Presentation on theme: "Hepatic Disorders: Hepatitis/Cirrhosis"— Presentation transcript:
1 Hepatic Disorders: Hepatitis/Cirrhosis Lisa Randall, RN, MSN, ACNS-BCRNSG 2432
2 ObjectivesCompare and contrast risk factors associated with hepatitis and cirrhosisAnalyze the etiology and pathophysiology of hepatitis and cirrhosisIntegrate diagnostic tests with etiology, pathophysiology, and signs/symptoms of both disordersFormulate relevant prioritized nursing diagnoses that address physical, pyschosocial, and learning needs and evaluate nursing interventions
4 A LiverB Hepatic veinC Hepatic arteryD Portal veinE Common bile ductF StomachG Cystic ductH Gallbladder
5 Pathophysiology Largest organ Metabolic functions Bile synthesis HepatocytesBile secretionStorageMononuclear phagocyte systemKupffer cellsPhagocytic activity
6 Metabolic functions Metabolism of glucose Protein Fatty acids Cholesterol
7 Other Functions Immunologic Blood storage Plasma protein synthesis ClottingStorage of vitamins and mineralsWaste products of hemoglobinBile formation and secretionSteroids and hormonesAmmoniaDrugs, ETOH, toxin metabolism
21 Hepatitis E Fecal/oral Contaminated water Poor sanitation 15-64d Labs S/SHBVNo vaccine
22 DiagnosticsLFTALPSerum bilirubinLiver biopsyAntigen specific
23 Treatment Diet Fluid management Bed rest Drug therapy High cal/protein, low fatVitamins (B, K)ETOH/DrugsFluid managementBed restDrug therapyPrevention of HAV and HBVInterferonLamivudineRibavirinAcetaminophen
24 Nursing Diagnoses Risk for infection (transmission) Imbalanced nutritionDisturbed body imageKnowledge deficit
26 PathophysiologyCaused by destruction of liver cells, fibrosis and nodule formation restricting blood and bile flowNormal hepatic blood pressure is near zero. Restriction of blood flow in liver dysfunction causes hypertension, and blood will attempt to find other pathways, bypass liverResults in significant impairment of liver function80% destroyed before signs and symptomsLiver can regenerate itself if good nutrition, rest, and no alcohol
27 Types of Cirrhosis Classified by risk factors Post necroticHepatitisAlcoholic CirrhosisLaennec’smetabolic changes in liver, particularly fatBiliaryobstructiveCardiacright side heart failureDrug inducedINH, rifampin, Tylenol
35 Liver Biopsy Adequacy of clotting- PT/ INR, Platelets (Vit. K?) Type and cross match for bloodStop aspirin, ibuprofen, and anticoagulants 1 wk. beforeChest x-rayConsent form & NPO 4 to 8 hr.Vital signs & Empty bladderSupine position, R arm above headHold breath after expiration when needle insertedBe very still during procedure – 20 minutes
36 After Needle Liver Biopsy PressureRight sideminimum of 2 hrsflat hrsVital signs & check for bleedingNPO X 2 hr afterAssess for peritonitis, shock, & pneumothoraxRt. shoulder pain commoncaused by irritation of the diaphragm muscleusually radiates to the shoulder a few hours or days.Soreness at the incision siteTylenolavoid aspirin or ibuprofen for the first week because they decrease blood clotting, which is crucial for healing.Avoid coughing, straining, lifting x 1-2 weeks
53 Sclerotherapysclerosant solution (ethanolamine oleate or sodium tetradecyl sulphate) Complicationsfever, dysphagia and chest pain, ulceration, stricture, and (rarely) perforation.
54 Band ligationFewer treatment sessions and complications than sclerotherapy.
55 Balloon tube tamponade Tube is inserted through the mouthCorrect placement within the stomach is checked by auscultation while injecting air through the gastric lumenGastric balloon is then inflated with 200 ml of airGastric balloon is pulled up against the esophagogastric junction, compressing the submucosal varicesTension is maintained by strapping a split tennis ball to the tube at the patient's mouthComplicationsgastric and esophageal ulcerationaspiration pneumoniaesophageal perforation.
56 Minnesota Tube Sengstaken-Blakemore tube – has only 3 lumens **Respiratory assessment**
66 Donors Live donor Liver regenerates 5 yearsSurvival rates increase / shorter wait timeMedical and psychological evaluationsPotential donors evaluated for:liver disease, alcohol or drug abuse, cancer, or infection.hepatitis, AIDS, and other infections.matched according to blood type and body size.Age, race, and sex are not considered.Cadaver donor have to wait for brain dead donor
68 QuestionA client presenting with ascites s/t liver failure is being evaluated for fluid balance. Which of the following provides the best indicator of fluid status?a. I&Ob. LFTc. caloric intake and serum protein levelsd. daily weight
69 QuestionWhen providing DC teaching to the patient with cirrhosis, his wife asks the RN to explain why there is so much emphasis on bleeding precautions. Which of the following provides the most appropriate response?a. “The liver affected by cirrhosis is unable to produce clotting factors.”b. “The low protein diet will result in reduced clotting factors.”c. “The increased production of bile decreases clotting factors.”d. “The required medications reduce clotting factors.”
70 QuestionWhen explaining the rationale for the use of lactulose syrup ot the patient with chronic cirrhosis, the nurse would choose which of the following statements?a. “lactulose reduces constipation, which is a frequent complaint with cirrhosis.”b. lactulose suppresses the metabolism of ammonia and aids in its elimination through feces.”c. lactulose helps to reverse cirrhosis of the liver.”d. lactulose can be taken intermittingly to reduce side effects.”
71 QuestionThe patient has just had a liver biopsy. Which of the following nursing actions would be the priority after the biopsy?A. monitor pulse and BP every 30 minutes until stable and then hourly for up to 24 hours.B. ambulate every 4 hours for the first day, as long as the patient can tolerate it.C. measure urine specific gravity every 8 hours for the next 48 hours.D. maintain NPO status for 24 hours post-biopsy.
72 QuestionA male client is being treated for ruptured esophageal varices with a Sengstaken-Blakemore tube. His VS have been stable, and the suction port is draining scant amounts of drainage. He suddenly becomes acutely dyspneic, and oximetry reveals an O2 sat of 74%. The nurse’s immediate action is toA. release the esophageal balloonB. release the gastric balloonC. increase the suctionD. irrigate the gastric balloon
73 QuestionA newly admitted client with cirrhosis of the liver has a distended abdomen and the umbilicus is protruding. The nurse knows the pathological basis for this isA. increased fluid intake resulting from excessive use of alcohol causing overhydrationB. increased size of the liver resulting in abdominal distentionC. hypoalbuminemia causing fluid to leave the vascular system and enter the peritoneal cavityD. shunting of the blood to the collateral circulation in the esophagus resulting in decreased blood volume and accumulation of fluid
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