Nursing care of clients with gallbladder liver and pancreatic disorders
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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

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Liver gallbladder and pancreas
Liver, Gallbladder and Pancreas Pancreatic Disorders


Gallbladder disorders
Gallbladder Disorders Pancreatic Disorders

Cholelithiasis- Formation of stones

Cholecystitis-Inflammation of the

gallbladder

Patho&risk- age, hx, gender, OC

  • gallstones form due to

    • abnormal bile composition

    • biliary statis

    • inflammation of gallbladder


Gallbladder disorders1
Gallbladder Disorders Pancreatic Disorders

Cholelithiasis

asymptomatic

epigastric fullness after fatty meal

biliary colic

jaundice

Acute cholecystitis

RUQ pain - back

a/n/v

fever with chills


Gallbladder disorders2
Gallbladder Disorders Pancreatic Disorders

  • Treatment

    • laparoscopic cholecystectomy

  • Nursing Diagnoses

    • Pain

    • Imbalanced Nutrition

    • Risk for Infection


Liver
Liver Pancreatic Disorders


Hepatitis
Hepatitis Pancreatic Disorders


Liver disorders
Liver Disorders Pancreatic Disorders

  • Hepatitis

    • inflammation of the liver due to virus, ETOH, drugs, toxins, may be acute or chronic

  • Viral Hepatitis

  • Hepatitis A - infectious hepatitis

    • fecal-oral route

    • benign, self-limiting


Liver disorders1
Liver Disorders Pancreatic Disorders

  • Hepatitis B

    • transmission - infected blood and body fluids

      • at risk - healthcare workers, drug users, multiple sexual partners, hemodialysis clients

  • Hepatitis C

    • transmission - infected blood and body fluids

    • manifestations - mild, non-specific

    • world wide cause of chronic hepatitis


Liver disorders2
Liver Disorders Pancreatic Disorders

  • Disease pattern

    • Onset

    • Transmission

    • Carrier

    • Prevent

    • Treatment


Hepatitis1
Hepatitis Pancreatic Disorders

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.

See book.


Liver disorders3
Liver Disorders Pancreatic Disorders

  • Nursing Care

    • teaching

      • handwashing

      • blood and body fluid precautions

      • vaccines for persons at high risk


Advanced cirrhosis
Advanced Cirrhosis Pancreatic Disorders


Liver disorders4
Liver Disorders Pancreatic Disorders

  • 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,


Cirrhosis of the liver
Cirrhosis of the Liver Pancreatic Disorders

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.


Cirrhosis of the liver1
Cirrhosis of the Liver Pancreatic Disorders

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


Liver disorders5
Liver Disorders Pancreatic Disorders

  • Complications

    • portal hypertension

    • splenomegaly

    • ascites

    • esophageal varices

    • hepatic encephalopathy

    • hepatorenal syndrome


Hepatitis2
Hepatitis Pancreatic Disorders

Nursing Care- Supportive care. Prevent transmission of disease!!

Teaching needs- If at risk, need vaccine!!!!!

Complications- Cirrhosis!


Pancreatitis
Pancreatitis Pancreatic Disorders

  • Pancreatitis

    • inflammation of pancreas characterized by release of pancreatic enzymes into pancreatic tissue itself leading to hemorrhage and necrosis

  • Risk factors

    • alcoholism, gallstones


Pancreatitis1
Pancreatitis Pancreatic Disorders

  • 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


Pancreatitis2
Pancreatitis Pancreatic Disorders


Pancreatitis3
Pancreatitis Pancreatic Disorders

  • Diagnostic tests

    • labs - amylase and lipase

    • Ultra sound, ERCP, C-T scan, needle bx

  • Treatment

    • NPO,hydration, pain control and antibiotics


Pancreatitis4
Pancreatitis Pancreatic Disorders

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.

See text


Pancreatic cancer
Pancreatic Cancer Pancreatic Disorders

  • Very lethal

  • Risk factors

    • smoking, chemical or environmental toxins

  • Manifestations

    • non-specific, a/n, wt. loss, dull epigastric pain

  • Treatment

    • surgery - Whipple, radiation and chemotherapy


Nclex
NCLEX Pancreatic Disorders

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


Nclex1
NCLEX Pancreatic Disorders

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.”


Nclex2
NCLEX Pancreatic Disorders

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


Nclex3
NCLEX Pancreatic Disorders

The nurse is caring for a client with acute pancreatitis. Which nursing assessment should receive the highest priority?

  • Assess intake and output

  • Assess cardiovascular status and fluid volume status

  • Assess bowel sounds and fecal output

  • Assess mental status


Nclex4
NCLEX Pancreatic Disorders

A client with cirrhosis is scheduled for discharge. The nurse recognized the need for further teaching if the client states

  • I will use a soft toothbrush for oral hygiene

  • I will maintain a low-protein diet

  • I will report increased difficulty breathing to my provider

  • I will limit alcohol intake to two servings per day


Nclex5
NCLEX Pancreatic Disorders

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?

  • Increased urine output

  • Reduced serum ammonia levels

  • Reduced steatorrhea

  • Increased serum potassium levels


Nclex6
NCLEX Pancreatic Disorders

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:

  • A. an obstructed gallbladder

  • B. turner’s sign

  • C .cullen’s sign

  • D. steatorrhea


Ammonia levels and liver failure
Ammonia Levels and liver failure Pancreatic Disorders

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?


Pancreatitis5
Pancreatitis Pancreatic Disorders

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.