Question

List S/S of serious and life threatening abdominal pathology (for one disease) you may not use the same topic as another student; List diagnostic testing used to diagnose, what the result mean, pharmacological treatment and list a minimum of 1- nursing diagnosis with a minimum of 3 interventions.

Use at least 2 sources and cite those sources in your discussion response.

Answer 1

TOPIC IS CIRRHOSIS OF LIVER-  

Pathology of cirrhosis of liver ...It is a chronic progressive disease and irreversible destruction of hepatocytes that leads to necrosis ( cell death) then it leads to scarring ( scar is a fibrous tissue formed in place of healthy liver cells ) then scar obstruct blood flow and increase pressure with in portal vein then it leads to PORTAL HYPERTENSION...

Normal healthy liver cells ( hepatocytes) replaced by Scar tissue (fibrous tissue)

Portal hypertension is caused by liver cirrhosis .

Liver contain STELLATE CELLS / KUFFER CELL ...In normal condition Stellate cells remain dormant ...In liver injury Stellate cells become active and secrete TGF-B(Transforming growth factor B ) start forming collagen fibre and then forms SCAR.

Sign and symptoms- 1- nausea ,vomiting 2- diarrhoea ,constipation 3- right upper qudrant pain 4- hepatomegaly 5- splenomegaly 6- Oesophageal varices. 6- Haemorrhoids. 7- jaundice ( liver is not able to metabolise bilirubin) 8- dark (yellow) color urine 9- clay color stool 10- Ascites ( decrease albumin, decrease oncotic pressure ) 11-water more 3from vessels to peritoneal cavity

Diagnostic test- 1- ALT( alanine aminotransferase /transaminase) also known as SGPT (Serum glutamic pyruvic transaminase) .produce by liver .Normal level is 4-36 unit/litre

2-AST (aspartate amino transferase / aminase) also known as SGOT ( serum glutamic oxaloacetic transaminase) .produce by liver,pancreas,heart,skeletal muscles ..Normal level is 0-35 unit/litre

3- ALP( alkaline phosphate ) .produced by liver ,pancreas,kidney,intestine,bones..Normal level is 35-120 unit/litre

4-GGT(gama glutamyl transpeptidase level) .produce by liver ,pancreas ,kidney,intestine and prostate gland ..Normal level is 9- 48 unit/ litre

5- serum albumin decrease

6- PT/ INR- increase

7-serum ammonia -increase

8- serum bilirubin

9- complete blood count-decrease RBC ,decrease WBC ,decrease platelets

10- liver biopsy -it is a confirmatory diagnosis

11-CT AND USG

Pharmacological treatment- 1- vasopressin - vasoconstrictor ..control bleeding 2- propanolol- ( B- blocker ) to control portal hypertension 3- VITAMIN -K injection for coagulation 4- Antacid ,proton pump inhibitor to decrease upper GI bleeding 5- Antiemetics

6- Diuretics - potassium sparing diuretic ( spironolactone) 7- Loop diuretics 8- Lactulose ( laxative) 9- Vitamins

Nursing diagnosis -

1- Imbalance nutrition less than body requirement

Intervention- (i) measure diary intake by calorie count (ii) daily measure weight (iii)encourage client to eat all meals including suplementry feedings (iv) encourage client to take small and frequent meals

2-Excess fluid volume

​​​​​Intervention- (i)measure intake and output , weight and note gain of more than 0.5 kg/day.  (ii) monitor blood pressure .note abdominal vein distension (iii)assess respiratory status, note increasing respiratory rate and dyspnoea (iv) assess degree of peripheral oedema

3-Risk for impaired skin integrity

Intervention - (i) inspect pressure point and skin surface closely and routinly (ii) recommend elevate lower extremities (iii) assist with active and passive range of motion exercises (iv) keep linens dry and free of wrinkles

4- Risk for injury

Intervention - (i) asses sign and symptoms of GI bleeding (ii) observe for presence of petechiae , ecchymosis, bleeding from one or more site .(iii) monitor pulse, blood pressure (iv)monitor haemoglobin, hematocrit value and clotting factors