explain the management of patients with the hepatic disorder
Discuss the nursing management of patients with hepatic disorders
1) Explain/define the jaundice.
=> Jaundice is also called icterus.
=> Jaundice is not any disease but it is seen as a sign of disease after many diseases.
=> Jaundice is such a condition that when the amount of bilirubin (bilirubin) in the body increases, the skin, mucous membrane, sclera of the body becomes yellow coloration, it is called jaundice.
=> Jaundice is seen when the amount of bilirubin in the body increases above 2.5 mg/dl, the condition of jaundice is seen.
(Note:=normal bilirubin level is 0.3 to 1.0 mg/dl.)
(In jaundice := level of bilirubin is exceeded 2.5 mg/dl)
{direct/unconjugated/fat soluble bilirubin level is 0.1 -0.3 mg/dl.}
{ indirect/conjugated / water soluble bilirubin level is 0.2-0.8mg/dl.}
=> Bilirubin is a natural product that is released as a byproduct due to the breakdown of red blood cells and is excreted out of the body by the liver.
=> The condition of jaundice arises when the amount of conjugated bilirubin is not excreted from the body by the liver using the biliary system.
=> And billirubin accumulates in the body due to which the condition of jaundice arises.
2) Explain the type of jaundice. (Describe the types of jaundice.)
There are total four types of jaundice:
types:=
1) hemolytic jaundice,
2) obstructive jaundice (obstructive jaundice),
3) Hepatocellular jaundice
4) hereditary jaundice
1) hemolytic jaundice,
=> HEMO MEANS:= “BLOOD,”
=> LYTIC MEANS:= “BREAKDOWN OF CELL”
=> “HEMO LYTIC MEANS := “BREAKDOWN OF RED BLOOD CELL”
=> Hemolytic jaundice is also called pre hepatic jaundice.
=> Raised level of billirubin in jaundice is seen due to excessive breakdown of red blood cells.
=> some common causes of hemolytic jaundice are:
sickle cell anemia,
transfusion reaction,
malaria,
thalassemia,
Autoimmune disorders.
2) obstructive jaundice (obstructive jaundice),
=> Obstructive jaundice is called extra hepatic type of jaundice.
=> Obstructive jaundice occurs when there is bile duct blockage and bilirubin is not excreted from the liver and remains in the liver.
=> So it is called cholestatic jaundice because due to obstruction of bile duct, billirubin cannot be excreted from the liver.
=> Obstructive jaundice causes extreme level of itching in the body because salt builds up in the body.
Some of the common causes of obstructive jaundice :=
Due to carcinoma in gall bladder and bile duct,
Due to the presence of gallstones in the biliary system,
Due to infection and inflammation.
3) Hepatocellular jaundice
=> Hepatocellular jaundice is called the most common type of jaundice.
=> Hepatocellular jaundice occurs when the liver cells are damaged due to any reason, the liver is unable to excrete bilirubin from the body and due to this, the bilirubin increases in the blood.
Hepatocellular jaundice is mainly
liver failure,
liver diseases,
liver cancer,
hepatitis,
Viruses such as
yellow fever,
Epstein bar virus (epstain bar viral), is seen due to some types of drugs.
4) hereditary jaundice
=> Hereditary Jaundice is mainly observed in any person through inheritance from his family.
=> Hereditary jaundice is mainly due to impairment in the metabolism of bilirubin from the time of birth, excessive amount of bilirubin accumulates in the body.
=> It is mainly seen when due to excessive production of bilirubin or its non-excretion from the body.
1) Dubin/Johnson syndrome
=> This is an inherited disorder.
=> In this jaundice, the level of conjugated bilirubin increases in the liver.
2) Gilbert’s syndrome
=> Gilbert’s syndrome is an inherited condition mainly seen due to benign conditions in which the level of billirubin increases to a mild level.
3) Rotor’s syndrome
=> This is an inherited disease in which intermittent jaundice is seen.
3) Explain the causes/Etiology of jaundice. State the cause of jaundice
Due to excessive amount of billirubin in the body.
Due to any liver cell abnormality.
Due to blockage of bile duct.
Due to inflammation in liver and bile duct.
These are some common conditions that can cause jaundice
1) Pre hepatic cause (before bile is made in liver)
=> Due to destruction of red blood cells,
=> A condition in which red blood cells break down like:=
2) hepatic (the problem arising in the liver)
=> Hepatic Jaundice is mainly seen when there is incapacity of the liver due to which the condition of jaundice is seen.
=> Due to hepatitis (alcoholic or viral),
=> Cirrhosis of Liver,
=> Due to certain types of drugs,
=> Gilbert syndrome,
=> Cancer
3) Post-hepatic jaundice (after bile has been made in the liver)
=> This is mainly seen due to any obstruction.
=> Due to gallstones.
=> Because of cancer.
=> Due to stricture of bile duct.
=> Cholangitis (colengitis).
=> Pancreatitis.
4) Explain the clinical manifestation/sign and symptoms of jaundice. State the symptoms and signs of jaundice
Yellowish discoloration of skin, membrane and sclera is seen in the body.
Stool is light colored.
yellowish brown colored urine.
Itchy skin.
feeling tired
Abdominal pain.
Nausea.
Vomiting.
Fever.
Weakness.
loss of appetite.
headache.
Confusion.
Swelling in leg and abdomen.
Loss of appetite.
5) Explain the diagnostic evaluation of jaundice. Write the diagnostic evaluation of jaundice
history taking and physical examination.
blood test.
complete blood count test.
Liver function test.
urinalysis.
Liver Biopsy.
imaging studies.
ct scan.
MRI.
Abdominal ultrasonography.
hepatitis A,B,c test.
6) Explain the management of jaundice. (Write Management of Jaundice)
Provide intravenous fluids to the patient to prevent the condition of dehydration.
If the patient is experiencing nausea and vomiting, then provide antiemetic medicine.
If the patient is in pain, provide analgesic medicine.
Provide antibiotic medicine if the patient has any bacterial infection.
Provide antiviral medicine to the patient.
Transfusion of blood when required by the patient.
Providing chemotherapy and radiation therapy to patients.
If newborn, provide photo therapy.
Providing steroid and immunoglobulin to the patient.
Provide high carbohydrate and low protein diet to the patient.
Providing nutritional supplementation to the patient.
Provide vitamin K injection to prevent bleeding.
Any drug, toxic chemical, and alcohol cause the condition of jaundice so avoid these things.
7) Explain the surgical management of patients with jaundice. State the surgical management of a patient with jaundice
If there is a cancerous condition then there is a need for surgical treatment.
If the condition of jaundice is due to obstruction of bile duct then its surgical opening.
Liver transplantation is often required.
If the patient has a gallstone, surgery to remove it.
If the patient has hemolytic jaundice, treat him by providing medication.
8) Explain nursing management of patients with jaundice. Write the nursing management of a patient with jaundice.
Advise the patient to drink plenty of fluids.
Ask the patient to take adequate rest.
Tell the patient to avoid things like coffee, alcohol, junk food, drink soda, etc.
Ask the patient to take fruits and vegetables.
Avoid foods that contain preservatives.
Tell the patient to avoid meat and animal fat.
Do not ask the patient to take dairy products like cheese, milk etc.
The patient should avoid fat like ghee, butter, cream, oil for 2 weeks.
Soybean, egg, according to the patient’s condition. Dale, milk should be provided sparingly.
Ask the patient to eat carbohydrate foods like roti, bread, boiled potato etc. in small quantities.
Taking medicine as prescribed by health care personnel.
1) Explain/define the hepatic cirrhosis.
=> Hepatic cirrhosis is a chronic, degenerative disease in which the normal cells of the liver are damaged and fibrous scar tissues (fibrous scar tissues) are formed in the liver.
=> Instead of healthy tissues of the liver, scar tissues are formed and due to this, the blood flow in the liver is blocked and the liver does not function properly, leading to liver failure.
=> Liver is distorted, hardened and lumpy.
2) Explain the classification of hepatic cirrhosis. (Describe the classification of hepatic cirrhosis.
1) Alcoholic cirrhosis
2) Post necrotic cirrhosis (Post necrotic cirrhosis)
3) Biliary cirrhosis
••••>
1) Alcoholic cirrhosis
=> Laennec’s cirrhosis to alcoholic cirrhosis
(Linex Cirrhosis)
It is called and this is the most common type of cirrhosis.
=> This cirrhosis is mainly seen due to hepatitis-c (hepatitis-c) and chronic alcohol (cronic alcohole).
=> Liver is damaged mainly due to malnutrition and chronic alcohol consumption.
=> In this type of cirrhosis, there is formation of fibrous tissues around the portal area and central veins.
2) Post necrotic cirrhosis (Post necrotic cirrhosis)
=> Post necrosis cirrhosis is mainly due to any toxic agent and viral hepatitis.
=> Liver cell is damaged due to this, it is called postnecrosis cirrhosis.
=> Post necrosis cirrhosis is seen in 10-30% of patients.
3) Biliary cirrhosis
=> Biliary cirrhosis is a chronic disease. Which is mainly seen due to inflammed damage to the bile duct in the liver.
=> Formation of fibrous tissue and scar in biliary cirrhosis occurs around the bile duct of the liver.
=> Due to this, chronic obstruction in the bile duct occurs
3) Explain the etiology of hepatic cirrhosis. State the cause of hepatic cirrhosis
Due to long-term consumption of alcohol.
Due to chronic hepatitis.
Because of obesity.
due to Wilson’s disease.
Due to cystic fibrosis.
Due to blockage of bile duct.
due to autoimmune hepatitis.
Due to toxic hepatitis.
Due to chronic congestive heart failure.
Due to non-alcoholic fatty liver disease.
due to biliary atresia.
Gold due to bladder surgery.
Due to the occurrence of glycogen storage disease.
Due to alpha 1 antitrypsin deficiency.
Due to galactosemia.
4) Explain the clinical manifestation/sign and symptoms of hepatic cirrhosis. State the symptoms and signs of hepatic cirrhosis
early stage:=
weight loss,
feel tired,
liver enlargement,
nausea,
vomiting,
vascular spider (Vascular spider := in this the superficial capillaries are dilated and red dots are seen)
palmar erythema.
In ankle AD.
Intense itching.
late stage:=
SITS
(Acities := abnormal collection of fluid in the abdominal cavity.)
jaundice,
light color stool,
Yellowish bright color urine,
brushing and bleeding,
Distended vein in abdomen
later stage:=
Brain function is lost.
The liver cannot remove toxic material from the blood.
Mental disturbance.
poor concentration.
sluured speech.
Atrexis
Flapping and hand tremors are seen.
Motor control is lost in some parts of the body.
An involuntary flapping movement of the hand is observed.
5) Explain the diagnostic evaluation of hepatic cirrhosis. Write the diagnostic evaluation of hepatic cirrhosis.
history taking and physical examination.
assess blood test.
ct scan.
MRI.
LFT (SGPT,SGOT Test).
ultrasonography.
Liver Biopsy.
esophago gastroduodeno scopy.
6) Explain the management of hepatic cirrhosis.
Ask the patient to take a nutritious diet.
Provide adequate amount of nutrition to a person with hepatic cirrhosis.
If patient develops ascites then provide sodium restricted diet.
Provide vitamin and mineral supplements to the patient.
If the patient has fluid retention, provide potassium sparing diuretic (ex:= sporonolectone).
To treat the infection and treat the patient orally with antibiotic medicine.
Stop drinking alcohol if hepatic cirrhosis is caused by alcohol.
If hepatic cirrhosis is due to a viral infection, provide the patient with antiviral medicine.
If the patient has autoimmune hepatitis, provide steroid medicine to the patient.
If the patient has a condition of esophageal varices, then provide vasopressin to the patient.
Provide laxative medicine to the patient.
Provide the patient with such medicine that improves blood flow to the kidney.
Treating the patient if any complications occur.
Liver transplantation when complications are not treated.
7) Explain the nursing management of patients with endocrine disorder. Write the nursing management of a person with endocrine disorder.
1) Altered nutrition less than body requirement related to loss of appetite.
improving nutritional status of the patient.
Assess the patient’s dietary intake and nutritional status.
to the patient
High protein, high calorie, and providing vitamin A (A), D (D), E (E), K (k) and folic acid as a supplement.
Ask the patient to take small and frequent diet.
Ask the patient to maintain adequate oral hygiene.
If the patient has conditions like nausea, vomiting, then provide anti-emetic medicine.
2) Fluid volume excess related to disease condition.
maintain the fluid volume of the patient.
Maintaining intake-output chart of patient.
Monitor the patient’s blood pressure.
Monitor the patient’s respiratory status.
Assessing whether the patient has a condition like AD in the peripheral area or not.
Monitor the patient’s serum electrolyte level.
3) Activity intolerance related to generalized body weakness.
Maintain rest and comfort of the patient.
Assess the patient’s activity level.
Ask the patient to take adequate rest.
Provide a comfortable position to the patient.
Ask the patient to take a high protein and high calorie diet.
Providing oxygen to the patient.
Ask the patient to exercise.
Ask the patient to perform daily routine activities in small amounts.
4) Risk for Impaired skin integrity related to disease condition.
maintaining skin integrity of the patient.
Assess the patient’s skin integrity.
Changing the patient’s position frequently.
Do not use irritating soap.
Back massage to the patient every two hours.
Ask the patient to use a comfort device.
5) Knowledge deficit related to disease condition and treatment.
providing knowledge to the patient.
Assessing the patient’s knowledge level.
To provide complete information about the disease to the patient and his family members.
Providing education to the patient for nutritious and rest.
Ask the patient to avoid alcohol.
Ask to clear all the doubts of the patient and his family members.
Ask the patient to report immediately if there is any complication.
1) Define/explain portal hypertension. Define portal hypertension.
=> Portal hypertension is a vascular disease.
=> Hyper tension or high blood pressure is a disease in which the pressure of the blood increases against the wall of the vessels.
=> The condition when the blood pressure increases in the portal veins and its branches is called portal hypertension.
=> •••{ About the portal vein := Portal veins are large blood vessels that transmit blood from the abdominal organs (digestive system) to the liver. }•••
=> Portal hypertension is mainly seen due to liver cirrhosis or any other liver disease condition.
=> In portal hypertension, the portal pressure gradient is more than 12 mmHg (portal pressure gradient: = difference in the pressure of portal vein and hepatic vein. ).
=> Esophageal varices (oesophagus varices) and condition of ascites (Acities) are seen due to portal hypertension.
••{ meaning of varices := Varices is a condition that occurs due to portal hypertension in which the vein in the lower part of the esophagus is
Enlarge becomes swollen. }•••.
=> •••{ Acities
( Ascites:= . Ascites is mainly seen due to portal hypertension and liver cirrhosis in which fluid collects in the abdominal area, due to which the abdominal area becomes swollen and enlarged. )}•• •.
2) Explain the etiology/cause of portal hypertension. State the causes of portal hypertension
prehepatic cause (prehepatic cause):=
1) Thrombosis of the portal vein.
=> Blood flow obstruction due to blood clot in the portal vein causes the condition of portal hypertension.
2) Thrombosis of the splenic vein (Thrombosis of the splenic vein. )
=> Obstruction due to blood clot in the splenic vein leads to the condition of portal hypertension.
3) congenital atresia or stenosis
=> Atresia (Atresia) => Atresia means tubular structure in the body is absent since birth.
Stenosis: = Stenosis is the narrowing of the tubular structure of the body.
4) massive spleenomegaly
=> If there is only spleenomegaly, then the length of spleen is 12 to 20 cm.
=> But the condition of portal hypertension is seen due to massive spleen megalimma spleen length increases more than 20 cm.
5) Atriovenous fistula
=> Due to abnormal connection between battery and vein.
6) Compression by tumor
=> The condition of portal hypertension is also seen due to the increased pressure on the body parts due to the formation of abnormal tumors.
hepatic cause
1) Liver cirrhosis
=> In the condition of liver cirrhosis, fibrous scar tissues (fibrous scar tissues) are formed at the place of normal tissues of the liver, due to which the blood flow is impaired and the condition of portal hypertension is seen.
2) Schistosomiasis
=> Schistosomiasis is a type of parasitic infection. This disease mainly converts liver tissues into fibrous and scar tissues, due to which blood flow is impaired and portal hypertension condition occurs.
3) Alcoholic liver cirrhosis
=> In this condition, due to long-term consumption of alcohol, the condition of liver cirrhosis (liver cirrhosis) is seen and due to this, portal hypertension is seen.
4) Hepatic veno-occlusion disease
=> In this condition hepatic vein occlusion is seen and due to this the condition of portal hypertension is seen.
5) cytotoxic deug (cytotoxic drug)
=> Liver cell is damaged due to certain types of drugs and due to this also impairment is seen in blood flow and condition of portal hypertension is seen.
post hepatic cause
1) Hepatic vein thrombosis/Budd chiary syndrome
=> In this the hepatic vein is occluded due to which the blood flow is impaired and the condition of portal hypertension is seen.
2) congestive cardiac failure (congestive cardiac failure)
=> Pressure is seen in the hepatic vein due to heart failure. Due to this condition of portal hypertension is seen.
3) constrictive pericarditis
=> Due to the thickening and hardening of the pericardium layer of the heart, the heart cannot function properly, due to which the blood flow is impaired.
4) Right side heart failure
=> Due to right side hard failure, right ventricle cannot pump blood in adequate amount to lungs, due to which back flow of blood occurs and pressure in veins increases due to condition of portal hypertension. can be seen.
3) Explain the clinical manifestation/sign and symptoms of portal hypertension. Describe the symptoms and signs of portal hypertension.
Abdominal pain,
Abdominal girth increases,
Gastro Intestinal Bleeding,
Rapid weight gain,
Ascities (fluid is collected in the abdomen area),
Varicose vein
difficulty breathing,
black, terry stool or blood in the stool (maleana),
Discomfort due to enlarged abdomen,
Blood in vomiting (hemetemesis:= hematemesis),
A distended vein is visible in the abdominal area,
Decreased platelet count,
Fluid and electrolyte imbalance,
Jaundice (jaundice := serum bilirubin is greater than 2.5 mg/dl),
Hepatic encephalopathy: Hepatic encephalopathy is mainly a central nervous system (CNS) disturbance and is due to hepatic insufficiency.
Spiner angiomata swelling (Abnormal dilatation of any vascular vessels beneath the skin results in red spot.)
Umbilical hernia, ( abnormal bud that can be seen at the umbilicus area. ),
Gynecomastia (gynecomastea := enlargement of man’s Breast due to Hormonal imbalance or Hormonal therapy.),
feel tired,
weakness,
pruritus (itching),
Increased irritability,
Alteration of sleep patterns,
caput medusae (caput medusa := veins around the umbilicus are dilated.)
4) Explain the diagnostic evaluation of portal hypertension. Write the diagnostic evaluation of portal hypertension.
history taking and physical examination.
x rays,
endoscopic examination,
ct scan,
MRI,
Abdominal ultrasound,
assess the abdominal girth,
liver function test,
5) Explain the management of portal hypertension. Write the management of portal hypertension
1) Dietary modifications
=> In the condition of portal hypertension, the patient has fluid retention, so to prevent fluid retention, ask the patient to avoid sodium.
Ex:= table salt, salty food, salted butter,
And margarine to avoid such food.
2) Medication/ drug therapy
=> Provide beta blocker medicine to the patient.
Ex:= nadolol and propranolol,
=> Provide lactulose to the patient for treating the hepatic encephalopathy.
=> Providing anti-emetic medicine to the patient.
=> Provide vitamin K to prevent gastero intestinal bleeding.
=> Provide diuretic medicine to the patient.
3) Endoscopy therapy
=> Endoscopic therapy acts as the first line treatment for the treatment of variceal bleeding, in
1) Banding (banding) and
2) Includes sclerotherapy.
1) bending
=> In the banding procedure, the blood vessel is blocked by using a rubber band.
2)Sclerotherapy
=> Sclerotherapy is mainly used when the banding procedure cannot be used.
=> In sclerotherapy, a sclerosant solution (sclerosant solution) is injected where there are bleeding varices (bleeding varices), so a scar (scar) is formed at the bleeding site.
4) life style changes
=> Ask the patient to maintain good nutritional habit.
=> Providing education to the patient to avoid intake of alcohol.
=> Telling the patient not to use over the counter drugs.
=> Tell the patient to take adequate bed rest.
5) Transjugular intrahepatic portosystemic shunt ( TIPS := Trans jugular intrahepatic portosystemic shunt)
=> In this procedure, a stent (tubular device) is placed in the middle of the liver.
=> This stent connects the hepatic vein and the portal vein (connect the hepatic vein to the portal vein).
=> By doing this procedure, the impaired blood flow in the liver is rerouted (Re toutes) due to which the abnormal pressure of the blood in the veins is corrected and the condition of portal hypertension is treated.
6) Distal spleenorenal shunt (DSRS := Distal splenorenal shunt)
=> Distal splenic renal shunt is a surgical procedure in which the splenic vein is detached from the portal vein and attached to the left kidney.
=> This surgery reduces the pressure in the varices and controls the build-up due to portal hypertension.
=> This is mainly done in patients whose liver function is good.
7) Devascularization
=> This is a surgical procedure in which bleeding varices are removed.
=> This procedure is mainly done only when Tips and surgical shunt procedure is not successful.
8)paracentesis (paracentesis)
=> This is a procedure in which the fluid accumulated in the abdominal cavity due to ascites is removed.
9) Liver transplantation
=> This mainly happens when there is end stage liver disease.
8) Nursing management of patients with portal hypertension. Write the nursing management of patient with portal hypertension
Nursing management Nursing assessment
To assess patient’s vital signs.
Measure the patient’s abdominal girth.
Perform an integrated assessment of the patient’s skin.
Assessing the patient’s skin for any abnormality or discolouration.
Ask whether the patient consumes alcohol or not.
Ask whether the patient uses over the counter drugs.
Asking about the patient’s eating pattern.
Nursing diagnosis
1) Ineffective breathing pattern related to restriction of thoracic expansion secondary to the ascities, abdominal distension.
improve respiratory status of the client:=
Assess the patient’s respiratory rate.
Provide the patient with a favorable position.
To provide reinsurance to the client.
Ask the client to do deep breathing.
Change the position of the patient every two hours.
2) Imbalance nutritional status less than body requirement related to abdominal distension.
improve the nutritional level:=
Assess the nutritional status of the patient.
To assess the patient’s like and dislike of food.
Ask the patient to maintain oral hygiene.
Providing a conductive environment to the patient.
Provide the patient with a high carbohydrate and low sodium diet.
Ask the patient to take food in small and frequent amounts.
Serving food to the patient in an attractive manner.
Do not ask the patient to ingest alcohol.
If the patient has conditions like vomiting or nausea, provide anti-emetic medicine.
3) Impaired skin integrity related to oedema.
improve the skin integrity of the client.
Assessing the patient’s skin integrity.
Ask the patient to maintain skin hygiene.
Ask the patient to wear a clean cotton cloth.
Ask the patient to keep fingernails short.
Do not ask the patient to use a dry shop.
Ask the patient to apply an emollient.
Ask the patient to perform range of motion exercises.
Ask the patient to follow a sodium restricted diet.
Assess the patient’s skin every 4 to 8 hours.
4) Activity intolerance related to fatigue and lethargy.
enhance the activity level of the client.
Assessing the patient’s activity level.
Ask the patient to do daily routine activities in small amounts.
Ask the patient to take bed rest.
Ask the patient to rest between activities.
Provide the patient with prescribed vitamin supplementation.
5) Disturbed body image related to changes in approach, role function.
improve the self esteem and body image of the patient.
Assessing the patient’s coping ability.
Provide information to the client about the disease condition and the changes caused by it.
To provide reinsurance to the client.
To involve the patient’s family members in the care of the patient.
To clear all the doubts of the patient.
Do not give false reassurance to the patient and his family members.
1) Explain / define the Activities. Define ascites.
=> Ascites is a condition in which serous fluid accumulates in the abdominal cavity (Accumulate of serous fluid into the abdominal cavity).
=> In this the fluid increases more than 25 ml.
=> Abdominal cavity enlarges and swelling due to accumulation of serous fluid in abdominal cavity.
2) Explain the Etiology of Ascites. State the cause of SITS
liver cirrhosis
heart failure,
portal hypertension,
Constrictive pericarditis,
hepatic venous occlusion:=Budd chiary syndrome or veno occlusive disease.
due to infection.
Hypoalbuminemia (hypoalbunemia := decrease serum protein levels).
Pericarditis (infection and inflammation of pericardium layer of heart).
Cancer.
Nephrotic syndrome.
Hereditary angioedema: Hereditary angioedema is a hereditary disorder in which fluid collects on the outside of the blood vessels, due to which the normal flow of blood and lymph is impaired and due to the accumulation of fluid in the face, hand, and Swelling is seen in the extremities.),
Due to mal nutrition.
Renal dialysis.
3) Explain the pathophysiology of Acitties. (Write pathophysiology of ascites. )
=> When the amount of aldosterone increases in the body.
=> Then the damaged hepatocytes (liver cells) cannot metabolize aldosterone.
=> Due to this, the amount of sodium in the body increases.
=> Due to the increase in the amount of sodium in the body, water accumulation occurs in the body.
=> And due to this ascites and oedema are seen in the body.
4) Explain the clinical manifestation/ sign and symptoms of Acitities.
Write the symptoms and signs of ascites.
Abdominal distension.
Abdominal pain.
Weight gain.
Portal hypertension.
Swelling in leg and ankle.
brushing.
Swelling in the leg.
Gynecomastea (gynecomastea := enlargement of the man’s breast tissues. Encephalopathy (encepalopathy := when the liver does not function properly, there is an accumulation of ammonia in the body and due to this the brain function is impaired).
Feeling tired and weak.
Heart failure.
Hypokalemia (hypokalemia:=low level of potassium in the blood)
4) Explain the diagnostic evaluation of Acoties. Write the diagnostic evaluation of ascites
history taking and physical examination.
complete blood count (CBC test).
Assess the electrolyte level. #check the liver enzyme.
protein level.
CT scan.
Albumin and cell counts.
culture, gram stain, cytopathology.
Abdominal ultrasound.
Albumin and cell count.
serum Acitities Albumin gradient (SAAG).
Ultrasound.
Ct scan of abdomen.
5) Explain the management of activities. (Write management of ascites)
Provide patient with salt restricted diet.
Provide albumin intravenously to the patient.
Provide patient with diuretic medicine (ex:= sporonolectone).
Removal of fluid from the patient’s abdominal area by peracentasis.
6) Explain the management of activities. (Write management of ascites)
Checking patient’s abdominal girth daily.
Maintaining intake output chart of patient.
Maintain fluid and electrolyte balance in the patient.
Checking the patient’s daily weight.
Ask the patient to follow a salt restriction diet.
To check patient’s vital signs.
Monitoring the patient’s respiratory status.
To assess how effective the treatment given to the patient is.
Providing the prescribed medicine to the patient.
To check patient’s vital signs when paracentesis is performed.
1) Explain/define hepatic encephalopathy. Define hepatic encephalopathy.
=> Hepatic means ” “of the liver “
=> Encephalopathy means “A Disorder of the brain”.
{“Hepatic Encephalopathy means := Disturbance in the central nervous system function because of hepatic insufficiency. (If there is impairment in the function of the central nervous system due to any hepatic insufficiency, it is called hepatic encephalopathy.) }
=> Hepatic encephalopathy is a condition in which there is impairment in the function of the central nervous system due to any hepatic insufficiency, it is called hepatic encephalopathy.
=> Hepatic encephalopathy impairs/alters the function of the brain. This is mainly seen when the liver is unable to remove toxic substances from the body due to any abnormality of the liver and when these toxic substances accumulate in the body, a condition like hepatic encephalopathy is observed. Get.
2) Explain the causes/Etiology of hepatic encephalopathy. State the cause of hepatic encephalopathy.
Having any liver diseases.
Cirrhosis of liver.
Hepatitis (hepatitis :=infection and inflammation of the liver),
liver cancer,
portal hypertension,
Alkalosis,
Due to potassium deficiency.
narcotics.
Viral infection.
renal failure,
Electrolyte Abnormalitis,
factors precipitating hepatic encephalopathy.
1) disorder that increases the protein.
Gastrointestinal bleeding.
Due to taking high protein diet.
2) metabolic stress:=
diuretic drugs,
dehydration,
Renal failure,
Electrolyte imbalance especially hypokalemia.
3)Non specific cerebral depressants:=
alcohol,
sedative,
analgesic,
Other factors :=
increase the sensitivity of GABA (Gamma Aminobutairic Acid),
increase the circulating level of endogenous benzodiazepanes.
3) Explain the risk factor of the hepatic encephalopathy. State the risk factors of hepatic encephalopathy.
Due to dehydration,
Due to too much protein intake,
Due to electrolyte abnormalities,
Intestinal stomach, or
Due to bleeding from esophagus.
Due to infection.
Due to kidney problem.
Due to low amount of oxygen in the body.
Due to the use of medications that suppress the central nervous system.
4) Explain the pathophysiology of the hepatic encephalopathy. State the pathophysiology of hepatic encephalopathies:=
=> Due to any etiological factor.
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=> Since the liver cells are damaged, they cannot convert the toxic substances in the body such as ammonia into urea.
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=> Due to this ammonia accumulates in the body.
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=> The level of this ammonia increases in the blood.
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=> As the level of ammonia increases in the blood, ammonia enters the blood stream.
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=> Due to this the blood permeability increases and the blood crosses the brain barrier.
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=> So ammonia reaches the brain and damages the brain and alters the function of the brain.
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It causes
=> Hepatic encephalopathy
5) Explain the clinical manifestation/sign and symptoms of hepatic encephalopathy.
State the symptoms and signs of hepatic encephalopathy
Asterixis ( Asteraxis := “Flapping tremor”) ,
Disturbance in sleep patterns.
Restlessness.
Mental confusion.
Insomnia.
from app ( Apathy :=
lack of feelings and emotions),
Drowsiness,
confusion,
Foul smelling brid,
Sluggish movement,
poor concentration,
dysurination,
Behavior is to be in appropriate.
Poor judgment.
Slurred speech.
Attention decreases.
childish behaviour,
behaving aggressively,
6) Explain the diagnostic evaluation of hepatic encephalopathy. Write the diagnostic evaluation of hepatic encephalopathy.
history taking and physical examination.
Elevated blood ammonia levels.
hypokalemia.
assess the albumin level.
assess the bilirubin level.
electroencephalogram (EEG).
Assess the prothrombin time.
Cerebrospinal fluid examination (SCF examination).
ct scan.
complete blood count.
erythrocyte sedimentation rate.
Assess the electrolyte level.
assess the liver function test (LFT).
assess the Renal function test (RFT).
7) Explain the management of hepatic encephalopathy. Write the management of hepatic encephalopathy
management
Hospitalization of the patient.
Maintaining patient’s airway bridging and circulation (airway, circulation and breathing).
Providing intravenous fluid to the patient.
Keep the patient’s fluid and electrolyte balance normal.
Do not ask the patient to take protein rich diet.
Ask the patient to take a glucose-rich diet.
Providing a solution for lactolose to the patient to reduce constipation.
Providing antibiotic medicine to the patient.
Ex:= neomycin,
Rigaximine,
Ampicillin,
Metronidazole.
Patient should avoid sedative and tranquilizer medicine.
Patients should avoid medicines containing ammonium.
Prevent bleeding in the patient’s gastro-interstitial track.
8) Explain the nursing management of patients with hepatic encephalopathy.
1) Impaired nutritional level less than body requirement related to Anorexia.
2) Impaired skin integrity related to oedema.
3) Activity intolerance related to fatigue.
4) Risk for injury related to diminished perception.
Monitor patient’s intake output chart.
Monitor the patient’s weight daily.
Monitoring the patient’s fluid balance.
To monitor patient’s vital signs.
Monitor the patient’s central venous pressure frequently.
Providing the prescribed medicine to the patient.
Ask the patient to take adequate rest.
To provide patient comfort and quiet atmosphere.
Taking care of the patient’s skin.
Ask the patient to take a low protein diet.
Use of appropriate safety measures to prevent injury to the patient.
Monitoring the consciousness level of the patient.
Monitor patient’s intake-output chart and monitor electrolyte balance.
To carry out laboratory investigation of the patient.
Tell the patient to stop alcohol.
Ask the patient to take complete bed rest.
Ask the patient to take adequate nutrition.
Ask the patient to take a proper diet.
Ask the patient to avoid hepatotoxic drugs.
Providing psychological support to the patient.
explain/define hepatitis. Describe hepatitis.
=> Hepatitis is a condition in which there is infection and inflammation of the liver.
=> Viral hepatitis A mainly
••>Hepatitis A viral,
••>Hepatitis B viral,
••> Hepatitis c viral,
••> Hepatitis D viral,
••>Hepatitis E is caused by viral.
•••> epstain bar viral virus,
•••> Yellow fever virus (yellow fever viral),
•••> rubella virus (rubbella viral),
•••> Herpes simplex (herpes simplex),
•••> Varicella virus (varicella viral),
•••> adeno viral
All these viruses also cause hepatitis.
=> The hepatitis virus enters the liver and multiplies there, then damages the liver and causes inflammation and necrosis of the hepatocytes.
=> When the hepatitis virus enters the body, its signs and symptoms are seen in three phases.
1) Pre icterus phase (prodromal phase)
2) Icterus phase
3) convalescent phase. (convulsant face)
★★★••••>
1) Pre icterus phase (prodromal phase)
=> This phase can be seen from one to two weeks (1 to 2 weeks).
=> In this phase, the patient has flu-like symptoms.
like,
=> feeling tired,
=> loss of appetite,
=> body pain,
=> Nozia,
=> Vomiting,
=> diarrhea,
And
=> Constipation.
2) Icterus phase
=> Icterus face starts in five to ten days (5-10 days) after coming in contact with hepatitis virus and signs and symptoms are seen.
=> This face is seen from two to six weeks (2 to 6 weeks).
=> In this phase, the level of billirubin increases in the body, due to which the skin and mucous membrane of the body is seen in a yellowish color.
=> Jaundice condition is seen in this phase.
=> In this phase, itching (itching / pruritus) occurs due to bile salt deposits in the patient’s skin.
=> In this phase, stool is light brown and clay color due to non-excretion of bile through the normal fecal pathway.
3) convalescent phase. (convulsant face)
=> Convalescent phase is observed after icterus phase.
=> This phase is seen for some weeks and some months.
=> In this phase, signs and symptoms improve gradually.
1) Explain/define hepatitis A.
=> Hepatitis A is a viral infection that causes infection or inflammation of the liver.
=> It is mainly R. N. A (RNA Viral) is caused by a virus.
Hepatitis A is mainly transmitted through the feco-oral route.
=> It is mainly transmitted through food or liquid contaminated with hepatitis A (A) virus.
=> Hepatitis-A virus is mainly transmitted by a person who has been infected by hepatitis A virus and who has not washed his hands properly after a bowel movement and that person prepares food. is
=> The incubation period of hepatitis A is between 15 to 50 days. And the average is 30 days.
=> Hepatitis A (A) virus can be seen from four to eight weeks (4 to 8 weeks).
2) Explain the etiology/cause of Hepatitis A disease. State the cause of Hepatitis A ( A ).
1) Contaminated food or water
=> Transmitted through food and food material prepared by an infected person.
2) Person to person content (person to person contact)
=> Due to coming in direct contact with any infected person or coming in contact with his items.
3) Due to poor sanitation.
4) Due to poor hygiene.
5) Due to over crowding.
6) Due to not washing hands properly after bowel movement.
7) Drinking contaminated water.
8) eating undercooked shellfish.
9) Due to blood transfusion.
10) Having oral or anal sex with a person who has hepatitis A.
11) To reuse the contaminated niddle.
3) Explain the clinical manifestation/sign and symptoms of hepatitis A viral. Write the symptoms and signs of hepatitis A virus:=
In this the patient has flu like symptoms.
upper respiratory tract infection.
Getting a low grade fever.
Lack of appetite (anorexia).
Indigestion (indiagetion:= indigestion).
nausea,
vomiting,
diarrhea,
clay colored stool,
Heart burn.
Jaundice (jaundice:= yellow discoloration of the skin and mucous membrane).
Weakness.
headache.
feeling tired
generalized weakness.
stomach cramps.
the patient may develop a strong sense of cigarette smoking.
4) Explain the diagnostic evaluation of hepatitis A viral. Write the diagnostic evaluation of hepatitis A virus
history taking and physical examination.
blood test.
assess the immunoglobulin level.
assess the liver function test.
ultrasound.
ct scan.
MRI.
5) Explain the medical management of the patient with the hepatitis A virus. (Write the medical management of a patient with hepatitis A.
Do not ask the patient to consume alcohol.
Ask the patient not to eat fatty food.
Asking the patient to maintain personal hygiene.
Ask the patient to do thourouly hand washing.
Tell the patient to avoid unprotected sex.
Ask the patient to take a nutritional diet.
Provide intravenous glucose to the patient.
Maintain the patient’s body weight.
Ask the patient to take edequate bed rest.
Ask the patient to avoid physical activity.
Ask the patient to do small amounts of activity.
If the patient has nosia and vomiting then provide anti emetic medicine.
6) Explain the nursing management of the patient with the hepatitis A. (Write the nursing management of the patient with hepatitis A.)
To monitor patient’s vital signs frequently.
Monitor the patient’s weight daily.
Assess the patient’s stool frequently.
Provide oral fluids to the patient frequently.
Providing intravenous feed to the patient.
Monitoring the patient’s intake-output chart.
Monitoring the nutritional status of the patient.
Ask the patient to eat in sitting position.
Providing patients with small, free quantitative dietary supplements.
Maintain patient’s oral hygiene.
Providing oral care to the patient.
Asking the patient to take diet in small and frequent amounts.
Provide calm and quiet environment while eating to the patient.
Ask the patient to take adequate rest.
Monitoring the patient’s daily intake output chart.
Provide oxygen to the patient properly.
1) Explain/define hepatitis B. (Describe Hepatitis B:=
=> Hepatitis B is also called serum hepatitis.
=> Hepatitis B is mainly transmitted by hepatitis B virus.
=> Hepatitis B virus is mainly present in blood, saliva, semen and vaginal secretion of an infected person.
=> Hepatitis B virus creates infection and inflammation in the liver which is called infection of severe form (life threatening condition).
=> Because Hepatitis B virus is a life long infection
•••>liver cirrhosis (scaring),
•••> Liver failure (liver failure),
•••>Liver cancer (liver cancer) ••••>Death can also happen.
=> Hepatitis B •••>Acute (Acute := rapidly developing) and •••>Chronic (cronic:=long lasting) are found in both forms.
=> The incubation period of hepatitis B is from one to six months (1 to 6 months).
=> Hepatitis B is mainly transmitted by hepatitis B virus which is mainly present in blood, semen, and other body fluids.
2) Explain the Etiology/cause of hepatitis B.
Caused by hepatitis B virus.
It is transmitted through the blood, saliva, semen, vaginal secretion etc. of an infected person.
Unprotected Sexually contect
By saring the infected niddle.
Mother to Child Transmission.
Intravenous drug users.
Health care workers. A person who undergoes frequent blood transfusions.
By coming into sexual contact with an infected person.
Due to sexual contact with multiple partners.
Indra Venus due to drug abuse.
Due to repeated exposure to blood.
Because of sharing toothbrushes and razors.
Dialysis patients.
A person doing tattooing.
Due to repeated any medical procedure.
3) Explain the sign and symptoms/clinical manifestation of the hepatitis B virus. (State the symptoms and signs of hepatitis B virus.)
Hepatitis B virus after exposure to the virus
12 weeks (12 weeks /range 9-21 weeks) is observed.
Jaundice (jaundice:= yellowish of the skin and the sclera)
Fever.
Loss of appetite.
To see respiratory symptoms.
Abdominal discomfort.
Rashes.
Abdominal pain.
Nausea.
Vomiting.
Generalized pain.
Weakness.
Dark yellow urine.
Liver is tender, enlarged.
clay colored stools.
Lethargy.
Spleen is also enlarged and palpable in a few patients.
4) Explain the diagnostic evaluation of hepatitis B viral. (Write diagnostic evaluation of hepatitis B.)
history taking and physical examination.
assess the albumin level.
assess the liver function test.
assess the prothrombin time.
assess about the presence of antibody HBsAG (anti-HBs).
antibody to hepatitis B core antigen (Anti-HBc).
hepatitis B surface antigen (HBsAG).
hepatitis E surface
Antigen (HBeAG).
5) Explain the management of hepatitis B virus. (Write management of hepatitis B virus.)
medical management
If the patient has acute hepatitis, lifestyle modification should be done.
Ask the patient to take proper bed rest.
Ask the patient to take adequate fluids.
Advising the patient on nutritional diet.
Ask the patient to avoid alcohol if he has a chronic hepatitis condition.
Telling the patient to avoid over the counter (over the medicine) medicine.
Providing interferon-alpha medication to patients with chronic hepatitis B conditions.
Interferon-alpha is the body’s immune system
Increased activity and hepatitis-B
It impairs reproduction of the virus.
Interferon-Alfa tablets are taken daily or three times a week for six months.
provide lamivudine and adenovir medicine to the patient.
Ask the patient to take adequate bed rest.
Monitor the patient’s nutritional status.
Provide adequate fluid to the patient.
Liver transplantation if the patient has severe condition.
Explain the nursing management of the patient with the hepatitis B virus. (Write the nursing management of a patient with hepatitis B.)
Maintain patient’s skin integrity.
Providing good skin care to patients.
Tell the patient not to use irritating ointments.
Ask the patient to apply an emollient.
Ask the patient to keep finger nails.
Assess the patient for any bleeding.
If the patient has itching, provide medication to reduce it.
Change the patient’s position frequently to prevent pressure ulcers.
Assessing the patient for any neurological signs and symptoms.
Providing patient work and quiet environment.
Ask the patient to report any bleeding immediately.
Monitor the patient’s prothrombin time and bleeding time and administer vitamin K.
Do not perform any procedure that causes any trauma to the patient.
Take proper care to avoid any needle stick injury to the patient.
6) Explain the prevention of occurrence of hepatitis B. (Write the prevention of hepatitis B.)
Getting the hepatitis B vaccine properly to prevent hepatitis B.
Proper screening of donated blood.
Use of disposable series-needle.
Ask the patient to maintain good personal hygiene.
Disinfect the working area daily.
Wear gloves when working with any body fluid.
Asking a person who is a health care person and a person who is high risk to get the hepatitis B vaccine.
=> A total of three doses of hepatitis B are taken.
=> One month after taking the first dose, the second dose (2nd dose) and then six months after that dose, the 3rd dose of hepatitis B is taken.
If anyone has come in contact with hepatitis B virus due to a needle stick injury, get vaccinated immediately.
Avoid sexual contact with a person who has acute or chronic hepatitis.
Using a barrier method as a contraceptive during sexual activity.
Avoid sharing personal items like toothbrushes and razors.
Do not use any needle that has not been disinfected and use disposable series and needles.
Avoid coming in contact with the body fluid of an infected person.
1) Explain the hepatitis c virus. (Describe hepatitis C virus.)
=> Hepatitis C is an infection and inflammation of the liver and it is mainly caused by the hepatitis C virus.
Caused by (hepatitis c viral).
Hepatitis C is a viral infection caused by hepatitis C virus which is an RNA virus belonging to the Flaviviridae family of viruses.
=> Hepatitis C was first identified in 1989.
=> Hepatitis C is mainly spread by direct contact with the blood of any infected person.
=> Hepatitis C (C) is different from Hepatitis A (A) and B (B).
=> The incubation period of Hepatitis C is 15-160 days.
2) Explain the Etiology/cause of hepatitis c viral.
Due to hepatitis C virus,
Due to prolonged dialysis,
Due to working with blood regularly.
Due to having unprotected sexual activity with a person who has hepatitis C infection.
Due to contact with any body fluid of a person who has hepatitis C infection.
Due to any needle stick injury.
Due to blood transfusion.
Due to tattooing by any infected instrument.
Due to any accidental needle stick injury.
Due to any organ transfusion.
Due to sharing of personal items like toothbrush and razor.
Due to giving birth to her child by a mother who has hepatitis C infection.
In individuals who are sexually active.
Among individuals who have multiple partners.
To health care personnel.
3) Explain the clinical manifestation/sign and symptoms of hepatitis c viral. (State the symptoms and signs of a person with Hepatitis C)
liver failure,
Cirrhosis of liver,
Abdominal pain (Right upper abdomen),
Abdominal swelling (Due to fluid collection in the abdomen its called Acidities.)
Jaundice (jaundice := yellowish discolouration of the skin, mucous membrane and sclera of the eyes.),
Passing dark urine and pale and clay colored stool.
Building coming from esophagus (oesophagus) and stomach (stomach).
Dark urine.
feeling tired
Itching.
Muscle and joint pain.
Fever.
Loss of appetite.
nausea
Vomiting.
Liver cancer.
4) Explain the diagnostic evaluation of the patient with hepatitis c viral. Write the diagnostic evaluation of a patient with hepatitis C.
history taking and physical examination.
assess the liver function test.
assess EIA (enzyme immunoassay) to detect the hepatitis c antibody.
hepatitis c genotype.
assess albumin level.
assess liver function test.
assess the prothrombin time.
Liver Biopsy.
5) Explain the management of the hepatitis c virus. State the management of a patient with hepatitis C.
Provide antiviral medicine to the patient to treat hepatitis C virus
Ex:= pegylated interferon alfa and ribavirin.
Ask the patient to maintain good hand washing technique.
Ask the patient to follow streak aseptic technique.
Follow strict aseptic technique while visiting a person who has an infection.
Provide patient education not to scratch the itchy area.
If the patient has abdominal discomfort, feels very tired, has rashes on the skin and has fever and vomiting, then immediately inform the doctor.
Hepatitis B can also be transmitted due to providing patient education or tattooing and skin piercing.
Provide patient education or don’t donate blood after hepatitis C infection.
Ask the patient to rest between activities.
Ask the patient to come for regular checkup.
A person who is infected with hepatitis C should avoid sexual activity with a person.
Ask the patient to use a barrier method of contraception during sexual activity.
1) Explain/define the hepatitis D.
=> Hepatitis D is also called delta virus.
=> Liver infection and inflammation in hepatitis D is mainly seen due to hepatitis D virus.
=> Hepatitis D is a viral infection caused by hepatitis D virus.
=> Hepatitis D is also called satellite infection because hepatitis D is mainly seen in individuals who have hepatitis B.
=> Hepatitis D can exacerbate the severity of hepatitis B and damages the liver to a greater extent.
It is mainly transmitted through contact with any infected blood.
2) Explain the etiology/cause of hepatitis D viral. State the cause of hepatitis D virus.
Due to coming into contact with infected blood and body fluid.
In individuals who have hepatitis B.
Due to sharing of needles, series, and personal utensils (like tooth brush, razor) of infected persons.
Due to sexual activity with an infected person.
Due to unprotected sexual activity.
intra venous drug users.
Due to direct contact with the blood of an infected person.
Due to the birth of a baby by an infected mother.
Due to having hepatitis B infection in the past.
Due to receiving blood transfusion.
3) Explain the clinical manifestation/sign and symptoms of the hepatitis D. State the symptoms and signs of Hepatitis D.
1) Flu like symptoms:=
feel tired,
weakness,
muscle aches,
Fever, 2) Jaundice
Yellowish discoloration of skin, mucous membrane and sclera is seen due to accumulation of billirubin in the body. 3) Abdominal pain
Due to the inflammation of the liver, there is pain and discomfort in the upper right quadrant of the abdomen. 4) dark urine
Urine is dark in color due to the buildup of bilirubin in the body. 5) Pale or clay color stool
Due to non-excretion of bilirubin from the body, the stool is pale and clay colored. 6) nausea and vomiting
People with hepatitis D often experience nausea and vomiting. 7) Loss of appetite (Loss of appetite)
A person does not feel hungry due to hepatitis D. 8) joint pain
(joint pain)
A person experiences joint pain due to disease.
9) Confusion.
10) Itching.
11) Fever.
5) Explain the diagnostic evaluation of the hepatitis D virus. (Write the diagnostic evaluation of a patient with hepatitis D.)
history taking and physical examination.
liver biopsy.
blood test.
Liver function test.
liver enzyme.
Abdominal ultrasound.
anti delta agent antibody test.
6) Explain the management of the patient with hepatitis D. Write the management of a patient with hepatitis D
medical management
Provide antiviral medication to the patient.
Ex:=tenoflovir, Entecavir.
Provide interferon-alpha (interferon-alpha) medication to the patient.
Monitor the patient’s liver function test regularly.
Ask the patient to take an adequate nutritional diet.
If the patient has the condition of nausea and vomiting, then do antiemetic medicine.
If the patient’s condition is very severe, liver transplantation should be done.
Providing vaccines to patients.
Tell the patient to avoid alcohol that impairs liver function.
Ask to avoid drugs that alter liver function or damage liver cells.
Asking the patient to take high carbohydrate foods like bread, jam, whits, biscuits, rice, veg…
1) Explain/ define hepatitis E. Describe Hepatitis E ( E ).
=> Hepatitis E is a viral infection that is transmitted by hepatitis E virus.
=> Hepatitis E is an infection and inflammation of the liver and it is mainly transmitted by hepatitis E virus.
=> Hepatitis E was primarily discovered in the 1990s.
=> Hepatitis E is mainly transmitted through the feco oral route, i.e. through contaminated/infected food or water.
=> The incubation period of hepatitis E is from two to nine weeks (2 to 9 weeks).
=> Hepatitis E is self limited but it severely affects pregnant women. It can also cause abortion and intrauterine death in pregnant women.
2) Explain Etiology/cause of hepatitis E. (State the cause of Hepatitis E.)
by hepatitis E virus. genotypes:=1,2,3,4
Genotype := 1,2 are associated with the human infection.
Genotype:=3,4 are associated with the animal infection.
Due to intake of contaminated food and water.
Due to poor sanitation.
Due to poor hygienic conditions.
Due to low socio economic condition.
During the third trimester of pregnancy.
In International Travelers.
A person who lives in an area with an outbreak of hepatitis E.
A person who has sexual activity with an infected person.
Due to unprotected sexual activity.
3) Explain clinical manifestation/sign and symptoms of the hepatitis E. Explain the symptoms and signs of a patient with hepatitis E.
weakness,
feel tired,
Fever,
muscle aches,
nausea,
vomiting,
loss of appetite (anorexia),
Abdominal pain,
Pain in right upper quadrant part of abdomen.
Jaundice (Jaundice: Yellowish discoloration of skin, mucous membrane and sclera in jaundice).
Passing dark colored urine due to bilirubin.
Passing pale and pale colored stools.
Enlargement of the liver (hepatomegaly).
Itching due to accumulation of bullirubin in the skin,
weakness,
malaise,
joint pain,
muscle aches,
Weight loss.
4) Explain the diagnostic evaluation of the hepatitis E. Write the diagnostic evaluation of hepatitis E.
history taking and physical examination.
assess the blood test of the patient.
Anti-HEv igG antibody test.
Anti-HEV igM
Antibody test.
assess the liver function test.
assess the serological test.
assess the stool examination.
assess the imaging study.
assess the hepatitis A,
hepatitis B, hepatitis c test.
5) Explain the management of the patient with hepatitis E virus. Write the management of a patient with hepatitis E.
Explain the medical management of the patient with hepatitis E.
There is no specific treatment for hepatitis E but it subsides on its own.
Keep the patient on a nutritious diet.
Administer antiemetic medicine to treat the patient’s condition of nausea and vomiting.
Provide the patient with high carbohydrate foods such as bread, jam, wheat, biscuits, rice, vegetables, and potatoes.
Asking the patient to maintain good hygienic condition.
Do not eat uncooked food.
Do not drink contaminated water.
Nursing management
Complete health history and physical examination of the patient.
Ask the patient about any signs and symptoms of hepatitis.
Ask the patient to take some rest between activities.
Assess the patient’s working ability.
To provide work and quiet environment to the patient.
Provide high calorie diet to the patient.
Monitoring the patient’s intake output chart.
Serving food to the patient in an attractive manner.
Providing a relaxing environment to the patient.
Ask the patient to maintain oral hygiene.
Ask the patient to avoid alcohol.
Ask the patient to avoid carbonated drinks.
Ask the patient to adopt proper hand washing technique.
Ask the patient to maintain personal hygiene.
Ask the patient to avoid unprotected sexual activity.
Avoiding sexual activity with an infected person.
Use of barrier method as contraceptive during sexual activities.
Providing education to patients on proper skin care.
Asking the patient to bathe with warm water, do not use warm water as it increases skin dryness.
Ask the patient to avoid using soap containing alcohol.
Ask the patient to apply an emollient properly.
Ask the patient to keep his fingernails short.
If the patient is bed ridden then provide proper back care.
1) Explain/define liver cyst. (Define liver cyst.)
=> Liver cyst is also called hepatic cyst.
=> Liver cysts and hepatic cysts are round, thin, and sac-like structures that are irregularly located in the tissues of the liver.
=> Liver cysts range in size from (two millimeters) 2 mm to 20 cm (vis centimeters).
=> A liver cyst is a fluid-filled sac that is located in the tissues of the liver.
=> The most common size of liver cyst is up to two centimeters (2 cm).
=> The cyst is mainly surrounded by liver tissue, the cyst is empty
(empty) or semi-fluid substance is present in it.
2) Explain the etiology/cause of the liver cyst. State the causes of liver cysts.
Liver cysts are also present at birth due to any developmental abnormality.
Due to polycystic liver diseases.
Due to parasitic infection.
Due to any injury or trauma.
Due to liver cancer.
Due to congenital hepatic fibrosis
It is a hereditary disorder,
In which bile duct irregular shape is made along with scar tissues and that and
Impairment of renal function is also seen in it.
caroli’s disease
Carroll’s disease is mainly frequent
Inflammation of the bile duct
Due to and formation of stone in it
Due to and intrahepatic
Dilatation of the bile duct
seen due to.
choledochal cyst
Due to a congenital abnormality of the bile duct.
Due to congenital hepatic fibrosis.
Due to echinococcus infection.
3) Explain the clinical manifestation/ sign and symptoms of the hepatic cyst. State the signs and symptoms of hepatic cyst.
Swelling and discomfort in the upper part of the abdomen.
Abdominal pain.
Nozia.
Digestive problem.
Shoulder pain.
Liver enlargement.
Bile duct infection and blockage.
Jaundice (yellowish discoloration of the skin, mucous membrane
and sclera).
Feeling of heaviness and fullness in the abdomen.
Filling of a mass-like structure in the abdomen.
4) Explain the diagnostic evaluation of the liver cyst. Write the diagnostic evaluation of liver cyst
history taking and physical examination.
abdominal ultrasound,
ct scan,
MRI,
Biopsy of the affected part,
blood test,
liver function test,
5) Explain the management of the liver cyst. Write the management of liver cyst.
In the treatment of liver cyst, the cyst is aspirated and the cyst is surgically removed.
The affected area is also removed to prevent the cyst from returning.
Providing antibiotic medication to the patient.
If the patient is in pain, provide Analgesic medicine.
Explain the nursing management of the patient with the liver cyst. Write the nursing management of patient with liver cyst.
Continuously monitor the patient.
To monitor patient’s vital signs.
Assessing the patient’s pain level.
If the patient is in pain, provide Analgesic medicine.
The patient should not have any complications like jaundice, nozia,
Assessing whether there is a condition like vomiting or not.
Monitoring the patient’s intake output chart.
Maintain patient’s hydration status.
To provide complete information about the disease to the patient.
Providing psychological support to the patient.
Alleviating patient anxiety.
Assessing the patient for any complications after cyst removal.
explain / define liver cancer
Introduction:=
=> Liver cancer originates in the liver.
=> And it is called hepatocellular carcinoma.
=> This cancer is produced in the cells of the liver.
=> Abnormal (abnormal) and uncontrollable (uncontrollable) growth of cells and tumor formation.
=> And this tumor is malignant (cancerous) or benign (non-cancerous)
may be.
This cancer is also called hepatoma.
2) Explain the etiology / cause of the patient with the liver cancer. State the causes of liver cancer patients:=
certain type of liver disease:=cirrhosis,
hepatitis B virus,
hepatitis c virus,
diabetes,
obesity,
Aflatoxin:=
birth control pills,
Tobacco use,
vinyl chloride,
Anabolic steroids,
Arsenic,
Cytological drug,
use of steroids.
3) Explain the clinical/manifestation sign and symptoms of the patient with the liver cancer (write the symptoms and signs of the patient with the liver cancer:=
Abdomen pans in the right side.
And this pen is transferred to the back side and shoulder.
Abdomen right side becomes swollen.
Lump occurs in the abdomen.
The liver is enlarged.
Weight is reduced.
malaise occurs.
Abdomen feels very full as soon as you don’t feel hungry and eat a little.
Feels very tired.
Eyes, skin and whole body become yellowish.
nausea,
vomiting,
fever,
fluid retention (acities),
liver damage,
Metabolic disturbance,
splenomegaly,
Hepatic encephalopathies,
Jaundice,
Esophageal varies (the esophagus is enlarged).
Abdominal distension.
4) Explain the Diagnostic evaluation of the patient with the liver cancer Write the diagnostic evaluation of the patient with the liver cancer:
History tacking and physical examination,
Hepatological investigation,
->( AFT := Alpha feto protein),
->blood test,
-> liver function test,
->Albumin Alkaline Phosphate,
->Prothrombin time,
X Ray,
ultrasonography,
ct scanning,
MRI,
Laparoscopy,
biopsy,
hepatitis b test,
hepatitis c test
5) Explain medical management of the liver cancer Write the management of liver cancer:=
chemotherapy,
radiation therapy,
Ablation therapy,
Immunotherapy,
Biotherapy,
6) Explain surgical management of the liver cancer Write surgical management of liver cancer:=
Surgical resection,
liver transplantation (liver transplantation).
7) Complications:=
Malnutrition,
Biliary obstruction,
sepsis,
liver abscess,
Metastasis.
8) Explain the nursing management of the patient with the liver cancer: = Write the nursing management of the patient with the liver cancer:=
Nursing assessment:=
Assessing the patient’s pen level.
Assessing the patient’s coping ability.
To check patient’s vital signs.
Checking the patient’s skin turgor and looking for heel-like conditions.
Dietary conditioning of the patient.
Assess the patient’s activity level and sleep pattern.
Monitor the patient for any side effects of chemotherapy, radiotherapy, and immunotherapy.
Nursing diagnosis
1) Pain related to liver enlargement.
Nursing interventions:=
Controlling pain:=
Providing analgesic drugs to the patient.
Providing Mind Divergent Therapy to the patient
Observe the patient for any signs of drug toxicity.
Provide guided imagery to the patient.
Ask the patient to exercise moderately.
Providing comfort measures to the patient.
2) Altered nutrition less than body requirement related to disease and side effects of chemotherapy.
Nusing interventions:=
Improving nutritional status:=
Tell the patient to take small amounts of food.
Tell the patient to take supplementary drugs.
Give food that the patient likes to eat.
Know the patient’s likes and dislikes.
Giving the patient a high calorie meal.
Do not keep bad smelling things near the patient while he is eating.
3) Fluid level excess related to oedema.
Nursing interventions:=
Relieving excess*fluid volume:=
To check patient’s vital sign.
Checking the patient’s intake output.
Do not give sodium rich food to the patient.
Administer fluids to the patient as prescribed.
Administer diuretic medicine to the patient.
Maintain the patient’s potassium level.
Providing patients with albumin and protein supplementation.
Checking the patient’s abdominal girth daily.
Check the patient’s weight. If there is weight gain, it indicates fluid retention.
Conduct laboratory tests of the patient.
Preparing the patient and his family members for surgery.
To clear all doubts of patient and family members.
Providing psychological support to the patient and his family members.
4) Discomfort related to disease condition.
5) Altered sleeping* pattern related to pain.
6) Activity intolerance related to weakness.
7) Risk for infection related to bone marrow depression secondary to chemotherapy.
1) Explain/ define liver abscesses. Describe liver abscess
=> Liver Abscess A condition in which pus (pus) collects in the liver tissues due to any type of infection is called liver abscess.
=> Due to this abscess, the healthy tissue pressure of the liver increases,
=> Because of this, the healthy tissues of the liver are also killed, after which this infection enters the blood stream and creates a very extreme level of infection in the blood stream.
=> When any infection a
When it occurs in the gastrointestinal track (GI track) or in the biliary track (biliary track), this infection is a
••>By biliary system (biliary system),
••> Through the portal system (portal system),
, reaches the liver through the lymphatic system.
=> Then destroys the normal cells of the liver and causes necrosis.
=> Then these necrotic cells of the liver
Abscess/pus is formed in the liver by
2) Explain the type of the liver Abscesses. State the type of liver abscess:=
1) Pyogenic liver Abscesses (pyogenic liver abscess),
2) Amoebic liver Abscesses,
3) Fungal Abscess
•••••••>>
1) Pyogenic liver Abscesses (pyogenic liver abscess),
=> Pyogenic liver abscess is mainly due to infection.
Like:=
=> bacterial infection (bacterial infection),
=> Parasitic infection
•••> Pyogenic liver abscess is the most common type of liver abscess.
2) Amoebic liver Abscesses,
=> Amoebic liver abscess is caused by microscopic organisms called Amoebas and Entamiba histolytica.
=> Thus amoebic liver abscess is seen by this microscopic organism.
3) Fungal Abscess
=> Fungal abscess is mainly caused by fungal microorganisms.
Ex:= most common fungus is candida albicans.
3) Explain the Etiology/cause of the liver Abscesses.
State the cause of liver abscess:=
Immune deficiency
for this reason,
Abdominal infection such as appendicitis
(Appendicitis),
Diverticulitis
( diverticulitis), and perforated bowel
(perforated bowel).
Diabetes mellitus.
Due to blood infection.
Due to infected hepatic cyst.
Bile duct
(bile duct) due to infection (cholengitis).
Due to metastatic liver tumors and cancer.
Due to endoscopy of bile draining tube.
Due to any liver trauma.
Due to amoebic dysentery.
Due to bacterial infection.
4) Explain the clinical manifestation/ sign and symptoms of the liver abscesses. State the symptoms and signs of liver abscess
Pain in right upper quadrant of abdomen.
Fever.
Feeling cold.
nausea,
Vomiting.
Sweat profusely.
Weight loss.
Right sided chest pain.
Jaundice.
Weakness.
Abdominal pain.
Anemia.
Passing dark urine.
Passing pale and clay colored stools.
Hepatomegaly (hepatomegaly := enlargement of the liver).
Joint pain.
Sepsis and shock.
Do not feel hungry.
feel very tired
General discomfort.
Itching.
5) Explain the diagnostic evaluation of the patient with liver abscesses. Write the diagnostic evaluation of a patient with liver abscess
history taking and physical examination.
blood culture.
abdominal ct scan.
ultrasound of the abdomen.
aspiration of the liver Abscesses.
bilirubin blood test.
liver biopsy.
bilirubin blood test.
Liver function test.
blood culture for bacteria.
complete blood count test.
Liver function test.
white blood cell count.
6) Explain the management of the patient with liver abscesses. Write the management of a patient with liver abscess
Treatment depends on the cause of the abscess.
Providing chemotherapy to the patient.
Provide antibiotic medicine to the patient.
Ex:=
Aminoglycoside,
Amikacin,
Gentamycine,
Clindamycin,
Piparacillin-
tazobactam,
Metronidazole.
Aspiration of abscess through needle to the patient.
do percutaneous drainage and aspiration of the abscess.
7) Explain the nursing management of patients with the liver abscesses.
Nursing assessment
To assess the patient’s vital signs.
Conduct a thorough physical examination of the patient.
Assess the patient for any signs and symptoms of liver abscess.
Asking about the patient’s eating habit.
Assessing whether the patient has a jaundice-like condition or not.
Nursing diagnosis
1) Hyperthermia related to disease condition and infection.
maintaining body temperature of the patient
Monitoring the patient’s body temperature.
To assess patient’s vital signs.
Provide room ventilation to the patient.
Provide cold compression to the patient.
Provide sponge bath to the patient.
Administer antipyretic medicine to the patient.
Provide intravenous fluid to the patient.
2) Acute pain related to pus formation in the liver.
Relieving Abdominal pain.
Assessing the patient’s pain level.
Ask the patient to do deep breathing exercises.
Providing Mind Divergent Therapy to the patient.
Apply cold compression to the patient’s pain area.
Ask the patient to take frequent but small amounts of food.
Ask the patient to take a soft diet.
Providing analgesic medicine to the patient to relieve pain.
Provide antacid medicine to the patient.
3) Impaired nutritional status less than body requirement related to abdominal pain.
improve nutritional status of the patient.
Assess the nutritional status of the patient.
Gaining information from the patient about the food that the patient likes and dislikes.
Maintain patient’s oral hygiene.
Provide food to the patient in small but frequent amount.
Provide high protein and high carbohydrate food to the patient.
Providing food to the patient in an attractive way.
Keep food utensils properly cleaned.
4) Activity intolerance related to fatigue, malaise and weakness.
promote activity level of the patient.
Assess the patient’s activity level.
Change the position of the patient every two hours.
Asking the patient to do moderate daily routine activities.
Ask the patient to rest between activities.
Ask the patient to do a few range of motion exercises.
Provide the patient with a prescribed vitamin supplement.
5) Impaired knowledge of the patient related to disease condition.
promote knowledge level of the client.
Assessing the patient’s knowledge level of the patient.
Assess the patient’s anxiety level.
To provide information to the patient about his condition, its cause, its treatment.
Ask the patient to avoid alcohol.
To provide information about surgical management to patients.
Providing information about the patient’s antibiotic medication.
To clear all the doubts of the patient.
To provide complete information to the patient about his treatment.
1) Define/explain liver failure. Define liver failure.
=> Liver failure is a condition in which the liver is severely damaged and due to which the liver cannot perform its vital functions.
=> Liver performs many vital functions like detoxification (detoxification), metabolism (metabolisam) and protein formation (protien formation) which is responsible for blood clotting, all these functions are impaired due to liver failure. .
=> Liver failure condition is mainly caused due to any disease condition of liver.
=> Liver failure is a very life threatening condition, it is seen in two types.
=> 1) Acute liver failure (Acute liver failure) which occurs within 48 hours,
And 2) Chronic liver failure (cronic liver failure) or gradual liver failure for many months and years is called chronic liver failure.
2) Explain the Classification of the liver failure. State the classification of liver failure.
1)fulminant hepatic failure (FHF fulminant hepatic failure)
2) Late onset hepatic failure (late onset hepatic failure)
3) chronic decompensated hepatic failure. Chronic decompensated hepatic failure
••••••>
1)fulminant hepatic failure (FHF fulminant hepatic failure)
=> This type of hepatic failure is seen within eight weeks of the onset of any disease condition.
2) Late onset hepatic failure (late onset hepatic failure)
=> This type of hepatic failure is seen within 8 to 26 weeks of the onset of any disease condition.
3) chronic decompensated hepatic failure. Chronic decompensated hepatic failure
=> This type of hepatic failure is seen within six months (6 months).
Explain the type of hepatic failure.
1) Acute hepatic failure (acute hepatic failure).
2) cronic hepatic failure (chronic hepatic failure)
••••••>
1) Acute hepatic failure (acute hepatic failure).
=> In this type, liver dysfunction occurs within a week.
=> This type of hepatic failure can be due to many reasons like any infection,
••>Viral
Because of hepatitis,
••>Due to toxicity of any drug,
and,
••>Pregnancy occurs due to acute fatty liver.
=> This type of hepatic failure requires immediate medical attention as it progresses rapidly and can create a life threatening condition.
2) cronic hepatic failure (chronic hepatic failure)
=> This type of liver failure is seen progressively and gradually and it progresses for many months and years.
=> This type of liver failure a
••>Due to chronic liver disease,
••> Due to liver cirrhosis,
••>Due to chronic alcohol consumption,
••> due to viral hepatitis, ••> due to non-alcoholic fatty liver disease
A condition of chronic liver failure is seen.
3) Explain the etiology/cause of hepatic failure.
Due to viral infection,
Hepatitis B,
Because of hepatitis C,
Due to prolonged consumption of alcohol,
Due to liver cirrhosis,
Due to taking some kind of toxic drug.
Ex: = due to ecetaminnophen,
Due to hepatitis A, B and C,
Due to reactions to certain medications,
Due to ingestion of any poisonous and mushroom,
In hepatocellular carcinoma due to
Due to metastatic carcinoma.
Due to auto immune disease conditions.
Due to genetic disorder.
Due to any other liver disease.
4) Explain the clinical manifestation/sign and symptoms of the hepatic failure.
nausea,
loss of appetite,
Jaundice (yellowish discoloration of the, skin, mucous membrane, and sclera),
feel tired,
diarrhea,
Pain in upper right part of abdomen.
Acities ( Accumulation of the fluid in the abdominal cavity. ),
Difficulty in concentration.
Confusion.
fall asleep
Bleeding easily.
Abdominal pain.
Swelling.
Constant itching in the skin.
Darkening of the color of urine.
pale-clay colored stool.
Palmar erythematosus.
Scratch marks visible.
Gynecomastia (gynecomastea := enlargement of man’s breast tissues),
anemia,
coma,
In hepatocellular carcinoma.
5) Explain the diagnostic evaluation of the hepatic failure.
history tacking and physical examination,
blood test,
imaging test,
liver tissue biopsy,
Doppler ultrasound,
ct scan,
MRI,
electroencephalo
graphy.
Examination of the liver tissue.
Liver function test.
complete blood count test.
coagulation study.
ultrasound.
metabolic test.
autoimmune marker test.
Assess Ammonia level.
6) Explain the management of the patient with the hepatic failure.
1)Medication to reverse poisoning:=
Liver failure is mainly caused by overdose and intoxication of acetaminophen, so to prevent its adverse effects, antidotes such as
Penicillin-G, activated charcoal, and N-Acetykcystin provide agents that neutralize the poisonous agent.
2) Relieving excess fluid in the brain:=
=> In cerebral ED it is mainly due to liver failure so to reduce this pressure provide osmotic diuretic mannitol which prevents fluid build up in the brain so provide intravenous mannitol (0.5-1g/kg or 50-100g) to the patient. .
3) screening of the infection:=
=> Collect the patient’s blood and urine samples to assess whether there is any infection or not and if there is a condition of infection, provide antibiotic medicine to the patient.
4)prevention severe bleeding:=
=> A person who develops a condition of liver failure has a high chance of bleeding from the gastrointestinal tract, so to prevent that bleeding, provide meditation to the patient or, if the patient has lost a lot of blood, give blood transfusion to the patient.
5) Liver transplantation:=
=> Liver failure is an irreversible condition, so in this condition, the damaged liver is removed from the patient’s body and a healthy liver is transplanted into the patient’s body.
Explain the nursing management of the patient with hepatic failure. Write the nursing management of a patient with hepatic failure.
improve the nutritional status of the patient:=
Assess the nutritional status of the patient.
Provide food to the patient in small and frequent amounts.
Providing oral care to the patient.
Ask the patient to reduce sodium intake.
Providing feed to the patient through parenteral route.
If the patient has nosia and vomiting condition then provide antiemetic medicine.
Provide high calorie food to the patient.
Provide vitamin and mineral supplements to the patient.
2) Maintain adequate fluid volume.
To monitor patient’s vital signs frequently.
Monitor the patient’s weight daily.
Maintaining intake output chart of patient.
To record the patient’s abdominal gas.
Assessing whether the patient has any conditions like peripheral oedema.
Ask the patient to restrict sodium.
Maintain patient’s electrolyte level.
Assess the patient for any symptoms of bleeding or haemorrhage.
3) Improve Respiratory status:=
Assess the patient’s respiratory rate and depth.
To analyze the patient’s arterial blood gas.
To assess patient’s hemoglobin and hematocrit level.
Keeping the patient’s head elevated.
Ask the patient to do deep breathing exercises.
Provide oxygen to the patient.
1) define/explain the pancreatitis. (Define pancreatitis.)
=> Pancreatitis infection and inflammation of the pancreas
is called
=> Pancreas is a gland located behind the stomach that releases insulin, glucagon and many digestive enzymes that help in digestion and absorption of food.
=> There are two types of the pancreatitis.
1) Acute pancreatitis.
2) cronic pancreatitis (chronic pancreatitis)
1) Define/explain Acute pancreatitis. (Define acute pancreatitis.)
=> Acute pancreatitis is a condition in which there is infection and inflammation of the pancreas and it resolves within a few days and it creates severe complications.
=> In acute pancreatitis infection and inflammation of the pancreas occurs within a week.
=> Acute pancreatitis is a life threatening condition and creates severe complications.
2) Explain the etiology/cause of the acute pancreatitis.
=> State the causes of acute pancreatitis.
Because of being gallstone (gall stones := cholilithiasis:=a hardened deposit of digestive fluid that can form into the gall bladder.).
Due to disease in the biliary tract.
(Cholangitis) cholengitis := (inflammation of the bile duct) due to.
Due to prolonged intake of alcohol.
Due to taking certain types of medication.
Due to any bacterial and viral infection.
Due to trauma.
Due to any surgery of pancreatic duct.
Due to metabolic disorder.
Hereditary.
Due to pancreas surgery.
Due to any severe injury in the abdominal area.
Due to use of any oral contraceptive medicine.
Due to the abnormal structure of the pinnae.
Due to use of any corticosteroids.
Due to complications of cystic fibrosis.
Peptic ulcer
(A sore that can develop in the lining of the oesophagus, stomach and intestine.) due to
Due to high amount of lipids in the blood.
Due to pancreatic duct blockage.
Due to injury to the pancreas due to any accident.
3) Explain the sign and symptoms/clinical manifestation of the pancreatitis. (State the symptoms and signs of creatitis.)
Abdominal pain.
Abdomen is swollen or tender.
Back pain.
Nausea.
Vomiting.
Getting a fever.
Epigastric pain.
Increase in heart rate.
Abdomen is rigid and board (boared).
gaseous abdominal fullness.
Bruising around the umbels.
Going into hypotension and shock.
Jaundice.
Mild confusion.
Dehydration.
Low blood pressure.
Acute renal failure.
Seeing clay colored stool.
Respiratory distress.
Indization.
Hypocalcemia.
Hyperglycemia.
Myocardial depression occurs.
Rashes and sores can be seen on the skin.
Respiratory distress.
4) Explain the diagnostic evaluation of the patient with the acute pancreatitis
history taking and physical examination.
blood test.
assess the laboratory test.
assess the serum amylase and lipase level.
assess the urinary amylase level.
assess the Wbc count.
assess the calcium level.
assess the glucose level.
assess the complete blood count test.
Abdominal ultrasound.
x-rays.
ct scan.
MRI.
MRCP (Magnetic resonance cholangiopancreatography.).
assess the peritoneal fluids shows increase in the level of pancreatic enzyme.
stool examination.
5) Explain the medical management of the patient with acute pancreatitis. (Write the medical management of a patient with acute pancreatitis.)
Provide total parental fluid through the patient’s intravenous line.
Antibiotic medicine should be given to the patient if he has an infection condition.
If the patient has nosia,
If there is vomiting and abdominal distention, do nosogastric suctioning.
If the patient is in pain, provide analgesic medicine.
If the patient has a condition of vomiting
Provide antiemetic medicine.
If patient has condition of acidosis then provide sodium bicarbonate.
Blood if the patient has blood loss
Perform a transfusion.
Provide adequate amount of intravenous fluid to the patient.
If the patient is unable to take oral food and fluids, give nosogastric fluid.
surgery
placement of biliary drains in the pancreatic duct.
surgical removal of the pancreas.
Peghvical,
Monitor for cardiovascular and respiratory system problems.
To provide a calm and comfortable environment to the patient.
1) Define/explain chronic pancreatitis. Describe chronic pancreatitis.
=> In chronic pancreatitis, there is gradual and long-term infection and inflammation of the pancreas, which causes permanent damage to the pancreas.
=> This condition of the pancreas develops gradually in which ••>ongoing inflammation of the pancreas occurs, ••>scaring of the pancreatic tissues and ••>impairment in the function of the pancreas.
=> Chronic pancreatitis is a gradual infection and inflammation of the pancreas and it is healing.
(healing) does not occur and reaches the condition of permanent pancreas damage, it is called chronic pancreatitis.
is called
=> Chronic pancreatitis takes many years to develop but it takes approximately 10 years and even more years.
2) Explain the etiology/cause of chronic pancreatitis.
Due to alcohol intake for too long.
Hereditary.
Due to hypercalcemia.
Due to pancreatic duct blockage.
Due to cystic fibrosis.
Due to non-use of certain types of medication.
Due to hyperparathyroidism.
Due to some type of autoimmune condition.
Due to the increase in the amount of lipids in the body.
3) Explain the clinical manifestation/sign and symptoms of the chronic pancreatitis.
State the symptoms and signs#
Pain in the upper abdominal area.
Vomiting with pain.
Weight loss.
Loss of appetite.
Abdominal bloating.
Abdominal cramps.
diarrhea.
Diabetes mellitus.
Malabsorption.
Flatulence
(Flatianlens).
smelly and greasy faeces (stools).
pale or clay colored stool.
4) Explain the diagnostic evaluation of the chronic pancreatitis.
history taking and physical examination.
ultrasound.
X rays.
ct scan.
glucose tolerance test.
ERCP (Endoscopic retrograde chilangio pancreatography) for analyzing the composition of juice.
blood, urine and stool test.
5) Explain the management of the patient with chronic pancreatitis.
Write the management of patients with
1) Maintain adequate nutritional status of the patient.
=> Do not provide orally fluid and food to the patient.
=> Provide fluid through the patient’s intravenous line.
=> If the patient is vomiting, enter the tube from the nose into the stomach to remove fluid and air.
=> Provide nasogastric feeding to the patient if the patient has continuous weight loss.
2) Advise the patient about stopping drinking and smoking.
=> Advise the patient to stop alcohol.
=> Giving advice to the patient to avoid smoking.
3) Advice about dietary modifications:=
=> Pancreas plays an important part in digestion Now due to pancreatic disease one should ask the patient to take food in small but frequent amount instead of taking food in large amount three times a day.
Ask the patient to avoid fatty food.
4) control pain of the patient:=
The patient’s pain level is in different amounts, if the patient is suffering from mild level of pain then paracetamol.
(paracetamol) to provide and
Morphine if the patient has severe pain
Also providing drugs like morphine.
=> Due to the disease condition of the pancreas, the pancreas cannot release the enzyme, so providing the patient with insulin as a replacement.
surgical management
1) Endoscopy surgery:=
=> In this surgery, a narrow, hollow flexible tube is inserted into the digestive system under ultrasound guidance.
=> In this device, a small deflated balloon is placed at the tip of the endoscope.
=> Inflate the balloon when it reaches the duct
(inflate) is done and the duct is widened (widening).
=> Then a stent is placed in it so that the duct is narrowed again.
Not done.
2) Pancreas Resection
(Pancreas Resection)
=> In this procedure, the head of the pancreas is surgically removed.
=> This procedure not only reduces the pain but also reduces the pressure on the duct.
(Bagger Procedure)
=> In this procedure, the head of the inflamed pancreas is resected.
=> Frey procedure is mainly done when it is realized that the pain is due to inflammation of the head of the pancreas as well as blockage of the duct.
=> In this procedure, the head of the pancreas is surgically removed and the duct
It is decompressed and directly connected to the intestine.
( pylorus –
sparing pancrreatico
duodenectomy/ pylorus sparing pancreatico duodenectomy)
=> In this procedure, the gall bladder, duct and head of the pancreas are surgically removed.
=> This is mainly done when there is very chronic pain, the head of the inflamed pancreas and the blocked duct are removed.
=> This procedure is a very effective procedure to reduce pain.
=> But doing this procedure increases the chances of infection and internal bleeding.
3) pancreatectomy
=> In partial pancreatectomy, some body parts of the pancreas are removed, mainly the pancreas body and tail are removed.
(total pancreatectomy)
=> When the entire pancreas is removed in total pancreatectomy, the patient has to rely on continuous medical treatment to perform some of the vital functions of the pancreas in the body.
Providing analgesic medicine to relieve the patient’s pain.
Ex:=meperidine.
Avoid oral fluids and provide total parenteral nutrition to the patient.
Provide mind diversion therapy to relieve the patient’s discomfort.
Ask the patient to maintain his oral hygiene.
Ask the patient to take frequent bed rest.
Provide fluids and electrolytes to the patient through intravenous route.
To check for any infection or inflammation on the side of the wound which is drained.
Provide semi-fowler position to improve patient’s breathing pattern.
Patient’s breathing pattern
Anchoring for deep breathing exercises to improve
Tell the patient to avoid heavy meals.
To monitor patient’s vital signs continuously.
Monitoring the patient’s abdominal girth daily.
Patients with any neurological,
Careful monitoring for any abnormal signs and symptoms of cardiovascular and respiratory system.
To provide psychological support to the patient.
To provide a calm and comfortable environment to the patient.
To clear all the doubts of the patient and his family members and give him false assurance.
Don’t give false assurance.
define/explain pancreatic cancer.
=> Pancreatic carcinoma (pancreatic carcinoma).
Cancer of the pancreas is called.
=> In pancreatic cancer, abnormal and uncontrollable growth of pancreatic cells leads to tumor formation.
=> Tumors in this pancreas are found more in the head and body of the pancreas.
Cancer in the pancreas spreads rapidly and mainly
Stomach, gall bladder,
and duodenum
There is more spread in the duodenum and in the lymphatic system and distal organs
(Distal organ).
But spreads.
2) Explain the types of the pancreatic tumor.
There are two types of pancreatic tumors.
1) exocrine tumor
(Exocrine Tumor),
2) Endocrine tumor
(endocrine tumor)
••••••>
1) Exocrine tumor/pancreatic adenocarcinoma
(in exocrine tumor/pancreatic adenocarcinoma),
=> Exocrine tumor is the most common type of pancreatic cancer.
=> In this cancer, the cells of the pancreatic gland have a digestive enzyme
Cancer is found in the part that secretes (digestive enzyme).
=> Most of exocrine pancreatic tumors are malignant (cancerous).
=>example of exocrine gland tumor is:= Adenocarcinoma (in Adenocarcinoma)
2) Endocrine tumor/pancreatic neuroendocrine tumor
(Endocrine Tumor/ Pancreatic Endocrine Tumor)
=> The cell of the pancreas which secretes the hormone is called the endocrine portion.
=> The tumor occurring in this endocrine portion is called endocrine tumor/pancreatic neuroendocrine.
=> To these endocrine tumors
Islet cell tumor
(islet cell tumor)
Also called
=> Tumors of this endocrine pancreas are rare.
=> There are subtypes of islet cell tumor that are named according to type of hormone secreting cells they originate from:=
1) Glucogonomas
=> This type of tumor arises from cells that secrete glucagon.
2) Insulinomas
=> This tumor arises from the cells of the pancreas that produce insulin.
3) Somatostatinomas (Somatostatinomas)
=> This tumor is a pancreas
Produced from the cells from which somatostatin hormone is released.
4) Gastrinomas
=> Gastric mass tumors are produced from cells that release gastrin hormone.
5)Vip (vasoactive intestinal peptide)nomas
=> Whippano mass tumor arises from a cell which
Releases vasoactive intestinal peptide.
3) Explain the stages of the pancreatic tumor. Write the stages of pancreatic tumor.
1) stage 1:=
=> In this stage the cancer is limited to the pancreas only.
2)stage:=2
=> In this stage, the cancer in the pancreas spreads to tissues, organs and lymph nodes near the pancreas.
3)Stage:3:=
=> In this stage, the cancer in the pancreas spreads to the blood vessels and lymph nodes.
4) stage:=4
=> In this stage, the cancer spreads to the lining of the distal part like liver, lungs and abdominal organs.
4) Explain the etiology/cause of pancreatic cancer. State the cause of pancreatic cancer.
The exit cause is unknown.
smoking.
Due to advanced age.
Due to over weight.
male sex.
Due to chronic pancreatitis.
Due to diabetes mellitus.
Having a family history of pancreatic cancer.
Due to practice ulcer surgery.
Due to occupational exposure to carcinogens.
diet high in meat, cholesterol, fried food, and nitrosomide.
including family history of genetic syndrome that can increase the cancer risk,
•> BRCA 2 Gene mutation,
•>Peutz Jeghers syndrome,
•>Lynch syndrome,
•>Familial atypical mole-malignant melanoma
(FAMMM).
5) Explain clinical manifestation/sign and symptoms of pancreatic cancer.
Pain in the upper abdominal area.
Abdominal distension.
Jaundice.
nausea,
vomiting,
loss of appetite,
Indigestion,
Fever,
feeling cold,
itching,
weight loss,
weakness,
Passing pale and gray colored stools.
Steastoria
(steatorrhea:=
excess fat in stool),
bone pain,
Darkening of urine color,
Difficulty in sleeping.
history taking and physical examination.
routine blood tests,
liver function test,
ngogram,
endoscopic
ultra sound,
bariums swallows,
pancreatic biopsy,
MRI,
Computed tomography (ct scan),
Percutaneous transhepatic cholangiography
(percutaneous transhepatic cholangiogtaphy),
Positron emission tomography (positrone emission tomography),
7) Explain the management of pancreatic cancer.
In surgery, all parts of the pancreas are removed.
1) Pancreato duodenectomy
=> In this surgery duodenum (duodenam:=the initial part of the small intestine) head of pancreas, round bladder are removed.
=> Then remaining (remaining) pancreas, bile duct and stomach are jointed with intestine.
=> The remaining bile duct is then directly attached to the small intestine as pancreatic juice, etc.
of bile
For the flow to occur directly in the intestine.
2) Distal pancreactomy
=> In this surgery, only the body of the pancreas and
to its tail
is removed.
=> In majority of cases the spleen is also removed.
=> This surgery is mainly used to remove the tumor in the body and tail of the pancreas.
=> This procedure is mainly an islet cell.
And used to treat neuroendocrine tumors.
3) Total pancreactomy (total pancreatectomy)
=> entire pancreas in this procedure
And with it the spleen
is also removed.
=> This surgery is mainly used to remove tumors in the head and body of the pancreas.
=> Palliative surgery is used when pancreatic cancer cannot be removed.
=> Common bile duct and duodenum are bypassed in this surgery.
2) Chemotherapy
=> Abnormal cells are destroyed by using medicine in chemotherapy.
Ex:= gemcitabine,
Flurouracil,
Capacitabine.
3) Radiation therapy
=> Abnormal cells are destroyed using high energy Gamma Ray in radio therapy.
4)Target therapy
=> Use of medicine in target therapy
Abnormal cells are inhibited from growing and multiplying.
5) Dietary management
=> Adequate dietary management plays a very important role in cancer.
=> Ask the patient to take food in small and frequent amounts.
=> Ask the patient to take soft and light and easily digestible food.
=> Provide nutritional supplement to the patient.
=> Tell the patient to avoid high fat.
=> Tell the patient to avoid alcohol and smoking.
Assess the patient’s pain level.
Assessing the patient for jaundice or not.
Assessing the patient for body itching.
Assessing the patient’s urine.
To assess the patient’s vital signs.
Assessing the patient’s prothrombin time.
If the patient has abdominal distension, shock, blood in stool, report immediately.
Monitor secretions drained by nasogastric tube.
Maintain patency of nasogastric tube.
Providing nutritional supplementation to the patient.
Provide the patient with a low fat, high carbohydrate and high protein diet.
Ask the patient to take food in small and frequent amounts.
Provide patient with semi-fowler position to improve proper breathing.
Provide the patient with a pancreatic enzyme supplement.
Providing psychological support to the patient.
Ask the patient and his family members to explain his feelings.
Define/explain cholecystitis.
=> Goal Bladder
Inflammation and swelling of the gall bladder is called cholecystitis.
is called
=> Cholecystitis also has two types.
1) Acute cholecystitis
(acute cholecystitis),
=> Onset of acute cholecystitis is sudden.
have
2) chronic cholecystitis
(Chronic cholecystitis).
=> Chronic cholecystitis occurs progressively and gradually.
1) calculous cholecystitis (calculous cholecystitis)
=> In this condition, the outer floor of bile is impaired due to stones in the gall bladder.
=> Due to this bile remains in the gall bladder and due to this a chemical reaction is observed.
=> Because of this the blood vessels in the gall bladder are compressed and the vascular supply is compromised.
=> It finally leads to formation of gangrene and perforation.
2) Accumulated cholecystitis
(Calculus
cholecystitis)
=> Calculous cholecystitis is not due to any gall stone but any major surgical procedure,
Obstruction of cystic duct occurs due to severe trauma, any bacterial infection and multiple blood transfusion.
2) Explain Etiology/cause of the cholecystitis.
gold stone,
Due to blocked cystic duct,
ischemia,
Due to the adult disorder,
Due to infection by any micro organism.
Due to any allergic reaction.
3) Explain the clinical manifestation/sign and symptoms of cholecystitis.
Abdominal pain,
Abdominal tenderness,
nausea,
vomiting,
indigestion,
Getting a low grade fever,
jaundice,
Abdominal fullness and bloating.
clay colored stool.
4) Explain the diagnostic evaluation of the cholecystitis.
history taking and physical examination.
abdominal ultrasound,
ct scan,
x rays,
cholecystogram,
gallbladder radionuclide scane.
blood test.
Provide intravenous fluid to the patient.
Do not provide any fluid or food to the patient by mouth.
If the patient has nosia and vomiting, provide antiemetic medicine.
Maintain fluid and electrolyte balance of the patient.
If the patient is in pain, provide analgesic medicine.
Provide antibiotic medicine if the patient has any infection.
Ex:=piperacillin,
Ampicillin,
Metronidazole,
Cephalosporin,
Ciprofloxacine,
Surgery includes removal of the gall bladder
(cholecystectomy).
( ERCP:= Endoscopic retrograde chilangio pancreatography. )
=> This procedure is mainly used to remove stones in the common bile duct and open the bile duct for drainage.
Define/explain cholelithiasis.
=> Cholelithiasis is such a condition
In which gall stone (hard deposit/calculi) is formed in gall bladder due to solid composition.
2) Explain the type of gall stones.
1) Cholesterol stone
(cholesterol stone)
=> Cholesterol stone is the most common type of stone
=> Which is mainly formed due to high amount of cholesterol present in bile.
2) Pigment stone
=> Pigment stone is mainly formed due to excessive amount of bile in the gall bladder.
=> Pigment stone dissolves and can be surgically removed.
2) Explain the etiology/cause of cholelithiasis.
Adequate from gall bladder during pregnancy
Due to not removing the bile in the amount.
Due to infection in the biliary tract.
Liver cirrhosis.
Due to sickle cell anemia and chronic hemolytic anemia.
Diabetes mellitus.
Because of obesity.
Due to over weight.
Due to bone marrow transplantation.
Intravenous nutritional.
Obesity.
Inflammatory Bowel Diseases.
Due to certain types of medication.
3) Explain the clinical manifestation/sign and symptoms of cholelithiasis.
Pain in the upper part of the abdomen.
Abdominal swelling.
Abdominal bloating.
Abdominal tenderness.
Goal Bladder distended.
Gallbladder becoming infected and inflamed.
clay colored stool.
Fever.
Feeling cold.
Do not feel hungry.
Nausea without vomiting.
Work up a sweat.
Indigestion.
Jaundice.
4) Explain the diagnostic evaluation of the patient with the cholelithiasis.
history taking and physical examination.
Abdominal ultrasound.
abdominal x rays.
endoscopic ultrasound.
cholecystography.
blood test
Endoscopic retrograde cholangiopancreato
graphy (ERCP).
percutaneous transhepatic cholangiogram
(PTCA).
cholecystography.
Murphy sign.
5) Explain the management of the patient with cholelithiasis.
Ask the patient to take a low fat diet.
If the patient is bleeding, itching in the body, jaundice, then vitamin K should be given to the patient.
Administration
to do
If the patient is in pain, provide analgesic medicine.
If the patient has spasmodic pain, antispasmodic medicine and anticholinergic
Provide medicine.
If the patient has nosia and vomiting condition then provide antiemetic medicine.
Providing intravenous fluids to the patient.
Providing antibiotic medicine to the patient.
Cholestyramide if patient has severe jaundice condition
(cholestyramide) medicine to be provided.
Urodeoxycholic acid (UDCA) and chenodeoxycholic acid (CDCA) to the patient.
Provide to dissolve cholesterol.
=> In this dissolution therapy
Mono octane or methyl tertiary butyl is administered by inserting a tube or catheter directly into the gall bladder and dissolves the stones in the gall bladder.
The stone is removed by instrumentation.
Do extra corporeal shock wave lithotripsy.
Do intracorporeal lithotripsy.
1) elecro leproscopy cholecystectomy (electro laparoscopy cholecystectomy).
2)minicholecystectomy.
3) surgical choledocholecystectomy.
4) percutaneous cholecystectomy (percutaneous cholecystectomy).
Assessing the patient’s pain level.
Assess the patient’s level of consciousness and activity level.
Assessing the patient’s anxiety level.
Assess the patient’s respiratory status and nutritional status.
To monitor patient’s vital signs.
Assessing the patient’s pain level.
Advise the patient on deep breathing technique.
Providing analgesic medicine to the patient.
To assess the patient’s respiratory rate, depth and breath sounds.
If the patient has abdominal pain, nausea and vomiting, report immediately.
Advise the patient to follow a low fat and high protein diet.
To monitor patient’s vital signs regularly.
Assess the patency of the patient’s intravenous line.
If the patient needs blood transfusion then cross matching should be done.
Assess the patient for any signs and symptoms of infection.
To monitor patient’s vital signs.
Ask the patient to do deep breathing exercises.
Maintaining intake output chart of patient.
Q. If the patient is in pain
Provide analgesic medicine.
Advise the patient to do continuous exercise.
[) Explain/define choledocholithiasis.
Define .
=> Choledocholithiasis A condition in which gallstones are present in the common bile duct is called choledocholithiasis.
=> Gallstone is mainly formed in gall bladder then it passes from gall bladder to common bile duct and cystic duct and then it obstructs common bile duct.
2) Explain the etiology/cause of choledocholithiasis. State the cause of choledocho lithiasis
Due to being stoned.
Because of obesity.
Due to stasis in gall bladder.
Caused by gall bladder dysfunction.
Due to certain types of medication.
hereditary.
Because of obesity.
Cause of biliary stasis.
Due to any inflammation.
Due to any infection.
3) Explain the sign and symptoms/clinical manifestation of choledocholithiasis. Pain in the upper part of the abdomen.
obstructive jaundice
Dark urine.
Fever.
Clay color stool.
pruritus.
Nozia.
Vomiting.
loss of appetite.
Bleeding.
steatorrhea (presence of the fat into the stool).
4) Explain the diagnostic evaluation of choledocholithiasis. Write the diagnostic evolution of coli doco lithiasis.
history taking and physical examination.
Abdominal ultrasound.
Endoscopic ultrasound.
Endoscopic retrograde chilangiography
(ERCP).
Percutaneous transhepatic cholangiography
(PTCA).
x-rays.
Ct scan.
MRI.
complete blood count.
Liver function test.
assess pancreatic enzyme level.
Assess the bilirubin level.
5) Explain the treatment of choledocholithiasis. Write the treatment of choledocholithiasis.
1) Biliary Endoscopic Sphincterotomy (BES)
=> This is mainly used to remove stones in the bile duct.
2)lethotropsy can be done.
3) Do cholecystectomy
=> Cholecystectomy is done when stones are present in gall bladder and bile duct.
4) Biliary stents
=> When surgery is not possible, biliary stenting is done to open the occlusion so that adequate drainage can be achieved.
Nursing management
Advise the patient to do moderate amount of physical activity.
Advise the patient to take fiber rich food.
Advise patient to take low fat diet.
A low fat diet reduces the risk of stone formation.
To monitor patient’s vital signs.
Assess the patient for any dehydration condition.
Monitoring the patient’s intake output.
Moisturizer after bathing to prevent itching
(moisturizer) to apply.
Keep nails short to prevent scratching.
Ask the patient to avoid bathing with hot water.