NURS-341: Patho-Pharm 2 (Module 5)

What are the major functions of the liver?

Detoxification, metabolism, bile production, protein synthesis, nutrient storage, and infection defense

Why is liver failure dangerous?

It disrupts metabolism, detoxification, clotting, and fluid regulation

What is cirrhosis?

A chronic liver disease causing cell destruction and fibrosis/scarring of hepatic tissue

What is the leading cause of chronic hepatitis and cirrhosis?

Hepatitis C

What is the second leading cause of cirrhosis?

Alcoholic liver disease

What happens to liver tissue in cirrhosis?

Healthy liver tissue is replaced with scar tissue

What are common clinical manifestations of cirrhosis?

Ascites, portal hypertension, varices, hepatic encephalopathy, coagulopathy, hepatorenal syndrome, and spontaneous bacterial peritonitis

What complication of cirrhosis affects brain function?

Hepatic encephalopathy

What complication of cirrhosis affects kidney function?

Hepatorenal syndrome (HRS)

What type of infection can occur spontaneously in patients with ascites?

Spontaneous bacterial peritonitis

What is important in the management of cirrhosis?

Laboratory and diagnostic testing

Why are diagnostic studies important in liver disease?

They help assess liver function, clotting ability, and metabolic disturbances

What labs are commonly monitored in liver disease?

Liver enzymes, bilirubin, albumin, PT/INR, ammonia, and CBC

How does cirrhosis typically begin?

Insidiously

What is often an early symptom of cirrhosis?

Fatigue

Why do many patients with cirrhosis present late in the disease process?

Many have no symptoms until advanced disease develops

What are late manifestations of cirrhosis?

Jaundice, edema, ascites, GI bleeding, bruising, and weight changes

What nursing interventions are important for cirrhosis patients?

Promoting rest, nutrition, skin care, and reducing risks for hemorrhage, fluid excess, and hepatic encephalopathy

What causes jaundice in liver disease?

Impaired liver metabolism and secretion of bilirubin

What are the manifestations of jaundice?

Yellow discoloration of the skin/sclera and itching

Why does itching occur in jaundice?

Bilirubin and bile salts accumulate in the skin

What type of malnutrition is common in liver disease?

Protein-calorie malnutrition

Why are vitamin deficiencies common in cirrhosis?

The diseased liver cannot properly store and metabolize nutrients

What is decompensated cirrhosis?

Advanced liver disease with liver failure complications

What are major complications of decompensated cirrhosis?

Portal hypertension, varices, edema, ascites, hepatic encephalopathy, and hepatorenal syndrome

What is portal hypertension?

Increased pressure in the portal venous system

What complications can result from portal hypertension?

Splenomegaly, ascites, and esophageal/gastric varices

What are esophageal varices?

Fragile, tortuous veins in the lower esophagus that bleed easily

What are gastric varices?

Enlarged veins in the upper stomach

What is ascites?

Accumulation of serous fluid in the peritoneal cavity

What causes peripheral edema in liver failure?

Low albumin levels and increased portal pressure

Where is peripheral edema commonly seen in cirrhosis?

Ankles and presacral area

What causes portal hypertension?

Increased resistance to blood flow through the liver and increased blood flow from vasodilation

What are the major complications of portal hypertension?

Ascites and gastroesophageal varices

What are common non-selective beta blockers used in cirrhosis?

Propranolol, nadolol, and carvedilol

Why are non-selective beta blockers used in cirrhosis?

To prevent initial and recurrent variceal bleeding

How do beta blockers reduce portal pressure?

By reducing cardiac output and causing splanchnic vasoconstriction

Which beta blocker is most effective at lowering portal pressure?

Carvedilol

What should the hepatic venous pressure gradient be reduced to?

Less than 12 mmHg or more than 20% below baseline

What causes peripheral edema in liver disease?

Decreased oncotic pressure from low albumin and increased portal pressure

Why does low albumin contribute to edema?

Fluid shifts from the vascular space into tissues

What is ascites?

Fluid accumulation in the peritoneal cavity

What symptoms occur with ascites?

Increased abdominal girth, weight gain, and lower extremity swelling

How is ascites treated?

Sodium restriction, diuretics, paracentesis, or transjugular intrahepatic portosystemic shunt (TIPS)

What diuretics are commonly used for ascites?

Furosemide and spironolactone

Which diuretic is potassium-sparing?

Spironolactone

Which diuretic can cause potassium loss?

Furosemide

What is albumin?

A plasma protein derived from human blood

Why is albumin administered?

To expand blood volume and maintain oncotic pressure

What conditions may require albumin administration?

Hypovolemia, hypoalbuminemia, shock, burns, sepsis, trauma, surgery, and cirrhosis with ascites

What should be monitored during albumin infusion?

Vital signs, fluid status, renal function, and electrolytes

What serious reaction can occur with albumin?

Anaphylaxis

What signs indicate fluid overload during albumin infusion?

Crackles, edema, and elevated blood pressure

Why should albumin vials not be shaken?

Shaking can damage the protein solution

How is albumin administered?

IV infusion

What concentrations of albumin are commonly available?

5% and 25%

What are common side effects of albumin?

Allergic reactions, fever, nausea, and fluid overload

What are contraindications to albumin use?

Severe anemia, heart failure, renal dysfunction, and cardiac impairment

Why do esophageal varices develop in liver disease?

Portal hypertension causes increased pressure in esophageal veins

Why are esophageal varices dangerous?

They can rupture and cause life-threatening bleeding

What emergency treatment may be used for bleeding varices?

Balloon tamponade

What nursing care is important during balloon tamponade?

Monitor bleeding, verify balloon placement by x-ray, and ensure tube patency

Why is close observation necessary with bleeding varices?

Bleeding can rapidly become fatal

What is the prototype synthetic somatostatin drug?

Octreotide (Sandostatin)

How does octreotide help GI bleeding?

It reduces blood flow to the GI tract

What conditions commonly require octreotide?

GI bleeds, variceal bleeding, portal hypertension, and cirrhosis

How is octreotide usually administered?

IV bolus followed by continuous IV infusion

What are side effects of octreotide?

Abdominal pain, nausea, diarrhea, bradycardia, blood sugar changes, and gallstones

What should nurses monitor during octreotide therapy?

Vital signs, bleeding, blood glucose, GI symptoms, and cardiac rhythm

What signs indicate improvement with octreotide?

Reduced hematemesis, reduced melena, and stable hemoglobin/hematocrit

What cardiac adverse effects can octreotide cause?

Bradycardia and arrhythmias

What IV fluid is generally compatible with blood products?

Normal saline

Why should medications never be administered with blood products?

They can cause incompatibility or dangerous reactions

What is the difference between type & screen and type & cross?

Type & screen identifies blood type and antibodies, while type & cross matches donor blood to the recipient

True or False: Platelets require blood typing.

False

How quickly can platelets and FFP usually infuse?

As fast as the patient can tolerate

How long should RBCs infuse?

Within 4 hours or less

When are PRBCs generally indicated?

Symptomatic anemia or hemoglobin below approximately 6 g/dL

How much does one unit of PRBCs typically raise hemoglobin?

About 1 g/dL

How much does one unit of PRBCs typically raise hematocrit?

About 3%

How fast should PRBCs infuse during the first 15 minutes?

Slowly at about 5 mL/min

What complication is a major concern with PRBC transfusion?

Volume overload

Why might IV Lasix be given between blood units?

To prevent fluid overload

When are platelets transfused?

To prevent bleeding in thrombocytopenia or surgery

What platelet count is considered critically low?

Less than 10,000

What platelet level should be maintained during bleeding or surgery?

Greater than 50,000

How are platelets stored?

At room temperature with constant movement

When is fresh frozen plasma used?

Coagulation factor deficiencies, bleeding, invasive procedures, DIC, TTP, massive transfusion, or warfarin reversal

What does FFP contain?

Albumin, clotting factors (especially factors V and VIII), fibrinolytic proteins, and immunoglobulins

Why is FFP considered colloidal?

It raises oncotic pressure and pulls fluid into vessels

Why should FFP be given shortly before procedures?

It has a short half-life

What causes hepatic encephalopathy?

Accumulation of ammonia and toxic metabolites

How does ammonia affect the brain?

It crosses the blood-brain barrier and impairs neurologic function

What are manifestations of hepatic encephalopathy?

Confusion, behavior changes, lethargy, coma, asterixis, and fetor hepaticus

What is asterixis?

Flapping tremor of the hands

What medication reduces ammonia levels in hepatic encephalopathy?

Lactulose

What are nursing priorities for hepatic encephalopathy?

Prevent injury, infection, and bleeding

What vasoactive medication is commonly used for variceal bleeding?

Vasopressin

What is vasopressin?

A synthetic antidiuretic hormone

How does vasopressin help control variceal bleeding?

It causes vasoconstriction in the splanchnic circulation