Chapter 58 Care of Patients with Liver Problems

Learning Objectives Identify community resources for patients with chronic liver disease Describe health teaching plan for patients with hepatitis Explain alcohol-induced cirrhosis progression prevention to patient and families Identify emergency interventions for the patient with bleeding esophageal varices 2 Copyright © 2016, 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 2

Cirrhosis Structure and function of liver Effects of alcohol on liver Complications Ø Ø Ø PSE Ascites Neurologic changes Esophageal varices Hepatorenal syndrome 3 Copyright © 2016, 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 3

Clinical Manifestations of Cirrhosis From Price, S. A. & Wilson, L. M. (2003). Pathophysiology: Clinical Concepts of Disease Processes, 6 th Ed. St. Louis: Mosby. Copyright © 2016, 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 4 4

Esophageal Varices 5 Copyright © 2016, 2013, 2010, 2006, 2002 by Saunders, an imprint

Esophageal Varices Treatment 6 Copyright © 2016, 2013, 2010, 2006, 2002 by Saunders, an

Cirrhosis Complications Risk factors Characteristics Diagnostic tests Nurse’s role in management Interdisciplinary team’s role in management Treatment/intervention prioritization Teaching/health promotion 7 Copyright © 2016, 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 7

Hepatitis Viral hepatitis – A, B, C, D, E Transmission mode Onset Incubation Laboratory tests Nonsurgical management Follow-up care Plan of care for home 8 Copyright © 2016, 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 8

Other Liver Concerns Fatty liver (steatosis) Hepatic abscess Liver trauma Liver transplantation 9 Copyright

Liver Transplantation: Surgical Care How does preoperative and postoperative care for a patient undergoing a liver transplant align with that of other conditions? 10 Copyright © 2016, 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 10

Ethical Questions Should the patient with alcoholic cirrhosis be a candidate for liver transplantation? Should government funds be used in the care of patients with cirrhosis who continue to consume alcohol? 11 Copyright © 2016, 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 11

A 55 -year-old patient with a history of alcohol abuse spanning 10 years has been diagnosed with cirrhosis. The patient will be undergoing abdominal paracentesis on the medical unit today. Which assessment finding would alert the nurse that the paracentesis has been successful? A. B. C. D. Decrease in post-procedure weight No residual obtained during procedure Substantial decrease in blood pressure Immediate sensation of a need to urinate 12 Copyright © 2016, 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 12

(Cont. ) The patient’s assessment reveals yellowish coloration of skin and sclerae. Which laboratory values would the nurse anticipate? A. B. C. D. Increased urine bilirubin, decreased direct bilirubin Increased direct bilirubin, increased indirect bilirubin Decreased direct bilirubin, increased indirect bilirubin Increased direct bilirubin, decreased indirect bilirubin 13 Copyright © 2016, 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 13

(Cont. ) When a complete assessment of this patient is performed, what other manifestations would the nurse expect? (Select all that apply. ) A. B. C. D. E. Muscle twitching Dry skin with rash Personality changes Peripheral dependent edema Ecchymosis, spider angiomas 14 Copyright © 2016, 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 14

(Cont. ) The patient tells the nurse that once he is discharged to home, he has no intention to stop drinking alcohol. What is the appropriate nursing response? A. B. C. D. “Why do you continue to drink? ” “It’s your choice to drink or not to drink. ” “Does it frighten you to consider quitting? ” “If you continue to drink, you are going to die. ” 15 Copyright © 2016, 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 15

Chapter 58 Audience Response System Questions Copyright © 2016, 2013, 2010, 2006, 2002 by

Question 1 Which assessment finding requires immediate nursing intervention in a patient with severe ascites? A. B. C. D. Confusion Temperature 38. 2º C Tachycardia, rate 110 beats/min Shallow respirations, rate 32 breaths/min 17 Copyright © 2016, 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 17

Question 2 What is the priority nursing intervention in the management of a patient with decompensated cirrhosis? A. B. C. D. Limiting protein intake Managing nausea and vomiting Monitoring fluid intake and output Elevating the head of bed >30 degrees 18 Copyright © 2016, 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 18

Question 3 What is a primary reason for a higher incidence of liver cancer in the United States? A. B. C. D. Incidence of hepatitis C Incidence of HIV infection Incidence of illicit drug use Increased Asian population 19 Copyright © 2016, 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 19