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Med Surg Ch 35
Nursing Care of Patients with Liver, Pancreatic, and Gallbladder Disorders
| Question | Answer |
|---|---|
| Hepatitis G | was just discovered in 1915. Not much is known about it. It is thought to cause a mild illness; it is unknown if it causes longterm liver damage |
| Hepatitis G transmission | It is bloodborne and transmission may occur with transfusions, hemodialysis, IV drug use, sexual contact and mother to newborn |
| Who are co-infected with Hepatitis G | HBV and HCV |
| HIV and Hepatitis G relationship | those with HIV who are infected with HGV seem to have increased survival rate |
| Prevention of Hepatitis | vaccinations available for HAV and HBV provide permanent active immunity |
| Diagnostic tests for hepatitis | Liver enzymes elevated; serum bilirubin elevated; prothrombin time prolonged |
| Liver toxic drugs | acetaminophen; opioids; tranquilizers; sedatives; many drugs are metabolized by the liver and may need to be discontinued or dosage adjusted |
| Nursing care with liver failure | do not use acetaminophen or products with acetaminophen; position patient upright or sitting position |
| Acute liver failure therapeutic interventions | high-calorie, low-sodium, and low-protein diet |
| Meds to decrease ammonia level | lactulose, neomycin, sorbitol, magnesium citrate |
| Clotting defects and cirrhosis | impaired prothrombin and fibrinogen production; absence of bile salts prevents absorption of fat-soluble vitamin K; hemorrhage can develop |
| Therapeutic interventions for esophageal varices | vasoconstrictors (octreotide, vasopressin) |
| Encephalopathy and lactulose | makes colon more acidic which creates an insoluble form of ammonia that is excreted in the stool |
| Encephalopathy and Neomycin | to reduce colonic bacteria that change ammonium to ammonia |
| Reason to restrict dietary protein with encephalopathy | reduces ammonia production |
| Diet with acute liver failure and cirrhosis | low-sodium diet with fluid restriction; protein restriction and frequent mouth care may help imbalanced nutrition |
| Assessing neuromuscular status | ask patient to stand with his arms and hands out straight in front of him, if asterixis is present, his hands will unwillingly dip and return to horizontal position in a flapping motion |
| Med administration and acute liver failure and cirrhosis | give lactulose, neomycin, Mg citrate, sorbitol as scheduled; do not withhold lactulose for loose stools, this indicates the med. is working; question giving meds. such as sedatives, opioids, tranquilizers |
| Risk for deficient fluid volume/bleeding with acute liver failure and cirrhosis | monitor gastric secretions, stool, and urine for bleeding; advise use of soft bristle toothbrush and electric razor; avoid forceful coughing, nose blowing, straining, vomiting, or gagging |
| Signs of rejection for liver transplant | Pulse >100 bpm; temperature >101°F; RUQ Pain; increase in jaundice; decrease in bile from T-tube or change in bile color; elevated liver enzymes |
| Signs and symptoms of acute pancreatitis | abd pain; guarding; rigid and distended abd; hypotension; shock; jaundice; dry mucous membranes; tachycardia; respiratory distress; midline pain under sternum with radiation to spine, back, flanks; low fever; nausea and vomiting; eating worsens pain |
| Diagnostic test for acute pancreatitis | serum amylase and lipase elevation; elevated glucose , bilirubin, alkaline phosphatase, lactic dehydrogenase, ALT, AST, cholesterol and potassium; decreased albumin, calicium, sodium and magnesium |
| Acute pancreatitits therapeutic interventions with foley catheter | strict I and O |
| Acute and chronic pancreatitis interventions for pain | position in high Fowler’s, leaning forward to keep abdomen organs from pressing against inflamed pancreas |
| Acute and chronic pancreatitis interventions for imbalanced nutrition | effective treatment if weight loss is < 5% of baseline and patient’s albumin level is above 3.5 g/dl |
| Acute and chronic pancreatitis patient teaching | s/s of diabetes mellitus; teach self-monitor for malabsorption syndrome; vital signs are stable; urinary output > 30 ml/hr |
| Malabsorption syndrome s/s | fatty stools, weight loss, dry skin, bleeding |
| Signs and symptoms of cancer of the pancreas with obstruction of bile duct | jaundice; dark urine; light colored, clay colored stools; pruritus |
| Patient education for cancer of the pancreas | management of hyperglycemia; pancreatic enzyme replacement; s/s of hemorrhage, gastric ulceration, infection, fistula formation; dressing/drain care; complications to report |
| Fasting: less active GB, bile will concentrate-can lead to cholelithiasis | |
| Signs and symptoms of cholelithiasis | jaundice and clay-colored stools due to common bile duct blockage |
| T-tube and nursing care | placed in common bile duct during open cholecystectomy; drains 500-1000 ml the 1st post op day; decreases to 200 ml by 3rd post op day |
| Gallbladder disorders and acute pain | Incisional pain causes hesitancy to coughand deep breath; administer analgesics, have pt. splint the incision, perform C & DB or use of incentive spirometry |
| Gallbladder disorders and risk for deficient fluid volume | monitor I & O; give antiemetics |
| Gallbladder disorders and risk for ineffective breathing pattern | encourage C & DB; use incentive spirometry; control the pain; splint the incision; encourage early ambulation |
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laotracuata
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