Nursing Management: Disorders of the Liver

Physiology  Metabolism  Protein, carbohydrates, fat  Detoxification  Excretion  Storage By Mariana Ruiz Villarreal (Own work) [Public domain], via Wikimedia Commons

Disorders of the Liver  Impairment in liver function  Inflammation  Injury  Necrosis  Trajectory of illness  Acute vs. Chronic

Pathophysiology Local Tissue Injury  Release of inflammatory mediators  Vasodilation,  vascular permeability  Localized swelling Sx: Pain, inflammation, impaired function

Hepatitis Definition: Inflammation of the liver Etiology: viral infection, drugs, chemicals, autoimmune Acute vs. Chronic Complications

Etiology: Liver Disease  Viral hepatitis  Drug toxicity  Autoimmune, genetic, & metabolic diseases  Chronic viral hepatitis  Hemochromatosis  Alcoholic liver disease  Nonalcoholic fatty liver disease AcuteChronic

Clinical Manifestations  Inflammation  Altered metabolism EarlyLate

Complications  Portal hypertension & esophageal varices  Ascites  Hepatic Encephalopathy  Coagulation defects  Hepatrenal syndrome

Assessment: Subjective History of present illness: Symptoms Past Medical History: Medical & Surgical Hx, immunizations Social History: Substance use, sexual Hx, environmental toxins Family History: Hereditary disorders

Assessment: Objective General: VS, appearance Neuro: LOC, mental state, responsiveness, asterixis GI: Abdominal contour, ascites, hepato/splenomegaly Integument: Jaundice, angiomas, petechiae/purpura, edema, caput medusae Reproductive: gynecomastia

By James Heilman, MD (Own work) [CC BY 3.0], via Wikimedia Commons Characteristic yellowing of the skin and sclera (jaundice) in a patient with liver failure

Assessment: Labs & Diagnostics Labs: LFTS, serum chemistries, CBC, coags, toxicology screen, viral serologies Imaging: abdominal US/CT Diagnostics: liver biopsy Samir [CC BY 3.0], via Wikimedia Commons

Physiological: ABCD  Ineffective breathing pattern  Acute confusion  Excess fluid volume  Risk for bleeding  Imbalanced nutrition: Less than body requirements

Psychological  Disturbed body image  Dysfunctional family processes  Deficient knowledge

Interventions Monitor: VS, breathing pattern, s/s of bleeding, LOC & mentation, weight, I&O, abd. girth Support: Positioning, re-orientation, sleep/rest,  protein diet, fluid restriction

Interventions Administer: Diuretics, electrolytes, supplemental vitamins, albumin/plasma expanders Assist/Prep: Paracentesis, surgical tx of varices, dialysis Educate: Diet, fluid/electrolyte management, risk for bleeding, alcohol/substance use

Blausen.com staff. "Blausen gallery 2014". Wikiversity Journal of Medicine. DOI: /wjm/ ISSN Procedure to drain excess fluid accumulation from ascites

Evaluation: Desired Outcomes  Maintain effective breathing pattern  Maintain usual level of mentation/reality orientation  Maintain fluid & electrolyte balance with stabilization of VS and hemodynamic status

Evaluation: Desired Outcomes  Maintains food & fluid intake sufficient to meet nutritional needs  Free of injury

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