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.