Hepatic disorders (Jaundice/Hepatitis)

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Author:
alyn217
ID:
200016
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Hepatic disorders (Jaundice/Hepatitis)
Updated:
2013-02-13 10:54:02
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AMS2T1
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Description:
Adult MedSurg 2
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  1. How is the liver's blood supply unique?
    • Blood suppy
    • – Hepatic artery
    • – Portal vein
    • – Portal circulation
    • – Cardiac output (receives entire volume of cardiac output.)
  2. What is the functional cell of the liver?
    • Lobule
    • Hepatocytes
    • cuffer's cells
    • --last two create the blood filtration system
  3. funcitons of liver?
    • fat metabolism
    • glycogen-->glucose (gluconeogenesis)
    • glucose-->glycogen (glycogenolysis)
  4. Hepatic A & P review for liver function
    • Folks with hepatic encephalopathy will not respond to narcan.
    • Urea cannot be broken down--> ^ in ammonia levels-->v loc. Use laculose instead to absorb ammonia.
  5. How does liver change with age?
    • Decreased liver weight and size
    • Decreased ability to detoxify drugs
    • Increased risk of toxic levels in elderly 

    Tylenol: very toxic to liver. Max dose =4000mg/day.
  6. What are some liver fxn tests?
    • • LiverEnzymes
    • • Bilirubin (conjugated and unconjugated: makes stuff yellow (urine, skin, poo, bruises). RBCs get broken down and recycled. Hemogobin is recycled, unconjugated Bilirub (not water soluable) is a byproduct which will bind to albumin. Anything watersoluable can be broken down by bacteria. High levels of unconjugated will result in jaundice. Bilirubin is a problem because it will hemolocize healthy RBCs (rabdoanemia)-->poor filtration in kidneys-->renal damage. 
    • • Ammonia
    • • PT/INR
    • • Liver Biopsy: bleeding is a problem. Positioning can help. Look it up in book. 
    • • Ultrasound
    • • CT
    • • MRI: if fluid pouching. 
  7. What are some etiologies of jaundice?
  8. What are some nursing interventions for jaundice?
    • Assessment
    • – Determine cause
    • – Pruritis early sign
    • – Check sclerae, skin
    • Impaired skin integrity
    • – Control itching (benadryl, but only low doses if liver failure) 
    • Body image disturbance
    • – Reassure temporary
    • – Express feelings
    • • Altered health maintenance
    • – Educate
    • • Evaluation
    • – Resolves 4-6wks with tx 
  9. Make a chart to compare/contrast hep types. 
  10. general pathophys about hep viral types.
    • Similar changes for all causes of viral hepatitis
    • Hepatocytes affected by immune response
    • Specific antigen-antibody responses to different types of viral hepatitis
    • Liver inflammation and necrosis lead to altered function
    • Healing occurs in 3 to 4 months
  11. What are the preicteric SnSs of viral hep
    • Precedes jaundice
    • Lasts 1-21 days
    • GI symptoms: Anorexia, nausea, abd pain, vomiting, diarrhea
    • Other symptoms: Malaise, HA, fever, arthralgias
    • PE: hepatomegaly
  12. What are snss of icteric phase of viral hep?
    • Jaundice: Lasts 2-4 weeks
    • –  Urine dark
    • –  Light or clay colored stools
    • –  Pruritus: caused by secreting toxins through skin. 
    • –  GI symptoms, fever
    • –  Liver enlarged and tender
  13. What can you expect during posticteric phase?
    • Begins as jaundice subsides
    • – Average 2-4 months
    • – Malaise and tires easily
    • – Hepatomegaly
    • – Relapses may occur
  14. what are some complications of viral hep?
    • Fulminant hepatitis: Ful=most/worst
    • • Chronic hepatitis
    • • Cirrhosis: hardening/scarring of liver. 
    • • Hepatocellular carcinoma
  15. What are some diagnostic studies for viral hep?
    • Blood tests for specific types of viral hepatitis
    • • Liver function tests
    • • Prothrombin time
    • • Serum proteins
    • • Liver biopsy for chronic hepatitis 
  16. Collaborative care for viral hep?
    • Reduce fatigue
    • • Maintain nutritional and fluid balance
    • Avoid alcohol
    • • Avoid drugs detoxified by liver
    • • Drug therapy for chronic B & C
  17. What kidney responses can occur after nfxn
    Pyleonephritis and glomerionephritis

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