Prepare for your exams
Get points
Guidelines and tips

Sell on Docsity

Log in Sign up

Prepare for your exams

Study with the several resources on Docsity

Earn points to download

Earn points by helping other students or get them with a premium plan

Guidelines and tips

Sell on Docsity

Log in Sign up

Prepare for your exams

Study with the several resources on Docsity

Find documents

Prepare for your exams with the study notes shared by other students like you on Docsity

Search Store documents

The best documents sold by students who completed their studies

Search through all study resources

Docsity AINEW

Summarize your documents, ask them questions, convert them into quizzes and concept maps

Explore questions

Clear up your doubts by reading the answers to questions asked by your fellow students

Earn points to download

Earn points by helping other students or get them with a premium plan

Share documents

20 Points

For each uploaded document

Answer questions

5 Points

For each given answer (max 1 per day)

All the ways to get free points

Get points immediately

Choose a premium plan with all the points you need

Study Opportunities

Choose your next study program

Get in touch with the best universities in the world. Search through thousands of universities and official partners

Community

Ask the community

Ask the community for help and clear up your study doubts

University Rankings

Discover the best universities in your country according to Docsity users

Free resources

Our save-the-student-ebooks!

Download our free guides on studying techniques, anxiety management strategies, and thesis advice from Docsity tutors

From our blog

Exams and Study

Go to the blog

Adult Health II Hepatic disorders, Study notes of Nursing

South College Nursing

Liver disorders, Notes from ATI

Typology: Study notes

2021/2022

Uploaded on 05/27/2023

britainanne13 🇺🇸

3 documents

1 / 12

This page cannot be seen from the preview

Don't miss anything!

Adult Health 3 Exam 2 Review – Ch 49, 50, 54

Ch 49 Assessment & Mgmt. of Pts w/ Hepatic Disorders

1) Liver

a. Largest gland of the body located in RUQ

b. Liver affects all other body systems

c. Highly vascularized gland

2) Technique for assessing liver

a. Percussing produces dull sound.

3) Functions of liver

a. Metabolizes:

i. Drugs, glucose, fats, proteins

b. Drug metabolism

i. Hepatotoxic meds

ii. Acetaminophen Tylenol (foundation of other meds)

iii. 4g/daily max

c. Glucose Metabolism

i. Converts glucose to glycogen

ii. Affects DM

d. Protein metabolism

i. Fatty acids broken down for energy

e. Vitamin & iron storage

i. Vitamin deficiency (thiamin)

ii. Anemic

iii. Vit A, B, D, B complex

f. Converts ammonia

i. Slight LOC is an early warning sign of affected ammonia conversion

ii. ETOH abuse

1. Dehydrated, malnourished, vitamin deficiency (thiamin), anemic

iii. Non-acholic fatty liver disease (NAFLD)

g. Bile production & bilirubin excretion

4) Lactulose

a. Binds to ammonia and allows pt. to defecate extra ammonia out.

b. Produces instant effect.

5) Liver function labs:

a. PT/PTT/INR

i. Lab tests specific for clotting factor

b. AST (Aspartate Aminotransferase)

i. Most specific for liver tissue

ii. Prognosis of alcoholism, cirrhosis, liver cancer if AST is elevated

c. ALT (Alanine Aminotransferase)

i. Increases w/ liver disease

ii. Used to monitor progression of cirrhosis, liver cancer, hepatitis, & drug toxicity

d. ALP (Alkaline Phosphatase)

i. If elevated prognosis of biliary obstruction

e. GGT (Gamma Glutamyl Transferase)

i. If elevated prognosis of cholestasis & alcoholism

ii. Drawn for chronic ETOH disease

f. AFP (A-fetoprotein)

i. Protein synthesized in fetal livers

ii. Dx. of liver cancer if elevation of 50-75%.

6) Non-alcoholic fatty liver disease (NAFLD)

a. #1 chronic liver disease

b. Lipids accumulate in hepatocytes

c. Often seen in pt.’s w/ obesity

Partial preview of the text

Download Adult Health II Hepatic disorders and more Study notes Nursing in PDF only on Docsity!

Adult Health 3 Exam 2 Review – Ch 49, 50, 54

Ch 49 Assessment & Mgmt. of Pts w/ Hepatic Disorders

Liver a. Largest gland of the body located in RUQ b. Liver affects all other body systems c. Highly vascularized gland
Technique for assessing liver a. Percussing produces dull sound.
Functions of liver a. Metabolizes: i. Drugs, glucose, fats, proteins b. Drug metabolism i. Hepatotoxic meds ii. Acetaminophen Tylenol (foundation of other meds) iii. 4g/daily max c. Glucose Metabolism i. Converts glucose to glycogen ii. Affects DM d. Protein metabolism i. Fatty acids broken down for energy e. Vitamin & iron storage i. Vitamin deficiency (thiamin) ii. Anemic iii. Vit A, B, D, B complex f. Converts ammonia i. Slight LOC is an early warning sign of affected ammonia conversion ii. ETOH abuse

Dehydrated, malnourished, vitamin deficiency (thiamin), anemic iii. Non-acholic fatty liver disease (NAFLD) g. Bile production & bilirubin excretion

Lactulose a. Binds to ammonia and allows pt. to defecate extra ammonia out. b. Produces instant effect.
Liver function labs: a. PT/PTT/INR i. Lab tests specific for clotting factor b. AST (Aspartate Aminotransferase) i. Most specific for liver tissue ii. Prognosis of alcoholism, cirrhosis, liver cancer if AST is elevated c. ALT (Alanine Aminotransferase) i. Increases w/ liver disease ii. Used to monitor progression of cirrhosis, liver cancer, hepatitis, & drug toxicity d. ALP (Alkaline Phosphatase) i. If elevated prognosis of biliary obstruction e. GGT (Gamma Glutamyl Transferase) i. If elevated prognosis of cholestasis & alcoholism ii. Drawn for chronic ETOH disease f. AFP (A-fetoprotein) i. Protein synthesized in fetal livers ii. Dx. of liver cancer if elevation of 50-75%.
Non-alcoholic fatty liver disease (NAFLD) a. #1 chronic liver disease b. Lipids accumulate in hepatocytes c. Often seen in pt.’s w/ obesity

Non-alcoholic steatohepatitis (NASH) a. More serious than NAFLD b. May lead to fibrotic liver changes, cirrhosis, & liver damage
Tylenol a. Should not exceed 4g. daily.
Liver function diagnostic test a. Biopsy i. Most definitive test for liver disease/cancer ii. Location – RUQ iii. Post op – lay pt. on R side to splint puncture & clot wound. b. XR i. Detects ascites, hepatomegaly, & splenomegaly c. Esophagogastroduodenoscopy (EGD) i. Detects esophageal varices ii. Tx. w/ esophageal banding d. Trans jugular Intrahepatic Portosystemic Shunt (TIPS) i. Tx. complications of portal HTN (it has nothing to do w/ BP), tx. for ascites ii. Educate pt. on risk, benefits, recovery

Cannula is threaded into portal vein, via trans jugular route, expandable stent is then inserted which serves as a shunt.
Shunt between portal circulation & hepatic vein to decrease sodium retention which will relieve ascites.
Decreasing sodium retention increases urinary/renal function e. MRI i. Detects tumor or blockage in liver ii. Diabetic pt. receiving metformin cannot take med 48 hrs. pre/post exam. f. Paracentesis i. Pulls fluid off liver ii. Test fluid iii. Post op
Mgmt. pain
Assess dressing
Shunt puncture

Manifestations of Hepatic Dysfunction a. Jaundice b. Ascites c. Pruritus d. Esophageal varices e. Portal hypertension
Portal HTN a. Obstructed blood flow through a damaged liver resulting in increased pressure throughout the portal venous system b. Related to liver disease, obstruction, or anatomical structure failure that my change the way the liver works. c. Measured by ascites i. Extracellular fluid excreted into the extracellular space by increased portal BP & decreased synthesis of albumin ii. Caused by vasodilation of splanchnic circulation which moves albumin into the peritoneal cavity d. Measure the pt.’s abdominal girth at the same time daily
Manifestations of Portal HTN: a. Hemorrhoids b. Visible abdominal veins c. Pt. should remain on a diet low in sodium and processed foods d. Nurse should weigh pt. daily

Hepatitis a. A & E: Fecal-oral route b. B & C: Blood borne c. D: Only people w/ Hep B are at risk d. Early signs: i. Anorexia ii. Smoker distaste for cigs.
Hep A a. Spreads by fecal oral route i. Unsafe water ii. Contaminated food b. #1 way to prevent is hand hygiene & clean common bathroom areas w/ bleach after infected persons use c. May last 4-8 weeks d. Hep A vaccine given in series of 2 doses i. 1 st^ round given at 1 year of age ii. 2 nd^ round given at 1.5 years of age iii. Avoid if pt. is pregnant e. S/S: mild flulike symptoms, late jaundice, dark urine, hepatomegaly & splenomegaly f. Tx. Immunoglobin w/in 2 weeks, bed rest in acute phase, g. Precautions i. Contact - gown & gloves h. Hep A can live several months outside the body
Hep B a. Transmitted through blood, vaginal secretions, semen, saliva, b. Major cause of cirrhosis or liver cancer c. Risk factors chart 49- i. Highest risk of developing liver cancer d. Immunizations & standard precautions for prevention e. Hep B vaccine (Recombivax HB) given in series of 3 doses: i. 1 st^ round at 12 hours of life ii. 2 nd^ round at 1-2 months of life iii. 3 rd^ round at 6-8 months of life f. S/S: insidious & variable, like Hep A g. Pharmacological Tx. for HBV: i. Adefovir (Hepsera)

Drug of choice for Hep B
Pt. should complete cycle of drug
Blocks viral replication
AE: HA, severe chills inducing vomit ii. Given IM in 3 doses iii. Lamivudine
AE: HA, shakes, chills h. Pharmacological Tx. for chronic Hep B i. Alpha 2B ii. AE: thrombocytopenia iii. Assess for excessive bruising i. Monovalent Hep B i. Given to newborns less than 1 month old ii. IM thigh, vastus lateralis, largest muscle to give IM shot to a newborn.
Prevents sciatic nerve damage

Hep C a. Transmitted through blood & bodily fluid b. Most common blood borne infection c. 1/3 cause of liver cancer i. Basically, a death sentence d. Precautions – standard e. Pt. does not need to be isolated f. If jaundice improves i. Pt. is entering convalescent stage
Hep D a. Only persons w/ Hep B are at risk b. Blood & sexual contract transmission c. Tx. Interferon alpha
Hep E a. Transmitted fecal oral route b. Precautions: Contact – gown & gloves
Non-viral hepatitis a. Toxic hepatitis b. Drug-induced hepatitis i. Acetaminophen (Tylenol) ii. Pt. should follow daily recommendation c. Severe impairment or necrosis of hepatic function
Fulminant hepatic failure a. Fatal form of hepatitis b. Severe necrosis of hepatocytes
Types of Cirrhosis a. Alcoholic i. Scar tissue around the portal vein producing Portal HTN b. Post-Necrotic i. Broad bands of scars across the whole liver ii. After hepatic cells have died c. Biliary i. Scarring of the liver around the bile duct d. Develop varices, portal HTN, edematous, anemic, change in LOC, ascites e. Propranolol (beta blocker) i. Decreases BP ii. Blocks/decreases risk of variceal bleeds
Liver cancer a. #1 reason for liver transplant b. Women are more at risk due to oral contraceptives c. Terminal & extremely painful d. RN priority: i. Comfort & spiritual distress relief ii. No relief from pain med, RN should call MD to adjust pain med dose
Liver Transplant a. Anti-rejection meds for lifetime b. Immune suppression c. Infection prevention d. Education dressing change e. Can cause ethical dilemma for hospital f. RN priority pre op i. Education & support pt. g. RN priority post op i. Bleeding, liver dysfunction, monitor respiration, monitor LOC ii. Emphasize keeping all follow up lab tests & follow up apts.

Assessment of Pancreatitis a. Grey Turners sign i. Posterior left flank red/blue bruise ii. Blood stain exudate seeped out of pancreas due to severity of disease process b. P – Pain/Pancreatic enzyme replacement, non-narcotic analgesics c. A – Abdominal pain which radiates to the back d. N – NPO, TPN initiated, until serum lipase decreases e. C – Calcium lowered, calcium replacement f. R – Risk factors, alcoholism, penetrating duodenal ulcer, trauma, g. E – Elevated glucose and electrolytes and hematocrit, lipase, hypotensive h. A – Antibiotics, analgesics, anticholinergics, antacids, H2 antagonist i. S – Stimulant, spicy foods, alcoholism, #1 coffee & caffeine
Pharmacological Tx. for long-term chronic pancreatic pain a. Pancreatic enzyme w/ an H2 blocker
Pancreatic cancer a. Terminal b. Whipple i. Surgical removal of the head of the pancreas, first part of the duodenum, gallbladder, & bile duct ii. Post op care

Assess CBG’s, pt. is now insulin dependent diabetic due to resected pancreas.
Bed rest

Necrotizing pancreatitis a. Pharmacological Tx. for pancreatitis i. Antibiotic Primaxin ii. Potent, broad spectrum antimicrobial b. RN interventions i. Give a fluid bolus

250mls ii. Naso-jejunal enteral feeding (low fat formula to decrease secretion)
Meet caloric needs & maintain positive nitrogen balance iii. Urine catheter
Measure I&O’s
Prevent fluid overload

ASES high a. Amylase & lipase are high when pancreatitis is present b. Amylase will return to normal w/in 48-72 hrs., but lipase & WBC will stay elevated after beginning treatment
Kidney Disease a. Diabetes is the primary cause of chronic kidney disease
Glomerular Filtration Rate (GFR) a. Rate of fluid filtrating through the glomeruli per minute b. Normal value 100-120 ml/min
Creatinine clearance a. Measures amt. of creatinine the kidneys can clear from the blood in a 24-hr. period.
Alteration in Renal Perfusion a. Edema b. Pruritus c. Fluid in the lungs
Causes of Acute Kidney Failure/Injury (AKI) a. Rapid loss of kidney function i. Hypovolemia ii. Hypertension iii. Reduced cardiac output & HF iv. Obstruction of kidney or lower urinary tract v. Obstruction of renal arteries/veins vi. Muscle injury

Oliguric phase a. Decrease in urine formation b. Causes fluid overload c. Crackles in the lungs
Phases of AKI a. Prerenal i. Cause is before the kidney or glomerulus ii. Liver failure, shock, b. Intrarenal (Intrinsic) phase i. Caused by damaged kidney or glomeruli ii. Infection, pyelonephritis, glomerulonephritis, kidney cancer, nephrotoxic meds, autoimmune disease c. Postrenal i. Obstruction or tissue death of ureters ii. Prostate enlargement, urinary tract cancer
Diuretics Slide a. D – Diet; increase potassium V-tach or V-fib w/ elevated T waves b. I – I&O, daily weight c. U – undesirable effects; fluid & electrolyte imbalance d. R – Review HR, BP, & electrolytes e. E – Elderly caution f. T – Take w/ or after meals & in AM g. I – Increase risk of orthostatic hypotension h. C – Cancel alcohol
Glomerular Diseases a. Acute nephritic syndrome i. Most common ii. Post-surgery iii. S/S: hematuria, edema, proteinuria, hypertension b. Glomerulonephritis i. Pt. could be asymptomatic for a long time ii. S/S: Hypertension, hyperlipidemia, proteinuria, hypoalbuminemia, electrolyte imbalance, hematuria c. Nephrotic syndrome i. Damages glomerular membranes increasing permeability of proteins ii. S/S: Severe peripheral edema
Kidney Failure a. Results when the kidney cannot remove waste results in toxicity b. Systemic disorders like lupus may cause it c. S/S: Hyperkalemia, pericarditis, pericardium rub, pericardial fusion, pericardial tamponade, anemia, bone disease, metastatic calcification. d. Pt. must have dialysis because this is life threatening
Renal Replacement Therapies a. Continuous Renal Replacement Therapy (CRRT) b. Artificial kidney c. Done 1 on 1 in ICU d. It removes impurities through osmotic pressure, pt. must be stable e. Requires a vas-cath double lumen large bore catheter. f. Vas-cath accesses the artery and the vein
Hemodialysis a. Removes toxic nitrogenous waste from the blood.
Hemodialysis catheter a. Ensure placement is proper b. XR to visualize placement
Internal AV Fistula a. Palpate a thrill under the pt. skin b. Auscultate for a bruit c. Floor nurse cannot access fistula only dialysis/vascular nurse can

Diagnostic labs values to assess kidneys a. BUN b. Creatinine i. Usually below 1. ii. Tells how much creatinine is being produced c. Creatinine clearance i. Normal 85-125 mL/min ii. Measures the volume of blood cleared of indigenous creatinine in 1 min. iii. Used to measure renal disease progression iv. Helps measure GFR d. Glomerular Filtration Rate (GFR) i. Normal 120-130ml/min ii. Higher up in kidney failure stages, the lower the GFR

15mL/min is closest to dialysis e. Urinalysis (UA) i. Assesses for glucose in urine (should not be present) ii. When glucose is present it indicates a blood glucose level that exceeds the kidneys reabsorption capacity. f. Urine specific gravity

Lab values to monitor w/ renal failure pt. a. Sodium increases i. Normal 135- ii. Fluid overload in lungs; auscultate crackles, extremities, brain; leads to alterations in LOC b. Calcium decreases i. Normal 8.5-10. ii. Leads to bone fractures c. Potassium increases i. Normal 3.5- ii. Assess EKG iii. Causes dysrhythmias d. Phosphorus increases i. Normal 3.0-4. ii. Causes pruritus e. Magnesium increases i. Normal 1.8-3. ii. Monitor feet for sores, cramps, seizures f. BUN increases i. Normal 10- ii. Retaining fluid g. Hgb & Hct decreases i. Hgb needs to be > 8 ii. Decreased levels leads to anemia
Chronic kidney failure caused by a. Diabetes i. Constricts blood vessels impeding blood flow to the kidneys b. HTN i. 80% uncontrolled causes more intense renal failure c. Obstruction of kidney i. Kidney stone d. Medications i. ACE inhibitors can cause kidney failure ii. Ensure pt. is on diuretic e. Hereditary disorders f. Vascular disorders g. Obesity (2nd^ cause)
Oliguria a. Abnormal small amt. of urine output b. < 30ml/hr. or < 720ml/24hr.

Anuria a. No urine output b. < 350ml/24hr.
Diuretics a. Slide 12 b. Loop diuretics i. Lasix (Furosemide) & Bumex

Inject slow & low ii. Work on loop of Henle iii. Used for HF, HTN, AKI iv. Ototoxic AE
Causes ringing in the ear v. Causes hypokalemia & hypomagnesemia c. Thiazide diuretics i. HCTZ
Avoid giving to elderly ii. Used in conjunction w/ an ACE inhibitor iii. HTN, CHF, nephrolithiasis, diabetes insipidus d. Osmotic diuretics i. Mannitol ii. Tx. for increased ICP iii. Glaucoma or TBI’s iv. Can throw pt. into hypovolemia e. Potassium sparing i. Spironolactone (Aldactone)

Glomerular disease a. Proteinuria, hematuria, HTN b. Untreated can lead to death c. Corticosteroids can cause this
Chronic glomerular nephritis a. Causes renal insufficiency & renal failure b. Can be asymptomatic for years c. Med mgmt. d. Lab values to monitor i. Urine specific gravity ii. Are they able to urinate at all? iii. Huge electrolyte imbalances iv. Hypoalbuminemia
Nephrotic syndrome a. Any condition that seriously damages the glomerular membrane and increases the permeability to plasma protein b. Leads to edema, hypoalbuminemia c. Caused by diabetes, chronic glomerular nephritis, multiple myeloma, renal vein thrombosis, amyloidosis, lupus
Kidney failure a. Kidney cannot remove waste or perform its excretory function b. Chronic kidney failure is progressive & leads to end stage renal disease (ESRD) c. Complications i. HTN, anemia, hyperkalemia, hypocalcemia, pericarditis, pericardial effusion, pericardial tamponade d. Cystoscopy i. Examining lining of the bladder and the urethra. ii. Post blood-tinged urine is normal; bright red blood indicates hemorrhage
Continuous Renal Replacement Therapy (CRRT) a. Done at bedside in ICU b. 1:1 ratio critical procedure by certified nurse c. Used for unstable pt. unable to handle hemodialysis d. Removes blood via vas-cath from pt. & ultrafilters it through artificial kidney machine using osmotic pressure e. Cloudy dialysate indicates infection in the blood f. Hypothermia is an issue

Adult Health II Hepatic disorders, Study notes of Nursing

Related documents

Partial preview of the text

Download Adult Health II Hepatic disorders and more Study notes Nursing in PDF only on Docsity!

Adult Health 3 Exam 2 Review – Ch 49, 50, 54