Nursing Care of Clients with Gallbladder, Liver and Pancreatic Disorders. Chapter 27. Liver, Gallbladder and Pancreas. Gallbladder Disorders. Cholelithiasis- Formation of stones Cholecystitis-Inflammation of the gallbladder Patho&risk- age, hx, gender, OC gallstones form due to
Cholelithiasis- Formation of stones
Cholecystitis-Inflammation of the
Patho&risk- age, hx, gender, OC
epigastric fullness after fatty meal
RUQ pain - back
fever with chills
Course of acute viral hepatitis follows three phases:
Preicteric- abruptly before jaundice
Icteric- after 5-10 days of exposure
Convalescent- well being improves, energy increases, jaundice resolves.
Functional liver tissue is gradually destroyed and replaced with fibrous scar tissue, thus metobolic functions of the liver are 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 in the portal venous system, thus leading to many problems including esophageal varices.
Discussion see book.
As the liver is destroyed it’s ability to metabolize proteins is impaired!!! Ammonia and toxic wastes accumulate in the blood, these substances affect the CNS!!!
Hepatic Encephalopathy is the result of accumulated ammonia and toxic wastes(protein). CM are altered levels of consciousness, cognition and motor function.
Asterixis or liver flap is an early CM of hepatic encephalopathy. This is a muscle tremor that causes involuntary jerking movements that make it difficult to keep the extremities still
Nursing Care- Supportive care. Prevent transmission of disease!!
Teaching needs- If at risk, need vaccine!!!!!
Can be acute or chronic
Acute- middle life from gallstones and alcoholism which are the primary risk factors
Chronic- Alcoholism is the primary risk factor.
Pancreatic duct obstruction by a gallstone or spasm of the sphincter of oddi can obstruct the outflow of pancreatic enzymes then auto digestion begins.
A client diagnosed with cholelithiasis requests medication for pain relief. Which of the following medications is the provider most likely to prescribe?
A. Acetaminophen (Tylenol) D. ibuprofen
B. Meperidine (Demerol) (Motrin)
C. Morphine Sulfate
A client who was diagnosed with hepatitis A state he was told by the nursing 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 transmitted
D. Place a sign on the client’s door stating “blood precautions.”
A client is diagnosed with hepatitis B. Which of the following information, if obtained during the admission assessment would indicate a risk factor?
A. She ate in a dirty restaurant 2 weeks ago
B. She uses barrier protection during sex
C. She is an intravenous drug user
D. She has never received a blood transfusion
The nurse is caring for a client with acute pancreatitis. Which nursing assessment should receive the highest priority?
A client with cirrhosis is scheduled for discharge. The nurse recognized the need for further teaching if the client states
A 45 –year old client with liver disease is prescribed lactulose (Chronulac) 30 ML every 6 hours. Recognizing the action of this medication in the treatment of liver disease, the nurse would expect to assess which positive response to the medication?
A patient tells the nurse that his bowel movements are weird in that they look soapy and smell really bad. The nurse realizes that this client might be experiencing:
Ammonia levels are elevated because of inability of the liver to metabolize protein products. The medication Lactulose increases the absorption of ammonia from the bowel, thus reducing blood ammonia levels.
What do we see clinically in a patient who’s blood ammonia levels 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?
Acute- The pancreas is damaged or its duct to the duodenum is blocked, allowing pancreatic enzymes to accumulate within the pancreas.
Pancreatic duct obstruction by a gallstone or spasm of the sphincter of Oddi which is associated with alcohol use can obstruct the outflow of pancreatic enzymes. This creates autodigestion. Steatorrhea- Fatty stool. Alcoholism is the primary risk factor for chronic pancreatitis in the US.
Labs of importance:
Serum amylase and lipase will be elevated during pancreatitis.