Hepatic & GI Flashcards
Liver functions
- Drug, glucose, fat, and protein metabolism
- Ammonia conversion
3.Vitamin & Fe storage - Bile formation
- Bilirubin excretion
Chronic liver disease
-More common than acute
-Causes: cirrhosis, malnutrition r/t alcoholism, infections
Liver function test (LFT)
ALT normal range:
8-40
AST normal range:
10-40
Albumin normal range
3.5-5.2
Bilirubin normal range
0.3-1
PT/INR normal range
<1.1
Ammonia normal range
15-45
cholesterol normal range
0.6-0.7
HDL male
35-70
HDL female
35-85
LDL
< 130
4 types of jaundice
- hemolytic
- hepatocellular
- obstructive
- hereditary hyperbilirubin
Portal hypertension can cause…?
Ascites=
-rapid weight gain
-increased abdominal girth
-SOB
-distended veins
-striae
-umbilical hernias
-fluid & electrolyte imbalances
Portal hypertension is commonly caused by…?
cirrhosis
With portal hypertension your body retains what?
-H2O & Na+
-up to 20L
Portal Hypertension Nursing considerations with ascites
-I&Os
-Daily weight
-Measure abdomen
-Reposition for SOB
-Monitor labs (BUN & creatine)
Portal hypertension Education
-Dietary (low Na+ , 2g per day only)
-Be careful of salt substitutes- may have ammonia!
-Alcohol cessation support group
-May need diuretic -spironolactone
Portal hypertension can also cause what medical emergency?
esophageal varices
esophageal varices CM’s
-Medical Emergency!
-hematemesis
-melena (bloody stools, black tarry)
-general mental deterioration
esophageal varices nursing considerations
-Medical emergency
-Monitor vitals
-Monitor mental status / LOC
-Gastric suctioning may be needed
-monitor nutritional status
-Dental needs
Hepatic encephalopathy Risk Factors
- TIPS, portal vein thrombosis
- Infections
- AKI, electrolyte derangements
- GI Bleed
- Hypoxemia, hypercapnia
Hepatic encephalopathy–what happens to ammonia & K+
-Ammonia levels increase
-K+ level decrease
Hepatic encephalopathy can cause…
Seizures & coma
hepatic encephalopathy nursing considerations
-may need liver transplant
-lower ammonia
-electrolyte balance
- Monitor LOC
-May treat w/ benzo antagonists
Hepatitis A transmission
-passed on from small amounts of stool on food, objects, drinks, casual contact
Is Hep A vaccine preventable? Is it curable?
-Yes, promote the vaccine
-Curable
Hep A s/s:
-Flu-like symptoms
-low temp
-
Hep B transmission? Vaccine?
-Passed via body fluids
-Vaccine preventable
-no cure
–can become chronic
Hep C transmission? Vaccine? Curable?
-passed via body fluids
-No Vaccine
-curable
-Increases chance of liver cancer & cirrhosis
Acute liver faiure
-Sudden & severely impaired liver function in a previously healthy person
-onset can vary from short to weeks
-prognosis is worse than in chronic liver disease
Acute liver disease causes
- Hep B
-Drug overdose (acetaminophen)
Acute liver disease s/s:
-jaundice
-anorexia
As it progresses:
-kidney disease
-infections
-Cardiovascular disease
-hypoglycemia
-cerebral edema
-electrolyte imbalance
cirrhosis -alcoholic, postnecrotic, biliary
Normal liver tissue replaced with diffuse fibrous tissue –scar tissue
cirrhosis s/s:
-liver enlargement
-ascites
-portal obstruction
-infections
-GI varices
-generalized edema
-vitamin deficiency
-anemia
-mental deterioration
Cirrhosis nursing considerations
Treat symptoms:
-rest
-vitamin replacement
-Diuretics for edema
-I&Os
-Daily Weights
Liver Cancer
Primary liver tumors
-hepatocellular carcinoma most common type (75%)
Liver metastases
-GI, Breast, & lung are 2.5x more likely to found in liver
Liver cancer treatment
Chemo
Radiation
Surgical resection
Liver Transplants
-very stringent criteria
-Manage complications
-bleeding
- infection
-rejection
Liver transplant Nursing considerations
-incision site care
-IS
-focused assessments of renal, pulmonary, metabolic, cardio, respiratory function
Small bowel obstruction CMS:
-crampy pain
-hypoactive bowel sounds/absent
-no flatus usually
-vomiting
-dehydration
-abdominal distention
Small bowel obstruction nursing considerations
-NPO
-NG decompression
-Surgery may be needed if it is complete obstruction & not resolving
-risk of strangulation & necrosis
Large bowel obstruction CM’s
-Progresses slowly
-lower abdominal distension
-crampy lower abdominal pain
-hypoactive to absent bowel sounds
-Constipation may be only symptom
Large bowel obstruction medical management
-Restore fluid volume & balance electrolytes
-NPO
-NG decompression
-Colonoscopy
-rectal tube may be used if obstruction is low enough
-resection may be needed
Bowel obstruction nursing considerations
-I&Os
-Assess NG function (color & amount)
-Assess for fluid & electrolyte imbalances
-Monitor nutritional status
-Monitor for resolution/symptom improvement
-if not improvement, prepare for surgery
Ostomies Pre-op Educations
-diet
-fluid, electrolytes, blood
-Education about wound care
-involve family & support system
Happy stomas are…
-bright red
-shiny
-skin intact
ostomies nursing care
-Monitor for skin breakdown
-I&OPs
-emotional support
-empty every 4-6 hours
Ostomies complications
-skin irritation
-leaking
-ill-fitting appliance
-scar tissue
