Cirrhosis Flashcards
- Extensive scarring of the liver caused by necrotic injury or a chronic reaction to inflammation over prolonged period of time
- Repeated destruction of hepatic cells causes the formation of scar tissue.
Cirrhosis
All of the following are s/s of what?
- SHOb
- Jaundice
- Increased Abd girth /pain and bloating
- Enlarged spleen (splenomegaly)
- Elevated liver enzymes
- Increases risk of bleeding
- Thrombocytopenia
- Prolonged PT →↓ PIt’S.
- Hemorrhoids
- Elevated serum ammonia levels
- Change in LOC
- Changes in motor function
- Hyponatremia
- ASTERIXIS
- Infection d/t ↓ WBC’s
- Chronic dyspepsia ( GI upset)
Cirrhosis
Risk factors for cirrhosis
- Alcohol use disorder
- Chronic viral hepatitis (A,B, C)
- Autoimmune disease
- Steatohepatisis
- Damage to liver by meds, substance toxins, infections (hepatoxins)
- Chronic biliary cirrhosis
- Fatty liver
fatty liver disease causing chronic inflammation
Steatohepatitis
bile duct obstruction, bile stasis, hepatic fibrosis
Chronic bilary cirrhosis
Medications used to treat cirrhosis
- Diuretics
- Beta-blocking agents
- lactulose
- Electrolyte replacements
- Neomycin
- Ferrous sulfate and folic acid
- Vitamin K
- Blood products
- FFP
Medication used to decrease excess fluid in cirrhosis patients
diuretics
This medication is used in cirrhosis patients to manage systemic hypertension
Beta blocking agents
Medication used in cirrhosis patients to promote excretion of ammonia through stool
lactulose
flapping tremor of the hand when wrist extended
Asterixis
This medication is used in cirrhosis patients to destroy the bacteria that produces ammonia
neomycin
Why might a cirrhosis patient need potassium replacement
Potassium levels may be low associated with vomiting, diarrhea secondary to treatment for elevated ammonia levels, the use of diuretics, or low dietary intake of potassium-rich foods.
Why might a cirrhosis patient have hypomagnesmia
patients with a history of alcohol abuse is a result of poor nutrition and diarrhea.
Why might a patient with cirrhosis have hypophosphatemia
low phosphate levels, due to alcohol abuse, poor nutrition, use of diuretics
Liver disorders can affect ______ causing cirrhosis patients to need vitamin K or blood products
Clotting factors
Dietary teaching for cirrhosis patients
- Restrict sodium – less than 2grams per day
- Restrict fluid intake as ordered — Prevents fluid accumulation and edema
- Restrict protein intake — Elevated amounts of protein in the diet can raise ammonia levels and lead to hepatic encephalopathy.
- Instructed to eat small, frequent meals
A treatment for cirrhosis that removes several liters of fluid to relieve client’s clinical manifestations of abdominal bloating/pain and SHOB
Paracentesis
A treatment for cirrhosis that involves the placement of a shunt between the portal venous system and the systemic venous system to reduce ascites accumulation by decreasing portal pressure.
Transjugular intrahepatic portosystemic shunt
or
TIPS
All of the following are risk factors for what?
Alcohol use disorder
Chronic viral hepatitis (B,C ,or D)
Autoimmune hepatitis
Steatohepatisis
Damage to liver by meds, substance toxins, infections
Chronic biliary cirrhosis
Cardiac cirrhosis from severe R HF. Lack of blood flow (necrosis)
Cirrhosis
Normal lab findings in Cirrhosis
- Blood liver enzyme - elevated
◦ (ALT, AST,ALP) - Blood Bilirubin - Elevated
- Blood protein - decreased
- Blood albumin - decreased
- RBC-decreased
- HGB- decreased
- HCT- decreased
- PLT - decreased
- PT/INR - prolonged
- Ammonia levels- increased
- Blood creatinine - increase
The Liver Is Scarred
What does this stand for
Nursing dx for cirrhosis
- Fluid volume excess
- Fluid volume deficit
- Altered nutrition , less than
- Impaired skin intregity
- Risk for injury : bleeding.
- Activity intolerance
- disturbed body image
- pain
Diagnostic tests for cirrhosis
Ult
X-ray/ CT. MRI
Liver biopsy
Esophagogastrodudenoscopy
Endoscopic retrograde
cholangiopancreatogrpahy
What is Alcoholic cirrhosis
- Also called Laennec’s cirrhosis
- 2nd most common form
- Results from chronic alcoholism and malnutrition
- Develops vascular and arterial spider angiomas on abdomen
- Reddened palms (palmer edema or liver palms)
What kind of cirrhosis is this?
Bands of scar tissue in liver d/t prior acute viral hepatitis or exposure to hepatotoxins
Postnecrotic cirrhosis
What kind of Cirrhosis is this?
2nd most common form
Results from chronic alcoholism and malnutrition
Develops vascular and arterial spider angiomas on abdomen
Reddened palms (palmer edema or liver palms)
Alcoholic or Laennec’s cirrhosis
What type of cirrhosis is this?
Scarring of liver d/t chronic biliary obstruction and cholangitis (inflammation of the common bile duct)
Severe itching
Biliary cirrhosis
How many types of cirrhosis are there? What are they?
3
Alcoholic cirrhosis (Laennec’s cirrhosis)
Postnecrotic cirrhosis (Micronodular cirrhosis)
Biliary cirrhosis
Complications associated with Cirrhosis
- Hepatic encephalopathy / coma
- Hyponatremia
- Hepatorenal syndrome → AKI in clients W/ liver failure
- Spontaneous bacterial peritonitis
- Esophageal varices
- Acute graft rejection post liver transplantation
- Portal HTN
- Anemia
- Coagulopathy
- Gynecomastia in males
How are esophogeal varices treated?
through an EGD with esophageal banding. It’s like a tourniquet applied internally to stop the blood flow.
accumulation of protein-rich fluid in the abdominal cavity. Once fluid is greater than 500ml, the patient develops an increase in abdominal girth, abdominal pain, and bloating.
Ascites
What stage of encephalopathy is this?
- Confusion
- difficult to awaken
- increased deep tendon reflexes
- rigid extremities
Stage 3
What phase of encephalopathy is this?
Slurred speech, tremors, lethargy, asterixis,
impaired handwriting
Stage 1
What stage of encephalopathy is this?
Coma, nonresponsive to painful stimulus
Stage 4
What stage of encephalpathy is this?
Drowsiness, disorientation, mood swings,
asterixis, feter hepaticus
Stage 2
What to assess in a cirrhosis patient
Respiratory
Vital signs
Peripheral edema
Abdominal girth
Bleeding
Signs of organ rejection
Skin, sclera, urine, stool color
Mental status
Intake and output
Daily weight
Acid-base balance
What to expect to see during the respiratory assessment of a cirrhosis patient
- shortness of breath
- Adventitious breath sounds
- decreased breath sounds
- increased respiration rate may indicate pulmonary fluid overload or inability to lower the diaphragm because of ascites.
Expected vitals signs in a patient with cirrhosis
Increased BP
Bleeding gums, ecchymosis, epistaxis, and petechiae can indicate what?
Decreased clotting factors and vitamin k deficiency
Jaundice, dark urine, clay colored stools indicate what?
increased bilirubin levels
anxiety, behavioral or personality changes, lethargy, stupor, asterixis indicate what?
Hepatic encephalopathy r/t increased ammonia
Liver transplant rejection occurs within the first ________
10 days
List S/S of liver transplant rejection
- Occurs within 10 days
- RUQ pain
- changes in bile drainage
- fever
- tachycardia
- jaundice
How should an a patient with cirrhosis be positioned and why?
HOB and legs elevated
Helps respiratory status by decreasing pressure on the diaphragm secondary to ascites and minimizes dependent edema
Nursing interventions for cirrhosis
Administer medications as ordered
Electrolyte replacement
Restrict protein intake
Elevate HOB and legs
Administer blood products
Promote rest periods
Patient teaching for cirrhosis
- Promote disease process and dietary restriction ( protein, sodium, fluid)
- Lifestyle changes
◦ No alcohol intake, avoid medication that can cause liver damage (Tylenol, OTC herbs) - Seek routine care for liver disease (monitor labs and disease progression)
- Consume adequate calories to minimize weight loss (fruit, veg, whole grains)
- Minimize risk for bleeding (bleeding precautions)
Treatment for Cirrhosis is considered successful when patient meets what criteria?
Stable vital signs
Stable weight
Decreased abdominal girth
Absence of bleeding
