Nursing Management Disorders of the Liver Physiology Metabolism

Nursing Management: Disorders of the Liver

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

Disorders of the Liver § Impairment in liver function o o o § Inflammation Injury Necrosis Trajectory of illness o Acute vs. Chronic

Pathophysiology Local Tissue Injury 9 Release of inflammatory mediators 9 Vasodilation, vascular permeability 9 Localized swelling Sx: Pain, inflammation, impaired function

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

Etiology: Liver Disease Acute Viral hepatitis § Drug toxicity § Autoimmune, genetic, & metabolic diseases § Chronic viral hepatitis § Hemochromatosis § Alcoholic liver disease § Nonalcoholic fatty §

Clinical Manifestations Inflammation § Altered metabolism § Early Late

Complications § § § Portal hypertension & esophageal varices Ascites Hepatic Encephalopathy Coagulation defects Hepatrenal syndrome

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

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

Characteristic yellowing of the skin and sclera (jaundice) in a patient with liver failure By James Heilman, MD (Own work) [CC BY 3. 0], via Wikimedia Commons

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

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

Psychological Disturbed body image § Dysfunctional family processes § Deficient knowledge §

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

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

Procedure to drain excess fluid accumulation from ascites Blausen. com staff. "Blausen gallery 2014". Wikiversity Journal of Medicine. DOI: 10. 15347/wjm/2014. 010. ISSN 20018762.

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

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

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. ), Up. To. Date. 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. ), Up. To. Date. 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. ), Up. To. Date. 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. ), Up. To. Date. Retrieved from http: //www. uptodate. com/contents/search