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Hepatic PCC obj 2&3

QuestionAnswer
hepatic dysfunctions are caused from? (7) alcoholism, malnutrition, viral hepatitis, drugs & toxins, biliary disease, metabolic/genetic causes, hemolytic transfusion reactions
s/s of hepatic dysfunctions? Jaundice, ascites, esophageal varices, portal HTN, hepatic encephalopathy, generalized edema, hepatomegaly
This type of Dx test shows extent of dysfunction -not determined by tests alone (measured by serum enzyme activity) Liver function Test
Liver function test include? ALT, AST, GGT, alkaline phosphatase, ammonia, bilirubin, protien, albumin, PT/INR, lipids
Aspartate Aminotranserase (AST): 10-40 U/L Present in high metabolic tissues, so it increases if damage to the heart, liver, skeletal muscle, or kidneys. Not specific to liver disease but may be high in patients with cirrhosis, hepatitis, & liver cancer
Alanine Aminotransferase (ALT): 5-35 U/L Levels increase primarily in liver disorder and may be used to monitor the course of hepatitis or cirrhosis or the effects of tx toxic to the liver
GGT: 10-48 IU/L Increase in alcohol use
Lactate dehydrogenase (LDH) 100-225 unit mol/L Increase in alcohol abuse. Marker for biliary cholestasis
ammonia (plasma): 15-45 ug/dL (liver converts ammonia to urea) Used to support the Dx of severe Liver disease/failure
Serum Bilirubin (direct) 0-0.3 mg/dL
Serum bilirubin (total) 0-0.9 mg/dL
Urine bilirubin 0
bilirubin levels these studies measure the ability of the liver to conjugate & excrete bilirubin. Results are abnormal in liver & biliary tract disease and are associated w/ jaundice
Serum creatine may be elevated due to? decreased kidney function
Liver test include? Ultrasound, CT/MRI, esophagogastroduodenoscopy (EGO) Endoscopic retrograde cholangloparcetogram (ERCP) & liver biopsy
What is ERCP? (Page 1174) Endoscopic Retrograde Cholangiopancreatogram An endoscope is inserted to view hepatobiliary system, fluorscopy & multiple xrays (used druing to evaluate the presence & location of ductal stones) Requires multiple postion changes to retrieve gallstones
This exam of the hepatobiliary system is carried out via a side viewing flexible fiberoptic endoscope inserted through the esophagus to the descending duodenum...? ERCP
ERCP requires mult. position changes to pass the endoscope during procedure. what position does the patient begin in? Left Semiprone Position
Nursing Care for ERCP before the procedure includes? Cooperative Pt Give pt explanation and their role NPO for several hours before procedure Moderate sedation used Monitor sedated pt closely Meds (glucagon or anticholinergics) to make cannulation easier by decreasing peristalsis
ERCP, the nurse observes closely for S/S of _______. (if glucagon is admin) respiratory & CNS depression Hypotenstion Oversedation Vomiting
during ERCP nurse does? Monitors IV fluids admin meds positions the patient
AFTER ERCP nurse monitors ? monitors pt's condition Observes VS Monitors for S/S of perforation or infection s/effects of any meds given Return of gag & cough reflexes after use of local anestetics,
Removal of a small amount of liver tissue usually through needle aspiration is? Liver biopsy
Why is liver biopsy performed? permits exam of liver cells. most common indication is to evaluate & diffuse disorders of the parenchyma and to Dx space occupying lesions. Esp usefull when clinical finding and lab tests are inconclusive
Major complication after liver biopsy? bleeding and bile peritonitis
Pre-Procedure for liver biopsy 1: results of coagulation tests and compatible donor blood made available 2: check for signed consent; check for informed consent 3: record pt P,R,BP immediatly before biopsy 4: describe steps of procedure, sensations expected, after-effects anticipat
Nursing care During Procedure of a percutaneous liver biopsy 1-support pt during procedure 2- expose the R side of pt upper abdomin 3- intruct pt to inhale/exhale deeply several times, finally exhale & hold breath @ end of expiration. The the physician promptly intro biopsy needle into intercostal space, penetrates
post procedure for percutaneous liver biopsy (nursing Int) 1-pt on R side w/ pillows and stay in position
Liver Assessment of skin & extremities skin, mucosa, sclera = check for jaundice bruises, spider angiomas, palmar erythema Extremities: edema, muscle atrophy, asterixis (liver flap) scratching
Liver assesment (cont) cognitive: recall/memory, abstract thinking, neuro Abdomen: acites, fluid wave, palpable liver in RUQ, tender, measure abdominal girth.
Liver assessment in males gynecomastia, testicular atrophy
Liver assessment CACO CACO vomit, stools, NG drainage, check for occult blood & melena
How do you find History for Liver disease? Previous exposure to hepatotoxic supbstances or infectious agents. Travel Hx, drug/booze use, medication Hx (APAP, nicoral, depakene) OTC, herbs & diet supplements.
Hx of liver disease cont> Lifestyle (IV/drug use, sex practices, foreign travel) Medical Hx, Family Hx, Previous symptoms
Created by: 504151831