Hepatic Disorders (Cirrhosis/Cancer)

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Author:
alyn217
ID:
200027
Filename:
Hepatic Disorders (Cirrhosis/Cancer)
Updated:
2013-02-16 20:41:40
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AMS2T1
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Description:
Adult MedSurg 2
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  1. What is some general info about cirrhosis?
    • Accumulation of fat in cells (alcoholic)
    • • Cell necrosis
    • • Fibrosis (scarring) and nodules
    • – Altered structure in liver alters blood flow, lymphatic and bile flow
    • • Bile stasis leads to jaundice 
  2. What are the early SnSs of cirrhosis?
    • – Insidious
    • – GI symptoms
    • – Abdominal pain
    • – Fever
    • – Enlarged liver and spleen 
  3. What are late SnSs of cirrhosis?
    • – Jaundice
    • – Peripheral edema (low albumin)
    • – Ascites
    • – Skin lesions
    • – Hematologic disorders
    • – Endocrine problems
    • – Periph. Neuropathies
    • – Small, nodular liver 
    • Fector hepaticus: poop-smelling burps
    • Asterixis: inability to keep hands flexed when arms are held out in front of pt.
    • Palmar erythema: will not blanch. 
  4. Possible complications related to cirrhosis?
    • • Structural changes
    • – Obstruct portal vein circulation
    • – Back up & congestion-->portal vein hypertension. 
    • • Varices
    • – Caput medusae
    • – Hemorrhoids
    • • Splenomegaly
    • • Bruits 
    • • Esophagealvarices: if portal hypertension-->inability of liver to accomodate blood-->distention of esophageal vein distention-->rupture (exsanguinate) 
    • – Common
    • – Bleed
    • • Slow
    • • Hemorrhage:emergent
  5. What is the etiology of acites related to cirrhosis?
    Portal hypertension–->Hypoalbuminemia–-> Hyperaldosteronism
  6. Cirrhosis complications hepatic encephalophathy
    • Clinical Manifestations
    • – CNS disturbance r/t serum ammonia levels 

    • – Early
    • • Irritable, confused, lethargy, slow speech, impaired judgement

    • – Later
    • • Disorientation
    • • Asterixis (liver flap)
    • • Coma 
  7. What is hepatorenal syndrome (HRS)
    • • Renal failure
    • – Azotemia
    • – Oliguria (usually dark brown, sludgy)
    • – Intractable ascites
    • • Etiology complex
    • • Reversible with liver transplantation 
  8. What diagnositics can you use for cirrhosis?
    • Elevated liver enzymes
    • – AST, ALT & GGT
    • • Decreased total protein & hypoalbuminemia
    • • Anemia
    • • Prolonged prothrombin time (PT)
    • • Liver biopsy 
  9. True or false: there are effective treatments to correct cirrhosis.
    • False. have to treat the symptoms.
    • Rest: reduces demand on liver
    • Ascites: sodium restriction, limit fluids, diuretics, paracentesis, shunt fluid back to high volume vessel (ie inferior vena cava)
    • Esophageal verices: Rx (Octreotide, vasopresin, NTG, beta blockers), endoscopic procedures, balloon tampenode, care for acute bleeding
    • --FFP + PC, Vit K, H-2 blockers, laculose/neomycin
  10. What are some long term interventions to care for long term esophageal verices
    • – Beta blockers
    • – Repeat endoscopic procedures
    • • Sclerotherapy
    • • Ligation
    • • Shunt
    • – Shunting procedures
    • • Transjugular intrahepatic portosystemic shunt (TIPS)
    • • Portosystemic shunts 
  11. Collaborative care for cirrhosis
    • Hepatic Encephalopathy
    • –  Reduce ammonia:
    • –  Protein restriction
    • –  Lactulose
    • –  Neomycin: prevents additional protein buildup. 
    • –  Treat causes
    • –  Liver transplantation 

    • Nutritional Therapy
    • – Hi CHO, low fat
    • – Protein varies
    • Low:encephalopathy, hepatic failure
    • High:malnourished
    • – Tube feedings
    • • Travasorb Hepatic or
    • Hepatic-Aid
    • – Low sodium
    • • Ascites, edema
  12. What are some nursing diagnosis related to cirrhosis?
    • – Imbalanced nutrition: less than body requirements
    • – Impaired skin integrity
    • – Ineffective breathing pattern r/t giant ascites. 
    • – Risk for injury
    • – Risk for infection 
  13. What are nursing measures for liver cancer?
    • Comfort measures
    • Safety
    • ...because of poor prognosis.

    • If transplant
    • Rx
    • monitoring
    • emotional support and pt teaching.
  14. Know which Rx you don't want to give to a pt with liver failure.
    These drugs don't necessarily mean they will be toxic to someone with renal failure.

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