Audio Transcript Auto-generated
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Hi, everyone.
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I'm Sara Hutchinson.
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If you're watching this video, you're probably a nursing student
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learning about how to care for patients with liver problems.
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And if you're not and you're still here, I hope
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these images inspire you to pay attention to your health,
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your body and take care of your liver.
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Today we're going to talk about skin lesions in cirrhosis
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patients, while most of the time you recognize liver patients
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by the characteristic jaundiced appearance, there are other skin manifestations
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that we as nurses, should recognize and provide education for
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our patients.
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So what is cirrhosis?
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I know that you know what it is, but let's
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just have a refresher.
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Cirrhosis is a disease of the liver, characterized by extensive
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and irreversible scar tissue, replacing the healthy liver cells, usually
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caused by chronic liver damage or disease.
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This progressive illness limits delivers ability to function properly and
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will lead to end stage liver disease if not identified
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and treated appropriately.
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There is no cure for cirrhosis, and treatment revolves around
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protecting the remaining healthy liver tissue and relieving the symptoms.
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Cirrhosis is most commonly caused by chronic alcoholism, hepatitis B
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and C nonalcoholic stay auto, hepatitis, Nash bile, duct disease
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or genetic causes.
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But there are others.
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So why is the skin important?
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We all know that the skin is the largest organ,
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and manifestations of the skin usually indicate that something is
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going on underneath in patients with liver damage.
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Some of their first symptoms they experience are jaundice and
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itchy, flaky red skin problems.
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This is why it is so crucial to thoroughly assess
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your patients in their entirety.
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And if you see something that is new or unusual
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with no obvious cause, it is your job to advocate
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for further testing.
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It is also important to know that if a patient
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comes in complaining of any of the skin changes, we're
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going to talk about a liver problems should be high
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on the list of differential diagnoses.
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So first, of course, is John Dis.
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It is one of the most common Cue Tatis man
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affection, manifestations of liver disease.
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When the liver does not remove enough Billy Rubin from
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the blood, high levels cause a yellow discoloration off the
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skin and Clara John.
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This will also cause dark urine as a Billy, as
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the Billy Rubin is excreted through the kidneys, it is
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one of the first signs of liver damage.
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So it is important to inform patients that they need
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to seek treatment if they start to notice.
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This yellow coloring the john does itself is usually not
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treated, but the underlying law underlying disorder is treated and
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the symptoms should subside.
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Next is Palmer Ara Thema.
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As you can see, Palmer era Thema is an abnormality
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characterized by bright red coloring of the poems look, particularly
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at the base of the thumb and the heels of
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the hand.
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While there is primary Palmer era thema that is hereditary,
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it is actually very rare, so it's usually secondary as
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a symptom to another condition.
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About 23% of cirrhosis stations experience Palmer era thema.
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It is usually non painful, non itchy and slightly warm.
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There is no treatment, however, treating the underlying liver issues
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may lessen the readiness over time.
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So it is important to assess your patients hands in
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poems and also know that a complaint of Red Palm's
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demands further investigation.
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Next is the Tiki I and ECA Moses Batikhi.
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I are formed when small cap Hillary's break open and
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blood leaks into your skin, which causes tiny purple and
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red spots on the skin, usually smaller than three millimeters.
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Echo Moses occurs when blood collects under the tissue in
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larger, flat areas, usually greater than one centimeter, so you
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can see higher up on the leg.
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There is a small little spots of petechiae, and around
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the ankle is the larger flat echo Moses areas.
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Because cirrhosis decreases liver function, there is a decrease in
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production of clotting factors in an imbalance of platelet production
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and destruct destruction, which puts patients at an increased risk
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for bruising and bleeding.
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It is important to make patients aware of this side
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effect, so they will take increased precautions to avoid activities
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that would cause bruising or internal bleeding.
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Next is Spider Ngoma as or spatter Nevis.
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Ah, These are caused by an abnormal collection of blood
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vessels near the surface of the skin.
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He specifically are found to have a red central spot
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in reddest extensions, which radiate outwards like a spider's web.
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There are common, benign lesion that can be seen healthy
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adults and Children.
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Multiple lesions are seen frequently in pregnant women as well
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as people with liver disease.
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They occur most frequently on the neck base, upper part
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of the trunk, arms and fingers.
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When assessing a patient with spider NGO, Miss, they should
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be blamed doble.
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So when you apply pressure, the red color will disappear
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and then reappear when you let go because blood is
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flowing back into the vessels.
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These lesions are harmless and painless by themselves and may
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resolve with liver treatment.
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However, laser therapy may be used if there is a
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cosmetic concern.
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Next is Caput Medusa, Caput Medusa.
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Also called the Poll Home Tree sign is the appearance
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of distended at the gastric veins that radiate from the
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humble like it's across the abdomen.
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It's called caput Medusa.
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Because the engorged veins resemble the head of Medusa, which
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was covered in snakes.
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It is most commonly caused by portal hypertension.
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The scarring from cirrhosis causes blood to back up into
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the portal vein.
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This increased pressure causes blood to attempt to flow through
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the nearest veins, including the Perry umbilical veins.
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These veins become enlarged with the blood volume and then
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combined with the aside, he's like, you see in this
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photo can be seen clearly on the abdomen.
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It is crucial to determine the direction of blood flow,
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because caput Medusa is also caused by blockage in the
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inferior vena cava.
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If the blood in these enlarged veins is flowing towards
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the legs, it is probably due to cirrhosis.
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Caput Medusa is a sign of advanced cirrhosis, so a
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C T or ultrasound should be ordered to confirm the
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direction of blood flow, and then it must be treated
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immediately, depending on the severity of shut may be placed
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to violate the portal vein.
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Medication maybe started or a liver transplant process will begin
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because there are better ways to detect liver damage in
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its earlier stages.
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Now could put 10 do says, becoming less common.
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However, if you do see this on a patient, you
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need to know that it requires immediate intervention.
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Next, our umbilical hernias umbilical hernias are seen in about
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2% of the general population and usually occur and females
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who are obese.
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However, in cirrhosis patients, umbilical hernias occur in 20% of
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patients and are more likely to affect men with societies
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because there is so much intra abdominal pressure due to
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the societies, the umbilical hernia occurs quickly and causes many
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complications. These hernias tend to become incarcerated, which means that
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that intestine were abdominal tissue becomes trapped, and blockage obstruction
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or necrosis of the intestines or abdominal tissue occurs well.
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They're not a medical emergency.
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They must be treated quickly so they do not become
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strangulated hernias.
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The proper intervention for umbilical hernias and cirrhosis patients is
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really debated because of the high risk of morbidity and
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mortality. Surgical complications include wound infection.
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Evisceration aside these drainage or peritonitis.
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If the hernia itself is causing complications, a laparoscopic approach
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may be taken.
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Most professionals seem to agree that the key to control
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is controlling the societies for risk of hernia re occurrence
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and complications.
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Some options for asides control include Inter intermittent Paris and
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T Sis.
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Ah, temporary peritoneal dialysis catheter or a trans jugular intra
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hepatic porto.
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Systemic shunt, also called tips.
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As a nurse, you should assess for an umbilical hernia
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and informa healthcare provider if it is present.
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Also educate your patients about the possibility and what to
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do if one occurs next.
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We have Peratis, and practice isn't technically a skin lesion,
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but it's a really common complaint from those with cirrhosis,
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specifically with police Stasis and biliary cirrhosis, as it's one
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of the most detrimental and debilitating aspects of the illness.
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Patients experience and irritating itchy sense of the skin, and
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the symptoms become more severe at night time.
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The itching is typically localized to the extremities, the soles
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of the feet and the palms, but it can also
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be generalized.
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Usually there are no observable primary skin lesions, but secondary
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excoriation is can occur from the intense scratching.
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Brightest can range from mild to severe.
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Ah, and the severe can really reduce the quality of
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life, cause sleep deprivation, depressive mood and maybe even induce
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suicidal ideations.
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For the patients who are most affected, it is uncertain
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the exact cause of brightest.
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Right now, it is suspected to be caused by a
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combination of factors which makes treatment difficult.
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As a nurse, you should teach your patients about some
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non pharmacologic methods to complement the world medications this patient
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will receive.
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Patients should avoid scratching the areas, and they should keep
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the skin covered or wear gloves when they sleep.
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Suggest that they use warm or cool water rather than
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hot water for showers.
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And that's Ah, gentle fragrance free moisturizers Ah, cold wet
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cloth to place on the area to reduce the urge
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to scratch like humidifier during the dry winter months.
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You can also ask about their mental status, and you
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need to question if they have felt depressed or have
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experienced any suicidal thoughts not to be confused.
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Liver spots are actually not caused by liver damage.
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They are flat oval areas of increased pigmentation that occur
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on skin that has had a lot of sun exposure
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over the years, such as the back of the hands,
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tops of the feet, face, shoulders and upper back.
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If you're patient tells you that they have liver spots
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where they ask you about their sunspots, you should obviously
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make the provider aware of their concern but assure them
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that it is not normally caused or is not normally
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a sign of liver damage.
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So what do we do now?
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Um, as nurses, we must take the time to fully
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assess our patients because, as I hope you can recognize,
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the skin really is a window to your overall health.
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Recognises, recognizing on these skin manifestations associated with liver disease
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can provide clues to diagnoses and divvy disease severity.
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However, these were not always disease specific, so it's really
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important that you report document your findings on an advocate
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for further testing an investigation just to confirm.
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So I hope you enjoy this presentation.
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And with this information you are able to feel more
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confident when assessing a patient with liver disease and addressing
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the holistic needs of your patients.
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If you just want to take a quick look at
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my we're excited.
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Thank you so much for watching.
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I hope you enjoyed.