FONP 3B: Person-Centred Practice, Liver Cirrhosis, and Planetary Health

A set of vocabulary flashcards covering person-centred care, the pathophysiology and management of liver cirrhosis (specifically the Jennifer Lawson case), and the impact of planetary health on nursing practice.

Person-centred practice

An approach to healthcare shaped by the interplay between individual, personal, contextual, and political attributes, emphasizing mutual respect, self-determination, empowerment, and healthfulness.

Person-Centred Practice Framework: Pre-requisites

The attributes of the practitioner, including professional competency, developed interpersonal skills, knowing self, clarity of beliefs and values, and commitment to the job.

Kupffer cells

Liver macrophages that serve as immune cells to filter blood, assist in tissue repair, and clear pathogens.

Hepatocytes

The main functional cells of the liver, comprising $80\%$ of its mass, responsible for metabolizing carbohydrates, lipids, and proteins, and detoxifying the blood.

Hepatic stellate cells

Cells that store vitamin A in a healthy liver but release cytokines when the liver is damaged.

Myofibroblasts

Cells that produce collagen; during inflammation, they produce excess collagen, leading to build-up in connective tissue.

Liver parenchyma

The functional tissue of the liver, which makes up $80\%$ of the organ's volume.

Fenestrations

Complex structures in the liver that filter blood for detoxification; these are lost during the development of liver cirrhosis.

Liver cirrhosis

A condition where functional liver tissue is replaced by non-functioning scar tissue, disrupting blood flow, bile flow, and metabolic function.

Portal Hypertension

Increased resistance to flow in the portal venous system with sustained pressure levels reaching $22\,mmHg$ (normal is $5-10\,mmHg$).

Esophageal varices

Swollen, twisted veins in the esophagus caused by portal hypertension; they have thin walls and are at high risk of rupturing.

Ascites

The accumulation of fluid in the peritoneal cavity, often exceeding $15\,L$, due to increased hydrostatic pressure and low albumin levels.

Hepatic encephalopathy

A condition where waste products like ammonia circulate to the brain because the liver cannot detoxify them, leading to confusion and altered mental status.

Asterixis

A clinical sign associated with hepatic encephalopathy, often described as a flapping tremor of the hands.

Albumin

A plasma protein that pulls water into the bloodstream to stop fluid from leaking into body tissues; low levels contribute to edema and ascites.

Unconjugated bilirubin

A fat-soluble version of bilirubin that travels to the liver to bind with albumin; high levels indicate liver damage or reduced bile flow.

MASLD (Metabolic dysfunction associated steatotic liver disease)

A condition where fat accumulates in hepatocytes due to metabolic dysfunction, highly prevalent in individuals with obesity ($70-80\%$) and $T2DM$ ($60\%$).

Fibrosis 4 score test

A diagnostic tool that uses age, platelet count, AST, and ALT to determine liver damage; a score greater than $2.67$ indicates high risk.

Spironolactone

A potassium-sparing diuretic and aldosterone antagonist used to treat edema by inhibiting sodium retention and potassium secretion.

Furosemide

A loop diuretic that inhibits the reabsorption of sodium and potassium to treat edema, but requires monitoring for dehydration and gout.

Lactulose

An osmotic laxative fermented by gut bacteria into acidic byproducts that trap ammonia as ammonium for excretion from the bowel.

SPIKES

A six-step strategy for breaking bad news: Setting, Perception, Invitation, Knowledge, Emotion, and Strategy.

ISBAR

A communication framework used for handovers, representing Identification, Situation, Background, Assessment, and Recommendation.

Sustainable Development Goal 13

A global goal calling for urgent action to combat climate change and its impacts.

Transjugular intrahepatic portosystemic shunt (TIPS)

An emergency procedure for severe portal hypertension that forms a mesh channel in the liver for blood to return to systemic circulation.