Chapter 49- hepatic disorders
A student accepted into a nursing program must begin receiving the hepatitis B series of injections. The student asks when the next two injections should be administered. What is the best response by the instructor?
"You must have the second one in 1 month and the third in 6 months."
management of encephalopathy
-lactulose to reduce ammonia -IV glucose to minimize protein catabolism -protein restriction (amino acids>>>ammonia) -NG tube- suction, enemas
what are patients with hepatic encephalopathy at risk for?
-seizures -changes in LOC -coma
A nurse is responsible for monitoring the diet of a client with hepatic encephalopathy. Which daily protein intake should this 185-pound (84-kilogram) male consume?
100 to 126 grams Daily protein intake should be maintained at 1.2 to 1.5 g/kg per day.
ammonia levels
15-45
normal ALT
8-40
A patient with a history of injection drug use has been diagnosed with hepatitis C. When collaborating with the care team to plan this patient's treatment, the nurse should anticipate what intervention?
A regimen of antiviral medications
A local public health nurse is informed that a cook in a local restaurant has been diagnosed with hepatitis A. What should the nurse advise individuals to obtain who ate at this restaurant and have never received the hepatitis A vaccine?
An immune globulin injection
A nurse is caring for a patient who has been admitted for the treatment of advanced cirrhosis. What assessment should the nurse prioritize in this patient's plan of care? A)Measurement of abdominal girth and body weight B)Assessment for variceal bleeding C)Assessment for signs and symptoms of jaundice D)monitoring of results of liver function testing
B)Assessment for variceal bleeding Esophageal varices are a major cause of mortality in patients with uncompensated cirrhosis.
A client is admitted to the hospital with acute hemorrhage from esophageal varices. What medication should the nurse anticipate administering that will reduce pressure in the portal venous system and control esophageal bleeding?
Octreotide is preferred over vasopressin?
After undergoing a liver biopsy, a client should be placed in which position?
Right lateral decubitus position
what can detect hepatomegaly, stones and what not?
Ultrasound
Which of the following is the most effective strategy to prevent hepatitis B infection?
Vaccine
hepatitis B and C transmission
bloodborne
obstructive s/s
dark orange-brown urine, clay stools -dyspepsia, intolerance to fatty foots -pruritis
A preoperative client scheduled to have an open cholecystectomy says to the nurse, "The doctor said that after surgery, I will have a tube in my nose that goes into my stomach. Why do I need that?" What most common reason for a client having a nasogastric tube in place after abdominal surgery should the nurse include in a response?
decompression
which is the most definitive test for liver damage
liver biopsy
hepatitis D transmission
only people with hep B are at risk
Most of the liver's metabolic functions are performed by:
parenchymal cells.
what causes ascites?
portal hypertension, vasodilation of splanchnic circulation (blood flow to the major abd organs) -changes in ability to metabolize aldosterone (increasing fluid retention) -decreased synthesis of albumin, decreasing serum osmotic pressure -movement of albumin into peritoneal cavity
Normal AST?
10-40
The single modality of pharmacologic therapy for chronic type B viral hepatitis is:
Alpha-interferon
A client has undergone a liver biopsy. After the procedure, the nurse should place the client in which position?
On the right side In this position, the liver capsule at the site of penetration is compressed against the chest wall, and the escape of blood or bile through the perforation made for the biopsy is impeded.
A nurse is caring for a patient with hepatic encephalopathy. The nurse's assessment reveals that the patient exhibits episodes of confusion, is difficult to arouse from sleep and has rigid extremities. Based on these clinical findings, the nurse should document what stage of hepatic encephalopathy?
Stage 3 Patients in the third stage of hepatic encephalopathy exhibit the following symptoms: stuporous, difficult to arouse, sleeps most of the time, exhibits marked confusion, incoherent in speech, asterixis, increased deep tendon reflexes, rigidity of extremities, marked EEG abnormalities.
Which medication is used to decrease portal pressure, halting bleeding of esophageal varices?
Vasopressin
A client is actively bleeding from esophageal varices. Which of the following medications would the nurse most expect to be administered to this client?
Vasopressin (Pitressin) Vasopressin (Pitressin) may be the initial mode of therapy in urgent situations, because it produces constriction of the splanchnic arterial bed and decreases portal pressure.
ascites teatment
abd girth and daily weight note striae, distended veins and umbilical hernia (because all pressure) fluid e-lyte balances -low na diet -diuretics -bedrest
types of cirrhosis
alcoholic/laennec post necrotic- late result of viral hepatitis or toxins biliary- prolonged bile duct obstruction
A client has just been diagnosed with hepatitis A. On assessment, the nurse expects to note:
anorexia, nausea, and vomiting.
portal hypertension can cause
ascites and esophageal varices This is from an obstruction of blood flow
Total parental nutrition (TPN) should be used cautiously in clients with pancreatitis because such clients:
cannot tolerate high-glucose concentration.
A client is admitted for suspected GI disease. Assessment data reveal muscle wasting, a decrease in chest and axillary hair, and increased bleeding tendency. The nurse suspects the client has:
cirrhosis.
hep A manifestations
flulike symptoms, low grade fever, anorexia, later jaundice and dark urine
what can esophageal varices cause/
hemorrhage
which diuretic medication would most often be used for a patient with ascites?
spironolactone (aldactone) -its easier on the liver -first line
serum ALT is increased more markedly than serum AST with liver disease TRUE/FALSE
true
tx of hemorrhage r/t esophageal varices
tx shock -nitroglycerin in combination with vasopressin -propanolol and nadolol to decrease portal pressure
cirrhosis
fibrous process of cells -livers supportive structure is not supportive anymore -scar tissue
hepatocellular s/s
mild or severely ill -lack of appetite, n/v, weight loss -malaise, fatigue -headache, chills, fever, infection
manifestations of hep B
similar to hep A
The nurse is caring for a patient with cirrhosis of the liver and observes that the patient is having hand-flapping tremors. What does the nurse document this finding as?
Asterixis, an involuntary flapping of the hands, may be seen in stage II encephalopathy
hepatitis A and E transmission
fecal-oral route
what is a major worldwide cause of cirrhosis and liver cancer?
hep B