Nursing Strategy for Cirrhosis Complications and Diabetic Patients

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Nursing Strategy for Cirrhosis Complications and Diabetic Patients

Partial splenic embolization has been used for quite a while in the treatment of patients with cirrhosis. However, with a variety of factors affecting the treatment process, the threat of not only liver abscess but also kidney failure can be expected. By satisfying the patients specific nutrition needs, however, the aforementioned issues can be avoided.

According to the existing research, PSE, though admittedly efficient, is fraught with such complications as transient ascites and portal vein thrombosis due to the coagulation processes, as well as splenic abscess and splenic necrosis (NKontchou et al., 2005). The aforementioned complications are triggered mostly by a continuous interruption of the blood flow. Cirrhosis is characterized by tissue replacement; to be more exact, scar tissue is accumulated and, thus, gradually ousts the liver tissue (Amin et al., 2009).

Several key tests are typically carried out to detect the key symptoms and diagnose the disease. Traditionally, a physical examination of the patient is not enough; it is necessary to take blood samples to check the functioning of the liver, its possible inflammation, and its image. Finally, a blood test for defining the causes of cirrhosis must be run. It is remarkable that at present, the procedure combines a test for cirrhosis and a test for fibrosis (Chou & Wasson, 2013) since both are triggered by a sharp increase in extracellular matrix (ECM) synthesis (Cox & Erler, 2011).

The role of the nurse in managing a patient with cirrhosis complications and facilitating the PSE procedures is quite impressive. Seeing how the process of the PSE can trigger enlargement of the spleen, splenic abscess, and even upper gastrointestinal bleeding, a nursing specialist must monitor the entire process and undertake the necessary measures once the need arises. A nurse, therefore, is supposed to perform the application of transcatheter embolization, monitor the patients state to prevent adverse reactions, such as post-surgery pneumonia development (Wu et al., 2011), etc. A team of nurses, in their turn, are supposed to distribute these roles and responsibilities among each other. In the case of a multidisciplinary approach and the involvement of an interdisciplinary team, the patients eligibility for the splenic embolization process is evaluated. As a rule, the help of oncologists, radiologists, and hepatologists is required in the given case (Bhatia et al., 2013, January 19).

It should be noted that in the cases of HCC development, priority is given to tumor progress prevention. Hence, the process of liver transplantation and the following transarterial chemoembolization or radiofrequency ablation is started before the PSE procedures. In addition, the patients that have fulminant hepatic failure, posttransplantation primary graft nonfunction, and hepatic artery thrombosis (Bope & Kellerman, 2014, p. 511), are traditionally considered high priority cases. In case of an emergency, urgent splenectomy and immediate angiography must be carried out so that the possible issues, such as abscesses, could be spotted straight away.

Needless to say, the given method of addressing cirrhosis in patients is rather risky; with several dangerous aftereffects, this treatment method may lead to dire consequences. Among the risk factors that need to be taken into account in the first place, such phenomena as high bilirubin level (1.4 mg/dl or more), high level of serum albumin (2.8 g/dl or more), big infracted splenic volume (450 ml or more), Child-Pugh class C with P being equal to 0.012 (Hayashi et al., 2008), etc. must be mentioned.

Finally, the issue of treatment of diabetic patients recovering from DKA should be brought up. Although claiming the given issue a major problem would be wrong, it is still necessary to keep in mind that such patients have very specific nutrition needs. To be more exact, it will be necessary to come up with a nutrition plan that will allow for some gastrointestinal rest. Seeing how the condition is caused by untreated hyperglycemia, it will be reasonable to suggest that the patient should drink more sugar-free fluids (23 liters per day). The given step is especially important for bedridden patients (Kitabchi, Umpierrez, Miles & Fisher, 2009, p. 1336). It is suggested that ½ cup of fruit juice should be fed to the patient daily. In addition, based on the bodyweight of the patient, a total of 1500, 1800, 2000, or 2400 kcal should be provided to the latter daily (Inzucchi, 2011, p. 4). Moreover, the patient needs to keep in mind that their circulating volume must be restored. While the restoration usually comes as a result of surgery, the patient must keep the track of the changes in their blood pressure so that the tiniest inconsistencies should be spotted at once and the smallest risks should be eliminated. Finally, it is recommended that the patient should be very attentive to the changes happening to their body, since DKA patients often suffer from complications, such as hypoglycemia, hypokalemia, etc. The slightest change may be the symptom of a complication.

Reference List

Amin, M. A., el-Gendy, M. M., Dawoud, I. E., Shoma, A., Negm, A. M. & Amer, T. A. (2009). Partial splenic embolization versus splenectomy for the management of hypersplenism in cirrhotic patients. World Journal of Surgery, 33(8), 17021710.

Bhatia, S., Venkat, S., Rocha-Lima, C. M., Gonzalez, E., Jun, E. & Narayanan, G. (2013). Treatment options for thrombocytopenia in cancer patients. Interventional Oncology. Web.

Bope, E. & Kellerman, R. D. (2013). Conns current therapy 2013: Expert consult: Online. Philadelphia, PA: Elsevier Health Sciences.

Cox, T. R. & Erler, J. T. (2011). Remodeling and homeostasis of the extracellular matrix: implications for fibrotic diseases and cancer. Disease Models & Mechanisms, 4(2), 165178.

Hayashi, H., Beppu, T., Okabe, K., Masuda, T., Okabe, H. & Baba, H. (2008). Risk factors for complications after partial splenic embolization for liver cirrhosis. British Journal of Surgery, 95(6), 744750.

Inzucchi, S. E. (2011). Diabetes facts and guidelines.

Kitabchi, A. E., Umpierrez, G. E., Miles, A. M. & Fisher, G. M. (2009). Hyperglycemic crises in adult patients with diabetes. Diabetes Care, 32(7), 13351343.

NKontchou, G., Seror, O., Bourcier, V., Mohand, D., Ajavon, Y., Castera, L., Beaugrand, M. (2005). Partial splenic embolization in patients with cirrhosis: efficacy, tolerance and long-term outcome in 32 patients. European Journal of Gastroenterology & Hepatology, 17(2), 179184.

Wu S. C., Fu, C. Y., Chen, R. J., Chen, Y. F., Wang, Y. C., Chung, P. K., & Lee, K. H. (2011). Higher incidence of major complications after splenic embolization for blunt splenic injuries in elderly patients. American Journal of Emergency Medicine, 29(2), 135140.

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