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NURS 3512 - Class 1-6 > Week 6 - Cirrhosis > Flashcards

Week 6 - Cirrhosis Flashcards

1
Q

what is cirrhosis

A
  • liver disease where liver cells become extremely damaged due to long term/severe damage
    = leading to the damaged cells being replaced with fibrous tissue (scarring of the liver) and hepatocyte dysfunction
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2
Q

what can cause cirrhosis (2)

A
  • chronic liver diseases (ex. chronic hep)

- excessive alcohol intake

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3
Q

what are some early symptoms of cirrhosis (3)

A
  • RUQ pain
  • nonspecific symptoms
  • GI symptoms
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4
Q

what are manifestations of advanced cirrhosis due to (2)

A
  • portal HTN

- liver failure

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5
Q

what is portal HTN

A
  • occurs when the portal vein becomes narrowed due to scar tissue in the liver
    = restricts the flow of blood to the liver and increases pressure in the portal vein
    = affect the organs connected to the portal vein –> spleen, GI tract, gallbladder, pancreas
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6
Q

what symptoms of cirrhosis occur d/t portal HTN (4)

A
  • splenomegaly
  • varicies
  • edema and ascites
  • gastropathy
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7
Q

what are varices

A
  • toruous, enlarged, and swollen veins
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8
Q

what can varices occur during cirrhosis (4)

A
  • esophageal
  • gastric
  • rectal varices –> hemorrhoids
  • abdominal –> caput medusae
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9
Q

where are esophageal varices located

A
  • lower end of the esophagus
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10
Q

where are gastric varices located

A
  • upper portion (fundus) of stomach
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11
Q

what is the danger associated w varices (3)

A
  • the varices are fragile and can rupture & bleed –> life threatening
  • esophageal varices can cause upper GI bleed
  • platelet count will be low along with clotting factors available AND levels of Vitamin-K…they are at risk for a total bleed out
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12
Q

why does edema and ascites occur in cirrhosis (3)

A
  • decreased oncotic pressure d/t impaired liver synthesis of albumin
  • venous congestion from portal HTN
  • hyperaldosteronism
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13
Q

what symptoms occur in cirrhosis d/t liver & hepatocyte failure (9)

A
  • ascites & edema
  • jaundice
  • coma
  • fetor hepaticus
  • asterixis
  • skin lesions
  • hematological problems
  • endocrine problems
  • peripheral neuropathy
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14
Q

why does jaundice occur in cirrhosis

A
  • liver has decreased ability to conjugate bilirubin

- may also have obstruction of biliary tract

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15
Q

what 2 types of skin lesions occur in cirrhosis

A
  • spider angiomas –> spider nevi

- palmar erythema

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16
Q

what are spider nevi

A
  • small, dilated blood vessels w bright red center and spdier-like branches
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17
Q

what causes the skin lesions in cirrhosis

A
  • increase in circulating estrogen d/t the damaged liver’s ability to metabolize steroid hormones
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18
Q

what hematological problems can occur in cirrhosis (4)

A
  • thrombocytopenia
  • leukopenia
  • anemia
  • coagulation disorders
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19
Q

what causes thrombocytopenia, anemia, and leukopenia in cirrhosis

A
  • splenomegaly –> overactivity of enlarged spleen = increased removal of blood cells (esp. plts) from circulation
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20
Q

the coagulation problems in cirrhosis occur d/t (3)

A
  • liver’s inability to produce prothrombin, low plts, low K
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21
Q

what coagulation problems can occur in cirrhosis

A

bleeding tendencies:

  • epistaxis
  • purpura
  • petechiae
  • easy bruising
  • gum bleeding
  • heavy menstrual bleeding
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22
Q

what impact does cirrhosis have on the endocrine system

A
  • the liver’s inability to metabolize estrogen, testosterone and adrenocorticla hormones
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23
Q

what endocrine symptoms occur in cirrhosis (4)

A
  • gynecomastia
  • loss of body hair
  • testicular strophy
  • amenorrhea
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24
Q

what does hyperaldosteronism in cirrhosis cause (3)

A
  • sodium retention
  • water retention
  • K loss
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25
Q

what is hepatic encephalopathy

A
  • changes in neuro and mental function d/t build up of ammonia
  • ranges from lethargy to coma
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26
Q

what are signs of hepatic encephalopathy (10)

A
  • sleep disturbances
  • lethargy
  • changes in neuro and mental responsiveness
  • coma
  • memory loss
  • irritability
  • confusion
  • droswiness
  • asterixis
  • fetor hepaticus
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27
Q

what is a serious complication of cirrhosis

A
  • hepatorenal syndrome
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28
Q

what is hepatorenal syndrome

A
  • functional kidney failure with advancing azotemia, oliguria, intractable ascites
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29
Q

what neuro S&S are present in cirrhosis (3)

A
  • hepatic encephalopaty
  • peripheral neuropathy
  • asterixis
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30
Q

what GI symptoms are present in cirrhosis (9)

A
  • anorexia
  • NV
  • change in bowel habits
  • RUQ abdominal pain
  • fetor hepaticus
  • esophageal and gastric varices
  • gastritis
  • hematemesis
  • hemorrhoidal varices
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31
Q

what reproductive symptoms are present in cirrhosis (4)

A
  • amenorrhea
  • testicular atrophy
  • gynecomastia
  • impotence
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32
Q

what integumentary symptoms are present in cirrhosis (6)

A
  • jaundice
  • spider nevi
  • palmar erythema
  • purpura
  • petechiae
  • caput medusae
33
Q

what hematological symptoms are present in cirrhosis (5)

A
  • anemia
  • thrombocytopenia
  • leukopenia
  • coagulation disorders
  • splenomegaly
34
Q

what metabolic symptoms are present in cirrhosis (3)

A
  • hypoalbumineria
  • hyponatremia
  • hypokalemia
35
Q

what CVS symptoms are present in cirrhosis (3)

A
  • fluid retention
  • peripheral edema
  • ascites
36
Q

what diagnostic studies are used for cirrhosis (5)

A
  • LFTs
  • elevated liver enzymes
  • PT or INR
  • liver biopsy
  • noninvasive fibrosis markers
37
Q

what is goal of collaboartive care in cirrhosis

A
  • treat complications and slow disease
38
Q

what is treated/managed in collaborative care of cirrhosis (6)

A
  • rest
  • ascites
  • esophageal varices
  • hepatic encephalopathy
  • nutrition therapy
39
Q

management of ascites is focused on (4)

A
  • sodium restriction (2g/day)
  • diuretics –> spironolactone
  • fluid removal –> paracentesis
  • admin of salt-poor albumin
40
Q

what should be monitered/assessed r/t mngmt of ascites (2)

A
  • I&O

- electrolyte balance

41
Q

when is paracentesis indicated in treatment of ascites? what is a con to paracentesis

A
  • if diuretic therapy fails
  • treatment of symptoms such as abdominal pain & troule breathing
  • con: only a temporary solution bc fluid reaccumulates
42
Q

what is the main therapeutic goal r/t esophageal and gastric varices

A
  • prevent bleeding
43
Q

pts w esophageal varices should avoid… (4)

A
  • NSAIDs
  • aspirin
  • alcohol
  • irritating foods
44
Q

management of bleeding varices include (3)

A
  • emergency
  • therapeutic
  • prophylactic interventions
45
Q

when esophageal variceal bleeding occurs, what are the initial steps (4)

A
  • stabilize pt and manage airway
  • VS
  • IV initiation
  • vasopressin
46
Q

how is variceal bleeding diagnosed

A
  • endoscopy
47
Q

what drug therapy is used for treatment of varices (5)

A
  • non-selective beta blockers –> propranolol
  • vasopressin (may be admin w nitro)
  • blood products
  • PPI
  • lactulose
48
Q

why is lactulose given as a treatment for variceal bleeding

A
  • prevent hepatic encepalopathy from breakdown of blood & release of ammonia
49
Q

what endoscopic treatment can be done for variceal bleeding (3)

A
  • banding
  • ligation
  • sclerotherapy
50
Q

what does sclerotherapy do

A
  • thromboses and obliterates the distended veins
51
Q

what is banding/ligation

A
  • small rubber band is slipped around base of the varix –> essentially strangles the vein so it cant be bleed
52
Q

what is an additional treatment for varices

A
  • balloon tamponade
53
Q

what is balloon tamponade? when is it used

A
  • controls the hemorrhage by mechanical compression of the varices
  • used if hemorrhage cannot be controlled on initial endoscopy
54
Q

what effect does propanolol have on management of varices

A
  • reduces risk of bleeding by decreasing portal HTN (prophylactic)
55
Q

what procedure can be done for esophageal varcies

A
  • surgical & nonsurgical shunting of blood away from the esophageal varices
56
Q

it is important to ensure pts are on ______, if they have varices. why?

A
  • stool softeners

- sudden rupture of vessels from increased abdominal pressure if straining can cause hemorrhage

57
Q

what is the goal of mngmt for heptic encephalopathy

A
  • reduction of ammonia formation
58
Q

what can be used to reduce ammonia formation r/t hepatic encephalopathy (2)

A
  • lactulose

- treatment of precipitating causes

59
Q

what are some factors precipitating hepatic encephalopathy (10)

A
  • GI hemorrhage
  • constipation
  • hypokalemia
  • hypovolemia
  • infection
  • cerebral depressants
  • metabolic alkolosis
  • paracentesis
  • dehydration
  • increased metab
  • uremia
60
Q

what nutrition therapy is indicated for cirrhosis (4)

A
  • high cal (3000/day)
  • high carb
  • mod to low fat
  • if ascites and edema, low sodium
61
Q

describe the acute intervention for cirrhosis (17)

A
  • conserve energy –> rest
  • maintain adequate nutrition
  • tx NV
  • assess jaundice
  • relief of pruritis
  • note color of urine and stools
  • record I&O, daily weights (r/t ascites & edema)
  • semi-fowlers for dyspnea (r/t ascites)
  • monitor VS and dressing post-paracentesis
  • turning schedule (q2h), skin care (edematous tissue prone to breakdown)
  • ROM exercise, DB&C (ascites - move very little, prevent resp problems)
  • elevate lower extremities
  • monitor electrolytes & S&S of imbalance
  • monitor signs of bleeding
  • assess pts response to altered body image
  • monitor cognition
  • provide meds as ordered (& analgesics)
62
Q

what interventions can help provide adequate nutrition for a pt with cirrhosis (4)

A
  • small meals
  • snacks
  • good oral care
  • food preferences available whenever possible
63
Q

what can help relieve pruritis (5)

A
  • cholestyramine
  • baking soda baths
  • lotions w antihistamines
  • calamine
  • short nails
64
Q

if a pt is undergoing paracentesis, what should they do prior to the procedure and why

A
  • void to prevent puncture of bladder
65
Q

if the pt has esophageal or gastric varices, what should you monitor (2)

A
  • signs of bleeding (hematemesis, melena)

- call physician if hematemesis present

66
Q

what should you assess/monitor regarding hepatic encephalopathy (5)

A
  • level of responsiveness
  • sensory & motor abnormalities (asterixis)
  • fluid & electrolyte
  • acid-base imbalances
  • effect of treatment
67
Q

how often should assessment of neuro status be completed

A
  • at least q2h
68
Q

what pt education should be completed r/t cirrhosis

A
  • avoid NSAIDs and ASA
  • avoid alcohol
  • avoid ACE-I (fluid retention)
  • avoid sleeping pills & sedatives (r/t encephalopathy)
  • low sodium diet
  • higher risk of infection –> imp of vaccinations, infection prevention
  • S&S of disease decomp
  • U/S monitoring q6 mo.
  • no heavy lifting (risk of hemorrhage)
69
Q

a nursing diagnosis r/t cirrhosis is imbalanced nutrition. what nursing interventions can be done for this

A
  • same as hepatitis
70
Q

a nursing diagnosis for cirrhosis is impaired skin integrity. what pruritis management can be done to provide relief of pruritis and maintain skin integrity (2)

A
  • keep fingernails trimmed short

- apply medicated creams and lotions

71
Q

a nursing diagnosis for cirrhosis is impaired skin integrity. what skin care & topical treatments can be used to help maintain skin integrity (8)

A
  • inspect skin daily for breakdown
  • provide support to edematous areas (scrotal, pillows under arms)
  • turn q2h
  • keep bed linen clean, dry, wrinkle free
  • use nonalkaline cleanser on skin
  • provide nail care
  • admin antipruritic med as ordered
  • provide distractions
72
Q

a nursing diagnosis for cirrhosis is excess fluid volume. what hypervolemia management interventions can be done to achieve normal fluid balance & maintain BP and urinary output within normal limits (4)

A
  • weigh pt daily
  • administer prescribed meds (diuretics)
  • monitor I&O
  • monitor changes in peripheral edema
73
Q

a nursing diagnosis for cirrhosis is excess fluid vol. what fluid/electrolyte management interventions can be completed ? (2)

A
  • provide prescribed diet (low sodium, fluid restriction, low protein, no added salt) to prevent additional fluid retention
  • obtain lab specimens for monitoring of latered fluid & electrolytes to evaluate effectiveness of treatment
74
Q

a nursing diagnosis of cirrhosis is ineffective health management r/t insufficient knowledge of therapeutic regimen. what substance use treatment can be implemented (4)

A
  • encourage or praise pt efforts to accept responsibility for substance use-related dysfunction & treatment
  • instruct pt on effects of substance used
  • assist pt in developing health, effective coping mechanisms
  • encourage pt to participate in self-help program during and after treatment
75
Q

what self responsibility facilitation interventions can implemented during cirrhosis (6)

A
  • hold pt responsible for own behavior to facilitate responsible behaviors
  • discuss w pt the extent of responsibility for present health status
  • discuss consequeces of not dealing w own responsibility to emphasize realistic outcomes
  • set limits of manipulative behavior
  • refrain from arguing or bargaining about the established limits w pt
  • provide positive feedback for accepting additional responsibility and/or behavior change
76
Q

a nursing diagnosis during cirrhosis is dysfunctional family process r/t ineffective coping strategies, substance misuse. what family therapy nursing interventions can be implemented (6)

A
  • assess family communication to identify approp interventions
  • identify family strengths and resources
  • help members prioritize and select the most immediate family issue to address
  • help family enhance existing positive coping strategies
  • help family set goals towards more competenet way of handling dysfunctional behavior
  • monitor for adverse therapeutic responses
77
Q

a potenatial complication of cirrhosis is hepatic encephalopathy. what nursing interventions can be implemented for this (3)

A
  • assess pts general behavior, orientation, speech
  • provide laxatives and enemas as ordered to move toxins out of body
  • watch for signs of infection to reduce risk of encephalopathy
78
Q

a potential complication of cirrhosis is hemorrhage r/t altered clotting factors and rupture of varices. what nursing interventions can be implemented for this (9)

A
  • monitor for hemorrhage to provide early inytervention
  • provide gentle nursing care to reduce risk of tissue trauma
  • watch for bleeding episodes –> hematuria, melena
  • use smallest gauge needle possible when giving injection & apply gentle but prolonged pressure after
  • use soft bristled toothbrush
  • avoid irritating foods to reduce trauma (mucous membranes have increased risk of injury d/t high vascularity)
  • teach pt to avoid straining at stool, vigorous blowing of nose, & coughing
  • observe for bruising on skin to detect bleeding early
  • monitor lab (hematocrit, hgb, PT time)

NURS 3512 - Class 1-6 (47 decks)

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