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120 Cards in this Set
- Front
- Back
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what to assess with jaundice
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urine / stool color changes
abdominal swelling pain at RUQ yellow sclera pruritis light/clay colored stools fever / chills increased indirect bilirubin increased direct bilirubin |
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when is it suspected that jaundice is OBSTRUCTIVE?
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when DIRECT bili is increased
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elevated level of bilirubin in urine is caused by...
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increased level of DIRECT bili because DIRECT bili is H20 soluble
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the organ that CONJUGATES bilirubin
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LIVER
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causes of JAUNDICE
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gallstones
tumors intrahepatic jaundice - caused by drug reactions hepatitis hemolytic reactions -RBCs transfusion reactions |
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the ratio that diagnoses type of liver dysfunction
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AST/ALT ratio
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if ALT is increased, what pathophysiology is suspected?
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damage to liver cells
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if AST is increased, diseases are suspected?
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if AST is 10x more elevated, GALLSTONES
if AST is 20x more elevated, HEPATITIS |
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skin care approaches to jaundice: (2)
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corticosteroids to relieve itching
Bile sequestering agents |
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when doing Diagnostic tests for liver disease, what are nursing interventions to prep the client?
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Keep PT NPO because food increases pain
give IV hydration give pain management |
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LIVER functions
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glucose metabolism
ammonia conversion protein metabolism vit and iron storage drug metabolism bile formation bilirubin excretion |
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liver function studies (6) LABS
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AST/ALT/GGT/GGTP/LDH
serum protein pigment studies (direct/indirect bili), urine bili and urobilinogen prothrombin time PTT alk.phos ammonia cholesterol |
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diagnostic studies for liver function
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liver biopsy
U/S CT MRI |
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most common cause of hepatic dysfunction
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MALNUTRITION r/t alcoholism
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other causes of hepatic dysfunction other than ETOH
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infection
anoxia metabolic disorders nutritional deficiencies hypersensitivity states |
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clinical manifestations of hepatic dysfunction
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jaundice
portal hypertension hepatic encephalopathy or coma nutritional deficiencies |
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types of jaundice
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hemolytic
hepatocellular obstructive hereditary hyperbilirubinemia |
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yello or green tinged body tissues, sclera and skin due to increased bili levels
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jaundice
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the jaundice types that are most associated with liver disease
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hepatocellular and obstructive jaundice types
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s/s of hepatocellular jaundice
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pT appears mildly or severely ill
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s/s of hepatocellular jaundice
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pt appears mild to severely ill
lack of appetite, nausea, wt loss malaise, fatigue, weakness headache, chills and fever if infectious in origin |
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s/s of obstructive jaundice
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dark orange brown urine and light clay colored stools
dyspepsia and intolerance of fats, impaired digestion |
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obstructed blood flow through the liver resulting in increased pressure throughout the portal venous system
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portal hypertension
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portal HTN results in ...
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ascites
esophageal varices |
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ascites is caused by ...
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portan HTN
vasodilation of splanchnic circulation (blood flow to organs) decreased metabolism of aldosterone decreased synthesis of albumin movement of albumin into the peritoneal cavity |
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assessment of ascites
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record abd girth and daily wt
look for striae, distended veins and umbilical hernia assess for fluid via percussion monitor F/E imbalances |
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treatment of ascites
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low Na diet
diuretics bed rest paracentesis admin of salt-poor albumin TIPS shunt |
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position of paracentesis
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sitting
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first line of therapy for patients with ascites from cirrhosis
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Aldactone
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a life threatening complication of liver disease. may result from the accumulation of ammonia and other toxic metabolites in the blood
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hepatic encephalopathy and coma
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assissment of hepatic encephalopathy
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EEG
LOC potential seizures fetor hepaticus - A peculiar odor of the breath in individuals with severe liver disease caused by volatile aromatic substances that accumulate in the blood and urine. |
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is a tremor of the wrist when the wrist is extended (dorsiflexion) --- It can be a sign of hepatic encephalopathy, damage to brain cells due to the inability of the liver to metabolize ammonia to urea. The cause is thought to be related to abnormal ammonia metabolism. most often in drowsy or stuporous patients with metabolic encephalopathies, especially in decompensated cirrhosis or acute hepatic failure.
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asterixis
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med to reduce serum ammonia levels
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lactulose
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medical management of hepatic encephalopathy
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eliminate cause
lactulose IV glucose to minimize protein catabolism protein restriction diet reduction of ammonia from GI tract via gastric suction, enemas, oral antibiotics discontinue sedatives, analgesics and tranquilizers monior for complications and infections |
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occurs with 1/3 of patients with cirrhosis and varices
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bleeding esophageal varices
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in esophageal varices, when is mortality high?
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first episode: 30-50%
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clinical manifestations of bleeding esophageal varices
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hematemesis
melena general deterioration schock |
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how often should PTs with cirrhosis undergo screening endoscopy? and why do they do it?
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every 2 years; to detect any bleeding esophageal varices
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tx of bleeding varices
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treatment of shock
O2 admin IV fluids, lytes, vol.expanders blood and blood products vasopressin, somatostatin, OCTREOTIDE nitro propranolol and nadolol (beta blockers) |
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refers to the use of mercury-weighted balloons instilled into the esophagus or stomach, and inflated to stop refractory bleeding from vascular structures -- including esophageal varices and gastric varices -- in the upper gastrointestinal tract.
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balloon tamponade
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tx that exert pressure directly to bleeding sites in the esophagus and stomach
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balloon tamponade (eg. sengstaken-blakemore tube)
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nsg interventions : bleeding esophageal varices
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monitor for hepatic ecephalopathy
monitor for DT R/T ETOH withdrawal monitor tx via tube care and GI suction oral care reduce stress/PT teaching |
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a systemic viral infection with necrosis and inflammation of liver cells with symptoms of cellular and biochemical changes
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viral hepatitis
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Hep transmitted via fecal oral transmission
incubation: 15-50 days lasting 4-8 weeks dark urine, indigestion, liver swelling |
A
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do liver cells regenerate?
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yes, within 3-4 months, however if damage is extensive, no regeneration occurs
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transmitted via blood, sex, semen and body fluids
incubation: 1-6 mos major cause of cirrhosis and LIVER CA |
Hepatitis B
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meds for chronic hep B
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interferon
antivirals: lamivudine (Epivir) and adefovir (Hepsera) |
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aka post transmission hepatitis and the MOST COMMON
via needle sticks and sex causes 1/3 of liver ca and most common cause of liver transplants |
Hep C
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`meds for hep C
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interferon
ribavirin (Rebetol) |
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3 stages of viral hepatitis
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prodromal
icteric posticteric (recovery) |
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who are at risk for hep D?
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only persons with hep B
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transmission is via blood / sex but more likely progresses to fulminant liver failure and cirrhosis
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hep D
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transmitted by fecal-oral route with incubation of 15-65 days
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hep E
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which is transmitted via poor hygiene/sanitation
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hep A
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T or F. Pt may remain aymptomatic with Hep C
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true
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non-viral hepatitis causes
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drugs
toxics |
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scarring, fibrosis, resulting in disrupted hepatic blood flow
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cirrhosis
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3 types of cirrhosis
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alcoholic
postnecrotic biliary |
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tx for hep A
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no tx
immunoglobulin for high-risk individuals (nurses, military) |
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tx for hep B
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no treatment
prevention, antiemetics, analgesics prn |
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s/s of hepatic cirrhosis
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edema,
ascites, portal HTN, hemorrhoids varicose veins esophageal varices anemia mental retardation |
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cirrhosis via scarring at portal areas, chronic alcoholism
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alcoholic cirrhosis
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obstruction of bile canaliculi, necrosis, fibrosis, gallstones, pancreatitis, can be autoimmune
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Biliary cirrhosis
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chronic disease; can be caused by dialysis, Wilson's disease
bands of scars are affected |
postnecrotic
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complications of cirrhosis
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decreased sex hormones
aloopecia menstrual disorders decreased metabolism of aldosterone leading to edema secondary to H20 and salt retention decreased metabolism of ammonia resulting to hepatic encephalopathy (decreased coordination, Coma, death) portal hypertension hematemesis, anemia esophageal varices |
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how to treal esophageal varices
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reduce portal hypertension via diuretics and B-blockers
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binds to ammonia to prevent coma, death on hepatic encephalopathy patients
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lactulose
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when NOT to give lactulose? and what is a normal effect on GI system by lactulose?
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constipation
diarrhea |
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the only definitive Dx of cirrhosis
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Liver Bx
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what to watch out for when doing liver Bx
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PT, PTT, INR = RISK OF BLEEDING
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is a medical emergency characterized by decreased HnH, slow bleeding, tachycardia, hypotension, esophageal tamponade
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ESOPHAGEAL VARICES
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labs to help screen for liver cirrhosis
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CBC
ammonia liver U/S |
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invasive tx of cirrhosis
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surgery (Levine shunt)
TIPS shunt |
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what should RNs do before/after paracentesis
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measure abd girth
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nsg mgt of liver cirrhosis
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daily wt
I/O fluid restriction skin integrity respiratory (SpO2) bleeding urine/stool soft toothbrush |
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meds for cirrhosis
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aldactone
lasix lactulose vit. K antiemetics |
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things to teach PT about self-mgmt of cirrhosis
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avoid canned/frozen foods
limit hi-protein foods caution with OTC drugs no alcohol daily weight |
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when is patient restricted from protein?
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when patient is at risk for ecephalopathy
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clinical manifestations of liver ca
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pain, dull continous ache RUQ, epigastrium or back
weight loss, weak, anemia jaundice |
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is the accumulation of plasma secondary to portal hypertension due to increased aldosterone, increased osmotic pressure, cirrhosis, sodium/H20 retention, 3rd spacing
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ascites
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tx of increased ammonia levels
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get rid of nitrogenous waste
correct F/E imbalance Lactulose |
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s/s of increased serum ammonia
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ALOC
confused lethargy |
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sometimes given to reduce abd bacteria, but be careful, drug is nephrrotoxic
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Neomycin
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caused by circulatory alterations due to liver cirrhosis
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heptorenal syndrome
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s/s of hyponatremia
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increased BUN/creatinine
decreased sodium |
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the elderly have decreased liver weight T or F
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T
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most common cause of parenchymal damage
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malnutrition
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most common symptoms of liver disease
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jaundice, portal htn, nutritional deficiencies, hepatic enceph
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jaundice is evident when bili level exceeds _____
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2.5 mg/dl
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types of jaundice associated with liver disease
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hepatocellular and obstructive
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complications of prolonged jaundice
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gallstones and brain stem damage
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jaundice caused by inability of damaged liver cells to clear normal amounts of bili from the blood
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hepatocellular
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bile is not reabsorbed by intestine and becomes backed up into the liver substance due to tumor, gallstone, inflammatory process, presure from enlarged organ
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OBSTRUCTIVE JAUNDICE
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possible s/e of diuretic therapy among ascites patients due to dehydration and hypovolemia
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ENCEPAHLOPATHY
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Why is bed rest (supine) good for ascites pts
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because upright position activates RENIN-Angiotensin-aldo system
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why is ascites a temporary fix?
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because removal of fluid activates Ren-Angio-Aldo system; ascites is back
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a shunt vetween the portal circulation and the hepatic vein
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TIPS
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any patient for liver transplant should be referred for
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TIPS
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med that decrease ammonia-secreting bacteria in the gut
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neomycin sulfate
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refer to liver transplant after first episode of....
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OVERT HEPATIC ENCEPHALOPATHY
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indicates that lactulose is working
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2-3 SOFT stools per day; If diarrheic, this may indicate overdose
_______ |
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_______can precipitate hep.encephalopathy therefore prevention should be via lactulose admin
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CONSTIPATION
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the cause of edema in liver dysfunction ...
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HYPOALBUMINEMIA
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The cause of bleeding in liver dysfunction
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reduced production of blood clotting factors
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cause of Wernicke Korsakoff
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Thiamine deficiency
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why does pruritis develop in liver dysfunction
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due to retention of bile salts
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landmark signs off Etoh cirrhosis on the skin
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liver (reddened palms); spider angioma
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the antibody of hep A
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HAV
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when is portal hypertension suspected?
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presence of dilated abdominal veins and hemorrhoids
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what to tell pancreatitis patients upon dc
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avoid crash dieting
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what causes shock on pancreatitis pts
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Kinin
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primary s/s of pancreatitis
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jaundice
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priority order for pancreatitis patients upon admission
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NG tube with low suction
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potential complication for pancreatitis pts
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pneumonia
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pain medication contraindicated for pancreatitis pts
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morphine
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what precautions are to be done when caring for hepatitis A pts
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contact precautions
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how long does fatigue last upon recovery from hep?
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2-4 mos
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typical diet recommended for hepatitis patients
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high carb high protein
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first line of defense from hep B
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Hep B vaccine
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Transmission of Hep C
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needlesticks/ blood exposure
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