1. Nursing Management: Disorders of the Liver

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

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

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

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

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

7. Clinical Manifestations  Inflammation  Altered metabolism EarlyLate

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

10. 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

11. 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

12. 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

13. 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

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

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

16. 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

17. 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

18. Blausen.com staff. "Blausen gallery 2014". Wikiversity Journal of Medicine. DOI:10.15347/wjm/2014.010. ISSN 20018762. Procedure to drain excess fluid accumulation from ascites

19. 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

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

21. Bibliography Bickley, L. S., Szilagyi, P. G., & Bates, B. (2013). Bates' guide to physical examination and history taking. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins. Croghan, A, & Heitkemper, M. M. (2011). Nursing management: Liver, pancreas, and biliary tract problems. In S. L. Lewis, S. R. Dirksen, M. M. Heitkemper, L. Bucher, & I. M. Camera (Eds.), Medical-surgical nursing: Assessment and management of clinical problems (8 th Ed., pp. 1058-1102). St. Louis, MO: Elsevier/Mosby. Goldberg, E., & Chopra, S. (2015). Acute liver failure: Etiology, clinical manifestations, and diagnosis. In R. S. Brown & A. C. Travis (Eds.), UpToDate. Retrieved from http://www.uptodate.com/contents/search Goldberg, E., & Chopra, S. (2015). Acute liver failure: Management and prognosis. In R. S. Brown & A. C. Travis (Eds.), UpToDate. Retrieved from http://www.uptodate.com/contents/search Goldberg, E., & Chopra, S. (2015). Cirrhosis in adults: Etiology, clinical manifestations, and diagnosis. In B. A. Runyan & A. C. Travis (Eds.), UpToDate. Retrieved from http://www.uptodate.com/contents/search Goldberg, E., & Chopra, S. (2015). Cirrhosis in adults: Overview of complications, general management, and prognosis. In B. A. Runyan & A. C. Travis (Eds.), UpToDate. Retrieved from http://www.uptodate.com/contents/search