INTERFERENCE TO NUTRITIONAL NEEDS DUE TO DEGENERATION AND INFLAMMATION Cirrhosis and Hepatitis Cirrhosis A scarring of the liver Slow and progressive in nature Causes Compensated Etoh Hepatitis C Hepatitis B No significant symptoms despite damage Uncompensated Impaired function demonstrated by Portal htn Ascites Esophageal varices Coagulation problems Jaundice Encephalopathy Hepatorenal syndrome peritonitis Identify the pathology which occurs with each of the complications that arises from cirrhosis (in other words, why do you see these problems) What other diseases are capable of causing cirrhosis? (hint: you just studied these problems over the last 2 weeks) Physical manifestations of the disease See your textbook pg 1372 for a great visual aide Laboratory testing (see page 1374, table 62-4) AST ALT LDH Alkaline Phosphatase Bilirubin Serum protein Total Direct/indirect Serum/urine Total Albumin Serum globulin Amonia PT What do each of these labs indicate? Look at the concept map on page 1376 and chart 62-2 on page 1377 Identify those s/s consistent with cirrhosis/liver disease (both subjective and objective) Give rationales for each nursing intervention identified (are there other interventions you could add to them?) Surgical management Peritoneovenous Portacaval shunt shunt What care would you expect to perform following these surgeries? What problems might you expect postoperatively? And how would you handle them? (treatments) Nonsurgical management Medications Why use betablockers? Gastric intubation/lavage Esophagogastric balloon tamponade to stop bleeding varices What is the nursing care for the patient who has undergone this procedure? Blood transfusions Endoscopic band ligation or sclerotherapy to treat varices Transjugular intrahepatic portal-systemic shunt – a last resort option Portal systemic encephalopathy is a complication of liver failure that is dangerous and potentially lethal. What are the nursing interventions you would perform for someone with this problem? Give rationales for each intervention. Include the medications the MD would typically prescribe to be administered by the nurse. Education is always a part of our job as nurses. What would you want to be sure to teach your patient with cirrhosis? Hepatitis What are the various types of hepatitis? What are the differences in how they are contracted? S/s are due, in part, to the infectious nature of the disease but also due to the disease’s impact on the liver. What s/s can you relate to the liver? To the infection? What lab tests would be indicative of hepatitis? What labs simply indicate liver involvement? Identify the nursing interventions you would perform and give the rationales for each. What medications are being used to treat hepatitis? How do they work? What are the dangers/risks using them?