Cirrhosis

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Author:
britsands
ID:
147453
Filename:
Cirrhosis
Updated:
2012-04-13 16:51:15
Tags:
brittany
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Description:
cirrhosis np2
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  1. Causes of cirrhosis
    • Alcohol
    • hepatitis bcd
    • autoimmune hepatitis
    • steatohepatitis
    • drugs and toxins
    • biliary disease
    • cardiac cirrhosis- end result of massive CHF
  2. Alcohol abuse and malnutrition:
    Laennec's cirrhosis
  3. Infection and drugs:
    Postnecrotic cirrhosis
  4. Biliary obstruction
    biliary cirrhosis
  5. How is portal hypertension develop
    • Destruction of hepatocytes
    • fibrosis and scarring
    • obstruction of blood flo
    • Increases pressure in the venous and sinusoidol channels
    • fatty infiltration, fibrosis and scarring
    • Portal hypertension
  6. Diagnostic studies for cirrhosis
    • history and physical examine
    • lab:
    • Liver function test
    • serum electrolytes
    • CBC
    • Prothrombin time
    • Serum albumin
    • stool for occult blood
    • analysis of ascitic fluid
    • Blood studies are a big deal!'
    • EGD
    • liver biopsy-right side, pressure, mon vitals!
    • Barium swallow
    • liver scan
    • liver ultrasound
    • angiography
  7. Signs and symptoms of cirrhosis
    • fatigue
    • significant change in weight
    • gi symptoms
    • abd and liver pain
    • pruritus
    • ascites
    • jaundice
    • petchiae
    • fector hepaticus
    • dependant edema of extremitis ans sacrum
    • astrerixis- Flapping hands (To much ammonia in brain)
  8. 3 things that portal hypertension cause:
    • 1. Hepatic encephalopathy
    • 2. Ascites
    • 3. Esohageal varices
  9. Lactulose
    • binds with ammonia in GI
    • Symptom- Massive diarrhea
    • It will hopefully get patient out of coma
    • (gi bleeding- old blood- increased bun)
  10. Paracentesis
    • Drains acitis
    • drain slowly to prevent shock
    • monitor leaking fluid and respiratory status
  11. Medical management cirrhosis
    • Rest
    • B-complex vitamins (intrinsic factor- helps with RBC production)
    • Avoidance of alcohol, aspirin, acetaminophen, and NSAIDS
    • Management of acites
    • diruetics
    • h2 receptor antatgoinsts
    • ppi's
  12. management of acitis
    • portacaval shunt aka TIPS
    • Reroutes circulation to bot put as much pressure on liver
    • decreases bleeding episodes
    • does not prolong life, patient dies of hepatic encephalopathy
  13. Supportive measures for acute bleed
    • fresh frozen plasma-will help clotting factors
    • Packed RBCs
    • Vitamin K
    • Histamine receptor blockers
    • Proton pump inhibitors
    • Neomycin- po, rectally, kills gi flora (will reduce ammonia)
    • Lactolose- reduce ammonia
  14. Diet for patien without complications
    • High in calories (3000calories/day)
    • High in carbs
    • Moderate fat
    • Protein restriction rarely justified (high bun end product)
    • Low sodium diet for patient with ascities and edema
  15. Nursing intervention
    • Monitor for:
    • Abdominal distention
    • N&V
    • RUQ pain
    • Rest
    • Oral care Between meal nourishment
    • dietary restrictions explained
    • Education on avoiding causative factors
    • Accurate I&O
    • Daily weights
    • Altered mentation
    • *reorient
    • *treat with medications- lactulose if encepholphathic
    • Skin care (no benydrl) itchy
    • Monitor electrolyte disturbances
    • observe for bleeding disorders
    • maintain safe enviroment
  16. one thing to remember with patient before parencentesis
    make sure bladder is empty
  17. Nursing interventions for paracentesis
    • Montior vitals signs
    • Monitor color and amount withdrawn
    • abdominal girth measurements before and after
    • monitor puncture site for bleeding and serous fluid oozing
    • monitor respriatory status before and after
  18. portal hypertension causes hypersplenism, what will this cause?
    • Moderate anemia
    • neutropenia
    • thrombocytopeina
  19. Happens when the body is unable to convert ammonia and other waste products to a less toxic form, ammonia crosses the bloo-brain barrier
    portal systemic encephalopathy (hepatic encephalopathy)
  20. Drug therapy for hepatic encephalpathy
    • lactulose
    • neomycin
    • metronidazole-flagyl
  21. nursing interventions fo hepatic encephalpathy
    • maintain safe enviroment
    • neruologic status q2h
    • prevention of constipation
    • limit physical activity
    • control hypokalemia
    • ensure proper nutrition -some TPN if can handle it
  22. Complication of esophageal varices
    hypovolemic shock
  23. Treatment for esophageal varices
    • EDG with ligating abnds
    • shunts
    • esophagogastric balloon tamponade
    • gastric lavage
  24. Drug therapy for esophageal varices
    • Beta-Blocker
    • Inderal
    • Vascoconstrictors
    • Sandostatin
  25. Blakemore tube
    • Drain blood from esophagus and stomach
    • WILL BE ON A TRACTION sedation
    • watch for resperatory status
    • 3ports -esophageal balloon, gastric balloon, suction blood.
  26. Nursing management on esophageal varices with blakemore tube
    • salin lavage/NG suction to rmove blood
    • Monitor for complications
    • Most common: aspiration pneumonia
    • Scissors at bedside
    • Semi-fowlers
    • Oral and nasal care

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