Discharge And Home Healthcare Guidelines

Teach the patient and significant others about the course of the disease, the treatment options, and how to recognize complications. Explain that the patient or family needs to notify the physician if any of the following occur: fever, chills, cough, sore throat, increased bleeding or bruising, new onset of bone or abdominal pain. Urge the patient to maintain a realistic but positive attitude. The return to an independent lifestyle is possible with the efforts of a competent healthcare team and the patient's cooperation. Provide a list of referral agencies as appropriate, such as the American Cancer Society, hospice, and support groups.

Discuss the patient's home environment to limit the risk of exposure to infections. Encourage the patient to avoid close contact with family pets because they carry infections. The patient should not clean birdcages, litter boxes, or fish tanks. Additional sources of bacteria in the home include water in humidifiers, standing water in flower vases, or water in fish tanks. Encourage the patient to have air filters in furnaces and air conditioners changed weekly. Explain that raw fruits, vegetables, and uncooked meat carry bacteria and should be avoided. If the patient is injured, encourage him or her to apply pressure, use ice to the area, and report excessive bleeding. Teach the patient to avoid blowing or picking the nose or straining at bowel movements to limit the risk of bleeding.

572 Liver Failure

Explain the proper administration and potential side effects of any medications. Teach the patient how to manage pain with the prescribed analgesics and other side effects specific to each chemotherapeutic agent. Explain that the chemotherapy may cause weight loss and anorexia. Encourage the patient to eat a diet high in calories and protein and to drink at least 2000 mL of fluids per day. If the chemotherapy leads to anorexia, encourage the patient to eat frequent, small meals several times a day. Arrange for a dietary consultation if needed before discharge. If the patient has oral lesions, teach the patient to use a soft toothbrush or cloth and to avoid hot, spicy foods and commercial mouthwashes, which can irritate mouth ulcers.

Liver Failure DRG Catego,r 205

Mean LOS: 6.1 days Description: MEDICAL: Disorders of Liver Except Malignancy, Cirrhosis, Alcoholic Hepatitis with CC

Liver (hepatic) failure is a loss of liver function because of the death of many hepatocytes. The damage can occur suddenly, as with a viral infection, or slowly over time, as with cirrhosis. Acute liver failure (ALF) is a term referring to both fulminant hepatic failure (FHF) and subfulminant hepatic failure. FHF occurs when sudden (within 8 weeks from onset), severe liver decompensation caused by massive necrosis of the liver leads to coagulopathies and encephalopathy. Subfulminant hepatic failure, also known as late-onset hepatic failure, occurs in patients with liver disease for up to 26 weeks prior to the development of hepatic encephalopathy. Approximately 2000 cases of FHF occur each year in the United States.

Because of the complex functions of the liver, liver failure leads to multiple system complications. When ammonia and other metabolic byproducts are not metabolized, they accumulate in the blood and cause neurological deterioration. Without normal vitamin K activation and the production of clotting factors, the patient has coagulation problems. Patients are at risk for infections because of general malnutrition, debilitation, impairment of phagocytosis, and decreased liver production of immune-related proteins. Fluid retention occurs because of decreased albumin production, leading to decreased colloidal osmotic pressure with failure to retain fluid in the bloodstream. Renin and aldosterone production cause sodium and water retention. Ascites occurs because of intrahepatic vascular obstruction with fluid movement into the peritoneum.

Complications of liver failure include bleeding esophageal varices (Box 1), hemorrhagic shock, hepatic encephalopathy, hepatorenal syndrome, coma, and even death.

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