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Nursing Care of Patients with Liver, Pancreatic, and Gallbladder Disorders

This chapter covers the nursing care for patients with liver, pancreatic, and gallbladder disorders, including hepatitis, acute liver failure, cirrhosis, liver transplant, cancer of the liver, acute pancreatitis, and chronic pancreatitis. It discusses the etiology, signs and symptoms, diagnostic tests, therapeutic interventions, complications, and nursing diagnoses for each condition.

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Nursing Care of Patients with Liver, Pancreatic, and Gallbladder Disorders

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  1. Chapter 35 Nursing Care of Patients with Liver, Pancreatic, and Gallbladder Disorders

  2. Hepatitis • Inflammation of the Cells of the Liver, Usually Caused by a Virus • Types of Hepatitis • HAV • HBV • HCV • HDV • HEV • HGV

  3. Prevention of Hepatitis • Hand Hygiene • Vaccines • HAV • HBV • Standard Precautions • Immune Globulin

  4. Signs and Symptoms • Prodromal Stage: 1 Week • Flu-like Symptoms, RUQ Pain • Icteric Stage: 2 to 6 Weeks • Jaundice, Worsening Symptoms • Convalescent: 2 to 6 Weeks • Returning to Normal Liver Function

  5. Complications • Liver Failure • Acute • Chronic • Chronic Infection • Carrier • Risk of Liver Cancer

  6. Diagnostic Tests • Liver Enzymes • Serum Bilirubin • Prothrombin • Serologic Tests • Liver Biopsy

  7. Therapeutic Interventions • Rest • Nutrition • Interferon Therapy • Antivirals • Avoidance of Alcohol and Liver-toxic Drugs

  8. Nursing Diagnoses • Pain • Imbalanced Nutrition • Risk for Impaired Skin Integrity • Risk for Ineffective Self-Health Management

  9. Acute Liver Failure • Pathophysiology • Sudden Massive Loss of Liver Tissue • Etiology • Drug Toxicity • Hepatitis

  10. Signs and Symptoms • Jaundice • Encephalopathy • Confusion • Coma • Bleeding

  11. Diagnostic Tests • ALT • AST • SerumBilirubin • PT • Potassium • BloodGlucose

  12. Therapeutic Interventions • Bedrest • Eliminate all Drugs • Possible Dialysis • High-calorie, Low-sodium, and Protein Diet • Lactulose, Neomycin, Magnesium Citrate, Sorbitol • Transplant

  13. Cirrhosis • Progressive, Irreversible Replacement of Healthy Liver Tissue with Scar Tissue • 12th Leading Cause of Death

  14. Cirrhosis (cont’d) • Etiology • Chronic Alcohol Use – Most Common • Hepatotoxins • Hepatitis • Gallbladder Obstruction • Heart Failure

  15. Pathophysiology • Inflammation of Liver Cells • Infiltration with Fat and WBC • Fibrotic Scar Tissue Replaces Liver Tissue • Abnormal Regeneration • Impaired Liver Blood Flow • Impaired Liver Function

  16. Signs and Symptoms

  17. Complications of Cirrhosis • Clotting Defects • Portal Hypertension • Varices • Ascites • Encephalopathy • Hepatorenal Syndrome

  18. Portal Hypertension

  19. Diagnostic Tests • LiverEnzymes • Bilirubin • SerumAmmonia • Prothrombin • AbdominalX-Ray • Ultrasound • Esophagastroscopy • LiverBiopsy

  20. Therapeutic Interventions • Ascites • Diuretics • SodiumRestriction • Paracentesis • AlbuminInfusion • TIPS

  21. Therapeutic Interventions (cont’d) • Esophageal Varices Vasoconstrictors • Banding • Sclerotherapy • Vitamin K • Antibiotics

  22. Therapeutic Interventions (cont’d) • Encephalopathy • Lactulose • Neomycin • Restrict Dietary Protein • Dialysis

  23. Nursing Diagnoses: Acute and Cirrhosis • Excess Fluid Volume • Imbalanced Nutrition • Pain • Risk for Disturbed Thought Processes • Risk for Ineffective Breathing Pattern • Risk for Deficient Fluid Volume • Risk for Infection

  24. Patient Education • Disease Process • Signs and Symptoms to Report • Adequate Rest • Diet • Avoid Narcotics, Sedatives, Tranquilizers, Alcohol • Follow-up Care

  25. Liver Transplant • Candidates • Liver Failure • No Cancer • No Complications • Otherwise Stable

  26. Anti-Rejection Meds • Cyclosporine (Cyclosporin A) • Tacrolimus (Protopic) • Azathioprine (Imuran) • Prednisone (Deltasone) • Mycophenolate mofetil (Cellcept)

  27. Signs of Rejection • Pulse >100 bpm • Temperature >101°F • RUQ Pain • Increase in Jaundice • Decrease in Bile from T-tube • Elevated Liver Enzymes

  28. Cancer of the Liver • Usually Metastasized from Another Site • Risk Factors • Chronic Hepatitis B • Nutritional Deficiencies • Exposure to Hepatotoxins

  29. Signs and Symptoms • Encephalopathy • Bleeding • Jaundice • Ascites

  30. Diagnosis • Serum Alkaline Phosphatase • Abdominal X-Ray • Liver Scan • Ultrasound • Biopsy

  31. Therapeutic Interventions • Surgery • Chemotherapy

  32. Acute Pancreatitis • Pathophysiology • Inflammation • Autodigestion • Elevated Enzymes • Fluid Loss • Complications • Shock • DIC • Chronic Pancreatitis

  33. Etiology • Alcohol • Biliary Disease • Trauma • Certain Drugs

  34. Signs and Symptoms • Abdominal Pain • Guarding • Rigid Abdomen • Hypotension or Shock • Respiratory Distress • Low-grade Fever • Nausea and Vomiting • Jaundice

  35. Complications • Cardiovascular Failure • Acute Respiratory Distress Syndrome • Acute Renal Injury • Hemorrhage • Infection

  36. Diagnostic Tests • Serum Amylase • Serum Lipase • X-Ray • CT Scan • Ultrasound

  37. Therapeutic Interventions • NPO • IV Fluids/TPN, Nutrition • NG Suction • Analgesics, Anti-anxiety Agents • Oxygen • Blood Products PRN

  38. Chronic Pancreatitis • Pathophysiology • Progressive Fibrosis • Obstructed Ducts • Ulceration • Etiology • Alcohol • Biliary Disease

  39. Prevention • Alcohol Abstinence • Biliary Disease Treatment • Nutritional Intake Monitoring

  40. Signs and Symptoms • Remissions and Exacerbations • LUQ Pain • Anorexia and Weight Loss • Malabsorption • Diabetes Mellitus

  41. Diagnosis • Pancreatic Enzymes Normal • High Fecal Fat Level • Changes on CT Scan

  42. Therapeutic Interventions • Analgesics • Pancreatic Enzyme Replacement • Surgery

  43. Nursing Diagnoses: Acute and Chronic Pancreatitis • Pain • Imbalanced Nutrition • Risk for Ineffective Breathing Pattern • Risk for Injury

  44. Cancer of the Pancreas • Ductal Adenocarcinoma of Exocrine Pancreas • Risk Factors • High-fat Diet • Smoking • Diabetes Mellitus • Alcohol • Chronic Pancreatitis

  45. Signs and Symptoms • Weight Loss • Abdominal Pain Radiates to Back • Anorexia • Nausea and Vomiting • Weakness • Jaundice

  46. Diagnostic Tests • Serum Amylase/Lipase • Alkaline Phosphatase • Bilirubin • Coagulation Studies • CEA • CT, ERCP • Biopsy

  47. Therapeutic Interventions • Surgery • Pancreatectomy • Whipple Procedure • Stent to Relieve Biliary Obstruction • Chemotherapy • Radiation

  48. Whipple Procedure

  49. Nursing Diagnoses • Pain • Imbalanced Nutrition • Risk for Deficient Fluid Volume • Risk for Impaired Skin Integrity

  50. Patient Education • Management of Hyperglycemia • Pancreatic Enzyme Replacement • Dressing/Drain Care • Complications to Report • Hospice Referral

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