Nursing Care of the Pediatric Patient with Liver Disease and Transplant

1
Nursing Care of the Pediatric Patient with Liver
Disease and Transplant

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

2
Objectives

• At 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

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Liver Functions

• Filters blood of waste
• Production of clotting factors
• Production of Proteins, Albumin, Fats, and
  Cholesterol
• Removes Ammonia from body
• Produces and secretes bile
• Excretes bilirubin
• Breakdown of glycogen into glucose

http//ourworld.compuserve.com/homepages/sbrillant
i/liver2.jpg
4
Small Bowel Function

• The small bowel has digestive functions which
  include
• Breakdown of carbohydrates, proteins and
  fats
• Absorption of nutrients, water and electrolytes
  into the bloodstream

5
Nursing 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.

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HEENT

• Jaundiced Sclera
• Enlarged lymph nodes
• - WBC
• - Bilirubin

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Neurological

• Altered mental status
• Headache Drowsiness
• Blurred vision Tremors
• Confusion Irritability
• Glucose level
• Prograf level
• Steroids
• Ammonia level

8
Cardiovascular

• Unstable Blood pressure Hypertension or
  Hypotension
• Hemorrhage
• Coagulopathy
• - CBC
• - Coags
• - Type/Screen
• - Potassium level

http//health.howstuffworks.com/heart-pictures7.ht
m
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Respiratory

• Ascites
• Atelectasis
• Pneumonia
• - Blood gas
• - WBC
• - Hgb / Hct
• - Renal / Ep1

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

• Ascites
• Malnutrition
• Weight loss
• Emesis
• Rejection
• - LFT
• - Ca, Mg, Phos, Albumin
• - Prograf level
• - TPN Profile

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Genitourinary

• Elyte imbalances
• Renal dysfunction
• - Strict I/O
• - Daily weights
• - UOP should be gt 1ml/kg/hr
• - Ostomy outputs

12
Musculoskeletal

• Provide a safe environment
• - side rails of cribs, choking hazards
• Incorporate play and OT / PT

13
Integumentary

• 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

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A4N

• 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

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Conclusion

• 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