NSG 210 Test 3 Study Guide

It is administered po or via ng tubeenema if pt is

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Unformatted text preview: If complete rest of the esophagus is indicated, parenteral nutrition is initiated  ­Gastric suction is usually initiated to keep the stomach empty & prevent vomiting  ­Oral care should be given b/c these pts complain of severe thirst  ­Vitamin K therapy & multiple blood transfusions may be indicated b/c of blood loss  ­Monitor coagulation studies. PTT & INR would be prolonged in pts w/ EV. Platelet count would be low.  ­Volume expanders may be indicated Hepatic Encephalopathy aka Portosystemic Encephalopathy (PSE) Disease Process: The damaged liver can’t remove toxins from the blood, causing them to accumulate in the blood & eventually the brain. PSE is a central nervous system manifestation that’s r/t serum ammonia levels. The liver normally converts ammonia to urea but b/c it’s damaged, ammonia accumulates in the blood & enters brain cells, causing disorientation & confusion. It can lead to coma & death, if left untreated.  ­Circumstances that increase serum ammonia levels include: The largest source of ammonia is the enzymatic & bacterial digestion of dietary & blood proteins in the GI tract. Ammonia from these sources increases b/c of GI bleeding from EV, a high protein diet, bacterial infection or uremia. Ingestion of ammonia salts  ­Serum ammonia levels may be decreased by elimination of protein from the diet & use of antibiotic agents  ­Other factors unrelated to increased serum ammonia levels that can cause PSE in immunocompromised pts include excessive diuresis, dehydration, infection, surgery, fever, constipation, hypovolemia, hypokalemia, elevated levels of serum Manganese & some medications (opioids, diuretics, hypnotics).  ­PSE is usually seen in late stages of cirrhosi...
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