Liver failure

Hepatic (liver), liver failure, loss of function caused by the death of many hepatocytes. In
damage can occur suddenly, such as viral infection, or slowly over time, and cirrhosis.
Acute liver failure (ALF) is a term that refers to fulminant hepatic failure (FHF) and subfulminant liver failure. FHF occurs when suddenly (within 8 weeks from the beginning), severe liver damage caused by massive hepatic necrosis leading to decompensation of coagulopathy and encephalopathy. Subfulminant liver failure, also known as liver damage in patients with late-onset liver disease for up to 26 weeks for the development of hepatic encephalopathy. Approximately 2000 cases of FHF happens every year in the United States.

Because of the complex functions of the liver, liver failure, leading to many complications of the system. As ammonia and other byproducts of metabolism is not metabolized, it accumulates in the blood and cause neurological damage. Without regular production of vitamin K to activate clotting factors, the patient had bleeding problems. Patients with an increased risk of infection caused by general malnutrition, weakness, liver disorders of phagocytosis and the production of immune-related proteins. Fluid retention due to decrease in albumin production, leading to a reduction in colloid osmotic pressure, fluid levels are not supported. Renin and aldosterone causes sodium and water retention. Ascites occurs due to the intrahepatic vascular obstruction in the smooth movement of the peritoneum.

Complications include liver failure, bleeding from esophageal varices, hemorrhagic shock, hepatic encephalopathy, hepatorenal syndrome, coma and even death.

The main causes of FHF is viral hepatitis and hepatotoxic effects. Although viral hepatitis can lead to liver failure is less than 5% of patients with viral hepatitis is actually developed. Other causes include chronic alcohol abuse, hepatotoxic effects (especially acetominophen), acute infection or bleeding with prolonged cholestasis (biliary excretion of storage), shock and metabolic disorders. Many of them lead to liver cirrhosis, chronic liver disease, leading to widespread tissue fibrosis unit formation, and necrosis of liver tissue.

Care Plan assessment and physical examination
Get a detailed medication history, with special emphasis on hepatotoxic medications such as anesthetics, analgesics, anti-epileptic drugs, cocaine, alcohol, isoniazid (INH), and oral contraceptives. Ask any recent trip to China, Southeast Asia, sub-Saharan Africa, the Pacific islands and areas around the Amazon River, a patient with hepatitis B patient history of exposure to hepatitis A day care worker, dental staff physicians , nurses, laboratory and hospital workers are exposed are particularly vulnerable. Ask the patient if he or she had previous liver or biliary disease. Intravenous (IV) drug users and gay men at increased risk of hepatitis and failure. Those who eat raw shellfish such a risk. Initial symptoms include personality changes (anxiety, forgetfulness, disorientation), fatigue, anorexia, lethargy and mild tremor. Some patients have trouble sleeping at low temperatures. The greater the liver is destroyed, the patient is more fatigue, confusion and sleepiness. If the patient is long hepatic failure, he or she experiences jaundice, dry skin, morning nausea, vomiting, anorexia, weight loss, changes in bowel habits, and epigastric discomfort. If it happens suddenly FHF patients encephalopathy (decreased mental status, fixed facial expression), peripheral edema, ascites, and bleeding tendencies. Urine is often dark bilirubin and stool is often lighter in color due to the lack of bilirubin.

Patients with acute liver failure, jaundice usually skin and eyes. Fluid retention leading to ascites and peripheral edema. patient's face appeared, her movements were hesitant and slow speech. Usually the patient's mental condition is substantially reduced, and the smell of the liver, sweet breath of patient fecal odor. The patient may have more bruising, bleeding nose or gums bleed. The patient has a peripheral pulses racing and fast, suggesting fluid, and hyperdynamic circulation. Maybe you feel peripheral edema, dilatation of the company and less demanding in acute liver with chronic liver disease, enlarged spleen, stomach and abdomen relaxed moves dullness on percussion and a positive wave, because of ascites fluid. As ascites worsened, the patient developed a hernia, navel outwards, and an elevated heart and displaced as a result of increased diaphragm. Typically, patients with late disease, swollen neck veins, and individuals develop gynecomastia (enlarged breasts), testicular atrophy, and rarely hair. If your monitor patient vital signs, you can high temperatures and low to normal blood pressure if your doctor starts hemodynamic monitoring of cardiac output may be lower if the reduction of ascites and right ventricular filling pressure and systemic vascular resistance is low.

The patient may get angry or guilty if he or she has the illness contracted during travel. Use unbiased approach to the feelings of the patients achieved if the disease is associated with alcohol abuse. If the patient is eligible for a liver transplant patient to the emotional stability to handle the complex medical system and rely on significant others to determine.

Nursing plan, primary nursing diagnoses: Fluid volume has more to do with water and sodium retention.

Care plan interventions and treatment
Patients are managed with supportive therapy, depending on their symptoms. Fluid and electrolyte imbalance, malnutrition, ascites, esophageal varices bleeding and respiratory failure may occur with liver failure. If the patient is clinically significant hyponatremia, the patient is usually limited to IV fluids and foods that contain sodium, as sodium intake increased peripheral edema and ascites worse. Patients with ascites are usually limited to 500 mg of sodium per day. Puncture can be used to remove 6.4 L of fluid. If the refractory ascites surgical placement of peritoneal-venous shunt may be required. Hypokalaemia should usually be corrected with IV substitutes. If a patient has severe fluid imbalance, pulmonary arterial catheter is appropriate hemodynamic monitoring.

If respiratory failure, the patient may require endotracheal intubation and mechanical ventilation with supplemental oxygen. The management of nutrition in patients without signs of hepatic encephalopathy, high quality 80 - to 100-G-protein diet is to ensure cell repair. Some patients may enteral and total parenteral nutrition calories and protein level. Hepatorenal not treated with fluid restriction, maintaining fluid and electrolyte balance and withdrawal of nephrotoxic drugs. Dialysis is usually used because it does not improve survival and may lead to further complications.

If the patient develops hepatic encephalopathy, serial neurological examinations are necessary. Patients with symptoms of increased intracranial pressure or hepatic coma, the doctor gives intracranial monitoring. Some patients with liver failure are suitable for transplantation. Liver transplantation is indicated for patients with irreversible progressive disease with no alternative to liver transplantation. The liver transplantation for FHF is the mortality rate is generally higher than 80%, 5% after liver transplantation for FHF in the United States.

The most common problem in patients with liver failure is fluid volume excess. Measure abdominal circumference of patients in the same place every day and took note of the location as a basis for further measurements. Ask your doctor if the circuit is increased by 2 cm per 24 hours. The provision of water distribution three times during the night. If the patient wants liquids like ice chips. Providing care in the mouth every 2 hours. As the area of ​​the swelling is probably fragile and prone to rashes, skin care.

One of the most life-threatening complications of liver failure due to respiratory or neurological deterioration of lung function. Endotracheal intubation equipment is stored and the oral airway in bed anytime. Raise the head of the bed patient to 30 degrees and the wind to support the shoulder pads on patient work of breathing. It is important that the bed and the size of all critical systems to determine run. Field of activities and restrictions on visits, if necessary, so the patient gets enough rest. Promoting peace, non-pharmacological methods such as distraction and relaxation techniques.

The patient may be anxious, depressed, angry or emotionally unstable. Let the patient anxiety and fear of the ERP. If necessary, refer the patient to the consultant. Carefully consider applying for a liver transplant, make sure it is able to deal with complex situations. Answer all questions and explain the risks and benefits. Referring to an alcohol counselor, if necessary.

Nursing guidelines for discharge planning and home care
To teach patients prescribed sodium and fluid restrictions follow. Helping the patient to a diet plan customized solutions, including a dietician, if necessary, to make the most individually. Patient Support solution is limited to reading labels on all canned soups, sauces, vegetables and fruit, and all non-prescription medicines. Make sure the patient understood the pain medication is prescribed, including dose, route, actions and reactions. To teach the patient and the family has an increased risk of infection, good hand, others with colds and early treatment can be avoided by a caregiver during the infection. Refer the patient to alcohol support group.

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