Nursing Assessment

Question 1

Juandice

Answer 1

yellow discolourationof skin and eyes due to increase in bilirubin.
Raised levels of unconjugated bilirubin
Liver coverts this to conjugted bilirubin (excreted in bile via kidneys)
If Liver is not working bilirubin is not being excreted

Question 2

Management of Juandice

Answer 2

• Monitoring of jaundice -documentation
• Monitoring of blood levels –bilirubin
• Monitoring of stool colours- pale?
• Monitoring of urine colour- Any colour?
• Monitor for other signs of liver
  disease

Question 3

Faltering Growth

Answer 3

liver stores vitamins and minerals

Failing liver=poor function = impaired digestion and storage
of fat soluble vitamins = poor growth and development

Question 4

Management of Faltering Growth

Answer 4

• Close monitoring of weights
• Vitamin supplements
• Dietician input
• Feeding support – Nasogastric tubes
• Training of parents with feeding tubes
• Specialist milks
• Parental nutrition – prep for liver transplantation

Question 5

Pruritis (itching)

Answer 5

Pruritus is an indication for liver transplantation
in paediatric patients.

Question 6

Management of Pruritis

Answer 6

• Medication
• Cool environment
• Psychological / emotional support
• Prevent scratching (mittens/toys to hold)
• Wound management

Question 7

Portal Hypertension

Answer 7

Increased blood pressure in the portal veins as a result of liver disease or a blockage of the portal vein.

Question 8

Varices

Answer 8

vessels develop in the wall of the oesophagus
or stomach

varices grow larger to carry more blood, the wall becomes stretched thinner and thinner. Eventually the wall of the vein may stretch so thin that it splits open, causing a variceal bleed.

Question 9

Management of Varices

Answer 9

• ABCDE
• Code red- emergency blood
• Fluid management
• NBM – 2/3 maintenance
• Medication: Octreotide
• Monitoring of blood numbers:
  INR/PLT/Hb
• Theatre – banding/sclerotherapy

Question 10

Ascites

Answer 10

protein rich fluid which accumulates in the peritoneal cavity
Albumin helps fluid stay in blood vessels at a higher
osmotic pressure than surrounding tissues
Indication of decompensated liver disease.

Question 11

Nursing management

Answer 11

• Daily weights and girths
• Close respiratory assessments
• Nursed upright
• Feeding support – NGT
• Albumin infusions
• Ascitic tap