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

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

3. 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

4. Esophageal Varices
Esophageal varices caused by cirrhosis.

5. 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.

6. 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

7. Hepatitis Types
Video:

8. 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

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

10. NCLEX Review Questions
Chapter 61
NCLEX Review Questions 10

11. 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.

12. 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.

13. 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.

14. 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.

15. 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).

16. 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