Care of Patients with Liver Problems Chapter 61 Care of Patients with Liver Problems

Structure & Function http://www.youtube.com/watch?v=O71niTozP-o Cirrhosis: http://www.youtube.com/watch?v=JFedMDtPldw

Cirrhosis What are the effects of alcohol on liver? Complications of Cirrhosis PSE (Portal Systemic Encephalopathy) Ascites Neurologic changes Esophageal varices Hepatorenal syndrome Biliary Obstruction Jaundice

Esophageal Varices Esophageal varices caused by cirrhosis.

Esophageal Varices Treatment Sengstaken-Blakemore tube in place for the emergency treatment of hemorrhage from esophageal varices. The tube has three openings for (1) gastric aspiration, (2) inflating the esophageal balloon, and (3) inflating the gastric balloon. The esophageal balloon is inflated to a pressure of 20 to 40 mm Hg (monitored by attachment to a gauge or a sphygmomanometer) that compresses the esophageal veins. The gastric balloon, inflated with 250 cc of air, applies pressure to the fundal veins when slight traction is applied.

Cirrhosis Complications Risk factors for Cirrhosis Hepatitis C Alcoholism Biliary Obstruction What are the diagnostic tests & labs? Nurse’s role in management Interdisciplinary team’s role in management Treatment/intervention prioritization Teaching/health promotion

Hepatitis Types Video: http://www.youtube.com/watch?v=xdsdz8IhMDQ

Hepatitis: Group assignment 5 groups: Viral hepatitis – A, B, C, D, E Transmission mode Onset Incubation Laboratory tests Nonsurgical management Follow-up care Plan of care for home Diet Medications

Other Liver Concerns Fatty liver (steatosis) page 1309 Hepatic abscess pg 1310 Liver trauma Liver transplantation pg 1311

NCLEX Review Questions Chapter 61 NCLEX Review Questions 10

Question 1 Which assessment parameter requires immediate intervention in a patient with severe ascites? Shallow respirations, rate 32 breaths/min Temperature 38.2° C Confusion Tachycardia, rate 110 beats/min Answer: A Rationale: Ascites can increase abdominal distention, which interferes with lung expansion and compromises ventilation and oxygenation. Risk for infection, fluid displacement, and confusion are also assessment variables requiring monitoring in a patient with ascites.

Answer Answer: A Rationale: Ascites can increase abdominal distention, which interferes with lung expansion and compromises ventilation and oxygenation. Risk for infection, fluid displacement, and confusion are also assessment variables requiring monitoring in a patient with ascites.

Question 2 What is the priority intervention in the management of a patient with decompensated cirrhosis? Limiting protein intake Monitoring fluid intake and output Managing nausea and vomiting Elevating the head of bed >30 degrees Answer: C Rationale: Decompensated cirrhosis has multiple complications. However, bleeding esophageal varices can present a life-threatening emergency. Preventing nausea and vomiting is an important intervention in the management of esophageal varices. Monitoring protein, fluid balance, and patient positioning are also important interventions in the care of the patient with end-stage liver disease.

Answer Answer: C Rationale: Decompensated cirrhosis has multiple complications. However, bleeding esophageal varices can present a life-threatening emergency. Preventing nausea and vomiting is an important intervention in the management of esophageal varices. Monitoring protein, fluid balance, and patient positioning are also important interventions in the care of the patient with end-stage liver disease.

Question 3 What is a primary reason for a higher incidence of liver cancer in the United States? Incidence of illicit drug use Rising obesity Incidence of hepatitis C Increased Asian population Answer: C Rationale: In the United States and worldwide, the incidence of liver cancer is increasing because there is an increase in cases of hepatitis C (HCV). Liver cancer tumors are most often seen in regions of Asia and the Mediterranean area. Worldwide the disease kills about 1 million people each year, and affects Vietnamese men more than any other group. Black and Hispanic populations have twice the rate of the disease as Euro-Americans, and older adults are affected more than other age-groups (Rossi et al., 2010).

Answer Answer: C Rationale: In the United States and worldwide, the incidence of liver cancer is increasing because there is an increase in cases of hepatitis C (HCV). Liver cancer tumors are most often seen in regions of Asia and the Mediterranean area. Worldwide the disease kills about 1 million people each year, and affects Vietnamese men more than any other group. Black and Hispanic populations have twice the rate of the disease as Euro-Americans, and older adults are affected more than other age-groups