Liver, pancreas, gallbladder Flashcards
ARF is
Characterized by sudden & rapid decrease in renal function
Reversible with early, aggressive treatment its contributing etiology
ARF Phases
Initiation phase: contributing event reduced blood flow to nephrons leads to acute tubular necrosis
Oliguric phase: initial cellular insult fluid volume excess, azotemia seizures, coma, death
Diuretic phase: nephrons recover excretion of wastes & electrolytes still impaired BUN, creatinine, potassium, & phosphate levels still elevated
Recovery phase: takes 3-12 months for recovery normal glomerular filtration & tubular function are restored
Acute/ Chronic Renal Failure Findings
BUN, creatinine, potassium, magnesium, & phosphorus: elevated
Calcium: decreased
RBC count, H&H: decreased
pH of blood: Acidotic (< 7.35)
Urinalysis: decreased urine specific gravity
IVP: shows evidence of renal dysfunction
Percutaneous renal biopsy: destruction of nephrons
Imaging & US: structural defects
Renal angiography: obstructions in blood vessels
S/S of Kidney transplant rejection
Htn, edema, oliguria, fever, abdominal pain, swelling/tenderness over transplanted kidney, shortness of breath, weight gain, increase in serum creatinine levels
If the transplanted kidney was rejected what would you expect next?
Hemodialysis than wait for second transplant.
Hemodialysis
Artificial Kidney Removes Waste Products and Excess Water from Blood
Peritoneal dialysis
The peritoneal membrane is used as a semipermeable membrane across which excess wastes and fluids move from blood in peritoneal vessels into dialysate solution
AV Fistula
AV Fistula is made by sewing a vein and artery together under the skin. AV fistulas may take 1-4 months to mature.
AV graft
An AV graft uses a tube of synthetic material to attach to an artery and a vein in the upper or lower arm. Needles are inserted into the graft to access the patient’s blood. AV grafts 14 days after insertion.
Hemodialysis Nursing Care
Assess & record VS before & during HD
Weigh client; obtain blood for lab tests
Prepare vascular access: “feel the thrill hear the bruit”: Note color of skin, nailbeds, & mobility of fingers. Avoids puncturing the same site used prior
Observe for disequilibrium syndrome
Hemodialysis Teaching
Avoid carrying heavy items
Wear clothing with loose sleeves
Do not sleep on vascular access arm
Do not permit venipunctures, injections, or BPs in vascular access arm
Wash skin over vascular access daily
Asses for a thrill or bruit daily
Report s/sx of infections or impaired blood flow
How is peritoneal dialysis done
Uses peritoneum to filter fluid, wastes, & chemicals
Hypertonic dialysate due to dextrose
Dialysate instilled & drained from abdominal cavity through a catheter
Catheter is sutured in place with dressing applied
Peritoneal Dialysis Nursing care
Obtain & review lab test findings
Record VS & weight
Monitor for s/sx of peritonitis: fever, nausea; vomiting; severe abdominal pain, rigidity, or tenderness before, during, or after PD
More peritoneal dialysis nursing care
*Instillation: Warm solution
Add prescribed drugs e.g. antibiotics
Attach dialysate & tubing to catheter
Instill solution & clamp
Record instillation time, volume, type of dialysate, any drugs added
Monitor BP & pulse frequently
Drainage: Open clamp to observe appearance of fluid
Report drainage if cloudy or blood-tinged
Notify HCP if marked abdominal distention
Measure difference between volume instilled & volume removed
Functions of the liver
Metabolizes glucose
Regulates blood glucose connectration
Converts glycogen to glucose to maintain normal glucose levels
Synthesizes amino acids fromt he breakdown of protein and form muscles produce during excerise
Coverts ammonia
Metabolizes proteins and fats
Stores vitamin A, B, and some B-complex vitamins as well as iron and copper
Metabolizes drugs
Forms and excretes bile
Extretes bilirubin
Synthesizes factors needed for blood coagulation
Liver Dysfunction (Early and late)
*Early:
GI symptoms common-anorexia, n&v, flatulence, diarrhea or constipation
Abd pain- right upper quadrant - enlarged liver
Fever, lassitude (lack of energy, slight wt loss
*Later:
Jaundice
Peripheral edema and ascites
Skin changes / lesions
Hematologic disorders
Endocrine disorders
Peripheral neuropathy
Hemolytic jaundice
due to increased breakdown of RBC`s – increased unconjugated bilirubin in the blood
Hepatocellular jaundice
due to liver`s decreased ability to take up bilirubin, or to conjugate it or to excrete it
Obstructive jaundice
due to impeded flow of bile thru liver or biliary system
Cirrhosis
Chronic progressive, degenerative liver disorder caused by generalized cellular damage
Types of Cirrhosis
- Alcoholic- -associated with excess intake of alcohol and other hepatotoxic substances
- Postnecrotic - complication of viral, toxic or idiopathic hepatitis
- Bililary- assosicated with bililary infection and obstruction
- Nonalcoholic Steatohepatitis (NASH)- fatty live
Hematologic problems
Thrombocytopenia
Leukopenia
Anemia
Coagulation disorders
Peripheral neuropathy
Due to dietary deficiencies of thiamine, folic acid and vitamin B-12
Characterized by numbness and tingling, loss of feeling or weakness
Assessment Findings of Cirrhosis
Clinical manifestations: compensated and decompensated
Chronic fatigue, anorexia, dyspepsia, nausea, clay-colored stools, diarrhea
Constipation, tea-colored urine, weight loss, abdominal discomfort
Shortness of breath, nosebleeds, signs of incomplete estrogen metabolism in men
Nursing Management Liver
Monitor vital signs, weight, intake, output, and abdominal girth; small meals
Client response to drug therapy: change in mental status, signs of GI bleed
Client teaching: liver disorder, support groups, treatment regimen, home care
Nutritional Therapy for Liver
Fat is restricted for clients with fat malabsorption (steatorrhea).
Sodium is restricted to 2 g/day when ascites is present.
Fluid restriction is imposed in clients with hyponatremia.
A high-calorie diet is recommended for clients with malnutrition, weight loss, or infection.
Adequate calories are essential to ensure protein sparing.
A high-protein diet is used to prevent muscle wasting.
Small, frequent meals and the use of nutritional supplements may help boost intake in clients who have nausea, vomiting, or fatigue
Because of the anorexia that accompanies severe cirrhosis, the client may better tolerate frequent, small, semisolid, or liquid meals rather than three full meals a day
Client Education Liver
Follow the diet recommended by the primary provider.
Consult a dietitian if you require a special diet
Avoid situations that could further damage the liver, such as drinking alcohol, taking tranquilizers, or inhaling chemicals such as benzene or vinyl chloride, which are toxic.
Rest frequently, especially if activity causes fatigue.
Avoid exposure to people with known infections.
Continue skin care.
Avoid nonprescription drugs (especially aspirin and products that contain it because they contribute to bleeding problems) unless approved by the primary provider.
Contact the primary provider immediately about vomiting of blood, tarry stools, extreme fatigue, yellow skin, light-colored stools, or dark urine
Major Complications of Cirrhosis
Portal Hypertension
Clients can experience:
GI bleeding as evidenced by vomiting of blood, or black, tarry stools or bloody stools
Portal Hypertension can cause
Esesophageal and gastric varices, caput medusae and hemorrhoids
Interventions for Esophageal Varices
Prevent a rupture:
Interventions for Ascites
Sodium restriction
Fluid restrictions
Diuretics
Paracentesis
Shunting procedures
Hepatic Encephalopathy
Hepatic encephalopathy – also called Portal-systemic encephalopathy(PSE) due to an accumulation of ammonia in systemic circulation – the ammonia crosses the blood brain barrier and produces toxic neurologic effects
lethargy to deep coma –
Confusion, mood swings, personality changes
Asterixis – flapping tremors or liver flap
Fetor hepaticus- slightly sulfurous (fecal) breath odor
Cholelithiasis
stones in the gallbladder
Choledocholithiasis: stones located in the common bile duct
Cholecystitis
Inflammation or infection of the gallbladder caused by stones.
Gallbladder Disorders
1) Initially:
belching, n/v
RUQ discomfort
pain or cramps after high-fat meals
Symptoms become acute when a stone blocks bile flow from the gallbladder.
2) With acute cholecystitis, clients usually are very sick
fever, vomiting, abdominal tenderness over the liver
severe RUQ pain called biliary colic.
Slight jaundice
dark urine
Light-colored stools
Pancreas functions
Produces hormones
Islets of Langerhans
Hormones that regulate blood sugar (insulin, glucagon)
Regulate pancreatic secretions
Blood sugar is crucial to brain, liver and kidney function.
Acute Pancreatitis-
Severe mid-abdominal to upper abdominal pain radiating to sides and back; vomiting
Frothy and foul-smelling stools; sign of steatorrhea: increased fat in the stool
Physical examination: jaundice, diminished bowel sounds, abdomen is tender to palpate, hypotension. Severe pancreatitis may result in bruising around the umbilicus or on the flanks.
Acute Pancreatitis Nursing Management
Monitor client for life-threatening changes; alcohol withdrawal
Perform the prescribed treatment measures: NG tube, IV fluids
Perform assessments
Report any sudden changes to physician
Nutrition:
TPN cautiously due to high glucose levels
Tube feed
“Bowel rest”
Chronic Pancreatitis Nursing Management
Administer analgesics as ordered..
Withhold oral feedings. “bowel rest” Instruct client to remain on bed rest. Bed rest reduces metabolic rate and thus decreases secretion of pancreatic and gastric enzymes.
Report unrelieved pain or sudden increased intensity of pain. Increased pain stimulates secretion of pancreatic enzymes. Sudden increased pain may indicate pancreatic rupture.
Administer anticholinergic medications as ordered. They reduce gastric and pancreatic secretions.
Maintain continuous nasogastric drainage. Drainage removes gastric contents and prevents gastric secretions from entering the duodenum
Pancreatic Cancer
Similar to chronic pancreatitis:
Speculation on whether pancreatitis is a precursor or consequence of tumor development
Left upper abdominal pain;
jaundice, obstructive jaundice; pruritus; ascites
tumors of the head of the pancreas tend to cause obstructive jaundice
anorexia, weight loss;
Pancreatic Cancer Nursing Management
Acute Pain related to surgical procedure
Hypovolemia related to hemorrhage and loss of fluids
Altered Breathing Pattern related to abdominal discomfort and drainage tubes
Infection Risk related to invasive procedure and poor physical condition
Malnutrition Risk related to high metabolic requirements and decreased ability to digest food
Injury Risk related to failure to consume adequate calories or get enough insulin
Death Anxiety related to shortened lifespan and poor prognosis
Chronic Traumatic Encephalopathy
Repetitive concussions
Sports related
Long-term effects: dementia, depression, Parkinson’s disease, and early-onset Alzheimer’s
Cerebral Hematomas Management
Burr holes
Intracranial surgery: craniotomy, craniectomy, and cranioplasty
*Surgical Approaches
Supratentorial-through the cerebrum
Infratentorial- through the cerebellum
Cerebral Hematomas Nursings Management
*Preoperative Nursing Care
Hair removal, vital signs, neurologic assessment; antiembolism stockings
Restrict fluids
*Postoperative Nursing Care
Supine or side-lying position
Regular monitoring; observe for increased ICP
Control thrombus or embolus; cerebral edema
Spinal Nerve Root Compression Management
Spinal support and alignment; bed rest in semi-Fowler’s position; tractions
Proper body mechanics
Muscle relaxants and analgesics; moist heat application
Evaluation of client response to therapy
Acromegaly (Hyperpituitarism)
oversecretion of GH due to hyperplasia
Coarse features; huge lower jaw, thick lips, thickened tongue, bulging forehead
Bulbous nose, large hands and feet
Enlarged organs, muscle weakness
Simmonds’ Disease (Panhypopituitarism)
Hypothyroidism, hypoglycemia, adrenal insufficiency; gonads and genitalia atrophy; premature aging; cachexia
Hyperthyroidism (Graves Disease)
Restless, agitated, hand tremors, diarrhea
Increased appetite, weight loss, visual changes, exophthalmos, neck swelling
Diagnostic Findings: serum T3, T4, TSH; thyroid scan and ultrasonography
Thyrotoxic Crisis (Thyroid Storm)
Cardiac dysrhythmias, vomiting, delirium
Hyperthyroidism history, laboratory tests
High temperature, rapid pulse, dyspnea
Hypothyroidism
Slow metabolic rate, lethargy, weight gain, dry skin, menstrual disorders
Enlarged heart, atherosclerosis, anemia
Diagnostic Findings: serum TSH, T3, T4; FT4; RAI uptake
Thyroiditis
High fever, malaise, and swollen
Tender thyroid gland
Diagnostic Findings: thyroid scan; lab tests
Hyperparathyroidism
Fatigue; hypotonic muscles
Skeletal tenderness and pain
Cardiac dysrhythmias
Nursing Management
Monitor I and O; urinary calculi; self-care; safe environment
Encourage fluid intake
Provide postoperative care
Client education: effects of disease; adherence to treatment
Adrenal Insufficiency (Addison’s Crisis)
Anorexia, vomiting, diarrhea, abdominal pain, hypotension, fever
Diagnosis: symptoms; history
Cushing’s Syndrome
Cushingoid syndrome, muscle wasting
Moon face, buffalo hump, wounds, masculinization, kyphosis
Diagnostic findings: dexamethasone suppression test; 24-hour urine; blood test; radiographs; IV pyelogram; CT; MRI
Hyperaldosteronism
Muscle weakness, fatigue, cardiac dysrhythmias; Headache; Increased urine; Hypertension
Laboratory tests; CT; MRI; adrenal venography
