hepatic encephalopathy clinical pathway

suzanne4, RN · Apr 15, 2006

I moved your post to the Nursing Student Forum.

The GI Forum deals more with the actual procedures that are performed in the GI lab, such as endoscopy procedures, placement of G-tubes, etc.

-------------------

Now to your question:

What is happening to your patient with that diagnosis? Why does he need to go to a rehab unit for further treatment? If you think about it in this way, it will be much easier for you to understand.

What happens when the liver is not functioning properly? Toxins build up in the system. What happens to the brain at this time? They have altered mental status, can be very confused or not, can even be very combative. Their brain is no longer functioning properly, and will it return to normal? Each case is different. Each patient is different.

What role is the dietitian going to play? What type of diet does your patient need, what foods need to be avoided?

Try to think of things in these terms................let us know if you need more help.

dalegirl · Apr 15, 2006

Thank you,

This is from a case study in my critical thinking class, the patient is an alcoholic. I will think along those lines.

VickyRN, MSN, DNP, RN · Apr 15, 2006

welcome to the nursing student assistance forum, dalegirl :)

some very useful information in working through your case study:

http://adam.about.com/encyclopedia/000302.htm

http://www.nursingcenter.com/prodev/ce_article.asp?tid=539097

http://www.emedicine.com/med/topic101.htm

http://www.emedicine.com/med/topic3185.htm

http://www.health.gov.au/internet/wcms/publishing.nsf/content/health-pubhlth-publicat-document-metadata-alc_treatinggp.htm/$file/alc_treatinggp.pdf

http://alcoholism.about.com/od/cirrhosis/index.htm

http://www.emedicine.com/med/topic745.htm

hope this helps :)

Daytonite, BSN, RN · Apr 15, 2006

you have to start with a look at the anatomy and physiology of the liver and what happens when it goes wrong. there are so many important functions that the liver does that can get screwed up along with hepatic encephalopathy. this usually goes in hand with end stage liver disease, usually cirrhosis, often the result of career alcoholism. to be fair, problems other than alcoholism can cause liver disease. make a list of what the doctor is likely to order. your nursing actions start with those. other nursing actions will involve helping the patient achieve his activities of daily living and if you are supposed to incorporate gordon's functional health patterns or mazlow's hierarchy of needs into to your nursing actions you need to address each one of those subjects. look at the signs and symptoms the patient is having and provide nursing actions for those as well.

this link http://www.fpnotebook.com/gi149.htm will give you in a nice outline form the pathophysiology, signs and symptoms, diagnostic tests and medical management of hepatic encephalopathy, one of the main things being to get the blood ammonia levels down because they are what is causing the patient to be obtunded and stuporus.

http://www.merck.com/mrkshared/cvmhighlight?file=/mrkshared/mmanual/section4/chapter38/38f.jsp%3fregion%3dmerckcom&word=hepatic&word=encephalopathy&domain=www.merck.com#hl_anchor - discussion of the etiology, pathogenesis, signs and symptoms, diagnosis, prognosis and treatment of hepatic encephalopathy

http://www.labtestsonline.org/understanding/analytes/ammonia/test.html - from lab tests online, an explanation of the plasma ammonia, a component of a liver panel http://www.labtestsonline.org/understanding/analytes/liver_panel/glance.html

http://www.nlm.nih.gov/medlineplus/ency/article/000302.htm - an overview of hepatic encephalopathy from the national institute of health

dalegirl · Apr 19, 2006

I desperately need help developnig a pathway, I know the basics assesssmnet, monitoring, dx tests and nutrition etc. I do not know how to put it together. I have a paper due this mon and I am a nervous wreck. My professor is not available to help me

Thanks

Daytonite, BSN, RN · Apr 19, 2006

Do it exactly the way and in the sequence it was done on the Family Practice site. Describe what hepatic encephalopathy is. Then go into a discussion of it's pathophysiology. Go through the physical assessment and the signs and symptoms you expect to see in these patients. Discuss all the tests that might be needed to help diagnose this condition. What kind of results are you going to find in the hepatic encephalopathy patient. Then, go into the treatments and what each treatment is expected to achieve. In other words, give rationales for what the doctor is ordering. Do the same for nursing actions.

dalegirl · Apr 19, 2006

Do it exactly the way and in the sequence it was done on the Family Practice site. Describe what hepatic encephalopathy is. Then go into a discussion of it's pathophysiology. Go through the physical assessment and the signs and symptoms you expect to see in these patients. Discuss all the tests that might be needed to help diagnose this condition. What kind of results are you going to find in the hepatic encephalopathy patient. Then, go into the treatments and what each treatment is expected to achieve. In other words, give rationales for what the doctor is ordering. Do the same for nursing actions.

Thanks for all your help