Wilson's Disease: Liver-related Symptoms (Nursing)

00:01 So let's take a look at how it feels with the liver.

00:04 See the patient the changes are kind of insidious.

00:07 They take a little while for them to be a parent.

00:09 So the patient may be completely unaware that they have the disease until they've suffered significant damage.

00:15 So they start to present these kind of vague symptoms.

00:19 That's why Wilson's disease diagnosis takes an entire team of healthcare providers to help the patient identify the problem.

00:28 Now, I'm going to give you some background because it's normally diagnosed somewhere between 5 and 35 years.

00:35 Now how that number can kind of stick in your brain? Remember your liver should have developed this pathway by age one, but typically if it's going to be diagnosed we see the diagnosis somewhere between 5 and 35, and with children, most often between the ages of 9 and 13.

00:53 Okay, more than memorize those actual numbers what I want you to get a feel for the symptoms are vague, so far were focusing on the ones that are in the liver, and the ones in your brain that are mood and movement.

01:07 The age range between once this is diagnosed is huge, 5 and 35 is a 30-year span.

01:16 So more importantly, than memorizing exact numbers is put into your brain that there's a wide range of time when it can actually be diagnosed.

01:26 So we've kind of hinted at how the disease symptoms are varied but I really want to underscore or emphasize that point because even within the same family, symptoms can be different.

01:39 Okay, but you're predominantly going to see them in these three main categories: your liver and your brain.

01:46 Now I know that's two but I put two categories with the brain because it's mood and movement.

01:53 That's what I want you to have in mind.

01:54 So when we're talking about the symptoms, it's most important that you remember those categories rather than the exact names were going to share with you about those symptoms.

02:03 So we've got the liver and the brain and the brain gets two options of mood and movement.

02:12 So we've got liver, brain, mood and movement.

02:15 And we're going to be talking about what this will look like when you meet a patient.

02:21 Does your brain do what my brain does when you see a traditional list like that? This is no way to learn and if you're trying to cram all these bulleted list in your brain, it just won't work.

02:32 That's why Lecturio, we like to do things differently.

02:36 We understand on our team that your brain can't process a bunch of bulleted.

02:42 So here's what we're going to walk you through.

02:44 We want to show you what you do when you see big list like this and how you can make them easier to remember.

02:52 Now we're going to start with a liver and this list but don't worry about it, we're going to show you how you can take these things chunk information together and make it work for you.

03:02 So here's what I want you to do.

03:04 I want you to put a box around the left side of that list, right, and from weakness and feeling tired all the way down to muscle cramps.

03:13 Now I want you to write in big letters on top of that 'FEEL'.

03:17 Okay? Then on the right side, I want you to put another box around jaundiced all the way down to spider angiomas which by the way, those are really weird looking.

03:28 So we're going to show you a picture of what those look like, but I want you to write the word on top of their of 'LOOK'.

03:35 Okay.

03:36 Now we've given her brings something that it can grab onto, we've got two boxes.

03:42 But still a lot of words, let me show you how your knowledge if you've walked through this with the other video series.

03:49 You already know what the liver does when you know normal, then it's really easy to chunk symptoms for abnormal.

03:58 Somebody with Wilson's disease their liver isn't functioning well.

04:02 Well, the liver is a gigantic part of the GI system, right? It makes bile, it sends it on down to the small intestine then that bile helps break up the food that we eat, right? Because you put it in your mouth, it goes to your stomach that enters your small intestine, right where the liver has dropped has the drop that bile.

04:24 Remember that bile will help break up that food in the nutrients and then all those vessels around your guts, right, that portal vein system, they come together and come back up to the liver to deliver the nutrients, then the liver processes them, stores them, changes them, detoxifies them, but not if your liver is struggling.

04:46 So we've just pointed out how important it is the livers role, in us being able to use the food that we're eating if your liver isn't working you don't do well with food.

04:59 So look at those three symptoms in the middle: weight loss, nausea and vomiting, and loss of appetite.

05:06 Well, it's much easier to remember, somebody with liver problems, and look, this just doesn't work for Wilson's disease.

05:14 This works for liver problems across the board.

05:17 These are the general symptoms that someone whose liver is struggling will feel.

05:22 So you put that circle around those three.

05:25 They don't feel like eating, they're nauseated, and they're likely to be losing weight without trying and not in a fun way.

05:34 So we know liver problems how they're going to feel, they're not going to feel like eating anything, right, and that we understand why.

05:42 If they're not eating, that would make sense that they're weak and tired.

05:47 All right. Now that liver we talked about detoxifying, it's not able to detoxify so then stuff starts coming out in my skin, which is why they're itchy and why I have issues with waste products and electrolytes, that's why their muscles are going to cramp.

06:04 So when you think about overall liver signs and symptoms think about the effect on our food, and the effect on the toxic areas, that's why they feel not like eating, nauseous vomiting, they're itchy and they might even have muscle cramps.

06:21 Alright, so that's our first side and let me tell you, work you put in here on Wilson's disease is going to pay off for all the liver problems across the board.

06:30 So we've got how the patient would feel, if you're really into this today and engaged pause the video and see if you can put your hand over your notes and recall those major points we just talked about as chunks of information.

06:46 Now we're going to look at the LOOK.

06:48 How about that for a transition? We're going to take a look at how the patient would look.

06:53 See these are nursing assessments that are critically important that you do.

06:57 I'm also going to ruin your next trip to the mall because when I go to the mall, and I see a liver patient, I'm like, oh, I mean, there's this guy that works out at the gym and he has the perfect, liver failure bent belly and he's also got the signs and I feel torn between wanting to tell him, sir, have you had your liver looked at recently? And the next time you go shopping, you're going to be looking at people the same way, wondering if they're aware of their health problems, but I digress.

07:26 Let's get back to how patients look.

07:29 They're going to look kind of jaundiced or yellow.

07:32 Now this might be difficult to see on a patient whose skin is already all of complected or dark-skinned on someone like me, I am white as copy paper.

07:41 So you're going to see those changes in my color right away, but in other patient populations, it might be more difficult, so be aware what their normal skin tone is.

07:53 Now again, how they're going to look to me if the livers not doing well, I know that there's going to be extra bile and bilirubin piling up.

08:00 So they're going to be, their skin is going to look different.

08:04 So I would connect jaundice, and right down there, you see, we have spider angiomas.

08:10 Now, these are like some little branch like blood vessels on the skin.

08:14 We're showing you a picture of that right now.

08:16 So you can get a feel for what spider angiomas look like.

08:20 So when looking at people's skin, someone who has liver disease, they're going to be kind of yellowy and they might have these little spider angiomas or tiny little branch like blood vessels on their skin.

08:33 Now again, the liver, you're going to have problems with they don't, remember, doesn't make protein very well.

08:38 So would you expect these patients to be swollen or did you expect dehydrated.

08:45 No.

08:45 They're swollen.

08:47 Remember the livers involved in making protein, albumin, and that helps us keep fluid in the appropriate space, the intro vascular space and without that albumin it ends up, going out into our tissue.

09:00 So that's why their legs will be swollen, their belly, remember that guy talk to you about the gym with the perfect liver belly.

09:07 Yeah, they're going to have swelling or ascites is what we call it in their abdomen and they're going to feel bloated.

09:13 That's another reason why they don't feel like eating.

09:16 So see that's the trick when you see long list like this, your brain cannot remember these for very long.

09:23 You need to look for ways to chunk information that make sense to you.

09:27 Then always take the symptoms and go back to the normal function of the organ and see how they connect, see how we walk through this knowing we know we talked about skin the first point and the last point, we talked about how the livers involved in bilirubin and breaking that down we've gone over that and that's why you end up with yellow skin.

09:46 Spider angiomas, got problems with blood pressure, they don't they can clot more.

09:51 So that's why you have those little changes in their skin.

09:54 Edema and swelling, pain and bloating.

09:57 That's because you're not able to keep fluid in the intravascular space as a healthy liver is able to do.

10:04 Okay so liver signs and symptoms, We did a lot of work there, but combined into two categories: feel and look, so I know as a nurse I am going to be on the look out for those problems on the right.

10:16 On the left, that's going to be the type of information that I get from the patient, just in what they seized casual conversation because I want them to trust me and feel comfortable.

10:27 But I'm going to be asking them these questions throughout our conversation on admission and as I care for them throughout their stay.