Nursing Care of the Nursing Care of the Pediatric Patient Pediatric Patient
with Liver Disease with Liver Disease and Transplantand Transplant
Presented by Patti Presented by Patti Winford R.N., B.S.N.Winford R.N., B.S.N.
ObjectivesObjectivesAt 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
Liver FunctionsLiver Functions1. Filters blood of waste2. Production of clotting
factors3. Production of Proteins,
Albumin, Fats, and Cholesterol
4. Removes Ammonia from body
5. Produces and secretes bile
6. Excretes bilirubin7. Breakdown of glycogen
into glucose
http://ourworld.compuserve.com/homepages/sbrillanti/liver2.jpg
Small Bowel FunctionSmall Bowel Function
The small bowel has digestive functions which include:
1. Breakdown of carbohydrates, proteins and fats
2. Absorption of nutrients, water and electrolytes into the bloodstream
Nursing AssessmentNursing 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.
HEENTHEENT• Jaundiced
Sclera• Enlarged
lymph nodes - WBC - Bilirubin
NeurologicalNeurological• Altered mental statusHeadache – DrowsinessBlurred vision – TremorsConfusion – Irritability• Glucose level• Prograf level• Steroids• Ammonia level
CardiovascularCardiovascular• Unstable Blood
pressure: Hypertension or Hypotension
• Hemorrhage• Coagulopathy
- CBC- Coags- Type/Screen- Potassium level
http://health.howstuffworks.com/heart-pictures7.htm
RespiratoryRespiratory• Ascites• Atelectasis• Pneumonia
- Blood gas- WBC- Hgb / Hct- Renal / Ep1
http://health.howstuffworks.com/lung.htm
GastrointestinalGastrointestinal• Ascites• Malnutrition• Weight loss • Emesis• Rejection
- LFT- Ca, Mg, Phos, Albumin- Prograf level- TPN Profile
GenitourinaryGenitourinary• E’lyte imbalances• Renal dysfunction
- Strict I/O- Daily weights- UOP should be > 1ml/kg/hr- Ostomy outputs
MusculoskeletalMusculoskeletal
• Provide a safe environment- side rails of cribs, choking hazards
• Incorporate play and OT / PT
IntegumentaryIntegumentary• 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
A4NA4N• 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
ConclusionConclusion• 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
