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N244 Chronic liver failure (notes)
Terms in this set (33)
In chronic liver failure the liver disease is slow and progressive. CLF pt take laculose daily to keep ammonia low and is titrated to?
two to four bowel movements daily
CLF patients do not typically get cerebral edema like?
acute liver failure pts do
Factors that increase to Hepatic encephalopathy in chronic liver failure are?
*high protein intake
*worsening hepatic function
What is azotemia?
Elevated nitrogenous waste such as BUN and creatinine
What causes pt to develop esophageal varices?
*normal pressure is 2-6 but in portal hypertension its 10-12mmHg
What are esophageal varices?
dilated and tortuous vessels usually in upper stomach and esophagus
What can cause these varices to rupture and cause life threatening hemorrhage?
*coughing, vomiting, straining (vagal)
*this increases the pressure
What happens if the pt gets
*massive IV fluids and blood
*endoscope to visualize and treat bleeding vessel
**sengstaken-Blakemore (tamponade the bleeding vessel
What is ascites?
abnormal collection of fluid in the abdominal (peritoneal) cavity.
What are the big causes of ascites?
What is a big complication that can occur from ascites?
*ascites causes stomach to swell pushing up on diaphragm
*fluid can leak into the diaphragm causing that can accumulate within the plural space causing a pleural effusion, called hepatic hydro-thorax and compromising ventilation.
*fluid volume deficit in the vascular space
What is another complication with ascites?
Kidney circulation is decreased due to pressure on the renal vessels
**compartment syndrome -when 4 liters or more is compressing the bladder pressure
When taking off large volumes of fluid with ascites this can cause a massive fluid shift. How do we compensate for this?
*8-10 grams of albumin for every liter taken off
**In CLF what factor contributes to development of hepatic encephalopathy?
In Chronic Liver failure pt why do they take oral laculose daily?
to prevent encephalopathy
What cause esophageal varices bleeding?
increased portal hypertension
(coughing, vomiting, vagal)
What therapy would be considered to relieve severe abdominal ascites?
What is preventive measures for esphogeal varacies?
****mononitrates (isosobide mononitrate)
*elective shunt surgery
*endoscopic variceal banding
How do we control bleed in an esophageal bleed?
*octreotide (reduces portal pressure)
fresh frozen plasma
Aggressive correction measures for esophageal bleed?
portal systemic shunt surgery
*TIPS Transjugular intrahepatic portosystemic shunt
*distal spenorenal shunt
The goal for these pt with chronic liver failure?
*promoting stable hemodynamics
*preventing or minimizing secondary complications
*monitoring for S/S of multi-system complications
What type of diet would a chronic renal pt need?
You may need to make changes to your diet when you have chronic kidney disease. These changes include:
**Eating a low-protein diet
**Limiting salt, potassium, phosphorous, and other electrolytes
**Getting enough calories if you are losing weight
What are we monitoring for in respiratory complications?
*Fluid volume deficet
*diminished or adventitious breath sounds (crackles)
*abnormal trends in blood pressure and pulse
It is imperative that the nurse monitor Neurological function by?
level of consciousness
Focused GI assessment?
*hepatic tenderness and enlargement
Focused Integumentary assessment?
*poor wound healing
*ecchymosis or petechiae
*pale mucous membranes and nail beds
Frequent nursing diagnosis are?
*ineffective breathing pattern
*deficient fluid volume
*risk for acute confusion
*risk for infection
How do we reduce ammonia?
How do we treat bleeding?
How do we increase kidney function to 0.5ml/kg/hr?
*oncotic agents (albumin)
**What is the major underlying goal that drives the majority of medical management activities?
*to prevent further deterioration of liver function
Leukopenia places the ALF for which nursing diagnosis?
Risk for infection
The presence of asterixis indicates that ____ is present?
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