Hepatic Disorders -Ls2-Ec

Front 1

asterixis

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involentary flapping movements of the hands ass/w metabolic liver disfunction

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ballon tamponade

Back 2

use of ballon placed within esophagus and proximanl portion of the stomach inflated to compress bleeding vessels {espohageal and gastric varices}

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cirrhosis

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chronic liver diease in which the dense connectiliver has subsequent degenerative changes tissue within the liver

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constructional apraxia

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inability to draw figures figures in two or three dimensions

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hepatic encphalopathy

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cns dysfunction resulting from liver diease , ass/w elevated amonia levels altered mental state and coma

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fector hepaticus

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sweet slightly fecal order to the breath presumed to be intestinal orgin

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portal hypertention

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elevated pressure in the portal circulation resulting from obstructed venous flow into the liver

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sclerothearpy

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injection of subtances into around the esophagogastric varice to cause constriction

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assessment -liver function

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occupational recreational, travel hx, industrial chemicls and toxins,alcohol and drug abuse, tylenol, ketoconazole, valproic acid, are responsible for hepatic diease,amt and type of alcohol.

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protein studies for liver function tests

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total serum protein- 7.0-7.5g/dl
serum albumin- 4.0-5.5g/dl
is for cirrhosis chronic,hepatitis edema, asites,

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ARF

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Acute renal failure abrupt loss of function over a period of hrs/days a decrease blood flow to the nephrons

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ARF three phases

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oliguric,diruretic, recovery phase

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oliguric phase

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urine output less than 400 ml/day , with oliguria complication of fluid overload, pulmonary edema, and metabolic acidosis with hyperkalemia, {kussmals breathing and { low Hg,ht anemia }
anuira output less than 100 ml/day, diuretic phase urine increases >2000 ML/DAY
, oliguria phase ,recovery phase it normalizes

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causes of acute renal failure

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hemorrhage, renal loses, heart
failure, MI ,sepsis, anahlasxis

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s/s arf

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dry mucous membrane, lethargic, breath will have urine smell, {uremic fector ]hematuria, increased BUN, creat,,hyperkalemia,in which pt cant excrete potasium
metabolic acidosis , anemia,

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Diet for ARF

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avoid foods and beverages high in potisum and phosphrus, they are salt substitutes, cirtus fruits, fruit juice, bannans, coffee recommend diet is as follows high carbohydrate, low to moderate protein fluid and NA restricted

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CRF - three phases

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1stRenal reserve,2nd renal insufficiency,3rd and end stage renal diease

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CRF- major causes

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poorly controlled DM, Chronic htn, and kidney infection .

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S/S OF CRF neuro

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Neurologic -weakness, fatigue ,confusion,tremors, inability to concentrate, buring of soles of feet, behaviour changes

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S/S of CRF- skin

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INTEGUMENTARY- grey bronze skin, dry flaky skin, pruitis, eccymosis, brittle nails, course , thinning hair

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s/s OF CRF-cardiovascular

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htn, pitting edema, { feet hands sacrum, preorbital edema, engoraged neck veins, pericardial tamponade, hyperkalemia, hyperlipidema

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s/s of crf - pulmonary

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crackles, thick sputum, deep cough reflex, sob, kusmauls respirations uremic lung,

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S/S crf - GI

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amonia oder to breath, {'uremic fector, "}metabolic taste in mouth, ,lbms, n, v hiccups,

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s/s of CRF -hematologic

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anemia, thrombocytopenia

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rreproductive s/s crf

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amenorrhea, infertility, decreased libidio

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s/s crf- muscle skeletal

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muscle cramps, loss of musclestrength renal osteodystrophy, bone pain ,fractures,a nd foot drop

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nutritional thearpy CRF

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REGULATE PROTEIN, FLUID INTAKE, NA INTAKE TO BALANCE NA, CALORIC INTAKE AND VITAMINS, protein restricted, because uria uric acid breakdown

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nsg dx crf

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hyperkalemia due to decreased excretion
metabolic acidosis
pericarditis pericardial tamponade due to retention of uremic waste products,
htn due to na and water retention, malfucction of angiotension
anemia due to destruction of rbcs gi tract irritations and and blood loss during hemodyalsis

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what is hemodyasis-

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the pt is attached to a dialyzer
by way of av fistula this kidney functions like a artificial kidney 3-4 times/week

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AV SHUNT is patent when

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when the nurse palpates and asculatates over the shunt site if the site is open the nurse will feel a slight thrill and hear a whistling sound { bruit } between the vein and artery.if no tremor is felt contact the MD

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complications of hemodialysis

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air embolism, infecton disequilbrium , internal bleeding1- air embolism, defined as presense of air bubble in a vessle, sx include chest pain, pt hob lowered, dyspnea occurs sudden drop in bp, nurse turns pt to lt side, cyanosis may occur

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hemodialysis , -infections

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redness pain swelling are common, nurse feels warmth over fistula, is r/t presence of microorganisms

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hemodialysis,Disequilbrium syndrome

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altered loc, backache, n,v, ha, muscle twitching, seizures,flow rate should be slowed or stopped

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Hemodialysis -internal bleeding

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sx hypotention, restlessness, cold clammy skin, extreme thirst, nurse prepares for possible blood transfusion

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hemodialysis - a pt diet for dialysis

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sinse protein is lost through peritonela dialysis a diet high in protein, low carb suggested to pevent wt gain

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rrenal transplant -drugs given

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given immunosuppresants cyclosporin , and steroids to decrease the chance of regection, taken for duration of a pt lives major side effects are increase susptibility to various infections , viral abcterial and yeast.shingles is a viral infection cause by ner e pain tx is zovirax

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kidney rejection seven s/s of kidney rejection

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oliguria, fatigue, gradual wt gain, fever, elevated bp, pain, tenderness in the flank, serum creat levels > 20 %

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Peritoneal dialysis major complication is infection, of the linning of teh abdominal cavity

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peritonisis may be caused by irritation from antibiotic tx or staf , strep infection usually results from inadequete hand washing before needle insertion

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define nephrectomy

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removal of one kidney, due to diease or injury, diet f/u si restrictoins on protein, na{ sodium } and ka{ potasium }

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define urolithiasis

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refer to stones, { calculi } in the urinary tract calcium oxalate,phospate,uric acid increase

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s/s of urolithiasis

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depends on obstruction, infection and edema.infection [pylonephritisand cystitis are chills fever, dysuria, in renal pelvis intense ache and paincostoverbral region causes hematuria, stones in ureters asue excruciating coliky pain, wavelike pain radiating to the thigh, genitalia area

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medical mang of stones,

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control obstruction and releive pain NSAIDS, analgesics, hot baths moist heat to flank areas

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calcium stones
uric acid stones
cystine stone
oxalte stones

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restrict calcium
low purine diet reduces uric acid, foods high in uric acid are ( shell fish anchovies, asparagus, mushrooms, organ meats}ZYLOPRIUM meds given to reduse serum uric acid levels
low protein diet for cystine stones
limit oxalate-spinach, rubard, choclate tea, wheatbrand

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Diet recommendation for prevention of kidney stones are as follows

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protein 60 g /day na restrict3/4 g/day, table salt redused low calcium diets arent generally recommended oxalate foods, spinach strawberri rubard avoided

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surgical mng for kidney stones

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ureterscopy ESWL SHOCK WAVES CYSTOSCOPE,

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URIC ACID STONES prevent measures

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shellfish avoided, zyloprium { allopurinol }a high -purine high protein avoided , alkaline ash diet recommended

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calcium stones prevent measues

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ash diet recommended {calcbind may be given } low protein low calcium diet

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oxalate stones- prevent measures

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choclate and spinach avoided, nuts also