Question

1..what are the complications that occur in a respirtaory system of a patient diagnose with liver cirrhosis during anesthesia

2...what should be the nursing intervention to prevent this complications

3...is organ transplantion possible for a patient with liver cirrohosis and explain the reason for your answer

4...whats the nurisng diagnosis and discharge plan foe this patient with liver cirrhosis

Answer 1

1. What are the complications that occur in a respirtaory system of a patient diagnose with liver cirrhosis during anesthesia?

▪ Hepatopulmonary Syndrome

Hepatopulmonary syndrome is a syndrome of shortness of breath and hypoxemia (low oxygen levels in the blood vessels) caused by vasodilation(due to decreased hepatic perfusion) in the lungs of patients with liver diseases due to anesthesia.

▪ Hepatic hydrothorax

Hepatic hydrothorax in which presence of a pleural effusion in a patient with cirrhosis who does not have other reasons to have a pleural effusion apart from surgical anesthesia. Hepatic hydrothorax occurs in approximately 5 to 10 percent of patients with cirrhosis postoperatively.

▪ Porto pulmonary hypertension

Portopulmonary hypertension (PPHTN) refers to pulmonary arterial hypertension that is associated with portal hypertension. Anesthesia causes an initial reduction in hepatic arterial blood flow in the first 30 minutes of induction of anesthesia. These hypoperfusion of liver will increase the pressure in the lungs to lead into hypertension.

▪ Hypoxia

Hypoxia can develop due to the inadequate supply of oxygen to the lungs followed by hypoxemia and hydrothorax.

2. What should be the nursing intervention to prevent this complications?

Nurses a plays a major role in preventing thses kind of complications.

▪ Patient preoperative liver enzyme sample should be evaluated(Liver function test)

▪ Compare both pre and post operative liver enzymes ranges

▪ Changes in Liver function tests (AST, ALT, total and direct Bilirubin) from the preoperative values to 48 hours postoperative has to checked

▪ Monitor vital signs especially heart rate and blood pressure

▪ Air patency has to be checked by assessment and auscultation

3.Is organ transplantion possible for a patient with liver cirrohosis and explain the reason for your answer?

Yes, organ transplantion (Liver transplantion) for a patient with liver cirrohosis.

Liver transplant is a last-resort measure for chronic (long-term) liver diseases and severe acute (sudden onset) liver diseases.For Example, Patient with Liver cirrohosis.

In some cases liver transplants may be option for chronic liver disease or if liver failure happens very quickly. Cirrhosis is the most common reason where patients need liver transplants. Cirrhosis replaces healthy liver tissue with scarred tissue. A doctor may recommend a liver transplant for a person ath the end-stage liver disease where patient will die without a transplant. A doctor may also suggest a liver transplant if other treatments for liver disease aren’t enough to keep a person alive.

The reasons where patient may not be eligible to receive a liver transplant due to:

*The presence of some other life-threatening disease or condition that would not improve with transplantation

_cancers

_infections that cannot be treated or cured

_significant brain damage that is not thought to be reversible

4. What is the nurisng diagnosis and discharge plan foe this patient with liver cirrhosis?

a) Imbalanced nutrition: less than body requirements related to abdominal distention, inadequate diet and anorexia.

b) Excess fluid volume related to compemised regulatory mechanism

C) High risk for injury related to altered clotting mechanisms and altered level of consciousness

D) Chronic pain and discomfort related to enlarged liver and ascites.

E) Activity intolerance related to fatigue, lethargy, and malaise.

F) Disturbed thought processes and potential for mental deterioration related to abnormal liver function and increased serum ammonia level

G) mpaired skin integrity related to pruritus from edema.

H) Ineffective breathing pattern related to ascites and restriction of thoracic excursion secondary to ascites, abdominal distention, and fluid in the thoracic cavity

I) Deficient knowledge related to unfamiliarity with information resources

*Prepare for discharge by providing dietary instruction, including exclusion of alcohol.

*Refer to counseling, or spiritual advisor if indicated.

*Encourage to continue sodium restriction

*Provide written instructions, teaching, support, and reinforcement to patient and family.

*Encourage rest and probably a change in lifestyle (adequate,well-balanced diet and elimination of alcohol).

*Instruct family about symptoms of impending encephalopathy and possibility of bleeding tendencies and infection.

*Offer support and encouragement to the patient and provide positive feedback when the patient experiences successes.

*Refer patient to home care nurse, and assist in transition from hospital to home.