nursing care of the pediatric patient with liver disease and transplant presented by patti winford...

Nursing Care of the Nursing Care of the Pediatric Patient Pediatric Patient

with Liver Disease with Liver Disease and Transplantand Transplant

Presented by Patti Presented by Patti Winford R.N., B.S.N.Winford R.N., B.S.N.

ObjectivesObjectivesAt the end of this program students will

be able to:• Name five functions of the Liver• Name two functions of the Small Bowel• Identify pertinent assessment criteria

of the liver transplant patient• Analyze pertinent lab values • Recognize assessment factors needing

intervention

Liver FunctionsLiver Functions1. Filters blood of waste2. Production of clotting

factors3. Production of Proteins,

Albumin, Fats, and Cholesterol

4. Removes Ammonia from body

5. Produces and secretes bile

6. Excretes bilirubin7. Breakdown of glycogen

into glucose

http://ourworld.compuserve.com/homepages/sbrillanti/liver2.jpg

Small Bowel FunctionSmall Bowel Function

The small bowel has digestive functions which include:

1. Breakdown of carbohydrates, proteins and fats

2. Absorption of nutrients, water and electrolytes into the bloodstream

Nursing AssessmentNursing Assessment• Complete head to toe nursing assessment

should be completed Q4H and PRN• Vital signs with oxygen saturation and pain

assessment.• Documentation of all access lines and

medical equipment: PICC and peripheral IV sites, ostomies, NG, NJ, G-tubes, wound vacs, dressings, etc.

• Chart a description of patient so that others reading your charting can visualize what this patient looks like.

HEENTHEENT• Jaundiced

Sclera• Enlarged

lymph nodes - WBC - Bilirubin

NeurologicalNeurological• Altered mental statusHeadache – DrowsinessBlurred vision – TremorsConfusion – Irritability• Glucose level• Prograf level• Steroids• Ammonia level

CardiovascularCardiovascular• Unstable Blood

pressure: Hypertension or Hypotension

• Hemorrhage• Coagulopathy

- CBC- Coags- Type/Screen- Potassium level

http://health.howstuffworks.com/heart-pictures7.htm

RespiratoryRespiratory• Ascites• Atelectasis• Pneumonia

- Blood gas- WBC- Hgb / Hct- Renal / Ep1

http://health.howstuffworks.com/lung.htm

GastrointestinalGastrointestinal• Ascites• Malnutrition• Weight loss • Emesis• Rejection

- LFT- Ca, Mg, Phos, Albumin- Prograf level- TPN Profile

GenitourinaryGenitourinary• E’lyte imbalances• Renal dysfunction

- Strict I/O- Daily weights- UOP should be > 1ml/kg/hr- Ostomy outputs

MusculoskeletalMusculoskeletal

• Provide a safe environment- side rails of cribs, choking hazards

• Incorporate play and OT / PT

IntegumentaryIntegumentary• Jaundice

– itching• Skin breakdown

– Breakdown around stoma bags and diaper areas

• Infection– Risk for infection at GT,

PICC and CVC sites– Strict hand washing – Isolation precautions

A4NA4N• Check all VS – age

specific – Notify primary nurse of

any abnormal values

• Strict I/O • Accurate and complete

documentation• Prograf given on time

as ordered• Enjoy your patient, Play

with them

ConclusionConclusion• Questions• Case study

References

A4N Nursing Unit Information Packet for Nurses, A systems approach to nursing care of pediatric transplant patients

Keating, S. B. (2006). Curriculum development and evaluation in nursing Philadelphia: Lippincott Williams & Wilkins

Marieb, E. N. (2001). Human anatomy & physiology 5th edition Benjamin Cummings