Chapter 27 care of clients with gallbladder liver and pancreatic disorders fall 2011 dunn.ppt

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Transcript of Chapter 27 care of clients with gallbladder liver and pancreatic disorders fall 2011 dunn.ppt

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    Nursing Care of Clients with

    Gallbladder, Liver andPancreatic Disorders

    Chapter 27

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    Liver, Gallbladder and Pancreas

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    Gallbladder Disorders

    Cholelithiasis- Formation of stonesCholecystitis-Inflammation of the

    gallbladderPatho&risk- age, hx, gender, OC

    gallstones form due to abnormal bile composition biliary statis inflammation of gallbladder

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    Gallbladder Disorders

    Cholelithiasis

    asymptomatic

    epigastricfullness afterfatty meal

    biliary colic

    jaundice

    Acute cholecystitis

    RUQ pain - back

    a/n/v

    fever with chills

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    Gallbladder Disorders

    4 Treatment laparoscopic cholecystectomy

    4 Nursing Diagnoses Pain Imbalanced Nutrition

    Risk for Infection

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    Liver

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    Hepatitis

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    Liver Disorders

    4 Hepatitis inflammation of the liver due to virus, ETOH,

    drugs, toxins, may be acute or chronic4 Viral Hepatitis4 Hepatitis A - infectious hepatitis

    fecal-oral route benign, self-limiting

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    Liver Disorders

    4 Hepatitis B transmission - infected blood and body fluids

    at risk - healthcare workers, drug users, multiplesexual partners, hemodialysis clients

    4 Hepatitis C transmission - infected blood and body fluids manifestations - mild, non-specific world wide cause of chronic hepatitis

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    Liver Disorders

    4 Disease pattern Onset

    Transmission Carrier Prevent

    Treatment

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    Hepatitis

    Course of acute viral hepatitis follows three phases:

    Preicteric- abruptly before jaundiceIcteric- after 5-10 days of exposureConvalescent- well being improves, energy

    increases, jaundice resolves.See book.

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    Liver Disorders

    4 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

    4 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 replacedwith fibrous scar tissue, thus metobolic functions of the liverare 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 inthe portal venous system, thus leading to many problemsincluding esophageal varices.

    Discussion see book.

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    Cirrhosis of the Liver

    As the liver is destroyed its ability to metabolize proteins isimpaired!!! Ammonia and toxic wastes accumulate in the

    blood, these substances affect the CNS!!!

    Hepatic Encephalopathy is the result of accumulatedammonia and toxic wastes(protein). CM are altered levels ofconsciousness, cognition and motor function.Asterixis or liver flap is an early CM of hepatic

    encephalopathy. This is a muscle tremor that causesinvoluntary jerking movements that make it difficult to keepthe extremities still

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    Hepatitis

    Nursing Care-Supportive care.Prevent

    transmission ofdisease!!

    Teaching needs-If at risk, need

    vaccine!!!!!Complications-Cirrhosis!

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    Pancreatitis

    4 Pancreatitis inflammation of pancreas characterized by

    release of pancreatic enzymes into pancreatictissue itself leading to hemorrhage and necrosis4 Risk factors

    alcoholism, gallstones

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    Pancreatitis

    4 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

    4 Diagnostic tests

    labs - amylase and lipase Ultra sound, ERCP, C-T

    scan, needle bx4 Treatment

    NPO,hydration, paincontrol and antibiotics

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    Pancreatitis

    Can be acute or chronicAcute- middle life from gallstones and alcoholism which arethe primary risk factors

    Chronic- Alcoholism is the primary risk factor.Pancreatic duct obstruction by a gallstone or spasm of thesphincter of oddi can obstruct the outflow of pancreaticenzymes then auto digestion begins.

    See text

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    Pancreatic Cancer

    4 Very lethal4 Risk factors

    smoking, chemical or environmental toxins4 Manifestations

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

    4 Treatment surgery - Whipple, radiation and chemotherapy

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    NCLEX

    A client diagnosed with cholelithiasis requestsmedication for pain relief. Which of the

    following medications is the provider mostlikely 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 thenursing 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 transmittedD. Place a sign on the clients door stating blood precautions.

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    NCLEX

    A client is diagnosed with hepatitis B. Whichof the following information, if obtained

    during the admission assessment wouldindicate a risk factor?A. She ate in a dirty restaurant 2 weeks ago

    B. She uses barrier protection during sexC. She is an intravenous drug userD. She has never received a blood transfusion

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    NCLEX

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

    A. Assess intake and output

    B. Assess cardiovascular status and fluid volume statusC. Assess bowel sounds and fecal outputD. Assess mental status

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