interventions for clients with liver problems. cirrhosis cirrhosis is extensive scarring of the...
TRANSCRIPT
![Page 1: Interventions for Clients with Liver Problems. Cirrhosis Cirrhosis is extensive scarring of the liver, usually caused by a chronic irreversible reaction](https://reader036.vdocuments.mx/reader036/viewer/2022081603/56649ebe5503460f94bc7e25/html5/thumbnails/1.jpg)
Interventions for Interventions for Clients with Liver Clients with Liver
ProblemsProblems
![Page 2: Interventions for Clients with Liver Problems. Cirrhosis Cirrhosis is extensive scarring of the liver, usually caused by a chronic irreversible reaction](https://reader036.vdocuments.mx/reader036/viewer/2022081603/56649ebe5503460f94bc7e25/html5/thumbnails/2.jpg)
Cirrhosis Cirrhosis
• Cirrhosis is extensive scarring of the liver, usually caused by a chronic irreversible reaction to hepatic inflammation and necrosis.
• Complications depend on the amount of damage sustained by the liver.
• In compensated cirrhosis, liver has significant scarring but performs essential functions without causing significant symptoms.
![Page 3: Interventions for Clients with Liver Problems. Cirrhosis Cirrhosis is extensive scarring of the liver, usually caused by a chronic irreversible reaction](https://reader036.vdocuments.mx/reader036/viewer/2022081603/56649ebe5503460f94bc7e25/html5/thumbnails/3.jpg)
![Page 4: Interventions for Clients with Liver Problems. Cirrhosis Cirrhosis is extensive scarring of the liver, usually caused by a chronic irreversible reaction](https://reader036.vdocuments.mx/reader036/viewer/2022081603/56649ebe5503460f94bc7e25/html5/thumbnails/4.jpg)
![Page 5: Interventions for Clients with Liver Problems. Cirrhosis Cirrhosis is extensive scarring of the liver, usually caused by a chronic irreversible reaction](https://reader036.vdocuments.mx/reader036/viewer/2022081603/56649ebe5503460f94bc7e25/html5/thumbnails/5.jpg)
Complications Complications
• Portal hypertension• Ascites • Bleeding esophageal varices• Coagulation defects• Jaundice• Portal-systemic encephalopathy with
hepatic coma• Hepatorenal syndrome• Spontaneous bacterial peritonitis
![Page 6: Interventions for Clients with Liver Problems. Cirrhosis Cirrhosis is extensive scarring of the liver, usually caused by a chronic irreversible reaction](https://reader036.vdocuments.mx/reader036/viewer/2022081603/56649ebe5503460f94bc7e25/html5/thumbnails/6.jpg)
![Page 7: Interventions for Clients with Liver Problems. Cirrhosis Cirrhosis is extensive scarring of the liver, usually caused by a chronic irreversible reaction](https://reader036.vdocuments.mx/reader036/viewer/2022081603/56649ebe5503460f94bc7e25/html5/thumbnails/7.jpg)
Etiology Etiology
• Known causes of liver disease include:– Alcohol – Viral hepatitis– Autoimmune hepatitis– Steatohepatitis– Drugs and toxins– Biliary disease
(Continued)
![Page 8: Interventions for Clients with Liver Problems. Cirrhosis Cirrhosis is extensive scarring of the liver, usually caused by a chronic irreversible reaction](https://reader036.vdocuments.mx/reader036/viewer/2022081603/56649ebe5503460f94bc7e25/html5/thumbnails/8.jpg)
EtiologyEtiology (Continued)(Continued)
–Metabolic/genetic causes– Cardiovascular disease
![Page 9: Interventions for Clients with Liver Problems. Cirrhosis Cirrhosis is extensive scarring of the liver, usually caused by a chronic irreversible reaction](https://reader036.vdocuments.mx/reader036/viewer/2022081603/56649ebe5503460f94bc7e25/html5/thumbnails/9.jpg)
Clinical ManifestationsClinical Manifestations
• In early stages, signs of liver disease include:– Fatigue– Significant change in weight– Gastrointestinal symptoms– Abdominal pain and liver tenderness– Pruritus
![Page 10: Interventions for Clients with Liver Problems. Cirrhosis Cirrhosis is extensive scarring of the liver, usually caused by a chronic irreversible reaction](https://reader036.vdocuments.mx/reader036/viewer/2022081603/56649ebe5503460f94bc7e25/html5/thumbnails/10.jpg)
![Page 11: Interventions for Clients with Liver Problems. Cirrhosis Cirrhosis is extensive scarring of the liver, usually caused by a chronic irreversible reaction](https://reader036.vdocuments.mx/reader036/viewer/2022081603/56649ebe5503460f94bc7e25/html5/thumbnails/11.jpg)
![Page 12: Interventions for Clients with Liver Problems. Cirrhosis Cirrhosis is extensive scarring of the liver, usually caused by a chronic irreversible reaction](https://reader036.vdocuments.mx/reader036/viewer/2022081603/56649ebe5503460f94bc7e25/html5/thumbnails/12.jpg)
Clinical ManifestationsClinical Manifestations
• In late stages, the signs vary:– Jaundice and icterus– Dry skin– Rashes– Petechiae, or ecchymoses (lesions)–Warm, bright red palms of the hands– Spider angiomas– Peripheral dependent edema of the
extremities and sacrum
![Page 13: Interventions for Clients with Liver Problems. Cirrhosis Cirrhosis is extensive scarring of the liver, usually caused by a chronic irreversible reaction](https://reader036.vdocuments.mx/reader036/viewer/2022081603/56649ebe5503460f94bc7e25/html5/thumbnails/13.jpg)
![Page 14: Interventions for Clients with Liver Problems. Cirrhosis Cirrhosis is extensive scarring of the liver, usually caused by a chronic irreversible reaction](https://reader036.vdocuments.mx/reader036/viewer/2022081603/56649ebe5503460f94bc7e25/html5/thumbnails/14.jpg)
Abdominal AssessmentAbdominal Assessment
• Massive ascites
• Umbilicus protrusion
• Caput medusae (dilated abdominal veins)
• Hepatomegaly (liver enlargement)
![Page 15: Interventions for Clients with Liver Problems. Cirrhosis Cirrhosis is extensive scarring of the liver, usually caused by a chronic irreversible reaction](https://reader036.vdocuments.mx/reader036/viewer/2022081603/56649ebe5503460f94bc7e25/html5/thumbnails/15.jpg)
![Page 16: Interventions for Clients with Liver Problems. Cirrhosis Cirrhosis is extensive scarring of the liver, usually caused by a chronic irreversible reaction](https://reader036.vdocuments.mx/reader036/viewer/2022081603/56649ebe5503460f94bc7e25/html5/thumbnails/16.jpg)
Other Physical AssessmentsOther Physical Assessments
• Assess nasogastric drainage, vomitus, and stool for presence of blood
• Fetor hepaticus (breath odor)• Amenorrhea• Gynecomastia, testicular atrophy,
impotence• Bruising, petechiae, enlarged spleen• Neurologic changes• Asterixis
![Page 17: Interventions for Clients with Liver Problems. Cirrhosis Cirrhosis is extensive scarring of the liver, usually caused by a chronic irreversible reaction](https://reader036.vdocuments.mx/reader036/viewer/2022081603/56649ebe5503460f94bc7e25/html5/thumbnails/17.jpg)
![Page 18: Interventions for Clients with Liver Problems. Cirrhosis Cirrhosis is extensive scarring of the liver, usually caused by a chronic irreversible reaction](https://reader036.vdocuments.mx/reader036/viewer/2022081603/56649ebe5503460f94bc7e25/html5/thumbnails/18.jpg)
Laboratory AssessmentLaboratory Assessment
• Aminotransferase serum levels and lactate dehydrogenase may be elevated.
• Alkaline phosphatase levels may increase.
• Total serum bilirubin and urobilinogen levels may rise.
• Total serum protein and albumin levels decrease.
(Continued)
![Page 19: Interventions for Clients with Liver Problems. Cirrhosis Cirrhosis is extensive scarring of the liver, usually caused by a chronic irreversible reaction](https://reader036.vdocuments.mx/reader036/viewer/2022081603/56649ebe5503460f94bc7e25/html5/thumbnails/19.jpg)
Laboratory AssessmentLaboratory Assessment
(Continued)(Continued)
• Prothrombin time prolonged; platelet count low
• Decreased hemoglobin and hematocrit values and white blood cell count
• Elevated ammonia levels
• Serum creatinine level possibly elevated
![Page 20: Interventions for Clients with Liver Problems. Cirrhosis Cirrhosis is extensive scarring of the liver, usually caused by a chronic irreversible reaction](https://reader036.vdocuments.mx/reader036/viewer/2022081603/56649ebe5503460f94bc7e25/html5/thumbnails/20.jpg)
![Page 21: Interventions for Clients with Liver Problems. Cirrhosis Cirrhosis is extensive scarring of the liver, usually caused by a chronic irreversible reaction](https://reader036.vdocuments.mx/reader036/viewer/2022081603/56649ebe5503460f94bc7e25/html5/thumbnails/21.jpg)
![Page 22: Interventions for Clients with Liver Problems. Cirrhosis Cirrhosis is extensive scarring of the liver, usually caused by a chronic irreversible reaction](https://reader036.vdocuments.mx/reader036/viewer/2022081603/56649ebe5503460f94bc7e25/html5/thumbnails/22.jpg)
Surgical InterventionsSurgical Interventions
• Peritoneovenous shunt
• Portocaval shunt
• Transjugular intrahepatic portosystemic shunt
![Page 23: Interventions for Clients with Liver Problems. Cirrhosis Cirrhosis is extensive scarring of the liver, usually caused by a chronic irreversible reaction](https://reader036.vdocuments.mx/reader036/viewer/2022081603/56649ebe5503460f94bc7e25/html5/thumbnails/23.jpg)
![Page 24: Interventions for Clients with Liver Problems. Cirrhosis Cirrhosis is extensive scarring of the liver, usually caused by a chronic irreversible reaction](https://reader036.vdocuments.mx/reader036/viewer/2022081603/56649ebe5503460f94bc7e25/html5/thumbnails/24.jpg)
Potential for HemorrhagePotential for Hemorrhage
• Interventions include:– Identifying the source of bleeding and
initiating measures to halt it–Massive esophageal bleeding– Esophageal varices– Nonsurgical management includes:• Drug therapy: possibly nonselective beta
blocker• Gastric intubation• Esophagogastric balloon tamponade
![Page 25: Interventions for Clients with Liver Problems. Cirrhosis Cirrhosis is extensive scarring of the liver, usually caused by a chronic irreversible reaction](https://reader036.vdocuments.mx/reader036/viewer/2022081603/56649ebe5503460f94bc7e25/html5/thumbnails/25.jpg)
![Page 26: Interventions for Clients with Liver Problems. Cirrhosis Cirrhosis is extensive scarring of the liver, usually caused by a chronic irreversible reaction](https://reader036.vdocuments.mx/reader036/viewer/2022081603/56649ebe5503460f94bc7e25/html5/thumbnails/26.jpg)
Management of Hemorrhage Management of Hemorrhage
• Blood transfusions
• Endoscopic procedures
• Transjugular intrahepatic portal-systemic shunt
• Surgical management
![Page 27: Interventions for Clients with Liver Problems. Cirrhosis Cirrhosis is extensive scarring of the liver, usually caused by a chronic irreversible reaction](https://reader036.vdocuments.mx/reader036/viewer/2022081603/56649ebe5503460f94bc7e25/html5/thumbnails/27.jpg)
Potential for Portal-Systemic Potential for Portal-Systemic EncephalopathyEncephalopathy
• Interventions include:– Role of ammonia– Reduction of ammonia levels– Diet therapy using simple and brief
guidelines– Drug therapy:• Lactulose• Neomycin sulfate• Metronidazole
![Page 28: Interventions for Clients with Liver Problems. Cirrhosis Cirrhosis is extensive scarring of the liver, usually caused by a chronic irreversible reaction](https://reader036.vdocuments.mx/reader036/viewer/2022081603/56649ebe5503460f94bc7e25/html5/thumbnails/28.jpg)
Hepatitis Hepatitis
• Widespread viral inflammation of liver cells
• Hepatitis A
• Hepatitis B
• Hepatitis C
• Hepatitis D
• Hepatitis E
• Hepatitis F and G are uncommon
![Page 29: Interventions for Clients with Liver Problems. Cirrhosis Cirrhosis is extensive scarring of the liver, usually caused by a chronic irreversible reaction](https://reader036.vdocuments.mx/reader036/viewer/2022081603/56649ebe5503460f94bc7e25/html5/thumbnails/29.jpg)
Hepatitis AHepatitis A
• Similar to that of a typical viral syndrome; often goes unrecognized
• Spread via the fecal-oral route by oral ingestion of fecal contaminants
• Contaminated water, shellfish from contaminated water, food contaminated by handlers infected with hepatitis A
• Also spread by oral-anal sexual activity(Continued)
![Page 30: Interventions for Clients with Liver Problems. Cirrhosis Cirrhosis is extensive scarring of the liver, usually caused by a chronic irreversible reaction](https://reader036.vdocuments.mx/reader036/viewer/2022081603/56649ebe5503460f94bc7e25/html5/thumbnails/30.jpg)
Hepatitis A Hepatitis A (Continued)(Continued)
• Incubation period for hepatitis A is 15 to 50 days.
• Disease is usually not life threatening.
• Disease may be more severe in individuals older than 40 years of age.
• Many people who have hepatitis A don’t know it; symptoms are similar to a gastrointestinal illness.
![Page 31: Interventions for Clients with Liver Problems. Cirrhosis Cirrhosis is extensive scarring of the liver, usually caused by a chronic irreversible reaction](https://reader036.vdocuments.mx/reader036/viewer/2022081603/56649ebe5503460f94bc7e25/html5/thumbnails/31.jpg)
![Page 32: Interventions for Clients with Liver Problems. Cirrhosis Cirrhosis is extensive scarring of the liver, usually caused by a chronic irreversible reaction](https://reader036.vdocuments.mx/reader036/viewer/2022081603/56649ebe5503460f94bc7e25/html5/thumbnails/32.jpg)
Hepatitis BHepatitis B
• Spread is via unprotected sexual intercourse with an infected partner, sharing needles, accidental needle sticks, blood transfusions, hemodialysis, maternal-fetal route.
• Symptoms occur in 25 to 180 days after exposure; symptoms include anorexia, nausea and vomiting, fever, fatigue, right upper quadrant pain, dark urine, light stool, joint pain, and jaundice.
(Continued)
![Page 33: Interventions for Clients with Liver Problems. Cirrhosis Cirrhosis is extensive scarring of the liver, usually caused by a chronic irreversible reaction](https://reader036.vdocuments.mx/reader036/viewer/2022081603/56649ebe5503460f94bc7e25/html5/thumbnails/33.jpg)
Hepatitis BHepatitis B (Continued)(Continued)
• Hepatitis carriers can infect others, even if they are without symptoms.
![Page 34: Interventions for Clients with Liver Problems. Cirrhosis Cirrhosis is extensive scarring of the liver, usually caused by a chronic irreversible reaction](https://reader036.vdocuments.mx/reader036/viewer/2022081603/56649ebe5503460f94bc7e25/html5/thumbnails/34.jpg)
Hepatitis CHepatitis C• Spread is by sharing needles,
blood, blood products, or organ transplants (prior to 1992), needle stick injury, tattoos, intranasal cocaine use.
• Incubation period is 21 to 140 days.
• Most individuals are asymptomatic; damage occurs over decades.
• Hepatitis C is the leading indication for liver transplantation in the U.S.
![Page 35: Interventions for Clients with Liver Problems. Cirrhosis Cirrhosis is extensive scarring of the liver, usually caused by a chronic irreversible reaction](https://reader036.vdocuments.mx/reader036/viewer/2022081603/56649ebe5503460f94bc7e25/html5/thumbnails/35.jpg)
Hepatitis DHepatitis D
• Transmitted primarily by parenteral routes
• Incubation period 14 to 56 days
![Page 36: Interventions for Clients with Liver Problems. Cirrhosis Cirrhosis is extensive scarring of the liver, usually caused by a chronic irreversible reaction](https://reader036.vdocuments.mx/reader036/viewer/2022081603/56649ebe5503460f94bc7e25/html5/thumbnails/36.jpg)
Hepatitis EHepatitis E
• Present in endemic areas where waterborne epidemics occur and in travelers to those areas
• Transmitted via fecal-oral route
• Resembles hepatitis A
• Incubation period 15 to 64 days
![Page 37: Interventions for Clients with Liver Problems. Cirrhosis Cirrhosis is extensive scarring of the liver, usually caused by a chronic irreversible reaction](https://reader036.vdocuments.mx/reader036/viewer/2022081603/56649ebe5503460f94bc7e25/html5/thumbnails/37.jpg)
Clinical ManifestationsClinical Manifestations• Abdominal pain• Changes in skin or eye color• Arthralgia (joint pain)• Myalgia (muscle pain)• Diarrhea/constipation• Fever• Lethargy• Malaise• Nausea/vomiting• Pruritus
![Page 38: Interventions for Clients with Liver Problems. Cirrhosis Cirrhosis is extensive scarring of the liver, usually caused by a chronic irreversible reaction](https://reader036.vdocuments.mx/reader036/viewer/2022081603/56649ebe5503460f94bc7e25/html5/thumbnails/38.jpg)
Nonsurgical ManagementNonsurgical Management
• Physical rest
• Psychological rest
• Diet therapy
• Drug therapy includes:– Antiemetics– Antiviral medications– Immunomodulators
![Page 39: Interventions for Clients with Liver Problems. Cirrhosis Cirrhosis is extensive scarring of the liver, usually caused by a chronic irreversible reaction](https://reader036.vdocuments.mx/reader036/viewer/2022081603/56649ebe5503460f94bc7e25/html5/thumbnails/39.jpg)
Fatty Liver (Steatohepatitis)Fatty Liver (Steatohepatitis)
• Fatty liver is caused by the accumulation of fats in and around the hepatic cells.
• Causes include:– Diabetes mellitus– Obesity– Elevated lipid profile
• Many clients are asymptomatic.
![Page 40: Interventions for Clients with Liver Problems. Cirrhosis Cirrhosis is extensive scarring of the liver, usually caused by a chronic irreversible reaction](https://reader036.vdocuments.mx/reader036/viewer/2022081603/56649ebe5503460f94bc7e25/html5/thumbnails/40.jpg)
Hepatic AbscessHepatic Abscess
• Liver invaded by bacteria or protozoa causing abscess
• Pyrogenic liver abscess; amebic hepatic abscess
• Treatment usually involves:– Drainage with ultrasound guidance– Antibiotic therapy
![Page 41: Interventions for Clients with Liver Problems. Cirrhosis Cirrhosis is extensive scarring of the liver, usually caused by a chronic irreversible reaction](https://reader036.vdocuments.mx/reader036/viewer/2022081603/56649ebe5503460f94bc7e25/html5/thumbnails/41.jpg)
![Page 42: Interventions for Clients with Liver Problems. Cirrhosis Cirrhosis is extensive scarring of the liver, usually caused by a chronic irreversible reaction](https://reader036.vdocuments.mx/reader036/viewer/2022081603/56649ebe5503460f94bc7e25/html5/thumbnails/42.jpg)
Cancer of the LiverCancer of the Liver
• One of the most common tumors in the world
• Most common complaint: abdominal discomfort
• Treatment includes:– Chemotherapy– Surgery
![Page 43: Interventions for Clients with Liver Problems. Cirrhosis Cirrhosis is extensive scarring of the liver, usually caused by a chronic irreversible reaction](https://reader036.vdocuments.mx/reader036/viewer/2022081603/56649ebe5503460f94bc7e25/html5/thumbnails/43.jpg)
![Page 44: Interventions for Clients with Liver Problems. Cirrhosis Cirrhosis is extensive scarring of the liver, usually caused by a chronic irreversible reaction](https://reader036.vdocuments.mx/reader036/viewer/2022081603/56649ebe5503460f94bc7e25/html5/thumbnails/44.jpg)
Liver TransplantationLiver Transplantation
• Used in the treatment of end-stage liver disease, primary malignant neoplasm of the liver
• Donor livers obtained primarily from trauma victims who have not had liver damage
• Donor liver transported to the surgery center in a cooled saline solution that preserves the organ for up to 8 hours
![Page 45: Interventions for Clients with Liver Problems. Cirrhosis Cirrhosis is extensive scarring of the liver, usually caused by a chronic irreversible reaction](https://reader036.vdocuments.mx/reader036/viewer/2022081603/56649ebe5503460f94bc7e25/html5/thumbnails/45.jpg)
Complications Complications
• Acute, chronic graft rejection• Infection• Hemorrhage• Hepatic artery thrombosis• Fluid and electrolyte imbalances• Pulmonary atelectasis• Acute renal failure• Psychological maladjustment