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

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Liver, Gallbladder and Pancreas
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Gallbladder Disorders

• Cholelithiasis- Formation of stones
• Cholecystitis-Inflammation of the
• gallbladder
• Pathorisk- age, hx, gender, OC
• gallstones form due to
• abnormal bile composition
• biliary statis
• inflammation of gallbladder

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Gallbladder Disorders
Cholelithiasis asymptomatic epigastric fullness
after fatty meal biliary colic jaundice
Acute cholecystitis RUQ pain - back a/n/v fever
with chills
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Gallbladder Disorders

• Treatment
• laparoscopic cholecystectomy
• Nursing Diagnoses
• Pain
• Imbalanced Nutrition
• Risk for Infection

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Liver
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Hepatitis
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Liver 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

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Liver 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

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Liver Disorders

• Disease pattern
• Onset
• Transmission
• Carrier
• Prevent
• Treatment

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Hepatitis

• 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.

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Liver Disorders

• 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

• 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 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.

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Cirrhosis of the Liver

• As the liver is destroyed its 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

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Liver Disorders

• Complications
• portal hypertension
• splenomegaly
• ascites
• esophageal varices
• hepatic encephalopathy
• hepatorenal syndrome

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Hepatitis
Nursing Care- Supportive care. Prevent
transmission of disease!! Teaching needs- If at
risk, need vaccine!!!!! Complications- Cirrhosis!
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Pancreatitis

• Pancreatitis
• inflammation of pancreas characterized by release
  of pancreatic enzymes into pancreatic tissue
  itself leading to hemorrhage and necrosis
• Risk factors
• alcoholism, gallstones

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Pancreatitis

• 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

• Diagnostic tests
• labs - amylase and lipase
• Ultra sound, ERCP, C-T scan, needle bx
• Treatment
• NPO,hydration, pain control and antibiotics

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Pancreatitis

• 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

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Pancreatic Cancer

• 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

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NCLEX

• 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

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NCLEX

• 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 clients door stating
  blood precautions.

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NCLEX

• 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

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NCLEX

• 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

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NCLEX

• 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

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NCLEX

• 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

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NCLEX

• 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. turners sign
• C .cullens sign
• D. steatorrhea

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Ammonia Levels and liver failure

• 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 whos
  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?

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Pancreatitis

• 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.