Liver
What is jaundice?
What are the 3 types of jaundice?
yellow discoloration of body tissue d/t disruption of the flow of bile into the hepatic or biliary duct systems
Hemolytic, Hepatocellular, Obstructive
True or False: bleeding from esophageal varices are considered a medical emergency
TRUE
What is cholecystitis?
inflammation of the gallbladder wall (usually associated with gallstones)
What is an ERCP?
Endoscope inserted through the mouth to the duodenum
It can visualize the pancreatic and common bile ducts
A patient admitted with diabetes, malnutrition, osteomyelitis, and chronic alcohol use has a serum amylase level of 480 U/L and a serum lipase level of 610 U/L. Which diagnosis does the nurse expect?
A) Starvation
B) Pancreatitis
C) Systemic sepsis
D) Diabetic ketoacidosis
B) Pancreatitis
The patient with chronic alcohol use could develop pancreatitis as a complication, which would increase the serum amylase (normal, 30 to 122 U/L) and serum lipase (normal, 31 to 186 U/L) levels as shown.
What is hepatocellular jaundice?
What does it cause?
What are s/s?
Livers altered ability to take up bilirubin from blood, conjugate, or excrete it
Hepatitis and cirrhosis
s/s: lack of appetite, N/V, weight loss, malaise, fatigue, weakness
What is lactulose?
laxative, increases water content and softens stool
it prevents absorption of ammonia and decreases hepatic encephalopathy
Manifestations of cholecystitis
Sudden sharp pain in RUQ and spreads towards right shoulder, pain gets worse with deep breathing (controlling the pain is priority before it is treated)
Vary from indigestion to moderate-severe pain, fever, chills, jaundice, N/V
What is pancreatitis?
What is it caused by?
Inflammation of the pancreas that can lead to digestion of the pancreas by its own enzymes and/or irreversible structural damage to the organ
Caused by gallstones, infection, tumor
The family of a patient newly diagnosed with hepatitis A asks the nurse what they can do to prevent becoming ill. How would the nurse respond?
A) “You will need to be tested first; then treatment can be determined.”
B) “The hepatitis vaccine will provide immunity from this and future exposures.”
C) “There is nothing you can do since the patient was infectious before admission.”
D) “An immunoglobulin injection will be given to prevent infection or limit symptoms.”
D) “An immunoglobulin injection will be given to prevent infection or limit symptoms.”
Immunoglobulin provides temporary (1 to 2 months) passive immunity and is effective for preventing hepatitis A if given within 2 weeks after exposure. It may not prevent infection in all persons, but it will at least modify the illness to a subclinical infection. The hepatitis vaccine is only used for preexposure prophylaxis.
What is obstructive jaundice?
What does it cause?
What are s/s?
Impeded outflow of bile through liver and duct system
Cholelithiasis (gallstones) and cancer
s/s: dark orange-brown urine and clay colored stools
Nursing management for lactulose
Monitor I&O and skin care
What is murphy's sign?
Positive sign that occurs when pt is holding a deep breath and the inflamed gallbladder comes into contact with the examiners hand while palpating the right subcostal area
S/s of pancreatitis
Abdominal pain (mid epigastric or LUQ), can be felt in the back, pain worse when lying flat
N/V, low grade fever, leukocytosis, hypotension, tachycardia, jaundice
The nurse provides discharge instructions for a patient with ascites and peripheral edema related to cirrhosis. Which patient statement indicates teaching was effective?
A) “Lactulose should be taken every day to prevent constipation.”
B) “It is not safe to take acetaminophen up to four times a day for pain.”
C) “Herbs and other spices should be used to season my foods instead of salt.”
D) “I will eat foods high in potassium while taking spironolactone (Aldactone).”
C) “Herbs and other spices should be used to season my foods instead of salt.”
A low-sodium diet is indicated for patients with ascites and edema related to cirrhosis. Table salt is a well-known source of sodium and should be avoided. Alternatives to salt to season foods include the use of seasonings such as garlic, parsley, onion, lemon juice, and spices.
What is cirrhosis of the liver?
What are the most common causes of cirrhosis?
End stage liver disease
Hepatitis C and alcohol induced
What is hepatic encephalopathy?
What are some manifestations?
Loss of brain function occurs when the liver is unable to remove toxins from the blood (hepatic coma)
Asterixis (flapping tremors) is a late manifestation
Early: sleep and mood disturbance, mental status change, speech problems
Late: altered LOC to unresponsiveness, impaired thinking, neuromuscular problems
What is cholecystitis attack?
What kind of diet is suggested?
Attacks of pain often occurring 3-6 hours after a high fat meal or when pt lies down
Low fat diet
Why is pain felt in the back or worse when lying flat in pts with pancreatitis?
When might the pain start?
It is due to the location of the pancreas (behind the peritoneum)
After consuming greasy/high fat meal or alcohol
The nurse is caring for a patient with acute pancreatitis from gallstones. Which clinical manifestations would the nurse expect? (Select all that apply.)
A) Hematochezia
B) Nausea and vomiting
C) Hyperactive bowel sounds
D) Left upper abdominal pain
E) Ascites and peripheral edema
F) Temperature 99.3°F (37.4°C)
B) Nausea and vomiting
D) Left upper abdominal pain
F) Temperature 99.3°F (37.4°C)
Management of cirrhosis
Promote rest
Improve nutritional status (low sodium diet)
Skin care
Reduce risk of injury (impaired tissue integrity)
Minimize bleeding (soft bristle toothbrush, electric razor, small needle gauge, avoid straining such as blowing nose too hard)
Fluid balance
Airway and breathing is always a top priority
What is a paracentesis?
Nursing actions?
Drainage of fluid (ascites) from peritoneal cavity using a needle
Empty bladder prior to procedure, measure abdominal girth and vitals before and after, assess for signs of hypovolemia, monitor I&O
What is a cholecystectomy?
What is inserted during the surgery?
Describe the drainage seen within the first 24 hours post-op
Removal of the gallbladder
T-Tube may be inserted into the common bile duct to ensure patency of the duct
300-500 mL of thick blood tinged, bright yellow to dark green bile drainage
What can we do to allow the pancreas to rest?
insert NG tube and NPO status
A patient with cholelithiasis is being prepared for surgery. Which assessment finding is a contraindication for a cholecystectomy?
A) Low-grade fever of 100°F and dehydration
B) Abscess in the right upper quadrant of the abdomen
C) Multiple obstructions in the cystic and common bile ductIncorrect Answer
D) Activated partial thromboplastin time (aPTT) of 54 seconds
D) Activated partial thromboplastin time (aPTT) of 54 seconds
An aPTT of 54 seconds is above normal and indicates insufficient clotting ability. If the patient had surgery, significant bleeding complications postoperatively are very likely. Fluids can be given to eliminate the dehydration. The abscess can be assessed during surgery, and the obstructions in the cystic and common bile duct would be relieved with the cholecystectomy.