Aneurysm Tyeris

7/27/2019 Aneurysm Tyeris

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Liver Cirrhosis

Nikko G. MelencionAheh


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Introduct ion Cirrhosis is a complication of many liver diseases that is

characterized by abnormal structure and function of the liver.The diseases that lead to cirrhosis do so because they injure

and kill liver cells, and the inflammation and repair that is

associated with the dying liver cells causes scar tissue to

form. The liver cells that do not die multiply in an attempt toreplace the cells that have died.

This results in clusters of newly-formed liver cells

(regenerative nodules) within the scar tissue. There are many

causes of cirrhosis; they include chemicals (such as alcohol,fat, and certain medications), viruses, toxic metals (such as

iron and copper that accumulate in the liver as a result of

genetic diseases), and autoimmune liver disease in which the

body's immune system attacks the liver.


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SYMPTOMS Loss of appetite

Lack of energy (fatigue), which may be debilitating

Weight loss or sudden weight gain

Bruises

Yellowing of skin or the whites of eyes (jaundice) Itchy skin

Fluid retention (edema) and swelling in the ankles, legs,and abdomen (often an early sign)

A brownish or orange tint to the urine

Light colored stools Confusion, disorientation, personality changes

Blood in the stool

Fever


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RISK FACTORS Alcohilism

Malnutrition

Infection Drug Fibrosis

Scarring


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PATIENTS DATA

NAME: X

GENDER: Female

Birth Place: Atimonan,QuezonAge:81 yrs.old

Chief Complain: Edematous for 1 month with

difficulty of breathingAdmitting Diagnosis:Dr. Daquilanea


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PHYSICAL ASSESSMENT

HEAD

symmetric

proportionate to body size

HAIR

Black in color thin and fine.

EYES

White sclera

dark brown pupil

FACE

normal lining of the nose

EYES AND EARS

pinkish lips and not dry


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CHEST/THORAX

w/ respiratory distress

ABDOMEN Non-tender abdomen

no signs of abnormal sounds upon auscultation

not bloated SKIN

skin is warm to touch

no rashes or dryness noted

CARDIOVASCULAR SYSTEM heart rate within abnormal range


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Lower extremities

Knees, leg, feet and toe

With lesions With active range of motion

MUSCULO SKELETAL SYSTE

joint and muscle are not in pain


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LABORATORYRESULTS


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TEST RESULT REFERENCE

WBC Count 10.3x10 4-10x10

DIFFERENTIAL COUNT

Neutrophils .84 .55-.65

Lymphocytes .13 .25-35

Monocytes .01 .01-.03

Eusinophlls .02 .02-.04

RBC Count 3.88x10 4.0-5.4x10

Hemoglobin 102 120-160g/lHematocrit .35vol% .36-.46vol%

COMPLETE BLOOD COUNT


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TEST RESULT REFERENCE

FBS 219 70-105

Cholesterol 232.2 60

LDL 151.38


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ANATOMY ANDPHYSIOLOGY ANATOMY AND PHYSIOLOGY

The liver is the largest internal organ in the body, and weighs about 3 pounds in an adult. The

liver is located in the right upper quadrant of the abdomen, just below the diaphragm. A thick

capsule of connective tissue called Glisson's capsule covers the entire surface of the liver. The

liver is divided into a large right lobe and a smaller left lobe. The falciform ligament divides

the two lobes of the liver. Each lobe is further divided into lobules that are approximately 2

mm high and 1mm in circumference. These hepatic lobules are the functioning units of theliver. Each of the approximately 1 million lobules consists of a hexagonal row of hepatic cells

called hepatocytes. The hepatocytes secrete bile into the bile channels and also perform a

variety of metabolic functions. Between each row of hepatocytes are small cavities called

sinusoids. Each sinusoid is lined with Kupffer cells, phagocytic cells that remove amino acids,

nutrients, sugar, old red blood cells, bacteria and debris from the blood that flows through the

sinusoids. The main functions of the sinusoids are to destroy old or defective red blood cells,to remove bacteria and foreign particles from the blood, and to detoxify toxins and other

harmful substances. Approximately 1500 ml of blood enters the liver each minute, making it

one of the most vascular organs in the body. Seventy-five percent of the blood flowing to the

liver comes through the portal vein; the remaining 25% is oxygenated blood that is carried by

the hepatic artery.


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Functions of the Liver:

Bile production and excretion

Excretion of bilirubin, cholesterol, hormones, and drugs

Metabolism of fats, proteins, and carbohydrates

Enzyme activation

Storage of glycogen, vitamins, and minerals

Synthesis of plasma proteins, such as albumin and globulin, and clottingfactors

Blood detoxification and purification

A. liver B. hepatic vein C. hepatic artery D. portal vein E. common bileduct F. stomach G. cystic duct Gallbladder


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PATHOPHYSIOLOGY


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Predisposing Factors:

-Heredity

-Metabolic Disorders

(Iron overload, Glycogen,

Storage disease, Wilsons

diseases)

-Underlying condition (

hepatitis, fatty liver, liver

tumor, etc. )

-Females are more pronethan males but reports

have higher cases in

males

-Highly civilized

countries

Precipitating Factors:

-Alcoholic ( long term

ingestion of at least

80g/day of ethanol)

Female 20g/day

-Poor diet

-Diet high in fat/ low in

protein

-Obesity

Predisposing Factors:

-Heredity

-Metabolic Disorders (Iron

overload, Glycogen,

Storage disease, Wilsons

diseases)

-Underlying condition (

hepatitis, fatty liver, liver

tumor, etc. )-Females are more prone

than males but reports have

higher cases in males

-Highly civilized countries

Precipitating Factors:

-Alcoholic ( long term

ingestion of at least

80g/day of ethanol)

Female 20g/day

-Poor diet

-Diet high in fat/ low inprotein

-Obesity


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Increased liver synthesis of triglycerides and fatty acids, reduction in oxidation of the

fatty acids, and decreased release of lipoprotrein

Fat accumulation in the parenchymal cells of liver and distention of cytoplasm with

fats

Liver Steatosis/ Fatty liver

Hepatocytes degenerate and become infiltrated with leukocytes and lymphocytes,

now called as Mallorys bodies or alcoholic hyalin

Mallory bodies may result to fibrosis of its surrounding cells and veins

Inflammation of the Liver


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Alcoholic hyalin leads to a hardened hyalin by which nechrosis may occur

Progressive hepatocytes destruction leads to early scar formation and further damage

to liver parenchyma

Liver capsule become firm and formation of regenerative nodules happenns

ALCOHOLIC CIRRHOSIS


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DOCTORS ORDER


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Doctors Order Medical Intervention Nursing

Responsibility

Sept. 25 2013 Please admit to female

ward

>Client was admitted

for further care and

management.

Admisson of patient

Route TPR >This serves as basis

for initial v/s

>Assess and get pt.s

initiial v/s

Low Salt Low FatDiet

>To decreased thecholesterol

>to inform thedietrician and SO

CBC,

Urinalysis,BUN,Creati

nine

>Baseline lab test for

diagnosis

>Obtain request

form,specimen and

refer to the lab for the

test.

0.9 PNNS 1L to drop

30 ghs

>useful for daily

maintenance of body

fluids and nutrtion

and for rehydration.

>to regulate IVF as

desired.


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Sept. 26, 2013 Hydrochlorothizide heart failure in pt.

who cannot to

elevate ACE

inhibitors

>To administer initial

dose and note iin

med sheet.

Digoxin

Increased Digoxin 0.2

mg 1 tab am

Continue meds tab

pm

>to continue

treatment regimen

>to continue the

right meds

Sept. 27, 2013 For Ultrasound whole

abdomen 0.9 PNSS 1Lto KVO


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NURSING CAREPLAN


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ASSESSMENT DIAGNOSIS PLANNING INTERVENTION RATIONALE EVALUATION

Objective:

>Tachycardia

>Shortness

of breath

>Cool,clammyskin

>Increased blo

od pressure

>BP=150/90.

mmHg

Hypertension After 8 hrs

of nursinginte

rventions, blo

od pressure

will bewithinset parameter

s for theclient

1. monitor VS

atleast q 1-2

hrs and prn.

2. encourage

patienttodecrease

intake

of caffeine,

cola

andchocolates.

3. administer vao

activedrugsand

titrate

asordered to

maintain press

ures at

set parameters

for patient.

4. observe

for complaints

of blurred

vision,tinnitus

or confusion.

1. Tomonitor bas

eline data.

2. caffeine is

acardiac

stimulantandmay

adverselyaffec

t

cardiacfunctio

n.

3. these frugs

haverapidaction andmay

decrease

the blood

pressure

toorapidly,

resulting

incomplication

s

4. may

indicatecyanid

e toxicityfrom

increasingintra

cranial pressure

After 8 hrs

of nursinginte

rventions, blo

od pressure

maintainedwithin

set parameter

s for

theclient.Goal

was met


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5. monitor I&Ostatus

6. Observe extremities

for swelling,

erythema,tenderness and

pain.Observefor decreased

peripheral pulses, pallor,

coldness and cyanosis

7. instruct client in signs/

symptoms to report to

physician such asheadache upon rising,

increased blood pressure,

chest pain shortness of

breath,increased heart

rate

5. I&O will give anindication

offluic balance

or imbalance thus

allowing for changes

intreatment regimenwhenrequired

6. Bedrest promotesvenous

statis whichcan increase

the risk of

thromboembolus

formation. If treatment istoo rapid and aggressivein

decreasing the blood

pressire,tissue perfusion

will be impaired

andischemia can result

7. promote sknowledge andcompliance with

treatment.

Promotes prompt

detection and

facilitates prompt

intervention


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>weakness

>Abnormal

heart rate or

BP response

to activityExertional

>discomfort

or dyspnea

Activity

Intolerance

related to

generalized

weakness

After 8

hours of

nursing

intervention

the clientwill able to

move her

body or

extremities

1. Assess the

patients

response to

activity, noting

pulse rate morethan 20

beats/min faster

than resting

rate; marked

increase in BP

during/afteractivity (systolic

pressure

increase of 40

mm Hg or

diastolic

pressure

increase of 20mm Hg);

dyspnea or chest

pain; excessive

fatigue and

weakness;

diaphoresis;

dizziness.

1. The stated

parameters

are helpful

in

assessingphysiologic

al

responses

to the

stress of

activityand, if

present,

are

indicators

of

overexertio

n.

After 8 hours

of nursing

intervention

the client w

sable to moveher body or

extremities.


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2. Establish guidelines

and goals of activity

with the clients and

caregiver.

3. Anticipate the

clients need.

4. Encourageverbalization of

feelings regarding

limitations.

2. Motivation is

enhanced if the client

participates in goal

setting. Depending on

the etiological factors

of activity intolerance,

some clients may be

able to live

independently and

work outside the

home. Other clientswith chronic

debilitating disease

may remain.

3. This reduces risk for

falling while reaching.

4. Acknowledgment thatliving with activity

intolerance is both

physically and

emotionally difficult

aids coping.


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5. Encourage active

ROM exercises. If

further

reconditioning isneeded, confer with

rehabilitation

personnel.

6. Teach ROM and

strengthening

exercises.

7. Change position

often.

5. Exercise

maintains muscle

strength.

6. Exercisepromotes

increased venous

return, prevents

contractures, and

maintain /

increases muscle

strength

7. This distributes

work to different

muscles to avoid

fatigue.


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Objecive:

- NGT

Feeding

- Impaired

Swallowing- Glasgow

Coma Scale

of 2/13

- Severe body

weakness

Risk for

Aspiration

related to

impaired

swallowingsecondary

to

nasogastric

tube

feeding

After 8 hours

of nursing

intervention

my patient

had reducedrisk for

aspiration as

evidenced by:

>patent

nasogastric

tubing

>toleratenasogastric

tube feeding

>patent

airway

>active gag

reflex

1. Monitor

level of

consciousne

ss.

2. Assesscough and

gag reflexes.

3. Auscultate

bowel

sounds to

evaluate

bowelmotility and

assess for

abdominal

distention

and

firmness

4. Assess

pulmonary

status for

clinical

evidence of

aspiration.

1. decreased level of

consciousness is a

prime risk factor

for aspiration.

2. A depressedcough or gag

reflex increases

the risk for

aspiration

3. Decreased

gastrointestinal

motility increasesthe risk of

aspiration because

food or fluids

accumulate in the

stomach.

4. Aspiration of

small amounts can

occur without

coughing,

especially in

patients with a

decreased level of

consciousness

After 8

hours span

of care,

patient hadreduced

risk for

aspiration

as

evidenced

by:>patent

nasogastric

tubing

>tolerate

nasogastric

tubefeeding

>patent

airway


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5. Keep suction setup

available and use as

needed.

6. Position patient

with a decreasedlevel of

consciousness on

their side.

7. Provide oral care

after meals.

8. Instruct watchers on

signs and symptoms

of aspiration.

5. This is necessary to

maintain a patent

airway.

6. This decreases the

risk for aspiration bypromoting drainage

of secretions away

from the airway.

7. This removes

residual food that

can be aspirated at alater time

8. Aids in appropriate

assessment of high-

risk situation and

determination of

when to call forfurther evaluation.

ASSESSMENT DIAGNOSIS PLANNI NG INTERVENTIIION RATIONALE EVALUATION


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ASSESSMENT DIAGNOSIS PLANNI NG INTERVENTIIION RATIONALE EVALUATION

>Speech

abnormalities

>changes in

pupillary

reactions;>extremity

weakness or

paralysis;

>altered

mental

status;

>difficult in

swallowing;

>changes in

motor

response;

>behavioral

changes

Alteration in

tissue

perfusion

(cerebral)

related tointerruption in

cerebral blood

flow.

After 8 hours

of nursing

interventon

the patients

interruptionin blood flow

decrease.

1. Note

customarybas

eline data

2. Review result

of diagnosticstudy

3. Note history

of syncope,br

ief/intermitte

ntperiods

of confusion

4. Instruct in

bloodpressur

emonitoring

athome,

advicepurcha

se of

homemonitoringequipment

refer

tocommunity

resources

asindicated

1. providecom

parison

withcurrent

findings

2. Todeterminel

ocation/sev

erity

of condition

3. Suggestive

of transient

ischemicatt

ack

4. Facilitatema

nagement

of hyperten

sion,which

is amajor risk

factor

for damage

bloodvessel

s/organfunc

tion

After 8 hours

of nursing

interventon

the patients

interruptionin blood flow

decreased.


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6. Elevate HOB

7. Administer med

ication

8. Assist with

monitor hypoth

ermia therapy

9. Recommend

with physicalrehabilitation

therapy

6. To promote

circulation/

venous drainage

7. To promote

pharmacologic

regimen

8. Which may be

used todecreases

metabolic and

O2needs.

9. To have contact

with other

healthcareprovider


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DRUG STUDY

THERAPEUTIC ACTION CONTRAINDIC TOXIC/SIDE INTERVENTIIO SAFE DOSE


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THERAPEUTIC

EFFECT

ACTION CONTRAINDIC

ATION

TOXIC/SIDE

EFFECT

INTERVENTIIO

N

SAFE DOSE

Cefazolin

Anti-biotic

Cephalosporin

Anti-infectives

Susceptible

bacterial

infections

includingsepticemia,

respiratory,

biliary or GU

tract, skin and

skin structure,

bone and

joint,

endocarditis.

Surgical

prophylaxis.

Hypersensitiv

ity to

cephalospori

ns

CNS:

Seizures (high

doses)

GI:Pseudomembran

ous colitis,

diarrhea,

nausea,

vomiting,

cramps

GU:

Interstitial

nephritis

DERM:

Rashes, urticaria

HEMAT:

Blood dyscrasias,hemolytic

anemia

LOCAL:

Pain at IM site,

phlebitis at IV

site

> Assess

patient for

infection at

beginningand during

therapy.

>observe

patient for

signs and

symptoms of

anaphylaxis

>Monitor site

for

thrombophle

bitis . Change

sites every

48-72 hr to

prevent

phlebitis.

Pneumococcal

pneumonia:

500mg every

12 hours. Mildinfections:

250500mg

every 8 hours;

moderate to

severe

infections:

500mg1g

every 68

hours. Severe,

life-

threatening

infections (eg,

endocarditis,septicemia): 1

1.5g every 6

hours; max

12g/day. UTIs:

1g every 12

hours.


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THERAPEUTIC

EFFECT

ACTION CONTRAINDICA

TION

TOXIC/SIDE

EFFECTS

INTERVENTION SAFE DOSE

Furosemide

Loop

diuretic

Inhibits there

absorption of

sodium and

chloride from the

loop of henle and

distal renal

tubule.

Hypersensitivity nausea

andvomiting,hea

dache,dizziness,

fatigue,diarrhea,

dyspepsia,abdo

minal

pain,anorexia

BLACK BOX

WARNING:

Profound

diuresis with

water and

electrolyte

depletion can

occur; careful

medical

supervision is

required.

Administer

with food or

milk to

prevent GIupset.

Reduce

dosage if

given with

other

antihypertensives; readjust

20,40,80, mg OD

THERAPEUTIC ACTION CONTRAINDICAT TOXIC/SIDE EFFECT INTERVENTION SAFE DOSE


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THERAPEUTIC

EFFECT

ACTION CONTRAINDICAT

ION

TOXIC/SIDE EFFECT INTERVENTION SAFE DOSE

CAPTOPRIL

Anti-hypertensive

ACE inhibitors

Blocks ACE from

converting

angiotensin I to

angiotensin II, a

powerfulvasoconstrictor,

leading to

decreased blood

pressure,

decreased

aldosterone

secretion, a

small increase in

serum

potassium

levels,

and sodium and

fluid loss;

increased

prostaglandinsynthesis also

may be involved

in the

antihypertensiv

e

action.

Contraindicat

ed with

allergy to

captopril,history of

angiodema.

Use

cautiously

with

impairedrenal

function;

CHF; salt or

volume

depletion,

lactation,pregnancy.

CV:Tachy

cardia, angina

pectoris, MI,

Dermatologic: Rash,dermatitis,

photosensitivity,

alopecia

GI: Gastric

irritation, aphthous

ulcers, peptic

ulcers, jaundice,

injury, anorexia,

constipation

GU: Proteinuri

a, renal

insufficiency, renal

failure

Hematologic: hemolytic anemia,

pancytopeniaOther:

Cough, malaise, dry

mouth,

Administer 1

hr before or 2

hr after

meals.

>montor for drop

of BP

>reduce dosage

in patients with

impaired renalfunction

Tab:

12.5 mg

25mg

50mg

100mg


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THERAPEUTIC

EFFECT

ACTION CONTRAINDICATI

ON

TOXIC/SIDE

EFFECTS


Digoxin

Cardiac Drugs

Management of

supra ventricular

arrythimias

particularly atrialfibrillation and

heart failure

Hypertonic

obstructive

cardionyopathy

Nausea,

Vommiting,

anorexia, head

ache, facial pain,fatique,

weakness,dizzine

s,drowsiness,

These drugs may

generally be

taken without

regard to mealstaking your

medication after

a high fiber meal

reduces the

amount of drug

absorbed into

your blood

500mg tab

THERAPEUTIC ACTION CONTRAINDICATI TOXIC/SIDE INTERVENTION SAFE DOSE


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THERAPEUTIC

EFFECT

ACTION CONTRAINDICATI

ON

TOXIC/SIDE

EFFECTS


Hydrochlorothizid

e

Angiotensin

Heart failure in

pt. who cannot to

elevate ACE

INHIBITORS anddiabetic

nephropathy

Pregnancy Dizziness, head

ache,fatique,back

pain,infection

Good with or

without food

Dosage:

50mg 1 tab OD


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M Medication -Furosemide 1 amp slow IV Push OD

-Captopril 1 tab OD

-Hydrochlorothiazide 25 mg-Digoxin 0.2 mg

-Cefazoline 500 mg

E Environment -Ensure safety precautions outside and inside of the

house

-Keep patient away from materials or equipments that

may harm her.

-Remove everything that may cause injury.

T Treatment -Follow up check-up after 1 week .

H Healh teaching -Provide adequate knowledge regarding Liver Cirrhosis

-Encourage SO to give medication at home on the rght

time and right dose-Instructed SO to be with the patient anytime.

Instruct the patient to report any deterioration in

neurological status to the physician

-Avoid drinking of alcohol

O Ob ti P ti t till it h i

DICHARGE PLANNING

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Aneurysm Tyeris