care of pt. with liver problems Flashcards
cirrhosis
- Characterized by widespread fibrotic (scarred) bands of connective tissue
- Tissue become nodular
- Nodules block blood and lymph flow
- Liver shrinks in size and hardens
types of cirrhosis
- post-necrotic
- laennec’s (alcoholic)
- billiary
complication of cirrhosis
- portal hypertension
- ascites
- esophageal varices
- billiary obstruction
- hepatic enecphalpathy
- hepatic encephalopathy
- hepaorenal syndrome
- spontaneous bacterial peritonitis
portal hypertension
a persistent INCREASE in pressure within the portal vein greater than 5 mm hg
ascites
collection of FREE FLUID within the peritoneal cavity caused by increased hydrostatic pressure from portal hypertension
esophageal varices
occur when fragile, thin-walled esophageal veins become distended and tortuous from increased pressure
- severe bleeding= medical emergency
billiary obstruction
When the bile duct becomes blocked
hepatic encephalopathy
complex cognitive syndrome that results from liver failure and cirrhosis
ciirhosis history
- Age, gender, employment history (especially of exposure)
- **Needlestick injury
- Sexual, family, social histories
cirrhosis physical assessment & s/s
- Fatigue, weight change, GI symptoms
- abdominal pain
Abdominal assessment
physiological effects of cirrhosis
- ascites, splenomegaly, testicular atrophy, and leukopenia
cirrhosis lab assessment
- **AST, ALT, LDH: elevated–> shows hepatic inflammation
- Alkaline
- phosphatase
GGT
**Serum bilirubin: elevated
**Serum albumin: low
**PT/INR
CBC
**Ammonia level: advanced chirrosis
imaging assessment cirrhosis
- xrays
- ct
- mri
cirrhosis anaylyze and prioritize hypotheses
- Fluid overload due to third spacing of abdominal and peripheral fluid
- Potential for hemorrhage due to portal hypertension
- Acute confusion and other cognitive changes due to increased serum ammonia levels and/or alcohol withdrawal
- Pruritis due to increased serum bilirubin and jaundice
managing fluid volume cirrhosis
Treat ascites, consider nutrition therapy (decrease sa), drug therapy, paracentesis, and respiratory support (02)
preventing hemmorrhage cirrhosis
- Monitor for esophageal varices by endoscopy
- because massive esophageal bleeding can cause rapid blood loss, emergency interventions are needed
- Prevent bleeding and infection, non-selective beta blocking agent to prevent bleeding, antibiotics used to prevent infection
- Endoscopic therapies include ligation of the bleeding veins or endoscopic sclerotherapy
- Transjugular intrahepatic portal-systemic shunt (TIPS)- procedure used for patient who have not responded to other modalities for hemorrhage or long-term ascites
- NGT, Packed RBCS, fresh frozen plasma, Dextran, albumin, and platelets may be needed
- Monitor vs every hour, PT, PTT, and INR
preventing or managing confusion in cirrhosis
Slow or stop increase of ammonia in the blood, assess and monitor neuro status, nutrition counseling and protein in diet, lactulose used to excrete ammonia in stool, nonabsorbable antibiotics if lactulose does not help
managing pruritus IN CIRRHOSIS
Avoid being too warm, moisture skin, avoid irritants to skin, cool compress and/or corticosteroid creams
cirrhosis evaluating outcomes
- Have a decrease in or have no ascites
- Have electrolytes within normal limits
- Not have hemorrhage or will be managed immediately if bleeding occurs
- Not develop encephalopathy or will be managed immediately if it occurs
- Successfully abstain from alcohol or drugs (if disease is caused by one or more of these substances)
hepatitis
viral HAV HBV HCV HDV HEV
HAV
- shellfish
- contaminated water
HBV
- sex
- sharing needs
- razors
- needsticks
- blood transfuion
- hemodilaysis
- blood
- birth
HCV
- needle
- blood
- hemodilaysis
- prisoners
- drugs
HDV
- rna virus
- iv drugs
hev
waterborn infection
which hepatitis have the vaccines
hav
hbv
HAV specifc recommendation
- proper hand-washing
- avoid contaminated food or water
heptatitis history s/s
History
- May not have symptoms, yet lab tests are abnormal
Physical assessment/signs and symptoms
- May have abdominal pain, icterus, jaundice
Psychosocial assessment
* patient feels sick and fatigued, may feel depressed * Social stigma
hepatits labs
Laboratory assessment
- Liver enzymes
- Blood tests specific to hepatitis type
Other diagnostic assessment
- Liver biopsy
- Ultrasound
hepatitis analysis cues
- Weight loss due to complications associated with inflammation of the liver
- Fatigue due to decreased metabolic energy production
hepatitis promoting nutriton
- May refuse food due to malaise, anorexia, abdominal discomfort, or nausea
- Diet HIGH in carbs and calories with moderate amounts of **fat and protein added after nausea and anorexia subside
- SMALL, frequent meals preferred
- Ask patient about FAV meals; high-calorie snacks may be needed; supplemental vitamins often prescribed
hepatitis managing fatigue
- Drugs used sparingly to allow the liver to rest
- Antiemetic for nausea
- Due to life-threatening nature of hep b and hep c, several drugs given including antiviral and immunomodulating drugs
- Complementary and integrative therapies used to promote well being and improve quality of life such as herbs and vitamin supplements, green tea, and vitamin e
hepatitis evaluating outcomes
- Maintain nutritional status adequate for body requirements.
- Report increasing energy levels as the liver rests.
- Important to prevent the spread of infection
liver transplantation
- For patients with ESRD or acute liver failure
- Transplantation considerations
Is the patient a good candidate for liver transplant? - Transplantation complications
- Transplant rejection (treated with immunosuppressive drugs); infection (treated with organism-specific anti-infective agents)
interventions after transplant
Psychosocial impact
Side effects of immunosuppressive drugs
Long-term management
