cirrhosis dx and tx

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  1. Cirrhosis Dx
    • Physical Exam
    • LFT's= elev in the aminotransferases
    • - AST (SGOT), ALT (SGPT), GGT
    • - 70% of the liver is not functioning, damage release enzymes
    • Labs
    • - dec albumin, total protein
    • - dec cholesterol- alter fat metabolism
    • - elev PT and PTT- not clotting factos
    • - elev bili- bc of dec excretion
    • - eleva ammonia
    • - elev Alk. phosp- found in the liver Kupffer cells
  2. Cirrhosis other dx
    • Liver US
    • Liver scan- size, blood flood
    • aspiration of ascites fluids- paracentesis
    • liver biopsy- confirm dx
    • - see brunner
    • before:
    • - 1. coag labs
    • - 2 CBC
    • - 3 VS
    • After:
    • assess
    • vs, o2 stat
    • pain
    • site- bleeding
    • avoiding coughing or straining
    • turn pt on right side to help put pressure- reduce bleeding
    • no heavy lifting for a week
  3. other cirrhosis dx
    child pugh classification
    • prognostic indicator
    • predicting outcomes of pt with liver disease
  4. cirrhosis
    nx dx
    prioritize
  5. Cirrohosis treatment
    • Rest****
    • - encourages regeneration of the liver
    • - decr metabolic demands
    • - HOB up- dyspenia
    • - assess skin d/t edema, changes in skin mentation
    • oxygen therapy
    • IS/DB
  6. Cirrhosis
    nutrition
    • with no complications: high calorie, high CHO, mod-low fat
    • protein- 1-1.5 grams: problems low protein no problems mod protein
    • - bc low protein watch for malnutrition
    • - needs are based off of s/s
    • *** sodium- 2G/d or 250-300mg/d if severe ascites
    • vitamins: MVI, thiamine, folate
    • fluids: may have fluid restriction (balancing act) w/ascites
    • intervention: altered nutrition
  7. High Na sources
    • canned soup, vegatable
    • salted snacks, nuts
    • smoked meats, fish
    • crackers, bread
    • olives, pickles
    • ketchup
    • OTC meds ie antacids
    • teach pt to read labels
  8. what to do w/ascites
    • assess fluid and electrolyte status
    • Na restriction- becareful with malnutrition
    • Strict I&O, qd wts and girth- mark the measurements for the right places
    • hydration status
  9. Ascites meds
    • SPA (salt poor albumin)- inc colloid oncotic pressure: temporary works while in the blood
    • - s/e FVE- holding on
    • Beta Blocker
    • - decr pressure in portal vein- bc it vasodilates
    • - hypotension, H/A, dizziness, bradycardia
    • directics- spironolactone w or w/out furosemide (blocks aldosterone)
    • - monitor electrolytes
    • - furosemide- is a loop diurectic (strongest one)
    • - one holds on to k and the other lets it go
    • - used for ascites
    • - 90% effective
  10. paracentesis
    • bedside, local anesthesia
    • fluid withdrawn with a needle
    • baseline VS, IV access, girth, coags
    • pt instructed to void prior
    • position upright
    • monitor VS during procedure and monitor hypovolemia
    • this could be to dx or to tx
    • temporary measure with tx
    • sometimes use a foley cath to help drain
    • make sure u don't pull out too fast- sometimes they take some fluid and then clamp it to help it with shifting
  11. paracentesis- post
    • check VS freq- q 15 1 hr, q 30 x2hr, q 1 x2 hrs
    • position on right side for several hrs- to seal it
    • compare abd girth pre and post
    • bandaid to site clean and dry 3-5 d
    • watch site for bleeding
    • risk- hypovolemia, infection
    • post teaching: no heavy lifting, straining, slow position changes d/t loss of volume
    • normal to leak a lil- use 2x2 or 4x4
  12. peritovenous shunt
    • severe ascites: nothing else worked
    • LaVeen shunt- surgically placed
    • one end in the periteneus, other in jugular vein or SVC
    • 1 way valve prevents back flow
    • - valve opens with pressure
    • incr abd pressure pushes fluid from abd into venous system- get fluid back in the blood
    • palliative for ascites****
    • risk thrombosis (whenever u add something foriegn in the body), infection, occulsion, FVO
    • it has to interfer with life like pain, SOB
  13. Shunting procedures
    • TIPS= transjugular intrahepatic portosystemic shunt
    • - severe ascites or bleeding varices
    • redirects portal blood flow
    • - shunt btw portal vein and portal artery
    • decr portal pressure and pressure at varices
    • c/o; sepsis bleeding, thrombosis, organ failure
    • encephalopathy
    • only fair long term success
  14. Esophageal varices
    • bleeding may be life threatening
    • dx/tx by endoscopy
    • - sclerotherapy, ligation
    • prevention
    • - avoidance of irritants- even big pill
    • - beta blocker: helps with bleeding, dec portal pressure but becareful bc it can hyperprefuse liver and cause encephalopath
  15. Esophageal varices
    Sengstaken- Blakemore tube
    • for severe bleeding uncontrolled by other measures
    • balloon tampanade
    • esophageal balloon- cork
    • gastric balloon- cork, anchor- stabilizer
    • *** airway***
    • like an NG tube inserted in nose
    • assess for respiratory distress
    • keep scissors at bedside****
    • if gastric balloon starts to leake- the will go up- cut esophageal balloon to deflate and pull out
  16. Sengstaken-Blakemore tube
    nursing care
    • careful assessment of airway
    • blackmore- deflate esophageal balloon q 8-12h, gastric balloon always inflated- u want to deflate to decr risk of pressure ulcers and the other one stays inflated to help anchor it
    • scissors at bedside
  17. Esophageal varices meds
    • stabilize pt (airway, iv access)
    • Vasopressin- DOC
    • - splenic vasoconstriction- dec portal pressure, dec splenic congestion
    • - se: chest pain, HA, arrithymias (VS, HR)
    • ocetrotide (sandostatin)- same as above
    • - dec portal htn and pressure
    • - se: HA
    • nitroglyerin
    • - dilate portal vein
    • - se: dec BP, HA
    • beta blocker
    • PRBC, FFP (clotting)
    • Vitamin K not IM
    • H2, PPI- dec acid
    • - risk for bleeding- HE
    • Lactulose, Neomycin, rifaximin- dec risk for H/E
    • antiobiotics- preemptive
    • - flagyl and cipro- broad spectrum, intra abdominal site- gets in there
  18. Esopha varices
    nursing responsibilities
    • similar to with those with GIB
    • HOB eleb
    • NS lavage- put in saline and suction it out
  19. Hepatic Enceph
    • potentially life threatening
    • goal: reduce NH3, formation
    • avoid constipation and straining
    • Assess neurologic s/s
    • - escalating NH3 level threaten CNS function
    • assess ammonia levels
    • careful adm: sedative, analgesics
  20. HE
    meds
    • Lactulose
    • - NH3 attracted to acid environment, produces stools, dec bacterial flora
    • - this creates acid environment in the GI- ammonia is attracted to acid
    • - goal 2-3 soft stools 24 hrs
    • - becareful of dehydration
    • - no constant loose stools
    • Neomycin
    • - dec bacterial flora, NH3 production
    • - works only in GI tract
    • - SE
    • Rifaximin
    • - MOA- unknown
    • - fever, GI, H/A
  21. HE
    nutrition
    • protein restriction (if acute)
    • 1.2-1.5g/Kg/d
    • dairy, vegetable protein better tolerated than meat protein
    • high CHO foods, encourage to maintain glucose, spare protein
    • limit high protein foods in diet
    • small freq meals
  22. Liver transplant
    • last resort
    • recurring encephalopathy
    • end stage liver disease
    • availability a major obstacle
    • incr success with living donors

Card Set Information

Author:
Prittyrick
ID:
314957
Filename:
cirrhosis dx and tx
Updated:
2016-01-30 01:01:41
Tags:
dx tx
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Description:
cirrhosis
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