Detail Analysis on Liver Cirrhosis - Causes, Symptoms, Pharmacodynamics and Nursing Care Plan
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This document provides a detailed analysis on liver cirrhosis, including its causes, symptoms, pharmacodynamics and nursing care plan. It also discusses the impact of the disease on the patient and their family.
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Running head: DETAIL ANALYSIS ON LIVER CIRHOSSIS DETAIL ANALYSIS ON LIVER CIRRHOSIS Name of the Student: Name of the University: Author note:
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1 DETAIL ANALYSIS ON LIVER CIRRHOSIS Q1)Outline the disease, causes, incidence and risk factors. Discuss the impact of the selected disease on the patient and their family Liver cirrhosis results due to liver damage, when scar tissue replaces the healthy cells in the body. In this condition, the liver is incapable to carry out any vital activities such as production and metabolism of proteins, filtering of toxins and drugs and production of blood coagulation factors(Healthdirect.gov.au, 2019). There are many causes responsible for liver cirrhosis resulting in liver fail or damage. The common causes of liver cirrhosis includes consumption of excess alcohol, long-term infection from hepatitis C and hepatitis B, accumulation of additional fat or fatty liver, autoimmune diseases associated with liver such as autoimmune hepatitis, congenital liver diseases like haemochromatosis and alcohol-associated liver disease, which include non- alcoholicsteatohepatitis(NASH)andnon-alcoholicfattyliverdisease(NAFLD) (Betterhealth.vic.gov.au, 2019). The death rate directly linked to the alcohol consumption has decreased over years as compared to the mortality rate in 1990s. The Australian Bureau of Statistics (ABS) compared the mortality rate and recorded 5.1 demises per 100,000 Australians in the year 2017. In 2017, 1,336 death were recorded due to alcohol consumption with higher incidence in males as compared to females(Abs.gov.au, 2019). Alcohol-related liver disease is considered as the most significant sponsor in mortality gap of Australia including both females and males with an approximate age of 35-54 years. In United Nations, approximately 88,000 people die due to alcohol-associated disease. Hence, alcohol is marked as the fourth chief preventable reason of demise in United Nations (Mokdad et al., 2014). The various risk factors associated with liver leading to the condition of liver cirrhosis includes the following (Tsochatzis, Bosch & Burroughs, 2014):
2 DETAIL ANALYSIS ON LIVER CIRRHOSIS Chronic hepatitis B Chronic hepatitis C Excess intake of alcohol and cigarette smoking Autoimmuneliver sickness such as biliarycirrhosis, autoimmunehepatitisand sclerosing cholangitis. Rare inherited alcohol-associated liver disease, Wilson disease and hemochromatosis. Overweight and obesity Sustained exposure to poisonous chemicals In the case study, the patient used to smoke and consume alcohol every day. He had a previous history of drug abuse. He was also diagnosed with Hepatitis C approximately 10 years ago. These risk factors were responsible for the bad condition of James, which eventually lead to advancement of his liver impairment. With the increasing complexity of hepatocytes progression in the patient, the severity level of liver damage was increasing, which ultimately lead to symptomatic liver cirrhosis. The deteriorating health condition of the patient was effecting his and family’s quality of life, which included emotional, physical, social and financial conditions (Potosek et al., 2014). The factors such as muscle cramps, weight loss and reduced appetite had decreased the physical ability of the patient to involve with his kids activity, hence reducing his quality time with his family. As the patient was a truck driver, he was not financially sound and could possibly lose his work due to his bad health, which would have a negative impact on the care taking of his family, increasing the possibility of emotional conflict and financial strain.
3 DETAIL ANALYSIS ON LIVER CIRRHOSIS
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4 DETAIL ANALYSIS ON LIVER CIRRHOSIS Q2) discussthree (3) common signs and symptoms of the selected disease and explain the underlying pathophysiology of each. The signs and symptoms observed in the patient includes jaundiced sclera, distended and tight abdomen and oedema in ankles, visible bruises, spitting blood stained sputum and lack of appetite with weight loss (Poordad, 2015). The above-mentioned symptoms clearly demonstrated that he was suffering from liver cirrhosis. The pathophysiology of the symptom associated with the patient condition are explained as follows: Signs and Symptoms (James’s condition)Pathophysiology 1. Bruises on legs and armsIn a healthy person, the synthesis of inhibitors and blood clotting factors takes place in liver Portalhypertensionresultsin enlargement of spleen, which leads to holding of plateletsand WBC, hencereducingtheplateletand WBC count in blood (Zhou, Zhang & Qiao, 2014). The shortage of platelet count in the blood lads to bruising in the effect area of the body. 2. Jaundiced ScleraHepatocytesdamagesthe elimination of conjugated bilirubin into canaliculated bile. Thehypodermictissueslikeskin, mucousmembraneandsclera experienceexcessdepositionof bilirubin (McCance & felver, 2018). Bilirubin is considered as a waste component in blood and its excess accumulationleadstojaundiced appearance in the patient with4.9 mcg/dl of bile content 3.Distendedandtightabdomenwith oedema in ankle (ascites) Portal hypertension and hydrostatic pressure results in increase of blood circulation, which ultimately causes
5 DETAIL ANALYSIS ON LIVER CIRRHOSIS fluid build-up in peritonealcavity (Poordad, 2015). This leads to excess-production of endogenous vasodilators These vasodilators reduces the blood flowinarteries,henceactivating renin-angiotensin-aldosterone scheme and sympathetic activity In turn the expansion of total plasma volume was detected, which lead in the decline of sodium level in urine excretion thereby increasing the total plasmavolume(Kanwaletal., 2018). Oedemaandascitesformation accompaniedbyappetitelossand weight loss 4. Spluttering blood stained mucusThe blood vessel of stomach and oesophagus is enlarged due to portal hypertension. The gastric and oesophageal varices result inthinning of vessel walls, which in turn increases the blood pressurehence,thebloodvessels burstout(Moza&Margenian, 2019). Due to bursting of blood vessels, serious bleeding takes place in the stomach and oesophagus. Q3) Discuss the pharmacodynamics & pharmacokinetics of one (1) common class of drug relevant to the chosen patient. As portal hypertension stimulates formation of varices and the development of ascites, varicealhaemorrhageandhepaticencephalopathy,beta-blockersorbeta-adrenoceptor antagonists will be predominantly favourable for liver cirrhosis patients in case of portal pressure, impulsive bacterial peritonitis and bacterial translocation (Cizmarikova et al., 2019). Pharmacokinetics of beta-blockers:
6 DETAIL ANALYSIS ON LIVER CIRRHOSIS Beta-blockers are extremely lipophilic in nature, which includes metaprolol and propranolol. There are very limited bioavailability of beta-blockers. The lipophilic agents are absorbed through the gut and undergo extensive initial metabolism. The half-life of these agents are short and are designed or formulated in such a way so that they prolong the period of drug action (Mandorfer & Reiberger, 2017). They are rapidly distributed and cross the BBB. Metabolism of lipophilic drug takes place in liver. Hydrophilic nature of beta-blockers are also present, which include atenolol, sotalol, pindolo and nadolol. They are not entirely absorbed through the gut and undergo almost negligible initial metabolism. The total half-life of hydrophilic drugs are longer as compared to the lipophilic drugs. Pharmacodynamics of beta-blockers: Beta-blockers bind with and act on cardiac cells, blood vessels and bronchioles, which in turn will block the receptors of ß1 and ß2. Calcium antagonist might interact with these beta-blockers and develop serious problems like heart failure, cardiac abnormalities and hypotension. Blockage of β1-adrenoceptors inhibits the impulse stimulation in the heart, which in turn reduces the pressure, circulation and cardiac output in portal vein (Bryant & knights, 2015). While the blockage of ß2-adrenoceptors leads to vasoconstriction in the vein thusreducingbloodcirculation.Thoughbeta-blockersmightrelieveascites,portal hypertension, variceal haemorrhage and hepatic encephalopathy, it will have a negative effect on reducing the cardiac output and blood flow, which might affect the cardiac function (Smolders et al., 2018). Cardiac function is already impaired by liver cirrhosis. Hence, this adverse effect might arise in patients who are susceptible towards oral verapamil and ophthalmic blocker.
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7 DETAIL ANALYSIS ON LIVER CIRRHOSIS Q4)In order of priority, develop a nursing care plan for your chosen patient who has just arrived on the ward from ED. Nursing care plan goals, interventions and rationales must relate to the first 8 hours post ward admission The patient was diagnosed in the emergency department (ED) and in such situations, the nursing care strategy initiates using Airway, Breathing, and Circulation (ABC) sequence (Liou, 2014). The patient had a clear airway with normal respiratory rate and95% of 6L SpO2 received through Hudson Mask that is satisfactory in his stage or condition. The nursing care plan for the patient would include the risk assessment for severe haemorrhage. The aim of this care plan would be to reduce hypovolemic shock to further prevent any complication of renal failure, hepatic decomposition and bacterial infection related to internal bleeding (Mueller et al., 2014). As the patient was suffering from blood loss, the urgency of his clinical presentation will decide the treatment approaches. The patient’s immune system was weak as he was suffering from tachycardia, tachypnea and leukopenia; detail analysis was required to monitor his health symptoms and thus creating a nursing care plan to eliminate the symptoms of patient. The approved medication should be given to the patient, whichincludeantibiotics,beta-blockersandfrusemide.Nursingcareplaninvolves monitoring of patient renal output and weight in order to prevent the side effects of electrolytic imbalance and dehydration. In case the patient lack response to diuretic therapy, he will be provided with an external catheter (Halcomb & Ashley, 2019). The patient was spitting blood stained sputum since few weeks, which was due to portal hypertension in case of patient suffering from liver cirrhosis. This can further result in haemorrhagic shock, which is indicated from the pulse rate, haemoglobin count and systolic blood pressure of the patient (Qi, Han & Fan, 2014). From the patient history, it was clear that he was suffering from variceal haemorrhage as his haemoglobin, WBC, albumin and plateletscountwaslowbelowtherequiredvalues.Nursingcareplanincludesthe
8 DETAIL ANALYSIS ON LIVER CIRRHOSIS investigation techniques, which isconducted for the patient like magnetic resonance imaging, ultrasonographyandcomputerisedtomographyfordetectingtheoccurrencefocal abnormalities in case of hepatocellular carcinoma and ascites (Huber et al., 2015). It will also show the quantity of portal blood flow. In few circumstances of hematemesis, an external endotracheal tube is required to assess the consciousness level of a patient and further preventionofpulmonaryaspirationandhypoxia.Ifthepatientrequiresanysurgical approach, then the nurse should explain the entire procedure to the patient highlighting the possible risk. Before the commencement of the surgical procedure, the patient must sign an informed consent. The requirements should be ensured by the nurse before surgery, which includesmonitoringinstructedfastingcondition,propermedicationandcorrect documentation (Porter, 2018). The haemoglobin level, conscious level, renal output, and monitoring of vital signs are few important criteria, which should be assessed before the surgery. The nurse should provide support to the patient by educating the patient, providing correct information to the patient, supporting the patient, listening to the patient carefully, and evaluating the patient’s health symptoms (Moses, 2018). In this case study, the patient required a detail knowledge on his visible sign and symptoms, diagnosis, knowledge about fluid retention and hypertension, knowledge on medication and the level of progression of the disease.
9 DETAIL ANALYSIS ON LIVER CIRRHOSIS References Abs.gov.au.(2019).3303.0-CausesofDeath,Australia,2017.Retrievedfrom http://www.abs.gov.au/ausstats/abs@.nsf/latestProducts/3303.0Media %20Release62017 Betterhealth.vic.gov.au.(2019).Cirrhosisoftheliver.Retrievedfrom https://www.betterhealth.vic.gov.au/health/ConditionsAndTreatments/cirrhosis-of- the-liver Bryant, B., & Knights, K. (2015). Pharmacology for health professionals (Fourth ed.). Chatswood, Australia: Elsevier Australia. Čižmáriková,R.,Habala,L.,Valentová,J.,&Markuliak,M.(2019).Surveyof Pharmacological Activity and Pharmacokinetics of Selected β-Adrenergic Blockers in Regard to Their Stereochemistry.Applied Sciences,9(4), 625 Halcomb, E., & Ashley, C. (2019). Are Australian general practice nurses underutilised?: An examination of current roles and task satisfaction.Collegian. Healthdirect.gov.au.(2019).Cirrhosisoftheliver.Retrievedfrom https://www.healthdirect.gov.au/cirrhosis-of-the-liver Huber, A., Ebner, L., Heverhagen, J. T., & Christe, A. (2015). State-of-the-art imaging of liver fibrosis and cirrhosis: A comprehensive review of current applications and future perspectives.European journal of radiology open,2, 90-100. Kanwal, F., Tapper, E. B., Ho, C., Asrani, S. K., Ovchinsky, N., Poterucha, J., ... & Volk, M. (2018). Development of Quality Measures in Cirrhosis by the Practice Metrics Committee of the American Association for the Study of Liver Diseases.Hepatology. Liou, I. W. (2014). Management of end-stage liver disease.Medical Clinics,98(1), 119-152.
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10 DETAIL ANALYSIS ON LIVER CIRRHOSIS Mandorfer, M., & Reiberger, T. (2017). Beta blockers and cirrhosis, 2016. Dig Liver Dis., 49, 3–10. McCance, K., & Felver, L. (2018). Study guide for Pathophysiology : The biologic basis for disease in adults and children, eighth edition (8th ed.). St Louis: Elsevier - Health Sciences Division. Mokdad, A. A., Lopez, A. D., Shahraz, S., Lozano, R., Mokdad, A. H., Stanaway, J., ... & Naghavi, M. (2014). Liver cirrhosis mortality in 187 countries between 1980 and 2010: a systematic analysis.BMC medicine,12(1), 145. Moses, A. (2018). Health coaching: Empowering patients to improve health outcomes in rural Australia.Australian Nursing and Midwifery Journal,26(4), 42. Moza,D.,&Margenian,C.(2019).A62LIVERCLEANSE,ASOLUTIONOR PROBLEM?ACASEREPORT.JournaloftheCanadianAssociationof Gastroenterology,2(Supplement_2), 125-126. Poordad, F. F. (2015). Presentation and complications associated with cirrhosis of the liver. Current medical research and opinion,31(5), 925-937. Porter, K. L. (2018).Recognition of Clinical Deterioration: Does Nursing and Patient Education Improve Outcomes?(Doctoral dissertation, Grand Canyon University). Potosek, J., Curry, M., Buss, M., & Chittenden, E. (2014). Integration of palliative care in end-stage liver disease and liver transplantation.Journal of palliative medicine, 17(11), 1271-1277. Qi, X., Han, G., & Fan, D. (2014). Management of portal vein thrombosis in liver cirrhosis. Nature reviews Gastroenterology & hepatology,11(7), 435. Smolders, E. J., ter Horst, P. J., Wolters, S., & Burger, D. M. (2018). Cardiovascular Risk Management and Hepatitis C: Combining Drugs.Clinical pharmacokinetics, 1-28.
11 DETAIL ANALYSIS ON LIVER CIRRHOSIS Tsochatzis, E. A., Bosch, J., & Burroughs, A. K. (2014). Liver cirrhosis.The Lancet, 383(9930), 1749-1761. Zhou, W. C., Zhang, Q. B., & Qiao, L. (2014). Pathogenesis of liver cirrhosis.World journal of gastroenterology: WJG,20(23), 7312.