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Incidence and risk factors

Discuss about the Management of Cirrhosis and Acites.

The diseases is caused by several factors like alcohol, hepatitis B, hepatitis C and non-alcoholic fatty liver. The disease may have more than one cause in an individual depending on their lifestyle and other factors (Suk, Kim, & Baik, 2014). However, in the case of Nathan, the major cause of the disease is alcohol. This indicates that he is suffering from alcoholic liver cirrhosis that develops from drinking over ten years. He is a smoker and has been consuming two glasses of beer every day for the past fifteen years. The life of Nathan has made him exposed to risk factors associated with the disease. This may have led him to develop the fatty liver disease which may have led to the development of the disease.

The incidence and risk factors of liver cirrhosis in patients can be analyzed in phases based on the signs and symptoms that are reported by the patient. The condition is described as the result of all chronic liver disease (Karageorgos, et al., 2017).  From the clinical information, Nathan is in the asymptomatic phase or compensated cirrhosis which is followed by complications of portal hypertension, ascites, hepatic encephalopathy and variceal bleeding which are signs that have been reported by the patient. The transition in the disease occurs at a rate of 5-7% per year which leads to liver cancer. The condition advances from one stage to another as the individual continues exposing the body to the conditions that accelerate the disease and move it from one stage to another.

The impact of the liver cirrhosis is the burden it has to the family and the patient. The disease has a big impact on the finances and the time spend to take care of the patient. Nathan has been admitted in the dependency unit for investigation which makes him vulnerable this requiring the assistance of family. The longer he stays in the unit the higher the cost. According to Hung, Liang, Hsu, & Wei-Chen Tai (2017) add that when the stage develops to the severe stage with signs like yellowing of the skin, loss appetite, itching, bruising and swollen belly start to show, the patient develops psychological problems when he discovers that the body is slowly failing. Further, the disease leads to stressful complications like salt restrictions and elimination of proteins in the diet which may lead to changes in normal family diet. Therefore, the disease carries both physical and psychological burdens to the patient and his family.

The impact of liver cirrhosis on the patient and family

The liver and the brain communicate to regulate the appetite of the individual through increasing craving for food. Through the liver enzyme liver fructose-1, 6-bisphosphates, the appetite of an individual is controlled. Liver cirrhosis patients report loss of appetite because their liver is not functioning well thus leading to clogging fluids in the body system (O’Shea, Dasarathy, & McCullough, 2010). These fluids make the patient loose appetite since some of them need to be egested while others need to circulate in the whole body. Lack of a good functioning liver leads to loss of appetite since the body is not functioning normally. Nathan has experienced this problem and has been struggling to eat all the time.

Bruising is a result of weakened blood vessels due to diseases and decreased production of blood clotting factors by the diseased liver. Since the liver plays a major role in clotting of blood (p., Cardenas, Arroyo, & Rodes, 2004). Then when the liver is weakened, there is a problem producing these clotting elements which makes the skins to easily get bruised even with the slightest compression.

The liver plays the role of filtering toxics from the body to ease digestion. When the liver is overworked due to indulgence in alcohol, toxic residues build up. Loss of body weight is one of the factors associated with loss of appetite (Suk, Kim, & Baik, 2014). This problem may also lead to build up of fats around the belly thus reducing the absorption of minerals into the body which leads to weight loss.

This is one of the complication signs that show the disease is moving to the severe. Ascites is described as the buildup of fluids in the abdomen which leads to increased abdominal size (Friedman & Keeffe, 2011). Nathan has reported this symptom which has led to shortness in breath and abdominal discomfort. Further, Nathan reported a mildly jaundiced sclera which may be a result of the disease.

The liver coordinates with the rain to increase alertness and functioning of the body. Through removal of toxins in the body, the brain works well thus keeping the individual alert all times (Friedman & Keeffe, 2011). When the liver fails to work well the toxins build up in the bloodstream thus affecting the function of the central nervous system which coordinates normal body functioning thus leading lack alertness, apnea, confusion and difficulty thinking clearly among others.

Two common types of drugs are used to treat alcohol-related liver disease; Glucocorticosteroids and pentoxifylline. Glucocorticosteroids use is based on steroid therapy that has been widely used to treat such patients because they have an early response to treatment through a decrease in serum bilirubin level (Thursz, Richardson, Allison, & Austin, 2015). Through use of the therapy and aggressive eternal nutrition, patients can be assisted to overcome the condition and lead a better life. The treatment relies on the effect of steroids on polymorphonuclear neutrophil functions thus inhibiting pro-inflammatory transcription factors which may increase toxicity in the bloodstream. This leads to suppressed inflammatory and immune-mediated hepatic destruction (O’Shea, Dasarathy, & McCullough, 2010). The therapy is based on an equivalent of 30-40 mg/d of prednisone for 30 days and a rapid taper and withdrawal for two weeks. However, Lewis & Stine (2013) suggests that the treatment method has reported several complications like development of life-threatening infections. Marked anti-anabolic effects of the steroids mat suppress regeneration and lead to slowed healing Further, if after seven days of treatment there is no reduction in serum. Steroids need also to be avoided in patients with gastrointestinal bleeding requiring transfusion, chronic hepatitis B virus infection, evidence of active infection, and probably in hepatorenal syndrome.

Loss of appetite

Pentoxifylline is used as an alternative to corticosteroids in patients with severs alcoholic cirrhosis.  The drug works through increasing intracellular concentration of adenosine and guanosine which improve the outcome of liver problem through downregulation of pro-inflammatory cytokines that play a role in pathogenesis of the disease. The treatment is also said to have antifibrotic effects that work through attenuation of profi-brogenic cytokine and procollagen expression (Assimakopoulos, Thomopoulos, & Labropoulou-Karatza, 2009). However, Pentoxifylline has been highly regarded as the better option when compared to prednisone since it reports higher survival of patients (Gupta & Lewis, 2008). It also improves renal function of the system thus leading to increased efficacy in preventing hepatorenal syndrome in the severe complications of hepatitis patients (Parker, Armstromng, orbett, Rowe, & Houlihan, 2013). Studies have indicated the effectiveness of the drug in achieving a positive response in the patient and controlling the manifestation of the disease. Despite side effect challenges that lead to fatal situations, the medication has more positive results than negative results.

The first nursing care strategy in patients with liver cirrhosis is nursing assessment through assessing bleeding, fluid retention and mentation. Bleeding entails checking the skin, gums, stool, and vomit to determine if the patient has internal and external bleeding (Vlaisavljevi? & Rankovi, 2015).  Fluid retention is measured through weight the patient and their abdominal girth to understand the level of fluid retention and lastly mentation entails assessing the level of consciousness through analyzing behavior and personality.

The next step is diagnosis of the risk factors that the patient is suffering from. Cardenas, Arroyo, & Rodes (2004) argue that such factors may include activity intolerance, imbalanced nutrition, and high risk for injury, chronic pain, fluid volume excess, ineffective breathing pattern and disturbed thought. Each of these factors is important in shaping the nursing care goals that will be established. The patient needs to be assisted overcome the challenges that they are facing through reducing the distress caused by the disease before treatment begins.

The next step is setting nursing care plan and goals. If the patient has good consciousness, then the plans can be set with him or her. While if they are not conscious, then the plans can be set by their kin who needs to understand the nursing care plan that will be used before medication and after medication. Each goal is related to the condition of the patient and the signs and symptoms that they have displayed (Cardenas, Arroyo, & Rodes, 2004). The need to set goals with the patient is a participatory approach used to increase the patient’s participation and cooperation in achieving the desired treatment.

Bruising

The last step in the application of nursing interventions to the patient. The first intervention is promoting rest to increase respiratory efficiency or provision of oxygen if needed. Efforts need to be initiated to prevent respiratory, circulatory or vascular disturbances to the patient to allow the body pull itself together (Cardenas, Arroyo, & Rodes, 2004). Nutritional status can also be used through providing high proteins supplemented with vitamins. The patient needs to be encouraged to eat small portion frequently and if there is difficulty in eating, then nutrients need to be provided through feeding tube.

Since most patients with the diseases have problems with their skin, then skin care needs to be provided through changing their position frequently and avoiding use of irritating substances on the skin.  Also lotions can be used to sooth the skin to prevent itching (Vlaisavljevi? & Rankovi, 2015). Risk injury needs to be reduced too through use of side rails on the bed or orienting time and place procedures to prevent agitation. The patient needs to be instructed on body management instructions like being assisted to get out of the bed and other forms of assistance.

The last intervention is offering of psychological support to the patient. The patient needs to be assisted develop a positive mentality that the disease can be cured to increase their response to medical intervention. This strategy prevents denial and self-blame which may hinder response and intake of medication (Friedman & Keeffe, 2011). The family and health practitioners work together to assist the patient manage the condition by adapting to the healthcare routine provided. Without this, then the patient will face difficulty in responding to the therapy since it requires personal commitment to overcome the challenges that they are facing.

References

Assimakopoulos, S. F., Thomopoulos, K. C., & Labropoulou-Karatza, C. (2009). Pentoxifylline: A first line treatment option for severe alcoholic hepatitis and hepatorenal syndrome? World Journal of Gastroenterol, 15(25), 3194-3195.

Friedman, L. S., & Keeffe, E. B. (2011). Handbook of Liver Disease. Elsevier Health Sciences.

Gupta, N., & Lewis, J. (2008). Review article: the use of potentially hepatotoxic drugs in patients with liver disease. Aliment Pharmacol Therapy, 28, 1021-1041.

Hung, T.-H., Liang, C.-M., Hsu, C.-N., & Wei-Chen Tai. (2017). Association between complicated liver cirrhosis and the risk of hepatocellular carcinoma in Taiwan. PLOS One, 12(7).

Karageorgos, S. A., Stratakou, S., Koulentaki, M., Voumvouraki, A., Mantaka, A., Samonakis, D., . . . Kouroumalis, E. A. (2017). Long-term change in incidence and risk factors of cirrhosis and hepatocellular carcinoma in Crete, Greece: a 25-year study. Annals of Gastroenterol, 30(3), 357-363.

Lewis, J., & Stine, J. (2013). Review article: prescribing medications in patients with cirrhosis – a practical guide. Alimentary Pharmacology & Therapeutics, 37(12).

O’Shea, R., Dasarathy, S., & McCullough, A. (2010). Alcoholic liver disease. Hepatology, 51, 307-328.

p., G., Cardenas, A., Arroyo, V., & Rodes, J. (2004). Management of cirrhosis and acites. New England Journal of Medicine, 350, 1646-1654.

Parker, R., Armstromng, M., orbett, C., Rowe, I., & Houlihan, D. (2013). Systematic review: pentoxifylline for the treatment of severe alcoholic hepatitis. Alimentary Pharmacology & Therapeutics, 37(9).

Suk, K., Kim, M., & Baik, S. (2014). Alcoholic liver disease: treatment. World Journal of Gastroenterology, 20(36), 12934–12944.

Thursz, M. R., Richardson, P., Allison, M., & Austin, A. (2015). Prednisolone or Pentoxifylline for Alcoholic Hepatitis. The New England Journal of Medicine, 372, 1619-1628.

Vlaisavljevi?, Z., & Rankovi, I. (2015). Specific Nursing Care Rendered In Hepatic Encephalopathy: Contemporary Review and New Clinical Insights. Nursing & Care, 4(4), 1-7.

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