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Chapter047

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  • 1. Timby/Smith: Introductory Medical-Surgical Nursing, 10/e Chapter 47: Caring for Clients with Disorders of the Liver, Gallbladder, or Pancreas Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • 2. The Liver • Functions – Metabolizes: Glucose, proteins, and fats; Drugs, chemicals, bacteria, and foreign elements – Converts glycogen to glucose – Regulates blood glucose – Stores vitamins; Forms and excretes bile and bilirubin – Synthesizes factors for blood coagulation Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • 3. The Liver Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • 4. The Liver Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • 5. Jaundice • Results from an abnormally high concentration of the pigment bilirubin in the blood • Visible, notably on the skin, oral mucous membranes, and (especially) sclera • Three forms of jaundice Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • 6. Cirrhosis • Degenerative liver disorder caused by generalized cellular damage • Pathophysiology and Etiology – Irreversibly damaged liver cells – Consequences of damaged liver cells • Affects digestion and metabolism • Fluid and electrolyte imbalances • Impaired ability to metabolize hormones and detoxify chemicals – Types: Laënnec’s, postnecrotic, and biliary Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • 7. Cirrhosis • Assessment Findings: Signs and Symptoms – Clinical manifestations: Compensated and decompensated – Chronic fatigue; Anorexia; Dyspepsia; Nausea; Clay-colored stools; Diarrhea – Constipation; Tea-colored urine; Weight loss; Abdominal discomfort – Shortness of breath; Nosebleeds; Signs of incomplete estrogen metabolism in men Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • 8. Cirrhosis • Diagnostic Findings – Liver biopsy, blood tests, CT, MRI, and radioisotope liver scan: Demonstrate liver’s enlarged size, nodular configuration, and distorted blood flow • Medical and Surgical Management – No specific cure; Prevents further deterioration; Vitamins and nutritional supplements; No alcohol; Advanced liver disease: Restrict protein intake; Lactulose administration – Ursodeoxycholic acid; Potassium-sparing antidiuretics; Sodium intake; Platelet transfusion; Liver transplantation Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • 9. Cirrhosis • Nursing Management – Monitor vital signs, weight, intake, output, and abdominal girth; Small meals – Client response to drug therapy: Change in mental status; Signs of GI bleed – Client teaching: Liver disorder; Support groups; Treatment regimen; Home care Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • 10. Cirrhosis Complications • Portal Hypertension – Blood backs up in portal system – Congestion; Pressure – Treatment: Sodium restriction; Drug therapy; Surgical and nonsurgical shunt • Esophageal Varices – Result of portal hypertension – Esophageal bleeding: Treatment – Sclerotherapy; Variceal band ligation; Sengstaken-Blakemore tube – IV fluids; Blood products Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • 11. Cirrhosis Complications • Ascites – Hepatorenal syndrome; Serum protein into peritoneal cavity – Abdominal paracentesis: Procedure; Care; Diet and drug therapy • Hepatic Encephalopathy: CNS manifestation of liver failure: Coma and death; Increased ammonia level – CNS effects: Disorientation, confusion, personality changes, and asterixis – Treatment: Eliminating dietary protein; Removing residual protein; Depleting intestinal microorganisms Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • 12. Hepatitis • Pathophysiology and Etiology – Liver inflammation after exposure to drugs or chemicals, alcohol abuse, or infection – Viral infection: A, B, C, D, E, and G – Hepatitis A: Oral-fecal route – Hepatitis B, C, D: Chronic persistent; B and C hepatocellular carcinoma – Other types: Autoimmune; Toxic; Drug induced Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • 13. Hepatitis • Assessment Findings: Signs and Symptoms – Associated with phases: Incubation; Preicteric, prodromal, icteric, posticteric phases • Assessment Findings: Diagnostic Findings – Serology analysis; Liver biopsy • Medical and Surgical Management – Symptomatic treatment; Bed rest; IV fluid; Vitamins and antiemetics – Liver transplantation; Immunosuppressives • Nursing Management Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • 14. Liver Tumors • Abnormal mass of cells in the liver • Benign or malignant • Pathophysiology and Etiology: Common liver malignancy—metastatic lesion from the breast, lung, or GI tract – Benign liver tumors: Tuberculosis; Fungal and parasitic infections • Assessment Findings: Jaundice; RUQ pain; Liver enlargement; Ascites • Diagnostic Findings: Liver scan, ultrasonography, MRI, or CT scan; Biopsy Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • 15. Liver Tumors • Medical and Surgical Management – Hepatic lobectomy, cryosurgery, or cryoablation – IV chemotherapy or infusions directly into hepatic artery; Peritoneum drugs – Chemotherapy radiation therapy • Nursing Management – Ensure client safety and comfort; Support ventilation – Medication administration – Client and family teaching: Support, referrals Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • 16. Nursing Process • Assessment • Diagnosis • Planning • Implementation • Evaluation of Expected Outcomes Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • 17. Gallbladder Disorders • Cholelithiasis: Stones in the Gallbladder – Choledocholithiasis: Stones located in the common bile duct • Cholecystitis: Inflammation or infection of the gallbladder caused by formation of stones; Chronic or acute • 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 Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • 18. Gallbladder Disorders • Assessment Findings: Signs and Symptoms – Discomfort: Result of inflammation and contractile spasms; Digestion problems from reduced or absent bile; Swelling; Necrotic gallbladder • Diagnostic Findings: Cholecystography; CT scan; Ultrasonography; Radionuclide imaging; PTCA; ERCP; MRC • Medical, Surgical Management: NG tube; Antibiotics; Parenteral fluids; Low-fat diet; Lithotripsy; Sphincterotomy; Laparoscopic, Open cholecystectomy • Nursing Management Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • 19. Gallbladder Disorders Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • 20. Pancreatitis • Inflammation of the Pancreas; Acute or chronic • Acute Pancreatitis – Mild form: Inflammation and edema of the pancreas – Severe form: Enzymatic digestion of the pancreas; Necrotic tissue, local and systemic complications • Pathophysiology and Etiology – Autodigestion; Swelling of pancreatic duct; Destruction of the pancreas Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • 21. Acute Pancreatitis • Assessment Findings: Signs and Symptoms – Severe mid- to upper abdominal pain radiating to sides and back; Vomiting – Frothy and foul-smelling stools; Sign of steatorrhea; Increased fat in the stool – Physical examination • Diagnostic Findings – Elevated serum and urine amylase, lipase, and liver enzyme levels – Elevated blood glucose levels and white blood cell counts; Low serum electrolyte levels; CT scan; Endoscopic examination Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • 22. Acute Pancreatitis • Medical and Surgical Management – Relieve pain; Reduce pancreatic secretions – Restore fluid and electrolyte losses – Treat systemic complications – Nasogastric tube administration – Fluid therapy; IV albumin; Diuretics – Atropine or other anticholinergics: Reduce the activity of the vagus nerve – IV antibiotic therapy: Prevent localized abscesses or treat systemic sepsis – Diet therapy; Surgical intervention Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • 23. Acute Pancreatitis • Nursing Management – Monitor client for life-threatening changes; Alcohol withdrawal – Perform the prescribed treatment measures: NG tube, IV fluids – Perform assessments – Report any sudden changes to physician Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • 24. Chronic Pancreatitis • Pathophysiology and Etiology – Causes: Alcohol, hereditary predisposition, hyperparathyroidism, autoimmune pancreatitis, trauma, and anatomic abnormalities • Assessment Findings: Signs and Symptoms – Digestive disturbances: Flatulence, vomiting, diarrhea; Dark urine; Secondary diabetes; Light-colored stools; Weight loss • Diagnostic Findings: CT scans, MRI, ultrasound, and endoscopic retrograde study Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • 25. Chronic Pancreatitis • Medical and Surgical Management – Treatments: Abstinence from alcohol, fat-free diet, and correction of associated biliary tract disease – Drug therapy: Meperidine, narcotics, nonopioid methods, and pancrelipase – Partial or total pancreatectomy • Nursing Process – Assessment; Diagnosis – Planning; Implem – entation – Evaluation of Expected Outcomes Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • 26. Pancreatic Cancer • May occur in the gland’s head, body, or tail • Pathophysiology and Etiology – Accumulation of malignant cells – Consequence of tumor development – Factors that correlate with pancreatic cancer • Assessment Findings: Signs and Symptoms – Left upper abdominal pain; Jaundice, anorexia, weight loss; Obstructive jaundice; Pruritus; Ascites • Diagnostic Findings: Abdominal ultrasonography; CT scan; Biopsy Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • 27. Pancreatic Cancer • Medical and Surgical Management – Radical pancreatoduodenectomy • Removes head of the pancreas; Resects the duodenum and stomach; Redirects flow of secretions from stomach, gallbladder, and pancreas – Cholecystojejunostomy: Rerouting of pancreatic and biliary drainage – Inoperable tumors: Radiation therapy or chemotherapy with 5-fluorouracil • Nursing Management Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • 28. Pancreatic Surgery Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • 29. End of Presentation Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins