Nursing Care of Clients with Gallbladder, Liver and Pancreatic Disorders - PowerPoint PPT Presentation

Loading...

PPT – Nursing Care of Clients with Gallbladder, Liver and Pancreatic Disorders PowerPoint presentation | free to download - id: 6cdeab-OTIxZ



Loading


The Adobe Flash plugin is needed to view this content

Get the plugin now

View by Category
About This Presentation
Title:

Nursing Care of Clients with Gallbladder, Liver and Pancreatic Disorders

Description:

Nursing Care of Clients with Gallbladder, Liver and Pancreatic Disorders Chapter 27 Pancreatitis Acute- The pancreas is damaged or its duct to the duodenum is blocked ... – PowerPoint PPT presentation

Number of Views:76
Avg rating:3.0/5.0
Slides: 35
Provided by: BethA176
Learn more at: http://bakersfieldcollegevn75.yolasite.com
Category:

less

Write a Comment
User Comments (0)
Transcript and Presenter's Notes

Title: Nursing Care of Clients with Gallbladder, Liver and Pancreatic Disorders


1
Nursing Care of Clients with Gallbladder, Liver
and Pancreatic Disorders
  • Chapter 27

2
Liver, Gallbladder and Pancreas
3
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

4
Gallbladder Disorders
Cholelithiasis asymptomatic epigastric fullness
after fatty meal biliary colic jaundice
Acute cholecystitis RUQ pain - back a/n/v fever
with chills
5
Gallbladder Disorders
  • Treatment
  • laparoscopic cholecystectomy
  • Nursing Diagnoses
  • Pain
  • Imbalanced Nutrition
  • Risk for Infection

6
Liver
7
Hepatitis
8
(No Transcript)
9
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

10
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

11
Liver Disorders
  • Disease pattern
  • Onset
  • Transmission
  • Carrier
  • Prevent
  • Treatment

12
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.

13
Liver Disorders
  • Nursing Care
  • teaching
  • handwashing
  • blood and body fluid precautions
  • vaccines for persons at high risk

14
Advanced Cirrhosis
15
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,

16
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.

17
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

18
Liver Disorders
  • Complications
  • portal hypertension
  • splenomegaly
  • ascites
  • esophageal varices
  • hepatic encephalopathy
  • hepatorenal syndrome

19
Hepatitis
Nursing Care- Supportive care. Prevent
transmission of disease!! Teaching needs- If at
risk, need vaccine!!!!! Complications- Cirrhosis!
20
Pancreatitis
  • Pancreatitis
  • inflammation of pancreas characterized by release
    of pancreatic enzymes into pancreatic tissue
    itself leading to hemorrhage and necrosis
  • Risk factors
  • alcoholism, gallstones

21
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

22
Pancreatitis
23
Pancreatitis
  • Diagnostic tests
  • labs - amylase and lipase
  • Ultra sound, ERCP, C-T scan, needle bx
  • Treatment
  • NPO,hydration, pain control and antibiotics

24
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

25
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

26
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

27
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.

28
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

29
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

30
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

31
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

32
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

33
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?

34
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.
About PowerShow.com