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Regine C.

Sulib BSN-III
Cirrhosis
Cirrhosis is a chronic disease characterized by replacement of normal liver tissue with diffuse
fibrosis that disrupts the structure and function of the liver
Three major forms:
Laennecs (alcohol induced) Cirrhosis- This is the most common form of cirrhosis and
results from chronic alcoholism and malnutrition.
Postnecrotic (micronodular) Cirrhosis- I w/c there are broad brands of scar tissue.
Biliary Cirrhosis- result from chronic biliary obstruction and infection
Causes:
Excessive alcohol intake
Nutritional deficiency (reduce protein intake)
Exposure to chemicals ( carbon tetrachloride, chlorinated naphthalene, arsenic or
phosphuros)
Signs and sypmtoms
Compensated:
Intermittent mild fever
Vascular erythema (reddened palms)
Unexplained epistaxis
Ankle edema
Vague morning digestion
Flatulent dyspepsia
Abdominal pain
Enlarged liver
Decompensated:
Ascites
Jaundice
Weakness
Muscle wasting
Weight loss
Continuous mild fever
Clubbing of fingers
Purpura
Spontaneous bruising
Epistaxis
Hypotension
Spars body hiar
White nails
Gonadal atrophy
Diagnostic Evaluation:
Elevated serum liver enzyme levels
Reduced serum albumin and cholinesterase level
Liver biopsy
Liver scan
Bilirubin test
Prothrombin test
CT scan
Paracentesis
Medical Management:
>Surgical Intervention
Transjugular intrahepatic portosystemic shunt
Orthotopic liver transplantation may be necessary.
Pharmacologic Highlights:
Antacids
Vitamins and nutritional supplements
potassium-sparing diuretics
Pain medications and antiemetics.
I.V albumin to maintain osmotic pressure and reduce ascites.

Nursing Interventions:
Observe stools and emesis for color, consistency, and amount, and test each one for
occult blood.
Monitor fluid intake and output and serum electrolyte levels to prevent dehydration
and hypokalemia.
Maintain some periods of rest with legs elevated to mobilize edema and ascites.
Encourage and assist with gradually increasing periods of exercise.
Encourage the patient to eat high-calorie, moderate protein meals and supplementary
feedings. Suggest small, frequent feedings.
Administer or teach self-administration of medications for nausea, vomiting, diarrhea or
constipation.
Keep the patient quiet and limit activity if signs of bleeding are evident.
Encourage the patient to eat foods high vitamin C content.
Protect from sepsis through good handwashing and prompt recognition and
management of infection.
Pad side rails and provide careful nursing surveillance to ensure the patients safety.
Stress the importance of giving up alcohol completely.
Involve the person closest to the patient, because recovery usually is not easy and
relapses are common.
Balananced diet



Diverticulitis
Food and bacteria retained in a diverticulum produce infection and inflammation that can
improve drainage and lead to perforation or abscess formation
Cause:
Low fiber diet
Constipation
Trapped organisms
Age
Signs and symptoms:
Chronic constipation
Nausea
Anorexia
Abdominal distention
Cramps and narrow stool
Weakness and fatigue
Bloating or gas
Complications:
Abscess, perforation, and peritonitis
Fistula (an abnormal passage between two organs)
Intestinal obstruction
Rectal bleeding
Diagnostic evaluation
complete blood count
Fecal occult blood test
Abdominal ultrasound
CT scan.
colonoscopy
Barium enema
Medical management:
In few cases, surgery may be required. If diverticulitis becomes frequent, or the patient
does not respond to the given antibiotics and resting of the colon, then surgery
becomes the given choice.
CT-guided percutaneous drainage. Followed by IVantibiotics
>One-stage resection, in w/c the inflammed area is removed and a primary end-
to-end anastomosis is completed
>Mulitple-stage procedure to complication such as obstruction or perforation
Pharmacologic Highlights:
Antibiotics
Opioid
Antispasmodic
Analgesics
Laxatives
Nursing Interventions:
Prevention of diverticulitis
To prevent getting the troublesome diverticulas at the first place, try to follow the
following,
Eat lots of veggies and other high fiber food
Avoid red meat and food high in fat
Drink plenty of water
Exercise, without fail
Recommended dietary changes
High fiber diet is the KEY for avoiding and treating this condition. Patient should aim at
increased consumption of fiber through whole-grain breads and cereals, fruits like pears
and apples, vegetables like peas, spinach, and turnip, starchy lentils like kidney and
black beans.
Patients once diagnosed with diverticulits should avoid whole nuts, popcorn, and seeds
like sunflower, pumpkin, caraway, and sesame out of fear that such hard and difficult to
digest food particles could enter, block, or irritate the diverticula.
Recommend bed rest, pain reliever, oral antibiotics, and can keep the patient on a
liquid diet for a while.
Focus of treatment for diverticulitis is on clearing up of the inflammation and infection,
resting the colon, and minimizing/preventing complications.
Severe diverticulitis cases are treated with IV antibiotics and a few days without oral
food or drink to rest the colon.