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Nursing Care of the Pediatric Patient with Liver Disease and Transplant. Presented by Patti Winford R.N., B.S.N. Objectives. At the end of this program students will be able to: Name five functions of the Liver Name two functions of the Small Bowel
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Nursing Care of the Pediatric Patient with Liver Disease and Transplant Presented by Patti Winford R.N., B.S.N.
Objectives At the end of this program students will be able to: • Name five functions of the Liver • Name two functions of the Small Bowel • Identify pertinent assessment criteria of the liver transplant patient • Analyze pertinent lab values • Recognize assessment factors needing intervention
Liver Functions • Filters blood of waste • Production of clotting factors • Production of Proteins, Albumin, Fats, and Cholesterol • Removes Ammonia from body • Produces and secretes bile • Excretes bilirubin • Breakdown of glycogen into glucose http://ourworld.compuserve.com/homepages/sbrillanti/liver2.jpg
Small Bowel Function The small bowel has digestive functions which include: • Breakdown of carbohydrates, proteins and fats • Absorption of nutrients, water and electrolytes into the bloodstream
Nursing Assessment • Complete head to toe nursing assessment should be completed Q4H and PRN • Vital signs with oxygen saturation and pain assessment. • Documentation of all access lines and medical equipment: PICC and peripheral IV sites, ostomies, NG, NJ, G-tubes, wound vacs, dressings, etc. • Chart a description of patient so that others reading your charting can visualize what this patient looks like.
HEENT • Jaundiced Sclera • Enlarged lymph nodes - WBC - Bilirubin
Neurological • Altered mental status Headache – Drowsiness Blurred vision – Tremors Confusion – Irritability • Glucose level • Prograf level • Steroids • Ammonia level
Cardiovascular • Unstable Blood pressure: Hypertension or Hypotension • Hemorrhage • Coagulopathy - CBC - Coags - Type/Screen - Potassium level http://health.howstuffworks.com/heart-pictures7.htm
Respiratory • Ascites • Atelectasis • Pneumonia - Blood gas - WBC - Hgb / Hct - Renal / Ep1 http://health.howstuffworks.com/lung.htm
Gastrointestinal • Ascites • Malnutrition • Weight loss • Emesis • Rejection - LFT - Ca, Mg, Phos, Albumin - Prograf level - TPN Profile
Genitourinary • E’lyte imbalances • Renal dysfunction - Strict I/O - Daily weights - UOP should be > 1ml/kg/hr - Ostomy outputs
Musculoskeletal • Provide a safe environment - side rails of cribs, choking hazards • Incorporate play and OT / PT
Integumentary • Jaundice – itching • Skin breakdown • Breakdown around stoma bags and diaper areas • Infection • Risk for infection at GT, PICC and CVC sites • Strict hand washing • Isolation precautions
A4N • Check all VS – age specific • Notify primary nurse of any abnormal values • Strict I/O • Accurate and complete documentation • Prograf given on time as ordered • Enjoy your patient, Play with them
Conclusion • Questions • Case study References A4N Nursing Unit Information Packet for Nurses, A systems approach to nursing care of pediatric transplant patients Keating, S. B. (2006). Curriculum development and evaluation in nursing Philadelphia: Lippincott Williams & Wilkins Marieb, E. N. (2001). Human anatomy & physiology 5th edition Benjamin Cummings