Transcript hepatitic disorders -Hart sp 16 lecture

Treatment of Hepatitis
Acute and Chronic
 Well-balanced diet
 Vitamin supplements
 Rest (degree of strictness varies)
 Avoidance of alcohol intake and drugs
detoxified by the liver
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Nursing Implementation
 Acute interventions
 Rest
 Jaundice/ pruritus
 Small, frequent meals
 Ambulatory and home care
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Dietary teaching (avoid ETOH) (low fat, high CHO)
Assessment for complications
Regular follow-up for 1 year after diagnosis
Medication teaching
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Collaborative Care: Drug therapy
 No specific drug therapies (acute hepatitis)
 Supportive therapy
 Antiemetics
 Watch for drugs metabolized by liver
 Vitamins
 Milk Thistle (Silymarin)
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Drug therapies: Chronic HBV & HCV
 Anti-virals: Interferon
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↓ viral load
↓ liver enzyme levels
↓ rate of disease progression
 Side effects
Flu-like SX
 Anemia, anorexia
 Depression, insomnia
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Prevention/Health Promotion
 Hepatitis A
 Hepatitis B and C
 Hand washing! Food
 Screen donated blood
Washing
 Use disposable needles
 Proper personal hygiene
 Hand washing
 Immunization: HAV
 Safe sex
vaccine (2 shots,
 Avoid sharing
immunity in 30 days)
toothbrushes/razors
 Immune Globulin
 Immunization: HBV
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1-2 weeks post exposure
Table 44-8: preventative
measures for Hepatitis
vaccine (3 doses, 1st @
birth/complete by 18m/o)
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Evaluation: Expected outcomes
 Adequate nutritional intake
 Increased tolerance for activity
 Verbalization of understanding of
follow-up care
 Able to explain to others methods of
transmission and methods of preventing
transmission
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Major Functions (pg 870/Table 39-4)
Review
 Metabolic
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CHO, Protein, and Fat metabolism
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Albumin, clotting factors
Detoxification – Ammonia (NH3) to Urea
 Management of Bilirubin (Production/Excretion)
 Liver cells destroyed – scar tissue forms – alters
blood flow in liver – BP in GI system elevates
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Liver dysfunction
 Early S/SX of liver DX
 Pain, Fever, Anorexia (N/V)
 Fatigue
 Physical exam may reveal hepatomegaly,
lymphadenopathy, and splenomegaly.
Complications:
 Progressive S/SX
- Fulminant/acute hepatic
failure
 Jaundice
- Chronic hepatitis
 Ascites, anasarca
- Cirrhosis
 Skin Lesions/bruising
- carcinomas
refer to Patho Map – figure 44-5 pg 1018/Text
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Liver Dysfunction
 Bleeding
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Inability to make clotting factors
Development of collateral circulation r/t portal
hypertension
 Increased serum Ammonia
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Inability to convert NH3, from metabolism of
protein,to urea
 Third spacing – ascites
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Inability make plasma protein (albumin)
 Other: altered drug metabolism, electrolyte
imbalances, etc
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Nursing Assessment (table 44-14)
 Past health history
Chronic alcoholism
 Viral hepatitis
 Chronic biliary
disease
 Medications
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 Physical examination
 Weight loss
 Jaundice
 Abdominal distention
 Nausea/vomiting
 Altered
mentation/asterixis
 RUQ pain
 Abnormal laboratory
values
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Complications of liver failure
 Portal hypertension
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Esophageal and gastric varices
 Peripheral edema and ascites (table 44-9)
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Portal HTN, Hypoalbuminemia, hyperaldosteronism
 Hepatic encephalopathy (table 44-10)
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Protein metabolism dysfunction produces elevated
ammonia levels (conversion of ammonia to urea)
 Hepatorenal syndrome
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Kidney failure related poor circulating blood volume
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Esophageal Varices
 No special assessment findings – obvious GI
bleed,
low H & H, occult
Sengstaken-Blakemore
Tubeblood
 Goal: Avoid bleeding/hemorrhage
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Avoid alcohol, aspirin, irritating foods, straining.
 Supportive measures for acute bleeds
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Next slide
 Treatment Measures
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Endoscopic sclerotherapy, Endoscopic ligation
Balloon tamponade (Blakemore tube) – old TX
 Shunting procedures (TIPS) (portacaval shunt)
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Treatment for acute UGI bleed
 Support ABCs, fluid resuscitation
 Drug therapy may include
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Octreotide (Sandostatin)
Vasopressin (VP, Terlipressin)
 Fresh frozen plasma, Packed RBCs
 Vitamin K
 Histamine blockers, Proton pump inhibitors
 Lactulose & Neomycin – prevents hepatic
encephalopathy from increased RBC
breakdown/ammonia
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Treatment of Ascites
 High-carbohydrate, low-Na+ diet (2 g/day)
 Diuretics, albumin infusion
 Paracentesis
 Peritoneovenous shunt
Continuous reinfusion of
ascitic fluid from abdomen to
vena cava
 Complications : Thrombosis, infection,
fluid overload
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Paracentesis
 Patient Positioning – sitting upright, HOB ↑
 Empty bladder
 Complications:
Persistent leak from the puncture site, bruising
 Hypotension after a large-volume paracentesis
 Perforation of bowel, infection, Major blood
vessel laceration
 Post procedure
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Position on right side to splint puncture site
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Hepatic encephalopathy
 S/SX: altered mentation, asterixis (liver
flap), fetor hepaticus,
NH3 (ammonia)
 Goal: Decrease ammonia formation
 May reduce protein in diet
 Sterilization of GI tract with antibiotics (e.g.,
neomycin)
 Lactulose (Cephulac) traps NH3 in gut.
 Cathartics/enemas
 Treatment of precipitating cause
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Generalized Collaborative Care
 Rest, avoid further liver damage
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Avoidance of alcohol, aspirin, acetaminophen,
and NSAIDs
Monitor LFTs, electrolytes
 Management of ascites
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Accurate I/O, Daily weights, Abdominal girth,
extremities measurement
Nursing care r/t paracentesis
 Prevention and management of esophageal
variceal bleeding
 Management of encephalopathy
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Nutritional Treatment
 High in calories (3000 kcal/day)
↑ carbohydrate
 Moderate to low fat
 Protein restriction depends on degree of
hepatic encephalopathy
 Low-sodium diet for patient with ascites and
edema
 Between-meal nourishment, Explanation of
dietary restrictions
 Administration of B-complex vitamins, vitamin K
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Nursing Evaluation
 Maintenance of food/fluid intake to meet
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needs
Maintenance of muscle tone and energy
Maintenance of skin integrity
Normalization of fluid balance
Maintenance of blood pressure and urinary
output
Reports increased ease of breathing
Experiences normal respiratory rate/rhythm
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