Adult+Health+nursing%2C+Week+11+_2024_.pptx

Adult Health Nursing –II Week-11 Cirrhosis of the Liver Nurse. Jule Lindsay RN, BScN, MN Objectives Define terminologies Etiologies Assessment Signs and symptoms Medications Diagnostic tests Nutritional requirements Health Teachings Community Resources 2 3  End-stage of liver disease  Extensive de...

Adult Health Nursing –II Week-11 Cirrhosis of the Liver Nurse. Jule Lindsay RN, BScN, MN Objectives Define terminologies Etiologies Assessment Signs and symptoms Medications Diagnostic tests Nutritional requirements Health Teachings Community Resources 2 3  End-stage of liver disease  Extensive degeneration and destruction of Cirrhosis liver cells  Results in replacement of liver tissue by fibrous and regenerative nodules of the Liver  Usually happens after decades of chronic liver disease 4 Definition Cirrhosis is a condition in which your liver is scarred and permanently damaged. Scar tissue replaces healthy liver tissue and prevents your liver from working normally. As cirrhosis gets worse, your liver begins to fail. 5  Thermal burns Types of Burn Injury  Chemical burns  Smoke inhalation injury  Electrical burns  Cold thermal injury Etiology and Pathophysiology  Most common causes in United States are chronic hepatitis C and alcohol-induced liver disease  Other causes  Extreme dieting, malabsorption, obesity  Environmental factors  Genetic predisposition 6 Etiology and Pathophysiology Biliary cirrhosis  Primary biliary cirrhosis (PBC)  Primary sclerosing cholangitis (PSC) Cardiac cirrhosis  Results from long-standing severe right-sided heart failure 7 Clinical Manifestations  Few symptoms in early-stage disease  Fatigue and enlarged liver may be early symptoms  Blood tests may be normal liver function (compensated cirrhosis) 8 Clinical Manifestations Late manifestations  Result from liver failure and portal hypertension Jaundice, peripheral edema, ascites  Other Skin lesions, hematologic problems , endocrine problems , and peripheral neuropathies  Liver becomes smaller, nodular 9 Clinical Manifestations of Cirrhosis 10 Clinical Manifestations Jaundice  Results from decreased ability to conjugate and excrete bilirubin  Overgrowth of connective tissue in liver compresses bile ducts  Leads to obstruction  Increase in bilirubin in vascular system  May be minimal or severe 11 Clinical Manifestations Skin lesions  Due to increase in circulating estrogen due to inability of liver to metabolize steroid hormones  Spider angiomas (telangiectasia or spider nevi)  Palmar erythema 12 Clinical Manifestations Hematologic disorders  Thrombocytopenia  Leukopenia  Anemia  Coagulation disorders 13 Clinical Manifestations Endocrine disorders  Secondary to decreased metabolism of hormones  In men—gynecomastia, loss of axillary and pubic hair, testicular atrophy, impotence and loss of libido  In women—amenorrhea or vaginal bleeding  Hyperaldosteronism in both sexes 14 Clinical Manifestations Peripheral neuropathy  Common finding in alcoholic cirrhosis  Dietary deficiencies of thiamine, folic acid, and cobalamin  Sensory and motor symptoms  Sensory symptoms may predominate 15 Complication  Compensated cirrhosis  Decompensated cirrhosis  Portal hypertension  Esophageal and gastric varices  Peripheral edema  Abdominal ascites  Hepatic encephalopathy  Hepatorenal syndrome 16 Complication Portal hypertension  Increased venous pressure in portal circulation  Splenomegaly  Large collateral veins  Ascites  Gastric and esophageal varices 17 Complication Esophageal varices  Complex of tortuous, enlarged veins at lower end of esophagus Gastric varices  Upper part of stomach Both are very fragile, bleed easily  Most life-threatening complication 18 Complication Peripheral edema  Decreased colloidal oncotic pressure from impaired liver synthesis of albumin  Increased portacaval pressure from portal hypertension  Occurs as lower extremities/presacral edema 19 Complication Ascites Accumulation of serous fluid in peritoneal or abdominal cavity Several mechanisms  Portal hypertension  Hypoalbuminemia  Hyperaldosteronism 20 Diagnostic Studies  Liver enzyme tests  Alkaline phosphatase, AST, ALT, GGT  Total protein, albumin levels  Serum bilirubin, globulin levels  Cholesterol levels  Prothrombin time  Ultrasound elastography (Fibroscan)  Liver biopsy 21 Interprofessional Care Hepatic encephalopathy  Reduce ammonia formation Lactulose (Cephulac), which traps ammonia in gut Rifaximin (Xifaxan) antibiotic Prevent constipation  Treatment of precipitating cause Lower dietary protein intake Control GI bleeding Remove blood from GI tract 22 Interprofessional Care Drug therapy  Not specific for cirrhosis  Several drugs used to treat symptoms and complications of advanced liver disease 23 Nutritional Therapy Diet for patient without complications  High in calories (3000 cal/day)  High carbohydrate  Moderate to low fat  Protein restriction rarely needed 24 Nursing Management Nursing Assessment Health promotion  Reduce or eliminate risk factors  Treat alcoholism  Maintain adequate nutrition  Identify and treat acute hepatitis  Bariatric surgery for morbidly obese 25 Nursing Management Nursing Assessment Acute care Rest needs  Prevent complications  Modify schedule Nutritional needs  Oral hygiene  Between-meal snacks  Offer preferred foods  Explanation of dietary restrictions 26 Nursing Management Nursing Assessment Acute care  Assess for jaundice  Measures to relieve pruritus  Cholestyramine or hydroxyzine  Baking soda or Alpha Keri baths  Lotions, soft or old linen  Antihistamines  Temperature control  Short nails; rub with knuckles 27 Nursing Management Nursing Assessment Acute care  Monitor color of urine and stools  Accurate I/O recording  Daily weights  Extremities measurement  Abdominal girth measurement 28 Nursing Management Nursing Assessment Acute care  Relief of dyspnea Semi- or high Fowler’s position  Skin care Special mattress Turning schedule, at least every 2 hours  ROM exercises  Coughing/deep breathing exercises  Elevate lower extremities/scrotum 29 Nursing Management Evaluation  Maintenance of food/fluid intake to meet nutritional needs  Maintenance of skin integrity  Normalization of fluid and electrolyte balance  Treatment for substance use 30 31 Thank You