Cirrhosis
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| Cirrhosis | End stage of liver disease
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| progressive, irreversible, leads to liver failure | cirrhosis
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| cirrhosis | 10th leading cause of death
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| Alcoholic's(Laennec's) cirrhosis | most common type in North America
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| Other causes of cirrhosis include: | chronic Hep B or C, prolonged biliary drainage obstruction(bile), severe right sided heart failure, other uncommon liver disorders, maybe unknown cause
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| pathophysiology of cirrhosis | functional liver tissue is destroyed and replaced by fibrous scar tissue
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| metabolic functions are lost in cirrhosis as _______ and ________ are gradually destroyed | hepatocytes, liver lobes
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| hepatocytes | liver cells
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| fibrous nodules form and causes... | disruption of blood flow and bile
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| types of cirrhosis | alcoholic, biliary, posthepatic, and cardiac
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| alcoholic cirrhosis | alcohol causes metabolic changes in liver
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| alcoholic cirrhosis causes | increased triglycerides and fatty acid synthesis and decreased formation and release of lipoproteins
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| abstinence of this can cause liver to heal | alcohol
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| continuance of this causes liver to become inflamed | alcohol
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| alcoholic hepatitis | continued alcohol use causes this
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| Patient has shrunken liver/nodular, client malnourished in this cirrhosis | alcoholic cirrhosis
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| biliary cirrhosis | alot of jaundice, bile flow obstruction within liver/biliary tree leads to inflammation, fibrosis and nodule formation
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| posthepatic cirrhosis | most commonly results from chronic hepatitis B or C; possible results from an unknown cause(liver shrunken, nodular, fibrotic)
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| cardiac cirrhosis | results from severe, long-standing right-sided heart failure
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| early cirrhosis | few manifestations, liver enlarged and possible tender, possible dull aching pain RUQ, anorexia & wt loss, diarrhea & constipation may vary, fever and palpable liver possible
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| portal hypertension | increase pressure in portal venous system which causes shunting of blood to adjoining vessels w/a lower pressure within them
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| portal hypertension usually affects veins in | esophagus, rectum and abdomen: engorged or congested
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| what happens during portal hypertension tha causes ascites | the increased hydrostatic pressure within th portal system vessels causes fluid leaking through the capillaries
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| ascites | plasma-rich fluid accumulates in the abdominal cavity and portal hypertension is the main cuase
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| splenomegaly | due to portal hypertension; removes and destroyes RBC's and WBC's faster: anemia, leukopenia, thrombocytopenia occur
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| hypoalbuminemia | causes decreased plasma colloidal osmotic pressure which allows fluid to escape into extravascular compartments
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| hyperaldoosteronism | causes sodium and H2O retentino which leads to ascites and general edema
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| esophageal and gastric varices | enlarged, thin-walled, collateral veins that develop in lower esophagus and upper stomach from portal hypertension
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| varices may rupture and cause massive hemorrhage which can be precipitated by... | eating high-roughage foods, spicy foods, straining at BM, coughing, sneezing, retching, vomiting, etc.
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| Patient is already at risk for hemorrhage from _________, decreased _________, and decreased ____________________ | throbocytopenia, platelets, clotting factors
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| hepatic encephalopathy | liver destruction causes ammonia accumulation in vlood; acts as a neurotoxin
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| normally liver converts this to urea which is then excreted by the kidneys | ammonia
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| other precipitating factors of hepatic encephalopathy | sedatives, tranquilizers, narcotics, anesthetics, dehydration, constipation, GI bleeding, blood transfusions, high-protein diet, hypoxia, severe infection, surgery
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| early signs of hepatic encephalopathy | asterixis, changes in personality and mentation, agitation, restlessness, impaired judgement, slurred speech
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| asterixis | liver flap; flapping tremor of hands when arms extended; can also affect legs, arms, face, and eyelids
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| late signs of hepatic encephalopathy | confusion, disorientation, incoherence; final stage is deep coma
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| hepatorenal syndrome | renal failure with azotemia(increased nitrogen), sodium retention, oliguria, and hypotension; cause unclear
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| fetor hepaticus | a musty, sweet breath odor from accumulation of digestive by-products that liver can't break down
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| jaundice | skin/sclera is yellow color to varying degrees; body can't conjugated/excrete bilirubin; skin itching from bile salts
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| palmar erythema | a red area on palm that blanches with pressure: secondary to increased estrogen levels
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| spider angiomas | small dilated blood vessels with bright red center and spiderlike branches
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| spider angiomas are seen | nose, cheeks, upper trunk, neck, shoulders; secondary to increased estrogen levels
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| endocrine problems cause | amenorrhea, testicular atrophy, gynecomastia, impotence
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| peripheral neuropathy | most likely due to dietary deficiencies, ex:thiamine, folic acid
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| diagnostic tests for cirrhosis | liver enzymes(increased levels may decrease as body compensates), serum bilirubin & globulin levels elevated, cholesterol level decreased secondary to abn. fat metanolism, PT increased secondary to liver damage, liver bx, ascites fluid analyzed
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| globulins | antiodies produced by B lymphocytes
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| liver enzyme tests | alkaline phosphatase, AST, ALT, GGT
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| liver biopsy is used to | ID liver cells & structural changes
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| analysis of ascites fluid is to | establish diagnosis
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| medications: Diuretics | Aldactone and Furosemide(Lasix)
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| Aldactone | choice tx drug; a potassium-sparing diuretic that competes w/aldosterone; reduces ascites and aldosterone levels; must monitor for hyperkalemia
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| furosemide(Lasix) | loop diuretic; not passium-sparing; must monitor for hypokalemia; may bew used in combo with Aldactone if serum postassium levels WNL
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| Nursing Responsibilities:Diuretic Therapy | Monitor I&O, daily wt before breakfast, fluid restriction if ordered:divide fluids, monitor labs:potassium, BUN, creatinine, monitor hyponatremia(confusion,lethargy, apprehension), admin meds in AM to avoid nocuturia, admin by 6pm
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| Medications: Hepatic Encephalopathy | lactulose and neomycin sulfate
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| lactulose | decreases ammonia-forming organisms in bowel and increases colon acidity to prevent ammonium absorption: PO liquid
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| ammonium is excreted in | feces
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| lactulose pulls water into bowels and ____________ the number of stools | increases
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| monitor these when taking lactulose | bowel sounds, # stools, abdominal girth, hydration, and electrolytes
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| take lactulose with... | crackers/soft-drink PRN nausea
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| neomycin sulfate | an aminoglycoside antibiotic; reduces # ammonia-forming bacteria in bowel; oral or rectal routes
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| toxic effects of neomycin sulfate | ototoxic, nephrotoxic, and neurotoxic
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| monitor these when on neomycin sulfate | I&O, BUN/creatinine levels
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| neomycin sulfate causes decreases absorption of... | digitalis
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| No protein restriction unless ___________ levels high | serum ammonia
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| Paracentesis | aspiration of fluid from peritoneal cavity to treat severe ascites that does not respond to diuretic therapy
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| goal of paracentesis | relieve respiratory distress + preserve F&E balance, may removed 500ml to 4-6 liters
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| IV albumin is administered with paracentesis to... | maintain intravascular volume
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| Nursing Responsibilites of paracentesis | consent, teach, weight, VS, void, positioning, dressing, labs
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| which diagnostic test would assist to confirm a suspected diagnosis of hepatitis? | serum bilirubin
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| The client says to the nurse, "I think I got this case of Hep A from giving blood a few months ago.". The nurse realizes that Hep A is most often contracted through: | contaminated food
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| Which info obtained from a client would suggest the most probable cause of Hep B diagnosis? | "I got my belly button pierced last month"
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| When teaching a community class about Hep C, the nurse would stress which characteristic about the virus | It is a very virulent virus with no cure
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| A client with Hep C asks the nurse about life-style modifications he could make to decrease the progression of his illness to chronic Hep C. The nurse understands that the most important life-style modification is: | abstinence from alcohol
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| The client with cirrhosis is ordered a very low protein diet. What is the scientific rationale for this? | Dietary restriction will reduce the breakdown of protein by the intestinal bacteria in the GI tract, thereby decreasing serum ammonia levels.
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| Portal Hypertension is caused by: | increased hepatic portal system pressure from scar tissue contraction around hepatic blood vessels
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| Asterixis | an accumulation of nitrogenous wastes in the body
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| The client with esophageal varices is eating snacks brought to his room by visitors. Which of the following foods would be contraindicated? | peanut brittle
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| Failure of the liver to remove ammonia and metabolic wastes from the blood leads to: | mental confusion
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| The nurse caring for a client with cirrhosis notes that the physician has written new orders. Which of the following orders would the nurse question? | rectal temperature every four hours
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| The bedridden client with ascites is experiencing sternal retractions, dyspnea, and restlessness. Rank each of the following nursing interventions in order of priority. | 1. Sit client up in semi-fowler's position 2. Assess pulse oximetry 3.Assess Vitals 4. Assess breath sounds 5. Reassess abdominal girth
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| The client with chronic cirrhosis has just completed a bedside liver bx 15mins ago. The nurse assesses the bx site dressing consisting of 2 4x4 gauze pads, & notes that it is semi-saturated w/sero-sanguinous drainage. What action should the nurse take? | Put pressure on the site for 5 mins and reassess
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| The client is about to have a bedside paracentesis. In what position would the client be placed? | Fowler's
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| The client with an elevated ammonia level is ordered Lactulose 30ml PO BID. What expected drug action should the nurse explain to the client? | "You will move your bowels 2-3 times a day"
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| The nurse is expecting a client w/chronic cirrhosis, bleeding esophageal varices, and a minnesota tube to be admitted to the nursing unit. What equipment should the nurse have in the client's room before they arrive? | A suction machine
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| The client w/cirrhosis has a high ammonia level. Which portion of the diet prescription should the nurse question? | High Protein
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| A client who is jaundiced and is suspected of having contracted Hep B has been admitted to the hospital. Which of the following nursing interventions would be most appropriate for this client? | Encourage bed rest to reduce the liver's metabolic demands
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| A client is suspected of having hepatitis. Which diagnostic test will assist in confirming this diagnosis? | elevated serum bilirubin
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