care of client with liver and pancreatic disorder

8/7/2019 Care of Client With Liver and Pancreatic Disorder

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Caring for Clients with

Disorders of the Liver,Gallbladder, or Pancreas


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The Livery Functions

y Metabolizes: Glucose, proteins, and fats; Drugs,

chemicals, bacteria, and foreign elements

y Converts glycogen to glucose

y Regulates blood glucose

y Stores vitamins; Forms and excretes bile and

bilirubin

y Synthesizes factors for blood coagulation


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The Liver


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The Liver


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Jaundice

y Results from an abnormally highconcentration of the pigment bilirubin in theblood

y Visible, notably on the skin, oral mucousmembranes, and (especially) sclera

y

Three forms of jau

ndice


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Cirrhosisy Degenerative liver disorder caused by

generalized cellular damagey Pathophysiology and Etiology

y

Irreversibly damaged liver cellsy Consequences of damaged liver cells

y Affects digestion and metabolismy Fluid and electrolyte imbalancesy Impaired ability to metabolize hormones and detoxify

chemicals

y Types: Lannecs, postnecrotic, and biliary


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Cirrhosisy Assessment Findings: Signs and Symptoms

y Clinical manifestations: Compensated anddecompensated

y Chronic fatigue; Anorexia; Dyspepsia; Nausea;Clay-colored stools; Diarrhea

y Constipation; Tea-colored urine; Weight loss;Abdominal discomfort

y Shortness of breath; Nosebleeds; Signs ofincomplete estrogen metabolism in men


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Cirrhosisy Di stic Fi i s

y i r i s , l t sts, , I,r i is t li r sc : Demonstr te li ersenl r ed si e, nodul r confi ur tion, nddistorted lood flow

y Medic l nd ur ic l Managementy o s ecific cure; revents furt erdeterioration;

itamins andnutritional supplements; o

alcohol; dvanced liverdisease: estrict proteinintake; actuloseadministration

y Ursodeoxycholic acid; otassium-sparingantidiuretics; odium intake; latelettransfusion; iver transplantation


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Cirrhosisy Nursing Management

y Monitor vital signs, weight, intake, output, and

abdominal girth; Small mealsy Client response to drug therapy: Change in

mental status; Signs of GI bleed

y Client teaching: Liver disorder; Support groups;Treatment regimen; Home care


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Cirrhosis Complicationsy Portal Hypertension

y Blood backs up in portal systemy Congestion; Pressurey

Treatment: Sodium restriction; Drug therapy;Surgical and nonsurgical shunty Esophageal Varices

y Result of portal hypertensiony Esophageal bleeding: Treatment

y Sclerotherapy; Variceal band ligation;Sengstaken-Blakemore tube

y IV fluids; Blood products


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Cirrhosis

Complications

y Ascitesy Hepatorenal syndrome; Serum protein into

peritoneal cavity

y

Abdominal paracentesis: Procedu

re; Care; Dietand drug therapy

y Hepatic Encephalopathy: CNS manifestation ofliver failure: Coma and death; Increasedammonia levely CNS effects: Disorientation, confusion,

personality changes, and asterixis

y Treatment: Eliminating dietary protein;Removing residual protein; Depleting intestinalmicroorganisms


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Hepatitisy Pathophysiology and Etiology

y Liver inflammation after exposure to drugs or

chemicals, alcohol abu

se, or infectiony Viral infection: A, B, C, D, E, and G

y Hepatitis A: Oral-fecal route

y Hepatitis B, C, D: Chronic persistent; B and C

hepatocellu

lar carcinomay Other types: Autoimmune; Toxic; Drug induced


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Hepatitisy Assessment Findings: Signs and Symptomsy Associated with phases: Incubation; Preicteric,

prodromal, icteric, posticteric phases

y Assessment Findings: Diagnostic Findingsy Serology analysis; Liver biopsy

y Medical and Surgical Management

y Symptomatic treatment; Bed rest; IV fluid;

Vitamins and antiemeticsy Liver transplantation; Immunosuppressives

y Nursing Management


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Liver Tumorsy Abnormal mass of cells in the liver

y Benign or malignant

y Pathophysiology and Etiology: Common livermalignancymetastatic lesion from the breast,lung, or GI tracty Benign liver tumors: Tuberculosis; Fungal and

parasitic infections

y Assessment Findings: Jaundice; RUQ pain; Liverenlargement; Ascites

y Diagnostic Findings: Liver scan,ultrasonography, MRI, or CT scan; Biopsy


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Liver Tumorsy Medical and Surgical Management

y Hepatic lobectomy, cryosurgery, or cryoablation

y

IV chemotherapy or infu

sions directly intohepatic artery; Peritoneum drugs

y Chemotherapy radiation therapy


y

Ensu

re client safety and comfort; Su

pportventilation

y Medication administration

y Client and family teaching: Support, referrals


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Nursing Process

y Assessment

y

Diagnosisy lanning

y Implementation

y EvaluationofExpected utcomes


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Gallbladder Disordersy Cholelithiasis: Stones in the Gallbladder

y Choledocholithiasis: Stones located in thecommon bile duct

y Cholecystitis: Inflammation or infection of thegallbladder caused by formation of stones;Chronic or acute

y Pathophysiology and Etiology: Incidence

increases progressively with age: Women,middle age, multiple pregnancies, diabetes,and obesity; Bile stasis, dietary factors,infection; Gallstones impair passage of bile;Gallbladder inflamed; Distended with bile


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Gallbladder Disorders

y Assessment Findings: Signs and Symptoms

y Discomfort: Result of inflammation and contractilespasms; Digestion problems from reduced or absentbile; Swelling; Necrotic gallbladder

y Diagnostic Findings: Cholecystography; CT scan;Ultrasonography; Radionuclide imaging; PTCA;ERCP; MRC

y Medical, Surgical Management: NG tube;

Antibiotics; Parenteral fluids; Low-fat diet;Lithotripsy; Sphincterotomy; Laparoscopic, Opencholecystectomy



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Gallbladder Disorders


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Pancreatitis

y Inflammation of the Pancreas; Acute or chronic

y Acute Pancreatitis

y Mild form: Inflammation and edema of the

pancreas

y Severe form: Enzymatic digestion of the pancreas;Necrotic tissue, local and systemic complications

y Pathophysiology and Etiology

y Autodigestion; Swelling of pancreatic duct;Destruction of the pancreas


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Acute Pancreatitis


y Severe mid- to upper abdominal pain radiating tosides and back; Vomiting

y Frothy and foul-smelling stools; Sign ofsteatorrhea; Increased fat in the stool

y Physical examination

y Diagnostic Findings

y Elevated serum and urine amylase, lipase, andliver enzyme levels

y Elevated blood glucose levels and white bloodcell counts; Low serum electrolyte levels; CT scan;Endoscopic examination


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Acute Pancreatitisy Medical and Surgical Management

y Relieve pain; Reduce pancreatic secretions

y Restore fluid and electrolyte losses

y Treat systemic complicationsy Nasogastric tube administration

y Fluid therapy; IV albumin; Diuretics

y Atropine or other anticholinergics: Reduce the

activity of the vagus nervey IV antibiotic therapy: Prevent localized abscesses

or treat systemic sepsis

y Diet therapy; Surgical intervention


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Acute Pancreatitisy Nursing Management

y Monitor client for life-threatening changes;

Alcohol withdrawaly Perform the prescribed treatment measures: NG

tube, IV fluids

y Perform assessments

y

Report any su

dden changes to physician


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Chronic Pancreatitisy Pathophysiology and Etiology

y Causes: Alcohol, hereditary predisposition,

hyperparathyroidism, autoimmune pancreatitis,trauma, and anatomic abnormalities


y Digestive disturbances: Flatulence, vomiting,

diarrhea; Dark urine; Secondary diabetes; Light-colored stools; Weight loss

Diagnostic Findings: CT scans, MRI, ultrasound,and endoscopic retrograde study


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Chronic Pancreatitisy Medical and Surgical Management

y Treatments: Abstinence from alcohol, fat-free diet, andcorrection of associated biliary tract disease

y Drug therapy: Meperidine, narcotics, nonopioid methods, andpancrelipase

y Partial or total pancreatectomy

y Nursing Process

y Assessment;

y

Diagnosisy Planning;

y Implementation

y Evaluation of Expected Outcomes


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Pancreatic Cancery May occur in the glands head, body, or tail

y Pathophysiology and Etiology

y Accumulation of malignant cells

y Consequence of tumor development

y Factors that correlate with pancreatic cancer


y

Leftu

pper abdominal pain; Jau

ndice, anorexia,weight loss; Obstructive jaundice; Pruritus;Ascites

y Diagnostic Findings: Abdominalultrasonography; CT scan; Biopsy


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Pancreatic Cancery Medical and Surgical Management

y Radical pancreatoduodenectomy

y Removes head of the pancreas; Resects the duodenum

and stomach; Redirects flow of secretions fromstomach, gallbladder, and pancreas

y Cholecystojejunostomy: Rerouting of pancreaticand biliary drainage

y Inoperable tumors: Radiation therapy orchemotherapy with 5-fluorouracil



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Pancreatic Surgery

care of client with liver and pancreatic disorder

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