Lactulose for hepatic encephalopahty due to liver cirrhosiselimination of ammonia in stool, reduce ammonia formationRifaximin for hepatic encephalopathy from liver cirrhosisantibiotic, poorly absorbed systemically so we give it b/c it forces on any bacteria in the gut, reduce ammonia production by eliminating ammonia producing bacteriaNutritional therapy for liver cirrhosishigh in calories (3,000 cal/day), and carbs
- moderate to low fat, protein restriction rarely needed (may see with acute encephalitis)Protein supplements given for liver cirrhosisfor protein-calorie malnutritionSodium diet for liver cirrhossilow for patient with ascites and edemameasures to relieve pruritus with liver cirrhosischolestyramine or hydroxyzine, baking soda or alpha keri baths, lotion/soft or old line, antihistamines, temp control, short nailsWhat position should the patient be in for paracentesishigh fowler's position or sitting on side of bedElevate lower extremities/scrotum with liver cirrhosisscrotum swell and it becomes large, take a towel and roll it up, and elevate it to improve venous returnAssessing neuro with hepatic encephalopathyevery 2 hours
- assess carefully (going to be confused)Treatment of gallstones depends on what (cholelithiasis)the stage of the disease and the health of the patientTreatment of bile acids (cholelithiasis)cholesterol solvents such as ursodeoxycholic acid and chendoeoxycholic acid are used to dissolve the gallstonesWhat medications are given to dissolve the gallstonesursodeoxycholic acid and chendoeoxycholicERCP with sphincterotomy for cholelithiasisclips the sphincter of Oddi that connects the common bile duct to the duodenum, this allows visualization of the biliary system, dilation of duct strictures, stent placement, and stone removalESWL for cholelithiasisuses high-energy shock waves to break up gallstonesAnalgesics for cholelithiasisincluding morphine to manage pain related to gallstone movement or inflammationAnticholinergics for cholelithiasisdecrease spasms of the gallbladderbile salts for cholelithiasisbinds to excess bileCholestyramine for cholelithiasisa resin that bids to bile salts, increasing their excretions, used to treat pruritusNutritional therapy for cholelithiasisthe patient who is not a candidate for surgery or has milder gallbladder disease will need to follow a special diet to prevent future gallstone attackWhat should the diet include for cholelithiasissmaller, more frequent meals with some fat, reduction in intake of saturated fats, increased intake of fiber and calciumNonoperative treatment for cholelithiasissome patients have underlying comorbidities and cannot handle general anesthesia
- care may be supportive and focused on controlling symptoms to maintain fluid/electrolyte imbalances, control possible infection, and reduce painN/V of cholelithiasisinsertion of NGT and gastric decompression to prevent gallbladder stimulation from food intakeGI secretions and smooth muscle spasms with cholelithiasisadministration of anticholinergicsPurulent material in gallbladder with cholelithiasischolecystostomy to drain purulent materialPreferred surgery for cholelithiasislaparoscopic cholecystectomy decreases recovery timeWho is laparoscopic cholecystectomy contraindicated in?peritonitis, cholangitis, gangrene, perforation of the gallbladder, portal hypertension, or serious bleeding disordersOvert signs of pain and any changes in stool color or consistency need to be assessed for gallbladder diseaseguarding or grimacing, N/V, jaundice, clay-colored stoolWhen does the nurse need to assess the patient with gallbladder diseasebefore, during, and after diagnostic and surgical procedures for pain, N/V, and the condition of incisions related to a cholecystectomy if applicableOverall goals for patient with gallbladder diseaserelief of pain and absence of postoperative complications and recurrent attacks of cholecystitis or cholelithiasisWhat food status is needed with gallbladder diseaseNPO, insertion of NG tube and gastric decompression as neededWhat position should you position a patient with gallbladder disease in?Sims' position to help move retained carbon dioxide away from the diaphragmMonitor complications of post-op carethe nurse should assess and monitor patients for respiratory complications, as well as complications of stone obstruction and postoperative structural sameWhat assessments should be completed to monitor for complications of post-op gall bladder surgeryventilation, gag reflex (ability to swallow), bilirubin and liver enzyme levels, skin coloration and turgor (jaundice)Skin care for a patient with open cholecystectomycare for the T tube
- assess/document the color and volume of the drainage form the drainage bag
- empty the drainage bagWhat should the patient be aware of after cholecystectomynecessary dietary changes, how to care for surgical wounds, when to call the physician or seek emergency careIV narcotics for acute pancreatitismorphine, hydromorphone
- PCAAntispasmodics with acute pancreatitisbentyl- decreases pancreatic enzymatic outflowHow to decrease pancreatic secretions for acute pancreatitiskeep patient NPO/good oral care, NGT to suction, G-tube will stimulate pancreas so NO G-tubeWhy do you keep patients NPO for pancreatitisfood that enters the duodenum that triggers the release of the pancreatic enzymesNG to suction for pancreatitisreduces vomiting, gastric content from entering duodenum
- NO G-TUBEShock care with acute pancreatitisplasma or plasma volume expanders (dextran or albumin)CVP reading for acute pancreatitisto monitor, gives measures of preload- how much volume is coming into the right side of the heartChanges in blood glucose due to acute pancreatitisdamage to islets of langerhans (decreased insulin = hyperglycemia)Vital signs with acute pancreatitishypotension, fever, tachypnea
- pain causes BP to shoot up, once pain is under control may find that their BP dropsPositions of comfort for acute pancreatitisflex trunk and draw knees to abdomen
- side-lying with HOB elevated 45 degreesHow does pain with chronic pancreatitis feelheavy, gnawing feeling; burning and cramp-likePain relief for chronic pancreatitisanalgesics
- morphine or fentanyl patch (duragesic)Pancreatic enzyme replacement for chronic pancreatitiscontain amylase, lipase, trypsinAntidepressants given with chronic pancreatitisgiven as compliment to pain medication as well as to reduce anxietyWhen is surgery indicated with chronic pancreatitiswhen biliary disease is present or if obstruction or pseudocyst develops
- diverts bile flow or relieves ductal obstructioncholedochojejunostomyanastomose the common bile duct to the jejunum which relieves biliary obstruction, drain bile right into the jejunum (chronic pancreatitis)Roux-en- Y pancreatojejunostomyremove part of the pancreas and sew the pancreas to the jejunum (chronic pancreatitis)Endoscopic procedures for chronic pancreatitispancreatic drainage
- ERCP with sphincterotomy of the sphincter of oddi/or stent placement
