liver disorers and cirrhosis Flashcards
WHAT IS CIRRHOSIS
- end stage of liver disease
- progressive , irreversible , leads to liver failure
- alcoholic cirrhosis is most common type
- may result from chronic hepatitis B and C, prolonged billary obstruction, severe right sided heart failure, and other liver diseases
LIVER DISEASE
- impaired liver cells has multiple effects, including
- impaired protein metabolism with decreased production of albumin and clotting factors
LOW ALBUMIN LEVELS=EDEMA INPERIPHERAL TISSUES AND ASCITES
- alteration in blood glucose levels
- inadequate vitamin K, affects production of clotting factors, leads to bleeding tendency
-feminization in men and irregular menses in women
CIRRHOSIS
- functional liver tissue replaced by fibrous scar tissue
- hepatocytes and liver lobules are destroyed, metabolic functions are lost
- structurally abnormal nodules encircled by connective tissue
- restricted blood floe leads to portal hypertension
- incidence and mortality vary greatly among populations
ETIOLOGY
ALCOHOLIC CIRRHOSIS
-alcohol causes metabolic changes in liver
BILIARY CIRRHOSIS
- bile flow obstructed within liver, biliary system
POST-HEPATIC CIRRHOSIS
-results from chronic hepatitis or unknown cause
RISK FACTORS
- high risk behaviors
- drug use
- alcohol use
CLINICAL MANIFESTSTIONS STAGES
EARLY STAGES:
- liver enlarged may be tender
- weight loss, weakness, anorexia
AS DISEASE PROGRESSES
- manifestations related to liver cell failure
- portal hypertension
TREATMENT
- supportive
- slowing progression to liver failure
CLINICAL MANIFESTATIONS (7)
- PORTAL HYPERTENSION
- causes blood to be rerouted to adjoining vessels - SPLENOMEGALY
- blood shunted to splenic vein
- greater destruction of RBC, WBC, platelets - ASCITES
- plasma rich fluid in abdominal cavity
- hypoalbuminemia and hyperaldosternism - ESOPHAGEAL VARICES
- enlarged , thin walled veins form in submucosa of esophagus
- from portal hypertension
- may rupture (massive hemorrhage) - PORTAL SYSTEMIC ENCEPHALOPATHY
- hepatic encephalopathy
- asterixis (hand twitch)
- changes in personality, mentation - HEPATORENAL SYNDROME
- renal failure with:
- azotemia,sodium retention, oliguria, hypotension, result of imbalanced blood flow - SPONTANEOUS BACTERIAL PERITONITIS
- inflammatory response to peritonitis
COLLABORATION
- holistic approach
- nurse coordinates care among providers
- family is included in plan of care
DIAGNOSTIC TESTS
- liver function test
- CBC
- coagulation studies
- serum electrolytes
- bilirubin
- serum albumin
- serum ammonia
- serum glucose, cholesterol
- abdominal ultrasound
- liver biopsy ( increased risk for bleeding lay flat )
PHARMOCOLOGIC THERAPY
- used to treat complications, effects
- will not reverse or slow process
DIURETICS: reduce fluid retention , ascities
LACTULOSE , NEOMYCIN : reduce nitrogen load, lower serum ammonia
BETA-BLOCKERS- prevent rebleeding of esophageal varices
FERROUS SULFATE, FOLIC ACID-treat anemia
ANTACIDS
OXAZEPAM (SERAX)- treats acute agitation
NUTRITIONAL THERAPY
- sodium intake restricted to < 2g/day
- fluid restriction
- protein restricted/eliminated (monitored)
- high calorie, moderate fat
- vitamin, mineral supplement
SURGERY
TRANSPLANTATION INDICATIONS
- functional decline
- increasing bilirubin
- decreasing albumin
- increasing problems with complications
CONTRAINDICATIONS:
- malignancy
- active alcohol or drug abuse
- poor surgical risk
NURSING PROCESS
- reduce further liver damage
- teach client to make healthier lifestyle choices
- minimizing symptoms of disease
ASSESSMENT
HEALTH HISTORY:
- current manifestations
- extent of alcohol, injection drug use
PHYSICAL ASSSESMENT:
- vital signs
- mental status
- condition of skin and mucous membranes
- peripheral pulses, edema
- abdominal assessment
DIAGNOSIS
- excess fluid volume
- risk for acute confusion
- ineffective protection
- impaired skin integrity
- imbalanced nutrition: less than body requirements
PLANNING
- goals may include that client will
- maintain :
- proper hydration levels as indication by urine specific gravity (1.005- 1.030)
- appropriate diet
- vital signs within normal limits - report regular bowel elimination
- be orientated to person, place, time
- avoid alcohol
INTERVENTIONS
- stress relationship between alcohol, drug abuse and disease
- balance fluid volume
- weigh daily
- assess urine specific gravity
- provide low sodium diet
- restrict fluids as ordered
- monitor for signs of impaired renal function
- maintain mental status
MINIMIZE BLEEDING
- monitor vital signs
- institute bleeding precautions
- monitor coagulation studies,platlet count
- monitor client who has had bleeding esophageal varices
MAINTAIN SKIN INTEGRITY
- use warm water rather than hot
- use measures to prevent dry skin
- if indicated , apply mittens to hands
- institute measures to prevent skin breakdown
- administer prescribed antihistamine
PROMOTE BALANCE NUTRITION
- weigh daily
- provide small meals with snacks
- promote protein and nutrient intake (unless protein restricted)
- arrange consultation with dietitian
EXPECTED OUTCOMES
-monitor lab data (values should improve if therapy is successful)
biophysical data expectations:
- improvement in vital signs, LOC, appetite, mobility
- absence of bruising and bleeding
- adequate urinary and bowel elimination
- decreasing ascites
- restorative sleep and decreased discomfort
HOW TO RELIEVE PORTAL HYPERTENSION
transjugular intrahepatic portosystemic shunt (TIPS)
