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16 Cards in this Set

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What are the manifestations of cirrhosis?
chronic indigestion
weight loss
spleenomegally
spider telangiectasis
varices-d/t portal HTN
decrease in albumin
vitamin deficiency
gastritis
ascites
caput medusae-enlarged vessels ATC belly button
anemia
coma
encephalopathy
bleeding
What are the different types of cirrhosis?
Laennac's-chronic ETOH
Post necrotic-viral infection
Biliary-scarring in bile duct
Cardiac-CHF r/t engaged liver
Early-liver large, cells loaded with fat
LATE-liver size decreased as scar tissue contracts
What do you assess?
chief complaint
GI-pain, anorexia, nausea, vomiting, wt. change, indigestion, fat intolerance, eructation, bowel changes, melena, clay colored stools, steatorrhea
Neurologic-drowsiness, clouded sensorium, irritability, change in mental status
GU-change in urine color (orange)
Skin-jaundice, petechiae, dilate abdominal veins, unexplaine punctures
CV-nosebleeds, bruising, hemorrhoids, ascites, edema
Past Health HX
major illness, hospitalizations
procedures causing skin, membrane disruption
medications
What are the functions of the liver?
glucose metabolism
lipid metabolism
protein metabolism
vitamins and mineral levels
drug metabolism and detoxification
bile formation
billirubin excretion
blood volume reservoir
blood filter
blood clotting
hormone detoxification
What do radiologic exams tell you?
structure
What are the complications of paracentisis?
hypovolemia and shock
What are the interventions used to treat ascites?
d/c meds that dec. prostaglandins
diuretics, esp. aldactone
IV albumin
low na diet
restrict fluids
paracentisis
pertioneovenous shunt
What is ascites?
sequel to portal HTN
fluid accumulation in peritoneal cavity
chronic problem-liver sweats
What are the contraindications of a liver biopsy? What are some complications?
CONTRAINDICATIONS:
thrombocytopenia
prolonged PT
peritonitis
mass axcites
enlarged gallbladder
cancer
COMPLICATIONS:
hemorrhage
pneumothorax
infections
peritonitis
What are some nursing intervetions used in treating ascites?
daily weights
girth measurements
strict I&O
small frequent feedings
limit protein and fluids
teach to read food labels-NA
skin care
What is hepatic encephalopathy?
results from accumulation of ammonia and other toxic metabolites in blood
damaged liver cells fail to detoxify and convert to urea the ammonia that is constantly entering bloodstream
Diagnostic Exams
ALT (SGPT)-liver specific
AST
ALP
LDH-#4&5
Billirubin-conjugated vs onjugated
PT-prolonged in liver failure
Serum ammonia-inc. r/t no breakdown and elimination
Serum albumin-r/t dec. urea production
globulins-dec. related to dec. production except with cirrhosis initially
What are the causes that result in damage to liver parenchymal cells?
infectious agents
toxins
nutritional deficiency
cirrhosis
anoxia
medications
hypersensitivity
Medical management Hepatitis?
bedrest
diet of high CHO and low fat
frequent small feedings
IV if indicated
What are the clinical manifestations of hepatic encephalopathy?
minor mental and motor changes
slight confusion, alteration in mood
asterixis (hand flapping)
handwriting changes
LATE-frank coma