AC3 EXAM 4 SG55 - exam 4 study guide with tegrity notes PDF

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exam 4 study guide with tegrity notes...

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o Goal of management is the reduction of ammonia formation (HOW?) o Lactulose or erythromycin enema to pull out protein o S/S 

Asterixis – flapping tremor of the hands

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Take sample of handwriting – signature or draw a star

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DTR hyperactive in early stages and disappear as condition worsens; coma, muscle rigidity, seizures, & death = stage IV

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Fector hepaticus – musty odor in breath due to high ammonia levels

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Breath smells like old wine/acetone

o Management 

Lactulose (cephulac) given to reduce serum ammonia levels, causes mucoid diarrhea; goal is 2-3 stools a day

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Lactulose or neomycin enemas

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Pruritis and other skin changes o Severe itching due to retention of bile o INTERVENTIONS: 

Cool tepid baths

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Moisturize skin

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Scratch w/ knuckles instead of nails

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Avoid antihistamines and sedatives 

WHY? o Processed by the liver; give very cautiously...