NCM118 Critical Care Nursing - Altered Metabolism of Liver, Pancreas PDF

NCM118 CRITICAL CARE NURSING Transes made by: Erika Mae A. Sarmiento Universidad de Sta. Isabel, Inc. BSN 4 Batch 2025 weight of the patient for NURSING CARE OF CLIENTS WITH ALTERED...

NCM118 CRITICAL CARE NURSING Transes made by: Erika Mae A. Sarmiento Universidad de Sta. Isabel, Inc. BSN 4 Batch 2025 weight of the patient for NURSING CARE OF CLIENTS WITH ALTERED baseline data METABOLIC-GASTROINTESTINAL, LIVER 2. Fluid and electrolyte management Monitor fluid status Electrolyte balance ASSESSMENT 3. Medication administration Health History Administer meds as prescribed ○ Diet Monitor for side effects ○ Lifestyle 4. Monitor for complications ○ Previous medications Monitor for signs of bleeding ○ Alcohol consumption ○ Bruising, petechiae, melena, ○ Family History hematemesis, altered mental ○ Liver or intestinal diseases status particularly for pt with ○ Jaundice liver disease ○ Bloating, N/V, Diarrhea, Constipation Watch for signs of infection Physical Examination ○ Occurs dt decrease in I immune ○ Abdominal distenstion function, decreased ○ Tenderness temperature, increased WBC ○ Bowel sounds Observe for neurological changes ○ Signs of metabolic imbalances ○ May develop hepatic Edema encepatholpathy Diagnostic Tests 5. Promoting skin integrity ○ Review the previous results from liver Prevent skin breakdown function test, electrolytes, and CBC. ○ Frequent repositioning q 45 Then compare the results from the new minutes tests results. ○ Egg tray like mAttress 6. Client education NURSING DIAGNOSIS Disease process ○ Teach pt, the family about the condition, Imbalance nutrition less than body requirements and management Fluid volume excess or deficit Medication adherence Risk for bleeding ○ Teach pt the importance of taking meds Impaired skin integrity as prescribed. Pt should know the Risk for infection potential side effects of meds Activity intolerance Dietary recommendations ○ Diet is modified based on the pts NURSING INTERVENTIONS condition, such as in pt with diabetes Lifestyle changes 1. Nutrition Management ○ Cessation of smoking and alcohol intake Dietary modifications 7. Psychological support Nutritional support Support coping strategies ○ In severe malnutrition or Encourage involvement in care dysphagia, thus parenteral ○ Pt should be given the nutrition may be given independence to take care of Monitor for signs of malnutrition themselves ○ Weight loss (weighing of the 8. Evaluation same time and clothes of the 9. Collaboration with the healthcare team day). Upon admission, get the  Communicate clearly ACUTE GASTROINTESTINAL BLEEDING EVALUATION a potentially life-threatening condition requiring immediate medical attention and nursing care Hemodynamic stability It can occur either in the upper GI tract Bleeding control (esophagus, stomach, or duodenum) or the lower Client understanding GI tract (small intestines, colon, rectum) COLLABORATION WITH HCT COMMON CAUSES OF ACUTE GI BLEEDING interdisciplinary communication Peptic ulcer Dietician consultation Variceal bleeding Pharmacy consultation Esophageal or gastric cancer Diverticulosis IBD (inflammatory bowel disease) Hemorrhoids INTRA-ABDOMINAL HYPERTENSION AND ABDOMINAL COMPARTMENT SYNDROME NURSING CARE IAH critical condition characterized by increased Vital signs pressure within the abdominal cavity Signs and symptoms Both conditions can lead to organ dysfunction ○ Hematemesis and are associated with high morbidity ○ Melena (avoid dark-colored food) History and risk factors CAUSES AND RISK FACTORS ○ Get detailed medical history of patients Abdominal trauma Major surgery NURSING INTERVENTION Severe infections 1. Positioning Burn supine with an elevated head Intraabdominal hemorrhage 2. Oxygen therapy Massive fluid resuscitation (bowel edema, Maintain oxygen saturation ascites) 3. Intravenous access Abdominal obstructions of masses (tumor, 4. Fluid and blood management pregnancy) Fluid resuscitation ○ Isotonic solution PATHOPHYSIOLOGY Blood transfusion ○ Check the chart for consent Increased intraabdominal pressure Monitoring intake and output ○ Compress Venous return that reduces 5. Monitoring and diagnostics perfusion to vital organ Continuous monitoring Organ dysfunction ○ Vs q4, q1 ○ As IAP increases results in decreased Lab tests output, renal perfusion, respi NGT compromised and severe arterial 6. Medication administrations pressure PPI Progression to ACS Vasoactive drugs Vit k or fresh frozen plasma NURSING CARE FOR IAH AND ACS 7. Preparation for diagnostic and therapeutic ASSESSMENT procedures Endoscopy preparation Frequent monitoring of VS Radiological studies Assess symptoms of IAH/ACS 8. Psychosocial support ○ Cardiovascular Provide reassurance  ○ Respiratory tachypnea, dyspnea, LIVER FAILURE decreased airway pressure ○ Gastrointestinal abd distension Is a severe condition where the liver loses its tenderness decrease bowel sound NV ability to function properly. It can be acute ○ Renal oliguria increased serum (occurring suddenly within days or weeks) or creatinine chronic (gradual deterioration over months or Measurement of IAP years, often due to cirrhosis). Liver failure can ○ 5-7 mmHg normal lead to life-threatening complications such as ○ If increased (12mmhg) there is an organ hepatic encephalopathy, coagulopathy, dysfunction like ACS jaundice, and multi-organ failure. Acute LF is the rapid loss of function in pt with preexisting NURSING INTERVENTIONS ○ Viral hepatitis A,B,E 1. Monitoring and Supportive care ○ Drug-induced liver injury Frequent reassessment (acetaminophen overdose IAP monitoring ○ Intake of toxins like chemicals or poison Respiratory support ○ Autoimmune hepatitis 2. Fluid management Chronic Optimize fluid balance (avoid excessive ○ There is a gradual decline of liver fx fluid administration, follow balanced overtime due to liver dse like resuscitation mngt) (give diuretics for Hepatitis B fluid overload and if sure for adequate Alcohol dse renal function) Alcoholic fatty liver Monitor fluid status ○ May lead to cirrhosis that results in EKD 3. Decompression strategy Non-surgical decompression (Trendelenburg position, NGT to Loss of Hepatocyte Function decompress bowel and reduce, ○ Liver cells are damaged which impairs Surgical decompression ( ○ Dcsd production of bile 4. Pain and anxiety mngt Impaired Detoxification Pain control ○ Accumulation of toxins like ammonia Anxiety reduction leads to hepatic encephalopathy 5. Prevent complications Coagulopathy Monitor renal function ○ Risk for bleeding Assess for respiratory compromise Portal Hypertension Prevent infection ○ Incsd pressure in the portal weight system dt cirrhosis leading to complications like variceal bleeding snd EVALUATION ascites 1. Monitor for improvement Stable vs and improved mental status S SX 2. Assess for organ function Jaundice Hepatic encephalopathy COLLABORATION WITH HCT ○ Confusion altered mental status and coordinate with the surgeon and an intensivist coma Dietician and pharmacist collaboration Ascites ○ Care for IAH/ACS is Complex and ○ Accumulation of fluid in the peritoneal. requires a multidisciplinary approach Cavity that leads to abm distention thus continuous monitoring supportive Coagulopathy care and timely intervention are ○ Easy bruising and prolonged bleeding important ○ Petechsie Edema ○ Dt hypoalbuminemia Fatigue, weakness, anorexia. And weight loss  ○ Dt kiver j avility to metabolze ○ Antihistamines or Cholestyramine Pruritus Infection prevention ○ Dt accumulation of bile salt ○ Aseptic technique Dark urine and pale stool ○ Monitor infection ○ Dt altered bilirubin metabolism EVALUATION NURSING CARE FOR CLIENTS WITH LIVER FAILURE monitor for improvement ○ Regularly assess improvement of liver ASSESSMENT function Vital Signs Dcsd jaundice Neurological Status Stable vs Respiratory Status dyspnea hypoxia dt fluid Reassess complications overload or pleural effusion Abdominal Examination COLLABORATION WITH HCT Skin and Mucous Membranes Coordination with specialist Prepare for potential lover transplantation NURSING DIAGNOSES Impaired skin integrity related to jaundice and pruritus Impaired gas exchange related to pleural ACUTE PANCREATITIS effusion or ascites Imbalanced nutrition: less than body Is an inflammatory condition of the pancreas requirements related to anorexia and characterized by sudden onset. It can range from malabsorption mild discomfort to a life-threatening illness, with complications like systemic inflammatory response syndrome (SIRS), pancreatic necrosis, NURSING INTERVENTIONS and multi-organ failure. Monitoring and Assessment The pancreas releases digestive enzymes that ○ Frequent Monitoring can cause tissue damage when activated ○ Neurological Checks prematurely, leading to inflammation. ○ Blood Tests Monitor Ammonia Levels›Management of CAUSES AND RISK FACTORS Hepatic Encephalopathy ○ Lactulose Administration 2 most common causes ○ Antibiotics Gallstones ○ Monitor Ammonia Levels (to check ○ This obstructs the common bile die. neurological improvements or When the bile duct is obstructed, this worsening) prevents pancreatic enzymes from Management of Coagulopathy and Bleeding entering the intestines ○ Prevent Bleeding Alcohol use ○ Administer Vitamin K ○ This can lead to a direct toxic effect on ○ Blood Products the pancreatic cells causing FLUID AND ELECTROLYTE MANAGEMENT inflammation ○ Fluid Restriction ○ Diuretics (ascites , edema) OTHER CAUSES ○ Paracentesis Nutritional Support Hypertriglyceridemia ○ High-Calorie, Low-Sodium Diet ○ High triglycerides can result in ○ Vitamin Supplements (thiamin, folic to pancreatic damage correct deficiency) Medications ○ Enteral or Parenteral Nutrition ○ There are certain meds that can induce Skin Care and Pruritus Management pancreatitis ○ Skin Care ○ Corticosteroids  ○ Diuretics Bruising along the flanks Infection ○ Mumps ○ Hepatitis NURSING CARE FOR CLIENTS WITH ACUTE Trauma or surgery PANCREATITIS ○ If there is abdominal trauma or surgical procedures, it can lead to pancreatic ASSESSMENT surgery. Autoimmune disorders Vital Signs ○ This causes autoimmune pancreatitis Pain Assessment Idiopathic Abdominal Examination ○ Unknown cause ○ check for tenderness and guarding behavior Fluid and Electrolyte Status PATHOPHYSIOLOGY ○ Monitor for signs of dehydration Premature Activation of pancreatic enzymes ○ Hypocalcemia ○ Pancreatic enzymes like Trypsin, once is Respiratory Status maturely activated within the pancreas ○ Tachypnea, Dyspnea, and Hypoxia can lead to auto-digestion of pancreatic Indicates pleural effusion or tissue respi distress syndrome Inflammation and tissue Damage ○ Auto-digestion of pancreatic tissue can NURSING DIAGNOSIS lead to inflammation and tissue damage, thus inflammatory mediators are Acute pain related to inflammation and released that result to _______ autodigestion of pancreatic tissue Systemic complications Fluid volume deficit related to vomiting, ○ The release of inflammatory mediators decreased intake, and third-spacing into the bloodstream can lead to Imbalanced nutrition: less than body hypertension, renal failure, respi requirements related to nausea and inability to distress, and multi-organ dysfunction tolerate oral intake S SX NURSING INTERVENTION Severe abdominal pain 1. pain management ○ Sudden, intense, constant typically in the a. Analgesics upper abdomen or epigastric region i. Opioids like morphine to control ○ Pain is radiating to the back pain (give med if not scheduled ○ It worsens with eating for surgery) N/V ii. ○ Persistent and severe NV b. Positioning Abdominal Tenderness and guarding i. Sit up and lean forward ○ ii. Fetal position to reduce pain and Fever discomfort ○ Low-grade fever due to inflammation c. Non-pharmacological measure Tachycardia and hypotension i. Relaxation techniques ○ Results from dehydration, hypovolemia, ii. Cold compress if tolerated or systemic inflammatory response iii. Quiet environment Jaundice 2. Fluid and electrolyte management ○ Due to gallstones or bile duct a. IV fluids obstructions i. Isotonic solution (PNSS or LRS) Signs of hemorrhage to maintain hydration and ○ Cullen s sign prevent hypovolemia bluish discoloration around the b. Monitor intake and output umbilicus ○ Grey turner sign  i. Keep an accurate record of urine output to assess fluid BARIATRIC CARE balance c. Electrolyte replacement focuses on the management and treatment of 3. Nutritional support individuals with obesity, particularly those a. NPO status undergoing or having undergone bariatric i. To reduce secretions surgery. b. Nasogastric suction is a weight-loss surgery designed to reduce the i. If there is severe nausea, stomach's capacity or limit nutrient absorption, vomiting, and abdominal which assists in significant weight loss distention to decompress the stomach and reduce pancreatic TYPES stimulation c. Enteral nutrition Restrictive Surgeries: i. Via nasojejunal tube if ○ Sleeve Gastrectomy (Gastric Sleeve) prolonged ———- 75-80% of stomach is removed ii. To maintain gag integrity Decreases stomach capacity d. Parenteral nutrition and reduces hunger-regulating i. If can't tolerate enteral nutrition hormones thus low appetite 4. Monitoring for complications Results of weight loss a. Signs of infection ○ Adjustable Gastric Band (Laparoscopic i. Fever Adjustable Gastric Banding, LAGB) ii. Increased WBC (sepsis or Placing an adjustable silicon pancreatic abscess) band around an upper band of b. Observe Respi compromise the stomach to create a small c. Monitor for hypocalcemia pouch, restricting food intake i. Muscle cramps Malabsorptive surgery ii. Administer calcium gluconate as ○ Biliopancreatic diversion with duodenal px switch (BPD/DS) 5. Psychosocial support Combination of restrictive and a. Educate client and fam malabsorptive techniques i. Teach about dse process and tx Remove a portion of the plan stomach and reroute a small ii. Explain the importance of part of intestine, reducing alcohol cessation nutrient absorption b. Address anxiety Combination surgery i. Provide emotional support ○ Roux en Y Gastric Nypass (RYGD) A common type is where asmall stomach pouch is created and EVALUATION connected directly to the small — intestine by passing a large portion of the stomach and duodenum wherein this reduces COLLABORATION WITH HCT food intake and nutrient coordinate with gastroenterologists and absorption surgeons Dietician consultation Pharmacist consultation PREOPERATIVE NURSING CARE FOR BARIATRIC SURGERY Severe pancreatitis focuses on: Managing pains ASSESSMENT Maintaining f/e Promoting supportive care Vital Signs Pain Assessment Intake and Output  Nutritional Status i. To prevent respi complications ○ Evaluate the current eating habits such as: dvt, and promote bowel ○ Food preferences function ○ Nutrient deficiency 3. Wound care and monitoring ○ Ensure the client understands pre-op a. Inspect surgical sites dietary changes b. Wound sites Psychological evaluation 4. Nutritional support and education ○ Asses psychiatric conditions like eating a. Clear liquid diet disorders and addiction issues b. Small, frequent meals ○ Ensure the client is psychologically c. Nutrient supplements prepared for changes after surgery i. Multivit Laboratory tests ii. Calcium ○ Cbc iii. Vit d ○ Electrolytes iv. Iron ○ Liver fx tests 1. For nutrients na kulang ○ Vit levels 5. Hydration and electrolyte management Physical examination a. Encourage fluid intake ○ VS i. 1.5-2 L of water intake per day ○ Weight b. Monitor electrolytes ○ Bmi 6. Monitor for complications Signs of complications from obesity a. Dumping syndrome ○ Joint pain i. Rapid gastric emptying which ○ Skin infection causes nausea, vomiting, dizziness, and diarrhea after eating high-sugar food. NURSING INTERVENTION 1. Take small frequent 1. Education and counseling meals that is Low in a. Teach client about surgical procedures, sugar and fat including risk and outcome and lifestyle b. Nutirent deficiencies change i. Signs of malnutrition 2. Dietary counseling 1. Fatigue a. Teach preop dietary restrictions like low 2. Hair loss calorie and high protein diets to reduce 3. Brittle nails liver size and improve surgical outcome c. Postoperative bleeding or leaks 3. Discuss postoperative lifestyle changes i. Low blood pressure a. Emphasize on the pt to adhere to the ii. Tachycardia dietary changes and portion control, hydration, and regular physical activity EVALUATION after surgery to induce weight loss _________________________________________________ Monitor weight loss Assess nutritional status 1. Pain management Pain control a. Analgesics Assess for complications i. Opiod or nonopioid to manage pain effectively b. Positioning i. Use pillow for comfort and DIABETIC KETOACIDOSIS change position frequently to reduce discomfort is a serious and potentially life-threatening 2. Respiratory management complication of diabetes mellitus, primarily type a. Incentive spirometry 1 diabetes, but it can also occur in type 2 diabetes i. To prevent atelectasis and under certain circumstances. improve lung expansion results from a severe insulin deficiency that leads b. Early ambulation to hyperglycemia, ketosis, and metabolic acidosis.  Kussmaul Respirations ○ Deep shallow breathing since body CAUSES AND RISK FACTORS compensates for metabolic acidosis infection Fruity breath odor Such as Pneumonia Altered mental status ○ The stress hormones counteract insulin Weakness, fatigue Inadequate insulin therapy ○ Probs with insulin administration NURSING CARE FOR CLIENTS New onset diabetes ○ The first manifestations of type one diabetes ASSESSMENT Other medical conditions Vital Signs ○ Mi, Stroke, Pancreatitis, and Trauma Blood Glucose Monitoring Increase stress and Neurological Status counterregulatory release ○ Signs of cerebral edema Medications like diuretics Altered consciousness Substance abuse like alcohol or recreational drug Headache use Fluid and Electrolyte Status Psychological factors Ketone Levels ○ Eating disorders ○ To assess the severity of ketoacidosis ○ Psychological stress and monitor response to treatment PATHOPHYSIOLOGY NURSING INTERVENTION Insulin Deficiency 1. Fluid replacement ○ Absolute or a. Intravenous fluids ○ Without sufficient insulin, the body cells i. 0.9% sodium chloride cannot use glucose results in ii. 0.45% Sodium chloride once hyperglycemia dehydration improves Hyperglycemia iii. —————————- ○ ——————————— b. Monitor fluid balance Ketosis i. Monitor I and O (To assess ○ ——————————— adequacy ——- and renal Metabolic Acidosis function) ○ Dt accumulation of ketones which are 2. Insulin therapy acidic leads to metabolic acidosis a. IV insulin infusion ○ The body tries to compensate by b. Transition to subcutaneous insulin respiratory ————— and carbon 3. Electrolyte management dioxide a. Potassium replacement Electrolyte Imbalances b. Monitor for other electrolyte ○ Insulin deficiency, Hyperglycemia, and replacement Acidosis 4. Acidosis management ○ Potassium a. Monitor ABGs K shifts out the cells in exchange b. Sodium bicarbonate for hydrogen ions leading to i. Rarely indicated unless pH is less hyperkalemia initially but overall than 6.9 as rapid correction can in the hody K is depleted lead to ————— ○ Sodium 5. Monitor cor complications ○ Phosphate a. Cerebral edema (occurs if rapid hypoglycemia) S SX i. Headache ii. LOC Polyuria, Polydipsia, and Polyphagia iii. Seizure Dehydration 1. Common in children Abdominal Pain and Nausea/Vomiting 6. Hypoglycemia  a. Sweating b. Tremors c. Confusion EVALUATION Monitor Blood Glucose Levels Assess Fluid and Electrolyte Balance Neurological Status Prevention of Complications