Cirrhosis

foreign Ninja nerds in this video we're going to talk about cirrhosis if you like this video give it a thumbs up comment down below and don't forget to subscribe and then check out ninja.org where we have all of our notes and illustrations for every lecture we put up here on YouTube but let's get started with cirrhosis so when we focus on cirrhosis we're focusing on the liver right and the liver located in the right upper quadrant of our abdomen and its function and we need to talk about first what is cirrhosis specifically so cirrhosis is this fibrotic decrease in the ability for the liver to function properly so what happens so over time there is a lot of stress and chronic irreversible damage to the liver and that is what we call the scarring right so this scarring causes an impediment of the proper function of the liver and if we have to think back to our pathophysiology and think back to our anatomy and physiology what is the function of our liver what are the processes that our liver helps with we want to start thinking about our liver we people who should think of it as like the filter or it helps do all these things but what are some of those things you want to think about absorption so it's going to help us absorb it helps us do some production but what it really does is it helps us detoxify okay and we want to start thinking about how does that work so let's go back to anatomy and just go over some of the structures here really quickly of what these are and what's going on with our liver so our liver right right here it's located at the top here for us and we want to think about this being our right our right upper quadrant here and there's a couple more organs here that help with our liver function and and contribute to the liver's function the first one here being our pancreas in our pancreas does a lot of different things but what is one of the big functions of our pancreas is the production of insulin then we have the next organ over here we're going to talk about which is our spleen all right and what does our spleen do our spleen does a lot of red blood cell white blood cell platelet production one of the big things that it does contribute to the production of is essentially bilirubin if you want to break it down into a very simple format as there's Billy Rubin and we also want to talk about right here which is our stomach and our stomach does what it helps with absorption particularly the stomach helps with aspirin and alcohol absorption and then we also want to just over here generalize talking about our intestines we'll put that here so our large and small colon and this also helps with particularly water absorption all right and with all these different organs that help contribute to the blood flow to the liver we have to get this big vessel here that's helping with that blood flow to the liver and what is that called what is this vessel right here called this big one that leads into the liver it's really important is our portal vein so we have this anatomy and physiology here we have this layout of our liver all of these different organs that help contribute to the blood flow that essentially lands into the portal vein and goes up into the liver and then our liver does its processes of filtering and absorbing and taking things out and putting things in and modifying things in order for them to go to the rest of the body we need to think about what happens when we have this fibrotic scarring these nodules that start to occur within the liver because our liver has little functioning parts that when all these scars start to occur from chronic long time abuse or other type of viral illnesses we have an impediment in that blood flow and that process of the liver the liver is not able to function properly and when we look at our patients and we look at the anatomy of physiology it's for me easier to start thinking about what is happening here so then I can understand the manifestation of all the blood work and all of the signs and symptoms of our patients so let's just think for a second if we have our blood flow right and our blood flow is going from our intestine and our stomach and our spleen all those processes that are occurring and it's going up in through the portal vein into the liver and if that blood flow is being impeded if it's having some issue of flowing it's going to create some congestion right so maybe some issues and think of it as like a stampede if you've ever gone to like a big concert and you're all trying to get that cage the front row right against the stage you're run you're all running in there well at some point people start to flow out to the side and then there's eventually a backflow as people fill in essentially that is happening with the liver here as that blood is trying to go through liver but now the liver is not being being able to function as properly as it needs to there's creates kind of like a backflow and when we have that backflow we have some issues and I don't want you to think like it's completely going back to all the organs but it's creating this congestion this this impediment of flow so things aren't going to be able to flow as properly as they want to and when that happens we get some manifestations of our signs and symptoms and we'll talk about that in a little bit but why does this occur in our patient what's going on with our patient that we start to think oh they are at risk for cirrhosis one of the big ones is the easiest one people usually know is alcohol abuse right and this is chronic alcohol abuse this isn't one of those you have a wild night with your friends you feel like crap the next day and you're like I'm never drinking again that was absolutely horrible your liver will be able to work its way through that and hopefully have no little to no damage and then we will be able to live our life normally but if we are doing chronic alcohol abuse over and over again over long periods of time years and years eventually we create this fibrotic scarring nodules that are within our liver and it's not properly functioning anymore and we cannot reverse that another risk factor is going to be hepatitis specifically b c and d we can also think about other types of Damages what other things can go in and damage our liver so you can think of things like certain medications and street drugs so I just say drugs and any type of abuse like that can also cause issues or impediment within our livers function and another one that's really common is a fatty liver over time those liver cells accumulate within the liver the fatty cells accumulated within the liver and it impedes the function of our liver and then we start having chronic problems with our liver and with other organs so let's think back real quick if we're having this congestion and we start having issues with our pancreas you want to start thinking okay I'm going to have problems maybe with regulation of insulin if I'm having impediment of blood flow out of the spleen I'm going to have trouble with bilirubin right because the spleen helps with our rbcs and our white blood cells in our platelets and if our red blood cells the heme is specifically being broken down a byproduct of that is bilirubin and then we're going to have an increased amount of bilirubin within our blood you also want to think about our absorption especially with things like aspirin or alcohol and our water absorption and all of this will manifest within our patients and those signs and symptoms that we're going to be able to identify so let's go talk about those signs and symptoms now all right Engineers so now we're going to talk about the signs and symptoms of cirrhosis and unfortunately this patient right here has got basically every clinical manifestation or assignment symptom that you could possibly get from the cirrhosis of the liver so with cirrhosis we want to start thinking back to that portal vein and back to the the impediment of all the blood flow through the liver and what that could look like for all those other organs and essentially what that would look like in our patients so the biggest one that is what the NCLEX likes to hit on all the time is the hepatic encephalopathy and what does that mean so with empathic hepatic encephalopathy we're going to have issues with our ammonia within our brain and our ammonia levels are going to be really high that has to do with our liver not being able to detoxify the blood so what does that look like in our patient our patient can have things like an altered mental status okay they're going to be confused they might have some delirium they might be seeing things they're also going to have something called asterixis which is these Tremors within the hands so if they can hold their hand out straight and not have any Tremors within the hand and twitching right in within the arm here then they wouldn't have as trixes but it's this tremoring twitching within the arm it has to do with all the neural Pathways that we have within our body with that ammonia level and that Ultram mental status they're also going to have things like increase in their bilirubin because we talked about the spleen is the production site of our red blood cells and when heme is broken down from our red blood cells it creates a bypotic of bilirubin bilirubin then is not being able to be broken down so when we have that increased amount we are going to things like jaundice or ictares which is the yellowing of the whites of the eyes or the yellowing of the skin as in jaundice because of that we also have other issues with bleeding right so we want to think we're break breaking down these red blood cells the spleen's not able to produce them they're not the spleen's not going to be able to reproduce in white blood cells as well the patient's going to have some issues with platelets which we call thrombocinopedia so with that thrombocytopenia the patient's going to have issues with bleeding right so you want to look at this patient and you're going to see things like spidery angiomas on the face these these veins and vessels on the face that are looking like spiders right they're gonna have issues maybe with nosebleeds so you want to start thinking about those bleeding precautions you want to put our patients on the soft bristled toothbrush the electric razor patients are also going to have something within the esophagus what is a bleeding risk that we think about all the time with patients that could be manifesting with an esophagus you want to think of esophageal varices so we'll bring me soft varices all right and why would that occur think about that blood flow if there's an hindrance of blood flow with the liver and the blood going through the liver it actually creates a shunt sometimes to be able to shunt out blood around the liver because the liver is now this backflowing it's like a rock it's just impeding all this movement because of that it creates a lot of pressure within the esophagus and allows those vessels to be a little more engorged a little more enlarged so when that does happen now we have these very very vulnerable vessels within the esophagus that if they are to be punctured they could bleed and they can be bleeding out really quickly so with esophageal varices we want to start thinking about a patient with cirrhosis and esophageal varices they're going to bleed really quickly because again we have the destruction of the thrombocytopenia and the red blood cells and the white blood cell production being low so therefore we're going to have issues with clotting what else is going to be going on with this patient they're going to have things like pulmonary erythema where the the hands usually in women are red they're looking red and they're going to have what's the one big thing you're probably like geez can you just get to that one already is the edema right and what's going on with the edema particularly the ascites and the peripheral dependent edema the lower leg edema what's going on with that again we want to start thinking there's a lot of pressure within that portal vein it's pushing this fluid out in third spacing it when it third spaces it we're going to get that ascites within the belly and they're going to look like they're super pregnant even though it's going to be a lot of fluid third face in there and they're also going to have issues with their feet feet being really swollen so there's a way we can assess that is by that the wave test if you've never done it or you've never seen it before if you have a patient in clinical or in your hospital that does have ascites and you have a chance to go assess them check that out it's the fluid wave test where you have your patient put their hand right in the middle above their umbilicus and if you're able to tap on one side of the abdomen it should create a wave on the other side of the abdomen that's how you know it to cities so with this patient they're going to have all these manifestations but the biggest things that we're going to be focusing on is that altered mental status right so we want to think about safety the bleeding so we want to think about all the bleeding risks and then the fluid overloaded and when we start looking at this patient and we start thinking about all the messed up processes they have because of our liver being impeded we want us to think about what kind of labs are going to be abnormal and with these patients the biggest test question is usually the liver enzymes and what are the two liver enzyme tests that we have we have the AST and the alt and we also have the Alp now are these enzymes going to be high or low I think in your head they are going to be high now with bilirubin we're going to get a bilirubin number back is that going to be high or low and you're going to be saying hi why because you're expecting them to be jaundice You're Expecting expecting another terrorists with their whites of their eyes becoming yellow now what about their protein is that going to be high or low it's actually low along with albumin which is a type of protein and why is that because our body isn't able to do the processes it needs to in order to have albumin within the blood so therefore it's going to be dropping down what about our PTINR we talked about this a little bit patient is having issues with thrombin so our PT and INR is going to be prolonged or it's going to be increased meaning they're at more of a risk to bleed then we're going to have ammonia we talked about this one too they are going to be increased ammonia is increased because we are not able to do the process of detoxifying the blood getting that out of the blood and therefore as it builds up over time within the body we could start seeing those manifestations of neurological changes changes in our mentality changes in our awareness changes in our hand movements and what we're looking at there is a patient that's having a possible increase in ammonia and the last is going to be our right blood cells our hemoglobin hematocrit and our platelets those are all going to be low that again has to do with the spleen so when we look at this patient we want to start thinking about what are we going to do to take care of them if they're having all these issues we want to start thinking what are the tests that we can do to make sure that this cirrhosis is it an alcoholic induced is it a viral induced is it medication induced and then how can we help our patient out with that so let's go in to talk about these tests here when we get these blood work this blood work done we're also going to be doing a lot of these tests but we as a nurse aren't doing them is the whole team so the doc's going to order maybe an abdominal x-ray CAT scan or ultrasound depending on what's available depending on what they're thinking might be the problem and the biggest things for this is we're just going to be able to identify the what the spleen looks like is the spleen enlarged or having splatomegaly what does the liver looked like do we have a patomegaly and what else is going on we're going to be looking at that ascites within the abdomen seeing where that fluid is is it fluid how much fluid from there we want to also visualize maybe with an MRI the liver as well I want to hopefully be able to identify if there's any type of lesions or masses on the liver maybe there's something else going on that the patient is having issues with an appearance of cirrhosis but really there is something underlying going on and then we'll have one of our gold standard tests of the liver biopsy to be able to tell if we have a benign Mass if there is a mass or if it's malignant so that we can figure out what our process is here and then we also might have the EGD to be able to visualize if there's any varices within the esophagus and any other issues that might be going on because what we are looking at here and ulcers as well because what we are looking at here is trying to make sure we are just not saying our patient is Rose to the liver because of drinking we want to make sure that we are Wheeling out with our patient and identifying what is the main cause once we do this we're going to work in through our procedures depending on what these tests show if the patient needs a paracentesis which is a draining of that abdomen we're going to be able to do that we want to make sure that we do a paracentesis we are caring for our patient it's a fluid removal right so one of the big things is weights we want to make sure we are weighing our patient we're measuring the fluids we want to think I know right because we're going to be taking this fluid the ascites basically the fluid in the abdomen out they're going to be testing it because this can spontaneously get infected so I want to keep an eye on that as well patients might also have to go if the EGD shows varices they're going to be getting the endoscopic Ferris eligation hopefully putting in some pressure with on those varices that they don't have the potential to rupture they might also get a portal hypertension shunting if the patient does have that hypertension that backflow through the portal vein that's causing a lot of hypertension they can be able to put a shunt in that'll help bypass that so that patient doesn't have all the backflow to all those other organs that we talked about and then if it does really come down to it if the liver is so unsavable that we would have to do a liver transplant they would go in to get that transplant as well and these are individual procedures that we will talk about here on this channel in different videos but we're not going too in depth with them today so now let's go in and talk about what are the nursing interventions generally for a patient of suffering with cirrhosis and what is the education that you're going to be giving that patient when they do go home so now when we have a patient that we have identified has cirrhosis there's some common interventions that we can do as nurses and one of the biggest things is to be giving medication there's certain medications that we can give and we're going to run through them really quickly but we want to start thinking of these patients again as like a fluid overloaded an impedance impediment of the circulation or process with flu fluids you want to start thinking about their nutrition is going to be possibly really bad and then we're also going to think about their neuro and safety so when we look at these patients we're going to be getting medications what is a medication that we typically use to help with edema you should be saying we're going to be given things like diuretics right you want to be careful with these because patients have already impaired liver function they could potentially have an impaired kidney function as well but we want to look at how we're going to get that edema off depending on the amount of demon that they have if they didn't get a paracentesis ever are we going to be able to get that fluid off of them if they have portal hypertension or any other issues we might be using some beta blockers right and then you want to be looking at ammonia so we talked about an increased ammonia level within the patient medication that we can give to decrease that is lactulose and if you've never given this before never seen a given before this is a medication that helps the patient go to the bathroom so they're going to be taking the ammonia that's in their blood because it's so much of it it's actually going to come out in our fecal material so you want to start having a bedside commode or possibly some Chucks because sometimes patients can actually get diarrhea a real really soft stool which is a good thing because we want to get that ammonia level down and keep it down but it can be a little messy so if you've ever seen it given or when you do for the first time you're going to say wow this really does work the patient does poop a lot so we also want to think about some supplements then or anything else that is lacking for these patients so we usually give them some albumin or a folic acid folate if you will and you want to start thinking about those supplements that are going to help them as well and there's a lot of other interventions it's really Case by case these are generally the same things or very similar the things that we're going to be giving our patient and then they're also going to be on those strict eyes and O's remember they're going to have those daily weights all right they're going to have issues with their fluids or they're going to be on fluid restriction and they're also going to have those neurostatuses and you want to start thinking about those changes within the neurostatus from shift to shift is there a change right how does it work we want to be asking them what the date is today we're going to start asking them what their name is where they are okay and what is their date of birth all those things are just those simple little assessments that we can do to say this patient was fine two hours ago but something's up something's a little different here and we want to talk to our patient along with all these different strict eyes and O's and those neurostatuses and how we can talk to the family as well and say these are the things you want to look for in case maybe medication needs to be changed but one of the other big things we want to talk about with these patients is sometimes the hard conversation of what do we need to do in order to prevent this from occurring any further or getting any worse so usually there's some type of therapy they're going to need it was alcohol or if they're going to need any type of rehab okay or any type of other extensive care maybe they're gonna have to go on some type of other regimen and be seen every couple of weeks and we also want to talk to them about their diet their day-to-day diet there's a lot of things that are going on with people that have cirrhosis one of the biggest things is they usually have a decrease in appetite so one of those things is for their diet we want them to have a high calorie diet okay but we want them to have a low protein diet and you're going to say what and remember protein is something that then becomes a byproduct of protein is ammonia so we don't want them having a lot of protein because then they could create a lot of ammonia within their body and then the last thing if you're thinking about all of that fluid overload you want to start thinking about a low sodium diet now they don't have to eliminate protein and sodium but we do want them to have a limited amount of it in order to help with that byproduct of what happens when we take a lot of sodium in or we take a lot of protein into the body so I hope that made sense Mr nerds I hope you got something out of it if you did make sure to give it a thumbs up or comment down below and then as always until next time foreign [Music] [Music]

Channel: Ninja Nerd Nursing

Views: 46,506

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Id: NM1wYdQ-eZE

Length: 24min 8sec (1448 seconds)

Published: Tue Dec 13 2022