AISHA V.

MALINTAD BSN-3B

Nursing Disease Analysis

HEPATIC DYSFUNCTION
It is an uncommon condition in which rapid deterioration of
liver function
results in coagulopathy and alteration in the mental status.

Signs & Symptoms

• Jaundice and cholestasis
• Hypoalbuminemia
• Hypoglycemia
• Palmar erythema
• Spider angioma
• Hypogonadism
• Gynecomastia
• Weight loss
• Muscle wasting

General Physical Assessment

• Patient appears weak and jaundice. Patients experience fatigue,
loss of appetite and unusual diarrhea. Patient has a swollen
abdomen.

Diagnostic Exam
• Physical examination
• CBC
• Prothrombin time
• SGOT, SGPT
• Serum bilirubin level, serum ammonia level
• ABG
• Serum creatinine level
• Serum free copper
• Ceruloplasmin level
• EEG

Medical management
• IV to maintain blood pressure.
• Laxatives or enemas to flush toxins.
• Blood sugar monitoring (RBS)
Surgical management
• Liver transplant

Nursing diagnosis
Deficient knowledge related to lack of recall.
o The client will identify necessary lifestyle changes and
participate in care.
o The client will correlate symptoms with causative factors.
Risk for injury
o The client will maintain homeostasis in absence of bleeding.
o The client will demonstrate behaviors to reduce the risk of
bleeding.
Imbalanced nutrition: Less than body requirements
o The client will demonstrate progressive weight gain toward a
goal with the client appropriate normalization of laboratory values.
o The client will experience no further signs of malnutrition.
Excess fluid volume
o The client will demonstrate stabilized fluid volume, with
balanced I&O.
o The client will also demonstrate stable vital signs within the
client’s normal range and absence of edema.
Disturbed body image related to altered physical appearance.
o The client will verbalize understanding of changes and
acceptance of self in the present situation.
o The client will identify feelings and methods for coping with a
negative perception of self.

Independent Nursing Management

• Encourage the client to eat.
• Give small, frequent meals.
• Provide salt substitutes, if allowed; avoid those containing
ammonium.
• Restrict intake of alcohol, raw or uncooked food, and
excessively fatty foods.
• Encourage bed rest when ascites are present.
• Restrict sodium and fluids as indicated.
• Administer medication as prescribed.
• Support and encourage the client; provide care with a positive,
friendly attitude.
PATHOPHYSIOLOGY

Cirrhosis + Portal
Hypertension

Increased splanchnic
vasodilators.

Increased splanchnic
vasodilation + arterial
underfilling

Vasoconstrictors
activation

RAAS activation

Renal
vasoconstrictor

Increased vasoconstrictor
Hepatorenal decreased renal
syndrome vasodilators
PORTAL HYPERTENSION
It is an increase in the blood pressure within a system of
veins called the portal venous system. It is defined as the
elevation of the hepatic venous pressure gradient to > 10 mmHg.

Signs & Symptoms

• Ascites
• Hypersplenism
• Caput medusae
• Hemorrhoids
• GI bleeding
• Abdominal pain
• Melena
• Hematemesis
• Jaundice
• Pruritus
General Physical Assessment
Diagnostic Exam
• Blood count
• Liver function test
• Oesophagogastroduodenoscopy
• USG
• MRI
• Liver Angiography
• Coeliac-mesenteric Arteriography
• Splenic Portogram
Medical management
• Reduce or eliminate alcohol
• Maintain a low-sodium diet
o Beta blockers
o Nitrates
o Vasoactive drugs
o Lactulose (to treat mental confusion)
Surgical management
• Trans jugular intrahepatic portosystemic shunt (TIPS)
Nursing diagnosis
• Risk for infection related to ascites
o The patient will be able to prevent getting infected and quickly
recover.
o The patient will be able to show infection prevention methods
such wound care and hand washing
• Activity intolerance related to weakness
o The necessity to progressively increase activity level and how to
do so will be verbally understood by the patient.
o The patient will be able to carry out everyday tasks on their
own.
• Risk for imbalanced fluid volume related to edema.
o The patient verbally expresses understanding of the underlying
causes and the necessary actions to remedy the fluid deficit.
o Measures that can be performed to treat or stop fluid volume
loss are described by the patient.
• Acute pain related to headache as symptoms of the disease
process.
o The patient will report less pain.
o The patient can move at his or her own free will.
• Deficient knowledge related to information misinterpretation.
o The patient will express verbally his or her understanding of the
disease's course, prognosis, and any side effects.
o The client will express verbally how they comprehend the
therapeutic
needs.

Independent Nursing Management

• Encourage the client to elevate the lower extremities and wear
support hose to prevent lower-extremity edema.
• Administer salt-poor albumin, which temporarily elevates the
serum albumin level
• Administer medications, which may include diuretics.
• Measure and record abdominal girth and body weight daily,
assess for
abdominal fluid wave.
• Promote measures to prevent or reduce edema.
PATHOPHYSIOLOGY
Portal
vascular resistance is
increased in chronic liver
disease.

Liver cell
injury

Stellate cell
activation

De novo expression of
specific smooth muscle
protein alpha-actin

Contraction of activated
cells

Abnormal blood flow

pattern
causing increased
resistance

Increased
resistance
ASCITES
Ascites is defined as the presence of excessive fluid in the peritoneal
cavity. Fundamental to the formation of ascites in cirrhosis are portal
hypertension, which causes splanchnic vasodilation, and activation of the
renin-angiotensin-aldosterone system, further resulting in renal sodium
retention.

Signs and symptoms

● Swelling in the abdomen
● Weight gain
● Sense of fullness
● Bloating
● Nausea
● Indigestion
● Sense of heaviness
● Edema
General physical assessment
● Patient appears bloated and upon palpation of the abdomen
tenderness is noted.
Diagnostic Exam
● Ultrasound
● MRI
● CT scan
● X-ray
Medical management
● Diuretics
● Administration of salt-poor albumin
● Spironolactone (Aldactone)

Surgical management
● Liver transplant
● Peritoneovenous shunting
● Portosystemic shunting
Nursing diagnosis

Excess fluid volume related to compromised regulatory mechanisms

o Patient will manifest a decrease in abdominal girth.
o Patient will report a decrease in abdominal discomfort.
• Ineffective breathing pattern related to increased abdominal pressure.
o Patient will demonstrate an effective respiratory pattern as indicated by a
respiratory rate within 12-20 bpm with normal depth and absence of
cyanosis,
o Patient will express the relief of shortness of breath.
• Risk for infection related to statis of body fluid.
o Patient will remain free form any infection.
o Patient will verbalize strategies to prevent infection.
• Activity intolerance related to fatigue and malaise.
o The client will be able to demonstrate activities that could lessen fatigue.
o The patient will be able to participate with ADL on her own and to report
the decrease in fatigue.
• Deficient knowledge related to diagnosis of the disease process.
o The patient will be bale to demonstrate sufficient knowledge of ascites.

Nursing management
• Assess patient’s abdominal girth.
• Measure the weight of the patient daily and compare the finding with
previous findings.
• Further assess the signs and symptoms of the disease.
• Provide bed rest to the patient.
• Provide fluid management to the patient.
• Educate the patient to take low sodium diet.
• Maintain the skin integrity of the patient.
• Monitor respiratory rate, depth and effort.
• Place the patient in semi-fowler’s position, as appropriate.
PATHOPHYSIOLOGY

Portal hypertension

Splanchnic arterial
vasodilation

Reduction in effective
arterial volume

Activation of
vasoconstrictor systems

Retention of sodium

Ascites
HEPATIC ENCEPHALOPATHY
It is a decline in brain function that occurs because of severe liver
disease.
Signs & symptoms
● Difficulty thinking
● Personality changes
● Poor concentration
● Problems with handwriting
● Confusion
● Forgetfulness
● Severe
● Drowsiness
● Anxiety
● Seizures
● Severe personality changes
General physical assessment
● Patient appears disoriented and confused. Blood pressure is high.
Hyperthermia is noted with fast heartbeat upon auscultation.
Diagnostic Exam
● Blood test
● CT scan
● MRI
● Liver function test
Medical management
● Eliminate precipitating cause.
● Lactulose to reduce serum ammonia levels.
● IV glucose to minimize protein catabolism
● Protein restriction
● Reduction of ammonia from GI tract
● Enemas and oral antibiotics
Surgical management
● Trans jugular intrahepatic portosystemic shunt
● Colonic procedures
Nursing diagnosis

• Excess fluid volume related to compromised regulatory mechanisms

o Patient will manifest a decrease in abdominal girth.
o Patient will report a decrease in abdominal discomfort.
• Ineffective breathing pattern related to increased abdominal
pressure.
o Patient will demonstrate an effective respiratory pattern as indicated by
a respiratory rate within 12-20 bpm with normal depth and absence of
cyanosis.
o Patient will express the relief of shortness of breath.
• Risk for infection related to stasis of body fluid.
o Patient will remain free from any infection.
o Patient will verbalize strategies to prevent infection.

Nursing management
Provide fluid management to the patient.
• Educate the patient to take a low sodium diet.
• Maintain the skin integrity of the patient.
• Monitor respiratory rate, depth and effort.
• Place the patient in the semi-fowler's position, as appropriate.
• Note any onset of abdominal discomfort.
• Monitor the temperature of the patient this might be an indication of
infection.
PATHOPHYSIOLOGY

Damaged liver cells failed to

detoxify and convert urea

Ammonia constantly
enters blood stream
from GI absorption,
kidney, and muscle cells

Increased ammonia
concentration in blood

Brain dysfunction and

damage

Hepatic encephalopathy
ESOPHAGEAL VARICES
Are enlarged or swollen veins on the lining of the esophagus. It
occurs in about one third of patients with cirrhosis and varices.

Signs and symptoms

● Hematemesis
● Melena
● General deterioration/shock
● Lightheadedness
General physical assessment
● Patient is unconscious.
Diagnostic Exam
● Esophagogastroduodenoscopy (EGD)
● CT scan
● MRI
Medical management
● Administer oxygen; for shock
● IV fluids, electrolytes, volume expanders, blood, blood products
● Vasopressin
● Somatostatin
● Octreotide
● Propranolol and nadolol
● Balloon tamponade
● Endoscopic sclerotherapy
Surgical management
● Surgical bypass procedures
● Devascularization and transection
PATHOPHYSIOLOGY Portal hypertension

Development of pressure
gradient of 12
mmHg

Venous collaterals develop from high

portal system pressure to systemic veins
in esophageal plexus, hemorrhoid
plexus, and retroperitoneal veins

Abnormal varicoid vessels

form in any of above
locations

Vessels may rupture

causing life-threatening
hemorrhage
HEPATITIS
Viral hepatitis; a systematic viral infection that causes necrosis and
inflammation of liver cells with characteristic symptoms and cellular and
biochemical changes.A & E – fecal-oral route, B & C- bloodborne, D- only
people with hepatitis B are at risk, Hepatitis G and GB virus-C, Nonviral
hepatitis; toxic and drug induced.

Signs & symptoms

● Mild-flu like symptoms, low-grade fever, anorexia, later jaundice and

dark urine, indigestion and epigastric distress, enlargement of liver
and spleen.
● Insidious and variable; similar to HAV, loss of appetite, dyspepsia,
abdominal pain, generalized aching, malaise, and weakness.
Diagnostic test
● History taking
● Physical examination
● Abdominal ultrasound
● Hepatitis virus serological
● Liver function test
● Liver biopsy ( check liver for damage)
● Paracentesis
● ALT and AST test
Medical management
● Lamivudine

Prevention;
○ Good handwashing, safe water and proper sewage disposal
○ Vaccine
○ Immunoglobulin for contacts to provide passive immunity
Alpha interferon and antiviral agents
● Entecavir ETV and tenofovir
● Bed rest and nutritional support
● Vaccine; for persons at high risk, routine vaccination of infants
● Passive immunization for those exposed
● Standard precautions and infection control measures
● Screening of blood and blood products.
Antiviral medications
● Alcohol potentiates disease; medications that effect the liver should
be avoided.
● Prevention: public health programs to decrease needle sharing
among drugs users
● Screening of blood supply
● Safety needles for health care workers.
Nursing diagnosis
● Imbalanced nutrition: less than body requirements related to
insufficient intake to meet metabolic demands.
- Client will initiate behaviors, and lifestyle changes to maintain an
appropriate weight.
- Client will demonstrate progressive weight gain toward the goal with
normalization of laboratory values and no signs of malnutrition.

● Fatigue related to decreased metabolic energy production

- Client will report an improved sense of energy.
- Client will perform ADLs and participate in desired activities at the
level of ability.

● Situational low self-esteem related to isolation.

- Client will verbalize feelings.
- Client will verbalize acceptance of self in situation of need for
isolation.

● Risk for infection related to immunocompromised.

- Client will verbalize understanding of individual causative factors.
- Client will demonstrate techniques to avoid transmission to others.
 ● Risk for impaired skin integrity related to bile salt accumulation in the
tissues.
- Client will display intact skin free of excoriation.
- Client will report a decrease of pruritus.

Independent nursing management

● Encourage the intake of fruit juices.
● Institute bed red or chair rest during toxic state. Provide a quiet
environment; limit visitors as needed.
● Do necessary tasks quickly and at one time as tolerated.
● Increase activity as tolerated and demonstrate passive or active ROM
exercises.
● Contract with patient regarding time for listening.
● Encourage the client to discuss his or her feelings or concerns.
● Avoid making moral judgements regarding lifestyle.
● Discuss recovery expectations.
● Establish isolation techniques for enteric and respiratory infections
according to infection guidelines and policy.
● Encourage or model effective handwashing.
PATHOPHYSIOLOGY Virus enters the system

Virus circulates through

blood stream

Virus reach the liver

Infect the hepatocytes

Viruses multiply

Antigen & antibody

reaction

Inflammatory process
activated throughout
the whole liver

Hepatocytes are
destroyed by cytotoxic
cytokines and natural
killer cells

Cellular necrosis takes

place

Cholestasis and
disruption of normal
blood supply to the cells

Damage the liver cells

HEPATIC CIRRHOSIS
Cirrhosis is a late-stage liver disease in which healthy liver tissue is
replaced with scar tissue and the liver is permanently damaged.

Signs & symptoms

● Liver enlargement
● Portal obstruction
● Ascites
● Edema
● Fever
● Anorexia
● Fatigue
Diagnostic Exam
● Liver function test
● ALT
● LDH
● Liver biopsy
● Blood tests
● Serum examination
● Abdominal paracentesis
Medical management
● Antacids
● Antiemetics
● Vitamins and nutritional supplement
● Balanced diet
● Potassium sparing diuretics (spironolactone)
● Avoidance of alcohol
Surgical management
● Portal-vacal shunt
● Splenorenal shunt
● Liver transplant
Nursing diagnosis
● Activity intolerance related to fatigue and discomfort
 1. Client will identify alternative ways to maintain desired activity level.
2. Client will identify conditions or symptoms that require medical
reevaluation.
● Risk for injury related to coagulopathy
1. Client will maintain homeostasis in absence of bleeding.
2. Client will demonstrate behaviors to reduce the risk of bleeding.
● Impaired skin integrity related to jaundice
1. Client will maintain skin integrity.
2. Client will identify individual risk factors and demonstrate behaviors to
prevent skin breakdown.
● Knowledge deficit related to disease process.
1. Client will verbalize understanding of the disease process.
2. Client will correlate symptoms with causative factors.
● Risk for acute confusion related to alcohol abuse.
1. Client will maintain the usual level of mentation.
2. Client will initiate behaviors to prevent the recurrence of the problem.
Nursing management
● Assess sign of bleeding, observe stools and vomiting for color and
consistency.
● Instruct the patient to limit or avoid activities if there is bleeding.
● Administer vitamin K as ordered.
● Assess and document degree of jaundice of skin and sclera.
● Promote adequate nutrition
● Assess for adequate hydration.
● Instruct the patient to elevate legs to mobilize edema and ascites
● Encourage active and passive exercises to patient to promote muscle
strength.
PATHOPHYSIOLOGY
Alcohol abuse Malnutrition Infection Drugs or biliary
obstruction

Destruction of hepatocytes

Fibrosis

Obstruction of
blood glow

Increase pressure
in venous/
sinusoidal channels

Fatty infiltration
fibrosis/ scarring

Portal
hypertension
CHOLELITHIASIS
It is a usual form in the gallbladder from the solid constituents of bile
and vary greatly in size, shape and composition.
Signs & Symptoms
• Epigastric distress
• Feeling of fullness
• Abdominal distention
• Vague pain in the right upper quadrant of the abdomen
• Pain and biliary colic
• Fever
• Palpable abdominal mas
• Constant pain, restless in all position
• Jaundice
General Physical Assessment
• Patient appears lethargic and noted jaundice.
• Having guarding behavior.
• Complaints of abdominal pain.
Diagnostic Exam
• Abdominal X-ray
• USG
• Radionuclide imaging or cholecystography
• Cholecystography
• ERCP
• PTC
Medical management
• Urso deoxycholic acid (UDCA)
• Chenodeoxycholic acid ( chenodiol or CDCA)
• Dissolving gallstone- MTBE-methyl tertiary butyl ether
• Extracorporeal shoch-wave lithotripsy (ESWL)
• Intracorporeal lithotripsy
Surgical management
• Cholecystectomy
• Mini cholecystectomy
• Laparoscopic cholecystectomy

Nursing diagnosis
• Risk for deficient fluid volume
o The client will demonstrate adequate fluid balance.
o The client will maintain a balance fluid volume.
• Acute pain related to inflammatory process.
o The client will report relief or control of pain.
o The client will demonstrate the use of diversional activities as indicated
for the individual situations.
• Risk for imbalanced Nutrition: less than body requirements
o The client will report from nausea / vomiting.
o The client will demonstrate progression toward desired weight gain or
maintain weight as individually appropriate.
• Deficient knowledge related to information misinterpretation.
o The client will verbalize understanding of the disease process, prognosis,
and potential complications.
o The client will verbalize understanding of therapeutic needs.
Independent Nursing Management
• Relieving pain of the patient by giving comfort and pain medication as
ordered.
• Improve the respiratory status of the patient
• Promoting skin care and biliary drainage.
• Educate patient about home care considerations
• Monitoring and managing potential complications.
• Eliminate noxious sights or smells from the environment.
• Perform frequent oral hygiene with alcohol-free mouthwash; apply
lubricants.
PATHOPHYSIOLOGY Decreased bile acid synthesis

Increased cholesterol synthesis in

the liver

Super saturation of bile with

cholesterol

Formation of precipitates

Gall stones (cholelithiasis)

Inflammatory changes
(cholecystitis)
DIABETES MELLITUS
TYPE 1- insulin-producing beta cells in the pancreas are destroyed
by a combination of genetic, immunologic and environmental factors
TYPE 2- insulin resistance and impaired insulin secretion.

Signs and symptoms

Depend on the level of hyperglycemia
● Polyuria
● Polydipsia
● Polyphagia
● Fatigue
● Weakness
● Vision changes
● Tingling or numbness
● Dry skin, skin lesions or wounds that are slow to heal
● Type 1 may have sudden weight loss

General physical assessment

Diagnostic Exam
● Fasting blood glucose 126 mg/dL or more
● Casual glucose exceeding 200 mg/dL
Medical Management
Main goal is to normalize insulin activity and blood glucose levels to
reduce the development of complications.
● Nutritional therapy
● Exercise
● Monitoring of the sugar level
Surgical management
● Bariatric surgery
Nursing diagnosis
● Risk for impaired skin integrity related to decreased circulation.
1. Patient’s skin on legs and feet remains intact while the patient is
hospitalized.
2. Patient will demonstrate proper foot care. Use gentle moisturizers on
the feet.
3. Wash feet daily with mild soap and warm water. Check the water
temperature before immersing feet in the water.
● Fatigue related to decreased metabolic energy production.
1. Client will verbalize increase in energy level.
2. Discuss with the patient the need for activity. Plan a schedule with the
patient and identify activities that lead to fatigue.
● Powerlessness related to dependence on others.
1. Client will acknowledge feelings of helplessness.
2. Client will identify healthy ways to deal with feelings.
● Acknowledge the normality of feelings.
1. Provide an opportunity for significant other to express concerns and
discuss ways in which they can be helpful to the patient.
2. Encourage patient and SO to express feelings about hospitalization
and disease in general.
● Imbalanced nutrition: less than body requirements related to insulin
deficiency
1. Client will ingest appropriate amounts of calories.
2. Client will display the usual energy level.
3. Review the carbohydrate counting method with the patient.
4. Identify food preferences, including ethnic and cultural needs.
● Risk for unstable blood glucose level
1. Patient will achieve and maintain glucose in satisfactory range.
2. Patient will acknowledge key factors that may contribute to unstable
glucose levels.
3. Educate the patient how to perform home glucose monitoring.
4. Instruct the patient to avoid heating pads and always wear shoes
while walking.
PATHOPHYSIOLOGY Insufficient insulin

Reduced tissue uptake of

glucose

Intracellular
Extracellular
hypoglycemia
hyperglycemia

Glucogenesis and Blood glucose

Hyperosmotic
gluconeogenesis
plasma
>

Breakdown Renal threshold

Dehydration of cells
Of fats

High levels of Decreased protein Glucosuria- urine

ketones synthesis. Hyperglycemic has a high SG
Cachexia coma
Lethargy
Polyphagia
Decreased gamma
globulins. Osmotic diuresis
Susceptibility to
infections -polyuria
Impaired wound
healing Polydipsia

Hypokalemia

Hyponatremia
HYPOPITUITARISM
is when you have a short supply (deficiency) of one or
more of the pituitary hormones.

Signs & Symptoms

● Stomach pain
● Fatigue
● Nausea & vomiting
● Dizziness
● Sensitivity to cold
● Changes in weight
● Muscle aches
General Physical Assessment
● The patient has delayed relaxation of tendon reflex, having
coarse skin, puffy face, slower heart rate than a normal
range (bradycardia) and the eyebrows are thinner.
Diagnostic
● MRI
● CT scan of brain
● Vision test (to test whether the tumor damages the eyesight)
● Insulin tolerance (the gold standard test for hypopituitarism)
Medical management
● Hormone replacement

Medication
● Oral corticosteroids
● Levothyroxine
● Sex hormones (testosterone for male/estrogen &
progesterone for female)
Surgical management
● Hypophysectomy
Nursing Diagnosis
1. Acute pain related to disease process.
○ Client will report pain is controlled.
○ Client will follow prescribed pharmacological regimens.
2. Risk for electrolyte imbalance as evidenced by vomiting.
○ Display laboratory results within normal range.
○ Client will be free of complications resulting from
electrolyte imbalance.
3. Disturbed body image related to changes in body structure.
o Patient will verbalize an understanding of body changes.
o Patient will verbalize the acceptance of self.
4. Low self-esteem related to changes in body appearance.
o Verbalize understanding of negative evaluation of self
and reasons for this problem.
o Demonstrate behaviors and lifestyle changes to
promote positive self-image.
5. Self-care deficit related to the decrease in muscle strength.
o Maintain responsibility for planning and achieving self-
care goals and general well-being.
o Identify and use resources appropriately

Independent Nursing Management

• Monitor vital signs.
• Assess lung and heart sounds every 4 hours.
• Watch for chest pain or dyspnea.
• Educate patient that thyroid replacement therapy must be taken
for a lifetime
and administered in the morning on an empty stomach because
thyroid
medications can cause insomnia if taken at night.
• Provide high protein, low-calorie fiber food.
• Provide an iodine-rich diet, which is easily accomplished with
iodized salt.

PATHOPHYSIOLOGY Adenoma/
Craniopharyngiomas/ Empty
Sella Syndrome

Demand more blood

Blood flow
Tend to compress

High Blood pressure

Pituitary becomes
nonfunctional
Swells up

Low Secretion of hormones

Rupture

Bleed

Hemorrhage
HYPERPITUITARISM
Over secretion of one or more of the hormones secreted by
the pituitary gland.
Signs & Symptoms

a. Brain fog
b. Cold intolerance
c. Constipation
d. Dry, coarse hair & skin
Pituitary shrinks
e. Decreased sexual interest
and flatten
f. Heavy, frequent menstrual periods
g. Tiredness
h. Weight gain
General Physical Assessment
• The patient appears weak, and confused. The patient cannot
tolerate a cold environment as it is sensitive to cold. Also, the
patient has dry coarse skin and complaints of having constipation
and disturbances with her menstruation(female).
Pathophysiology
Diagnostic
• Increased serum somatotropin
• X-rays
• Physical exam
• Blood test
• Thyroid test
• Oral glucose tolerance test
• Specialized blood sampling test
• MRI
• CT scan if tumor is suspected
Medical management
Medication
• Dopamine agonists
• Somatostatin analogs
• Growth hormone receptor antagonists
Surgical management
a. Tumor resection
- Transsphenoidal hypophysectomy

Nursing diagnosis
• Disturbed body image related to disease process as
evidenced by enlargement of face, hands and feet.
o Client will recognize and incorporate body image change into
self-concept
in an accurate manner without negative self-esteem.
o Client will verbalize the acceptance of self in a situation.
• Impaired physical mobility related to decreased in strength
and endurance as evidenced by body weakness.
o Client will verbalize understanding of situation and individual
treatment
regimen and safety measures.
o Client will demonstrate techniques or behaviors that enable
resumption of
activities.
• Ineffective coping related to change in appearance
o Client will assess the current situation accurately
o Client will verbalize awareness of own coping abilities.
• Disturbed sensory perception
o Client will regain usual level of cognition
o Client will recognize and correct or compensate for sensory
impairments.
• Disturbed sleeping pattern related to soft tissue swelling.
o Client will report improved sleep
o Client will identify individually appropriate interventions to
promote
sleep.
Independent Nursing Management
• Elevate head of bed 30 degree to dec headache and pressure
• Administer analgesics
• Mouth care soft swabs, orals rinses, no toothbrushing until 10
days
• Observe for csf leak
• Avoid coughing, sneezing, blowing of nose, bending, straining at
stool
• Check nasal drainage
• Monitor for complications
o Adrenal insufficiency
o Diabetes insipidus
o Meningitis
HYPERTHYROIDISM
Excess thyroid secretion
Signs & Symptoms
• Intolerance to heat
• Bulging eyes
• Facial flushing
• Tachycardia
• Breast enlargement
• Weight loss
• Muscle wasting
• Finger clubbing
• Tremors
• Diarrhea
• Menstrual changes
• Localized edema
General Physical Assessment
• The patient appears sensitive to heat, tremor is present, and
having shortness of
breath. The patient lower extremities are swelling (edema),
muscle weakness is also
noted.
Diagnostic Exam
• Hormone and antibody blood tests
• Thyroid ultrasound
• CT or MRI scan
• Radioactive iodine uptake
• Fine needle aspiration biopsy
• Blood test
• Thyroid exam (physical exam)
Medical management
• Thyroid hormone antagonist
• Radiation therapy (oral administration of radioactive iodine)
Medication
• Antithyroid therapy (Propylthiouracil PTU)
• Methimazole (Tapazole)
• Iodine preparations

Surgical management
• Thyroidectomy (partial or total)
Nursing diagnosis
• Imbalanced nutrition: less than body requirements
o Goal; The patient will have balanced nutrition
o Client will demonstrate progressive weight gain toward goal.
• Impaired swallowing
o Patient will be free of aspiration
o Client will demonstrate feeding methods appropriate to the
individual
situation.
• Ineffective airway clearance
o Goal; clean the airway
o Client will demonstrate behaviors to improve or maintain clear
airway.
• Fatigue related to hypermetabolic imbalance with increased
energy requirements as evidenced by decreased
performance.
o Client will report improved of sense of energy.
o Client will participate in recommended treatment plan.
• Risk for dry eye as evidenced by periorbital edema.
o Client will be free of discomfort to eye related dryness.
o Client will verbalize understanding of risk factors and ways to
prevent
dry eye.
Independent Nursing Management
• Isotonic solutions or eye lubricants to keep the eyes moist; eye
guards to prevent drying
• Tinted or dark wrap-around glasses
• Move hands toward face cautiously
• Assess for positive gag reflex
• Maintain fowler’s position
• Encourage drinking slowly; chewing thoroughly
• Suctioning equipment readily available
• Administer analgesic as ordered
• Dietary consultation
PATHOPHYSIOLOGY
HYPOTHYROIDISM
Inadequate thyroid secretion
Signs & Symptoms
• Intolerance to cold
• Receding hairline
• Facial & eyelid edema
• Dull-blank expression
• Extreme fatigue
• Thick tongue-slow speech
• Anorexia
• Brittle nails
• Hair loss
• Apathy
• Lethargy
• Dry skin
• Muscle aches
• Constipation
• Menstrual disturbances
General Physical Assessment
• The patient appears weak and very sensitive to cold
temperature. Also experiences
extreme fatigue, appears dry skin, lethargic, and thinning of hair.
Complains of
muscle pain and appears disoriented or confused.
Diagnostic Exam
• Thyroid-stimulating hormone assay
• Antithyroglobulin antibody
• Thyroxine index, free (FT4)
• Thyroxine (T4)
• Triiodothyronine uptake(T3)
• Thyrotropin-releasing hormone (TRH)
Medical management
• T4 levothyroxine
• T3 Liothyroxine
• T3 & T4 thyro-globulin liotrix
• Sodium levo-thyroxine
• Replacement therapy ( used for myxedema)
Surgical management
• Thyroidectomy (partial or total)

Nursing diagnosis
• Activity intolerance
o Goal; regain normal activity levels
o Client will identify negative factors affecting activity tolerance
and
eliminate their effects when possible.
• Ineffective tissue perfusion
o Goal; To regain effective cardiopulmonary perfusion
o Client will demonstrate behaviors and lifestyle changes to
improve
circulation.
• Constipation
o Goal; regain regular bowel movements
o Client will identify measures that prevent constipation.
• Risk for imbalanced body temperature related to cold
intolerance
o Maintain of normal body temperature

Independent Nursing Management

• Educate patient to avoid foods high in iodine
• Informed patient to eat high-fiber, high-protein, and low-calorie
food must be
intake.
• Gradually increase activity; rest between activity
• Develop exercise program to maintain activity
• Assess for chest pain; report angina immediately
• Monitor for vital signs; weight, intake and output of the patient.

PATHOPHYSIOLOGY

HYPERPARATHYROIDISM
• Overactivity of the parathyroid gland. Or the excessive secretion
of parathormone.
Signs & Symptoms
• Asymptomatic or generalized weakness
• Polyuria
• Chronic low-back pain
• Bone tenderness
• Renal calculi
• Lethargy; drowsiness; fatigue; changes in level of
consciousness
• Memory loss or loss of initiative
General Physical Assessment
• The patient is lethargic and appears weak. Patient complains of
having urinating
more than usual and does have excessive amounts of urine each
time of
urination.
Diagnostic Exam
• Blood tests ( levels of PTH)
• Urine test
Medical management
• Diuretics (Furosemide-Lasix)
• Calcitonin-human (Cibacalcin)
• Plicamycin (Mithracin)
• Magnesium or phosphate-based drugs
• Dialysis
Surgical management
• Surgical removal of 3 ½ of the 4 parathyroid glands
• Parathyroidectomy
Nursing diagnosis
• Risk for injury
o Goal; the patient will be free from injury
o Client will verbalize understanding of individual factors that
contribute
to possibility of injury.
• Impaired urinary elimination
o Goal; The patient will have normal urine output
o Client will verbalize understanding of condition.
• Activity intolerance
o Goal; regain normal muscle mass and strength
o Client will demonstrate a decrease in physiological signs of
intolerance.
• Acute pain
o The patient will be able to verbalize of free from pain
o Patient will demonstrate the use of appropriate diversional
activities and
relaxation skills.
Independent Nursing Management
• Raised side rails always
• Prevent injury
• Assist the patient with every activity
• Encourage the patient to drink enough fluids.
• Alternate rest and activity periods
• Assist with prescribed, individualized activities
• Encourage self-care,
• support efforts to perform activities

HYPOPARATHYROIDISM
 Deficiency of parathyroid hormone or decreased action of
peripheral
parathyroid hormone.
Signs & Symptoms
• Tetany
• Dry skin
• Brittle hair
• Alopecia
• Loss of eyelashes
• Hypotension
• Apprehension and depression
• Tingling fingers and around the lips
• Cardiac dysrhythmias
General Physical Assessment
• The patient appeared weak and upon getting the vital signs
blood pressure is
decreased (hypotension). Patient’s hair and eyelashes are thin
and skin appears
dry.
Diagnostic Used/assessment;
• Chvostek’s sign
• Trousseau’s sign
Medical management
• Calcium supplementation
o Calcium carbonate
o Calcium citrate
• Active vitamin D analogues
o Calcitriol
o Alphacalcidiol
• Parent vitamin D
o Longer half-life than calcitriol
• Thiazide diuretics
o Can reduce urinary calcium excretion
Surgical management
• Total thyroidectomy
Nursing diagnosis
• Risk for injury
o Goal; Prevent injury from tetany
o Client will modify environment as indicated to enhance safety.
• Imbalanced nutrition: less than body requirements related to
inadequate
calcium intake.
o Goal; patient’s nutritional intake will be balanced.
o Client will verbalize understanding of causative factors when
known and
necessary interventions.
• Activity intolerance related to weakness and apathy.
o Client will identify alternative ways to maintain desired activity
level.
o Client will identify conditions or symptoms that require medical
reevaluation.
• Risk for ineffective airway clearance related to laryngospasm.
o Client will maintain airway patency.
o Client will demonstrate behaviors to improve or maintain clear
airway.
• Impaired skin integrity related to dry skin.
Independent Nursing Management
• Monitor Chvostek’s and trousseau’s sign; serum calcium and
phosporus levels,
monitor EKG changes.
• Keep tracheostomy tray readily available
• Maintain seizure precautions
• Support ambulation
• Encourage patient to consume calcium-rich foods
• Monitor for digoxin toxicity

HYPERALDOSTERONISM
Hypersecretion of aldosterone. Reabsorption of sodium and
water; excretion of potassium and hydrogen
Signs & Symptoms
• High blood pressure
• Low levels of potassium in the blood
• Fatigue
• Headache
• Muscle weakness
• numbness
General Physical Assessment
• The patient is hypertensive, has faster heart rate than the
normal range. The
patient appears weak and complains of headache.
Diagnostic Exam
• Blood tests ( levels of aldosterone and renin in the blood)
• Urine tests
Medical management
• Spironolactone (Aldactone)
• Amiloride (midamor)
Surgical management
• Unilateral or bilateral adrenalectomy
Nursing diagnosis
• Ineffective coping related to inadequate coping methods as
evidenced by verbalization of inability to cope or ask for help.
- Patient will identify ineffective coping behaviors and
consequences.
- Patient will verbalize awareness of own coping abilities.
• Decreased activity tolerance related to muscle weakness as
evidenced by verbal report of fatigue.
- Patient will participate in necessary activities.
- Patient will demonstrate a decrease in physiological signs of
intolerance.
• Deficient knowledge related to lack of knowledge as evidenced
by verbalization of the problem.
- Patient will verbalize understanding of disease process and
treatment regimen.
- Patient will describe reasons for therapeutic actions regimen.
• Electrolyte imbalance related to changes in the regulation of
potassium as evidenced by low serum potassium level in the
body.
- Patient will demonstrate serum potassium levels within
normal limits.
- Patient will not experience dysrhythmias.
• Risk for falls related to muscle weakness.
- Patient will participate in physical therapy sessions.
- Patient will be bale to regain muscle strength.
Independent Nursing Management
• Increased fluid intake.
• Assess fluid intake and output
• Monitor vital signs
• Provide patient with information with regards to its condition.
• Secure safety of the patient.
• Always raise the siderails of the patient.
• Note client reports of weakness, fatigue, pain, difficulty
accomplishing task or
insomnia.
• Observe and describe behavior in objective terms. Validate
observation.

HYPOALDOSTERONISM
Signs & Symptoms
• Muscle weakness
• Nausea
• Irregular heartbeat
• Irregular blood pressure
General Physical Assessment
• Muscle tenderness is noted upon palpation. The patient also has
decreased muscle reflex and is experiencing cardiac arrhythmias.
Diagnostic Exam
• Blood test ( plasma renin activity, aldosterone and serum
cortisol)
Medical management
• Loop diuretics
• Corticosteroids
• Alkalinizing agents
• Diuretics
• Thiazide
Surgical management
• Adrenalectomy
Nursing diagnosis
• Impaired physical mobility
o Client uses safety measures to minimize the potential for injury.
o Patient will evaluate pain and the quality of management.
• Deficient knowledge related to lack of information as evidenced
by statements
of misconception.
o Client will verbalize understanding of the condition.
o Client will verbalize understanding of the therapeutic regimen.
• Imbalanced nutrition: less than body requirements related to
insufficient
dietary intake as evidenced by nausea and vomiting.
o Patient will recognize factors that are contributing to being
under or
overweight.
o Patient will consume adequate nutrition
Independent Nursing Management
• Provide nutritional supplements as appropriate or ordered.
• Educate the patient on the body’s nutritional needs.
• Provide the patient with resources regarding nutrition.
• Provide good oral hygiene.
• Monitor vitals signs
• Monitor intake and output as ordered.
• Assess physical mobility status.
• Evaluate the desire/readiness of patient to learn.
• Note factors affecting the current situation and potential time
involved.
• Assess client’s developmental level, motor skills, ease and
capability of movement,
CUSHING’S SYNDROME
• Results from increased ACTH
Signs & Symptoms
• Adipose deposition of face, neck and truck
• Purple striae on the abdomen; hirsutism; thin extremities
• Fatigue; muscle weakness; sleep disturbances
• Water retention
• Amenorrhea
• Decreased libido
• Decreased wound healing; ankle edema

General Physical Assessment

• The patient shows muscle weakness, easily irritated. Patient’s
lower extremities has wound that appears old and/ are not healed
yet. There is also edema on the ankle noted.
Diagnostic Exam
• 24-hour urinary free-cortisol test
• Blood tests
• Saliva tests
Medical management
• Aminoglutethimide (Cytadren)
• Ketoconazole (Nizoral)
• Mitotane (Lysodren)
Surgical management
• Adrenalectomy
• Hypophysectomy
Nursing diagnosis
• Disturbed body image
o Goal; the patient will verbalize feelings about appearance
o Client will verbalize an understanding of body changes.
• Risk for infection
o Goal; the patient will prevent infection
o Client will identify interventions to prevent or reduce risk of
infection.
• Risk for injury related to generalize fatigue and weakness.
o Client will be free of fractures or soft tissue injuries.
o Client will implement measures to prevent injury.
• Deficient knowledge related to lack of experience with the
disease as evidenced
by verbalizing misconceptions.
o Client will verbalize an understanding of Cushing’ s disease and
guidelines for therapy.
o Client will implement appropriate therapy.
• Risk for excess fluid volume related to fluid retention.
o Client will maintain normal fluid volume.
o Client will demonstrate changes to prevent imbalanced fluid
volume.
Independent Nursing Management
• Encourage the patient to verbalize feelings about changes of
body image.
• Offer emotional support.
• Provide realistic assessment of the condition.
• Avoid people with infections.
• Provide a private room with reverse or protective isolation.
• Monitor vital signs.
• Strictly monitor output and input of the patient
• Weight the patient daily.
• Assess the skin for signs of bruising.
• Instruct the client about keeping the skin clean and moisturized.
• Discuss with client safety measures for ambulation and daily
activities.

PATHOPHYSIOLOGY
ADDISON’S DISEASE
Deficiency in the production of the adrenal cortex also called
adrenal insufficiency.
Signs & Symptoms
• Bronze coloration of the skin
• Fatigue
• Muscle weakness
• Lightheadedness
• Weight loss
• Salt cravings
• Weak and irregular pulse
• Low blood pressure
General Physical Assessment
• The patient appears weak and experiencing dizziness. The
patient is also easily irritated and upon checking the vital signs,
the patient's blood pressure is lower than the normal range
(hypotension).
Diagnostic Exam
• Blood tests
• MRI
• CT scan
Medical management
• Life long maintenance of steroids
o Hydrocortisone
o Fludrocortisone acetate
• Kayexalate

Nursing diagnosis
• risk for deficient fluid volume related to vomiting.
o Patient will display laboratory results within normal range for
individuals.
o Be free from complications resulting from electrolyte imbalance.
• Risk for imbalanced nutrition: less than body requirements
related to loss of
appetite.
o Patient’s nutritional status is optimized.
o Client will identify individual risk and engage in appropriate
behaviors or
lifestyle changes to prevent or reduce frequency of electrolyte
imbalance.
• Risk for infection related to immunocompromise as evidenced
by fever
o Client will remain free from infection
o Client will demonstrate a meticulous hand washing technique.
• Fatigue related to disease process as evidenced by body
weakness.
o Patient will identify cause of fatigue.
o Patient will verbalize improved energy levels.
• Risk for falls related to lightheadedness.
o Client will verbalize understanding of the condition and its safety
issues.
o Patient will demonstrate interventions that reduce risk of falls.
Independent Nursing Management
• Encourage patient rest periods after eating.
• Suggest the need for frequent small meals.
• Encourage oral fluids as the patient tolerates.
• Instruct patient to ingest salt additives in conditions of excess
heat.
• Instruct patient to wear a medical alert bracelet.
• Monitor vital signs of the patient.
• Assess ECG rhythm.
• Monitor weight
• Minimize stress and assist with activities
• Monitor nutrition
• Monitor intake and output
• Maintain strict asepsis in any kind of nursing procedures.
• Do handwashing before performing any procedures.
• Secure the safety of the patient.

PATHOPHYSIOLOGY
DIABETES INSIPIDUS
Deficiency of ADH; inability to conserve water.
Signs & Symptoms
• Polyuria (4-24L/day)
• Polydipsia (2-20L/day)
• Weight loss
• Dry skin and mucous membranes
• Electrolyte imbalances
General Physical Assessment
• The patient appears weak and has dry skin. The patient also
complains of urinating several times a day.
Diagnostic Used
• Vasopressin test
• Water deprivation test
Medical management
• IV therapy
• ADH replacement
• Administer lifelong hormone replacement
o Vasopressin tannate (Pitressin)
o Desmopressin acetate (DDAVP,Stimate)
o Lypressin (Diapid) nasal spray
Surgical management
• Hypophysectomy to remove posterior pituitary tumor

Nursing diagnosis
• Deficient fluid volume related to compromised endocrine
regulatory mechanism
as evidenced by polyuria.
o Patient will have normal urine output.
o Patient will experience normal fluid volume.
• Risk for impaired skin integrity
o Patient’s skin remains intact.
o Patient will participate in prevention measures and treatment
program.
• Deficient knowledge related to unfamiliarity of the disease
process as evidenced
by questioning.
o Patient will verbalize understanding of the condition.
o Client will verbalize understanding of the therapeutic regimen.
• Sleeping pattern disturbances related to nocturia.
o Client will identify appropriate interventions to promote sleep.
o Client will report improved of sleep.
• Ineffective coping related to frequent urination.
o Client will assess the current situation accurately.
o Client will verbalize awareness of own coping abilities.
Independent Nursing Management
• Monitor I&O
• Monitor for excessive thirst or urination
• Assess for serum and urine values
o Decreased specific gravity; decreased urine osmolality;
increased serum
osmolality
• Provide medic alert bracelet
• Inspect skin; document condition and changes in status
• Assess factors that may increase the risk for patient’s skin
integrity.
• Keep bed linen clean, dry and wrinkle-free.
• Assess level of knowledge of DI cause and treatment.
• Assess readiness to learn.
• Provide information to the patient with regards to the disease
process.
• Monitor vital signs and neurological and cardiovascular status.
• Monitor electrolyte values and for signs of dehydration.
• Instruct the client to avoid food or liquids that produce diuresis.
• Provide a safe environment, particularly for the client with a
change in level of
consciousness or mental status.
• Assess the sleeping pattern of the patient.
• Assess the coping ability of the patient.
• Discuss with the patient about the disease and treatment.
 PATHOPHYSIOLOGY
Secretion of AHD

Renal tubular
permeability to water

Water resorption

- Bladder distention Excessive urine output Serum osmolality

- Interrupted sleep
- Urine
osmolality
Hypernatremia

Stimulate osmoreceptors
Renal Hydronephrosis
insufficiency
Urine specific gravity Insipid urine
Severe thirst
Interrupted ADLs

Fluid intake to
Hypernatremia
replace
losses

- Restlessness
- Agitation
- Decreased reflexes
Tachycardia - seizures
GOITER
It is an overall enlargement of the thyroid, or it may be the
result of irregular cell growth that forms one or more lumps.

Signs and symptoms

• Lump in front of the neck
• Feeling of tightness in the throat.
• Hoarseness
• Neck vein swelling
• Dizziness when arms are raise
General physical assessment
• Patient appears with a cosmetic distortion of the neck along with
a lump at the
base of the neck. Patient is also tachycardic, with good skin
turgor.
Diagnostic used
• Thyroid function test
• Ultrasonography
• FNAC
• Autoantibody titre
• Isotope scan
• CT scan
• MRI
• Chest radiograph
• Laryngoscopy
• Core biopsy
Medical management
• Iodine preparations
o Lugol’s solution
Hypotension

Hypovolemic shock
o Saturated solution of potassium iodide
• Dietary management of iodine intake
Surgical management
• Thyroidectomy
Nursing diagnosis
• Acute pain related to disease process
o The client will report control of pain.
o The client will demonstrate the use of relaxation skills and
diversional
activities appropriate to the situation.
• Risk for ineffective airway clearance related to swelling.
o The client will maintain a patent airway, with aspiration
prevented.
• Impaired verbal communication related to vocal cord injury.

Nursing Management
• Evaluate and keep track of your vital signs; keep an eye out for
bradycardia and
decreased breathing.
• All bodily functions, including respiration and heart output, are
slowed by the
lowered thyroid hormone levels. In order to maintain or increase
pulmonary
adequacy, encourage incentive spirometer use and keep an eye
out for slower
breathing and heart rate.
• Promote self-care and plan activities during the patient's most
energetic
moments.
• Urge patients to take care of themselves and engage in
activities when they are
feeling more energetic and providing rest periods as needed.

Iodine lack.
PATHOPHYSIOLOGY Goitrogens

Deficient thyroid
hormone production

Excessive TSH
stimulation

Cyclic hyperplasia-
involution

Diffuse goiter

Repeated
hyperplasia-
involution

Fibrosis of involuted Growth of

hyperplastic areas
are

Nodular goiter
ACROMEGALY
• Acromegaly is a disorder that occurs when your body makes too
many growth hormones.

Signs & Symptoms

• Abnormally large hands and feet
• Changes in face shape
• Increase in size of the lips
• Excessive sweating or oily skin
• Deepening of voice
• Headaches
• Joint pain
• Vision changes
• Increase in the number of skin tags
• Numbness in hands
• Sleep apnea
• Carpal tunnel syndrome
General Physical Assessment
• Patient has abnormal enlargement of his feet and hands.
Remarkable for skin tags, acanthosis nigricans and hyperhidrosis.
Noted frontal bossing and patient complains of headache.
Diagnostic used
• Echocardiogram
• Glucose tolerance test
• Sleep study tests
• Colonoscopy
• Visual filed examination
• MRI scan
• Pituitary function
• Prolactin
• Chest and abdominal radiology
Medical management
• Somatostatin receptor agonists;
o Octreotide and lanreotide (synthetic analogues of somatostatin)
• Dopamine agonists
• Growth hormone antaginists
Surgical management
• Trans-sphenoidal surgery
• Transfrontal surgery (rare required except for massive
macroadenomas)
Nursing diagnosis
• Disturbed body image related to anxiety over thickened skin and
enlargement of face, hands and feet.
o The patient will state his or her feelings and thoughts about
himself/herself.
o Recognize his or her positive characteristics and state that he or
she accepted his or her changing body image.
• Disturbed sleep pattern related to headache.
o The patient will verbalize a report of relief of pain.
o The patient will state that the symptoms of insomnia are
reduced and that he or she slept more and rested.
• Risk for electrolyte imbalance related to nausea and vomiting
o No electrolyte imbalance will be observed.
• Risk for fall related to weakness and fatigue.
o The patient will comply with preventive measures.
o The patient will not experience falling.
• Risk for infection
o Signs and symptoms of infection will not be observed.
o Preventive measures will be adopted by the patient and family
members
to prevent infection.
Independent Nursing Management
• Patient’s vital signs and neurological status were closely
monitored.
• Monitor signs and symptoms of hypernatremia.
• Monitor the amount of fluid intake and output and serum
electrolytes level.
• A noiseless and calm environment suitable for sleeping.
• Ensure the safety and security of the patient.
• Provide the patient with safe and clean environment.
• Reduced stimuli that could disturbed the patient.
• Give medication as ordered.

PATHOPHYSIOLOGY
SIADH
• SIADH is a disorder of impaired water excretion caused by
inability to suppress the secretion of antidiuretic hormone.
Signs & Symptoms
• Weight gain
• Decreased urine output
• Anorexia
• Thirst, dyspnea on exertion
• Headaches
• Nausea and vomiting
• Later confusion
• Irritability
• Seizure and coma
• Generalized muscle weakness
• Muscle aches
General Physical Assessment
• The patient appears weak and confused.
• Complain of headache, and muscle aches.
• Always asking water (excessive thirst)
Diagnostic used
• Urinalysis
• Renal function test
• Random blood sugar test
Medical management
• Volume status
• Duration of hyponatremia
• Presence of symptoms
• Etiology of hyponatremia
o Hypertonic Iv fluids to correct hyponatremia

Nursing diagnosis
• Excess fluid volume related to excessive amount of antidiuretic
hormone secretion.
o The patient will maintain electrolytes within acceptable ranges.
o The patient will maintain balanced intake and output.
• Imbalanced nutrition: less than body requirements related to
nausea and
vomiting.
o The patient will maintain laboratory values within expected
limits.
o The patient will verbalize how their disease process affects
nutrition
• Deficient knowledge related to misinformation.
o The patient will verbalize and understanding of the disease,
prognosis,
and treatments.
o The patient will not develop preventable complications.
• Electrolyte Imbalance related to the disease process of SIADH
o Patient will be able to re-establish a normal electrolyte and fluid
balance.
o No electrolyte imbalance will be observed.
• Acute confusion related to chronic hyponatremia secondary to
SIADH.
o The patient will be able to have a normal serum sodium level.
o The patient will be able to express knowledge about the disease
and
participate in the treatment plan.
Independent Nursing Management
• Monitor urine output
• Restrict fluids
• Administer sodium chloride IV
• Provide frequent small feedings.
• Administer salt tables
• Educate the patient about the condition, symptoms, and
treatments.
PATHOPHYSIOLOGY Due to etiological factors

Excessive ADH secretion

Increased renal tubule

permeability.

Increased water retention

and expanded extracellular
fluid volume

Reduced plasma Dilutional Diminished Elevated

osmolality hyponatremia aldosterone glomerular
secretion filtration rate

Intracellular Anorexia, Decreased Na+

fluid shift nausea, resorption in
vomiting, the Proximal
irritability, renal tubule
confusion,
seizure,
hallucinations

Increased sodium excretion

CANCER OF THE LIVER

• PRIMARY LIVER TUMORS

o Associated with hepatitis B and C
o Hepatocellular carcinoma
• Liver metastasis
o Few cancers originate in the liver
o Frequent site of metastatic cancer
Signs and symptoms
• Dull persistent pain
• Right upper quadrant pain
• Weight loss
• Weakness
• Jaundice
• Fatigue
• Anorexia
• Malaise
• Fever

General physical assessment

• Upon palpation, the abdomen has swelling and tenderness.
Patient appears lethargic and jaundice.

Diagnostic test
• Liver function test
• Alfa-fetoprotein
• Ultra sonography
• CT scan
Decrease urine volume

Increase urine osmolality

and urine sodium
• MRI
• Arteriography
• Needle biopsy
Medical management
• Radiation therapy
• Chemotherapy
• Percutaneous biliary drainage
• Other approaches;
o Lazar hyperthermia
o Radio frequency thermal ablation
o Immunotherapy
o Trans-cathetral arteria embolization

Surgical Management
• Lobectomy
• Cryosurgery
• Liver transplant
• Local ablation
Nursing diagnosis
• Acute pain related to enlarged liver.
o Patient will verbalize reduce pain and controlled.
o Patient will be able to perform relaxation and diversional
activities as instructed.
• Ineffective breathing pattern related to pressure on the
diaphragm.
o Client will report diminished of breathing difficulty.
o Client will maintain airway patency.
• Excess fluid volume related to fluid retention
o Client will maintain normal fluid volume
o Client will be able to recognize signs and symptoms of
dehydration
• Activity intolerance related to fatigue and anemia.
o Client will maintain activities of daily living.
o Client will report measurable increase in activity tolerance.
• Risk for infection related to immunosuppressive effects of
chemotherapy secondary to liver cancer treatment.
o Client will have a reduced risk of developing an infection.
o Client will verbalize knowledge about the signs and symptoms
of infection to watch out for.
Nursing management
• Assess the intensity, location and character of pain and
discomfort.
• Reduce fluid and sodium intake
• Encourage the use of distracting activities.
• Assess the breathing pattern , depth and rate.
• Provide semi-fowlers position
• Check the vitals signs of the patient.
• Informed the patient to follow strict sodium and water
restrictions.
• Monitor the weight daily
 Etiological factors
PATHOPHYSIOLOGY

Genomic DNA
Damage occurs

Loss of cellular
growth controls

Mutation takes
place

Adenomatous
hyperplasia

Additional genomic
alteration

Hepatocellular
carcinoma