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Adult Health 2 - Exam 1 > Liver Problems > Flashcards

Liver Problems Flashcards

1
Q

Viral Hepatitis - Pathophysiology (&types)

A
  • Viral infection of liver w/ necrosis & inflamm of liver cells
  • Types:
    > A & E: fecal-oral route
    > B: body fluids
    > C common cause for liver cx & transplant
    > D with some B; IV drug use
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2
Q

Viral Hepatitis - CMs

A
  • Incubation (1-6mnths)
  • Arthalgia and rashes
  • Anorexia
  • Malaise, weakness
  • Jaundice & dark urine
  • Vague epigastric distress, nausea, heartburn, & flatus
  • Enlarged liver/abd tenderness
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3
Q

Hepatitis B - Diagnostics

A
  • Incrd liver enzymes
    > ALT (4-36 iu/L)
    > AST (0-35 u/L)
  • Antibodies
  • Liver biposy
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4
Q

Hepatitis B - Medical/Surgical Interventions

A
  • Alpha-interferon
    > injections 3x weekly for 16-24wks
  • 2 antiviral agent
    > Entecavir
    > Tenofovir
  • Bed rest until manis resolve
  • Diet
  • Liver transplant
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5
Q

Hepatitis B - Nursing Diagnosis

A
  • Activity intolerance
  • Fatigue
  • Imbalanced nutrition, less than
  • Acute pain
  • Social isolation
  • Knowledge deficit
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6
Q

Hepatitis B - Nursing Interventions

A
  • Encourage physical activity
  • Avoid sexual contact
    > chronic: may pass infection; for life
  • Psychosocial issues & concerns
  • Education self care
  • Prevention
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7
Q

Non-Viral Hepatitis - Common Meds

that cause condition

A
  • Acetaminophen
    > leading cause
  • Psychotropic meds
  • Antimetabolites
  • Anesthetic agents
  • Anticonvulsants
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8
Q

Chemicals That Have Toxic Effects on Liver

A
  • Acute liver cell necrosis
  • Similar to acute viral hep, but parenchymal destruction tends to be more extensive
  • Most common cause of acute liver failure greater than 50%
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9
Q

Cirrhosis - Pathophysiology

A
  • Chronic disease characterized by replacement of normal liver tissue w/ diffuse fibrosis
    > disrupts structure & func
    > liver becomes nodular; blood & lymph flow are impaired
  • Men greater than women
  • 40-60yr old
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10
Q

Cirrhosis - Types

A
  • 3 Types:
    > Alcoholic cirrhosis: most common
    > Post-Necrotic Cirrhosis: late result of acute viral hep
    > Biliary Cirrhosis: scarring occurs around bile ducts
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11
Q

Cirrhosis - Medical/Surgical Interventions

A
  • Antacids: GI distress
  • Potassium sparing diuretics
    > Spironolactone: dcr ascites
  • Diet
  • Colchicine/Statins: antifibrotic activity
  • Herb milk thistle (Silybum marianum): regenerative properties
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11
Q

Cirrhosis - Diagnosis

A
  • Serum albumin lvl dcr
  • Serum globulin lvl rises
  • Liver func tests
    > serum alkaline phosphatase, AST, ALT, & GGT lvls incr
    > bilirubin incr
  • CT, MRI, US
  • Liver biopsy: confirms diagnosis
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12
Q

Cirrhosis - Risk Assessment

A
  • Exposure to alcohol & drugs, herbs, meds, & chemicals
  • Needle stick injury, tattoo placement
  • Employment as a hlthcare worker, firefighter, or police officer
  • Assess sexual hx & orientation
  • Inquire abt family hx
  • Collect previous medical hx
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13
Q

Cirrhosis - CMs

A
  • Pallor/jaundice
  • Muscle atrophy
  • Edema
  • Skin excoriation (scratching)
  • Petechiae/spider angiomas
  • Enlarge liver or small/hard
  • Bilateral gynecomastia & testicular atrophy
  • Cognitive status/weakness
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14
Q

Cirrhosis - Progression

A
  • Portal HTN
  • Ascites & edema
  • Esophageal varices
  • Coagulation defects/anemia
  • Jaundice/pruritus
  • Hepatic Encephalopathy/coma
  • Bacterial peritonitis
  • Metabolic abnormalities
  • Vit deficiencies
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15
Q

Cirrhosis - Vitamin Deficiency

A
  • Inadequate formation, use, and storage of certain vitamins
  • A, C, D, K
16
Q

Cirrhosis - Anemia

A

Chronic gastritis & impaired GI func, together w/ inadequate dietary intake & impaired liver func

17
Q

Cirrhosis - Clotting Factor Deficiency

A

Incrd bleeding

18
Q

Cirrhosis - Metabolic Abnormalities

A
  • Abnormalities of glucose metabolism
    > BG high after a meal
    > Hypoglycemia during fasting bc of dcrd hepatic glycogen reserves & dcrd gluconegensis
  • Abnormalities Endocrine
    > liver cannot properly metabolize hormones: androgens & sex hormones
19
Q

Cirrhosis - Nursing Diagnosis

A
  • Activity intolerance
  • Disturbed body image
  • Excess fluid vol
  • Risk for bleeding
  • Risk for injury: LOC
  • Risk for acute confusion
  • Imbalanced nutrition: less than
  • Impaired skin integrity r/t pruritus from jaundice & edema
  • Fatigue
20
Q

Cirrhosis - Nursing Interventions

A
  • Promoting rest
  • Improving nutritional status
  • Providing skin care
  • Reducing risk for injury
  • Monitoring & managing potential complications
21
Q

Cirrhosis - Jaundice & Pruritus

A
  • Flow of bile impeded
  • Bilirubin concentration in blood incrd; collects in tissues causing jaundice
    > serum bilirubin lvl exceeds 2.0 mg/dL
  • Bile salts cause severe pruritus
22
Q

Cirrhosis Progression & Hepatic Encephalopathy

A
  • Monitor: to identify early deterioration in mental stat
  • Early: include mental stat changes & motor disturbances
    > extensive baseline & ongoing neurologic evaluation is key
  • Monitor electrolytes & ammonia lvls
  • Provide pt safety; prevent injury, bleeding infection
  • Prevention & early identification of life-threatening comps
    > resp failure & cerebral edema
  • Treatment: admin lactulose; traps & expels ammonia in feces
23
Q

Cirrhosis Progression - Ascites & Edema

Formation

A
  • Blood from digestive organs collects portal veins; carried to liver
  • Cirrhotic Liver: no free blood passage
  • Blood backs up into spleen & GI tract; chronic passive congestion
    > indigestion/alt bowel func result
  • Protein rich fluid accumulate in peritoneal cavity, producing Ascites
  • Liver cannot metabolize aldosterone further incring fluid
  • Reduces plasma albumin = Edema
24
Q

Cirrhosis Progression - Ascites & Edema

Nursing Interventions

A
  • Measure abd girth
  • Daily weights (fluid); I&Os
  • Na restricted diet
  • No salt subs unless ok w/ HCP
    > salt subs contain potassium & should be avoided if pt has impaired renal func
  • Admin diuretics (Spironolactone)
  • Monitor electrolytes, Cr, BUN, ammonia
  • Admin Albumin; pulls fluid into vascular system to be excreted by kidneys
  • Monitor for signs of infec/peritonitis
25
Q

Cirrhosis - Esophageal Varices

A
  • Varices are varicosities tht develop from portal HTN
  • Prone to rupture; massive hemorrhages UGI tract & rectum (hematemesis, melena)
  • Major cause of death in pts w/ cirrhosis
  • Several type of procedures used to treat & stop bleeding
26
Q

Cirrhosis - Esophageal Varices

Nursing Interventions

A
  • Support through procedure
  • Admin/monitor parenteral nutrition
  • NG to suction
  • Oral care
  • Close monitoring VS
  • Admin vit K/blood products
  • Manage delirium secondary to alcohol withdrawal
27
Q

Liver Transplant

A
  • Used to treat End Stage Liver Disease (ESLD) which no other treatment is available
  • Pt must undergo a thorough eval
    > model for End Stage Liver Disease (MELD) classification
  • Total removal diseased liver & replacement w/ a hlthy liver from a cadaver donor or right lobe from live donor in same anatomic location
  • Success of liver transplantation depends on successful immunosuppression
28
Q

Liver Transplant - Post Op Complications

A
  • Bleeding
    > result from coagulopathy portal HTN, & fibrinolysis caused by ischemic injury
  • Infection
    > leading cause of death after liver transplantation
  • Rejection
    > perceived by the immune system as a foreign antigen; immunosuppressive agents
29
Q

Liver Transplant - Nursing Interventions

A
  • Preop
    > stop drinking
    > must be available at all times in case liver becomes available
  • Admin of platelets, fresh-frozen plasma, or other blood products
  • Immunosuppression
  • Bacteria free envir’t
  • Follow up appts
  • Recognize signs of organ rejection
30
Q

Liver Transplant - Home Care

A
  • Provide written/verbal education abt meds
  • Avoid running out of meds or skipping dose
  • S/S tht indicate problems; consultation transplant team
  • Pt w/ a T-tube in place must be educated abt how to manage tube, drainage, & skin care
  • Follow-up lab tests & appts w/ transplant team
    > trough blood lvls of immunosuppressive agents
    > labs assess the func of liver & kidneys
  • Routine ophthalmologic examinations
    > cataracts & glaucoma associated w/ long-term corticosteroid therapy
  • Dental Care: admin of prophylactic antibiotics before dental exams
  • Birth control
31
Q

Liver Cancer - Pathophysiology

A
  • Primary
    > Hep B & C
    > Cirrhosis
  • Secondary
    > Metastases: other primary sites, particularly the digestive system, breast, & lung
32
Q

Liver Cancer - CMs

A
  • Pain
  • Weight loss
  • Loss strength
  • Anorexia
  • Anemia
  • Jaundice
  • Ascites
33
Q

Liver Cancer - Nursing Diagnosis

A
  • Bleeding, risk for
  • Falls, risk for
  • Imbalanced nutrition, less than
  • Nausea
  • Fatigue
  • Infection, risk for
34
Q

Liver Cancer - Nursing Interventions

A
  • Education
  • Bleeding precautions
  • Antiemetics
  • Maintain sterile technique
  • Post op care
35
Q

Liver Cancer - Home Care

biliary drainage at home

A
  • Pt/family fear tht catheter will become dislodged
    > reassurance * instruction can help reduce
  • Instruction on:
    > how to assess cath & insertion site
    > how to keep cath site clean & dry
    > irrigation of cath w/ sterile normal saline solution or water
    > proper technique to avoid introducing bacteria into biliary system or cath
    > instruct: not to aspirate or draw back on syringe during irrigation; prevent entry of irritating duodenal contents into biliary tree or cath
    > signs of infec of other comps; when to call

Adult Health 2 - Exam 1 (7 decks)

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