Liver Dysfunction - Exam 2 Flashcards
Sources of Hepatitis A
Crowded conditions, poor personal hygiene, poor sanitization, contaminated food, milk, H20, infected food handlers, sexual contact
Sources of Hepatitis B
contaminated needles, syringes, and blood products, asymptomatic carriers, sexual contact, tattoos, piercings
Sources of Hepatitis C
Blood and blood products, needles, syringes, and blood products, sexual contact with infected partners
Toxic sources of Hepatitis
Systemic posions: carbon tetrachloride and gold compounds
Toxic/drug/chemical induced hepatitis
acetaminophen, INH, chlorothalazide (Diurill), methotrexate, methyldopa
Causes of Cirrhosis
Alcohol abuse
Postnecrotic: complication of viral, toxic, or idiopathic
Biliary: chronic billiary obstruction and infection
Cardiac: long standing, severe right sided heart failure
Active Natural Immunity
Natural contact with the antigen through clinical infection
Active Artificial Immunity
Immunization with an antigen (vaccine)
Passive Natural Immunity
Transplacental and colostrum trasnfer from mother to child
Passive Artificial Immunity
Infection of serum from immune human (providing antibodies)
Hepatitis A Immunity
- Active Natural - Contact with the antigen through clinical infection
- Active Artificial - HAV is inactivated Hepatitis A virus. Route is IM in the deltoid. Booster recommended. All children over the age of 1 should receive the vaccine, as should others at risk. Pre exposure prophylaxis as well as postexposure
- Passive natural - Mother must have h/o Hep A or is vaccinated against
- Passive Artificial - Immunoglobulin can be used for either pre or post exposure prophylaxsis. It is temporary immunity. Must be given within 2 weeks after exposure. May be given to household contacts, as well as co-working food handlers and patrons of restaurants
Hepatitis B Immunity
- Active Natural - Natural contact with antigen through clinical infection
- Active Artificial - HBV uses recombinant DNA to synthesize Hep. B antigen. Route is IM in the deltoid. Booster recommended. Vaccine is routine for all newborns and adolescents, as well as others at risk (health care workers). Used for pre and post exposure prophylaxis.
- Passive Natural - Mother must be vaccinated or have been exposed through active natural contact with Hep B
- Passive Artificial - Hepatitis B immune globulin (HBIG) is recommended for post exposure prophylaxis. It is temporary immunity. It is given within 24 hours of exposure. May be given in cases of needle stick mucus membrane contact or sexual exposure, and also to newborns of Hep B positive mothers
Hepatitis C Immunity
No vaccine available
Bilary Artesia
A progressive inflammatory process that causes both intrahepatic and extrahepatic duct fibrosis, resulting in obstructive bile flow
Portal Hypertension
The structural changes in the liver from the cirrhotic process causes obstruction to the normal flow of blood through the portal system. Obstruction leads to increased pressure.
Esophageal Varices
Complex, tortuous veins at the lower end of the espophagus, enlarged and swollen as a result of portal hypertension.
Hepatic Encephalopathy
Neuro-psychiatric manifestations of the liver damage, considered a terminal complication of liver disease. Occurs with high ammonia levels
End Stage Liver Disease
When liver function is so impaired that death is imminent, unless transplantation is performed.
Hepatitis
An inflammation of the liver, commonly caused by a virus.
Cirrhosis
A chronic, progressive disease of the liver characterized by extensive degeneration and destruction of liver cells
Ascites
An accumulation of serous fluid in the peritoneal or abdominal cavity, exacerbated by portal HTN and decreased serum albumin levels
Icterus
jaundice
Liver Biopsy
Description: Percutaneous procedure uses needle inserted between 6th and 7th or 8th and 9th RIGHT intercostal spaces to obtain a specimen
Purpose: To obtain a specimen of hepatic tissue, follow progress of liver disease, detect rejection, diagnose disease
Pre-Procedure Nursing Considerations: coagulation state (avoid blood thinners), T&C, Informed consent, baseline vitals
Procedure Nursing Considerations: Explain breath holding (liver descends in abdominal cavity and decreases risk of pneumothorax
Post-Procedure Nursing Considerations: Freq VS, Side-lying X 2 hours on RIGHT side to put pressure on site of biopsy, bed flat X 12-14 hours, assess for complications: infection, bleeding, bile, peritonitis, shock, pneumothorax)
Parencentesis
Description: To remove ascitic fluid for diagnostic and therapeutic purposes
Diagnostic: To send to the lab for analysis
Therapeutic: Temporary relief of ascites. Can improve ventilation. Reserved for those with impaired R and/or pain.
Palliative: Fluid usually reaccumulates, can have drain implanted for frequent fluid removal during late stages
Pre-Procedure Nursing Considerations: patient teaching, informed consent, urinate before test, check abdominal girth, check weight, check VS, may give albumin before and/or after procedure
Procedure Considerations: High fowler’s, sterile technique, measure volume removed, monitor abnormalities, check for leaks
Post-Procedure Considerations: band aid to site, label specimen, send to lab, observe site, measure girth, measure weight, take VS, monitor albumin, monitor electrolytes, monitor for infection
Administration of Serum Albumin
Description: Hyperosmolar-solution acts by moving water from extravascular to intravascular space.
Purpose of Procedure: Treats ascites and fluid volume overload
Considerations: no crossmatch necessary; these are pooled proteins from numerous donors, administer upon opening as there are no preservatives, administer cautiously in cardiac and pulmonary disease because circulatory overload may result from volume expansion
Oncotic Pressure - Is extended by colloids in solution. Protein molecules attract water, pulling fluid from the tissue space into the vascular space. Unlike electrolytes, the large protein molecules stay in the vascular space.
lactulose (Cephulac)
Classification: synthetic keto-analog of lactose
Mechanism of Action: Acidification of feces in bowel and trapping of ammonia, causing elimination VIA the bowels
Use: cirrhosis, to reduce ammonia formation in the liver, ex of hepatic encephalopathy
Side/Adverse Effects: Laxative effect
Nursing Implications: monitor mental status freq, monitor/record number and consistency of stool (may need to hold if too many stools/day), monitor ammonia levels, monitor bowel sounds, given PO when GI function is normal, also give PR/NG
spironolactone (Aldactone)
Classification: Diuretic
Mechanism of Action: Blocking of aldosterone, potassium sparing
Use: Cirrhosis; effective diuretic in patients with severe sodium retention
Side/Adverse effects: hyperkalemia, orthostatic hypotension, diuretics that works in different ways are more effective than single dose therapy
Nursing Diagnoses/TNIs for the patient with Cirrhosis
Imbalanced Nutrition: Less than body requirements r/t anorexia, impaired use and storage, N/V
-Monitor weight, provide oral care before meals, administer antiemetics, provide small freqent meals
Impaired skin integrity r/t edema, ascites, pruritis
-Keep fingernails short, apply medicated creams, support edematous areas, turn q2h
Excess Fluid Volume r/t portal hypertension
- Weight daily, administer diuretics, monitor I&O, monitor edema, provide appropriate diet
Potential Complication Hemorrhage r/t altered clotting factors and rupture of varices
-Monitor for bleeding, gentle nursing care, soft toothbrush, teach to avoid straining
Potential Complication: Hepatic encephalopathy r/t increased formation of ammonia
-Monitor behavior, LOC and ammonia levels
Early clinical manifestations of Cirrhosis
- GI Disturbances
- Anorexia
- Dyspepsia (indigestion)
- Flatulence
- N/V
- Change in bowel habits
- Abdominal pain
- Fever
- Lassitude (fatigue)
- Weight loss
- Enlarged liver or spleen
Late clinical manifestations of Cirrhosis
- Jaundice
- Decreased ability to conjugate and excrete bilirubin by liver cells
- Functional derangement of liver cells
- Compression of bile ducts by overgrowth of connective tissue
- Pruritus from accumulation of bile salts
- Splenomegaly (enlargement of the spleen)
- From backup of blood from portal vein
- Bleeding tendencies
- Decreased production of hepatic clotting factors
- Peripheral neuropathy (nerves to brain are not working properly)
- Dietary deficiencies of thiamine, folic acid, and vitamin B12
Esophageal and Gastric Varices Care
Goal: Avoid bleeding hemorrhage
- Avoid alcohol, aspirin, NSAIDs, and irritating foods
- Respiratory infection promptly treated to avoid coughing
If bleeding occurs:
- Stabilize patient
- Manage the airway
- Initiate IV therapy
- Endoscopic sclerotherapy
- Endoscopic ligation
- Balloon tamponade
- Fresh frozen plasma
- Packed RBCs
- Vitamin K
- Gastric ulcer prophylaxis
