1. INTERFERENCE TO NUTRITIONAL NEEDS DUE TO DEGENERATION AND INFLAMMATION Cirrhosis and Hepatitis

2. Cirrhosis  A scarring of the liver  Slow and progressive in nature  Causes  Etoh  Hepatitis C  Hepatitis B  Compensated  No significant symptoms despite damage  Uncompensated  Impaired function demonstrated by Portal htn Ascites Esophageal varices Coagulation problems Jaundice Encephalopathy Hepatorenal syndrome peritonitis

3.  Identify the pathology which occurs with each of the complications that arises from cirrhosis (in other words, why do you see these problems)  What other diseases are capable of causing cirrhosis? (hint: you just studied these problems over the last 2 weeks)  Physical manifestations of the disease  See your textbook pg 1372 for a great visual aide

4.  Laboratory testing (see page 1374, table 62-4)  AST  ALT  LDH  Alkaline Phosphatase  Bilirubin Total Direct/indirect Serum/urine  Serum protein Total Albumin Serum globulin  Amonia  PT  What do each of these labs indicate?

5.  Look at the concept map on page 1376 and chart 62-2 on page 1377  Identify those s/s consistent with cirrhosis/liver disease (both subjective and objective)  Give rationales for each nursing intervention identified (are there other interventions you could add to them?)

6.  Surgical management  Peritoneovenous shunt  Portacaval shunt  What care would you expect to perform following these surgeries?  What problems might you expect postoperatively?  And how would you handle them? (treatments)

7.  Nonsurgical management  Medications Why use betablockers?  Gastric intubation/lavage  Esophagogastric balloon tamponade to stop bleeding varices What is the nursing care for the patient who has undergone this procedure?  Blood transfusions  Endoscopic band ligation or sclerotherapy to treat varices  Transjugular intrahepatic portal-systemic shunt – a last resort option

8.  Portal systemic encephalopathy is a complication of liver failure that is dangerous and potentially lethal.  What are the nursing interventions you would perform for someone with this problem?  Give rationales for each intervention. Include the medications the MD would typically prescribe to be administered by the nurse.

9.  Education is always a part of our job as nurses. What would you want to be sure to teach your patient with cirrhosis?

10. Hepatitis  What are the various types of hepatitis?  What are the differences in how they are contracted?  S/s are due, in part, to the infectious nature of the disease but also due to the disease’s impact on the liver. What s/s can you relate to the liver? To the infection?  What lab tests would be indicative of hepatitis? What labs simply indicate liver involvement?

11.  Identify the nursing interventions you would perform and give the rationales for each.  What medications are being used to treat hepatitis? How do they work? What are the dangers/risks using them?