Liver subtitle style Click to edit Master

Cirrhosis
GROUP2

INTRODUCTION
The group chose the case of Liver cirrhosis to gain more knowledge about this case and to have an in depth understanding in their Medical-Surgical Nursing.

Liver Cirrhosis
Cirrhosis of the liver a chronic disease that causes cell destruction and fibrosis (scarring) of hepatic tissue. Fibrosis alters normal liver structure and vasculature, impairing blood and lymph flow and resulting in hepatic insufficiency and hypertension in the portal vein. Complications include hyponatremia, water retention, bleeding esophageal varices. Coagulopathy, spontaneous bacterial peritonitis, and hepaticencephalopathy.

Biographic Data
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Name: Mrs. C Address: Del Remedio San Pablo City Age: 61 y/o DOB: 06-07-50 Gender: Female Civil Status: Married Attending Physician: Dr. Alvin Belen Chief complaint: Body Weakness

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Clinical Data

Date of admission: Sept. 06, 2011 Room type: Private Room FW215 Time of admission: 7:15pm Chief complaint: Body weakness Ward: FW Admitting physician: Dr. Geraldine Rondilla Final diagnosis:
1. 2. 3.

Hepatic Encephalophaty, stage III Liver cirrhosis Chronic Kidney disease stage V Temp: 36.2 BP: 170/90 PR: 70 RR: 20

Vital Signs upon admission:

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PHYSICAL ASSESSMENT:
General Appearance Hair: w/ hair fall dry and coarse white and black in color Skin: dry skin yellowish in appearance Head: >Eyes: Reactive pupils to light 3mm in diameter yellowish sclera >Nose: (-) Nasal flaring with white to yellowish nasal charges w/ NGT >Mouth: with dry lips

Respiratory: >(-) DOB >with deep breathing pattern Cardio:> (-) episodes of tachycardia Gastrointestinal: with soft flabby abdomen upon palpation Genitourinary: >(+) edema @ lower extremeties both left and right and on the upper right arm >with Foley catheter connected to UB intact Musculoskeletal: with noted movements of both upper extremities With weak muscle tone

LABORATORY TESTS and DIAGNOSTICS

09-07-11

July 2, 2011

July 7, 2011

July 28, 2011

Clinical Discussion

The liver

Anatomy and Physiology of the LIVER

It is located in the upper right-hand portion of the abdominal cavity, beneath the diaphragm and on top of the stomach, right kidney and intestines. The liver, a dark reddish-brown organ that weighs about 3 pounds, has multiple functions.

The human heart is shaped like an upside-down pear and is located slightly to the left of center inside the chest cavity. About the size of a closed fist, the heart is made primarily of muscle tissue that contracts rhythmically to propel blood to all parts of the body. This rhythmic contraction begins in the developing embryo about three weeks after conception and continues throughout an individual's life. The muscle rests only for a fraction of a second between beats. Over a typical life span of 76 years, the heart will beat nearly 2.8 billion times and move 169 million liters (179 million quarts) of blood.

Functions of the HEART

The heart's duties are much broader than simply pumping blood continuously throughout life. The heart must also respond to changes in the body's demand for oxygen. The heart works very differently during sleep, for example, than in the middle of a 5-km (3-mi) run. Moreover, the heart and the rest of the circulatory system can respond almost instantaneously to shifting situations-when a person stands up or lies down, for example, or when a person is faced with a potentially dangerous situation.

PATHOPHYSIOLO Risk factors DM2 GY -DM

-Physical inability -Women >55 y/o Predisposing -HPN

Non-insulin resistance

Increase blood glucose Increase viscosity of blood

Decrease BV ejected from ventricles
Release of epinepherine and norepinephrine
Activation of RAAS Sodium and Potassium retention Water retention edema Increase blood pressure

Increase preload and after load of heart

Increase stress on ventricular wall

Contraction of myocardial muscle fiber

Diastolic blood volume in ventricle

Stretching of myocardial muscle fibers

Increase workload of heart

Myocardial dysfunction Congestive heart failure

Increase thickness of the heart muscle

Cardiomegaly

What is Congestive Heart Failure?

Congestive heart failure (CHF) is a condition in which the heart's function as a pump is inadequate to deliver oxygen rich blood to the body. Congestive heart failure can be caused by:
diseases that increase oxygen demand by the diseases that body tissue cause stiffening of beyond the the heart muscles, capability of the heart to deliver adequate oxygenrich blood.

diseases that weaken the heart muscle,

Right vs. Left Sided Heart Failure

Right Heart Failure The inability of the right side of the heart to adequately pump venous blood into the pulmonary circulation. This causes a back-up of fluid in the body, resulting in swelling and edema.

Left Heart Failure The inability of the left side of the heart to pump into the systemic circulation. Back-up behind the left ventricle causes accumulation of fluid in the lungs.

RISK FACTORS OF CHF

Advancing Age Gender Family History and Genetics Chronic Alcohol Abuse
Heart failure is the most common reason for hospitalization in the elderly, and as the population ages, the incidence of heart failure is rising dramatically. According to one report, it occurs at a rate of about 10 per 1,000 people after age 65. The positive implication is, however, that people are living longer with heart failure.

Men are at higher risk for heart failure than women, although the difference narrows with age. Women a lso have a better survival rate than men do when heart failure is caused by valvular heart disease, high blood pressure, or alcohol abuse. (Some studies indicate that this is because men may be more susceptible to the process of heart muscle-cell remodeling, a damaging effect of hypertension.)

A family history of early heart failure caused by cardiomyopathies (diseases that damage the heart muscle) may predispose people to the disease. Researchers are also looking for changes in specific genes that might regulate systems involved in heart failure and so increase susceptibility in certain populations.

Chronic alcohol abuse can damage the heart muscles, can cause hypertension, and may prove to be one cause of idiopathic dilated cardiomyopathy. Moderate alcohol consumption, on the other hand (generally defined as two drinks a day for men and one for women), may protect against heart failure. Non-drinkers, though, are not advised to begin drinking.

Medical Conditions that Increase the Risk for Heart Failure

Coronary artery disease
More than 60% of the cases of heart failure in the United States may be due to coronary artery disease and its risk factors (smoking, sedentary living, obesity).

Heart attack
The injured heart after an attack is at high risk for failure. Therefore, the improved survival rates from heart attack over the past decades have actually been responsible for the dramatic increase in heart failure rates.

High blood pressure

Hypertension is a significant risk factor and is present in 75% of patients with heart failure. (One study suggested that people with hypertension who suffer from depression are at particular risk for heart failure, possibly because depression affects the nervous system involved in regulating the heart.)

Diabetes
People with diabetes are at high risk for heart failure, particularly if they also have coronary artery disease. Even blood sugar abnormalities that precede diabetes increase the risk.

Obesity
Obesity is associated with both hypertension and type 2 diabetes, conditions that place people at risk for heart failure.

Valvular heart disease

Specific valvular conditions that are common in patients with heart failure include aortic stenosis and mitral regurgitation.

Severe emphysema
This chronic lung disease is a major risk factor for right-side heart failure.

Signs and Symptoms

Shortness of breath Fatigue Chronic Cough or Wheezing Lack of appetite or nausea

When the heart begins to fail, blood backs up in the veins attempting to carry oxygenated blood from the lungs to the heart. As heart failure becomes more severe, the heart is unable to pump the amount of blood required to meet all of the bodys needs. To compensate, blood is diverted away from lesscrucial areas, including the arms and legs, to supply the heart and brain. The fluid buildup in the lungs may result in a persistent cough or wheezing, that may produce phlegm, that may be tinged with blood When the liver and digestive system become congested they fail to receive a normal supply of blood.

Mental confusion Abnormal levels of certain substances, such as sodium, in the blood and reduced blood flow to the brain can cause memory loss or disorientation, which you may or may not be or Impaired thinking aware of. Rapid of Irregular heartbeat Fluid buildup and swelling Rapid weight gain

The heart may speed up to compensate for its failing ability to adequately pump blood throughout the body. Because blood flow to the kidneys is restricted, the kidneys produce hormones that lead to salt and water retention. The fluid build up throughout the body, may cause you to gain weight rapidly

DRUG STUDY

NURSING CARE PLAN

THE END
Arceo, Elsa Laureen Bernabe, Paula Cordova, Calvin Jun Lopez, Hera Patricia Mendoza, Jenny Mojica, Kiarra Mae Zulaybar, Anna Janella