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HPA 2 > Exam 2: Hepatic Disorders > Flashcards

Exam 2: Hepatic Disorders Flashcards

1
Q

Manifestations of hepatic dysfunction

A

Jaundice
Portal hypertension
Ascites
Esophageal varices
Nutritional deficiencies
Hematological problems
Hepatic encephalopathy or coma

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2
Q

Jaundice

A

Increase bilirubin concentration in the blood, can see on palms, sclera, sometimes mucous membranes

Hepatocellular: Damaged liver can’t clear bilirubin
Obstructive: Blocked bile duct
Hemolytic: Excessive destruction of RBCs

Serum bilirubin exceeds 2.0 mg/dL

Nursing management: Rest, oral hygiene, dietary education, assess for jaundice, measures to relieve pruritus, short nails, monitor color of urine and stools

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3
Q

Portal hypertension

A

Blood enters liver through portal venous system

When damaged, it is hard for blood to pass through, fluid and electrolytes find path of least resistance

Creates new vessels that leads to varices and ascites

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4
Q

Fluid volume imbalance

A

Transfer of fluid from intravascular space to extra vascular space

Leads to peripheral edema and ascites

BP drops, intravascularly depleted - I&Os

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5
Q

Clinical manifestations of ascites

A

Increased abdominal girth
Rapid weight gain
SOB
Discomfort
Striae and distended veins may be visible over abdominal wall (Caput Medusa)
Umbilical hernias
Fluid and electrolyte imbalances

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6
Q

Ascites management

A

Daily weights, measure abdomen, I&O
Paracentesis
Salt restrictions
Diuretics
Bed rest
Shunt placement

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7
Q

Paracentesis

A

Pre-procedure: Obtain baseline assessment, have PT void prior, position PT upright at side of bed or in high fowlers

Intra-procedure: Measure, collect, and describe fluid (cloudy = infection)
Monitor VS
Support PT

Post-procedure: Maintain dry sterile dressing, monitor for hematuria/leakage at side, fluid volume deficit

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8
Q

Esophageal Varices

A

Dilated, tortuous veins in lower esophagus and upper stomach caused by portal hypertension

Fragile, high risk for bleeding (bleeding precautions/suction at bedside)

50% of PTs with cirrhosis have varices

Prevention: Avoid meds that may lead to bleeding (anti-platelets, anti-coagulants), avoid constipation, avoid activities that increase portal hypertension

Assess: AIRWAY, fluid volume deficit, melena/hematemesis, CBC (hemoglobin), VS

Emergency: PROTECT AIRWAY, manage bleed and fluid volume deficit, place 2 large bore IVs, monitor labs, replace fluids and blood products, vitamin K, PPIs, lactulose and rifaximin, endoscopy, balloon tamponade

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9
Q

Balloon Tamponade

A

Puts pressure on bleed to stop bleeding

Protect airway
Cared for in ICU
Label each lumen
Observe for skin breakdown
Monitor for complications (aspiration pneumonia)
Scissors at bedside
Semi-fowlers
Oral-nasal care
Hooked up to traction

Sengstaken-Blakemore/Minnesota Tube

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10
Q

Medications for varices

A

IV Octreotide: Used during ACTIVE BLEED, decreases bleeding from varices, selectively causes splanchic vasoconstriction

Propanolol: Prophylaxis, decreases portal pressure

Vasopressin: Used in urgent situations, vasoconstricts splanchic arteries and reduces portal pressure. Monitor for: Myocardial and extremity ischemia, cardiac dysrhythmias (may use nitroglycerin)

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11
Q

Endoscopy: Nursing management

A

Pre-procedure: NPO, ensure informed consent signed and evaluate PT’s understanding of procedure, baseline labs, PT education

Intra-procedure: Position side lying with elevated HOB

Post-procedure: Keep NPO until gag reflex returns, position PT high fowlers or side-lying, monitor for complications

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12
Q

Transjugular Intrahepatic Portosystemic Shunt (TIPS)

A

Shunts blood around to prevent ascites and varices

Need to watch for bleeding

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13
Q

Hepatic Encephalopathy

A

Liver not able to breakdown ammonia, leading to toxic amounts of ammonia in the blood, progressive

Causes neurologic manifestations

Manifestations:
LOC ranges from confusion to coma
Sleep/motor disturbances
Seizures
Asterixis, flapping tremors
Fector hepaticus (rotten egg breath)
Acid-base imbalance

Management: Frequent neuro assessments:, VS, I&O, daily weights, electrolyte and ammonia levels, small frequent meals, eliminate precipitating cause and decrease ammonia

Medications: Lactulose, Riaximin

Normal ammonia level: 15-45

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14
Q

Lactulose

A

Goal: Reduction of ammonia formation

Produces osmotic effect in colon and decreases amount of ammonia in colon

Adverse effects: Abdominal cramps, diarrhea, flatulence

Monitor: Hypernatremia and hypovolemia

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15
Q

Rifaximin

A

Goal: Reduction of ammonia formation

Used to reduce ammonia forming bacteria in colon in PTs who do not respond to lactulose

May increase creatinine and ALT

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16
Q

Nutritional Therapy

A

Daily protein intake between 1.2-1.5 g/kg daily

High in calories
High carb
Moderate to low fat
Protein restrictions rarely justified

Low-sodium for ascites and edema

Needs supplements with vitamins A, B, C, K, folic acid

17
Q

Hematological problems

A

Decreased production of clotting factors (plasma proteins) leads to coagulation disorders

Portal hypertension leads to pooling of blood which can lead to throbocytopenia, leukopenia, anemia

Give platelets at 10,000

18
Q

Hepatitis

A

Systemic, viral infection causing inflammation of the liver cells producing clinical, biochemical, and cellular changes

Patho: Acute infection, liver damage, cholestasis (interruption of bile flow). Chronic infection can cause fibrosis (over decades) and progress to cirrhosis

Manifestations: Acute and chronic phases, many pts asymptomatic (with acute), or intermittent/ongoing symptoms: anorexia, weight loss, malaise, fatigue, myalgias/arthralgias, low-grade fever, heptomegaly, low-grade fever, heptomegaly

19
Q

Viral hepatitis teaching

A

Dietary teaching
Activity restrictions/tolerance
Prevent transmission
S/S to report
Assess for complications
Regular follow up 1 year after diagnosis
No alcohol
Medication education (no tylenol or hepatotoxic drugs)

20
Q

Cirrhosis

A

Chronic damage to liver cells, disorganized regeneration, overgrowth of connective tissue. Fibrotic, poorly functioning liver

Risk factors: Alcohol use disorder, chronic viral hepatitis (B, C, D), autoimmune hepatitis, steatohepatitis, chronic biliary hepatitis, cardiac cirrhosis

Manifestations:
Compensated: Abd pain, ankle edema, firm/enlarged liver, flatulent dyspepsia, intermittent mild fever, palmar erythema, splenomegaly, unexplained epistaxis, vague morning indigestion, vascular spiders

Decompensated: Ascites, clubbing of fingers, continuous mild fever, epistaxis, gonadal atrophy, hypotension, jaundice, muscle wasting, purpura, sparse body hair, spontaneous bruising, weakness, weight loss

21
Q

Cirrhosis management

A

Diuretics
Beta blockers (propanolol)
Lactulose
Vitamins
Antacids
Milk thistle herb
Paracentesis
Endoscopic variceal ligation/banding therapy
Endoscopic sclerotherapy
TIPS
Transplant

HPA 2 (20 decks)

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