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Liver-med surg II
Functions of the liver
| Question | Answer |
|---|---|
| Name some nursing diagnoses associated with Alterarations in Liver function. | Altered nutrition < body requirements, Activity Intolerance, Risk for bleeding |
| What does Bile do? | emulsifies fats, makes fats more digestable, helps the process of converting fats to carbohydrates |
| What happens when a person has Liver disease or liver cancer? | bile production is disrupted and the person is unable to digest fat |
| When the bile function is altered, what are some of the signs and symptoms? | Intolerance to fatty foods, heartburn, diarrhea, abdominal distention, flatulence, cramping, nausea and vomiting, malabsorption of fat soluble vitamins (vitamin A,D E & especially vit. K) |
| What are the nursing implications regarding altered function of bile? | educate patient regarding fatty food consumption, the lack of absorbing vit K and their tendencies for bleeding |
| What is Hemochromotosis? | a condition of impaired iron storage |
| How is Iron stored in the liver? | as ferritin |
| What, besides iron, does the liver store? | vitamins, and minerals |
| Where is bile stored? | in the gallbladder |
| What happens with hemochromotosis? | too much iron in the blood, builds up in the blood, is hereditary, usually found by accident, blood appears VERY dark, can lead to cirrhosis because the liver cannot store it, tx= 1 pint of blood removed every couple of weeks. |
| Why are people with liver disease anemic? | They cannot store iron(neccessary for RBC formation) and because of blood loss |
| What do you need to form RBC's? | 1. erythropoetin (hormone from kidney to stimulate bone marrow to make RBC) (2) Iron (3) Folic acid (4) Amino acids5. B 12 (6) good genes ( thalacemia and sickle cell-examples of bad genes) |
| What would labs show for RBC, Hgb, & Hct show if iron stores were altered? | a decrease in all |
| What are the signs of Anemia? | Fatigue, dizziness, pale, pallor cold extremities, dyspnic on exertion, tachycardia, changes in conjuctiva color, may lead to CHF |
| What is the result of altered function in iron storage? | Vitamins are depleted, the underlying anemia causes Tissue hypoxia |
| What are some nursing implications for iron deficiency or anmeia? | give iron- need vitamin C to be absorbed, OJ, Food-green leafy veggies, red meats, whole grains, fortified foods, cereals, breads Cold-give blankets, warm fluids Rest-provide rest periods Monitor heart rate, assess for hypoxia |
| What are the two types of liver biopsy? | Closed- done bedside Open-done during exploratory surgeries |
| What is the procedure for a closed biopsy? | (1) pt must be cooperative (2) pt supine with right arm over head,pillow under small of back (increase intercostal spaces) (3) Zylocaine administeres topically (4) pt holds breath 10-15 secs AFTER exhalation (deflates lungs, raises diaphragm) (5) doc |
| What are some complications of a Liver Biopsy? | Bleeding, shock, RARE-pnuemothorax, punctured diapragm, perforated colon (phrenic nerve= shoulder pain) |
| Name some nursing diagnosis for Hepatitis | Risk for Infection r/t dx process & transmission, Ineffective individual coping r/t diagnosis & potential long term process |
| What would you be given if you were exposed to HAV? Is there a vaccine? | Immune Globulin; yes there is a vaccine |
| What does the nurse do after a liver biopsy? | 1) put pt in lateral right side position on sand bag (2) monitor vital signs (compare baseline, chack Hgb & Hct for changes due to bleeding (3) Vitamin K prophylactically |
| How is Hepatitis A transmitted? | Oral-fecal route, assoc. with fast foos rest, institional living, through contaminated food and water, shellfish |
| What are the s/s of Preicteric Hepatitis? | (before jaundice)can't digest fats (anorexia, N&V, wt loss)inflammation of the liver (upper quadrant pain)decreased taste & smellviral syndrome - malaise, headache, fever, arthralgia, uticariaPhysical - large liver & spleen* |
| What are the s/s of Icteric Hepatitis? | Jaundice, pruritis, dark urine, Bilirubinuria, light stools, fatigue, palpable liver & spleen, wt loss |
| What happens in Post Icteric Hepatitis? | (after jaundice) the liver starts to heal (regeneration), about 4 months to heal, avoid ETOH, OTC & recreational drugs, eat proper, extra protein & rest |
| HAV uses travels with what? | Mono |
| What are the diagnostics for HAV, HBV, & HCV? | anti-HAV, HBsAG, HBcAG, anti-HBsAG, anti-HBcAG, HBeAG, anti-HCV |
| What is HBsAG? | First sign, detects surface antigen, shows up 4-12 weeks after exposure, earliest indicator |
| What is HBcAG? | six weeks later, detects the core or inner antigen |
| What is anti-HBsAG? | with titers, determines immunity to HBV |
| What is anti-HBcAG? | shows that there was a past infection of HBV |
| What is HBeAG? | means infectivity, (remember e as extra for replication) |
| What is anti-HAV? | shows antibodies to HAV |
| What is anti-HCV? | shows antibodies to HCV |
| What are some risk factors for HCV? | Blood transfusions before 1990, IV drug users (even just once), elevated liver enzymes, ^sexual partners or behavior, hemodialysis, needle stick injuries, baby of infected mom, sex with HCV+ person, excessive tattoos/piercing, intranasal cocaine use |
| Is there a vaccine for the different types of Hepatitis? | HAV & HBV have vaccines, the others do not. |
| What is the leading cause of chronic liver dx & transplants? | Hepatitis C |
| What ia acute Hepatitis C? | It has an incubation period of 7 weeks, in 15% of people it is self-limiting, usually does not cause hepatic failure |
| What do you need to know about chronic Hepatitis C? | most people have no symptoms, 60% progress slowly about 20 yrs, cirrhosis occurs in 20-30% within 20-30 yrs after infection, 10-15% will not develop cirrhosis,lv cx is 5% after infection with an increase of 4%/yr after cirrhosis is present, ETOH accelerat |
| What are some preventative measures of acquiring HAV? | Handwashing, vaccination after age 2, good sanitation, avoid shellfish, wash uncooked fruits & veggies, Immune Globulin shot if exposed |
| What are preventative measures to avoid acquiring HBV? | HBV vaccine, safe or no sex, sterile instruments for tattoos/piercing, do not share razors, toothbrushes, personal protective equipment, public education |
| What are preventative measures to avoid acquiring chronic HCV? | Decrease risk factors, public education, 50% of IV drug users-clean needle exchanges |
| What are the pharmocological managements for HBV & HCV? | For HBV & HCV, they use Interferon. With HCV, they add Ribovarin (which id active against RNA & DNA viruses |
| What are the multiple side effects of Interferon? | Hematologic - RXN to Neupogen |
Created by:
kpadilla
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