| What are the potential impacts of Co-existing mental health and substance use problems (CEP)? | higher rates of suicide
higher rates of homelessness
poor relationships with family and friends
poor physical health |
| what is OARS in the use to developing therapeutic relationship when talking to someone with CEP? | Open questions
affirmation
reflective listening
summary reflection |
| what are the 6 stages of change to identify the likelihood of someone wanting to change? | pre-contemplation
contemplation
preparation
action
maintenance
relapse or lapse |
| what is harm reduction in people who drugs or alcohol ? | About reducing short and longer term harms associated with substance use and gambling - not about the absence to the substance but more about reducing the harm it may cause.
Goals can be to support the person to:
change how substances are used
change how substances are accessed
cut down on the amount used
cut down on the frequency of use
sustain controlled use |
| what is the FRAMES model for brief intervention of someone with substance or alcohol use? | Feedback - from screening process
responsibility
advice
menu options
empathy
self-efficacy |
| after doing a brief intervention you should conclude the conversation by using the SEW acronym, what does this mean? | S- SUMMARISE - a summary of the person's statements in favour of change
E- EMPHASISE - emphasise strengths and their ability to make changes
W- WHAT? - what agreement has been reached? |
| what is acute alcohol withdrawal? | occur when someone who regularly drinks suddenly stops or significantly reduces their alcohol intake - nervous system is hyperactive |
| Signs and symptoms of AWS may appear anywhere from two hours to a few days after their last drink. What are some symptoms? | hallucinations
tremors
nausea/vomiting
sweating |
| what is Delirium Tremens in acute alcohol withdrawl? | medical emergency - extreme symptoms.
extreme confusion
extreme agitation
seizures
fever |
| What is the CIWA-AR scale screening tool for acute alcohol withdrawl? | used to assess the extent of withdrawal someone is experiencing - used to support the use to benzos to manage the symptoms of withdrawl |
| How does Disulfiram (Antabuse) work to help people remain absence from alcohol? | produces irreversible inhibition of aldehyde dehydrogenase (ALDH). Aldehyde dehydrogenase is the enzyme responsible for the oxidation of acetaldehyde (which is a metabolite of ethanol). |
| what are the nursing considerations for disulfiram? | Prescribed only with full consent of tangata whaiora, therefore education about the medication and its interactions with alcohol is paramount.
Dietary considerations – food containing, or prepared with, alcohol (e.g, sauces, vinegars, desserts).
Over the counter (OTC) products which may contain alcohol, E.g., cough medicine, mouth wash, after shave, perfumes. Check for alcohol content. |
| what is the point of the methadone program? | to support opiate withdrawl so that they no longer need to access illicit opioids such as heroin or morphine derivatives - pure opiate agonist, replaces opiate use in dependence.
stabilization (reduces the desire for taking other drugs), replacement (substitute for other opioids), reduction (reduces withdrawal symptoms) |
| what is the mode of action of methadone? | binds to opiate receptors in the cns |
| what are some symptoms of methadone intoxication? | can be fatal - slow breathing
constipation
drowsniness |
| emergency treatment of opioid overdose? | assess ABC
call for help
place in recovery position
airway and oxygen
given naloxone |
| what is the purpose of Substance Addiction (Compulsory Assessment and Treatment) Act, 2017? | Enable persons to receive compulsory treatment if they have a severe substance addiction and their capacity to make decisions about treatment for that addiction is severely impaired |
| how does substance addiction compulsory treatment help a person? | a) protect them from harm
b) facilitate a comprehensive assessment of their addiction; a
c) stabilise their health through the application of medical treatment (including medically managed withdrawal)
d) protect and enhance their mana and dignity and restore their capacity to make informed decisions about further treatment and substance use
e) facilitate planning for their treatment and care to be continued on a voluntary basis; and
f) give them an opportunity to engage in voluntary treatment. |
| A person may be subject to compulsory treatment under this Act only if? | (a) the person has a severe substance addiction
(b) the person’s capacity to make informed decisions about treatment for that addiction is severely impaired
(c) compulsory treatment of the person is necessary
(d) appropriate treatment for the person is available. |
| what are the features of a SEVERE substance addiction? | a) neuro-adaptation to the substance
(b) craving for the substance
(c) unsuccessful efforts to control the use of the substance
(d) use of the substance despite suffering harmful consequences.’ |
| For the purposes of section 7(c) compulsory treatment is necessary only if voluntary treatment is unlikely to be effective in addressing the severe substance addiction. true or false? | true |
| what is human development? | The physical, social, psychological, cognitive, emotional, cultural and spiritual development and acculturation that happens at different points in our lives |
| what are the tasks of adolescence? | -Transition from child to adult, learning skills for later life, self-reliance and confidence, development close relationships with peers and the formation of personal identity
-Identity develops over time and is part of the makeup of an individual’s overall sense of self.
-Most important part of life because of the risk taken as they trail different perspectives of self |
| what is gender identity? | person’s own sense of identification as male, female, neither, both, or somewhere in between and is a key part of human development. |
| what is Anatomical Sex (biological sex)? | is comprised of things like genitals, chromosomes, hormones, body hair, and more. But one thing it’s not: gender. |
| what is gender expression? | ways you present gender, through your actions, clothing, demeanor, and more. Your outward-facing self, and how that’s interpreted by others based on gender norms |
| Developing sexual and romatic attachment is a key developmental task of adolescence and includes? | body image
sexual orientation
how we experience intimacy, touch, and love
sexual experiences, thoughts, ideas, and fantasies |
| There is also strong evidence that gender diverse young experience mental and physical health problems. Including substance use, self harm, eating disorders and suicide. true or false? | true |
| what are some recommendations to make gender diversity inclusive? | Clear Pathway for gender affirming health care
Address discrimination in health care and respect gender diversity
Support schools to be safe and inclusive
Support health and wellbeing initiatives led by trans and non binary people |
| Generally the earliest signs of mental disorder to emerge in childhood are those related to ADHD, conduct disorders, and anxiety and depressive disorders. True or false? | true |
| Infants who feel loved and nurtured begin to develop a sense of self and identity. Through this they develop the ability to sympathise, empathise, understand the feelings of, and relate to others. True or false? | true |
| what risk factors can predispose children to long term problems in adolescence and adulthood? | Exposure to parental stress/violence
Poverty
Physical, emotional and sexual abuse
maternal depression |
| what are protective factors that significantly reduces the risk of problems in later life? | nurturing loving relationships
positive parenting
support from siblings and peers |
| what is attachment disorder? | occurs when an attachment relationship is impaired in some way - does not develop the skills necessary to build meaningful relationships as infant develops |
| an attachment disorder profoundly affects an infant’s development in relation to his/her ability to express emotions and develop relationships. true or false? | true |
| what is fetal alcohol spectrum disorder? (FASD) | umbrella term that occurs due to maternal use of alcohol during pregnancy that causes damage to the fetus (ethanol crosses the placenta and toxins accumulate in the fetus) - most common cause of intellectual disorders |
| what are the possible effects of FASD? | brain damage,
developmental delay
and social, emotional, behavioural and mental disabilities.
poor growth
facial abnormalities |
| FASD often present with of social, emotional, and behavioural difficulties. what are these? | frequently seen by others as intrusive, overly talkative, and generally unaware of social cues and conventions.
Poor social judgment and poor socialization skills are common and difficulty establishing friendships
Hyperactivity, short attention spans. Memory problems, thus creating further setbacks to adaptive functioning and academic achievement later on |
| what is Attention Deficit Hyperactivity Disorders? | are behavioural problems where the child lacks or has insufficient control over behaviour that is expected in a given setting and is appropriate to the child’s age - One of the most common childhood mental health disorders (affects boys more) |
| FASD can lead to many other impacts on the client and the family such as? | stigma
reluctant to seek health services
guilt
lack of understanding of the condition |
| what are the usual symptoms of ADHD? | difficulty paying attention and staying focused (inattention)
difficulty controlling behaviour (impulsivity)
hyperactivity (over-activity). |
| what are autism spectrum disorders? | life-long developmental disability which affects communication and social interaction and is associated with a lack of flexibility in thought and action - Children with ASD all share some difficulty in making sense of their world |
| People with ASD often use apparently rigid rules to make sense of the world. These rules are logical to the person with ASD, but may conflict with the flexible and often unspoken conventions that guide typical social interactions. true or false? | true |
| what are conduct disorders? | clustering of behavioural difficulties that is dissimilar to age-appropriate norms. These behaviours include hostility to others, aggression, rule infractions, defiance of adult authority and violations of social and cultural norms |
| what are the three key elements of severe behavioral conduct disorders? | - Severe - at an intensity and rate that is outside the levels of behavioural difficulties normally found in children of the same age.
- Persistent across contexts (at home, at school, and in other social situations and over time)
- Antisocial – involving repeated violations of societal and age-appropriate norms that result in a negative impact on family, early childhood centres, school, peers, self etc. |
| what is school phobia/refusal | Severe difficulty attending school resulting in prolonged absence |
| what can school phobia result from? | - Severe emotional upset
- At home with parents knowledge
- separation anxiety
- |
| Anxiety disorders are the most common mental disorder in adolescence.
true or false? | true |
| what is the purpose of a HEADSSS assessment? | psychosocial screening tool designed to work with young people to discover the context of a presenting complaint to a health professional - also assists with developing therapeutic relationship and strength based plan |
| what does HEADSSS stand for? | Home,
Education and Employment,
Eating and Exercise
Activities and peers,
Drugs,
Sexuality,
Suicide and depression,
Safety,
Spirituality |
| what are the three harms that need to be disclosed to someone else during a HEADSSS assessment? | (1) Someone might harm you,
(2) You might harm yourself,
(3) You might harm someone else. If I need to discuss your issues with someone else, I will try to let you know about that first |
| which people may be at a higher risk of self harm? | females
Children and young people who have experienced ACES
LGBTIQ community
People who live in state care, prisons or secure institutions |
| what is the self-harm cycle? | people experience emotional suffering, they are unable to regulate their emotions which then becomes too overloaded, this emotional overload causes people to panic and use self harm to regulate their emotions, this causes temporary relief but then the person often feels a sense of shame |
| what are some reasons people self harm? | temporarily relieves intense feelings, pressure or anxiety;
provides a sense of being real, being alive - of feeling something other than emotional numbness;
to draw attention for help |
| what are some distraction techniques to suggest people to try rather than self harm? | - write down thoughts and feelings on paper then screw the paper up
- mindfulness techniques
- flicking rubber band against skin
- excercise |
| what are some nursing considerations for people who self harm? | Show compassion
Respect what the person is telling you, even if you don’t understand it
Stay emotionally neutral
Listen, even if it makes you uncomfortable |
| what is anorexia nervosa? | an eating disorder defined by a restriction of energy intake relative to requirements, which leads to significantly low body weight - Patients with this eating disorder will have a fear of gaining weight along and a distorted body image with the inability to comprehend the seriousness of their condition |
| what are some potential health concerns for someone with anorexia? (malnutrition) | Loss of muscle tissue – low creatinine
Hypotension - dehydration
Electrolyte deficiencies
Gi tract unable to tolerate normal food
Bone marrow – fewer wbc – dampen immune response
Fewer rbc – low energy – anemia
Fewer platelets – easy bleeding and bruising
Osteoporosis
Dry skin
Brain atrophy
seizures, confusion |
| what is bulimia nervosa? | an eating disorder characterized by binge eating until they feel extremely full, followed by inappropriate compensatory behaviour to get rid of the calories (purging) - usually of normal weight or over weight rather than under weight |
| what is orthorexia? | an obsession with eating foods that one considers healthy. Person systematically avoids specific foods that they believe to be harmful. |
| what is ARFID: Avoidant/Restrictive Food Intake Disorder? | A person with ARFID has issues eating certain foods, which leads to inadequate nutritional intake |
| what is Psychodynamic psychotherapy for eating disorders? | Requires understanding the root cause of the illness, the motives and drivers. Behaviours are expressions of underlying needs, therapy offers alternative ways for an individual to get their needs met |
| what is acceptance and commitment therapy? (ACT) | Changing actions rather than thoughts and feelings, accepting that pain and anxiety are a part of life. ACT identifies core values and commits to creating goals that fulfil these values. |
| Cystic fibrosis is the most common inherited condition affecting NZ children
Affects multiple body systems, mainly respiratory and gastrointestinal. true or false? | true |
| what gene mutation does cystic fibrosis affect? | CFTR gene - which is located on chromosome 7. This gene is responsible for making a protein called Cystic Fibrosis Transmembrane Conductance Regulator |
| what is the CTFR gene responsible for and what happens when there is a mutation in that gene? | Controls movement of chloride ions in and out of cells. Mutation in the gene cause the CFTR protein to malfunction or not be made at all, leading to a buildup of thick mucus and flattened cilia which cant sweep away the mucous, which in turn leads to persistent lung infections, destruction of the pancreas, and complications in other organs. |
| how does CF affect the respiratory system? | mucus and other debris can’t be moved out of the system effectively and the mucus becomes thick and sticky, clogging up the airways and creating the colonization for bacteria leading to infection |
| what are some common signs associated with CF affecting the respiratory system? | chronic cough
hypoxia
thick muccus
short of breath |
| How does CF affect the GI system? | pancreatic duct that transport pancreatic enzymes out of the pancreas become blocked with mucus. The enzymes build up in the pancreas instead of reaching the digestive system (specifically, the lumen of the gut), causing the pancreas to become inflamed. |
| if the pancreas become blocked and does not secrete enzymes, how does this affect absorption? | Impaired absorption of fats, proteins and vitamins A, D, E & K |
| in CF the pancreas does not make enough bicarbonate to neutralise stomach acid. true or false? | true |
| what are the common symptoms of CF affecting the GI system? | Abdominal pain and cramps
Greasy stools
Constipation
Gastric reflux
Poor weight gain and growth |
| what is Cystic Fibrosis Related Diabetes (CFDR) ? | the effect on the pancreas can lead to cell death which can then lead to hyperglycemia as the pancreas stops producing insulin |
| how does CF lead to metabolic alkalosis? | High loss of sodium and chloride (acid) from sweat, gut, bronchial mucosa, saliva and tears leads to chloride depletion
Depleted chloride leads to excessive bicarbonate (base) resorption, leading to metabolic alkalosis |
| how can CF be diagnosed? | New born metabolic screening (Guthrie Heel Prick Test) – looks for an enzyme called Immunoreactive Trypsinogen (IRT)
Sweat test - measures the amount of salt (sodium and chloride) in the baby’s sweat – an abnormally high level of chloride can indicate CF
Blood test – To identify their CF gene mutations |
| what are the specific nutritional needs for someone with CF? | Salt
Fat-soluble vitamins (A, D, E, K)
Calcium
Calories |
| when would enteral tube feeding be considered in people with CF? | Individual has poor appetite
Nausea or vomiting causing decreased calorie intake
Difficulty gaining weight |
| Treatments aimed at relieving symptoms, reducing complications and improving quality of life. What are some possible treatments? | Mucous thinning drugs (hypertonic saline)
Bronchodilators (to relax smooth muscles in airways)
Antibiotics to treat and prevent infections
Stool softeners |
| what are some nursing considerations when caring for someone with CF? | Patient and family education
Respiratory support
Administering medications
Assisting to meet nutritional needs
Provide psychosocial support
Isolating CF patients from other CF patients or patients with infective respiratory conditions |
| IvACAFTOR is a new medication to treat the underlining cause of CF, how does this work? | improves the function of the defective transmembrane conductance regulator (CFTR) protein which improves regulation of salt and water absorption and secretion |
| how does CF affect the cystic fibrosis transmembrane conductance regulator (CFTR) protein? | affects chloride and sodium ions, mainly chloride channels on cell membranes. This prevents chloride and sodium movement into and out of cells which causes mucous to become dehydrated and thick |
| what is the meaning of sexuality? | sexuality describes the whole way a person goes about expressing themselves as a sexual being |
| what are the possible outcomes of porn use? | Promotes a sense of sexual entitlement amongst boys
objectification of women in porn.
increased risky & unprotected sexual practices, higher rates of sexual harassment & forced sex, willingness to engage in casual sex |
| pornography does not cause rape, rather it helps make rape inviting. true or false? | true |
| what are some sexual offences? | Sexual offences include sexual violation (vaginal, anal or oral penetration) and indecent assault |
| what is sexual violence? | unwanted acts of sexual contact or attempt to obtain a sexual act by violence or coercion |
| what is the ALLOW method health professionals can use if they believe someone has experienced sexual violence or has questions about sexual health? | ASK - permission to ask - be direct
LEGITAMIZING - normalizing, generalizing, use statistics, provide information
LIMITATIONS - role and what is possible, brief intervention, sexual history and refer on
OPEN CONVERSATIONS - letting ppl know its okay to talk about this
WORK TOGETHER & FOLLOW UP |
| the Sexual Assault Assessment and Treatment Service Provides forensic and medical care to survivors of sexual abuse and assault. what is the services three roles? | Clinical role – to look after the well-being of the patient
Forensic role – to collect evidence and document injuries
Legal role – to be an expert witness in the medicolegal process |
| what is child sexual abuse? | When another person uses a child for sexual gratification - can be exposure, showing pornography, touching, oral sex, sexual intercourse, or any other sexual act
Usually involves the use of threats, coercion, manipulation, bribery or force |
| what is child sexual exploitation? | children and young people receive something (such as food, accommodation, drugs, alcohol, cigarettes, affection, gifts, or money) as a result of performing, and/or others performing on them, sexual activities. |
| if a person discloses they have experienced sexual abuse, what are the 5 principals to follow? | Let them know you believe them.
• Let them know you’re glad they told you.
• Let them know you’re sorry it happened.
• Let them know it’s not their fault.
•Let them know you’ll help/get help |
| Any person who believes that any child or young person has been, or is likely to be, harmed (whether physically, emotionally or sexually) ill-treated, abused, neglected, or deprived may report the matter to a Social Worker or a member of the Police. true or false? | true |
| what should nurses do if they are concerned a child has experienced acute sexual abuse? | ASSESS RISK – immediate protection
DOCUMENT, DOCUMENT, DOCUMENT
CONSULT, CONSULT, CONSULT other staff
referral to oranga tamarki and or police should be made asap |
| what is a risk? | uncertain event or condition that, if it does occur, can present a positive or a negative effect |
| The most commonly identified areas of risk are? | risk to self through
Suicide, self-harm or neglect,
risk of violence to others
and risk of victimisation. |
| what are static risk factors for suicide? | do not change. They include developmental factors such as genetic make up, personality type (internal) and the person’s past environment such as childhood trauma (external) = propensity for long term risk |
| what are dynamic risk factors for suicide? | A change in mental state (internal) and current situational environment (external) = fluctuating nature of risk |
| what are the three major components of risk ? | 1) Likelihood : the probability and the possibility
2) Outcome: it needs to be adverse
3) Time: How close is the event to happening |
| face to face interview is an important assessment to help prevent suicide. what are the highest risk factors identified during the clinical assessment? | - Suicide intent (purpose of killing self)
- And the degree of planning involved
- And the availability and ease of access to the means |
| what risk factors may contribute to the risk of suicidal behavior? | History of trauma
Isolation/lack of social support
History of alcohol and substance abuse |
| what are some protective factors that may reduce the risk of suicide? | Family and community connectedness
Support from ongoing medical and mental health care relationships
access to services - cost, accessible etc
promoting awareness of mental health |
| what is the SADPERSONS scale? | factors to determine risk of suicide - helps with assessment |
| what are some warning signs for someone who may want to die by suicide? | Direct or indirect threats kill/hurt self
Questions about death and dying
Obsessing about death
Talking or writing about death and dying
saying goodbye |
| How we determine the probability and determination level of risk of someone who wants to die by suicide? SLAP acronym | Specific: Ask if they have specific thoughts of suicide/ killing themselves?
Lethality: Ask about the plan (lethality)? – specifics of the plan
Availability: Ask about the means for suicide? (remove the means if possible) – resources for dying by suicide
Proximity - Ask about the timeframe and availability of help (are there others around to interfere with the plan?)
Immediate risk judgement identified or described, i.e. Mild-low, moderate, severe, extreme |
| what is sensory modulation? | a clinical intervention that utilises environment, equipment, and activities to regulate a persons sensory experience and optimise well-being |
| what are the therapeutic effects of sensory modulation? | creates a sense of safety, a sense of control and positive associations. It is ‘grounding’, soothing, and aids in distraction from distressing thoughts or emotions |
| what is sensory integration? | the neurological process that allows us to take information we receive from our 5 senses, organize it and respond appropriately |
| what are the 5 external senses of sensory modulation? | taste
touch
see
feel
hear |
| The optimal level is the calm and alert state. This allows us to adapt to the changing demands of the environment but in a calm manner. true or false? | true |
| what are the 3 internal sensory systems? | Proprioception - bodys ability to sense its location, movement and action (joint and muscle sense – includes deep pressure) – weighted blanket
Vestibular (gliding motion_ - swiss ball, rocking chair
interoception - within body organs |
| what is sensory profile? | To understand the sensory processing of an individual -so we can suggest appropriate interventions |
| Nurses are required to do a comprehensive nursing assessment prior to using sensory modulation. what factors should be considered? | allergies
Diagnostic considerations - Respiratory and cardiac precautions
Medication changes or side effects
Environmental (e.g. lighting, background noise) -Seizure history.
Trauma history(avoid re-traumatization) |
| In addition to these assessments nurses should talk to pts about triggers, EWS, and strategies. what are these? | Triggers - what sort of situations or environments stress you out, make you feel overwhelmed or upset?
Early warning signs - what would we see if you were starting to feel overwhelmed or upset?
Strategies - what are some things that help you cope with stress? |
| what are some indications for catheterization? | To accurately measure urine output in acutely ill patients/stroke
To ensure complete bladder emptying prior to surgery or an investigative procedure
To relieve acute and chronic urinary retention
bladder weakness or nerve damage
defects affecting the urinary tract |
| Indwelling catheterisation should be viewed as a last resort for continence management and should only be used when other management strategies are inappropriate or have failed. true or false? | true |
| what are some risks for catherterization? | Urinary tract infection (UTI)
Injury to the urethra caused by inserting the catheter
Narrowing of the urethra because of scar tissue caused by repeated use |
| how to catheters cause UTI's? (CAUTI) | promote organisms into the bladder and promote colonisation by providing a surface for bacterial adhesion |
| how do CAUTI's impact a person? | patient discomfort, and a perception of poor quality of care,
unnecessary anti-microbial use,
an unnecessary increase in hospital length of stay |
| what are some ways to prevent a CAUTI? | Minimise catheter use and remove when no longer needed – long time insitu = risk
Infection control - hand washing
Aseptic technique |
| what are some nursing interventions for catheter care? | secure to patients thigh - decreases the risk of bleeding, trauma, meatal necrosis, and bladder spasms from pressure and traction/dragging
Bags must be kept below the level of the bladder. Gravity is important for drainage and the prevention of urine backflow
Adequate hydration intake daily helps to decrease the encrustations of the catheters, stone development, and catheter-associated UTIs
The bag should be emptied when 1/2 - 2/3 full or every 3 - 6 hours - prevents bag getting too full and causing trauma/falling out |
| how does surgery cause urinary retention? | disrupt the neural circuitry that controls the nerves and muscles in the urination process |
| what are some functions of the liver? | metabolism, detoxification, protein synthesis, and the production of bile, which is necessary for digestion |
| what is Non alcoholic fatty liver disease (NAFLD? | is the accumulation of abnormal amounts of fat in the liver -
high association with obesity, diabetes, metabolic syndrome, hyperlipidaemia - triglycerides, hypertension |
| what is steatosis? | Fatty liver |
| what is Non alcoholic steatohepatitis (NASH)? | aggressive form of fatty liver disease, which is marked by liver inflammation and may progress to advanced scarring (cirrhosis) and liver failure |
| what is Alcoholic fatty liver? | earliest stage of alcohol-related liver disease |
| Alcohol, NAFLD and hepatitis B and C are the most common causes of cirrhosis. true or false? | true |
| how does liver disease contribute to cirrhosis? | hepatocytes undergo repeated cycles of inflammatory process and regeneration, the process causes cell necrosis which contribute to pathogenesis of fibrosis (scarring) and eventually cirrhosis |
| what is compensated vs decompensated cirrhosis? | Compensated: When you don't have any symptoms of the disease, you're considered to have compensated cirrhosis. Decompensated: When your cirrhosis has progressed to the point that the liver is having trouble functioning and you start having symptoms of the disease |
| Most liver damage is caused by hepatitis viruses - B and C. true or false? | true |
| what are some other causes of hepatitis that are NON infectious? | alcohol
infections
drugs (paracetamol)
obesity |
| what is hepatitis A? | An acute infection of the liver that is transmitted by ingestion of infected food and water - Very contagious oral/faecal route (contaminated food or water) |
| what is hepatitis B? | acute or chronic infection caused by sexual contact, shared needles, or contaminated blood products, mother to baby during birth process. CAN CAUSE ACUTE LIVER FAILURE |
| what is hepatitis C? | acute or mostly chronic infection - Major cause of transfusion hepatitis
. causes mainly through blood |
| what is hepatitis D? | only replicates with hep B - not curable |
| what can cause liver cirhossis? | Obesity - Non alcoholic fatty liver disease NAFLD/Non alcoholic steatohepatitis (NASH)
Hepatitis B or C virus infection
Inflammation of the liver that is long-term (chronic)
alcohol |
| Liver cancer (Hepatocellular Carcinoma) is the fifth most common cancer in the world. Cirrhosis of the liver is a predisposing factor. true or false? | true |
| What are some common signs and symptoms of hepatocellular carcinoma? | Abdominal pain/tenderness (upper-right quadrant)
Nausea
Anorexia
Fatigue/malaise
Bruising (no apparent cause)
Ascites
Jaundice |
| what are hepatocellular carcinoma investigations? | Physical-enlarged tender liver
Blood Tests:
LFTs
Serum alpha fetoprotein
CRP
FBC/CBC
CT scan
Ultrasound
MRI
Liver biopsy |
| what are the treatments for liver cancer? | Surgery
Chemotherapy
Radiation
Ablation - destroys tumors without surgery
Liver transplant |
| how does liver dysfunction/cirrhosis contribute to portal hypertension? | vascular resistance and blood flow is impacted.
Cirrhosis/obstruction slows your blood flow and puts stress on the portal vein causing increased vascular resistance in the portal vein.
can cause collateral circulation (tiny blood vessels) to release pressure in portal vein |
| causes of portal hypertension can be pre, intra and post hepatic. true or false? | true |
| how does portal hypertension cause esophageal varices? | the increased pressure in the portal vein causes blood into smaller blood vessels within the lower part of the esophagus (gastro-oesophageal junction)- these thin walled veins may rupture/hemorrhage |
| what are esophageal varices? | abnormal enlarged veins within the lining of the esophagus |
| what are some other causes of esophageal varices? | Local changes in the distal oesophagus for example gastro-oesophageal reflux (GORD)
Bacterial infection
Cirrhosis |
| what is ascites? | Ascites is the accumulation of fluid in the peritoneal cavity
Ascites is associated with portal hypertension and low levels of albumin(liver synthesizes proteins) retain fluid and draw fluid in) fluid movement is impaired |
| what are some causes of ascites? | Liver disease/failure - hepatitis C or B infection, alcoholic cirrhosis
Cancer- colon, ovaries, uterus, pancreas, and liver
Portal vein thrombosis
Congestive heart failure
Acute/chronic pancreatitis |
| what are some symptoms of end stage liver disease? | abdo pain/bloating
short of breath - ascites may cause pleural effusion
fatigue-loss of energy
angioma - end stage liver disease
jaundice
bleeding or bruising (liver not making clotting factors)
hypotension - hypovolemia shock |
| what are some investigations of ascites? | Daily weight and girth measurement
CBC/FBC; Prothrombin time; Liver function tests; Albumin
CT and/or MRI of the abdomen |
| what is Paracentesis? | a procedure in which a needle or catheter is inserted into the peritoneal cavity to obtain ascitic fluid - used for diagnostic or therapeutic purpose |
| how is paracentesis used for diagnostics? | detect the presence of cancer cells, amount of albumen present |
| how is paracentesis used for therapeutic purposes? | to relieve the fluid and pressure and pain |
| what is cholecystitis? | inflammation of the gallbladder |
| what is the function of the gallbladder? | to store and concentrate bile from the liver |
| what are some symptoms of cholecystitis? | pain after eating - cos signals cause gallbladder to produce bile but ducts are blocked
referred pain to shoulder - same nerve supply
jaundice
pale stool - lack of bile into the intestine
fever |
| what are some risk factors for developing cholecystitis? | Overweight /obese - more cholesterol = gallstones
Female - three times more likely to get acute cholecystitis than men |
| what are some investigations of cholecystitis? | Physical examination
FBC/CBC , CRP/ ESR
US scan of abdomen |
| what are the treatment options for cholecystitis? | antibiotics, laparoscopic cholecystectomy or open cholecystectomy |
| acute cholecystitis is mainly causes by gallstones. true or false? | true |
| how do gallstone cause cholecystitis? | Develops when the cystic duct, gets blocked by a gallstone
Results in a build-up of bile inside the gallbladder
Pressure increase causes the gallbladder to become inflamed and swollen |
| what is acute pancreatitis? | inflammation of the pancreas that has a rapid onset |
| what are some causes of pancreatitis? | gallstone - main cause
alcohol use - stimulates release of cytokines = inflam response
medications
high lipid profile
hypercalcemia
cystic fibrosis
surgery |
| what are some symptoms of pancreatitis? | sudden severe pain in the upper abdomen extends to the back
pain after eating - stimulates pancreatic enzymes
fever
nausea/vomiting |
| how do gallstone cause pancreatitis? | a gallstone can block the common bile duct and pancreatic duct - inhibiting pancreatic enzymes to traveling to the small intestine -Auto digestion occurs due to activated pancreatic enzymes leading to pancreatic injury and back flow of bile into the pancreas |
| what are the diagnostics of pancreatitis? | Medical history - alcohol use?
Physical examination
Blood test - amylase or/and lipase (pancreatic enzymes) - elevated 3 times the normal level during acute pancreatitis
scans - (mrcp |
| what is the treatment of pancreatitis? | Uncomplicated cases require hospitalisation for 3 to 5 days for close monitoring, pain control, nill by mouth(during first 24-48 hours) and intravenous fluids |
| what is chronic pancreatitis? | when there is irreversible changes to the structure of the pancreas which decreases the function |
| blood has three major roles, what are they? | transportation,
regulation and
protection. |
| blood has two mayor components, what are they? | plasma and
blood cells |
| Plasma proteins include albumin, globulin and clotting factors (mostly fibrinogen). Most plasma proteins are produced by the liver. true or false? | true |
| what are the three types of blood cells in blood? | erythrocytes (RBCs) - primary function is oxygen transportation
leucocytes (WBCs) - involved in protecting the body from infection thrombocytes (platelets) - promote blood coagulation. |
| what is the primary function of thrombocytes (platelets) | initiate the clotting process by producing an initial platelet plug in the early phases of the process. |
| what four components contribute to hemostasis? | vascular response - smooth muscle in vascular wall constricts to reduce blood flow.
platelet plug formation - platelets stick to each other to form a temporary seal
the development of the fibrin clot - Thrombin converts fibrinogen into fibrin to form a stable fibrin mesh clot
lysis of the clot - Tissue plasminogen activator (tPA) converts plasminogen to plasmin, digesting the fibrin strands and dissolving the clot |
| what are the most common bleeding disorders? | Von Willebrand's disease, Hemophilia A and B |
| what bleeding disorders may develop as a result of other medical conditions? | Thrombocytopenia
Vitamin K deficiency
Disseminated intravascular coagulation (DIC) |
| what is von Willebrand's disease? | inherited bleeding disorder when there is a deficiency of von Willebrand factor that causes reduced platelet adhesion and
low levels of factor VIII (8) |
| what are hemophilia's? | A group of inherited clotting disorders, carried by genes present on the X chromosome (i.e. inheritance is sex-linked). Haemophilia can be divided into two categories: haemophilia A and B |
| what is hemophilia A? | factor 8 (VIII) is abnormal |
| what is hemophilia B? | (also known as Christmas disease) faults in factor IX results in deficiency of thromboplastin (clotting factor III |
| hemophilia ranges in severity from mild forms, where the defective factor has partial activity, to extreme forms, where bleeding can take days or weeks to control. true or false? | true |
| what are the symptoms of hemophilia? | Repeated episodes of severe and prolonged bleeding at any site, even in the absence of trauma.
Recurrent bleeding into joints is common - causing severe pain and permanent joint damage |
| how would you manage someone with hemophilia with active bleeding? | stop the bleeding asap - pressure
Administer the specific deficient coagulation factor
When joint bleeding (hemarthrosis) occurs, rest the injured joint totally until bleeding has stopped.
Monitor for signs of ongoing blood loss such as hypovolaemic shock |
| what is thrombocytopenia bleeding disorder? | abnormally low level of platelets - bellow (150 billion) platelets per litre of blood |
| what may cause thrombocytopenia? | bone marrow deficiencies - leukemia - tumors
Ionising radiation - damages the dividing bone marrow cells
medications that cause damage to the bone marrow |
| how does vitamin K deficiency cause problems with clotting? | Vitamin K is required by the liver for the synthesis of clotting factors II (2), VII (7), IX (9) and X (10)- therefore deficiency predisposes to abnormal clotting |
| why might vitamin K deffienceny cause bleeding in newborns? | Newborn babies, especially if premature, have limited stores of vitamin K and this can cause bleeding in the first few months of life |
| what might cause vitamin K deficiency in adults? | Vitamin K is fat soluble and bile are required in the colon for its absorption. Deficiency may occur in liver disease, prolonged obstruction of the biliary tract or any other disease where fat absorption is impaired |
| Disseminated intravascular coagulation (DIC), is a paradoxical condition characterized by both bleeding and thrombosis. What is the pathophysiology? | Micro-clots form within the capillaries and use up all the clotting factors in the circulating blood faster than the liver and bone marrow can replace them, which results in bleeding in other places |
| what are some causes of DIC? | severe infection (such as septicaemia)
severe trauma
acute pancreatitis (when digestive enzymes are released into the blood) |
| The key to reversing DIC is through addressing the causative factors.
what needs to be done In the short term? | maintain organ perfusion
restore blood components
drug therapy |
| what is the triad of death that makes DIC worse? | hypotension, hypoxia and acidosis |
| The risk for developing spontaneous thrombi is related to several factors, referred to as the Virchow triad. what are these factors? | injury to the blood vessel endothelium
abnormalities of blood flow, and
hypercoagulability of the blood. |
| what are some things that cause injury to the blood vessel endothelium? | Atherosclerosis (plaque deposits on arterial walls) - initiates platelet adhesion and aggregation
Exogenous chemical agents (e.g. toxins from cigarette smoke)
bacterial toxins |
| what are some things that can cause abnormalities to blood flow that may cause thrombus? turbulence in arteries. stasis in veins | turbulence - atrial fibrillation
surgery
heart failure
bed rest |
| how does turbulent blood flow cause thromi? | platelets and endothelial cells may be activated, leading to thrombosis |
| how does stasis blood flow cause thrombi? | platelets may remain in contact with the endothelium for prolonged times, clotting factors that would normally be diluted with fresh-flowing blood are not diluted and may become activated |
| hypercoagulability is defined as the tendency to have thrombosis as a result of certain inherited and or acquired abnormalities. true or false? | true |
| what may be the cause of inherited hypercoagulability? | defects in proteins/clotting factors involved in hemostasis |
| what may be the cause of acquired hypercoagulability? | variety of clinical disorders or conditions - cancer
smoking
hypertension
diabetes |
| A stationary clot attached to the vessel wall that may obstruct blood flow is called a ? | thrombus |
