Cirrhosis
What is cirrhosis?
Pathophysiology/etiology?
A chronic liver disease causing scarring (fibrosis) and liver failure.
Pathophysiology: Liver cells are damaged and replaced by scar tissue, leading to decreased liver function.
Etiology:
Chronic alcohol use
Hepatitis B & C
Non-alcoholic fatty liver disease (NAFLD)
Biliary disease
What is pancreatitis?
Pathophysiology/etiology?
Inflammation of the pancreas, which can be acute or chronic.
It occurs when digestive enzymes become activated inside the pancreas, leading to autodigestion, inflammation, and potential tissue damage.
This test measures the blood flow to the limbs and is used when screening for PAD.
Ankle brachial index (ABI)
What are 4 clinical manifestations of venous insufficiency?
Edema (blood pooling), varicose veins, leg pain/aching, skin discoloration, + pulses
Client education: Warfarin
Bleeding precautions, Dietary considerations, INR monitoring (therapeutic 2-3)
What are 5 clinical manifestations of cirrhosis?
Ascites, jaundice, hepatomegaly, splenomegaly, pruritis, palmar erythema, bruising/bleeding
compare/contrast:
Acute vs Chronic pancreatitis
Onset: Acute is sudden; chronic develops over time.
Causes: Acute is often due to gallstones or alcohol; chronic is usually from long-term alcohol use or repeated acute episodes.
Pathophysiology: Acute causes inflammation from enzyme activation; chronic leads to scarring and permanent damage.
Symptoms: Acute has severe, sudden pain with nausea and vomiting; chronic has recurring pain, weight loss, and fatty stools.
Enzyme Levels: Acute has high amylase and lipase; chronic may have normal or slightly elevated levels.
What are the 6 P's?
Pain, Pallor, Pulselessness, Paresthesia, Paralysis, Poikilothermia
DVT and PE clinical manifestations
Unilateral swelling, pain, erythema, heat, etc.
Sudden chest pain, sob/dyspnea, hemoptysis, etc.
Somatostatin analog that works by reducing splanchnic blood flow, leading to a decrease in portal pressure (helping to control variceal bleeding)
Octreotide
Describe what occurs in Hepatic Encephalopathy.
In liver disease, the liver is unable to convert ammonia --> urea (and cannot excrete this toxin either) causing neurologic symptoms (AMS, confusion, irritability, asterixis, fetor hepaticus)
Clients with pancreatitis should avoid ____
and consume a diet ________
Avoid alcohol
Consume a diet low in fat
Client education for arterial insufficiency
Dangle legs (gravity)
Nail care, inspect feet daily, wear properly fitted shoes, moisturize, avoid hot water/burns, smoking cessation, avoid crossing legs
Clinical manifestations of AAA
vs thoracic aneurysm
Pulsatile mass, back pain, hypotension, shock
Difficulty swallowing, hoarseness, chest pain, sob
Therapeutic effect of Lactulose?
Helps lower blood ammonia levels by facilitating the removal of ammonia from the intestines
Nursing considerations for the client with esophageal varices
Monitor for signs of bleeding (vomiting blood, black stools)
Administer blood products if needed
Give medications to reduce portal hypertension (beta-blockers)
Provide IV fluids to stabilize hemodynamics
Prepare for endoscopic treatment (banding or sclerotherapy)
Manage airway and breathing if active bleeding occurs
Teach client to: avoid alcohol and irritants, take prescribed medications to reduce pressure in the veins, avoid straining during bowel movements
List 4 nursing interventions/considerations for the client with acute pancreatitis
NPO during acute exacerbations
Pain management (opioids)
NG tube (reduces gastric secretions)
Positioning for pain (semi/high fowler's or fetal)
Aortic dissection manifestations
Sharp, tearing, ripping sensation, chest pain, back pain/shoulder/scapular pain
Hallmark symptom of peripheral artery disease (PAD)
Intermittent Claudication
Compare/Contrast:
Heparin
Alteplase
Heparin: anticoagulant (prevents clot growth)
Alteplase: thrombolytic (breaks down existing clots)
Dietary teaching for the client with:
Ascites
Hepatic Encephalopathy
Low-Sodium Diet – Helps reduce fluid retention and prevent worsening of ascites.
Low-Protein Diet – Reduces the buildup of ammonia, a toxin that can worsen encephalopathy.
Client education for Pancrelipase?
Do not crush/chew, Take with meals/snacks, Drink a glass of water directly after taking to prevent irritation, monitor stool, avoid taking pancrelipase with dairy
Raynaud's vs Buerger's
Raynaud's: episodic vasospasm (narrowing of blood vessels) in response to cold or stress, leading to temporary reduced blood flow to fingers, toes, or other extremities.
Buerger's: Inflammatory vascular disease that affects small and medium-sized arteries and veins, leading to blood clot formation and blockage of blood flow.
What are ways to reduce the risk of an aneurysm rupture?
Control blood pressure, avoid smoking, manage cholesterol, healthy diet, exercise, regular monitoring of aneurysm size, manage stress
This anticoagulant medication works by inhibiting factor Xa and is commonly used to treat DVT, PE, and to prevent stroke in patients with atrial fibrillation.
apixaban (Eliquis)