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Module 7 > Care of the Hepatic Failure Patient > Flashcards

Care of the Hepatic Failure Patient Flashcards

1
Q

how does the liver function

A

removes potentially toxic by products of certain medications
-prevents shortages of nutrients by storing vitamins, minerals and sugar
- metaabolizes or breaks down nutrients from food to produce energy, when needed
- produces most proteins needed by the body
helps your body fight infection by removing bacteria from the blood
- produces most of the substances that regulate blood clotting
-produces bile, a compound needed to digest fat and to absorb vitamins A, D, E, K

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2
Q

what could happen if the liver fails

A

build up of meds

  • uable to retain nutrients from food or breakdown ammonia
  • bacteria builds up in the blood
  • blood clotting goes haywire
  • bile cannot be regulated
  • no albumin production (protein)
  • shortage of vitamins, minerals and sugar
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3
Q

what is liver failure

A

inability of liver to function normally
starts out as inflammation of the liver cells
- can be acute or chronic

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4
Q

_______ inflammation eventually results in ______ _______ formation in the liver or _______

A

chronic; scar tissue; cirrhosis

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5
Q

liver cirrhosis is when the liver is made up of mostly

A

scar tissue

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6
Q

why will liver enzymes be elevated when drinking alcohol

A

because it gets rid of alcohol through the liver

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7
Q

complete liver failure =

A

death

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8
Q

if the liver fails, the body will

A

fail

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9
Q

if a person donates part of liver will it regenerate

A

yes

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10
Q

how much of the liver can an adult donate to another adult

A

part of liver

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11
Q

how much of the liver can an adult donate to a child

A

1/3 and it will grow with the child

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12
Q

how long does it take for the liver to regrow

A

6 weeks

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13
Q

for a pt who has a liver transplant how long is recovery

A

6 mos

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14
Q

what must match in order to donate a liver

A

blood type and body size

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15
Q

rapid deterioration of liver function

-appears in as little as 48hrs

A

acute liver failure

  • seen in previously healthy individual with NO prior S/S
  • *medical emergency
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16
Q

what are causes of acute liver failure

A
  • exposure to viruses Hep A, B, and C
  • drug use (acetaminophen and tuberculosis meds)
  • genetic disease
  • ingestion of poisonous substances
  • pregnancy
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17
Q

what are S/S of acute liver failure

A

encephalopathy
coagulation abnormalities
jaundice
*comes in being very vague (talking funny, not feeling great, foggy)

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18
Q

what is encephalopathy

A

confusion, family says they haven’t been themselves, forgetful

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19
Q

what is coag abnormalities

A

increased clotting time, abnormal bruising, frank blood, nose bleed, labs

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20
Q

what is an early sign of jaundice

A

yellow sclera

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21
Q

what are complications of acute liver failure

A 
cerebral edema
renal failure
hypoglycemia
metabolic acidosis
sepsis
multiorgan failure
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22
Q

what medical management is done to dx and correct the cause of liver failure

A
  • H and P
  • lab work (acetaminophen level, drug studies, viral hep serologies)
  • CT scan (enlarged liver)
  • MRI
  • ultrasound (enlarged liver)
  • liver biopsy
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23
Q

large bore needle inserted into liver through abd wall to remove sample of tissue for testing

A

liver biopsy

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24
Q

what should be done pre op of liver biopsy

A

assess coagulation tests (PT, PTT, platelets)
educate pt and obtain consent
assess vitals

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25
Q

what should be done post op of liver biopsy

A

assess vitals
monitor for bleeding and peritonitis
bedrest- risk for bleeding (6 or +hrs)
place client on right side with pillow under costal margin
avoid coughing or straining for 24hrs
avoid heavy lifting or exercise for one week

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26
Q

what are signs of bleeding

A

bruising, nose bleeds, bleeding gums, decreased BP, decreased H and H, blood in urine, pale, increased HR

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27
Q

why do we put the pt who just has a liver biopsy on their right side

A

this is the side the liver is on and we want to put pressure on and stop bleeding

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28
Q

what can we give pt to avoid straining

A

fiber, fluids, stool softener

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29
Q

elevated biliruben =

A

jaundice

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30
Q

AST level should be no more than

A

40

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31
Q

ALT level should be no more than

A

60

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32
Q

elevated WBC=

A

inflammation or infection

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33
Q

what two labs hold hands, are best buds

A

K and Mg

*low potassium and can’t get potassium up then know what Mg level is, if low then Mg should be given too

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34
Q

normal biliruben level

A

<1

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35
Q

normal PT level

A

11-12.5 sec

36
Q

normal INR level

A

0.8-1.1

37
Q

an AST/ALT level above 10,000 most often is

A

acetaminophen OD

38
Q

normal glucose level

A

76-106

39
Q

how can the glucose be extremely low

A

impairment in glycogen release, if liver is in failure it does not release glucose but the pancreas cont to secrete insulin, therefore blood glucose levels decreases

40
Q

normal WBC level

A

5,000-10,000

41
Q

WBC _____ in acute liver injury and ______ in splenomegally

A

elevates; decreases

42
Q

normal K level

A

3.5-5.0

43
Q

normal Mg level

A

1.3-2.1

44
Q

normal platelet level

A

150-400

45
Q

normal ammonia level

A

10-80

46
Q

normal lactic acid level

A

0.6-2.2

47
Q

normla creatinine level

A

0.5-1.21

48
Q

normal alkaline phosphatase level

A

30-120

49
Q

normal Hgb level

A

12-18

50
Q

normal Hct level

A

42-52% males and 37-47% in females

51
Q

activated charcoal binds to

A

poisonous substance

52
Q

antidote for acetaminophen

A

N-acetylcystine

53
Q

what medication pulls fluid off the brain

A

mannitol

*an osmotic diuretic but be careful too much can lead to dehydration of brain

54
Q

what drug should be given if pt is seizing, if your worried about encephalopathy

A

pentobarbital, thiopental

*barbiturate agents

55
Q

what drug is given for anxiety, pt with swelling in brain are at risk for ICP

A

midazolam

*benzo

56
Q

if pt is on ventilator they have to have an anesthetic agent which will most likely be

A

propofol

57
Q

if a pt is bleeding a LOT what is given

A

transfusions of fresh frozen plasma and/or whole blood

58
Q

what types of meds mask near changes the pt has and what should be done to avoid this

A

barbiturates, benzos, anesthetic agents

give sedation vacation to monitor near status

59
Q

when the majority of hepatocytes are replaced with scar tissue… scar tissue results in impaired blood flow through the liver… irreversible as of today

A

cirrhosis

60
Q

what are causes of cirrhosis

A 
any chronic liver disease
chronic alcoholism
chronic viral hepatitis
cardiac cirrhosis
nonalcoholic fatty liver disease (NAFLD) that leads to nonalcoholic steatohepatitis (NASH)
61
Q

cirrhosis is not a _____ but can cause you to have liver disease as a result

A

disease

62
Q

what is the “early” sign of cirrhosis

A

fatigue

63
Q

what are later signs of cirrhosis

A 
jaundice with or with our pruritis
peripheral edema
ascites
skin lesions- spider lesions on chest/neck
hematologic disorders
endocrine disturbances
peripheral neuropathies
64
Q

what causes peripheral edema in cirrhosis

A

no albumin telling fluid to stay in vascular system

65
Q

a cirrhosis pt will be _______, will have no muscle but big ______ full of fluid. these pt will sit at 90 degrees to breath, in pain, and uncomfortable

A

malnourished; bellies (ascites)

66
Q

what are major complications of cirrhosis

A

portal hypertension
peripheral edema
hepatic encephalopathy
hepatorenal syndrome (decreased blood flow to kidneys)

67
Q

portal vein is where the liver receives blood from the heart and these pts will be _______ but have _____ pressure at portal vein

A

hypotensive; high

68
Q

portal hypertension causes

A

ballooning out of vessels called varices

*most common in the stomach and esophagus

69
Q

once pt gets varicose they are at risk for

A

bleeding (they may pop)

70
Q

what are dx studies of cirrhosis

A

ultrasound- assess severity of cirrhosis
upper endoscopy (EDG)- to find varicies
radioisotope liver scan- show layout of liver, is blood getting through the liver

71
Q

what lab is for CHRONIC cirrhosis

A

alkaline phosphatase

72
Q

in cirrhosis AST and ALT initially will be ______ but in end stage may be normal

A

elevated

73
Q

what is the medical management for ascites

A

albumin infusion and diuretic therapy
fluid removal (paracentesis)
*normally we would just pull off fluid with lassie bit with these pts it will dehydrate them so give albumin and diuretic
*albumin should be given 30 min before lassie in order to work

74
Q

what is the medical management of varices

A
  • can’t just leave them because they are at risk for rupture so give BB, BB decrease pressure (these pts already have low BP but is is very important they have it ) so keep pressure up with fluids, FFP, more albumin
  • banding will keep blood from flowing into varicies
  • scleroptherapy is when they freeze them
  • balloon tamponade is ONLY done if bleeding can not stop and can’t clot (puts pressure on varices
75
Q

what is the medical management for nutritional needs of the cirrhosis pt

A

TPN, Tube feeding
high carb, high cal, moderate fat, don’t restrict protein
*but if pt has craving for whatever it is get it for them they just need something (usually have NO appetite)

76
Q

the removal of fluid from the abd cavity using a large bore needle

A

paracentesis

77
Q

what should be done pre op of paracentesis

A

educate
have pt void to avoid bladder injury
measure abd girth, wt, and vitals (baseline)
assist with positioning HOB at 30-45 degrees

78
Q

what should be done post op of paracentesis

A 
vitals
monitor for bleeding
measure abd girth and wt
monitor for hematuria and instruct pt to do the same (injury to bladder)
watch for hypovolemia
watch for infection and peritonitis
79
Q

what are S/S of hypovolemia

A

pale, nausea, decreased BP, increased HR, dizzy, same as hungover, decreased urine output, thirsty

80
Q

alteration of brain function or structure or both caused by a build up of toxins in the body as a result of liver dysfunction

A

hepatic encephalopathy

81
Q

what can cause hepatic encephalopathy

A 
GI bleeding
infection
hypokalemia and or met alkalosis
renal failure
hypovolemia 
hypoxia
sedative tranquilizer use
hypoglycemia
constipation
hepatocellular carcinoma and or vascular occlusion (rare)
82
Q

which posturing is worst

A

decerebrate is worse

*if pt goes from decorticate to decerebrate it indicates brain stem herniation

83
Q

what kind of painful stimulus should be done to get a response

A

core painful stimuli- sternal rub or orbital notch pressure every 2 hrs

84
Q

what are Symptoms of hepatic encephalopathy

A 
confusion
lethargy that may progress to coma
inappropriate behavior or personality changes
asterixis (flapping tremor when hands or feet are extended)
problems with fine motor activities
sweet breath or musty odor
seizures
hyperventilation
suppressed gag reflex
85
Q

what are severe complications of hepatic encephalopathy

A

brain swelling (increased ICP)
organ failure
brain herniation

86
Q

why is it important for the hepatic encephalopathy pt to have atlas 2 bowel movements

A

important to get rid of the ammodium if not it will build up
* DONT hold the lactulose, call doc first

87
Q

how would you lower ammonia levels

A

lactulose and rifaximin therapy

*rifaximin is to decrease risk for infection (curb bacteria from the food they eat)

Module 7 (8 decks)

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