Hyperaldosterism Sodium retention Potassium loss Supportive Care for Pruritus

Hyperaldosterism sodium retention potassium loss

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Hyperaldosterism -- Sodium retention, Potassium loss Supportive Care for Pruritus Warm, rather than hot water—don’t dry out skin more Avoid drying soaps Use emollients Keep clothing and bedding dry These patients can 3 rd space fluid—scratching, oozing out of skin (d/t deficiency in albumin) Administer Cholestyramine (Questran) Common med for High Cholesterol o Bile acids are excreted, plasma cholesterol is converted to bile acid to normalize bile acid levels o Lower their cholesterol too o Help to get rid of the bile acid and normalize what is in our blood (converts cholesterol to convert what is already in the blood) Administer Dyphenhydramine (Benadryl) more commonly given Liver Failure Complications Portal hypertension Esophageal and gastric varices Edema and ascites Hepatocellular carcinoma—high incidence for people with cirrhosis don’t heavily monitor patients for this because they don’t live long enough (increased awareness) Hepatic encephalopathy Hepatorenal syndrome Risk for infection Metabolic derangements Portal Hypertension Definition Increased venous pressure in portal circulation which is normally a low pressure system Damaged liver flow impaired to, from and through liver resistance to the blood flow (body senses liver not getting good BF Body sends more there which causes further increased venous pressure) *Increased pressure, starts to engorge the surrounding areas Leads to Splenomegaly (enlargement of the spleen), Edema & Ascites, Varices, and more -Internal hemorrhoids: increased pressure in portal vein—Occur because of the dilation of the mesenteric veins and rectal veins around the umbilicus (happens with chronic problems) -Caput medusa: Ring of varices around the umbilicus
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Esophageal and Gastric Varices About O NOT IN ACUTE LIVER FAILURE—CHRONIC ONLY O Liver attempts to develop collateral circulation to help relieve the increase in pressure in the portal venous system O Collateral veins that develop are called varices O Esophageal varices: O More common O Form at lower end of esophagus (may also form in gastric area) O Contain little elastic tissue and are quite fragile O Can dilate to accept more blood VERY DANGEROUS, HIGHER INCIDENCE OF RUPTURE O Varices very fragile increased risk for bleeding any increase in pressure can cause the varices to rupture (cough, straining) O Bleeding esophageal varices= Most life-threatening complication of cirrhosis O 30–50% of patients with cirrhosis die within 6 weeks of first bleed O Gastric varices: O Located in upper portion of stomach O Cause of life-threatening gastric hemorrhage
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Treatment If bleeding occurs: O Stabilize patient O Manage the airway O Try to control bleeding need to gauge how bad the bleed is (HR/ BP/ signs of perfusion/ Mental Status) O Outside of varices higher risk of bleeding anyway (soft bristle toothbrushes, electric toothbrushes) O Find the source of the bleed Drugs O Octreotide (Sandostatin) reduces splanchnic blood flow
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