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I. INTRODUCTION A. DISEASE OVERVIEW a. OBSTRUCTIVE JAUNDICE Jaundice, (also known as icterus, attributive adjective: icteric) is a yellowish discoloration of the skin, the conjunctival membranes over thesclerae (whites of the eyes), and other mucous membranes caused by hyperbilirubinemia (increased levels of bilirubin in the blood). This hyperbilirubinemia subsequently causes increased levels of bilirubin in the extracellular fluids. Typically, the concentration of bilirubin in theplasma must exceed 1.5 mg/dL ( > 35 micromoles/L), three times the usual value of approximately 0.5 mg/dL, for the coloration to be easily visible. Post-hepatic jaundice, also called obstructive jaundice, is caused by an interruption to the drainage of bile in the biliary system. Causes:  Gallstone in the Common Bile Duct  Pancreatic Cancer in the head of pancreas  Liver flukes in the common bile duct Symptoms:  Pale stool  Dark urine  Pruritus

Diagnostic Exam:  Typical Liver Exam: o minotransferases (ALT, AST) o alkaline phosphatase (ALP) o bilirubin (which causes the jaundice) o protein levels Treatments:  Surgical removal of obstruction - generally keyhole (laparascopic) surgery or ERCP  Cease drugs suspected to be causing liver inflammation - e.g. steroids, sulfonylureas


 Liver transplantation

b. VIRAL HEPATITIS Viral hepatitis is liver inflammation due to a viral infection. It may present in acute (recent infection, relatively rapid onset) or chronic forms. The most common causes of viral hepatitis are the five unrelated hepatotropic viruses Hepatitis A, Hepatitis B, Hepatitis C, Hepatitis D, and Hepatitis E • Hepatitis A Hepatitis A or infectious jaundice is caused by hepatitis A virus (HAV), a picornavirus transmitted by the fecal-oral route often associated with ingestion of contaminated food. It causes an acute form of hepatitis and does not have a chronic stage. The patient's immune system makes antibodies against HAV that confer immunity against future infection. People with hepatitis A are advised to rest, stay hydrated and avoid alcohol. A vaccine is available that will prevent HAV infection for up to 10 years. Hepatitis A can be spread

through personal contact, consumption of raw sea food or drinking contaminated water. This occurs primarily in third world countries. Strict personal hygiene and the avoidance of raw and unpeeled foods can help prevent an infection. Infected people excrete HAV with their feces two weeks before and one week after the appearance of jaundice. The time between the infection and the start of the illness averages 28 days (ranging from 15 to 50 days), and most recover fully within 2 months, although approximately 15% of sufferers may experience continuous or relapsing symptoms from six months to a year following initial diagnosis. Symptoms can return over the following 6–9 months and include:
            

Fatigue Fever Abdominal pain Nausea Diarrhea Appetite loss Depression Jaundice, a yellowing of the skin or whites of the eyes Sharp pains in the right-upper quadrant of the abdomen Weight loss Itching Bile is removed from blood stream and excreted in urine giving a dark amber colour Feces tend to be light in colour due to lack of bilirubin in bile

Hepatitis B Hepatitis B is caused by hepatitis B virus, a hepadnavirus that can cause both acute and chronic hepatitis. Chronic hepatitis develops in the 15% of adults who are unable to eliminate the virus after an initial infection. Identified methods of transmission include blood (blood transfusion, now rare), tattoos (both amateur and professionally done), sexually (through sexual intercourse or through contact with blood or bodily fluids), or via mother to child by breast feeding (minimal evidence of transplacental crossing). However, in about half of cases the source of infection cannot be determined. Blood contact can occur by sharing syringes in intravenous drug use, shaving accessories such as razor blades, or touching wounds on infected persons. Patients with chronic hepatitis B have antibodies against hepatitis B, but these antibodies are not enough to clear the infection of the affected liver cells. The continued production of virus combined with antibodies is a likely cause of the immune complex disease seen in these patients. A vaccine is available that will prevent infection from hepatitis B for life. Hepatitis B infections result in 500,000 to 1,200,000 deaths per year worldwide due to the complications of chronic hepatitis, cirrhosis, and hepatocellular carcinoma. Hepatitis B is endemic in a number of (mainly South-East Asian) countries, making cirrhosis and hepatocellular carcinoma big killers. There are six treatment options approved by th U.S. Food and Drug Administration (FDA) available for persons with a chronic hepatitis B infection: alpha-interferon, pegylated interferon adefovir, entecavir, telbivudine and lamivudine. About 65% of persons on treatment achieve a sustained response. A few patients may have more severe liver disease (fulminant hepatic failure), and may die as a result of it. The infection may be entirely asymptomatic and may go unrecognized.

Hepatitis C Hepatitis C (originally "non-A non-B hepatitis") is caused by hepatitis C virus (HCV), an RNA virus that is a member of the Flaviviridae family. HCV can be transmitted through contact with blood (including through sexual contact if the two parties' blood is

. and recipient of multiple drug transfusion. and avoid alcohol. HCV viral levels can be reduced to undetectable levels by a combination of interferon and the antiviral drug ribavirin. Symptoms are similar to hepatitis B except that patients are more likely to have fulminant hepatitis and progress to cirrhosis. Incubation is between 15 and 65 days. The virus requires hepatitis B antigen to replicate. Hepatitis C usually leads to chronic hepatitis. Antibodies are absent. culminating in cirrhosis in some people. Patients with hepatitis C are susceptible to severe hepatitis if they contract either hepatitis A or B. chronic forms do not develop. so all persons with hepatitis C should be immunized against hepatitis A and hepatitis B if they are not already immune.mixed) and can also cross the placenta. Prevention method is through handwashing. It is common in IV drug users. Jaundice is nearly always present. incubation varies from 21 to 140 days. • Hepatitis D Occurs in some cases of hepatitis B and only patients with hepatitis B are at risk. The genotype of the virus is the primary determinant of the rate of response to this treatment regimen. with genotype 1 being the most resistant. Sexual contact is an important mode of transmission for hepatitis B and D. Onset and symptoms are similar to hepatitis A. hepatitis E is a self-limiting course with abrupt onset. hemodialysis patient. It usually remains asymptomatic for decades. • Hepatitis G Is a post-transfusion with an incubation period of 14 to 145 days. • Hepatitis E Is transmitted by fecal-oral route. Treatment are similar to that of other hepatitis. principally through contaminated water and poor sanitation.

but are sometimes white or yellow in color. On the basis of their contents.  Content: o Gallstones have different appearance. palmitate phosphate.  Pseudoliths . Cholelithiasis and Cholecystitis In medicine. depending on their contents. and biliary tract infections. gallstones (choleliths) are crystalline bodies formed within the body by accretion or concretion of normal or abnormal bile components. contain between 30% and 70% of cholesterol. They may occur in any part of the biliary system. In most cases the other majority constituent is calcium salts such as calcium carbonate. they can often be visualized radiographically. Characteristics:  Size: o A gallstone's size can vary and may be as small as a sand grain or as large as a golf ball. however. Because of their calcium content.   Mixed Stones o All stones are of mixed content to some extent. They contain less than 20% of cholesterol. cirrhosis. often large stone or many smaller ones. Those classified as mixed. The gallbladder may develop a single. gallstones can be subdivided into the two following types:  Cholesterol stones are usually green. Risk factors for pigment stones include hemolytic anemia (such as sickle cell anemia and hereditary spherocytosis). Pigment stones are small.c. dark stones made of bilirubin and calcium salts that are found in bile. and/or bilirubinate. They are made primarily of cholesterol.

thus irritating surrounding structures such as the diaphragm and bowel. predominantly E. coli and Bacteroides species. . Risk Factors: • • • • • Gender (more on women than men) Use of oral contraceptives Age (usually older than 40 y/o) Multiparous status Obesity Clinical Manifestation:  Biliary colic  Nausea  Vomiting  (+) Murphy sign Cholecystitis is inflammation of the gall bladder." they are sludge-like gallbladder secretions that act like a stone. in the gallbladder). bile stasis. with choleliths most commonly blocking the cystic duct directly.o Also known as "Fake stones. Cholecystitis is often caused by cholelithiasis (the presence of choleliths. and secondary infection by gut organisms. or gallstones. The gallbladder's wall becomes inflamed. Extreme cases may result in necrosis and rupture. This leads to inspissation (thickening) of bile. Inflammation often spreads to its outer covering.

tenderness when hand taps the edge of right costal arch.pain when press between edges of sternocleidomastoid muscle. . However. Gallstones may recur however.Murphy's sign  Ortner's sign . Gallstones can be broken up using a procedure called lithotripsy (extracorporeal shock wave lithotripsy).Clinical Manifestations:  The same as those of cholelithiasis  fever (usually low grade in uncomplicated cases)  tender right upper quadrant +/. Diagnostic Exam:   Abdominal radiograph or ultrasonography Percutaneous transhepatic cholangiography Medical options o Treatments:  Cholesterol gallstones can sometimes be dissolved by oral ursodeoxycholic acid. but it may be required that the patient takes this medication for up to two years. this form of treatment is only suitable when there are a small number of gallstones. They are then passed safely in the feces.  Georgievskiy-Myussi's sign (phrenic nerve sign) . which is a method of concentrating ultrasonic shock waves onto the stones to break them into tiny pieces. Obstruction of the common bile duct with gallstones can sometimes be relieved by endoscopic retrograde sphincterotomy (ERS) following endoscopic retrograde cholangiopancreatography (ERCP). once the drug is stopped.

Laparoscopic cholecystectomy patients can generally resume normal diet and light activity a week after release. provided the stones are accurately located by cholangiogram prior to the procedure so that they can all be removed. with some decreased energy level and minor residual pain continuing for a month or two. followed by a few days of home rest and pain medication. Laparoscopic cholecystectomy: This procedure.  . is performed via three to four small puncture holes for a camera and instruments. there is a significant portion of the population — between 5 and 40% — who develop a condition called postcholecystectomy syndrome which may cause gastrointestinal distress and persistent pain in the upper right abdomen. with a return to normal diet a week after release and normal activity several weeks after release. o There are two surgical options for cholecystectomy:  Open cholecystectomy: This procedure is performed via an incision into the abdomen (laparotomy) below the right lower ribs. However. Surgical options o Cholecystectomy (gallbladder removal) has a 99% chance of eliminating the recurrence of cholelithiasis. as many as 20% of patients develop chronic diarrhea. introduced in the 1980s. Post-operative care typically includes a same-day release or a one night hospital stay. Recovery typically consists of 3–5 days of hospitalization. Only symptomatic patients must be indicated to surgery. The lack of a gall bladder may have no negative consequences in many people. Studies have shown that this procedure is as effective as the more invasive open cholecystectomy. In addition.

5. 1957 Address: Makiling Calamba. the students will: 1. II. Laguna Nationality: Filipino Religion: Roman Catholic Diagnosis: OBSTRUCTIVE JAUNDICE T/C VIRAL HEPATITIS.L Age: 53 years old Sex: Female Civil Status: Married Birth Date: September 15. To create proper and attainable care plans for a client that has this kind of disease. To Gain knowledge about the disease. 4.E. CHOLELITHIASIS.B. SPECIFIC OBJECTIVES After the case presentation. PERSONAL DATA/PROFILE OF THE PATIENT Patients Name: M. To construct a good discharge plan for the client. To provide knowledge to the patient about his/her disease. 3. To be able to meet the right needs of the patient. 2.CALCULOUS CHOLECYSTITIS . CLINICAL SUMMARY A.

with fever of 38.CHIEF COMPLAINT: Jaundice and Tea-colored Urine History of Present Illnes: 1 week prior to admission the patient complain of having jaundice and tea-colored urine.3C.E. (+) DM M. History of Past Medical Ilness: (+)HPN – since the patient is 45 years old No known other hospitalization No known food and drug allergy No known previous hospitalization Familial History: FATHER (+) HPN.L OBSTRUCTIVE JAUNDICE T/C VIRAL HEPATITIS. CHOLELITHIASIS. (-) DM MOTHER (+)HPN. CHOLECYSTITIS . with abdominal pain radiating to the flank.

Clean and evenly distributed Inspection Inspection Equally distributed and turned outward eyelashes No signs of discharge & discoloration Normal findings states no signs of . palpation Inspection and palpation Inspection NORMS Rounded(normocephalic) smooth skull contour. alignment. resilient hair No infection and infestation FINDINGS Normocepahlic symmetrical shape Plain & smooth when palpated.Facial Features 4. Evenly distributed. uniform consistency. shape and symmetry of the skull 2. skull. EYEBROWS Hair distribution. EYELASHES Evenness of distribution and direction of curl C. Normal findings states no signs of abnormalities Dry hair may cause of stress. Presence of infection and infestation IV. absence of nodules/ masses Symmetrical facial movements Eyes are not protrude & no signs of edema Evenly distributed. symmetrical Smooth. skin quality and movement B. Normal findings states no signs of abnormalities Normal findings states no signs of abnormalities Normal findings states no signs of abnormalities Hair equally distributed and intact skin Equally distributed. slightly outward Lids close. or thinness of hair 2. hair thick Silky. May possible due to stress. Presence of edema and hollowness in the eye.HAIR 1. All movements are well procured Eyes are hollowed. C.III. Evenness of growth thickness. Texture and oiliness over the scalp 3. Presence of nodules masses and depressions 3.EYES A. Dry hair No signs of lesions on scalp ANALYSIS and INTERPRETATION Normal findings states no signs of abnormalities Normal findings states no signs of abnormalities The face have no movement as abilities Insufficient sleep. But no signs of edema. symmetrically. there is no nodules/masses upon palpation. EYELIDS Surface characteristics TECHNIQUE Inspection and palpation Inspection and palpation Inspection Inspection and palpation Inspection and palpation Inspection. curled.PHYSICAL ASSESSMENT AREA SKULL 1.

PUPILS 1. Equal in size of both eyes.color. smooth pink/red Whitish color. shiny and smooth details of iris are available transparent Black in color. ability to blink and frequency of blinking) D.and position (in relation to cornea. equally round PERRLA Yellowish color Yellowish color Indicates jaundice Indicates jaundice Inspection Inspection Sclera is yellow in color Clear and smooth in texture Indicates jaundice Normal findings states no signs of abnormalities Normal findings states no signs of abnormalities Normal findings states no signs of abnormalities Normal findings states no signs of abnormalities Normal findings states no signs of abnormalities Inspection Inspection Inspection Transparent anterior chamber Pupil size is 3mm. able to close eyes.SCLERA Color and clarity F. blinking normally abnormalities Inspection Inspection Pinkish or red in color. Size ranges from 3-7 mm. shiny. texture and the presence of lesions in the bulbar conjunctiva 2. Equal in size.VISUAL ACUITY 1.CONJUCTIVA 1. Color. Capable of light reaction (constricts when there is light) Capable of reading newsprint Inspection Able to read newsprint . Color. no yellowish discoloration Transparent. texture and the presence of lesions in the palpebral conjunctiva E. EXTRAOCULAR MUSCLES skin intact. no discharge & discoloration . capillaries sometimes evident Pinkish or red in color. shape and symmetry of size 2.light reaction and accommodation I. clear.CORNEA Clarity and texture G. Near vision K.IRIS Shape and color H.

about 10 degrees from vertical Mobile. firm and not tender. move in unison. masses and displacements of bone and cartilage VII.SINUSES Identification of the Inspection Both eyes coordinated. size or color and flaring or discharge from the nares 2. Palpation Inspection Palpation Nasal septum intact and in midline Can breathe normally No tenderness nor lesions Inspection Not tender No pain when palpated . uniform color Nasal septum intact and in midline Air moves freely as the client breathes through the nares Not tender.Eye alignment and coordination L. no lesions Moves in unison . EARS A. NOSE 1. Any deviations in shape. Nasal septum(between the nasal chamber) 3. pinna recoils after it is folded Normal voice tones audible Symmetric and straight. Patency of both nasal cavities 4. has able to follows object. symmetrical. Can see objects in the periphery Normal findings states no signs of abnormalities Normal findings states no signs of abnormalities Inspection Inspection Same color as facial skin. Texture. client can see objects in the periphery Color same as facial skin. tip of auricle aligned at the outer canthus of the eye Smooth in texture. color. no tenderness Normal findings states no signs of abnormalities Normal findings states no signs of abnormalities Normal findings states no signs of abnormalities Normal findings states no signs of abnormalities Normal findings states no signs of abnormalities Normal findings states no signs of abnormalities Normal findings states no signs of abnormalities Normal findings states no signs of palpation Inspection Inspection Loss of hearing is absence Symmetrically no discharge Inspection. symmetry of size and position 2. with parallel alignment When looking straight ahead.VISUAL FIELDS Peripheral visual fields V. client’s response to normal voice tones VI. HEARING ACUITY TESTS 1. elasticity and areas of tenderness C. AURICLES 1. no discharge. tenderness. auricle aligned with outer canthus of eye.

or excoriated areas F. moist. lumps or No tenderness excoriated areas Inspection and palpation Inspection Pink. white. ability to purse lips Uniform pink color. moist. lateral margins Pale black in color Insufficient supply of vitamins. slightly rough. movement and base of the tounge 3. GUMS Color and condition E. lumps. color and texture 2.sinuses and for tenderness VIII. position. any nodules. shiny tooth. soft. smooth. Pink and moist. smooth. raised papillae. Color and texture of the mouth floor. Tongue moves freely and no pain felt Normal findings states no signs of abnormalities Normal findings states no signs of abnormalities Normal findings states no signs of abnormalities Located and positioned in the center. smooth posterior wall Not visible. color and texture palpation B. smooth texture. number and condition and presence of dentures D. pinkish Normal findings states no signs of abnormalities Normal findings states no signs of . size. Inspection Patient has dentures Inspection Inspection and palpation Inspection and palpation Inspection and palpation Pale color. TEETH Color. and abnormalities Uniform pink color. pinkish and No swollen or inflamed No presence of discharge. Pink and with whitish color at the edge. Inspection Pink color. No palpable nodules. texture and the presence of lesions C. smooth Normal findings states no signs of abnormalities Due to loss of teeth. intact dentures Pink gums Pink color. soft. BUCCAL MUCOSA Color. elastic texture 32 adult teeth. smooth. no tenderness Pink. TONGUE/FLOOR OF THE MOUTH 1. MOUTH A. Inspection. 2. color. OROPHARYNX and TONSILS 1. color and texture. LIPS Symmetry of contour. moisture. symmetry of contour.

Muscle size and comparison on the other side 2. even in both sides No presence of tremors on the patient Presence of back pain the muscles of the patient is normally firm The muscle strength on the lower extremities is lesser than the upper.discharge of the tonsil 3. trusting quality No tenderness. does not uses accessory muscle upon breathing “lub-dub” sounds No damage on 9 or 10 cranial nerve Yellow skin color with minimal itch.gag reflex Skin Breathing Pattern Heart sounds Inspection Inspection Inspection and Auscultation Inspection. There is no presence of swelling on Normal findings states no signs of abnormalities Normal findings states no signs of abnormalities Normal findings states no signs of abnormalities Presence of pain at the surgical site. Joint swelling Inspection and palpation -Symmetric pulse volumes -full pulsation. Muscle tonicity 4. Patient can breathe normally. masses or nodules Symmetric pulse volumes no masses and nodules Normal findings states no signs of abnormalities Normal findings states no signs of abnormalities Inspection Inspection and palpation Inspection and palpation Inspection and palpation Inspection and Equal size on both sides of the body No tremor Normally firm Equal strength on each body side -no swelling The muscles is proportionate to the body. JOINTS 1.Axillary. Normal findings states no signs of . Auscultation smooth . subclavicular. Normal rhythm th th abnormalities Normal findings states no signs of abnormalities Indicates jaundice Normal findings states no signs of abnormalities Normal findings states no signs of abnormalities CAROTID ARTERIES 1. no discharge Present No redness and itch Normal breath sounds. and supraclavicular lymph nodes MUSCLES 1. Fascination and tremors in the muscles 3. She does not use accessory muscle upon breathing. Muscle strength C. Carotid artery palpation Palpation AXILLAE 1.

palpation UPPER EXTREMETIES Nails Abdomen Inspection. no pain Upper extremities are normal. and no tenderness . no presence of sweeling and pain. Palpation. Palpation -no tenderness. Percussion. Bowel movement is normal Tenderness upon palpation abnormalities Normal findings states no signs of abnormalities Indicates jaundice/anemia Liver Palpation no masses. no pain or redness the patients joint. There are no signs of tenderness in the abdomen. There is presence of surgical site with dry and intake drainage. Surgical site is on the process of healing. auscultation Inspection. swelling and nodules -joints move smoothly No swelling. Pale color Presence of Jackson Pratt and drainage. nodularity.

warm and caring. During middle age the primary developmental task is one of contributing to society and helping to guide future generations. interest in the welfare of others grows during this stage. In relation to the patient. The goal of this stage is to establish a balance between the various life areas. the individual should now be well-balanced. . DEVELOPMENTAL STAGES Sigmund Freud’s Psychosexual Development Genital Stage: Post Puberty According to Freud to achieve this state you need to have a balance of both love and work. giving guidance for them in times of trouble and also giving the best that she could give to them. she already has a family whom she tries to constantly work hard for them to have a good life. Simply having or wanting children does not in and of itself achieve generativity. Socially-valued work and disciplines are expressions of generativity. perhaps by raising a family or working toward the betterment of society.a sense of productivity and accomplishment. During the final stage of psychosexual development. In contrast. a sense of generativity . Where in earlier stages the focus was solely on individual needs. a person who is self-centered and unable or unwilling to help society move forward develops a feeling of stagnation . If the other stages have been completed successfully.results. When a person makes a contribution during this period.a dissatisfaction with the relative lack of productivity. Erik Erickson Ego Development Outcome: Generativity vs Stagnation Generativity is the concern of establishing and guiding the next generation. the individual develops a strong sexual interest in the opposite sex.V. She is a hardworking mother all day and night as well as a caring mother who always cook for her children.

as well as apply all these processes to hypothetical situations. reason logically and draw conclusions from the information available. the world is viewed as holding different opinions. individuals move beyond concrete experiences and begin to think abstractly. In this stage.The patient does most of her time working and earning money for her family. She doesn’t want to put them into harm that’s why she does everything she could in order to provide them the best possible life they could have. in return. Now that her children had finished college and now working on a decent job. and inevitable compromise. Jean Piaget: Formal operational stage The formal operational period is the fourth and final of the periods of cognitive development in Piaget's theory. . Such perspectives should be mutually respected as unique to each person or community. She has this parently instinct that she has to work hard in order to give what is enough for her family. which follows the Concrete Operational stage. The patient felt the sense of gratitude in her family that they return back all the goodness and caring that their mother has given to them. Democratic government is ostensibly based on stage five reasoning. Those that do not promote the general welfare should be changed when necessary to meet “the greatest good for the greatest number of people”. they. This stage. she extended her time for work regardless for risking her own health. rights and values. commences at around 11 years of age (puberty) and continues into adulthood. she is very proud to have such good children who gives all goodness she has given them and also takes goodness from them. Lawrence Kohlberg: Post-Conventional Stage In Stage five (social contract driven). knowing at start that she cannot give enough for her family. are caring their mother now that she is sick and needs emotional support. She is also a law-abiding citizen and doesn’t have problems with society. This is achieved through majority decision. In return. The patient. she sacrificed time for her family in order to work and make her children finish studying. Laws are regarded as social contracts rather than rigid edicts. The patient respects the rights of every people she meets. In her family.

which incorporated the restoration of the usual health status of the nurse's clients into the delivery of health care—it is still practiced today. NURSING THEORY Nightingale’s Environmental Theory Florence Nightingale (1820–1910). wrote the first nursing notes that became the basis of nursing practice and research. Environmental Factors Affecting Health Defined in her environmental theory are the following factors present in the patient's environment: • • • • • • Pure or fresh air Pure water Sufficient food supplies Efficient drainage Cleanliness Light (especially direct sunlight) . The notes.that it involves the nurse's initiative to configure environmental settings appropriate for the gradual restoration of the patient's health. listed some of her theories that have served as foundations of nursing practice in various settings. including the succeeding conceptual frameworks and theories in the field of nursing. Nightingale is considered the first nursing theorist. Environmental Effects She stated in her nursing notes that nursing "is an act of utilizing the environment of the patient to assist him in his recovery" (Nightingale 1860/1969). One of her theories was the Environmental Theory. considered the founder of educated and scientific nursing and widely known as "The Lady with the Lamp".VI. What is not (1860). entitled Notes on Nursing: What it is.

.Any deficiency in one or more of these factors could lead to impaired functioning of life processes or diminished health status.

4–1. including the synthesis and breakdown of small and complex molecules.6 kg (3. triangular organ. and detoxification. A human liver normally weighs between 1.1–3.VII. The liver lies to the right of the stomach and overlies the gallbladder. one called the hepatic artery and one called the portal vein. decomposition of red blood cells. many of which are necessary for normal vital functions. resting just below the diaphragm. . This organ plays a major role in metabolism and has a number of functions in the body. It is located in the right upper quadrant of the abdominal cavity. and production of biochemicals necessary for digestion. It lies below the diaphragm in the thoracic region of the abdomen. The liver's highly specialized tissues regulate a wide variety of highvolume biochemical reactions. Medical terms related to the liver often start in hepato. It is both the largest internal organ (the skin being the largest organ overall) and the largest gland in the human body. including detoxification. It is connected to two large blood vessels.or hepatic from the Greek word for liver. including glycogen storage. hormone production. protein synthesis. there is currently no way to compensate for the absence of liver function. plasma protein synthesis. pinkishbrown. The liver is necessary for survival. an alkaline compound which aids in digestion. hēpar (ἡπαρ). and is a soft. It produces bile. The hepatic artery carries blood from the aorta whereas the portal vein carries blood containing digested nutrients from the small intestine and the descending colon. These blood vessels subdivide into capillaries which then lead to a lobule. LIVER ANATOMY AND PHYSIOLOGY The liver is a vital organ present in vertebrates and some other animals.5 lb). Anatomy The liver is a reddish brown organ with four lobes of unequal size and shape. via the emulsification of lipids. Each lobule is made up of millions of hepatic cells which are the basic metabolic cells. It has a wide range of functions.

. The bile produced in the liver is collected in bile canaliculi. accounting for the remainder of its blood flow. which merge to form bile ducts. and its associated organs. Oxygen is provided from both sources. Bile can either drain directly into the duodenum via the common bile duct or be temporarily stored in the gallbladder via the cystic duct. Biliary flow The biliary tree The term biliary tree is derived from the arboreal branches of the bile ducts. Supplying approximately 75% of the liver's blood supply. and once they exit the liver they are considered extrahepatic (outside the liver). The cystic duct from the gallbladder joins with the common hepatic duct to form the common bile duct. gastrointestinal tract. which leave the liver and empty into the inferior vena cava. The central veins coalesce into hepatic veins. which merge to form the common hepatic duct. and half is met by the hepatic arteries. The common bile duct and the pancreatic duct enter the second part of the duodenum together at the ampulla of Vater. The intrahepatic ducts eventually drain into the right and left hepatic ducts. these ducts are called intrahepatic (within the liver) bile ducts. the hepatic portal vein carries venous blood drained from the spleen.Blood flow The liver receives a dual blood supply from the hepatic portal vein and hepatic arteries. The hepatic arteries supply arterial blood to the liver. Within the liver. Blood flows through the sinusoids and empties into the central vein of each lobule. approximately half of the liver's oxygen demand is met by the hepatic portal vein.

veins and arteries that carry fluids to and from them. . the liver is covered entirely by visceral peritoneum. From behind. there are two additional lobes between the right and left. On the surface of the lobules there are ducts. separates these two lobes from the right lobe. Lobes Traditional gross anatomy divided the liver into four lobes based on surface features. and the right sagittal fossa. The falciform ligament is visible on the front (anterior side) of the liver. and below this the quadrate lobe. Each of the lobes is made up of lobules. which the inferior vena cava runs over. but they are easily recognizable surface landmarks. double-layered membrane that reduces friction against other organs. a vein goes from the centre of each lobule which then joins to the hepatic vein to carry blood out from the liver. the transverse fissure (or porta hepatis) divides the caudate from the quadrate lobe. The peritoneum folds back on itself to form the falciform ligament and the right and left triangular ligaments. the lobes are divided up by the ligamentum venosum and ligamentum teres (anything left of these is the left lobe). and have essentially no functional importance. and a right anatomical lobe. These "lits" are in no way related to the true anatomic ligaments in joints. which attaches the liver to the posterior portion of the anterior body wall.Surface anatomy Peritoneal ligaments Apart from a patch where it connects to the diaphragm (the so-called "bare area"). This divides the liver into a left anatomical lobe. to look at it from behind (the visceral surface). These are the caudate lobe (the more superior). An exception to this is the falciform ligament. If the liver is flipped over. a thin.

The medial segment is also called the quadrate lobe. an experimental treatment for liver failure. The left lobe is divided into the medial and lateral segments by the left hepatic vein.and left-sided vascular branches.Functional anatomy The central area where the common bile duct. lactate or glycerol). The right lobe is further divided into an anterior and posterior segment by the right hepatic vein. Currently. Some functions can be emulated by liver dialysis. The plane separates the liver into the true right and left lobes. The middle hepatic vein also demarcates the true right and left lobes. Glycogenolysis (the breakdown of glycogen into glucose) o . The fissure for the ligamentum teres also separates the medial and lateral segments. Note that humans and some other mammals cannot synthesize glucose from glycerol. The functional lobes are separated by an imaginary plane joining the gallbladder fossa to the inferior vena cava. The duct. Physiology The various functions of the liver are carried out by the liver cells or hepatocytes. and hepatic artery proper enter is the hilum or "porta hepatis". Synthesis Further information: Proteins produced and secreted by the liver • • A large part of amino acid synthesis The liver performs several roles in carbohydrate metabolism: o Gluconeogenesis (the synthesis of glucose from certain amino acids. hepatic portal vein. there is no artificial organ or device capable of emulating all the functions of the liver. and artery divide into left and right branches. and the portions of the liver supplied by these branches constitute the functional left and right lobes. The caudate lobe is a separate structure which receives blood flow from both the right. In the widely used Couinaud (or "French") system. vein. the functional lobes are further divided into a total of eight subsegments based on a transverse plane through the bifurcation of the main portal vein.

methylation) and most medicinal products in a process called drug metabolism. a polypeptide protein hormone that plays an important role in childhood growth and continues to have anabolic effects in adults. creating metabolites that are added to bile as pigment (bilirubin and biliverdin). the production of triglycerides (fats). and some is stored in the gallbladder. • • • Breakdown • • • The breakdown of insulin and other hormones The liver breaks down hemoglobin.g. the bone marrow has almost completely taken over that task. The liver produces and excretes bile (a yellowish liquid) required for emulsifying fats. X and XI. the toxins are conjugated to avail excretion in bile or urine. when the metabolite is more toxic than its precursor. Thrombopoietin is a glycoprotein hormone that regulates the production of platelets by the bone marrow. V. The liver also produces insulin-like growth factor 1 (IGF-1). By the 32nd week of gestation. The liver is a major site of thrombopoietin production. protein S and antithrombin. The liver breaks down or modifies toxic substances (e. The liver converts ammonia to urea. the liver is the main site of red blood cell production. II (prothrombin).. Preferably. • . In the first trimester fetus. • • The liver produces coagulation factors I (fibrinogen).o • • Glycogenesis (the formation of glycogen from glucose)(muscle tissues can also do this) The liver is responsible for the mainstay of protein metabolism. as well as protein C. This sometimes results in toxication. IX. Some of the bile drains directly into the duodenum. synthesis as well as degradation The liver also performs several roles in lipid metabolism: o o Cholesterol synthesis Lipogenesis. VII.

Other functions • The liver stores a multitude of substances. • • • GALLBLADDER In vertebrates the gallbladder (cholecyst. a hormone that is responsible for raising the blood pressure when activated by renin. an enzyme that is released when the kidney senses low blood pressure. It is divided into three sections: fundus. which then joins the common hepatic duct to become the common bile duct. acting as a 'sieve' for antigens carried to it via the portal system. vitamin A (1–2 years' supply). iron. Microscopic anatomy The different layers of the gallbladder are as follows: • The gallbladder has a simple columnar epithelial lining characterized by recesses . The neck tapers and connects to the biliary tree via the cystic duct. Human anatomy The gallbladder is a hollow system that sits just beneath the liver. The liver produces albumin.the reticuloendothelial system of the liver contains many immunologically active cells. vitamin B12 (1-3 years' supply). the gallbladder measures approximately 8 cm in length and 4 cm in diameter when fully distended. body and neck. The liver is responsible for immunological effects. The liver synthesizes angiotensinogen. the major osmolar component of blood serum. including glucose (in the form of glycogen). In humans the loss of the gallbladder is usually easily tolerated. vitamin D (1–4 months' supply). and copper. gall bladder) is a small organ that aids digestion and stores bile produced by the liver. In adults.

plus a few other organs (like the liver and pancreas) that produce or store digestive chemicals. 1. it was demonstrated that gallbladder removed from a patient expressed several pancreatic hormones including insulin. Food is partly broken down by the process of chewing and by the chemical action of salivary enzymes (these enzymes are produced by the salivary glands and break down starches into smaller molecules). .8 imp fl oz. The digestive system is essentially a long. Most of the digestive organs (like the stomach and intestines) are tube-like and contain the food as it makes its way through the body.Function The adult human gallbladder stores about 50 millilitres (1. The authors suggest that since gallbladder and pancreas are next door neighbors during embryonic development. it was thought that insulin was only produced in pancreatic β-cells. the bile becomes more concentrated than when it left the liver. twisting tube that runs from the mouth to the anus. increasing its potency and intensifying its effect on fats. our body has to break the food down into smaller molecules that it can process. DIGESTIVE SYSTEM The human digestive system is a complex series of organs and glands that processes food. it also has to excrete waste. In order to use the food we eat.7 US fl oz) of bile. This was surprising because until then. After being stored in the gallbladder. emulsifies fats in partly digested food. In 2009.  The Digestive Process: The start of the process . stimulating the secretion of cholecystokinin (CCK). The bile. there exists tremendous potential in derivation of endocrine pancreatic progenitor cells from human gallbladders that are available after cholecystectomy. This study provides evidence that β-like cells do occur outside the human pancreas.the mouth: The digestive process begins in the mouth. which is released when food containing fat enters the digestive tract. produced in the liver.

the first part of the small intestine. bile (produced in the liver and stored in the gall bladder). and Klebsiella) in the large intestine help in the digestion process. The end of the process . Many microbes (bacteria like Bacteroides. Food in the stomach that is partly digested and mixed with stomach acids is called chyme. sack-like organ that churns the food and bathes it in a very strong acid (gastric acid). wave-like muscle movements (called peristalsis) to force food from the throat into the stomach.The stomach is a large.Solid waste is then stored in the rectum until it is excreted via the anus. In the small intestine. The esophagus is a long tube that runs from the mouth to the stomach.On the way to the stomach: the esophagus . The first part of the large intestine is called the cecum (the appendix is connected to the cecum). Escherichia coli. .After being chewed and swallowed. In the small intestine . and other digestive enzymes produced by the inner wall of the small intestine help in the breakdown of food. The food travels across the abdomen in the transverse colon. In the large intestine .After being in the stomach. In the stomach . It then enters the jejunum and then the ileum (the final part of the small intestine).After passing through the small intestine. This muscle movement gives us the ability to eat or drink even when we're upside-down. pancreatic enzymes. In the large intestine. Lactobacillus acidophilus. food enters the duodenum. It uses rhythmic. some of the water and electrolytes (chemicals like sodium) are removed from the food. Food then travels upward in the ascending colon. goes back down the other side of the body in the descending colon. and then through the sigmoid colon. food passes into the large intestine. the food enters the esophagus.

the first part of the small intestine. When you swallow. gall bladder .the part of the large intestine that run upwards. Chyme goes on to the small intestine for further digestion. cecum .food in the stomach that is partly digested and mixed with stomach acids. chyme . intestines.the last part of the small intestine before the large intestine begins. stomach.the passage through which food passes. anus . ascending colon .a small. sac-like organ located by the duodenum.(also called the GI tract or digestive system) the system of the body that processes food and gets rid of waste. intestines . gastrointestinal tract . stored in the gall bladder.a small sac located on the cecum. . the epiglottis opens so that air can go in and out of the windpipe.a digestive chemical that is produced in the liver. esophagus . descending colon . bile . and secreted into the small intestine. this is between the diaphragm and the pelvis alimentary canal . the appendix is connected to the cecum. It uses rhythmic muscle movements (called peristalsis) to force food from the throat into the stomach.the first part of the large intestine. digestive system . it is located after the cecum. the epiglottis automatically closes. appendix . duodenum . including the mouth. In human beings.the part of the alimentary canal located between the stomach and the anus. and anus. Digestive System Glossary: abdomen .the flap at the back of the tongue that keeps chewed food from going down the windpipe to the lungs.(also called the gastrointestinal tract or GI tract) the system of the body that processes food and gets rid of waste. esophagus.the long tube between the mouth and the stomach.the opening at the end of the digestive system from which feces (waste) exits the body. When you breathe.the part of the large intestine that run downwards after the transverse colon and before the sigmoid colon. It stores and releases bile (a digestive chemical which is produced in the liver) into the small intestine. epiglottis . it is C-shaped and runs from the stomach to the jejunum.the part of the body that contains the digestive organs. ileum .

Chewing and salivary enzymes in the mouth are the beginning of the digestive process (breaking down the food). Peristalsis is involuntary . It is also what allows you to eat and drink while upside-down. stomach .an enzyme-producing gland located below the stomach and above the intestines. When food enters the stomach.the part of the large intestine that runs horizontally across the abdomen. where feces are stored before they are excreted. Enzymes from the pancreas help in the digestion of carbohydrates.a large organ located above and in front of the stomach. mouth . It filters toxins from the blood. fats and proteins in the small intestine.the part of the large intestine between the descending colon and the rectum. and makes bile (which breaks down fats) and some blood proteins.rhythmic muscle movements that force food in the esophagus from the throat into the stomach. salivary glands .the first part of the digestive system. sigmoid colon .glands located in the mouth that produce saliva. it is between the duodenum and the ileum.the lower part of the large intestine.jejunum . transverse colon . Saliva contains enzymes that break down carbohydrates (starch) into smaller molecules.a sack-like. liver . Both chemical and mechanical digestion takes place in the stomach. pancreas .you cannot control it. . coiled mid-section of the small intestine.the long. rectum . peristalsis . it is churned in a bath of acids and enzymes. where food enters the body. muscular organ that is attached to the esophagus.

. vitamin K deficiency can reduce prothrombin levels. bilirubin. In long-standing cholestasis. and D). K. shellfish -Contaminated food -Poor hygiene -Poor sanitation -Injection drug use absence of bile constituents (most importantly. and lipids) in the intestines spillage into the systemic circulation Stools are often pale because less bilirubin reaches the intestine Absence of bile salts can produce malabsorption.VIII. mussels. leading to steatorrhea and deficiencies of fat-soluble vitamins (particularly A. bile salts. concomitant vitamin D and Ca malabsorption can cause osteoporosis or osteomalacia. PATHOPHYSIOLOGY Pre disposing Factors: -Gender (more on women than men) -Age (usually older than 40 y/o) -Multiparous status Precipitating Factors -Alcohol abuse -oysters.

a yellowing of the skin or whites of the eyes Sharp pains in the right-upper quadrant of the abdomen Weight loss Itching Bile is removed from blood stream and excreted in urine giving a dark amber color Feces tend to be light in colour due to lack of bilirubin in bile Cholecystitis Biliary colic Nausea Vomiting (+) Murphy sign .VIRAL HEPATITIS Cholelithiasis Fatigue Fever Abdominal pain Nausea Diarrhea Appetite loss Depression Jaundice.

(hyperglycemia) Result 2.00 mmol/L Normal Value 2.5 – 6.87 mmol/L Tests BUN Kinetic UV Cholesterol Creatinine UV Normal Value 3. Low blood creatinine levels can mean lower muscle mass caused by a disease.6 mmol/L 1. or by aging.6 mmol/L 17. MEDICAL MANAGEMENT LABORATORY EXAMINATIONS Chemtech Glucose Hexok Result 7.43 mmol/L 16.7-2.2 mmol/L 0.3 mmol/L Interpretation High blood glucose indicates that the body doesn’t have enough insulin.7-4.80 mmol/L 1.8 mmol/L Interpretation Normal Elevated cholesterol in the blood is due to abnormalities in the levels of lipoproteins. Tests Normal Value Result Interpretation . Low levels can also mean some types Direct HDL 0. Hypoalphalipoproteinemia (HA) may be caused by familial or primary and secondary disorders that are associated with low plasma levels of high-density Triglycerides LDL 0.80-6.2 mmol/L 35. such as muscular dystrophy.IX.4-150.4 mmol/L <= 5.1 mmol/L 5.40-1.674 mmol/L lipoprotein (HDL) cholesterol. Normal High blood cholesterol occurs when there is too much cholesterol in the blood. Cholesterol level is determined partly by genetic makeup and the saturated fat and cholesterol in the foods a person eat. the particles that carry cholesterol in the bloodstream.2 mmol/L of severe liver disease or a diet very low in protein.

Infectious mononeuceosis. bleeding colon cancer). If conjugated bilirubin is elevated. there may be some kind of blockage of the liver or bile ducts. trauma to the liver.34 . vitamin B12.0 12. pancreatic disorder).51-0.9-10 0.67 128. B. a drug reaction. Some of the more common reasons are loss of blood (traumatic injury.3 mmol/L 0. High SGPT level is caused by Liver inflammation (hepatitis A. nutritional deficiency (iron.5-6 5. ALCOHOL. surgery. or long-term alcohol abuse. bone marrow problems.Sodium Potassium Neutrophils 135-148 mmol/L 3.3 0.4-5. Low A high white blood cell count usually indicates: An increased production of white blood cells to fight an infection A low hematocrit is referred to as being anemic.9 mmol/L 0.37-0.1 umol/L 4.3 6.5 mmol/L 3. Damage or inflammation of tissues can also lead to a high neutrophil count.4 umol/L 4. SGPT Total Bilirubin Direct Bilirubin Erythrocyte Leukocyte Hematocrit 0-49 U/L Up to 17 umol/L Up to 5. cirrhosis. hepatitis. and abnormal hematocrit (sickle cell anemia). acute viral fever. C.37 94 U/L 18. Another cause is a sudden infection from bacteria. folate).76 Low sodium level may caused by water-electrolyte imbalance and blood conditions Normal Sudden kidney failure can cause a high neutrophil count.

There is no focal lesion seen.1cm shadowing echogenic foci seen with gallbladder fossa exhibiting the wall-echoshaddow complex. The right and left intrahepatic ducts and common bile duct (1. The gallbladder is contracted. (ms): P/QRS/T Int.(ms) : QT/QTc Int. . -Mild patty liver -Intra and extrahepatic biliary tract obstruction secondary to choledocholithiasis -cholelithiasis ECG Vent.14 0. There is a 4.4 x 2. Findings: massive adhesive noted at cholecysto.91 131 161 87 14 0. There is a 1.1 cm echogenic focus in the proximal common bile duct.17 Open Cholecystectomy with choledoscopy with T-tube chole.Ultrasound of hepatobiliary tree: The liver is normal in size with homogenous parenchymal echopattern.13 0. Its ecogenicity is increased.(mV): 80 146 108 415 40 0. duodenal and cystic ares with huge stone 1 at the CB fundus and 1 at the proximal (CBC) GBL. PR Int.7 cm) are dilated.(ms): 358 P/QRS/T axis (deg): RVI/SV5 amp(mv): RV5/SVI Amp. The hepatorenal angle and inferior edge sharpness are maintained.

headache Nursing Management > Use drug only after diet and other non-drug therapies prove ineffective. serum LDLs. flatulence. Indication > Antilipidemics > In hyperlipidemia: an adjunct to diet to C.of serum hypercholesterolemia lactation. Porphyria. dyspepsia. apolipoprotein B & TG in patients w/ primary Contraindication > Active liver disease or unexplained persistent elevations transaminases. the enzyme that catalyzes the first step in the cholesterol synthesis pathway. LDL-C. > Obtain liver function test results at start of therapy and then periodically. . > Instruct patient to take drug with the evening meal reduce elevated total.DRUG STUDY Drug Simvastatin 20mg 1TAB OD Action Inhibits HMG-CoA reductase. > Pregnancy & Side Effects Constipation. resulting in a decrease in serum cholesterol. and either an increase or no change in serum HDLs.

diarrhoea. traumatic. . abdominal pain. Nursing Management > Assess patients who develop severe diarrhea and vomiting for dehydration and electrolyte Imbalance. dental. bactericidal Indication > Fluoroquinolones > UTI Contraindication Hypersensitivity to ciprofloxacin or other quinolones Side Effects Nausea. Childre n <14 yr. dizziness.antipyretic.Drug Ciprofloxacin 500mg BID Action Inhibits bacterial DNA synthesis. mainly by blocking DNA gyrase. vomiting. anorexia. tiredness. vomiting or abdominal pain Headache Dizziness Drowsiness Skin rashes Visual disturbances Nursing Management > Obtain specimen for culture and sensitivity test before giving first dose > Monitor I&O Drug Mefenamic acid 500mg 1 TAB BID Action Aspirin-like drug that has & anti-inflammatory activities Indication Relief of pain including muscular. flatulence. post-op & postpartum pain. diarrhoea. agitation. nausea. > Monitor blood glucose for loss of glycemic control if diabetic. analgesic. trembling Side Effects Disturbances of the gut such as indigestion. headache & in childn w/ fever & juvenile RA. Pregnancy. dyspepsia. constipation. headache. rheumatic. Contraindication Ulceration in the upper or lower intestinal tract. Also for the relief of primary dysmenorrhea.

vertigo. GI upsets. dizziness.Drug Nalbuphine 10mg TIV PRN for severe pain Action Indication Nalbuphine HCl has Relief of moderate the effect of lowering the cardiac work load and can be used immediately in myocardial infarction (use with caution where emesis is involved). Contraindication Patients who are hypersensitive to nalbuphine HCl. type/ onset of symptoms & anticipated. Post-op somatic & visceral pain. as a supplement to balanced anesth. for obstet analgesia during labor & relief of pain following MI. Infrequently sweating. > Document indications for therapy. Hemodynamic studies in patients with severe arteriosclerotic heart to severe pain . headache. Nursing Management > Note general client condition. Side Effects Sedation. surgical anesth. > Monitor V/S & I&O. dry mouth. allergic reactions. Pre-op analgesia. .

urticaria.Drug Diphenhydramine 50mg Tcap for pruritus Action Antihistamine that reduces allergic reactions. pruritus. vasomotor rhinitis. motion sickness and vertigo (dizziness and loss of balance). other allergic dermatoses. lactation Side Effects CV & CNS effects Blood disorders GI disturbances Antimuscarinic effectsAllergic reactions Nursing Management . food sensitivity. contact dermatitis. and Parkinson's disease Indication Hay fever. motion sickness Contraindication Premature & newborn infants. asthma attack. serum & penicillin reaction. atopic eczema. parkinsonism. drug sensitization. angioneurotic edema.

Galactosemia deficiency. vomiting.diarrhea. with hepatic encelopathy: regularly assess mental condition >monitor I & O >monitor for Inc. glucose level in diabetic pts . >Assess for adverse reactions >for pt. Side Effects Abdominal discomfort associated with flatulence and intestinal cramps. nausea.Drug Lactulose 30cc OD HS Action Inhibits bacterial DNA gyrase thus preventing replication in susceptible bacteria Indication Constipation. Treatment of hepatic encephalopathy Contraindication Pt who require a low lactose diet. Intestinal obstruction. diarrhea on prolonged use. Nursing Management >Assess condition before therapy and reassess regularly thereafter to monitor drug’s effectiveness >Monitor pt for any adverse GI reactions.vomiting. salmonellosis. Nausea.

cirrhosis. Contraindication Side Effects Unknown. Nursing Management Drug HNBB 10mg 1 TAB Action Indication Contraindication Side Effects Nursing Management . 2. 5.5mg (Vitamin B2) Liver extract antitoxic fraction 12. fatty liver.125mg (Vitamin B12) Pyridoxine HCl 25mg (Vitamin B6) Riboflavin 0.Drug Godex 2 caps BID Is a combination of: Adenine HCl 2.prevents fat accumulation and protects cell membrane integrity. increases nucleic acid synthesis and mtDNA copy number for repair of mitochondria. druginduced hepatitis. mitochondrial dysfunctions. provides efficient mitochondrial energy system.5mg (liver-protecting substance from the liver of cattle) Biphenyl Dimethyl Dicarboxylate 25mg (used to protect against chronic alcohol toxicity).restores elctron balance for greater energy supply. Indication acute & chronic hepatitis. 3. detoxifies acyl groups and ROS. general & alcoholic intoxication. Action hepato-protectant 1. 4.5mg (Vitamin B4) Carnitine orotate 150mg (antioxidant) Cyanocobalamin 0.


. To develop new skills and to cope with changes family understanding of current role obligations. the patient will: Be able to adapt to changes in role performance Nursing intervention Short term: Interview client regarding perceptions on inability to perform usual role in the family Assist client in developing strategies dealing with changes in role Encourage client to use techniques of role rehearsal Long term: Make information available for client about role expectations Emphasize to relatives the importance of accepting client in a changed role - Rationale series To evaluate factors that may influence client’s view on self Evaluation After conducting of nursing interventions.Assessment Subjective: “nanghihina ako at hindi halos makakilos” Objective: Body malaise Facial grimace Irritability Limited ROM Presence of post-operative site at the abdomen Nursing Diagnosis Ineffective role performance related to fatigue as evidenced by decreased level of activities. Planning After conducting nursing intervention. the patient was able to adapt to changes performance evidenced by role in role as client’s and acceptance in changes in To help client deal with current changes in role performance Goal met. To provide proactive opportunities in dealing with changes To provide reinforcement to client and facilitate continuation of efforts. - Be able to verbalize understanding to changes of role obligations.

- Planning After conducting nursing intervention. - moving Encouraged client to have diversional activities Long term: Refer client to rehabilitation program Discuss therapy regimen To improve stamina and sense of well-being To inform the client about continuance of care To refocus energy and diminish feeling of anxiety that can accompany fatigue .Assessment Subjective: “nanghihina ako at hindi halos makakilos” Objective: Body malaise Facial grimace Irritability Limited ROM Presence of post-operative site at the abdomen Nursing Diagnosis Fatigue related to post surgical procedure as evidenced by patient’s increased complaints and guarding behaviors. - Be able to participate in recommended treatment program. the patient will: Be able to report improved sense of energy Be able to perform ADLs at level of own ability Nursing intervention Short term: Obtain client’s description of fatigue Encourage client to do simple activities if possible Encourage client to have adequate sleep Encourage client to use assistive devices when - Rationale Evaluation After conducting To evaluate impact on client’s daily living activity as tolerated series was able by of to nursing decrease report of interventions. willingness to participate in continuation of therapeutic regimen. the patient To increase level of fatigability as evidenced client’s improved level of energy and activity as well as To reduce fatigability and regain energy To conserve body’s energy Goal met.

bile is corrosive to the After 8 hours of nursing skin to monitor interventions the patient’s reported pain 4. color bleeding.ASSESSMENT Subjective: DIAGNOSIS PLANNING INTERVENTION Independent: connect tubes RATIONALE EVALUATION Longterm: Impaired skin integrity Long Term: “Masakit yung tahi ko at related to altered biliary -After 14 days of nursing 1. Objective: biliary drainage -disruption of skin. will improve to 1. -yellow skin -yellow sclera -pain scale of 6/10 -with facial grimace -irritable Background Knowledge If the bile is not properly -After 8 hours of nursing drain it will leak into the interventions the patient’s 3. complications such as >Goal met of subhepatic space and will reported pain and itching frequently itching sensation. as verbalized by the incision patient. document amount. . to facilitate drainage >Goal met Short term: dressing 3. measure bile collected 4. the patient drainage receptacle and biliary secure tubing. Short Term: semi-fowlers position change of bile 2. the patient improved biliary drainage as evidenced by brown colored stool medyo nangangati ako” drainage after surgical interventions. elevate drainage as evidenced by above the abdomen brown colored stools. -insertion of T-tube for Bile is corrosive to skin. to avoid kinking After 14 days of nursing interventions. every and drainage 24 character for and itching was relieved. produce jaundice and will be relieved. hours. place patient in low 2.

5. short it prevents skin fingernails smooth and excoriation and infection from scratching removes waste 6. prescribed pharmacological for pain and diphenhydramine as management and itching . administer analgesic 1. provide frequent skin 6. Dependent: 1. and lotions care. avoid use of soap products from skin while alcohol-based preventing dryness of skin. keep patient’s 5.

Objective: -yellow skin -yellow sclera -abdominal pain -pain scale of 6/10 -with facial grimace -irritable ako” by DIAGNOSIS PLANNING INTERVENTION Independent: RATIONALE EVALUATION Long Term: 14 days of nursing interventions. u/L SGOT: ) Background Knowledge Hepatitis A virus -After 8 hours of nursing via the fecal-oral route will and agent leads The to hepatic understanding injury. encourage the client to 3. stress the importance 2. importance of hand elevations in serum liver liver failure as evidenced function test (SGPT: 94 by liver function studies. up an inflammatory in the process 3. Short Term: conscientious individual hygiene c. proper community and home sanitation b. and sets prevent HAV infections. avoidance of raw of meat and seafood causative individual risk factors that invades the contribute to possibility of 2. the patient to prevent exposure such HAV infections jaundice and marked will be free of signs of as: a. to reduce incidence of -After the infection as evidenced by interventions.ASSESSMENT Subjective: “Naninilaw verbalized patient. Risk for impaired liver Long Term: as function related to viral -After 14 days of nursing 1. Short Term: -After 8 hours of nursing interventions the patient verbalized of to liver HAV avoiding drinking liver damage individual risk factors that contribute of possibility by liver function studies SGPT: infection is transmitted interventions the patient hygiene d. replicates. to reduce severity of understanding alcohol mononuclear cells in the liver damage and ways to of liver. educate client on ways 1. fat interferes with damage and some ways avoid fatty foods normal function of liver to prevent parenchyma and portal . verbalized the patient was free of signs of liver failure as evidenced SGOT: .

for dietary needs including intake of protein and vitamins medications known to cause hepatoxicity accumulation of necrotic tissue in the lobules and portal ducts.ducts. liver cells when they cooked meats. and the liver regenerates within 2 to 3 months. . to promote healing indicated. some medications are client’s regimen Collaborative: 1. discuss safe use of 4. refer to nutritionist. as 1. can no longer regenerate 4. occur with Cellular regeneration and cellular necrosis. cell causing necrosis. hepatic cellular and cells and can cause infections such as hand to washing and eating additional damage collapse. This results in interference with bilirubin mitosis simultaneously excretion.

> Provide nonpharmacological Therapies such as listening to Radio and Socialization w/ others. of nursing intervention patient will be able to reduce anxiety. Rationale > To establish baseline data. as evidence by fear of consequence. Intervention > Assessed patient’s level of anxiety. As verbalized by the patient. Planning Short term: At the end of 3Hrs. patient was able to accept /understand his > Can lessen the anxiety of the patient. > Provide health teaching about hepatitis disease. . > To give more information about his health status. Evaluation Short term: At the end of 3Hrs. Long term: After two weeks of nursing care. > To help the patient have adequate period of rest and sleep. of nursing intervention patient was able to reduce feeling of anxiety. Objective: Vital signs taken and recorded: BP: mmHg PR: BPM RR: CPM Temp: Nursing Diagnosis Anxiety related to change in health status. > Placed patient in comfortable position.Assessment Subjective: “Nahihirapan ako ngayon sa sakit ko”. health status. > To relax & provide comfort to the patient. patient will be able to accept changes in health status. Long term: After two weeks of nursing care. > Provide calm activities.

-Recommend /provide small. Consider preferences in food choices. -Encourage frequent mouth care. . Patient may eat better if family is involved and preferred foods are included as much as possible. Evaluation Short term: At the end of 3Hrs. less than body requirements inadequate diet. Encourage patient to eat all meals. of nursing intervention patient will be able to verbalize understanding of causative factor Long term: Intervention -Assessed the clients risk for malnutrition -Assessed clients Weight daily and compare the recent weight history. Restrict intake of caffeine. measurements. generalized weakness. which contributes to anorexia. explain reasons for the types of diet. frequent meals. -Assisted /encouraged patient to eat.Patient is prone to sore and/or bleeding gums and bad taste in mouth. inability to process/digest nutrients Planning Short term: At the end of 3hrs.Assessment Subjective: Madalas wala akong ganang kumain dahil ang sama ng panlasa patient Nursing Diagnosis Nutrition: imbalanced. especially before meals. ko as verbalized by the related to Objective: Weight loss (+) Wt: After two weeks of nursing care. -to avoid of loss of interest in food or because of nausea. malaise. of nursing intervention patient was able to verbalize understanding of causative factor Long term: After two weeks of nursing care. patient will be able to display normalization of laboratory values and be free of sign of malnutrition . Rationale -to assess causative factors -To establish baseline parameters -Improved nutrition/diet is vital to recovery. patient was able to accept /understand his health status. gas-producing or spicy and excessively hot or cold foods.

• Ensure that the environment is conducive for relaxation to promote optimal healing to patient after hospitalization. • Discuss to client as well as to the relatives the side effects and/or adverse reactions of the medications prescribed. CUERDO) • Advise client to have a strict compliance to home medications. Medications should be taken regularly as prescribed by the physician.DISCHARGE PLAN Medications (DEÑA. making sure that the purpose of medication is fully disclosed by the health care provider to ensure safety. Exercise: • • • Treatment • Encourage client to ambulate as much as possible to increase activity tolerance Advise client to avoid strenuous activities to reduce fatigue Instruct client to do simple ROM exercises as tolerated to improve body movements Begin light exercise immediately such as walking . DE JESUS. Environment and/or Exercise Environment: • Environment should be kept hazard free and clean so that it may facilitate continuous recovery of the client.

Teach the patient about the proper care of drainage tube Emphasize the importance of hand washing. .• • Health Teachings • • • • • • Out patient Diet • • 2. usually for 1 week. Do not pull them off. Check incision site daily for signs of infection like redness and pus formation. sitting upright in bed or chair to manage pain 4. Allow adhesive strips on the incision site to fall off or put alcohol on it when removing. Wash the incision site with mild soap and water 3. keep the dressing clean and dry Avoid lifting objects exceeding 5 pounds after surgery. safe water supply and proper control of sewage disposal.