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Med Surg 1 > care of pt. with liver problems > Flashcards

care of pt. with liver problems Flashcards

1
Q

cirrhosis

A
  • Characterized by widespread fibrotic (scarred) bands of connective tissue
  • Tissue become nodular
  • Nodules block blood and lymph flow
  • Liver shrinks in size and hardens
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2
Q

types of cirrhosis

A
  • post-necrotic
  • laennec’s (alcoholic)
  • billiary
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3
Q

complication of cirrhosis

A
  • portal hypertension
  • ascites
  • esophageal varices
  • billiary obstruction
  • hepatic enecphalpathy
  • hepatic encephalopathy
  • hepaorenal syndrome
  • spontaneous bacterial peritonitis
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4
Q

portal hypertension

A

a persistent INCREASE in pressure within the portal vein greater than 5 mm hg

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5
Q

ascites

A

collection of FREE FLUID within the peritoneal cavity caused by increased hydrostatic pressure from portal hypertension

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6
Q

esophageal varices

A

occur when fragile, thin-walled esophageal veins become distended and tortuous from increased pressure
- severe bleeding= medical emergency

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7
Q

billiary obstruction

A

When the bile duct becomes blocked

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8
Q

hepatic encephalopathy

A

complex cognitive syndrome that results from liver failure and cirrhosis

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9
Q

ciirhosis history

A
  • Age, gender, employment history (especially of exposure)
  • **Needlestick injury
  • Sexual, family, social histories
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10
Q

cirrhosis physical assessment & s/s

A
  • Fatigue, weight change, GI symptoms
  • abdominal pain
    Abdominal assessment
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11
Q

physiological effects of cirrhosis

A
  • ascites, splenomegaly, testicular atrophy, and leukopenia
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12
Q

cirrhosis lab assessment

A
  • **AST, ALT, LDH: elevated–> shows hepatic inflammation
  • Alkaline
  • phosphatase
    GGT
    **Serum bilirubin: elevated
    **Serum albumin: low
    **PT/INR
    CBC
    **    Ammonia level: advanced chirrosis
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13
Q

imaging assessment cirrhosis

A
  • xrays
  • ct
  • mri
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14
Q

cirrhosis anaylyze and prioritize hypotheses

A
  • 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
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15
Q

managing fluid volume cirrhosis

A

Treat ascites, consider nutrition therapy (decrease sa), drug therapy, paracentesis, and respiratory support (02)

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16
Q

preventing hemmorrhage cirrhosis

A
  • 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
17
Q

preventing or managing confusion in cirrhosis

A

 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

18
Q

managing pruritus IN CIRRHOSIS

A

Avoid being too warm, moisture skin, avoid irritants to skin, cool compress and/or corticosteroid creams

19
Q

cirrhosis evaluating outcomes

A
  • 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)
20
Q

hepatitis

A 
viral 
HAV
HBV
HCV
HDV
HEV
21
Q

HAV

A
  • shellfish

- contaminated water

22
Q

HBV

A
  • sex
  • sharing needs
  • razors
  • needsticks
  • blood transfuion
  • hemodilaysis
  • blood
  • birth
23
Q

HCV

A
  • needle
  • blood
  • hemodilaysis
  • prisoners
  • drugs
24
Q

HDV

A
  • rna virus

- iv drugs

25
Q

hev

A

waterborn infection

26
Q

which hepatitis have the vaccines

A

hav

hbv

27
Q

HAV specifc recommendation

A
  • proper hand-washing

- avoid contaminated food or water

28
Q

heptatitis history s/s

A

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
29
Q

hepatits labs

A

Laboratory assessment

  • Liver enzymes
  • Blood tests specific to hepatitis type

Other diagnostic assessment

  • Liver biopsy
  • Ultrasound
30
Q

hepatitis analysis cues

A
  • Weight loss due to complications associated with inflammation of the liver
  • Fatigue due to decreased metabolic energy production
31
Q

hepatitis promoting nutriton

A
  • 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
32
Q

hepatitis managing fatigue

A
  • 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
33
Q

hepatitis evaluating outcomes

A
  • Maintain nutritional status adequate for body requirements.
  • Report increasing energy levels as the liver rests.
  • Important to prevent the spread of infection
34
Q

liver transplantation

A
  • 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)
35
Q

interventions after transplant

A

Psychosocial impact
Side effects of immunosuppressive drugs
Long-term management

Med Surg 1 (25 decks)

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