and complications for pancreatitis
Pancreatitis: inflammation of the pancreas
Risk factors
o Cholelithiasis in the common bile duct
o Alcohol slows the enzyme of the pancreatic duct
o Complication from ERCP
o Complications from GI surgery
o Genetics
o Cystic fibrosis
o Trauma
o Drug toxicity
o Penetrating gastric ulcers
, o Can be autoimmune process
Patho:
o Something causes activation of pancreatic enzymes in the pancreas commonly
obstructions, alcohol, autoimmune disease, enzymes begin to auto digest the
tissues of the pancreas causing inflammation & pain. Results in pain as well as
the inability to digest/ absorb food properly.
Manifestations
o GI: abdominal pain that radiates to back, flank or should & is described as a
“boring” pain’ polydipsia, polyphagia, weight loss, hypoactive bowel sounds,
clay-colored stools
o GU: polyuria
o Integ/Musc: Turner’s sign, Cullen’s sign, musculoskeletal tetany
Labs
o Amylase: increased and clears faster than lipase
o Lipase: elevated
o Glucose: elevated
o Mag: increased
o Calcium: low
o Bilirubin: elevated if liver damage
o CBC: look for elevated wbc, low Hgb/Hct
o ESR: elevated (indicates generalized inflammation)
Diagnostics
o CT
o Abdominal x-ray to assess for gallstones
o ERCP: diagnose problems of bile & pancreatic ducts
o HIDA scan: imaging procedure used to diagnose problems of liver, gallbladder, &
bile ducts
Pharmacology
o Analgesics: opioids, due to it’s painful nature
o Antiemetics
o Abx: for acute necrotizing pancreatitis (ANP)
o Anticholinergics: drugs that block & inhibit activity of neurotransmitter (Ach) at
both central & peripheral nervous system synapses
o PPIs/ H2 antagonist
o Pancreatic enzymes (pancrealipase)
o Insulin
o Calcium replacement
o Isotonic fluids
Nursing care
o Position client for comfort
o Ensure client is NPO & that GI system gets rest
o Possible insertion of NG tube: (look to see if there is hx of alcohol abuse, risk of
possible esophageal varices)
, o Monitor & treat pain
o Monitor lab values
o Ensure adequate hydration (administration of isotonic IVF)
Nutrition
o During acute bout of pancreatitis, the patient will be made NPO
o Might be started on TPN
o When over initial insult, patient will need small, frequent meals that are high
protein, high carbohydrate, & low fat
o Also gave patient bland food
o Avoid caffeine & alcohol
o Nutritional supplements are encouraged
o No smoking
Complications
o Hypovolemia: third spacing as well as loss
o Chronic pancreatitis
o Pancreatic abscess
o Pancreatic pseudocyst- less serious in most cases bc encapsulated
o Diabetes -> if islets of Langerhans are damaged than this could occur
o Pleural effusion
o Multi-system organ failure
o Pancreatic cancer: treated w/ Whipple procedure sometimes
Risk factors, pathophysiology, manifestations, lab values, diagnostics, pharmacological
treatments, nursing care, nutrition and complications for hepatitis and cirrhosis
o Hepatitis: inflammation of the liver
o Risk factors
o Autoimmune dysfunction
o Alcohol use disorder
o Chemical exposure
o Hepatotoxic drugs: acetaminophen
o Obesity (Non-alcoholic fatty liver disease) fatty tissues replaces healthy
tissue
o Viral infection
o Sharing needles (hepatitis C)
o Unprotected sex w/ infect individual (hepatitis B)
o Consuming tainted food or water (hepatitis A, E)
o Patho
o Causative agent (toxin, virus, antibody, etc.) attack hepatocytes directly or
affects them through general inflammatory response, large number of
hepatocytes are damaged leading to liver dysfunction leads to multiple
issues with bile production, coagulation, blood glucose, protein
production & metabolism & others
o Manifestations
that we find to be some of the most important information that was covered in the material for
the exam. This is not all of the information that will be on the exam, so please do not expect this
to be the only information covered on the exam.
Topics for exam 3:
GI:
TPN indications, maintenance, risk factors, possible complications
o Indications
o Maintenance
o Hung at night.
o Must use filter, if using filter, lipids must be connected distal to the filter.
o Must be verified with another RN.
o Bag & tubing must be changed every 24 hours even if bag is not empty.
o No other medications or fluids should be infused in the line being used
for TPN
o Monitor glucose & electrolytes
o If TPN unavailable for a patient who has been receiving TPN, hang D10 so
that they do not become hypoglycemic
o Start slowly with TPN & gradually increase to goal rate
o When discontinuing TPN ensure that it is weaned off instead of suddenly
stopped
o Risk factors
o TBD
o Complications
o Hyperglycemia
o Hypoglycemia
o Infection
o Fluid shifts
Risk factors, pathophysiology, manifestations, lab values, diagnostics, pharmacological
treatments, nursing care, nutrition, and complications for pancreatitis
Pancreatitis: inflammation of the pancreas
Risk factors
o Cholelithiasis in the common bile duct
o Alcohol slows the enzyme of the pancreatic duct
o Complication from ERCP
o Complications from GI surgery
o Genetics
o Cystic fibrosis
o Trauma
o Drug toxicity
o Penetrating gastric ulcers
, o Can be autoimmune process
Patho:
o Something causes activation of pancreatic enzymes in the pancreas commonly
obstructions, alcohol, autoimmune disease, enzymes begin to auto digest the
tissues of the pancreas causing inflammation & pain. Results in pain as well as
the inability to digest/ absorb food properly.
Manifestations
o GI: abdominal pain that radiates to back, flank or should & is described as a
“boring” pain’ polydipsia, polyphagia, weight loss, hypoactive bowel sounds,
clay-colored stools
o GU: polyuria
o Integ/Musc: Turner’s sign, Cullen’s sign, musculoskeletal tetany
Labs
o Amylase: increased and clears faster than lipase
o Lipase: elevated
o Glucose: elevated
o Mag: increased
o Calcium: low
o Bilirubin: elevated if liver damage
o CBC: look for elevated wbc, low Hgb/Hct
o ESR: elevated (indicates generalized inflammation)
Diagnostics
o CT
o Abdominal x-ray to assess for gallstones
o ERCP: diagnose problems of bile & pancreatic ducts
o HIDA scan: imaging procedure used to diagnose problems of liver, gallbladder, &
bile ducts
Pharmacology
o Analgesics: opioids, due to it’s painful nature
o Antiemetics
o Abx: for acute necrotizing pancreatitis (ANP)
o Anticholinergics: drugs that block & inhibit activity of neurotransmitter (Ach) at
both central & peripheral nervous system synapses
o PPIs/ H2 antagonist
o Pancreatic enzymes (pancrealipase)
o Insulin
o Calcium replacement
o Isotonic fluids
Nursing care
o Position client for comfort
o Ensure client is NPO & that GI system gets rest
o Possible insertion of NG tube: (look to see if there is hx of alcohol abuse, risk of
possible esophageal varices)
, o Monitor & treat pain
o Monitor lab values
o Ensure adequate hydration (administration of isotonic IVF)
Nutrition
o During acute bout of pancreatitis, the patient will be made NPO
o Might be started on TPN
o When over initial insult, patient will need small, frequent meals that are high
protein, high carbohydrate, & low fat
o Also gave patient bland food
o Avoid caffeine & alcohol
o Nutritional supplements are encouraged
o No smoking
Complications
o Hypovolemia: third spacing as well as loss
o Chronic pancreatitis
o Pancreatic abscess
o Pancreatic pseudocyst- less serious in most cases bc encapsulated
o Diabetes -> if islets of Langerhans are damaged than this could occur
o Pleural effusion
o Multi-system organ failure
o Pancreatic cancer: treated w/ Whipple procedure sometimes
Risk factors, pathophysiology, manifestations, lab values, diagnostics, pharmacological
treatments, nursing care, nutrition and complications for hepatitis and cirrhosis
o Hepatitis: inflammation of the liver
o Risk factors
o Autoimmune dysfunction
o Alcohol use disorder
o Chemical exposure
o Hepatotoxic drugs: acetaminophen
o Obesity (Non-alcoholic fatty liver disease) fatty tissues replaces healthy
tissue
o Viral infection
o Sharing needles (hepatitis C)
o Unprotected sex w/ infect individual (hepatitis B)
o Consuming tainted food or water (hepatitis A, E)
o Patho
o Causative agent (toxin, virus, antibody, etc.) attack hepatocytes directly or
affects them through general inflammatory response, large number of
hepatocytes are damaged leading to liver dysfunction leads to multiple
issues with bile production, coagulation, blood glucose, protein
production & metabolism & others
o Manifestations
