Cirrhosis

Cards (30)

  • What are the risk factors for cirrhosis?
    • alcoholism #1
    • Hepatitis #2
    • Non-alcoholic fatty liver disease (NAFLD)
    • Non-alcoholic steatohepatitis
    • Drug Toxicity ~ esp acetaminophen
  • What is the dose limit and antidote for acetaminophen?
    4 grams/day
    Antidote: N-acetylcysteine within 8 hours
  • What type of labs will you see increased in cirrhosis?
    • bilirubin
    • ammonia
    • coagulation times [INR, PT, PTT]
    • liver enzymes [AST, ALT]
  • When do labs suggest alcoholic liver disease for cirrhosis?
    AST is 2x greater than ALT
  • If ALT is higher in labs for a person in cirrhosis what does this suggest?
    non-alcoholic liver disease
  • What labs are decreased in cirrhosis?
    • Potassium
    • platelets
    • H&H
    • Albumin
    • BUN
    • glucose
    • Magnesium
  • What are the main symptoms presented in cirrhosis?
    • Ascites
    • Esophageal Varices
    • Hepatic Encephalopathy
    • Vitamin Deficiency
    • Jaundice
  • What are the symptoms the characterize ascites?
    • large, firm, abdomen
    • generalized edema
    • possible respiratory distress
  • What are esophageal varices?
    Thin-walled veins that are prone to rupture
    • risk factors to rupture = coughing, vomiting, straining, gastric reflux
  • What can the rupture of esophageal varices result in?
    hemorrhage
    • Turn pt to side ---> suction & protect airway
  • What are the symptoms presented in hepatic encephalopathy?
    • mental status changes
    • constructional apraxia ~ can't produce simple drawing/write legibly
    • Asterixis ~ "liver flap" twitching of extremities
    • Fector hepaticus = sweet fecal odor to breath
  • How does vitamin deficiency manifest in clients with cirrhosis?
    • decreased fat-soluble vitamins especially K will manifest into bleeding Sx
    • Decreased stores of vitamin B = paresthesia
    • Anemia
  • What does hepato-renal syndrome signify?
    signifies end-stage disease with death within 6 months of onset
  • What are symptoms of hepato-renal syndrome?
    edema, oliguria, azotemia
  • What is azotemia?
    high lvls of urea and creatinine in blood
  • What are the potential complications that the nurse should manage with a client with cirrhosis?
    • Fluid volume excess
    • Risk for injury d/t bleeding
    • Disturbed thought process r/t ammonia accumulation
  • How does the nurse manage fluid volume excess in a patient with cirrhosis?
    • Monitor Fluid balance: I & O, daily weights, edema, lung sounds
    • Measure abdominal girth QD
    • 2 g Na restriction & aldosterone restriction = 1st line Tx w/ or w/o lasix
    • Administer diuretics
    • Administer plasma proteins = Albumin
    • Assist with paracentesis
  • What are some diuretics given with the patient experiencing fluid volume excess in cirrhosis?
    Spironolactone & Furosemide combo
    • Aldactone preferred = blocks aldosterone which liver cannot detoxify
    • Not restricted fluids unless Na < 120
    • Monitor potassium closely ! = Aldactone is K sparing --> if pt has hepato-renal syndrome, potassium could rise
  • How does the nurse manage the client experiencing risk for injury r/t bleeding in a patient with cirrhosis?
    Bleeding precautions:
    • minimize high risk situations = coughing, vomiting,
    • avoid injections and invasive procedures
    • apply pressure to puncture sites for at least 5 min or draw from med lock
    • fall precautions
    • Administer prevention and treatment meds
    • Monitor INR & platelets; bodily fluids & VS for bleeding
  • How does the nurse manage the client experiencing disturbed thought process r/t ammonia accumulation?
    • Monitor ammonia lvls, mental status changes, presence of asterixis
    • Safety precautions: fall risk, infection control
    • treat infection
    • decrease dietary protein = 1 - 1.5 g/day; carb load (vegetables)
    • Medications: lactulose, antibiotics, rifaximin (Xifacin)
    • Avoid sedative drugs
  • A patient with cirrhosis presents with confusion, lethargy, fatigue and twitching of extremities. The nurse suspect hepatic encephalopathy d/t high ammonia lvls from morning blood draw. What type of medications should the nurse expect to see in her orders?
    • Lactulose = changes gut microbiome to decrease intestinal ammonia production
    • reduces colon pH = slows passage of ammonia to blood
    • causes pt to poop = less absoprtion
    • Antibiotics destroy intestinal bacteria which act on protein in feces to produce ammonia
    • Possible rifaximin (Xifacin) = add if not responsive to lactulose
  • What can the nurse do to prepare a patient pre-operatively for a paracentesis?
    • obtain consent
    • Ask pt to void
    • position in semi/high fowler's
  • What are some post-op nursing care given for the client who just finished a paracentesis?
    Monitor VS & Site
    • use site closer to mid-abdomen
    • observe color of the aspirate; should be clear light yellow
    • if cloudy consider spontaneous bacterial empyema
    • if removing > 8 L= administer albumin to reduce risk of hypovolemia shock
    • change positions slowly & check VS
    • in diuretic sensitive ascites > 5 L remove then manage by low Na
    • if diuretic refractory, take as much as possible
  • What are nursing care in the complications of paracentesis?
    • Monitor site for leakage, bleeding as site is portal for infection/peritonitis
    • could insert pleur-x drain for home management of chronic ascites
  • What is the nursing care for post-procedure: endoscopic banding?

    • monitor for return of swallow/gag reflex
    • neuro status
    • All Tx is temporary; varices will recur unless cirrhosis resolves
    • banding w/ beta-blockers = best Tx to reduce re-bleed
  • What is TIPS - Transjugular Intrahepatic Portsystemic Shunt?
    A shunt used to treat portal hypertension
  • What is some nursing care for a patient who had a TIPS procedure?
    • Monitor jugular site for bleeding
    • Monitor for encephalopathy
    • Patient Education
    • pt not good as surgical candidates d/t bleeding tendencies and poor protein stores
  • How does the nurse manage VTE prevention in a patient with cirrhosis?
    • Prevention: H2RA or PPI; stool softener, non-specific beta-blockers such as propranolol
    • Tx: Vitamin K, vasoconstriction such as octreotide or vasopressin, antibiotics
  • What does Octreotide (Sandostatin) do in the treatment plan of cirrhosis?
    VTE Prevention = decrease splanchnic and hepatic blood flow & portal pressure [more effective and fewer SE than pressin]
  • How does pressin help in VTE prevention of cirrhosis?
    • Pressin is gen vasoconstrictor that clamps down on varices 
    • S: mesenteric and cardiac ischemia so give concurrently w/ NGT