Download - Chapter 27 care of clients with gallbladder liver and pancreatic disorders fall 2011 dunn.ppt
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Nursing Care of Clients with
Gallbladder, Liver andPancreatic Disorders
Chapter 27
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Liver, Gallbladder and Pancreas
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Gallbladder Disorders
Cholelithiasis- Formation of stonesCholecystitis-Inflammation of the
gallbladderPatho&risk- age, hx, gender, OC
gallstones form due to abnormal bile composition biliary statis inflammation of gallbladder
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Gallbladder Disorders
Cholelithiasis
asymptomatic
epigastricfullness afterfatty meal
biliary colic
jaundice
Acute cholecystitis
RUQ pain - back
a/n/v
fever with chills
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Gallbladder Disorders
4 Treatment laparoscopic cholecystectomy
4 Nursing Diagnoses Pain Imbalanced Nutrition
Risk for Infection
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Liver
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Hepatitis
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Liver Disorders
4 Hepatitis inflammation of the liver due to virus, ETOH,
drugs, toxins, may be acute or chronic4 Viral Hepatitis4 Hepatitis A - infectious hepatitis
fecal-oral route benign, self-limiting
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Liver Disorders
4 Hepatitis B transmission - infected blood and body fluids
at risk - healthcare workers, drug users, multiplesexual partners, hemodialysis clients
4 Hepatitis C transmission - infected blood and body fluids manifestations - mild, non-specific world wide cause of chronic hepatitis
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Liver Disorders
4 Disease pattern Onset
Transmission Carrier Prevent
Treatment
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Hepatitis
Course of acute viral hepatitis follows three phases:
Preicteric- abruptly before jaundiceIcteric- after 5-10 days of exposureConvalescent- well being improves, energy
increases, jaundice resolves.See book.
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Liver Disorders
4 Nursing Care teaching
handwashing blood and body fluid precautions
vaccines for persons at high risk
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Advanced Cirrhosis
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Liver Disorders
4 Cirrhosis end state of chronic liver disease, progressive
and irreversible alcoholic cirrhosis, biliary, or secondary to hepatitis
Manifestations liver enlg. Tender, wt loss, weakness, anorexia ascites, jaundice, edema, anemia,
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Cirrhosis of the Liver
Functional liver tissue is gradually destroyed and replacedwith fibrous scar tissue, thus metobolic functions of the liverare lost. The scar tissue forms constrictive bands in the liver
and disrupts blood and bile flow within the liver.Impaired blood flow through the liver increases pressure inthe portal venous system, thus leading to many problemsincluding esophageal varices.
Discussion see book.
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Cirrhosis of the Liver
As the liver is destroyed its ability to metabolize proteins isimpaired!!! Ammonia and toxic wastes accumulate in the
blood, these substances affect the CNS!!!
Hepatic Encephalopathy is the result of accumulatedammonia and toxic wastes(protein). CM are altered levels ofconsciousness, cognition and motor function.Asterixis or liver flap is an early CM of hepatic
encephalopathy. This is a muscle tremor that causesinvoluntary jerking movements that make it difficult to keepthe extremities still
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Hepatitis
Nursing Care-Supportive care.Prevent
transmission ofdisease!!
Teaching needs-If at risk, need
vaccine!!!!!Complications-Cirrhosis!
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Pancreatitis
4 Pancreatitis inflammation of pancreas characterized by
release of pancreatic enzymes into pancreatictissue itself leading to hemorrhage and necrosis4 Risk factors
alcoholism, gallstones
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Pancreatitis
4 Manifestations abrupt onset of severe epigastric/abdominal
pain relieved by leaning forward, sitting up initiated by fatty meal or alcohol intake
n/v abd. distention and rigidity, decreased b.s. fever, 24 hours later jaundice
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Pancreatitis
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Pancreatitis
4 Diagnostic tests
labs - amylase and lipase Ultra sound, ERCP, C-T
scan, needle bx4 Treatment
NPO,hydration, paincontrol and antibiotics
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Pancreatitis
Can be acute or chronicAcute- middle life from gallstones and alcoholism which arethe primary risk factors
Chronic- Alcoholism is the primary risk factor.Pancreatic duct obstruction by a gallstone or spasm of thesphincter of oddi can obstruct the outflow of pancreaticenzymes then auto digestion begins.
See text
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Pancreatic Cancer
4 Very lethal4 Risk factors
smoking, chemical or environmental toxins4 Manifestations
non-specific, a/n, wt. loss, dull epigastric pain
4 Treatment surgery - Whipple, radiation and chemotherapy
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NCLEX
A client diagnosed with cholelithiasis requestsmedication for pain relief. Which of the
following medications is the provider mostlikely to prescribe?A. Acetaminophen (Tylenol) D. ibuprofen
B. Meperidine (Demerol) (Motrin)C. Morphine Sulfate
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NCLEX
A client who was diagnosed with hepatitis A state he was told by thenursing assistant that his disease could be transmitted only through
blood contact. The appropriate action by the nurse would be to:A. Provide the correct information to the client and nursing assistant.B. Take no further action because the information is correct.C. Remove all precautions because hepatitis A cannot be transmittedD. Place a sign on the clients door stating blood precautions.
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NCLEX
A client is diagnosed with hepatitis B. Whichof the following information, if obtained
during the admission assessment wouldindicate a risk factor?A. She ate in a dirty restaurant 2 weeks ago
B. She uses barrier protection during sexC. She is an intravenous drug userD. She has never received a blood transfusion
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NCLEX
The nurse is caring for a client with acute pancreatitis. Whichnursing assessment should receive the highest priority?
A. Assess intake and output
B. Assess cardiovascular status and fluid volume statusC. Assess bowel sounds and fecal outputD. Assess mental status
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NCLEX
A client with cirrhosis is scheduled for discharge. The nurserecognized the need for further teaching if the client states
A. I will use a soft toothbrush for oral hygiene
B. I will maintain a low-protein dietC. I will report increased difficulty breathing to my providerD. I will limit alcohol intake to two servings per day
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NCLEX
A 45 year old client with liver disease is prescribed lactulose(Chronulac) 30 ML every 6 hours. Recognizing the actionof this medication in the treatment of liver disease, the
nurse would expect to assess which positive response tothe medication?A. Increased urine outputB. Reduced serum ammonia levels
C. Reduced steatorrheaD. Increased serum potassium levels
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NCLEX
A patient tells the nurse that his bowel movements are weirdin that they look soapy and smell really bad. The nurserealizes that this client might be experiencing:
A. A. an obstructed gallbladderB. B. turners sign C. C .cullens signD. D. steatorrhea
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Ammonia Levels and liver failure
Ammonia levels are elevated because of inability of the liverto metabolize protein products. The medication Lactuloseincreases the absorption of ammonia from the bowel, thus
reducing blood ammonia levels.
What do we see clinically in a patient whos blood ammonialevels are too high from liver cirrhosis?
What is Asterixix?What type of diet should the patient with cirrhosis of the liver
and hepatic encephalopathy be prescribed?
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