Nursing IV: Cirrhosis, Hepatitis, Pancreatitis, and Chelecystitis!
HOLY CRAP!!!!!!! This is a lot of stuff but we can do this!!!!!
What is Cirrhosis?
It is an extensive scarring of the liver, usually caused by a chronic reaction to a hepatic inflammation and necrosis.
What are some EARLY stages of a liver disease?
Fatigue, Significant change in weight, GI symptoms, Abdominal pain, Liver tenderness, and Pruritus.
What are some LATE stages of a liver disease?
Jaundice, icterus, dry skin, rashes, petechiae, ecchymoses (lesions), warm, bright red palms of the hands, spider angiomas, and peripheral dependent edema of the extremities and sacrum.
What would you expect to find in the abdominal assessment of a patient with a liver disease?
Massive ascities, umbilicus protusion, caput medusae (dilated abdominal veins), and Hepatomegaly (liver enlargement).
What are some other "late" physical assessments of a patient with a liver disease?
Assess the NG drainage, vomitus, and stool for presence of blood, fector hepaticus (breath odor), amenorrhea, gynecomastia, testicular atrophy, impotence, brusing, petchiae, enlarged spleen, neurologic changes, and asterixis (quiver of the liver)!
What are some lab assessments you would look for in a patient with a liver disease?
Aminotransferase Serum Levels may be ELEVATED! Lectate Dehydrogenase may be ELEVATED! Alkaline Phosphatase levels may be INCREASED! Total Serum Bilirubin and Urobilinogen levels may RISE! Ammonia levels are ELEVATED! Serum Creatinine level is possibly ELEVATED! Prothromin Time is PROLONGED Platelet Count is LOW Total Serum Protein and Albumin Levels DECREASED!
How should the nutrition of a patient with liver disease consists of?
LOW Na+, Limited fluid intake, and Vitamin Supplements.
What are some comfort measures used on a patient with liver disease?
ELEVATE the head of bed at least 30 degrees, or as high as the patient wishes to help minimize SOB. Patient is ENCOURAGED to sit in chair. WEIGH patient in STANDING position because SUPINE position can aggravate dyspnea.
What are some fluid and electrolyte managements for a patient with a liver disease?
Test for: Blood Urea Nitrogen Levels (BUN) Serum Protein Levels Hematocrit (Hct) Levels Electrolytes
What are some surgical interventions in a patient with a liver disease?
What are some interventions to prevent a potential Hemorrhage?
Beta Blocker (keeps BP down) Gastric Intubation Esophagogastric Balloon Tamponade
How is Hepatitis A contracted and spread by?
The Fecal-Oral Route via ingestion of: Fecal Contaminants Contaminated Water Shellfish from Contaminated Water Food Contaminated by handlers infected with HVA Oral-Anal Sexual Activity, ewwwwwwwwwwww! Yuck! lol.
Is HVA life threatening?
NO WAY, HOESAY!
How is Hepatitis B contracted and spread by?
Unprotected Sexual Intercourse with an infected partner Sharing Needles Accidental Needle Sticks Blood Transfusions Hemodialysis Maternal-Fetal Route Promiscuous COTC Nursing Students
What are some symptoms that occur in a 25 to 180 days after exposure to HVB?
What are some clinical manifestations of an Acute Pancreatitis patient?
Generalized Jaundice Cullen's Sign (Grey, Blue Abdomen) Turner's Sign (Grey, Blue Flank) Abdominal Tenderness Rigidity Guarding Pancreatic Ascites Significant changes in vital signs (everything's up because of the pain process!)
What are some Lab Assessments on a person with Acute Pancreatitis?
Lipase is INCREASED Trypsin is INCREASE Alanine Aminotransferase is INCREASED WBC are INCREASED Glucose is INCREASED Alkaline Phosphatase is DECREASED Calcium is DECREASED
What is the #1 way to decrease pain for an Acute pancreatitis patient?
NPO!!!!! Fasting (pancreatic rest)
What are some other ways of nonsurgical management in an Acute pancreatitis patient?
Drug Therapy Comfort Measures Endoscopic Retrograde Cholangiopancreatography (ERCP)
What kind of diet should an Acute Pancreatic patient be on?
NPO in early stages Total Parenteral Nutrition (TPN) if N/V goes for too long! Small, Frequent, Moderate-to-High-Carb HIGH Protein LOW-Fat meals Avoid foods that cause GI stimulation
What is Chronic Pancreatitis?
Progressive Destructive Disease of the pancreas, characterized by remissions and exacerbations
What are some causes of Chronic Pancreatitis?
High Triglycerides Alcohol High Cholesterol
What is the process of giving the pancreatic enzyme to a Chronic Pancreatic patient?
Administer with a FULL glass of WATER With EACH meal WIPE their mouth because this stuff is ACIDIC!
What is Pancreatic Abscess?
The MOST serious complication of pancreatitis! ALWAYS FATAL if untreated!!!!!
What are some ways to find out if you have a Pancreatic Abscess?
Blood Cultures Drainage via the percutaneous method Laparoscopy
What is Insulinoma?
The MOST common type of Neuroendocrine pancreatic TUMOR!
How is the Insulinoma caused?
The benign tumor of the islets of Langerhans causes excessive insulin secretion and subsequent hypoglycemia!
What is the only way to rid of an Insulinoma?
Removal of Tumor via the Whipple Procedure (LAST DITCH!)