BY: LA Fortuna College Bachelor of Science in Nursing Group 3

Hepatic or Liver failure is a life-threatening condition in which there is a severe deterioration of liver function. The liver is a vital organ located in the right upper area of the abdomen under the ribs. Liver failure is caused by liver damage, which makes it difficult or impossible for the liver to function normally in processes that are critical to life and our overall health including:

Blood clotting Clearing the blood of toxins Fighting infection Making bile that assists with digestion Metabolizing medications and other substances Producing proteins, enzymes, and healthy blood Removing waste Storing vitamins, minerals and energy

Acute liver failure is a failure of liver function that occurs suddenly due to such conditions as an overdose of acetaminophen (Tylenol) or ingestion of toxic substances. Chronic liver failure is a deterioration of liver function that occurs over a long period of time, generally months to years. Chronic liver failure is the most common form of liver failure and is generally due to long-term liver diseases, such as cirrhosis of the liver and hemochromatosis.

The incidence of hepatic failure appears to be low in the United States, with approximately 2000 cases annually. Drug-related hepatotoxicity accounts for more than 50% of acute liver failure cases, including acetaminophen toxicity (42%) and idiosyncratic drug reactions (12%). Nearly 15% of cases remain of indeterminate etiology. Other causes seen in the United States are hepatitis B, autoimmune hepatitis, Wilson disease, fatty liver of pregnancy, and HELLP (hemolysis, elevated liver enzymes, low platelets) syndrome.

Liver failure is seen among all races. In a US multicenter study of acute liver failure, the ethnic distribution included whites (74%), Hispanics (10%), blacks (3%), Asians (5%), and Latin Americans (2%).

General This case presentation aims to identify and determine the general health problems and needs of the patient with an admitting diagnosis of Hepatic Failure. This presentation also intends to help patient promote health and medical understanding of such condition through the application of the nursing skills. Specific Specifically, this study aims to: To raise the level of awareness of patient on health problems that she may encounter. To facilitate the patient s parents in taking necessary actions to solve and prevent the identified problems on their own. To help patient s parents in motivating them to continue the health care provided by the health workers. To render nursing care and information to patient through the application of the nursing skills.

This study is focused on PATIENT BABY J, four months old.

-Patient s mother is hypertensive -Patient s father has no medical positive medical condition -Patient s vaccinations are as followed:
VACCINE 1ST DOSE 2ND DOSE 3RD DOSE

BCG

DPT

OPV

Hepa B

-Patient has no past medical illness -Patient has no past surgical procedures/operations -Patient has no previous hospitalizations

2 months of prior to admission -yellowish discoloration of sclera -highly colored urine -no abdominal distention -no fever -good suck, good activity, no meals taken, no consult done

3 days prior to admission -yellowish discoloration of face -with fever -with alcoholic stool -with abdominal distention -good suck, good activity, consult done (private dr.) in Bicol (pedia) -Referred to BRTTH, went to BRTTH done ultrasound done, result positive to Artesia and obstruction in intestine.. Referred to tertiary HOSPITAL in Manila. Cosult done in PCMC as OPD, after 24 hrs came back to hospital because of bleeding. Recheck and admitted by Dr. Mae Villenrose Borreo and diagnose prolonged bleeding probably secondary to beginning hepatic failure, cholestasis probably secondary hepatitis vs TORCH infection, biliary atresia, CHD cyanotic, with down syndrome

General Survey: Awake, Active, and Comfortable Anthropometric Measurement: Weight: 6kgs Height: 56cms Head circumference: 44cms Chest circumference: 41cms Abdominal circumference: 44cms

Vital sign: Temperature: 37.9 Cardiac Rate: 116 Respiratory Rate: 52 Skin-Warn moist, jaundiced skin Head- Open artrium fontanelle, highthy pale Ears- Patent ears canals Oropharyngeal- No seen congestion Nose- No nasonual discharge Chest/Lungs: Cardiovascular: AP, NRNR (- grade 3 systolic

Abdomen: globular, GI visible veins, liver span is 5cms below right central margin (+ spleenomegaly Genitalia: gives normal Anus and rectum: male external genitalia Extremities Upper and Lower: full and equal pulses on all extremities Muscoloskeletal: good muscle tone

ETIOLOGY Cholestasis Hepatitis VS TORCH Infection Biliary Atresia Congestive Heart Failure Ventricular Septal Defect

Destruction of Hepatocytes

Fibrosis/Scarring

LIVER FAILURE

Obstruction of Blood Flow Increased pressure in the venous and sinusoidal channel

Drugs: Spironolactone Mechanism of action: mild diueretic that acts on the distal tubule to inhibit sodium exchange for potasium resulting in increased secretion of sodium and water and conservation of water. Indication: use during pregnancy only if benefits clearly outweight risk. Contraindication: acute renal insufficiency, progressive renal failure, hyperkalemia, and anuria. Nursing management: when used as the sole drug to treat edema, maingtain he initial dose for,atleast 5 days. After that adjustment may be done.

Drug: cefuroxime Mechanism of action: is used PO, whereas cefuroxime sodium is used either IM or IV. Is excreted unchaged in the urine. Indication: for LRTI,uncomplicated lower UTI, uncomplicated gonorrhea and acute pharyngitis. Contraindication: hypersensitivity. GI absorption difficulties. Nursing management: cefuroxime is PO use is available in tablet and suspension forms. Swallow tablet whole and do not rush; crushed tablet has a strong, bitter, persistent taste.

Drugs: amikacin Mechanism of action: derived from kanamycin. Its spectrum is somewhat broader than that of other aminoglycosides, including serriatia and acinetobacter species, as well as certain staphyloccoci and streptococci. Indication:bacterial septimecia including neonatal sepsis. Serious infections of the resperatory tract inpections of the bone and joints. Contraindication: concurrent use of nephrotoxic agents or dieuretic. Nursing management: add 500mg of vial to 200ml of sterile diluents, such as NSS or D5W. administer over a 30-60 mins period for adult. Administer to infants in prescribed amount of fluid over 1-2 hours.

Drugs: salbutamol Mechanism of action: stimulates beta-2 receptors of the bronchi, leading to brochodilation. Indication:relief of brochospasm in patient w/ reversible obstructive airway disease Contraindication:cardiac arrythmias associated tachycardia caused by digitalis intoxication. Nursing management:when given by nebulization, either a face mask or a mouthpiece may be used. Use compressed air oxygen with a gas flow of 6-10/min; a single treatment last from 5- 15mins.

Drugs: furosemide Mechanism of action:inhibits the reabsorption of sodium and chloride in the proximal and distal tubules as well as the ascending loop of henle, this result in the excretion of sodium, chloride, and to a lesser degree of potassium and bicarbonate ions. Indication:cardiac, pulmonary, hepatic , renal peripheral edema of various ethiology. Contraindication: never us ethacrynic acid. Anuria, hypertensive to drug, severe renal disease associated w/ azotemia and oliguria, hepatic coma associated with electrolytes depletion. Nursing management: give 2-4 days/week, food decrease the bioavailability of furomeside and ultimately the degree of diuresis.

Drugs: paracetamol Mechanism of action : decrease by a hypothalamic effect leading to sweating and vasodilatation. Also inhibits the effect of pyrogens on the hypothalamic heat-regulating centers. Indication:relief of fever, minor aches and pains Contraindication: renal insufficiency, anemia. Clients with cardiac or pulmonary disease are more susceptible to acetaminophen Nursing management: do not exceed a dose of 4g/24hr in adults and 75mg/kg/day in children, do not take for more than 5 days for pain in children, 10 in adults, or more than 3 days of fever in adults or children w/out consulting the provider.

Drugs: NaCl Mechanism of action: is a major caution Indication: intraocular and peri ocular irrigating solution ophthalmic surgical procedures Contraindication: CHF severely impaired renal function, hypernatremia, fluid retention. Nursing management: give hypertonic injections of NaCl slowly through a small-bore needle placed within the lumen of a large vein. Avoid infiltration.

Drugs: vitamin E alanerv Mechanism of action: Indication: food supplement which helps prevent the dev elopment of the free radicals and help protect the nervous cells. Contraindication: Nursing management:

Drugs: calcitriol Mechanism of action: may be taken with w/ meals to reduce GI discomfort. Indication: renal osteodystrophy in pateints w/ chronic failure, particularly those undergoing hemodialysis. Contraindication:hypercalcemia. Vitamin D toxicity. Nursing management:

Drugs: propanolol Mechanism of action:manifests both beta-1 and beta-2 adrenegic blocking activity.antiarrhytmic action due to both beta adregenic receptor blockade and a direct membrane-stabilizing action on cardiac cell. Indication: adult HTN, angina pectoris. Contraindication: brochial asthma, bronchospasms including severe COPD. Nursing management: do not administer for a minimum of 2 weeks of MAO drug use, reserve IV for lifethreatening arrythmias or those ocuuring during anesthesia.

Drugs: vitamin K Mechanism of action:is essential for hepatic synthesis of factors II, III, IX, and X, all of witch are essential for blood clothing, Vitamin K defficiency can cause an increase in bleeding tendency, demontrated by ecchymoses, epistaxis, hematuria, GI bleeding, and postoperative and intracranial hemorrhage. Indication: treatment of hemorrhage or threatened hemorrhageassociated w/ a low blood level of prothrombin. Contraindication: severe liver disease. Nursing management: mix suspension only with water or D5W, colloidal injection with D5W, protect vitamin K from light.

Drugs: Ampicillin Mechanism of action: synthetic, broad-spectrum antibiotic suitable for gram-negative bacteria. Acid resistant, destroyed by penicillinas. Absorbed more slowly than other penicillin. Indication: infection of ear, nose, throat, & lower respiratory tract due to stapylococci & upper& lower RTI due to H influenza. Contraindication: Allergy to penicillin Nursing management: reconstituted PO solution is stable for 7days at room temperature, not exceeding 25 degree celcius or 14days refrigirated.

TEST NAME

RESULT

UNITS

REFERENCE VALUES

Ammonia

67.00

umol/L

9.00 33.00

PARAMETERS Prothrombin time (PT) Patient

RESULT

NORMAL VALUES

26.2 11.6 21.2 2.17

9.82 12.31 sec

Activity INR Partial Prothrombin Time (PTT)

ontrol

>=68.56% <=1.03

Patient ontrol

89.6 33.9

30 -45 sec

TEST NAME

RESULT

UNITS

REFERENCE VALUES 137.0 145.0

Sodium

141.00

mmol/L

Potassium Chloride Calcium

1.80 95.00 2.19

mmol/L mmol/L mmol/L

3.5 5.1 98.0 107.0 2.1 2.55

Assessment

Diagnosis

Planning After 8 hours of redendering care the client will maintain ore temp. within normal range.

Intervention Independent: >monitor temp. >monitor heart rate and rhythm >monitor respirations Dependent: >administer paracetamol as prtescribed by the doctor

Evaluation After 8 hours of duty the patient temp. was with in normal range. Temp:37.1

Subjective: Hyperthermia mainit siya, as related to liver verbalized by failure the mother . Objective: >increase body temp. 37.9 >increase respiratory rate-52 >skin closed,warm to touch

Assessment

Diagnosis

Planning

Intervention

Evaluation

mother.

bjective: Abnormal laboratory such as:

Eb >BEecf >SBC >jaundice >dys nea

Subj ctive: na ihira an kumain ang anak ko as verbalize by thw

utritional imbalance lessthan body requirements related to digest food.

After hours of duty the atient will minimized complication.

Independent: >discuss habits including food preferences >note daily intake >promote wellness such as: y Provide positive regards y Provide information regarding individual nutritional needs. >provide information about disease process.

After hours of duty the patient will dealing with current reality.

   

Assessment Subjective: Para siyang nahihirapang huminga as verbalized by the mother Objective: Dyspnea RR 52 bpm Use of accessory muscles to breathe. Nasal flaring

Diagnosis Ineffective breathing pattern related to decreased energy

Planning After 8 hours of duty the patient will: Establish a normal respiratory pattern Be free of signs of dyspnea

Intervention >Placing the client in a semi-fowler s or comfortable position >Auscultate chest, noting character of breath sounds >Administer oxygen as prescribed

Evaluation After 8 hours of duty the patient established a normal respiratory problem and was free of signs of dyspnea such as nasal flaring and use of accessory muscle to breath.

Medication: Deacribe the importance of regulalrly tak ing of prescribed medication including the potential unpleasant effects of non-compliance Instruct the mother to continue with follow up medical care Adviced the mother not to miss intake of medication given the physician upon discharge Instruct the mother the time & schedule of giving medication as ordered by the physician Environment & Exercise Encourage the mother regularly placed the client under the sun light early in the morning & massaging the client or applying passive ROM to client, this is to promote circulation of the blood & relaxation also Treatment Instruct the mother to continue home medication Also to repeat follow-up check-up Encourage the mother for giving of multivitamins/suplement for immunity

Health teachings: Life style change (proper food reference) -For NGT for gavage(for feeding) & lavage ( to excreate & to drained stomach content or for cleaning of stomach) Instruct the mother to always pinch the opening of the tube before & after the feeding to avoid entering of air that may cause _____. Before feeding instruct the mother always check the tubing if intact on the stomach using stethoscope. If intact instruct the mother to check for the stomach content by aspirating using of asepto syringe to see if theres a normal/abnormal content of the stomach. Instruct the mother to hold the feeding & immediately reffer the client to the physician if theres an abnormal content like coffee ground or greenish stomach content When feeding instruct the mother to placed the client on semi-fawlers/headd higher than body, in administering the o.f instruct the mother that the opening of the tube should higher than head then after administering o.f rinse it with water Provide the mother written/oral instruction about activity, diet recommendations,medications & follow-up visits. Out patient The mother will be adviced to go back in the hospital in a specific date to have a follow-up check up after discharge, consult the doctor for any problems or complication encountered.

Diet Diet as tolerated as much possible Spiritual Nursing action help the parents to meet their spiritual needs include Providing presence Supporing religious pratices Assisting the parents with prayer Reffering parents for spiritual counseling