Linda S. Williams / Paula D. Hopper Copyright © F.A. Davis Company Understanding Medical Surgical Nursing, 4th Edition Chapter 35 Nursing Care of Patients with Liver, Pancreatic, and Gallbladder Disorders

Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Hepatitis  Inflammation of the Cells of the Liver, Usually Caused by a Virus  Types of Hepatitis  HAV  HBV  HCV  HDV  HEV  HGV

Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Prevention of Hepatitis  Hand Hygiene  Vaccines  HAV  HBV  Standard Precautions  Immune Globulin

Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Signs and Symptoms  Prodromal Stage: 1 Week  Flu-like Symptoms, RUQ Pain  Icteric Stage: 2 to 6 Weeks  Jaundice, Worsening Symptoms  Convalescent: 2 to 6 Weeks  Returning to Normal Liver Function

Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Complications  Liver Failure  Acute  Chronic  Chronic Infection  Carrier  Risk of Liver Cancer

Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Diagnostic Tests  Liver Enzymes  Serum Bilirubin  Prothrombin  Serologic Tests  Liver Biopsy

Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Therapeutic Interventions  Rest  Nutrition  Interferon Therapy  Antivirals  Avoidance of Alcohol and Liver-toxic Drugs

Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Nursing Diagnoses  Pain  Imbalanced Nutrition  Risk for Impaired Skin Integrity  Risk for Ineffective Self-Health Management

Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Acute Liver Failure  Pathophysiology  Sudden Massive Loss of Liver Tissue  Etiology  Drug Toxicity  Hepatitis

Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Signs and Symptoms  Jaundice  Encephalopathy  Confusion  Coma  Bleeding

Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Diagnostic Tests  ALT  AST  Serum Bilirubin  PT  Potassium  Blood Glucose

Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Therapeutic Interventions  Bedrest  Eliminate all Drugs  Possible Dialysis  High-calorie, Low-sodium, and Protein Diet  Lactulose, Neomycin, Magnesium Citrate, Sorbitol  Transplant

Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Cirrhosis  Progressive, Irreversible Replacement of Healthy Liver Tissue with Scar Tissue  12 th Leading Cause of Death

Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Cirrhosis (cont’d)  Etiology  Chronic Alcohol Use – Most Common  Hepatotoxins  Hepatitis  Gallbladder Obstruction  Heart Failure

Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Pathophysiology  Inflammation of Liver Cells  Infiltration with Fat and WBC  Fibrotic Scar Tissue Replaces Liver Tissue  Abnormal Regeneration  Impaired Liver Blood Flow  Impaired Liver Function

Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Signs and Symptoms

Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Complications of Cirrhosis  Clotting Defects  Portal Hypertension  Varices  Ascites  Encephalopathy  Hepatorenal Syndrome

Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Portal Hypertension

Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Diagnostic Tests  Liver Enzymes  Bilirubin  Serum Ammonia  Prothrombin  Abdominal X-Ray  Ultrasound  Esophagastroscopy  Liver Biopsy

Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Therapeutic Interventions  Ascites  Diuretics  Sodium Restriction  Paracentesis  Albumin Infusion  TIPS

Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Therapeutic Interventions (cont’d)  Esophageal Varices Vasoconstrictors  Banding  Sclerotherapy  Vitamin K  Antibiotics

Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Therapeutic Interventions (cont’d)  Encephalopathy  Lactulose  Neomycin  Restrict Dietary Protein  Dialysis

Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Nursing Diagnoses: Acute and Cirrhosis  Excess Fluid Volume  Imbalanced Nutrition  Pain  Risk for Disturbed Thought Processes  Risk for Ineffective Breathing Pattern  Risk for Deficient Fluid Volume  Risk for Infection

Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Patient Education  Disease Process  Signs and Symptoms to Report  Adequate Rest  Diet  Avoid Narcotics, Sedatives, Tranquilizers, Alcohol  Follow-up Care

Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Liver Transplant  Candidates  Liver Failure  No Cancer  No Complications  Otherwise Stable

Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Anti-Rejection Meds  Cyclosporine (Cyclosporin A)  Tacrolimus (Protopic)  Azathioprine (Imuran)  Prednisone (Deltasone)  Mycophenolate mofetil (Cellcept)

Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Signs of Rejection  Pulse >100 bpm  Temperature >101°F  RUQ Pain  Increase in Jaundice  Decrease in Bile from T-tube  Elevated Liver Enzymes

Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Cancer of the Liver  Usually Metastasized from Another Site  Risk Factors  Chronic Hepatitis B  Nutritional Deficiencies  Exposure to Hepatotoxins

Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Signs and Symptoms  Encephalopathy  Bleeding  Jaundice  Ascites

Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Diagnosis  Serum Alkaline Phosphatase  Abdominal X-Ray  Liver Scan  Ultrasound  Biopsy

Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Therapeutic Interventions  Surgery  Chemotherapy

Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Acute Pancreatitis  Pathophysiology  Inflammation  Autodigestion  Elevated Enzymes  Fluid Loss  Complications  Shock  DIC  Chronic Pancreatitis

Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Etiology  Alcohol  Biliary Disease  Trauma  Certain Drugs

Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Signs and Symptoms  Abdominal Pain  Guarding  Rigid Abdomen  Hypotension or Shock  Respiratory Distress  Low-grade Fever  Nausea and Vomiting  Jaundice

Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Complications  Cardiovascular Failure  Acute Respiratory Distress Syndrome  Acute Renal Injury  Hemorrhage  Infection

Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Diagnostic Tests  Serum Amylase  Serum Lipase  X-Ray  CT Scan  Ultrasound

Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Therapeutic Interventions  NPO  IV Fluids/TPN, Nutrition  NG Suction  Analgesics, Anti-anxiety Agents  Oxygen  Blood Products PRN

Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Chronic Pancreatitis  Pathophysiology  Progressive Fibrosis  Obstructed Ducts  Ulceration  Etiology  Alcohol  Biliary Disease

Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Prevention  Alcohol Abstinence  Biliary Disease Treatment  Nutritional Intake Monitoring

Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Signs and Symptoms  Remissions and Exacerbations  LUQ Pain  Anorexia and Weight Loss  Malabsorption  Diabetes Mellitus

Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Diagnosis  Pancreatic Enzymes Normal  High Fecal Fat Level  Changes on CT Scan

Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Therapeutic Interventions  Analgesics  Pancreatic Enzyme Replacement  Surgery

Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Nursing Diagnoses: Acute and Chronic Pancreatitis  Pain  Imbalanced Nutrition  Risk for Ineffective Breathing Pattern  Risk for Injury

Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Cancer of the Pancreas  Ductal Adenocarcinoma of Exocrine Pancreas  Risk Factors  High-fat Diet  Smoking  Diabetes Mellitus  Alcohol  Chronic Pancreatitis

Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Signs and Symptoms  Weight Loss  Abdominal Pain Radiates to Back  Anorexia  Nausea and Vomiting  Weakness  Jaundice

Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Diagnostic Tests  Serum Amylase/Lipase  Alkaline Phosphatase  Bilirubin  Coagulation Studies  CEA  CT, ERCP  Biopsy

Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Therapeutic Interventions  Surgery  Pancreatectomy  Whipple Procedure  Stent to Relieve Biliary Obstruction  Chemotherapy  Radiation

Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Whipple Procedure

Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Nursing Diagnoses  Pain  Imbalanced Nutrition  Risk for Deficient Fluid Volume  Risk for Impaired Skin Integrity

Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Patient Education  Management of Hyperglycemia  Pancreatic Enzyme Replacement  Dressing/Drain Care  Complications to Report  Hospice Referral

Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Gallbladder Disorders  Cholecystitis: Inflammation  Cholelithiasis: Stones  Choledocholithiasis: Stones in Common Bile Duct

Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Etiology  Bile Stasis  High Cholesterol Intake  Fasting  Sedentary Lifestyle  Family History, Female  Risk Increases with Age

Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Signs and Symptoms  Increased Vital Signs  Vomiting  Jaundice  Epigastric Pain  RUQ Tenderness  Nausea  Indigestion  Positive Murphy’s Sign  Biliary Colic

Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Complications  Cholangitis  Necrosis/Perforation of Gallbladder  Empyema  Fistulas  Adenocarcinoma of Gallbladder  Pancreatitis

Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Diagnostic Tests  Ultrasound  ERCP  Radionuclide Scan  WBC  Bilirubin  Serum Amylase

Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Therapeutic Interventions  Analgesics  Bile Acid Sequestrants  Anti-Emetics  Diet

Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Cholelithiasis Treatment  Cholecystectomy  Laparoscopic  Traditional  ESWL  Medication to Dissolve

Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition T-Tube

Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Nursing Diagnoses  Acute Pain  Risk for Deficient Fluid Volume

Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Postoperative Nursing Diagnoses  Risk for Impaired Skin Integrity  Risk for Ineffective Breathing Pattern