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NSG 219 Med-Surg 1 > Liver Problems and Care, Ch. 53 > Flashcards

Liver Problems and Care, Ch. 53 Flashcards

1
Q

Priority Concepts for Liver Disorders

A

Impaired Cellular Reg. & Infection

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2
Q

Interrelated Concepts for Liver Disorders

A

Fluid and electrolyte balance
Inflammation
Pain
Nutrition

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3
Q

-Cirrhosis COMPLICATION, when fragile, thin-walled esophageal veins become distended and tortuous from ^ pressure (r/t portal hypertension)
-Bleeding=Lethal Emergency w/ RISK of shock from hypovolemia
-Sites: distal esophagus, rectum, stomach
-Treatment: Dec. Prothrombin time (LAB); AVOID NSAIDs and blood thinners

A

Esophageal Varices (EV)

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4
Q

-Complication of ESLF and Cirrhosis, complex cognitive syndrome
-SX: mood changes, LOC alt (respond only to pain), Sleep problems, Speech problems, Neuromuscular problems (ex. Asterixis: hand flapping)
-LAB: ^Serum Ammonia (bi-product of protein breakdown), ^bilirubin
-Treatment: LACTULOSE=laxative to dec. ammonia levels; Reversable if detected early

A

Hepatic Encephalopathy
a.k.a. Portal-Systemic Encephalopathy

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5
Q

Widespread inflammation and infection of liver cells
- ^ RISK: liver cancer or Cirrhosis, Chronic Viral Infection
- MUST REPORT case to health dept. and then CDC
- Types: A,B,C,D,E

A

Hepatitis

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6
Q

Liver enlargement, Palpatable, is common in Early Cirrhosis

A

Hepatomegaly

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7
Q

A rapidly growing liver DZ that is associated with obesity, DM type 2, and metabolic syndrome (aka insulin resistant syndrome; a group of conditions that together raise risk of Coronary Heart DZ, DM, Stroke, and other serious health problems)

A

Nonalcoholic Fatty Liver DZ (NAFLD)

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8
Q

An invasive PROCEDURE performed to ABD fluid in pt. who have massive ascites; Fluid Volume INTERVENTION

A

Paracentesis

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9
Q

Round, pinpoint, red-purple hemorrhagic lesions.

A

Petechiae

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10
Q

Major COMPLICATION of Cirrhosis.
Persistent ^ pressure in hepatic portal vein (>5mm Hg)
-Blood flow resistance or obstruction seeks alt. venous channels around the high-pressure area = Blood backflow into the spleen causing Splenomegaly
-results in ascites/esophageal varices (distended veins)

A

Portal Hypertension

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11
Q

Interventional radiologic PROCEDURE performed for pt. who has not responded to other modalities to MANAGE hemorrhage or long-term ascites
-Insert a stent (tube) to connect the portal veins to adjust blood vessels w/ low pressure
-dec. pressure through liver can stop bleeding and fluid back up

A

Transjugular Intrahepatic Portal-system Shunt (TIPS)

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12
Q

A DZ characterized by widespread fibrotic (scarred) bands of connective tissue that change the liver’s A&P

A

Cirrhosis

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13
Q

-Postnecrotic (Viral Hepatitis, Toxins)
-Laennec’s (Alcoholic)
-Biliary (Autoimmune disorder or chronic obstruction

A

Types of Cirrhosis

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14
Q
  1. Portal Hypertension
  2. Ascites/ Esophageal Varices
  3. Biliary Obstruction
  4. Hepatic Encephalopathy
A

Complications of Cirrhosis

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15
Q

COMPLICATION of Cirrhosis
-Obstruction of bile duct, either genetic, gallbladder DZ, or autoimmune DZ
-Prevents absorption of fat-soluble vit. (vit. A,D,E,K) = w/out vit. K clotting factors are dec. = possible bleeding and bruising
-S/SX: Jaundice r/t ^ bilirubin (body unable to excrete); Pruritus

A

Biliary Obstruction
a.k.a. Primary Biliary Cirrhosis (only r/t to autoimmune DZ)

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16
Q

Collection of free fluid w/in the peritoneal cavity caused by ^ hydrostatic pressure from Portal Hypertension, Painful and uncomfortable

A

Ascites

17
Q

-Fatigue, weight changes, GI sx, Dyspnea (ascites)
-ABD assess: pain over liver or ABD, distended ABD; Ascites
-Jaundice and Icterus (yellow sclerae)
-Dry skin; Pruritus; Rashes
-Petechiae; Ecchymoses (bruises)
-Palmer Erythema (warm and red palms)
- Vascular lesions w/ red center and radiating branches (spider veins) on nose, cheeks, upper thorax, and shoulders
- Peripheral dependent edema
- Vit. def. esp. fat-soluble (A,D,E,K)

A

Cirrhosis ASSESSMENT: S/SX of Cirrhosis

18
Q

Alcohol withdrawal: if pt. is dependent
Sleep, Behavioral changes, moods

A

Cirrhosis ASSESSMENT: Psychosocial

19
Q

-AST, ALT, LDH: ^ r/t inflamation
-Alkaline Phosphatase: ^ = Obstructive jaundice or hepatic metastasis
- Serum Bilirubin: ^ =jaundice & Pruritus
-Serum Albumin: ^ = Severe Liver dz
- PT/INR: Clotting factor, Long time frame = dec. clotting fxn
-CBC: (RBC, H&H, Platelets) = hemorrhage
- Ammonia Level: ^ = altered mental state

A

Cirrhosis ASSESSMENT: LABS

20
Q

PRIORITY PROBLEMS
-Fluid overload (ascites)
-Potential for Hemorrhage r/t Varices
-Acute Confusion r/t ^ammonia levels and/or alcohol withdrawal
-Pruritus r/t ^ Serum Bilirubin and Jaundice

A

ANALYZE CUES: Cirrhosis

21
Q
  1. Managing Fluid Volume
  2. Preventing or Managing Hemorrhage
  3. Preventing or managing Confusion
  4. Managing Pruritis
A

PLANNING: Cirrhosis

22
Q

-PREVENT additional accumulation & dec. existing fluid (RESTRICT Na (b/c Na ^ fluid retention and causes Polydipsia; and fluid intake)
- ^ HOB to min. SOA
-PROVIDE vit. supplements (B,A,C,K, folic acid, thiamine)
**- MONITOR Diuretics = I/O’s, edema, resp., electrolytes
-pt. wt. & measure girth
-Paracentesis = dec. resp. distress & ABD pain

A

INTERVENTIONS: Cirrhosis Fluid Volume

23
Q

-Explain PROCEDURE
-ASK pt. to void before to avoid bladder damage
- MEASURE drainage and record characteristics: NEVER drain >2000mL = hypovolemic shock
- Send fluid to LAB ANALYSIS
- REMOVE cath. and dress; ASSESS for leakage
-WT. pt. before and after procedure
-MONITOR for SPONTANEOUS BACTERIAL PARATENITIS (fluid shift into bowels; analysis LAB Leukocyte count >250 PMN)

A

Pt. Safety and Care: Paracentesis

24
Q

-Screened for Esophageal Varices (ENDO) before they bleed
- Bleeding Varices = EMERGENCY (sx: hematemesis, melena); RISK: Hypovolemic Shock = dramatic dec. BP
**- Propranolol = to dec. HR and hepatic venous pressure to reduce bleeding
- Endoscopic Variceal Ligation (EVL), Endoscopic Sclerotherapy (EST)
- Balloon Treatments, TIPS, Stents, Stents, Shunts
- MONITOR: H&H, PT/INR, BP, Resp.; ADMIN blood products

A

INTERVENTIONS: Cirrhosis Hemorrhage

25
Q

-Slow or stop accumulation of ammonia
-DIETARY LIMITS = limit proteins, fatty foods, simple carbs
**- Lactulose = Laxitive; dec. intestinal production/ absorption of ammonia; diarrhea gets rid of excess and converts the rest to nonabsorbable NH4+
-OBSERVE: LOC, orientation, drug rxn, ammonia lvls, dehydration, electrolytes, & skin (LABS: ordered q12hr or q24hr)
-CHECK for asterixis = worsening of encephalopathy

A

INTERVENTION: Cirrhosis Confusion

26
Q
  • Risk: Crowds, poor sanitation/ no hand washing
  • Transmission: Fecal/Oral, contaminated food, uncooked shellfish, water/ milk, poorly washed utensils; SX = Diarrhea
  • Infectious: 2-3 weeks, curable, can resolve w/out treatment; TEST: HAV antibodies present
  • Prevention: STRICT/ FREQUENT handwashing, stool and needle precautions, water treatments, AVOID contaminated food or water, Hep A VACCINE
A

Hepatitis A

27
Q

-Risk: IV drug users, HC workers, Long-term Hemodialysis
- Transmission: blood/body fluid contact while infected
- Incubation: sx last 28-180 days ( some ppl are aSX), can resolve w/out treatment
- Testing: Blood test = presence of Hep B antibodies (pt. is infectious)
- Prevention: STRICT handwashing, Blood Screening, Testing all pregnancies, HEP B VACCINE

A

Hepatitis B

28
Q
  • Leading cause of ESLD in world; Most common bloodborne infection in US
  • Risk: IV drug users (common), baby boomers, frequent transfusions
  • Transmission: Blood to Blood, blood products and blood transfusions done before 1992
  • Incubation: 2-6wks, most aSX and aren’t DX for months or years, CURABLE; Testing: HCV antibodies
  • Prevention: NO VACCINE, strict handwashing, blood screening, needle precautions
A

Hepatitis C

29
Q

Common among Mediterranean/ Middle East Areas
- Risk: drug users, hemodialysis, frequent blood transfusions
- Transmission: Blood to Blood
- Incubation: 2-26wks; Testing: Hep D antigen
- Prevention: HEP B VACCINE = HDV depends on HBV to replicate

A

Hepatitis D

30
Q

Waterborne infection assoc. w/ epidemics in countries (fecal contamination of food and water), Travelers
- Incubation: 2-9wks
- Prevention: STRICT handwashing

A

Hepatitis E

31
Q
  1. Fulminant Hepatitis = failure of liver cell regeneration, necrosis, severe acute and often FATAL form of hepatitis
  2. Chronic Hepatitis = >6mnths, results from Hep B&C; can lead to Cirrhosis and liver cancer
A

Hepatitis Complications

32
Q
  • Proper handwashing (esp. after handling shellfish)
  • AVOID contaminated food or water
A

special Recommendations for HAV

33
Q

Physical S/SX
-ABD pain, Icterus, Jaundice
- Palpation for tenderness, skin inspection
- depression, myalgia (muscle aches/ pain), renal issues, Cognitive Impairment, Heart DZ
Psychosocial
-Emotion of chronic illness, fatigue, social stigma, embarrassment, family afraid of getting DZ

A

ASSESSMENT: Hepatitis

34
Q

-Wt loss r/t complications assoc. w/ liver inflammation
- Fatigue r/t Dec. Metabolic energy production and Infection

A

ANALYZE CUES/ HYPOTHESES: Hepatitis

35
Q

PRIORITY: Rest the liver, promote regeneration, ^ immunity, prevent complications
- Diet: ^carbs and calories/ dec. Fats; small frequent meals; vit. supplements
- Manage fatigue: ^ ADL participation
**- Antiviral meds (“-vir): use sparingly to not overwork liver, Monitor Kidney fxn, pt. now a fall risk
-PREVENT SPREAD OF INFECTION

A

PLANNING/ IMPLEMENTATION: Hepatitis

36
Q

++-Tenofovir, Adefovir: monitor kidney function, Tenofovir ( teach pt risk of falls, bc causes bone demineralization)
++-Lamivudine: Monitor Kidney function, teach pt do not Dc without notifying MD bc can cause flare up
++-Entecavir: monitor kidney function, teach pt to avoid ETOH to prevent serious interactions!

A

Hepatitis B ANTIVIRAL MEDS “-vir”

37
Q

All can weaken immune system and cause pt to be susceptible to infections
++-Grazoprevir, Simprevir, partaprevir = Monitor labs, common reactions like HA, itching, nausea
++-Elbasvir: can cause Hep B to reactivate if pt had it previously
++-Ledipasvir: cannot be taken with amiodarone (Cardiac Med)

A

Hepatitis C ANTIVIRAL MEDS

38
Q

-Maintain an adequate nutritional status for body requirements.
-Report increasing energy levels as the liver rests.

A

OUTCOMES/ EVALUATION: Hepatitis

39
Q
  • Home Care Management – assess living situations (caregivers, bathroom, access)
  • Self-Management Education – on diets, drugs, ETOH abstinence, home drains and care, bleeding education, s/s of encephalopathy
    ++-AVOID all OTC meds esp. NSAIDs, Acetaminophen
  • Health Care Resources – home health nurses, group therapies, social & community supports, hospice services
A

Cirrhosis: CARE for Coordination

NSG 219 Med-Surg 1 (4 decks)

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