Nursing Care of Patients with Liver, Pancreatic, and Gallbladder Disorders
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| 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
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| Hepatitis G transmission | It is bloodborne and transmission may occur with transfusions, hemodialysis, IV drug use, sexual contact and mother to newborn
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| Who are co-infected with Hepatitis G | HBV and HCV
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| HIV and Hepatitis G relationship | those with HIV who are infected with HGV seem to have increased survival rate
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| Prevention of Hepatitis | vaccinations available for HAV and HBV provide permanent active immunity
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| Diagnostic tests for hepatitis | Liver enzymes elevated; serum bilirubin elevated; prothrombin time prolonged
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| Liver toxic drugs | acetaminophen; opioids; tranquilizers; sedatives; many drugs are metabolized by the liver and may need to be discontinued or dosage adjusted
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| Nursing care with liver failure | do not use acetaminophen or products with acetaminophen; position patient upright or sitting position
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| Acute liver failure therapeutic interventions | high-calorie, low-sodium, and low-protein diet
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| Meds to decrease ammonia level | lactulose, neomycin, sorbitol, magnesium citrate
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| Clotting defects and cirrhosis | impaired prothrombin and fibrinogen production; absence of bile salts prevents absorption of fat-soluble vitamin K; hemorrhage can develop
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| Therapeutic interventions for esophageal varices | vasoconstrictors (octreotide, vasopressin)
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| Encephalopathy and lactulose | makes colon more acidic which creates an insoluble form of ammonia that is excreted in the stool
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| Encephalopathy and Neomycin | to reduce colonic bacteria that change ammonium to ammonia
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| Reason to restrict dietary protein with encephalopathy | reduces ammonia production
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| Diet with acute liver failure and cirrhosis | low-sodium diet with fluid restriction; protein restriction and frequent mouth care may help imbalanced nutrition
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| 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
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| 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
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| 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
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| 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
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| 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
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| 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
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| Acute pancreatitits therapeutic interventions with foley catheter | strict I and O
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| Acute and chronic pancreatitis interventions for pain | position in high Fowler’s, leaning forward to keep abdomen organs from pressing against inflamed pancreas
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| 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
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| 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
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| Malabsorption syndrome s/s | fatty stools, weight loss, dry skin, bleeding
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| Signs and symptoms of cancer of the pancreas with obstruction of bile duct | jaundice; dark urine; light colored, clay colored stools; pruritus
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| 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
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| Fasting: less active GB, bile will concentrate-can lead to cholelithiasis |
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| Signs and symptoms of cholelithiasis | jaundice and clay-colored stools due to common bile duct blockage
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| 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
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| 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
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| Gallbladder disorders and risk for deficient fluid volume | monitor I & O; give antiemetics
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| 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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