- PRODROMAL PHASE - ICTERIC PHASE - (5-10 DAYS AFTER INTIAL S/S) - CONVALESCENT PHASE-(2-3 WEEKS OF ACUTE ILLNESS)

Liver Disorders Flashcards by Shanna Gray

what is the role of Albumin

maintains intravascular colloid osmotic pressure

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phases of hepatitis

PRODROMAL PHASE
ICTERIC PHASE - (5-10 DAYS AFTER INTIAL S/S)
CONVALESCENT PHASE-(2-3 WEEKS OF ACUTE ILLNESS)

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The “TIPS” procedure is completed to relieve______

Portal Hypertension

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Hematologic problems often seen with cirrhosis

Thrombocytopenia

Neutropenia

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TOTAL BILIRUBIN

normal lab values

0.1 - 1.2 mg/dl

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NORMAL LAB VALUES FOR :
ALT…
AST…
BILIRUBIN…

ALT 4-36 units/L
AST 0-35 units/L
BILI 0.1 - 1.2 mg/dL

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Three (3) medications that can cause liver damage and require sporadic liver function testing be performed

1) ALLOPURINOL
2) ISONIAZID
3) DILANTIN

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Vitamin Deficiencies of Cirrhosis (3)

1) Decreased Vitamin K
2) Decreased Vitamin A
3) Decreased Folic Acid

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NORMAL BILIRUBIN VALUES

0.1 - 1.2

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S/S of Spontaneous Bacterial Peritonitis

increased abdominal pain
Increased ascites
fever
worsening encephalopathy

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HEMATOLOGICAL PROBLEMS with CIRRHOSIS (2)

1) THROMBOCYTOPENIA (platelets <150,000)

2) NEUTROPENIA (ANC <1,500)

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_____________ is the byproduct of protein metabolism

ammonia

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Four (4) signs of Esophageal Varices

1) Distended vessels in esophagus
2) Hematemesis
3) Melena (dark tarry stools)
4) S/S of shock

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acute bacterial infection of ascetic fluid

Spontaneous Bacterial Peritonits (SBP)

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HGB

normal lab values

12 - 18

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NURSING INTERVENTIONS FOR:

HEPATIC ENCEPALOPATHY

ASSESS LOC
LOW PROTEIN DIET
SERUM AMMONIA LEVEL
LACTULOSE
SAFETY PRECAUTIONS

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WITH CIRRHOSIS—-what labs do we expect to be DECREASED?

-Albumin
-Total Protein
-RBC
-HGB
-HCT
-PLTS

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daily max dose of Tylenol for patient with healthy liver

4 grams

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PLATELETS

normal lab values

150 - 400

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NURSING INTERVENTIONS FOR:

BALANCE FLUID OVERLOAD

DAILY WEIGHT
I / O
MEASURE ABDOMINAL GIRTH
FOCUSED REPIRATORY ASSESSMENT
ADMINISTER DIURETICS

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Functions of Liver (7)

GAACVDB
“Girls Are Always Chasing Very Dumb Boys”

G---Glucose Metabolism/Storage
A---Albumin production
A---Ammonia to Urea
C---Clotting factor production
V---Vitamin absorption
D---Drug Metabolism
B---Bilirubin excretion

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Absorption of _______ vitamins are decreased with liver disease

fat soluble

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What is Melena?

Tarry Stool typically seen with UPPER GI bleeds (ie, esophagus, stomach, duodenum)

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NORMAL SERUM AMMONIA VALUES

15-45

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Why does ascites cause SOB?

-increased pressure on diaphragm causing pleural effusion of lungs leading to SOB

Four (4) risk factors for developing Cirrhosis

1) ETOH abuse 2) Chronic Hepatitis B or C 3) Acetaminophen use 4) IV Drug use

Cirrhosis typically caused by (3) things:

1) ETOH abuse 2) Viral Hepatitis 3) Medication

Medications used in the management of cirrhosis

Spironolactone (aldactone)-diuretic Furosemide (LASIX)-diuretic Lactulose (Cephulac)-Reduces ammonia level Vitamin K-Fat soluble vitamin

Assessment of Hepatic Encephalopathy (4)

1) Increased Ammonia (15-45) 2) Mental Status Changes 3) Asterixis (AKA: Liver Flap of hands) 4) Fetor Hepaticus (Sour-fecal smell to breath)

Liver converts ________ to urea to be excreted by the kidneys

ammonia

S/S of SBP (4) | (Spontaneous Bacterial Peritonitis)

1) Increased abdominal pain 2) Increased ascites 3) FEVER 4) Worsening Encephalopathy

Three (3) main problems to assess in patient with liver disease...and why?

1) Bleeding problems (r/t decreased clotting factors) 2) Toxin problems (r/t elevated ammonia & bilirubin) 3) Fluid problem (r/t increased fluid retention)

NORMAL PT LAB VALUES

10-13 SECONDS

(True/False) Lactulose can only be given PO

False. It can be administered rectally and PO

CLIENT EDUCATION WITH CIRRHOSIS

- AVOID ETOH - SODIUM, PROTEIN, FLUID RESTRICTIONS - REPORT S/S OF GI BLEEDING - SKIN CARE

NURSING INTERVENTIONS FOR: | SKIN INTEGRITY

- WARM WATER - LOTION FOR DRY SKIN - ANTIHISTAMINES

PROTHROMBIN (PT) | normal lab values

10 - 13 seconds

AMMONIA (normal lab values)

15 - 45

Portal HTN can cause _________ and ______ and______

Esophageal Varices Ascites Spleenomegaly

NORMAL PROTEIN LAB VALUES

6 - 8

The scar tissue in the liver blocks blood flow through the liver causing backup the venous system known as__________________

Portal HTN

TOTAL PROTEIN (Normal lab Values)

6-8 g/dl

ALT | normal lab values

4 - 36 units/L

RBC | normal lab values

4 - 6

Assessment of ascites

``` Increased Abdominal Girth Weight Gain Dyspnea 3rd spacing (NA and water retention) decreased serum albumin ```

Ammonia levels are typically _______ with liver disease | NORMAL VALUES?

elevated | (NORMAL) = 15-45

acute bacterial infection of ascitic fluid is called_____

Spontaneous Bacterial Peritonitis (SBP)

ammonia is the byproduct of ___________metabolism

protein

INFLAMMATION OF THE LIVER

HEPATITIS

NORMAL ALBUMIN LAB VALUES

3.5 - 5 g/dl

__________ is produced by the breakdown of RBC's which then get excreted by the liver

BILIRUBIN

ALBUMIN LAB VALUES (Normal)

3.5 - 5 g/dl

Assessment of patient with Esophageal Varices (4)

1) Distended vessel in esophagus (r/t yo Portal HTN) 2) Hematemesis (vomiting blood) 3) Melena (Tarry Stool-seen with upper GI bleeding) ___Esophagus, Stomach, Duodenum 4) S/S of Shock ***Rapid breathing/pulse ***cool, pale, clammy skin ***N/V ***Enlarged Pupils

decreased excretion of bilirubin leads to a condition called ___________

Jaundice

NURSING INTERVENTIONS FOR: | NUTRITION

- WEIGH DAILY - SMALL MEALS W/SNACKS - VITAMIN SUPPLEMENTS - DIET: HIGH CARBS-LOW PROTEIN-LOW SODIUM

How is albumin affected by a diseased liver? | Normal lab values for Albumin?

decreased albumin | (NORMAL)= 3.5 - 5 g/dl

Complications of CIRRHOSIS (2)

1) Hepatic Encephalopathy | 2) Esophageal Varices

why is the patient with liver disease at an increased risk for bleeding?

decreased production of clotting factors

End stage chronic liver disease is known as _________

Cirrhosis

Fat Soluble Vitamins (BAD FOLK)

- Vitamin B-12 - Vitamin A - Vitamin D - Folic Acid - Vitamin K

NURSING INTERVENTIONS FOR: | BLEEDING RISK

- MONITOR VSS - INSTITUTE BLEEDING PRECAUTIONS - CHECK COAGULATION PROFILES - TEST STOOL-EMESIS FOR BLOOD

___________ is produced by the breakdown of RBC's

BILIRUBIN

Four (4) signs of Hepatic encepalopathy

1) elevated ammonia level 2) Mental Status change 3) Asterixis 4) fetor hepaticus

HCT | normal lab values

37 - 52%

This medication is given to decrease the amount of ammonia absorbed into the blood

Lactulose (Cephulac)

ASSESSMENT OF CIRRHOSIS (14)

``` Jesse and shanna palmer, finally shanna gray found HAPPE (JASPFSGFHAPPE) ________________________________________ Jaundice Ascites Spider Angiomas Palmar Erythema Fetor Hepaticus Striae on abdomen Gynecomastia/Hirsuism Fatigue Hepatosplenomegaly Altered LOC Pruritis Petchiae Edema Esophageal Varices ```

Tylenol is contraindicated for which two patients?

RENAL or HEPATIC patients

RISK FACTORS FOR CIRRHOSIS (4)

1) etoh abuse 2) chronic viral HEP C/HEP B 3) acetaminophen abuse (4grams/day is max) 4) IV DRUG USE

AST | normal lab values

0 - 35 units/L

WHY IS THE LIVER BIOPSY PERFORMED?

To rule out other types of liver disease- It does NOT DX cirrhosis

Liver Disorders Flashcards

Digestion, Hepatitis (70 cards)