1. Nursing Care of the Pediatric Patient with Liver Disease and Transplant Presented by Patti Winford R.N., B.S.N.

2. Objectives At the end of this program students will be able to: Name five functions of the Liver Name two functions of the Small Bowel Identify pertinent assessment criteria of the liver transplant patient Analyze pertinent lab values Recognize assessment factors needing intervention

3. Liver Functions 1.Filters blood of waste 2.Production of clotting factors 3.Production of Proteins, Albumin, Fats, and Cholesterol 4.Removes Ammonia from body 5.Produces and secretes bile 6.Excretes bilirubin 7.Breakdown of glycogen into glucose http://ourworld.compuserve.com/homepages/sbrillanti/liver2.jpg

4. Small Bowel Function The small bowel has digestive functions which include: 1.Breakdown of carbohydrates, proteins and fats 2.Absorption of nutrients, water and electrolytes into the bloodstream

5. Nursing Assessment Complete head to toe nursing assessment should be completed Q4H and PRN Vital signs with oxygen saturation and pain assessment. Documentation of all access lines and medical equipment: PICC and peripheral IV sites, ostomies, NG, NJ, G-tubes, wound vacs, dressings, etc. Chart a description of patient so that others reading your charting can visualize what this patient looks like.

6. HEENT Jaundiced Sclera Enlarged lymph nodes - WBC - Bilirubin

7. Neurological Altered mental status Headache – Drowsiness Blurred vision – Tremors Confusion – Irritability Glucose level Prograf level Steroids Ammonia level

8. Cardiovascular Unstable Blood pressure: Hypertension or Hypotension Hemorrhage Coagulopathy - CBC - Coags - Type/Screen - Potassium level http://health.howstuffworks.com/heart -pictures7.htm

9. Respiratory Ascites Atelectasis Pneumonia - Blood gas - WBC - Hgb / Hct - Renal / Ep1 http://health.howstuffworks.com/lung.htm

10. Gastrointestinal Ascites Malnutrition Weight loss Emesis Rejection - LFT - Ca, Mg, Phos, Albumin - Prograf level - TPN Profile

11. Genitourinary E’lyte imbalances Renal dysfunction - Strict I/O - Daily weights - UOP should be > 1ml/kg/hr - Ostomy outputs

12. Musculoskeletal Provide a safe environment - side rails of cribs, choking hazards Incorporate play and OT / PT

13. Integumentary Jaundice – itching Skin breakdown –Breakdown around stoma bags and diaper areas Infection –Risk for infection at GT, PICC and CVC sites –Strict hand washing –Isolation precautions

14. A4N Check all VS – age specific –Notify primary nurse of any abnormal values Strict I/O Accurate and complete documentation Prograf given on time as ordered Enjoy your patient, Play with them

15. Conclusion Questions Case study References A4N Nursing Unit Information Packet for Nurses, A systems approach to nursing care of pediatric transplant patients Keating, S. B. (2006). Curriculum development and evaluation in nursing Philadelphia: Lippincott Williams & Wilkins Marieb, E. N. (2001). Human anatomy & physiology 5 th edition Benjamin Cummings