2. LEARNING OBJECTIVES: After 2 hours of active lecture discussion, the students will be able to: Define liver Cirrhosis Enumerate the different types of liver cirrhosis Enumerate the predisposing/ contributing factors of liver cirrhosis Discuss the pathophysiological changes and clinical manifestations of patients with liver cirrhosis Formulate possible nursing diagnoses applicable for patients with liver cirrhosis Enumerate nursing interventions applicable for each identified nursing diagnosis Integrate Christian Values in rendering nursing care for clients with liver cirrhosis MTCAT '10
3.
4. Liver Cirrhosis Types: Alcoholic Cirrhosis ( Laennec’s Cirrhosis) Most common type of liver cirrhosis Caused by chronic alcoholism Postnecrotic cirrhosis Late result of a previous bout of acute viral hepatitis Biliary cirrhosis Resulted from chronic biliary obstruction and infection Least common type MTCAT '10
55. inability of the liver to metabolize substances that can be toxic to the brain such as ammonia, which is produced by the breakdown of protein in the intestinal tractMTCAT '10
56. Pathogenesis of Hepatic Encephalopathy BRAIN LIVER Toxic N2 metabolites From Intestines MTCAT '10
73. early signs of encephalopathy (restlessness, slurred speech, dec. attention span)MTCAT '10
74.
75. the portal venous pressure causes blood to be forced into these vessels – become tortous and fragile
76. blood vessel become prone to injury by mechanical trauma from ingestion of coarse food and acid pepsin erosion which may result in bleeding
77. bleeding may also occur as a result of coughing, vomiting, sneezing, straining at stool or any physical exertion that abdominal venous pressure MTCAT '10
85. Possible Nursing Diagnoses Activity intolerance R/T fatigue, lethargy, and malaise Imbalanced nutrition R/T abdominal distention and discomfort, and anorexia Impaired skin integrity R/T pruritus from jaundice and edema High risk for injury R/T altered clotting mechanisms and altered LOC Disturbed body image R/T changes in appearance, sexual dysfunction, and role function Chronic pain R/T enlarged tender liver and ascites Fluid volume excess R/T ascites and edema formation Ineffective breathing pattern R/T restriction of thoracic excursion secondary to ascites and abdominal distention MTCAT '10
86.
87. eliminate ingestion of toxic substances to the liver: sedatives opiates, alcohol, acetaminophen
104. ASSIGNMENT: Answer situation #4 in critical thinking exercises, Brunner & Suddarth’s Textbook of Medical-Surgical Nursing, 11th Edition, 2009 Page 1341 WRITE your answers in a whole sheet of yellow paper MTCAT '10