chapter 25

Lactulose

(Cephulac) is administered to reduce serum ammonia levels can be administered orally or rectally. this promotes the excretion of ammonia through the stool. you want 2-3 stools per day indicating that the med is working.

saftey precautions for balloon tamponade

-the balloon should not be inflated for longer than 20 min to prevent ischemia -need suction available at the bedside, suction oral cavity, and pt needs to be sitting up -frequent mouth care -sponge to hold the tube in place -scissors at the bedside: grab the tube cut below the fingers and wait 10 sec for the balloons to deflate and pull out

Viral Hepatitis

A systemic, viral infection involving necrosis and inflammation of liver cells, Can result in either acute or chronic liver dysfunction and disease

A nurse is conducting a health promotion class. What would the nurse describe as the best method to prevent the transmission of the hepatitis A virus? A. Following proper hand washing techniques B. Avoiding chemicals that are toxic to the liver C. Using a condom during sexual contact D. Wearing a mask when in large crowds

A. Following proper hand washing techniques

AVPU

A: alert: eyes open, v: verbal when you call the persons name they open their eyes P: painful gotta know what will wake them and gotta use stim. U: unresponsive

ascites

Accumulation of fluid in the peritoneal cavity

A patient diagnosed with hepatic encephalopathy is receiving lactulose (Cephulac). When preparing to administer this medication, the RN understands that it is used to decrease which of the following serum levels? A. Calcium B. Ammonia C. Potassium D. Sodium

B. Ammonia

Patients with severe chronic liver dysfunction often have problems r/t inadequate intake of sufficient vitamins. Which of the following vitamin deficiencies would result in hemorrhagic lesions of scurvy? A. Riboflavin B. Vitamin C C. Vitamin A D. Vitamin K

B. Vitamin C

The nurse is caring for a patient diagnosed with ascites. The nurse would expect which of the following to be restricted from the patient's diet? A. potassium B. Calcium C. Sodium D. Magnesium

C. Sodium

manifestations of Hepatitis A Virus

Can present either asymptomatically or with acute symptoms such as fever, malaise, anorexia, nausea, diarrhea, vomiting, abdominal pain, and jaundice

A patient with hepatitis A is admitted to a general med/surg floor. The RN knows that this type of hepatitis is spread through which of the following modes of transmission? A. Injection of drugs B. Blood C. Semen D. Fecal-oral

D. Fecal-oral

Esophageal Varices

Dilated, tortuous veins that are usually found in the submucosa of the lower esophagus any additional pressure or defect in the varicies will lead to rupture and hemorrhage.

tx of Hepatic Encephalopathy and Coma

Lactulose Neomycin might be given in adjunct with lactulose

Hepatic Encephalopathy and Coma

Results from the accumulation of ammonia and other toxic metabolites in the blood

manifestations of Hepatic Encephalopathy and Coma

Results in mental changes and motor disturbances (eg, asterixis

treatment of portal HTN

TIPS: transjugular intrahepatic shunt

Hepatitis C Virus

The leading cause of liver disease and is the primary indication for liver transplantation. Occurs primarily through injection of drugs and through transfusion of blood products prior to 1992

Hepatitis A Virus

Transmission occurs through fecal-oral route. often seen in uncooked food or poor food handling practices

Hepatitis B Virus

Transmitted primarily by perinatal, percutaneous, sexual exposure, and close person-to-person contact HBV has a long incubation period

management of Hepatitis A Virus

Vaccination is encouraged Management usually occurs in the home unless symptoms are severe

treatment options for Esophageal Varices

Variceal banding endoscopic injection sclerotherapy balloon tamponade

types of viral hep

a,b,c,d,e and g

A patient with a history of heavy alcohol use is receiving lactulose for the treatment of hepatic encephalopathy. What is a desired outcome of this treatment? a. Two to three soft bowel movements daily b. Watery diarrhea several times daily c. Prevention of constipation d. Maintenance of fecal continence

a. Two to three soft bowel movements daily

the mainstay of tx of alcoholic liver disease is ____

abstinence

drugs that affect liver fxn

acetaminophen, anti depressants, anti convulsants, and anesthetics

factors that participate hemorrhage in Esophageal Varices

alcohol intake, physical exercise, straining at a bowel movement, vomiting.

____ is produced in the liver as a by- product of protein and amino acid breakdown

ammonia

two major complications of portal HTN

ascites and gastroesophageal varices

manifestions of decompensated Cirrhosis

ascites, jaundice, esophegeal varicies, hepatic encephalopathy, abdominal distention and bloating, GI bleeding, bruising, and weight changes (gain)

flapping tremor of the hands is termed

asterix

manifestations of compensated Cirrhosis

asymptomatic

TIPS procedure

cannula threaded through the portal vein by the transjugular route. the stent is inserted to serve as a intrahepatic shunt b/n portal circulation and the hepatic vein. this by passes the flow of blood avoiding the back up and allowing the pressure to go down.

portal htn

caused by increased resistance to blood flow through the liver and increased blood flow due to vasodilatation

assessment for Esophageal Varices

check for blood in the vomit and stool, mental status?, assess for shock (cool, clammy skin, hypotension, and tachycardia)

stage 4 of Hepatic Encephalopathy

comatose

two types of Cirrhosis

compensated and decompensated

management of Drug Related Hepatitis

discontinuation of meds and evaluation of liver damage,

Drug Related Hepatitis

drug induced hepatotoxicity and can range from mild to full on liver failure

most patients with acute or chronic hep C are symptomatic T/f?

false

the patient receiving lactulose is monitored closely for the development of constipation, which indicates medication overdose T/f?

false

Cholelithiasis

gallstones, May be made up of pigment or cholesterol

types of jaundice

hepatocellular jaundice, obstructive jaundice, and hemolytic jaundice

Nursing interventions for cirrhosis

include promoting rest and nutrition (increase protein and folic acid, thamine, vitamin b, skin care, and reducing risk of hemorrhage, fluid excess, and hepatic encephalopathy

s/s of ascites

increased abdominal girth, weight gain, swelling of the lower extremities, dyspnea, abdominal striae and general weakness

stage 2 of Hepatic Encephalopathy

increased drowsiness, disorientation, inappropriate behavior, mood swings, agitation

risk of developing Cholelithiasis

increased in pt with cirrhosis, hemolysis, and infection in the bilary tract

cause of hemolytic jaundice

increased production of bilirubin due to hemolysis or multiple transfusions

Cholecystitis

inflammation of the gallbladder

Paracentesis

is the insertion of a trocar catheter into the abdomen to remove and drain ascitic fluid from the peritoneal cavity. pt should sit with their arms on the overbed table leaning forward, remove 3-4 L, not a curative tx. worried about fluid shifts.

manifestations of the pt with hepatic dysfxn

lethargy, weakness, fatigue, puritus, changes in mental acuity, melena, increased bruising, and decreased libido in men and women, vitamin deficiency folate, vit b12 and thamine

Signs and symptoms of HBV

may be insidious and variable

nursing alert for lactulose

monitored closely for the development of watery diarrheal stools, because they indicate medical overdose.

stage 1 of Hepatic Encephalopathy

normal level of concesiouness with periods of lethargy and euphoria

Variceal banding

not for active bleeding, take a band around the engorged vein and put it around it cutting off the blood supply and body reabsorbs the blood over time.

cause of obstructive jaundice

obstructing the bile ducts: gall stones

hep B immune globulin (HBIG) provides ___ immunity to hep B

passive

Symptoms of Cholelithiasis

result from the disease of the gallbladder itself and obstruction of the bile passages by a gallstone: epigastric distress, vague pain in the right upper quadrant, nausea and vomiting.

manifestations of Cholecystitis

ridgity of right upper ab, pain radiating in the back or shoulder, nausea and vomiting.

Hep C s/s and tx

s/s: Most patients with acute or chronic hepatitis C are asymptomatic Tx: Antiviral therapy is available

Dietary restricitons of ___ is the primary mainstay of tx of ascities

salt

treatment of ascites

sodium restriction(<2g), diuretics (worry about dehydration low K+, reanal failure), paracentesis, or transjugular intrahepatic portosystemic shunt (TIPS)

stage 3 of Hepatic Encephalopathy

stuporous, difficult to arouse, sleeps most of time, marked confusion, incoherent speech

interventions for Cholelithiasis and Cholecystitis

surgical: cholecysectomy (removal of gallbladder through traditional surgerical tx) and laparoscopic cholecysectomy (removal of gallbladder through small incision through the umbilicus).

measuring abdominal girth for ascites

tape measure an wrap around the waist. level of umbilicus at the end of exhalation

Cirrhosis

the final stage of all chronic liver disease and is one of the leading causes of death in the US. Occurs when the normal liver tissue is replaced by fibrotic tissue in response to damage to liver cells

neomycin

to help with altering the flora in the gut and reducing the nitrogenous waste. pt will need to be assessed for neomycin toxicity for auditory loss

The goals of treatment for HBV are

to prevent replication of active hepatitis B virus (viral suppression) and reduce the effects of chronic liver inflammation

HBV has a long incubation period T/f?

true

Is the following statement true or false? A patient with decompensated cirrhosis is likely to exhibit increased abdominal girth and pedal edema.

true

esophageal varices are the most life threatening complications in patients with chronic liver disease T/f?

true

shock and multiple organ failure may occur with acute pancreatitis T/f?

true

balloon tamponade

used for active varice bleeding, aka blakemore tube: tube inserted through the nose down the mouth and into the stomach and the balloon is inflated to assert direct pressure from the inside to the bleeding varicies. there are two balloon options: esophegeal and gastric that can be inflated at different 20 min intervals. also has aspirate to suction out the stomach if there is any blood in there.

endoscopic injection sclerotherapy

used if the varice is bleeding, vasconstrict the vein with a potent vasoconstrictor (vassopressin) to stop the bleeding. complication: it will vasocontrict everything and the provider may put the patient on IV nitro to keep the cardiac dilated during this process.

The most effective strategy to prevent infection of HBV is through

vaccination

causes of hepatocellular jaundice

viral hepatitis and alcoholism

manifestations of hepatic dysfxn

vitamin deficiencies: in adequate intake of vitamins: folate acid, thiamine, vit b12 could be due to alcoholism or decrease of bile salts in the intestines which impairs the absorption of the vitamins

when is jaundice apparent?

when the serum bilirubin level exceeds 3 mg/dL

Jaundice

yellowing of the skin and sclerae of the eye. Caused by impairment of the liver's ability to metabolize and secrete bilirubin.