GI Accessory Disorders Flashcards
Appendix becomes inflamed increased intraluminal pressure, causes edema and obstruction of orifice
Etiologies
Result of becoming kinked or occluded with stool
Lymphoid hyperplasia secondary to inflammation or infection - appendicitis can be with or without infection
Rarely, foreign bodies (seeds) or tumors
Patho - GI Accessory: Acute Appendicitis
Severe/steady pain
Right lower quadrant
McBurney’s point - push on area and release it have rebound tenderness
Rebound tenderness
Low grade fever/nausea
Complications
Largest: Ischemia, gangrene, perforation
Ruptured/disintegration = Peritonitis: go further and cause sepsis/death
CM - GI Accessory: Acute Appendicitis
As push down little tender but lot more as release
Halfway between umbilicus and ant iliac crest
Go down slow and up fast - pain throughout but greatest pain on rebound
Appendicitis McBurney’s Point: Rebound tenderness - GI Accessory: Acute Appendicitis
CBC
Elevated WBC & Neutrophils
Normal: WBC (5000-10000 mm3)
Normal: Neutrophils (55-70 %)
Urinalysis: r/o UTI/stones
CT: right lower quadrant density
appendix enlargement (6 mm or >) - show inflammation and thickening of walls around appendix: sign inflammed
Pregnancy test: r/o ectopic pregnancy
Diagnostics - GI Accessory: Acute Appendicitis
Appendectomy
Laparotomy - open
Laparoscopy - closed
Healing time much less and lot less chance infection
IV Fluids - not feel like drinking and after remove appendix have paralytic ileus need rehydrate
Antibiotics
med/surg - GI Accessory: Acute Appendicitis
Infection, risk for - if not already got infection
Pain - acute
Fluid volume deficit, risk for
Surgery, knowledge deficit
Anxiety
Risk for: atelectasis, DVT, or ileus - need be up, moving around, turn and cough and deep breathing - trying get lungs clear and get bowels moving to prevent ileus - need be on DVT prophylaxis until moving around again
N. diagnosis - GI Accessory: Acute Appendicitis
Educate patient on surgery - most specifically: educate what expected of pat post-surgery; warn: IS and how use it and how often
Administer pain medications - enough get pain at stated level that usually 4 - so doing turning, coughing, deep breathing without great deal of pain and splinting
Administer IV fluids/encourage PO fluids (after pass gas) - after bowels wake up
Provide post operative care
Prevent post op complications
Educate patient on T,C,DB; IS
Position: High Fowler’s
Auscultates abdomin-BS - LOT - getting things back again and movement
Ambulate
Abdomen stays soft and not rigid or developing peritonits
Discharge instructions - variety
N. interventions - GI Accessory: Acute Appendicitis
Inflammation of peritoneum usually result of:
Bacterial infection
External sources such as abdominal surgery or trauma
Peritoneal dialysis - BIG ISSUE; after two issues having this and peritonitis cannot have dialysis - must go to chemo
Inflammation other organs - such as appendicitis
Patho - GI accessory: peritonitis
Fever - >101-102
Pain
Begins as diffuse pain then constant, localized, more intense over site, increases with movement
Rigid abdominal muscles/Distention of abdomen
N&V; paralytic ileus from the pressure
Hypovolemia-lack of movement of fluid
Without intervention -can lead to sepsis/shock
CM - GI accessory: peritonitis
WBC elevated with Bands - will see >10% - throwing out immature neutrophils because cannot produce enough mature WBCs to fight infection
Electrolytes
altered levels of potassium, sodium, and chloride
Fluid volume shifts
C&S of aspirate - peritoneal taps - catheter/needle inserted into peritoneum and draw off fluid; know what type antibiotics on - start broad
Abdominal X ray
Look for air and fluid levels; distended bowel loops; bad sign: fre air within abdomen - means somewhere within bowel air leaking out and that is source of peritonitis
CT: abscess formation
MRI: Intra-abdominal Abscesses
Diagnostics - GI accessory: peritonitis
Find infection source
Fluid/electrolyte replacement
Pain medication - in lot of pain and bowel issues - not stop up already are
Antiemetics - Zofran - stop from vomiting and massive nausea
Antibiotics - before C&S done, look at starting broad spectrum (Zosin)
NG tube-relieve distention on stomach
Airway clearway - airway intubation and ventilator assistance needed end up in ICU if become extremely septic
med/surg - GI accessory: peritonitis
Risk for infection - peritonitis does not have to have an infection
Deficient fluid volume
Acute pain
Risk for imbalanced nutrition: Less than body requirements - not being able to eat or drink
Constipation - fluid shifts and pain meds
Nausea
Risk for dysfunctional GI motility - lot pressure in peritonitis on bowels and not move appropriately
N. diagnosis - GI accessory: peritonitis
May prep for surgery - open exploratory laparotomy since not know what is going ok
Monitor: Assessment/Vital signs - good look at abdomen - not rigid abdomen, massive fever
Focus on Bowel sounds
Administer medications - not able swallow meds and NG tube - not able take meds PO; have meds changed into diff form
Advance diet as tolerated
Intensive care for septic shock
N. interventions - GI accessory: peritonitis
Distentended abdomen - pressure making skin taut
Not corrected - can turn into abdominal compartment syndrome
Is this pt at risk for intra-abdominal HTN - GI accessory: intra-abdominal compartment syndrome; intra-abdominal HTN
Sepsis - pts been septic/cap leak
Burns - large total body surface area burns
Massive resuscitation
Something in common in terms treatment: fluids; some sorts process making cap leaky; catecholamines act on caps and vascular sys to dilate and become leaky and all fluid instead going through vascular sys leaks out and causes third spacing - edema; fluid from intravascular space - edema and swelling throughout for pt; pts at high risk for intraabdominal pressures
Septic: cram full fluid; burns: replace all fluids lost in burned tissue; massive resuscitation - cont hang fluids - 3-6 L run
Risk factors - GI accessory: intra-abdominal compartment syndrome; intra-abdominal HTN
Extra pressure on cavity - Splanchnic hypoperfusion (ganglia - when smushed not do job effectively; pressure put on it - not have blood flow or transmit neuron signals freely if not under pressure) - resulting in hepatic ischemia - liver not getting enough O2; liver not do job appropriately and getting squished and liver makes coag factors so get weird Coagulopathy - clot and bleed at same time = acidotic state pt for same time; metabolic acidosis need fix as well; Coagulopathy increase bleeding - Intra-abdominal bleeding - cavity under pressure under exces pressure now have blood loss that will exacerbate pressure prob; bleeding and more pressure in abdomen
Gut - colon, SI, stomach - not enough blood supply - stomach not enough blood supply to refresh rugae get gastric ulcers - hydrochloric acid - not get rugae replaced - eat through and get hydrochloric acid in stomach in peritoneal cavity - autodigestion of various organs causing inflammation and increased swelling and edema; free radicals from extra H floating around damage extra tissues - cause abdominal-compartment syndrome
IAH
Patho - GI accessory: intra-abdominal compartment syndrome; intra-abdominal HTN
Hepatic ischemia
Gut mucosal acidosis
Bowel edema
Free oxygen radicals
Distant organ damage
Coagulopathy hypothermia acidosis
Intra-abdominal bleeding
If unrelieved can lead to ACS
IAH - GI accessory: intra-abdominal compartment syndrome; intra-abdominal HTN
Hopefully have transfusion measures in ICU - fill up bladder and measure it; med-surg unit - not as accurate: keep track of it: abdominal girth measurements; ideally same person doing them - track changes over time - also do daily weights - most accurate measure fluid volume status on pt
How measure intra-abdominal pressure
Cut down through fascia to relieve fascia - ACS - relieve pressure; abdomen squishy - stretch more than cavities - need relieve pressure; laparotomy - incision on pt - swelling pushed it into a circle - same concept - relieve pressure by opening up cavity so organs and vessels not squished
Pt at risk for: infection, sepsis, HF - fluid volume overload issues, impaired gas exchange, TPN/PPN/NG tube/PEG tube, skin integrity issue
High mortality once to this pt - be open like this for long time; covering over it
Swelling go down: combo surgical closure, wound vac and exact situation and natural closure; closure in layers
Too much pressure in body cavity: organs and vessels not do job effectively; depending on organ and sys effected have systemic issues; once hemodynamically stable - fluid off; pressure to high do something to relieve it: surgical intervention
Past intra-abdominal HTN and abdominal compartment syndrome
formation of gallstones
Cholesis
Inflammation of gallbladder
Acute vs Chronic
Stones vs not
Women greater than men
Age greater than 40, obese, fertile
Four F’s: Fat, fertile, female, and forty
Patho - GI accessory: cholecystitis
Biliary colic pain in RU abdomen
Radiates R shoulder and back
N&V - esp after fatty meal
Obstruction (stones/tightening of gallbladder tract) causes jaundice
Urine/stool changes
Urine dark; putty colored stool - bilirubin unable to be conjugated
Vitamin Deficiency
Esp Fat soluble vits: A, D, E, and K - so much pain after fatty mean
Major comps: Complications stone
Necrosis, peritonitis
CM - GI accessory: cholecystitis
Radiographic
Abdominal X-Ray - looking for thickening of wall
Ultrasonography - looking for thickening of wall
Endoscopic retrograde cholangiopancreatography (ERCP)
Procedural
Look up into biliary tract and see if stones/sphincter of Oddi competent; treatment as well
Laboratory
Increased Bilirubin (0.3-1 mg/dL) - why see jaundice/itchy skin; usually above 2 - organ dysfunc - esp liver
Diagnostics - GI accessory: cholecystitis
Diet/Supportive Therapy - low fat diet
Pharmacologic therapy - meds: uracil: helps dissolve clots
Dissolve small, gallstones
Nonsurgical removal gallstones
catheter inserted percutaneously
Surgical management
Laparoscopic – less invasive; much easier heal time; can be same day surgery oftne
Open – more invasive
Med/surg - GI accessory: cholecystitis
Laparoscopic versus traditional
Lower complication rate
Low death rates
Rare bile duct injuries
Quicker recovery
Less postoperative pain
Preoperative, intraoperative, postoperative similarities and differences are pretty much equal with each other
Infected gall bladders that are gaseous often done open - teach pts about both before go to surgery - during surgery may need convert from one to another
Cholecystectomy - GI accessory: cholecystitis
Acute pain - pre and post-op
Impaired gas exchange - must splint
Impaired skin integrity - surgery
Imbalanced nutrition; less than - unable to eat, nausea caused by fat
Risk for infection –surgical site
Also see abdominal surgery diagnosis
N. diagnosis - GI accessory: cholecystitis
Nursing Post op care
Pain relief - esp improves resp status; hard take deep breath if painful
Improve resp status
Maintain skin integrity - more upright position
Promote biliary drainage
Low fat diet/high carb and protein - low fat for sev weeks or forever
Monitor and manage potential complications
Bleeding
Peritonitis
Disruption of GI function
Discharge care
N. interventions - GI accessory: cholecystitis
Gas pain from surgery; sit up right/walk to ease; take
Esp true for laparoscopic surgery - filled with gas so catheter can go in - tell sit upright, walk, pass gas, take pain med as prescribed
Managing pain - Pt edu: home care - GI accessory: cholecystitis
Light activity
Avoid lifting greater than 5 lb for 1 week
Resuming activity - Pt edu: home care - GI accessory: cholecystitis
Daily
Not remove steri strips
Caring for the wound - Pt edu: home care - GI accessory: cholecystitis
Fat in diet slowly - back to regular diet if tolerated in 4-6 weeks
Resuming eating - Pt edu: home care - GI accessory: cholecystitis
Know s&s of infection, N&V, abd pain
Managing follow-up care - Pt edu: home care - GI accessory: cholecystitis
Inflammation of the pancreas
Self digestion of organ - two are elevated amylated and lipase - and if not allowed empty out backwash and digest pancreas
Risk Factors
Gallstones
Obstruction - backing up into pancreas
ETOH
Autoimmune disease
Patho - GI accessory: Acute pancreatitis
Abdominal/back pain - lot pain
Rigid abdomen/guarding
Peritonitis
N&V - long periods not able eat or drink; long periods NG tube; often on TPN
Ecchymosis (bruising) in the flank or around the umbilicus
Fever
Jaundice - due to bilirubin going up into blood and not conjugated
Hypotension/Hypovolemic shock
CM - GI accessory: Acute pancreatitis
History abdominal pain and hx drinking
CBC
Elevated WBC (infection and inflammation); H&H (bleeding/erosion)
Serum amylase/lipase
Elevated within 24 hour of symptoms starting
Transient hyperglycemia (pancreas failing to make sufficient insulin - close eye esp if on TPN since has d50 base - high BG) and glycosuria and elevated serum bilirubin in some patients
X ray-abdomen
US - look for gallstones and obstruction
Diagnostics - GI accessory: Acute pancreatitis
NPO
Parenteral feedings - IV and given via central line - infection risk
Hyperglycemia (TPN has D50W - high risk for growing medium and must watch for this)
NG to suction with decompression
Pain management - LOTS
Respiratory care - LOTS; may end up on ventilators
Biliary drainage - could have obstruction affecting gallbladder and pancreatitis
Surgical intervention - rarely used
Intensive care - septic and shock
med/surg - GI accessory: Acute pancreatitis
Acute pain - want good pain control able breath and move
Altered breathing pattern - pancreas close to lungs and causes issues there
Altered nutrition status: less than - unable eat - almost all from TPN
Impaired skin integrity, risk for - end up in bed rest for long period time
Ineffective health maintenance - can be due to drinking
Nausea
N. diagnosis - GI accessory: Acute pancreatitis
Administer analgesics
Positioning
Improve breathing pattern
For good skin integrity - lots major turning to keep lungs draining
NPO/NG tube care/IV fluids - good mouth care; NG tube draining appropriately; IV fluids - PO fluids not work
Enteral or parenteral nutrition - eye on IV line and not infected - sterile dressing; changing tubing on TPN - nothing in TPN when hung
Monitor for complications - infection and bleeding
Educate
ETOH in pancreatitis - formal plan for Alcoholics Anonymous - one more time drinking sends right back to pancreatitis
N. intervention - GI accessory: Acute pancreatitis
Etiologic factors
Alcoholism
Gallstones (biliary tract disease)
Blunt abdominal trauma
Operative manipulation and trauma
Drug use
Infection
Unknown and other causes
Pancreatitis - section where obstructed and end up with pancreas eating itself and then necrosis/hemorrhage
Process autodigestion in acute pancreatitis- GI accessory: Acute pancreatitis
Pancreatitis often results in this
Adenocarcinoma - super aggressive cancer; all cancers
Affect All parts of pancreas - probs with digestion, BG even tho islet cells throughout pancreas - could cause issue with insulin production
Incredibly Fast growing
Highly invasive
Primary/Secondary
Metastasis through venous and lymphatic systems - largest issue not know when happening: not lot clear signs that speak to it and by time diagnosed very late stage
Patho - GI accessory: pancreatic cancer:
Smoking - pipe smoking esp
Diabetes Mellitus
Chronic Pancreatitis
Cirrhosis
Male
Older age
Genetic (BRCA2 gene from breast cancer)
Risk factors - GI accessory: pancreatic cancer:
Weakness and Fatigue
Abdominal pain (dull/non-specific)
Jaundice - some sort of obstruction and non-drainage from bile
Clay-colored stools - issues from bile
Dark urine - issues from bile
Weight loss - not having amylase and lipase to break down food
Anorexia
Nausea and Vomiting
CM - GI accessory: pancreatic cancer:
Assessment of clinical manifestations
Elevated amylase and lipase - 24 hours after beginning of symp; this is big one
Elevated alkaline phosphatase - if liver involvement; congruent liver, gallbladder, pancreas
Elevated total bilirubin - looking for obstruction
Ultrasound/CT - looking for thickening of walls and obstruction
ERCP - looking for stones or outlet not working and need sphincterotomy
Pancreatic washings - most definitive ways; by use ERCP and taking biopsies little areas of pancreas
Diagnosis - GI accessory: pancreatic cancer:
Not easiest to treat
Chemotherapy/Radiation: Shrink Tumors
ERCP with Sphincterotomy and Stent - treatment
Pain control/Opioids
Whipple procedure
Open
Minimally invasive
Massive procedure - takes about ¼ inside - open and minimally invasive portion; takes about 1 week to recover and really good if can get cancer at early stage before traveled to lymph nodes; once lymph nodes involved secondary with chemo and radiation
med/surg - GI accessory: pancreatic cancer:
Anxiety
Ineffective family Coping
Fear
Grieving
Deficient knowledge
Spiritual distress
Risk for impaired liver function - whole tree involved
See nursing diagnosis for cancer, chemotherapy, surgery, and radiation depending on what going on with pt
Biggest issue with pancreatic cancer: cure/survivial rate extremely low: late presentation and identification
N. diagnosis - GI accessory: pancreatic cancer:
Administer analgesics
Positioning
Improve breathing pattern
NPO/NG tube care/IV fluids
Blood Glucose/TPN/Central line
Assess for bleeding, infection, abscess formation
N. intervention - GI accessory: pancreatic cancer:
Viral infection of liver with necrosis and inflammation of liver cells - will lead to cirrhosis and same CM of cirrhosis
5 Types
A and E fecal-oral route
B (Body fluids)
C common cause for liver cancer and need for transplant
D and with some B: IV drug use
Patho - GI accessory: hepatitis (viral)
Incubation (1-6 months): passed during that time
Arthralgia and rashes - lot joint pain
Anorexia - not very hungry
Malaise, weakness - feel weak and tired
Jaundice and dark urine - increased bilirubin in bloodstream and liver unable conjugate that
Vague epigastric distress, nausea, heartburn, and flatus
Enlarged liver/abdominal tenderness
CM - GI accessory: hepatitis (viral)
Increased liver enzymes
ALT (4-36 iu/L)
AST (0-35 u/L)
Positive Antibodies
Liver biopsy - big one; direct needle into liver; if liver not working like should not having coag properties necessary - watch carefully
Diagnostics - GI accessory: hepatitis B
Alpha-interferon
injections 3 X weekly 16-24 weeks
Two antiviral agents
Entecavir
Tenofovir
Bed Rest until manifestations resolve
Diet
Liver transplant
med/surg - GI accessory: hepatitis B
Activity intolerance
Fatigue
Imbalanced nutrition, less than body requirements
Acute Pain
Social isolation
Knowledge deficit
N. diagnosis - GI accessory: hepatitis B
Encourage physical activity as much as possible for pt
Avoid sexual contact
Chronic-may pass infection for life life
Psychosocial issues and concerns that go on
Education about self care
Prevention of further issues
N. interventions - GI accessory: hepatitis B
Cause Acute liver cell necrosis
Similar to acute viral hepatitis, but has more parenchymal destruction and destructive properties so tends to be more extensive
Most common cause of acute liver failure greater than 50%
Certain chemicals that have toxic/negative effects on liver- GI accessory: non-viral hepatitis
Acetaminophen
Leading cause
Any OD - no more than 3 g in 1 day
IV acetycysteine - causes liver protection
Psychotropic medications
Antimetabolites
Anesthetic agents
Anticonvulsants
Could be something that destroy the liver
Mushrooms that cause destruction to client’s liver
Common Medications - GI accessory: non-viral hepatitis
Portal HTN leads to ascites and esophageal varices
Chronic disease characterized by replacement of normal liver tissue with diffuse fibrosis - liver cells become hardened and non-flexible
Disrupts structure and function
Liver becomes nodular; blood and lymph flow are impaired - big deal with blood: portal HTN - blood backs up since cannot get through = esophageal varices and ascites
Affects Men greater than women; 40-60-year-old
Patho - GI accessory: cirrhosis
Alcoholic cirrhosis
MOST COMMON
Post-necrotic cirrhosis
Late result acute viral hepatitis
Biliary cirrhosis
Scarring occurs around bile ducts
Three types of cirrhosis - GI accessory: cirrhosis
Serum albumin level decrease - albumin protein made in liver: cirrhotic and nonfunctional albumin no longer able to come out into sys and cause lots of edema
Serum globulin level rises
Liver function tests
Serum alkaline phosphatase, AST, ALT, and GGT levels increase
Serum Bilirubin increase - due to livers inability to conjugate it - see darker urine, clay-colored stool, bile salt deposits within the skin
CT, MRI, US - obstructions and thickening and enlarging
Liver biopsy-confirms diagnosis - know if have clotting available - bleeding out easily since going directly into liver
Diagnosis - GI accessory: cirrhosis
Antacids-GI distress
Potassium sparing diuretics
Spironolactone –decrease ascites - may spare K must use salt substitutes and major ingredient is K so watch for elevated K - cardiac/muscle issues
Diet
Colchicine/Statins-antifibrotic effect on liver/activity
Herb milk thistle (Silybum marianum)-regenerative properties for liver
med/surg trtment - GI accessory: cirrhosis
What taking/exposed to
Exposure to alcohol and drugs, herbs, medications, and chemicals
Needle stick injury, tattoo placement
Employment as a healthcare worker, firefighter, or police officer - high risk
Assess sexual history and orientation
Inquire about family history.
Collect previous medical history
Risk assessment - GI accessory: cirrhosis
Pallor/Jaundice over pallor
Muscle atrophy - in extremities; large central trunks and muscles waste away in arms and legs
Edema - in trunk and abd esp - portal HTN and low albumin
Skin excoriation(scratching)
Petechiae/spider angiomas - veins popping up everywhere - blood not able flow through liver
Enlarged liver or small/hard liver
Bilateral gynecomastia and testicular atrophy
Cognitive status/weakness
CM - GI accessory: cirrhosis
Portal hypertension
Ascites and edema
Esophageal varices - rupture easily; veins show up easily on body as well
Coagulation defects/anemia
Jaundice/pruritus
Hepatic Encephalopathy/coma - built up ammonia in brain
Bacterial peritonitis
Metabolic abnormalities - many
Vitamin deficiencies
Progression - GI accessory: cirrhosis
Inadequate formation, use, and storage of certain vitamins (vitamins A, C, D and K)
Fat soluble - trouble getting out fats
Vitamin Deficiency - GI accessory: cirrhosis
Chronic gastritis and impaired GI function, together with inadequate dietary intake and impaired liver function
Never feel like eating so impaired dietary intake
Anemia - GI accessory: cirrhosis
Increased bleeding; platets not produced
Clotting factor deficiency - GI accessory: cirrhosis
Abnormalities of glucose met.
Blood glucose high after a meal
Hypoglycemia during fasting because no glycogen stores in liver and no conversion from glyconeogenesis from glycogen to glucose and of decreased hepatic glycogen reserves and decreased gluconeogenesis
Abnormalities Endocrine
Liver cannot properly metabolize hormones
Androgens and sex hormones
Testicular atrophy and gynecomastia
Metabolic Abnormalities - GI accessory: cirrhosis
Activity intolerance
Disturbed body image
Excess fluid volume
Risk for bleeding
Risk for injury: decreased LOC
Risk for acute confusion
Imbalanced nutrition: less than body requirements
Impaired skin integrity related to pruritus from jaundice and edema
Fatigue
N. diagnosis - GI accessory: cirrhosis
Promoting Rest
Improving Nutritional Status
Providing Skin Care
Reducing Risk of Injury
Monitoring and managing potential complications of pt
N. interventions - GI accessory: cirrhosis
Flow of bile impeded
Bilirubin concentration in blood increased; collects in tissues causing Jaundice
Serum bilirubin level exceeds 2.0 mg/dL - showing severe organ damage
Bile salts cause severe pruritus
Jaundice and Pruritus - issue with cirrhosis - GI accessory: cirrhosis
Cognitive level decreasing due to high levels of ammonia
Monitor: to identify early deterioration in mental status
Early: include mental status changes and motor disturbances; extensive baseline and ongoing neurologic eval is key - everytime see pt ensure not changing
Monitor electrolytes and ammonia levels (low Na and elevated ammonia makes you crazy)
Provide pt safety; prevent injury; bleeding infection - side rails, call light, bed alarm, sitter in there
Prevention and early identification life-threatening complications; resp failure and cerebral edema - ammonia very high and no longer able breathe on out - result in cerebral edema
Treatment: administer lactulose - traps and expels ammonia in feces - med
Cirrhosis Progression and hepatic encephalopathy - GI accessory: cirrhosis
Blood from digestive organs collects portal veins; carried to liver
Cirrhotic liver- no free blood passage
Blood backs up into spleen and GI tract veining sys-chronic passive congestion - engorged veins in esophagus and fluid in abdomen (varices and ascites)
Indigestion/altered bowel function result.
Protein rich fluid accumulate in peritoneal cavity, producing Ascites
Liver cannot metabolize aldosterone further increasing fluid
Reduces plasma albumin = Edema
Formation - Cirrhosis progresion: Ascites and edema - GI accessory: cirrhosis
Measure abdominal girth
Daily weights (fluid - gaining fluid/not esp quickly); I&O - accurate
Na restricted diet
No salt substitutes unless ok with HCP
Salt substitutes contain potassium and should be avoided if the patient has impaired renal function.
Adm. diuretics (Spironolactone - K sparing)
Monitor electrolytes, Cr & BUN, ammonia
Adm. Albumin – necessary because pulls extravascular fluid into vascular system to be excreted by kidneys
Monitor for signs and symp of infection/peritonitis
Nursing - Cirrhosis progresion: Ascites and edema - GI accessory: cirrhosis
Varices are varicosities that develop from portal hypertension
Prone to rupture - very thin - not able heal because pressure; rupture and massive hemorrhages: upper GI tract (esophageal varices) & rectum (hemorrhoids) (hematemesis, melena)
When varices ruptures - have yankauer catheters in patient’s mouth trying to suction it out while someone tries to quickly intubate them
Major causes of death in patients with cirrhosis
Several types of procedures used to treat and stop bleeding - balloon to stop bleeding
Nursing
Esophageal varices - GI accessory: cirrhosis
Support through procedure
Adm/monitor parenteral nutrition - central line, infection, high volume of sugar
NG to suction - depression
Good Oral care
Close monitoring VS - bleed out quickly
Adm Vitamin K/blood products esp if looking at losing lot blood
Manage delirium secondary to alcohol withdrawal - SiWa protocol
Nursing - Esophageal varices - GI accessory: cirrhosis
Nothing else can do
Take out entire liver - put in whole liver from cadaver right lobe from live
Used to treat ESLD when no other treatment is available
Total removal disease liver and replacement with healthy liver from cadaver donor or right lobe from live lonor in same anatomic location
Pt must undergo thorough eval: model for ESLD (MELD) classification
Imp piece: Successful liver transplantation depends on successful immunosuppression - take meds regularly to keep the liver
Post-op comps
Nursing
Home care
- GI accessory: liver transplant
Much less often
Bleeding
Result from coagulopathy, portal hypertension, and fibrinolysis caused by an ischemic injury
Infection
Leading cause of death after liver transplantation - not just surgical transplantation but also suppressed immune sys or reject liver
Rejection
Perceived by the immune system as a foreign antigen
Immunosuppressive agents
Post-op comps - GI accessory: liver transplant
Preoperative
Stop drinking
Must be available at all times in case liver becomes available - wear a pager - get ahold of them immediately
Administration of platelets, fresh-frozen plasma, or other blood products
Immunosuppression - suppressing person
Bacteria free environment
All Follow up appointments
Recognize signs of organ rejection: fever, jaundice, dark urine, itching, fatigue, headache, ascites
Nursing - GI accessory: liver transplant
Provide written/verbal edu about meds
Avoid running out med/skipping dose - can cause pt to reject
s&s indicate probs - rejection: consultation transplant team
Pt with T-tube in place educated about how manage tube, drainage, skin care
Follow-up lab tests and appts with transplant team
Trough blood levels immunosuppressive agents
Labs assess func of liver and kidneys
Routine ophthalmologic exams
Cataracts and glaucoma associated with LT corticosteroid therapy
Dental care - admin prophylactic antibiotics given before dental exams - so liver not reject
Birth contol
Home care - GI accessory: liver transplant
Primary
Hepatitis B and C
Cirrhosis
Secondary
Metastases
Other primary sites, particularly the digestive system (pancreatic cancer often), breast, and lung
Patho - GI accessory: liver cancer
Pain
Weight loss
Loss strength
Anorexia
Anemia due to bleeding
Jaundice
Ascites
CM - GI accessory: liver cancer
Bleeding, risk for
Falls, risk for
Imbalanced nutrition, less than body requirements
Nausea
Fatigue
Infection, risk for
N. diagnosis - GI accessory: liver cancer
Education
Bleeding precautions - electric razor
Antiemetics - zofran
Maintain sterile technique - suppressed immune sys
Post operative care
N. interventions - GI accessory: liver cancer
