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Hepatic PCC obj 5
| Question | Answer |
|---|---|
| What is the most common cause of portal HTN? | Cirrhosis |
| Portal HTN = blood backs up, which increases pressure in portal systems...so high pressure causes? | Colleteral vessels to develop, to open between the portal veins & systemic veins, which enables blood to by pass the obstructed vessels |
| S&S of ascites? | Increased abd. girth, rapid wt. gain, SOB, striae and distended veins visible on abd. wall. F&E imbalances are common also. |
| The presence and extent of ascites are assessed by? | Percussion of the abd & detecting a fluid wave. (flanks bulge when the pt is in supine position) |
| Treatment for ascites? | Decrease Na+ in diet, diuretics, bed rest, paracentesis, TIPS(transjugalr Intrahepatic Portosystemic Shunt), Shunts |
| Nursing management w/ ascites? | Daily wts. abd girth, I&O, low Na, monitor labs (ammonia, F/E, BUN, Protien, H&H), monitor response to therapy, s/s of encephalopathy, avoid ETOH, take meds as prescribed |
| What is the best way to measure abdominal girth? | Measure & record w/ tape measure daily Daily wt |
| How does sodium relate to ascites? | (think of the patho) The failure of the liver to metabolize aldosterone increases Na and H20 retention by the kidneys. Causing fluid to build up in the peritoneal cavity |
| What should the nurse teach the pt & family about ascites? | Avoid all alcohol intake, adhere to low Na diet, take meds as prescribed, check with DR b4 taking any new meds, teach about tx. plan, daily wt, I&O, don't take NSAIDS w/ ETOH, antibiotics, don't take antiacids w/ Na, S/S of complications |
| How is paracentesis performed? | Removal of fluid (ascites) from the peritoneal cavity through a puncture or a small surgical insision thru abdominal wall under sterile conditions. |
| Nursing care during procedure of paracentesis? | Help pt. maintain position, measure BP freq., monitor for vascular collapse (hypovolemia) pallor, increase pulse, or decrease BP |
| Nursing care post procedure w/ a paracentesis? | measure & CACO fluid, label & send fluid to lab, VS q 15 min for 1 hr then Q 30 min for 2 hrs, then Q1 hr for 2 hrs, then Q4. Pt temp, asses for hypovolemia, F/E shifts... |
| major side effects of paracentesis? | Bleeding, Infection, Hypovolemia |
| What is esophageal varices | Varicosities that develop from increase pressure in the veins that drain to the portal system. Once they form, they increase in size and eventually bleed/rupture causing life threatening hemorrhage. |
| Esophageal varices are most significant in what disease of the liver? | Cirrhosis (in 50% of these patients) 1st bleeding episode has mortalitiy rate of 30-50%! |
| Clinical Manifestations w/ bleeding in esophageal varices? | Hematemesis, melena, general deterioration in mental or physical status, & often have hx of alcohol abuse. |
| S/S of shock? | Cool clammy skin, hypotension, tachycardia |
| Pts w/ cirrhosis should undergo screening endoscopy every? | 2 years |
| Other assessment and Dx findings include? | barium swallow, ultrasonography, CT, & angiography. Portal HTN measurements. Lab tests |
| Treatment of bleeding varices? | Tx of shock, O2, IV fluids, electrolytes & volume expanders, blood/blood products, vasopressin, stomatostatin, octreotide to decrease bleeding, nitro used in combo w/ vasopressin to decrease coronary vasoconstriction |
| what meds tx bleeding varices? | Propanolol & Nadolol to decrease portal pressure. Vasopressin, somatostatin, octreotide to decrease bleeding |
| Pressure is exerted on the cardia and against bleeding varices by a ? | double ballon tamponade |
| What is the most important priority in caring for a pt w/ a balloon tamponade apparatus inserted for esophageal varices? | Possibility of injury or rupture of the esophagus (possibly from over inflation) displacement of the tube (obstructing airway) rupture of gastric balloon. |
| Other Nurs. care for balloon tamponade? | Freq mouth & nasal care, possible suction, provide support for anxious & frightened. carefully explain discomfort |
| An injection of sclerosing agent into esophageal varices thru an endoscope to promote thrombosis and eventual sclerosis, thereby obliteraing the varices | Endoscopic sclerotherapy or injection sclerotherapy |
| Nursing care for endoscopic sclerotherapy | After Tx for acute hemorrhage pt is observed for bleeding, perforation, of the esophagus, aspiration pneumonia and esophageal stricture Also antacids, H2 antagonist, or PPI may be administered after to counteract the chem effects of the sclerosing agent |
| nursing int. for bleeding esophageal varices | VS, monitor nutritional, neuro status, PTN, NG suction, quiet environment, blood transfusion, Vit K treatments, education |
| Manifestations of portal HTN? | Esophageal, gastric, hemorrhoidal varicosities Ascites Splenomegaly (enlarged spleen) *common |
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