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N324 > Ch. 53 Patients with Liver Problems > Flashcards

Ch. 53 Patients with Liver Problems Flashcards

1
Q

Hepatitis

A

A widespread inflammation and infection of the liver cells

Health promotion - Hep vaccines for A&B; no vaccine for hep C or E

5 types of hepatitis

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2
Q

Viral Hepatitis

A

Cause: environmental (chemicals, drugs, herbs)

Liver toxicity from drug therapy

Infection causes - Epstein Barr, Herpes simplex, varicella, CMV

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3
Q

Hepatitis Risk Factors

A

Advanced age

High risk exposures, travel, crowds

Blood transfusions (<1992)

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4
Q

Hepatitis A

A

Mild course

Flu-like symptoms, N/V/D

Fecal-oral route or food/water contamination

Cause: shellfish, direct contact or food exposure

Treatment: symptom control

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5
Q

Hepatitis B

A

Blood route: sharing needles, needle sticks, blood transfusions, hemodialysis, birth canal, unprotected sex

Diagnosed by blood test (up to 6 months from exposure to +blood test)

Treatment: acute = none; chronic = antivirals

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6
Q

Hepatitis C

A

Transmission: blood exposure, IV drug needle sharing, blood products, transplants, hemodialysis

Asymptomatic until routine lab tests

Treatment: antivirals

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7
Q

Which hepatitis is the leading cause of end stage liver disease-cirrhosis or liver cancer?

A

Hep C

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8
Q

Hepatitis Lab & Diagnostic

A

Hep A,B,C (lab test)

Hep C,D,E (antibody titers)

Elevated liver tests (AST, ALT, ALK phos, Bilirubin)

Liver biopsy
CT scan

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9
Q

Viral Hepatitis Clinical Manifestations

A

Upper abdominal pain
Yellow sclera (icterus)
Joint pain or muscle pain
Diarrhea or constipation
Light colored stools
Dark or yellow urine
Jaundice, Fever, Fatigue
N/V, Itchy and dry skin

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10
Q

Hepatitis Interventions

A

Promoting nutrition (HepA give carbs and calories)

Hydration

Prevention of spread of infection (universal precautions, hand washing, pt education)

Drug therapy

Managing fatigue w/ all hepatitis

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11
Q

Cirrhosis

A

Extensive, irreversible scarring of the liver, usually caused by chronic hepatic inflammation and necrotic injury

Scarring impairs cellular regulation = end stage liver disease

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12
Q

Cirrhosis Pathophysiology

A

Inflammation caused by toxins or disease with extensive degeneration/destruction of liver cells (hepatocytes)

Liver nodules blocks bile ducts and blood flow = decrease liver function over weeks to years

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13
Q

Cirrhosis Causes

A

Most common is chronic alcoholism

Chronic viral hepatitis & bile duct disease

Hep B&C

Autoimmune hepatitis

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14
Q

Cirrhosis Risk Factors

A

Age, obesity, DM, steatohepatitis (chronic inflammation from fatty liver disease), genetic

Drug - isoniazid and flutamide can cause post necrotic cirrhosis

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15
Q

Alcohol Withdrawal S/S

A

Tremors, jitters, delirium, confusion, anxiety, tachycardia, odd behaviors, high BP, sweating

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16
Q

Cirrhosis Physical Assessment (early signs)

A

Fatigue
GI symptoms - nausea, abd pain
Abdominal assessment (hepatomegaly, splenomegaly)
Daily wt. or changes in weight, girth measurements
Asterixis: coarse tremors w/ flexion
Anxiety, jitters, tremors
Confusion, agitation, altered LOC

17
Q

Cirrhosis Clinical Manifestations

A

Jaundice
Encephalopathy
Spider angioma
Lack of body hair
Muscle wasting
Widened blood vessels
Ascites
Red palms

18
Q

Jaundice

A

Cause: hepatocellular disease liver cells can’t excrete bilirubin, intrahepatic obstruction, edema, scarring on hepatic bile ducts interferes with excretion

Patients report itching excessively

Icterus

19
Q

Late Stage Cirrhosis

A

Jaundice & Icterus
Itchy and dry skin
Rashes
Petechiae or ecchymoses
Red, hot bright palms of hands (palmar erythema)
Spider angiomas on face, nose, chest
Ascites
Peripheral edema

20
Q

Cirrhosis Lab

A

Increased AST, ALT, LDH

Increased Alk phos

Increased total bili

Decreased albumin

Increased ammonia level

Decreased serum sodium

Increased creatinine (late)

Decreased WBC

21
Q

Complications of Cirrhosis

A

Ascites & Esophageal varices

Hepatic Encephalopathy

Portal HTN

Biliary Obstruction

22
Q

Nursing Priorities w/ Cirrhosis

A

Monitor respiratory status, skin integrity, fluid and electrolyte balance, neurologic status, overall nutrition, pain med, GI assessment

23
Q

Ascites

A

Collection of free fluid within the peritoneal cavity caused by increased hydrostatic pressure from portal HTN

Fluid shifts from vascular system to third spacing

Complications: hypovolemia and edema

24
Q

Esophageal Varices

A

Fragile thin-walled esophageal veins get distended from pressure

Elevated BP in veins carrying blood from intestines to liver

Location: distal esophagus, stomach, or rectum

Life threatening medical emergency causing hypovolemic shock

25
Q

Hepatic Encephalopathy

A

Complex cognitive syndrome from liver failure/cirrhosis (late)

Shunts portal venous blood into central circulation so liver is bypassed

Labs: elevated ammonia (>45)

26
Q

Hepatic Encephalopathy Clinical Manifestations

A

Confusion, mental status changes, mood changes , insomnia, speech difficulties (early)
Altered LOC, impaired thinking, neuromuscular problems (late)

27
Q

Lactulose

A

Indications: hepatic encephalopathy

PO or Rectal

MOA: excretes ammonia to improve levels (poop it out)

Side effects: can cause diarrhea which can lead to hypokalemia, cramps, distention

28
Q

Metabolic Encephalopathy Interventions

A

Strict I&O

Monitor VS trends

Assess pain and nutrition

29
Q

Portal Hypertension

A

Obstruction/blockage of blood flow in portal vein causing splenomegaly

Dilated veins in esophagus, stomach, intestines, abdomen, and rectum

Complications: ascites and esophageal varices

30
Q

Splenomegaly

A

From backup of blood into the spleen > enlarged spleen destroys platelets causing thrombocytopenia

31
Q

What is the early sign of liver disease?

A

Low Platelets

32
Q

Biliary Obstruction

A

Genetic

Obstruction of the bile duct that leads to biliary cirrhosis

Production of bile is decreased which prevents clotting factors to produce

33
Q

Biliary Obstruction Causes

A

Gallbladder (stones) disease or autoimmune disease

34
Q

Biliary Obstruction Intervention

A

Prevention of vitamin K absorption

35
Q

Managing Fluid Volume

A

Nutrition therapy - low Na diet, malnutrition w/ IV infusion with vitamins (banana bag)

Drug therapy - diuretic (furosemide or spironolactone); PO potassium or IV potassium

Paracentesis

36
Q

Paracentesis

A

Invasive procedure to remove abdominal fluid

US guided (at bedside)

HOB 30 degrees w/ oxygen as needed

Excessive fluid can cause respiratory problems w/ intra-abdominal pressure

Excessive fluid removal can cause fluid shifts

37
Q

Preventing/Managing Hemorrhage

A

Preventative med - beta blocker

Emergent Bleeding - Vasoactive drugs (beta blockers and vasopressin or octreotide)

38
Q

Managing Confusion

A

Fall risk precautions

Lactulose to remove ammonia in the blood

39
Q

Managing Pruritic

A

Due to high bilirubin in blood

Drug therapy - corticosteroids or sertraline

N324 (18 decks)

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