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Module 7 > Care of the Hepatic Failure Patient > Flashcards

Care of the Hepatic Failure Patient Flashcards

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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
what should be done post op of liver biopsy
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
26
what are signs of bleeding
bruising, nose bleeds, bleeding gums, decreased BP, decreased H and H, blood in urine, pale, increased HR
27
why do we put the pt who just has a liver biopsy on their right side
this is the side the liver is on and we want to put pressure on and stop bleeding
28
what can we give pt to avoid straining
fiber, fluids, stool softener
29
elevated biliruben =
jaundice
30
AST level should be no more than
40
31
ALT level should be no more than
60
32
elevated WBC=
inflammation or infection
33
what two labs hold hands, are best buds
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
34
normal biliruben level
<1
35
normal PT level
11-12.5 sec
36
normal INR level
0.8-1.1
37
an AST/ALT level above 10,000 most often is
acetaminophen OD
38
normal glucose level
76-106
39
how can the glucose be extremely low
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
normal WBC level
5,000-10,000
41
WBC _____ in acute liver injury and ______ in splenomegally
elevates; decreases
42
normal K level
3.5-5.0
43
normal Mg level
1.3-2.1
44
normal platelet level
150-400
45
normal ammonia level
10-80
46
normal lactic acid level
0.6-2.2
47
normla creatinine level
0.5-1.21
48
normal alkaline phosphatase level
30-120
49
normal Hgb level
12-18
50
normal Hct level
42-52% males and 37-47% in females
51
activated charcoal binds to
poisonous substance
52
antidote for acetaminophen
N-acetylcystine
53
what medication pulls fluid off the brain
mannitol | *an osmotic diuretic but be careful too much can lead to dehydration of brain
54
what drug should be given if pt is seizing, if your worried about encephalopathy
pentobarbital, thiopental | *barbiturate agents
55
what drug is given for anxiety, pt with swelling in brain are at risk for ICP
midazolam | *benzo
56
if pt is on ventilator they have to have an anesthetic agent which will most likely be
propofol
57
if a pt is bleeding a LOT what is given
transfusions of fresh frozen plasma and/or whole blood
58
what types of meds mask near changes the pt has and what should be done to avoid this
barbiturates, benzos, anesthetic agents | give sedation vacation to monitor near status
59
when the majority of hepatocytes are replaced with scar tissue... scar tissue results in impaired blood flow through the liver... irreversible as of today
cirrhosis
60
what are causes of cirrhosis
``` any chronic liver disease chronic alcoholism chronic viral hepatitis cardiac cirrhosis nonalcoholic fatty liver disease (NAFLD) that leads to nonalcoholic steatohepatitis (NASH) ```
61
cirrhosis is not a _____ but can cause you to have liver disease as a result
disease
62
what is the "early" sign of cirrhosis
fatigue
63
what are later signs of cirrhosis
``` jaundice with or with our pruritis peripheral edema ascites skin lesions- spider lesions on chest/neck hematologic disorders endocrine disturbances peripheral neuropathies ```
64
what causes peripheral edema in cirrhosis
no albumin telling fluid to stay in vascular system
65
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
malnourished; bellies (ascites)
66
what are major complications of cirrhosis
portal hypertension peripheral edema hepatic encephalopathy hepatorenal syndrome (decreased blood flow to kidneys)
67
portal vein is where the liver receives blood from the heart and these pts will be _______ but have _____ pressure at portal vein
hypotensive; high
68
portal hypertension causes
ballooning out of vessels called varices | *most common in the stomach and esophagus
69
once pt gets varicose they are at risk for
bleeding (they may pop)
70
what are dx studies of cirrhosis
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
what lab is for CHRONIC cirrhosis
alkaline phosphatase
72
in cirrhosis AST and ALT initially will be ______ but in end stage may be normal
elevated
73
what is the medical management for ascites
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
what is the medical management of varices
- 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
what is the medical management for nutritional needs of the cirrhosis pt
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
the removal of fluid from the abd cavity using a large bore needle
paracentesis
77
what should be done pre op of paracentesis
educate have pt void to avoid bladder injury measure abd girth, wt, and vitals (baseline) assist with positioning HOB at 30-45 degrees
78
what should be done post op of paracentesis
``` 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
what are S/S of hypovolemia
pale, nausea, decreased BP, increased HR, dizzy, same as hungover, decreased urine output, thirsty
80
alteration of brain function or structure or both caused by a build up of toxins in the body as a result of liver dysfunction
hepatic encephalopathy
81
what can cause hepatic encephalopathy
``` 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
which posturing is worst
decerebrate is worse | *if pt goes from decorticate to decerebrate it indicates brain stem herniation
83
what kind of painful stimulus should be done to get a response
core painful stimuli- sternal rub or orbital notch pressure every 2 hrs
84
what are Symptoms of hepatic encephalopathy
``` 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
what are severe complications of hepatic encephalopathy
brain swelling (increased ICP) organ failure brain herniation
86
why is it important for the hepatic encephalopathy pt to have atlas 2 bowel movements
important to get rid of the ammodium if not it will build up * DONT hold the lactulose, call doc first
87
how would you lower ammonia levels
lactulose and rifaximin therapy | *rifaximin is to decrease risk for infection (curb bacteria from the food they eat)

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