Nursing 212

Health Differences Across the Lifespan 2 Study Guide Treatment: Medical management includes the use of an esophageal balloon tamponade with a Sengstaken-Blakemore or Minnesota tube; position the patient on right side afterwards; withhold food and fluids with active bleeding; maintain emergency measures for gastric balloon rupture by having suction and scissors available to cut tube; check for signs of bleeding; avoid activities that increase intra-abdominal pressure; assess the level of consciousness and impending encephalopathy; sclerotherapy and banding are accomplished via endoscopy; physician locates bleeding vessel via endoscope and injects a sclerosing agent (causes thrombosis and hemostasis) A hepatitic coma is caused by high ammonia levels. Give Cephalic or lactulose to decrease the ammonia level. This results in an increased level of ammonia in the stool and improved constipation. Portal hypertension: Blood from the intestines and spleen is carried to the liver thru the portal vein; cirrhosis slows the flow causing HTN. Portal hypertension leads to varices. The treatment is to control blood pressure (i.e. beta-blocker). The major complications are fluid, electrolyte, and acid base imbalances. Medications are aimed at decreasing the portal venous pressure without causing hypotension; diuretics and fluid restrictions are treatments of choice. Propranolol (Inderal), a beta blocker is used to decrease portal venous pressure. Ascites Ascites is an accumulation of plasma rich fluid within peritoneal cavity secondary to portal hypertension. Patient will have increased aldosterone and decreased oncotic pressure (from decreased circulating albumin levels called hypoalbuminemia). Assessment: abdominal distension; weight gain; increased abdominal girth; dilated abdominal veins (caput medusa); generalized edema; respiratory distress if accumulation of ascetic fluid is large Interventions: Paracentesis to remove fluid; diuretics; shunting devices (to treat portal hypertension); monitor fluid and electrolytes, give fluids as ordered; monitor daily weights and measure abdominal girth; restrict intake of protein and sodium; monitor for respiratory distress from upward pressure on diaphragm; monitor vital signs for hypotension and or tachycardia. Nonalcoholic steatohepatitis (NASH): In NASH, fat builds up in the liver and eventually causes scar tissue. This type of hepatitis appears to be associated with diabetes, protein malnutrition, obesity, coronary artery disease, and corticosteroid treatment. Blocked bile ducts: When the ducts that carry bile out of the liver are blocked, bile backs up and damages liver tissue. In babies, blocked bile ducts are most commonly caused by biliary atresia, a disease in which the bile ducts are absent or injured. In adults, the most common cause is primary biliary cirrhosis, a disease in which the ducts become inflamed, blocked, and scarred. Secondary biliary cirrhosis can happen after gallbladder surgery, if the ducts are inadvertently tied off or injured.

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