Pharmacologic Highlights

Medication or Drug Class




Histamine receptor (H2) antagonists Thiamine

100 mg qd for several days or longer, depending on nutritional deficiencies Up to 10 mg IV as needed

Ranitidine and famotidine Vitamin supplement

Vitamin supplement

Decrease gastric secretion; used as prophylaxis for ulcers Reduces risk for neuropathies

Supplement vitamin K, which is needed for prothrombin production

Other Drugs: Sedatives and acetaminophen are avoided because poor metabolism can precipitate encephalopathy. Aspirin is usually avoided because of the action on platelets, which can lead to increased bleeding. If ascites is present, diuretics, particularly aldosterone antagonists such as spironolactone (Aldactone), may be prescribed and, if ineffective, more potent loop diuretics may be added. Silibinin is a derivative of silymarin, an active ingredient in herbal preparations that possesses antioxidant properties; its use may benefit liver disease management.

576 Lung Cancer


The most common problem for patients with liver failure is fluid volume excess. Measure the patient's abdominal girth at the same location daily, and mark the location as a reference point for future measurements. Notify the physician if the girth increases by 2 inches in 24 hours. Provide the required fluid allotment over the three meals and at night. If the patient desires, reserve some fluids to be used as ice chips. Provide mouth care every 2 hours. Because areas of edema are likely to be fragile and prone to skin breakdown, provide skin care.

One of the most life-threatening complications of liver failure is airway compromise because of neurological or respiratory deterioration. Keep endotracheal intubation equipment and an oral airway at the bedside at all times. Elevate the head of the patient's bed to 30 degrees to ease respirations, and support the patient's arms on pillows to decrease the work of breathing. It is essential to be at the bedside and to perform serial assessments of all critical systems. Space all activities and limit visitors as needed so that the patient gets adequate rest. To encourage rest, consider nonpharmacologic methods such as diversionary activities and relaxation techniques.

The patient may be anxious, depressed, angry, or emotionally labile. Allow the patient to verbalize anxieties and fears. If needed, refer the patient to a counselor. Evaluate thoroughly anyone who is a candidate for a liver transplant to ensure that she or he has the ability to cope with a complex situation. Answer all questions, and explain the risks and benefits. Refer to an alcohol counselor if appropriate.

• Physical responses: Vital signs, ease of respirations, breath sounds, heart sounds, level of consciousness, gastrointestinal distress, abdominal girth, daily weights, color of skin and sclera

• Nutrition: Tolerance of diet, appetite, ability to maintain body weight or to decrease fluid retention, presence of muscle wasting or signs of malnutrition, albumin level

• Response to therapy: Clearing of mental status, improvement in infection, decreased or stable blood ammonia level

Teach the patient to follow prescribed sodium and fluid restrictions. Assist the patient to individualize a diet plan to maximize personal choices, including a dietitian if necessary. Encourage sodium-restricted patients to read labels on all canned soups, sauces, and vegetables and on all over-the-counter medications. Be sure the patient understands any pain medication prescribed, including dosage, route, action, and side effects. Teach the patient and family the need to limit the rise of infections by good hand washing, avoidance of others with colds, and prompt treatment by a healthcare provider when an infection occurs. Refer the patient to an alcohol support group.

Lung cancer is the leading cause of cancer death among both men and women. Annually, over 163,500 deaths from lung cancer occur, which are 28% of all cancer deaths. Lung cancer accounts for more deaths than prostate, breast, and colon cancer combined. The 1-year survival

5 Easy Ways To Stop Smoking

5 Easy Ways To Stop Smoking

Your first day without cigarettes can be difficult, but having a plan will make it easier! Learn what steps to take on the day you quit smoking.

Get My Free Ebook

Post a comment