1. Understanding Medical Surgical Nursing, 4th Edition Nursing Care of Patients with Liver, Pancreatic, and Gallbladder Disorders

2. Understanding Medical Surgical Nursing, 4th Edition Hepatitis Inflammation of the Cells of the Liver, Usually Caused by a Virus Types of Hepatitis HAV HBV HCV HDV HEV HGV

3. Understanding Medical Surgical Nursing, 4th Edition Prevention of Hepatitis Hand Hygiene Vaccines HAV HBV Standard Precautions Immune Globulin

4. Understanding Medical Surgical Nursing, 4th Edition Signs and Symptoms Prodromal Stage: 1 Week Flu-like Symptoms, RUQ Pain Icteric Stage: 2 to 6 Weeks Jaundice, Worsening Symptoms Convalescent: 2 to 6 Weeks Returning to Normal Liver Function

5. Understanding Medical Surgical Nursing, 4th Edition Complications Liver Failure Acute Chronic Chronic Infection Carrier Risk of Liver Cancer

6. Understanding Medical Surgical Nursing, 4th Edition Diagnostic Tests Liver Enzymes Serum Bilirubin Prothrombin Serologic Tests Liver Biopsy

7. Understanding Medical Surgical Nursing, 4th Edition Therapeutic Interventions Rest Nutrition Interferon Therapy Antivirals Avoidance of Alcohol and Liver-toxic Drugs

8. Understanding Medical Surgical Nursing, 4th Edition Nursing Diagnoses Pain Imbalanced Nutrition Risk for Impaired Skin Integrity Risk for Ineffective Self-Health Management

9. Understanding Medical Surgical Nursing, 4th Edition Acute Liver Failure Pathophysiology Sudden Massive Loss of Liver Tissue Etiology Drug Toxicity Hepatitis

10. Understanding Medical Surgical Nursing, 4th Edition Signs and Symptoms Jaundice Encephalopathy Confusion Coma Bleeding

11. Understanding Medical Surgical Nursing, 4th Edition Diagnostic Tests ALT AST Serum Bilirubin PT Potassium Blood Glucose

12. Understanding Medical Surgical Nursing, 4th Edition Therapeutic Interventions Bedrest Eliminate all Drugs Possible Dialysis High-calorie, Low-sodium, and Protein Diet Lactulose, Neomycin, Magnesium Citrate, Sorbitol Transplant

13. Understanding Medical Surgical Nursing, 4th Edition Cirrhosis Progressive, Irreversible Replacement of Healthy Liver Tissue with Scar Tissue 12 th Leading Cause of Death

14. Understanding Medical Surgical Nursing, 4th Edition Cirrhosis (cont’d) Etiology Chronic Alcohol Use – Most Common Hepatotoxins Hepatitis Gallbladder Obstruction Heart Failure

15. Understanding Medical Surgical Nursing, 4th Edition Pathophysiology Inflammation of Liver Cells Infiltration with Fat and WBC Fibrotic Scar Tissue Replaces Liver Tissue Abnormal Regeneration Impaired Liver Blood Flow Impaired Liver Function

16. Understanding Medical Surgical Nursing, 4th Edition Signs and Symptoms

17. Understanding Medical Surgical Nursing, 4th Edition Complications of Cirrhosis Clotting Defects Portal Hypertension Varices Ascites Encephalopathy Hepatorenal Syndrome

18. Understanding Medical Surgical Nursing, 4th Edition Portal Hypertension

19. Understanding Medical Surgical Nursing, 4th Edition Diagnostic Tests Liver Enzymes Bilirubin Serum Ammonia Prothrombin Abdominal X-Ray Ultrasound Esophagastroscopy Liver Biopsy

20. Understanding Medical Surgical Nursing, 4th Edition Therapeutic Interventions Ascites Diuretics Sodium Restriction Paracentesis Albumin Infusion TIPS

21. Understanding Medical Surgical Nursing, 4th Edition Therapeutic Interventions (cont’d) Esophageal Varices Vasoconstrictors Banding Sclerotherapy Vitamin K Antibiotics

22. Understanding Medical Surgical Nursing, 4th Edition Therapeutic Interventions (cont’d) Encephalopathy Lactulose Neomycin Restrict Dietary Protein Dialysis

23. Understanding Medical Surgical Nursing, 4th Edition Nursing Diagnoses: Acute and Cirrhosis Excess Fluid Volume Imbalanced Nutrition Pain Risk for Disturbed Thought Processes Risk for Ineffective Breathing Pattern Risk for Deficient Fluid Volume Risk for Infection

24. Understanding Medical Surgical Nursing, 4th Edition Patient Education Disease Process Signs and Symptoms to Report Adequate Rest Diet Avoid Narcotics, Sedatives, Tranquilizers, Alcohol Follow-up Care

25. Understanding Medical Surgical Nursing, 4th Edition Liver Transplant Candidates Liver Failure No Cancer No Complications Otherwise Stable

26. Understanding Medical Surgical Nursing, 4th Edition Anti-Rejection Meds Cyclosporine (Cyclosporin A) Tacrolimus (Protopic) Azathioprine (Imuran) Prednisone (Deltasone) Mycophenolate mofetil (Cellcept)

27. Understanding Medical Surgical Nursing, 4th Edition Signs of Rejection Pulse >100 bpm Temperature >101°F RUQ Pain Increase in Jaundice Decrease in Bile from T-tube Elevated Liver Enzymes

28. Understanding Medical Surgical Nursing, 4th Edition Cancer of the Liver Usually Metastasized from Another Site Risk Factors Chronic Hepatitis B Nutritional Deficiencies Exposure to Hepatotoxins

29. Understanding Medical Surgical Nursing, 4th Edition Signs and Symptoms Encephalopathy Bleeding Jaundice Ascites

30. Understanding Medical Surgical Nursing, 4th Edition Diagnosis Serum Alkaline Phosphatase Abdominal X-Ray Liver Scan Ultrasound Biopsy

31. Understanding Medical Surgical Nursing, 4th Edition Therapeutic Interventions Surgery Chemotherapy

32. Understanding Medical Surgical Nursing, 4th Edition Acute Pancreatitis Pathophysiology Inflammation Autodigestion Elevated Enzymes Fluid Loss Complications Shock DIC Chronic Pancreatitis

33. Understanding Medical Surgical Nursing, 4th Edition Etiology Alcohol Biliary Disease Trauma Certain Drugs

34. Understanding Medical Surgical Nursing, 4th Edition Signs and Symptoms Abdominal Pain Guarding Rigid Abdomen Hypotension or Shock Respiratory Distress Low-grade Fever Nausea and Vomiting Jaundice

35. Understanding Medical Surgical Nursing, 4th Edition Complications Cardiovascular Failure Acute Respiratory Distress Syndrome Acute Renal Injury Hemorrhage Infection

36. Understanding Medical Surgical Nursing, 4th Edition Diagnostic Tests Serum Amylase Serum Lipase X-Ray CT Scan Ultrasound

37. Understanding Medical Surgical Nursing, 4th Edition Therapeutic Interventions NPO IV Fluids/TPN, Nutrition NG Suction Analgesics, Anti-anxiety Agents Oxygen Blood Products PRN

38. Understanding Medical Surgical Nursing, 4th Edition Chronic Pancreatitis Pathophysiology Progressive Fibrosis Obstructed Ducts Ulceration Etiology Alcohol Biliary Disease

39. Understanding Medical Surgical Nursing, 4th Edition Prevention Alcohol Abstinence Biliary Disease Treatment Nutritional Intake Monitoring

40. Understanding Medical Surgical Nursing, 4th Edition Signs and Symptoms Remissions and Exacerbations LUQ Pain Anorexia and Weight Loss Malabsorption Diabetes Mellitus

41. Understanding Medical Surgical Nursing, 4th Edition Diagnosis Pancreatic Enzymes Normal High Fecal Fat Level Changes on CT Scan

42. Understanding Medical Surgical Nursing, 4th Edition Therapeutic Interventions Analgesics Pancreatic Enzyme Replacement Surgery

43. Understanding Medical Surgical Nursing, 4th Edition Nursing Diagnoses: Acute and Chronic Pancreatitis Pain Imbalanced Nutrition Risk for Ineffective Breathing Pattern Risk for Injury

44. Understanding Medical Surgical Nursing, 4th Edition Cancer of the Pancreas Ductal Adenocarcinoma of Exocrine Pancreas Risk Factors High-fat Diet Smoking Diabetes Mellitus Alcohol Chronic Pancreatitis

45. Understanding Medical Surgical Nursing, 4th Edition Signs and Symptoms Weight Loss Abdominal Pain Radiates to Back Anorexia Nausea and Vomiting Weakness Jaundice

46. Understanding Medical Surgical Nursing, 4th Edition Diagnostic Tests Serum Amylase/Lipase Alkaline Phosphatase Bilirubin Coagulation Studies CEA CT, ERCP Biopsy

47. Understanding Medical Surgical Nursing, 4th Edition Therapeutic Interventions Surgery Pancreatectomy Whipple Procedure Stent to Relieve Biliary Obstruction Chemotherapy Radiation

48. Understanding Medical Surgical Nursing, 4th Edition Whipple Procedure

49. Understanding Medical Surgical Nursing, 4th Edition Nursing Diagnoses Pain Imbalanced Nutrition Risk for Deficient Fluid Volume Risk for Impaired Skin Integrity

50. Understanding Medical Surgical Nursing, 4th Edition Patient Education Management of Hyperglycemia Pancreatic Enzyme Replacement Dressing/Drain Care Complications to Report Hospice Referral

51. Understanding Medical Surgical Nursing, 4th Edition Gallbladder Disorders Cholecystitis: Inflammation Cholelithiasis: Stones Choledocholithiasis: Stones in Common Bile Duct

52. Understanding Medical Surgical Nursing, 4th Edition Etiology Bile Stasis High Cholesterol Intake Fasting Sedentary Lifestyle Family History, Female Risk Increases with Age

53. Understanding Medical Surgical Nursing, 4th Edition Signs and Symptoms Increased Vital Signs Vomiting Jaundice Epigastric Pain RUQ Tenderness Nausea Indigestion Positive Murphy’s Sign Biliary Colic

54. Understanding Medical Surgical Nursing, 4th Edition Complications Cholangitis Necrosis/Perforation of Gallbladder Empyema Fistulas Adenocarcinoma of Gallbladder Pancreatitis

55. Understanding Medical Surgical Nursing, 4th Edition Diagnostic Tests Ultrasound ERCP Radionuclide Scan WBC Bilirubin Serum Amylase

56. Understanding Medical Surgical Nursing, 4th Edition Therapeutic Interventions Analgesics Bile Acid Sequestrants Anti-Emetics Diet

57. Understanding Medical Surgical Nursing, 4th Edition Cholelithiasis Treatment Cholecystectomy Laparoscopic Traditional ESWL Medication to Dissolve

58. Understanding Medical Surgical Nursing, 4th Edition T-Tube

59. Understanding Medical Surgical Nursing, 4th Edition Nursing Diagnoses Acute Pain Risk for Deficient Fluid Volume

60. Understanding Medical Surgical Nursing, 4th Edition Postoperative Nursing Diagnoses Risk for Impaired Skin Integrity Risk for Ineffective Breathing Pattern