(2)
Implement the use of a soft bristle toothbrush.
(3)
Implement the use of an electric razor for shaving instead of a blade
razor.
(4)
Use small gauge needles for drawing blood and starting IVs.
(5)
Caution the patient against forceful nose blowing to prevent epistaxis.
d. Provide Skin Care.
(1)
Use gentle cleansers to decrease skin irritation.
(2) Use soothing lotions to control the itching that occurs as a result of bile
salt retention.
(3)
Administer prescribed medications for pruritis.
(4)
Keep the patient's fingernails short to prevent scratching the skin.
e. Observe and Assess for Indications of Hepatic Encephalopathy.
(1) Arouse the patient at intervals and assess level of consciousness and
orientation to place and time.
(2)
Observe for personality changes or mental changes.
(3)
Observe for signs of increasing lethargy.
(4)
Observe for signs of neuromuscular dysfunction.
(5)
Observe for evidence of hallucinations.
f. Provide Emotional Support.
(1) The patient will experience fatigue and malaise as a normal
consequence of the illness. Assure him that this is normal and will eventually resolve.
(2) Educate the patient and his family about the nature of the illness so that
they will be better able to cope.
1-62. PORTAL HYPERTENSION AND ESOPHAGEAL VARICES
a. Portal hypertension (elevated pressure in the portal vein) is a result of the
increased resistance in blood flow through the portal venous circulation. This disorder
is almost always the result of cirrhosis.
MD0918
1-63
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