Contributing factors/drugs 💊
What are common drugs that cause liver Disease?
What is: Acetaminophen* (most common); Sulfa Drug, Statins, Tetracyclines.
How do you diagnose liver disease?
Liver enzyme
Abdominal tenderness
Enlarged liver
What is treatment for Laennec's Cirrhosis?
What is Stop progression, avoid ETOH and it cant be reversed (can be controlled)
Cirrhosis is the final phase of alcoholic liver disease
What are complications of Liver disease?
What are:
Portal Hypertension
Hepatic Encephalopathy
Cirrhosis
Esophageal Varices
Ascites
Fluid volume Overload
Jaundice
What can do as nurses for these patients?
Nutrition, Skin care, Daily weights, I&O's, Seizure precaution, Education
What is treatment of drug induced liver injury?
what is Hold the medication
What are the role of the liver
Metabolizes (glucose, Lipids & protein)
Storage (vitamins B12, A,D,E,C,K)
Digestion (Hepatocytes make dile)
Production (blood plasma, Albumin, Fibrinogen, Prothrombin=clotting helper)
Detoxification (makes drug less harmful to body)
Treatment for Ascites?
What is Paracentesis.
temporarily removal of fluid.
Use to be routine treatment now it is a diagnosis
Clinical Manifestations for Hepatic Encephalopathy
What is:
Asterexis (hand flap, involuntary), Apraxia (inability to perform purposeful movements),Fector hepaticus (stinky breath), Motor disturbances, Incoherent speech, mood swings, LOC's changes EEG abnormal, Wt loss, ⬇️DTR's, Gi symptoms: anorexia, dyspepsia (indigestion)
Interventions for?
Na restriction, I&O, Respiratory status #1, Abd girth +edema, Diuretics (aldactone), Bedrest/Elevate HOB, Assessing abd fluid wave, Short nails, mild soap for skin
What is ascites
Given to absorb ammonia in the body.
what is lactulose
your patient with cirrhosis has severe splenomegaly. As the nurse you will make it priority to monitor the patient for signs and symptoms of?
Thrombocytopenia (low plt)
Leuokopenia (low wbc)
Pre and Post Assessments of Paracentesis
What is
Pre: Void and position upright with feet on stool
Post: Leakage, infection, vascular collapse, I&O's, mental status and F&E
Clinical manifestations for Portal hypertension
What is:
Splenomegaly,Ascites, Hemorrhoids,Caput medusae (veins on abd), Varices
Treatments for:
⬇️Protein diet, Neomycin enemas (⬇️intestinal bacteria), Lactulose (⬇️ammonia), assess neuro, assess mental status (monitor handwriting), give glucose,Assess I&O
What is Hepatic Encephalopathy
Risk factors of liver disease
Virus (Hepatitis B & C),Obesity, Exposure to toxic substances (ETOH, Tylenol, and Erythromycin use),Foreign travel, IV or injection drug use,
Autoimmune, Dile duct problem ⬆️Cholesterol, diabetes
While providing mouth care to a patient with late-stage cirrhosis, you note a pungent, sweet, musty smell to the breath. This is known as
Fetor Hepaticus
Treatments for Esophageal Varices.
what is
Endoscopic Sclerotherapy, Balloon Tamponade, Esophageal banding, Surgical bypass shunt.
secondary tx TIPS
(transjugular intrahepatic portosystemic shunt)
Clinical manifestations for Varices
What is
Hematemesis*, Melena (dark tarry stool), S&S of shock, general deterioration in mental status & physical status, Anemia, bleeding tendencies.
A patient is admitted with hepatic encephalopathy secondary to cirrhosis. What foods should be avoided with this patient?
What is BEEF, Eggs, Legumes, Broccoli rabe certain grains are high in protein
Patients who are experiencing hepatic encephalopathy are having issues with toxin build up in the body, specifically ammonia. Remember that ammonia is the byproduct of protein breakdown
Who is more at risk for Liver disease
Women
Asian and African American countries
preop- Type& cross match, PT/PTT, Exhale & hold,
postop- Splint site, turn on right side/pillow under site, no coughing or straining, monitor for pneumothorax, monitor for peritonitis.
what is liver biopsy
How to tx Jaundice (Icterus)
Babies: Light therapy: Blue light breakdown bilirubin
Adults: Milk thistle
Clinical manifestations of Jaundice
what is
Skin, Mucous membrane, Sclera: Yellow🍋
Urine: Orange 🍊foamy 💦
Clay color stool
Esophageal Varices Nursing care plan:
Assess for hypovolemia, Central venous cath, O2, IV fluids with electrolytes & volume expanders ex:albumin (caution not to over hydrate), Administer vasopressin (⬇bleeding), admin Vit K therapy, multiple transfusions, Parenteral nutrition, gastric suctioning, mouth care.
Prophylactically: Beta blocker