Midterm Exam: NR574/ NR 574 (2023/2024 Latest Update) Acute Care Practicum Review | Week 1-4| Questions and Verified Answers| 100% Correct- Chamberlain

Midterm Exam: NR574/ NR 574 (2023/2024

Latest Update) Acute Care Practicum Review

| Week 1-4| Questions and Verified Answers|

100% Correct- Chamberlain

Q: What is a TIPS procedure?

Answer:

The TIPS procedure bypasses a portion of the hepatic circulation by shunting blood flow from

the portal vein to the hepatic vein

-This reduces portal pressure and minimizes back pressure on the splanchnic organs. This also

decreases the likelihood of bleeding from the esophageal varies and reduces the amount of

ascites

*Hemorrhage is a significant risk during TIPS

Q: What is the treatment of choice for both type 1 and type 2 HRS?

Answer:

Liver transplant.

Q: What medications are used to tx type 2 HRS?

Answer:

vasoconstrictors (terlipressin, midodrine in combination with octriotide, norepinephrine)

combined with albumin.

Q: Bridge to transplant in Hepatorenal syndrome

Answer:

The combination of oc- treotide, midodrine, and albumin (triple therapy) is used to treat

hepatorenal syn- drome (HRS) often as a bridge to liver transplantation (LT).

Q: Module ** Bridge to transplant**

Answer:

In clients who do not respond to medical therapy, are not candidates for TIPS but are candidates

for liver transplantation or recovery for their liver disease,

continuous renal replacement therapy can be utilized as a bridge to recovery or transplantation.

HRS clients typically do not tolerate hemodialysis well.

Q: Joaquin is a 22-year-old male who presents to the emergency department (ED) with a 1-

week history of headache, concentration difficulty, fatigue, nau- sea, and vague abdominal pain.

He became concerned this morning when

he noticed that the whites of his eyes appeared yellow. History is significant for epilepsy, which

he has had since childhood but is well-controlled with antiepileptic medication. There is no

known history of liver disease. Notable physical exam findings include scleral icterus,

generalized abdominal tender- ness, and new-onset ascites. Urine alcohol and drug screen were

negative. Labs reveal severe transaminitis, hyperbilirubinemia, hyperammonemia, and

coagulopathy. The most likely diagnosis is :

a. Cirrhosis

b. Acute liver failure c. Acute hepatitis A

d. Acute gastroenteritis

Answer:

Acute liver failure

Rationale: Acute liver failure is an abrupt onset of liver failure, characterized by hepatic

encephalopathy, jaundice, and coagulopathy in the absence of pre-existing liver disease which

has been present for less than 26 weeks. Joaquin's symptoms are classic for that of acute liver

failure with antiepileptic medication as his biggest risk factor. For causes other than

acetaminophen toxicity, the onset of symptoms may be gradual and non-specific such as fatigue,

malaise, and changes in behavior or concentration. Asymptomatic jaundice and new-onset ascites

may also be present. Cirrhosis is a chronic disorder and is considered an end-stage liver disease.

Q: Chadwick presents to the ED following a suicide attempt. He reports swallowing

approximately 10,000 milligrams (mg) of acetaminophen 4-hours ago. An hour ago, he began to

develop generalized abdominal pain, nausea, and vomiting at which time he asked his brother to

take him to the hospital. Shortly after arrival, he becomes confused and agitated. Labs reveal

INR of 3.0, acute kidney injury (AKI) with creatinine 2.0, severe transaminitis, and lactic

acidosis. Urine toxicology showed an acetaminophen level of 200 milligrams per kilogram.

Serum alcohol was negative. The AGACNP knows that the best initial treatment for Chadwick

is:

a. Administer fresh frozen plasma (FFP) to reverse the coagulopathy b. Consult nephrology to

begin hemodialysis

c. Administer N-acetylcysteine (Mucomyst)

d. Consult the liver transplant team

Answer:

Administer N-acetylcysteine (Mucomyst)

Rationale: All clients with ALF should receive N-acetylcysteine (NAC), regardless of its

etiology, upon admission as it has been shown to improve transplant-free recovery. In this case,

N-acetylcysteine is the treatment for acetaminophen toxicity. While the client has a

coagulopathy, there are no signs that Chadwick is actively bleeding. Consulting nephrology and

gastroenterology is important but adminis- tering Mucomyst is a higher priority. Consulting the

liver transplant team before administering or assessing response to treatment is inappropriate.

Continuous renal replacement therapy can be utilized as a bridge to recovery or transplantation.

HRS clients typically do not tolerate hemodialysis well.

Q: Rhabdomyolysis

Answer:

Rhabdomyolysis is a potentially life-threatening condition that occurs following skeletal muscle

injury.

-dissolution of striated muscle (caused by trauma, extreme exertion, or drug toxicity;

in severe cases renal failure can result)

Q: When the muscle injury occurs, what is released into the blood stream?-

Answer:

muscle fibers release large quantities of potassium, phosphate, creatinine kinase

(CK), and myoglobin, a small protein that binds oxygen, into the circulation.

-As an unbound protein, myoglobin is excreted by the kidneys but can precipitate and cause renal

tubular obstruction.

Q: What happens to myoglobin in Rhabdo?

Answer:

myoglobin is release from skeletal muscle during injury.

it binds to oxygen

in excessive amount, as see with rhabdo, it is unbound.

when unbound it has to be excreted through the kidneys which can cause renal tubular

obstruction.

Q: Risk factors of Rhabdomyolysis

Answer:

Trauma, muscle compression, or ischemia

Heat-related causes

Infection with bacteria or viruses that can directly attack the muscle

Metabolic factors

Genetic factors

Medications that may cause direct myotoxicity Toxins which may cause indirect myotoxicity

Exertional activity

Nutritional supplements which contain substances that may induce muscle injury

Q: Subjective findings of Rhabdo (patient)

Answer:

muscle pain, dark urine and muscle weakness.

Other symptoms commonly associated with rhabdomyolysis can be nonspecific such as fever,

nausea, and vomiting, which developed over hours to days

Q: Physical exam findings in Rhabdo

Answer:

muscle tenderness soft tissue swelling

bruising

skin changes consistent with pressure necrosis muscle weakness

confusion, delirium, agitation anuria