Liver

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"CIRRHOSIS
Data depends on the underlying cause of the condition.
ACTIVITY/REST
* May report: Weakness, fatigue, exhaustion
* May exhibit: Lethargy
* Decreased muscle mass/tone
CIRCULATION
* May report: History of/recent onset of heart failure, pericarditis, rheumatic heart disease, or cancer (causing liver impairment leading to failure) * Easy bruising, nosebleeds, bleeding gums

* May exhibit: Hypertension or hypertension (fluid shifts) * Dysrhythmias, extra heart sounds (S3, S4)
* Jugular venous distension (JVD), distended abdominal veins, spider angiomas/collateral circulation * Ecchymosis, petechiae
* anemia, leukopenia, thrombocytopenia, coagulation disorders, splenomegaly ELIMINATION
* May report: Flatulence
* Diarrhea or constipation; gradual abdominal enlargement * May exhibit: Abdominal distension (hepatomegaly, splenomegaly, ascites) * Decreased/absent bowel sounds
* Clay-colored stools, melena
* Hemorrhoidal varices
* Dark, concentrated urine; oliguria (hepatorenal syndrome/failure) FOOD/FLUID
* May report: Anorexia, food intolerance/indigestion
* Nausea/vomiting, hematemesis
* May exhibit: Weight loss or gain (fluid)
* Tissue wasting, delayed wound healing
* Edema generalized in tissues
* Dry skin, poor turgor
* Halitosis/fetor hepaticus. bleeding gums
* Hypoalbuminemia
NEUROSENSORY
* May report: Significant other(s) may report personality changes, depressed mentation * May exhibit: Changes in mentation, confusion, hallucinations, coma * Slowed/slurred speech
* Asterixis (involuntary jerking movements of hands/tongue/feet associated with hepatic encephalopathy) PAIN/DISCOMFORT
* May report: Abdominal tenderness/RUQ pain
* Severe itching
* Pins/needles sensation, burning pain in extremities (peripheral neuropathy) * May exhibit: Guarding/distraction behaviors
* Self-focus
RESPIRATION
* May report: Dyspnea
* May exhibit: Tachypnea, shallow respiration, adventitious breath sounds * Limited thoracic expansion (ascites)
* Hypoxia
SAFETY
* May report: Itching/dryness of skin
* May exhibit: Fever (more common in alcoholic cirrhosis) * Jaundiced skin and sclera, pruritis
* Spider angiomas, telangiectasis, palmar erythema
* Confusion progressing to delirium and coma (hepatic encephalopathy) * Unsteady or shaky/jerking movements
SEXUALITY
* May report: Menstrual disorders (women), impotence (men) * May exhibit: Testicular atrophy, gynecomastia, loss of hair (chest, underarm, pubic) TEACHING/LEARNING
* May report: History of long-term alcohol or IV drug use/abuse, alcoholic liver disease. use of drugs affecting liver function * History of biliary disease, hepatitis, exposure to toxins, liver trauma, complications of portal hypertension (e.g. episodes of bleeding esophageal varices and hepatorenal syndrome)" "HEPATITIS

Data depends on the cause (type of hepatitis) and severity of liver involvement/damage. ACTIVITY/REST
* May report: Fatigue, weakness, general malaise, muscle aches CIRCULATION
* May exhibit: Bradycardia (severe hyperbilirubinemia)
* Jaundiced sclera, skin, mucous membranes
ELIMINATION
* May report: Dark urine
* Diarrhea/constipation, clay-colored stools
* current/recent hemodialysis
FOOD/FLUID
* May report: Loss of appetite (anorexia), weight loss or gain (edema) * Nausea/vomiting
* May exhibit: Ascites
NEUROSENSORY

* May exhibit: Irritability, drowsiness, lethargy, asterixis, headache PAIN/COMFORT
* May report: Abdominal cramping, right upper quadrant (RUQ) tenderness * Myalgias, arthalgias; headache
* Itching (pruritis)
* May exhibit: Muscle guarding, restlessness
RESPIRATION
* May report: Distaste for/aversion to cigarettes (smokers) * Recent flu-like URI signs and symptoms
SAFETY
* May report: Transfusion of blood/blood products in the past *...
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