MedSurg Ch. 49
The nurse is educating a patient who has been treated for hepatic encephalopathy about dietary restrictions to prevent ammonia accumulation. What should the nurse include in the teaching? A. Increase the amount of potassium in the diet B. The amount of protein is not restricted in the diet/Decrease the amount of protein in the diet C. Increase the amount of magnesium in the diet D. Decrease the amount of fats in the diet
B. The amount of protein is not restricted in the diet/Decrease the amount of protein in the diet Patients with hepatic encephalopathy and their families are advised about foods that are high in protein (e.g., meat, eggs), which may need to be limited in the diet for the short term to reduce production of ammonia • Minimize the formation and absorption of toxins, principally ammonia, from the intestine. • Keep daily protein intake between 1.2 and 1.5 g/kg body weight per day. • Avoid protein restriction if possible, even in those with encephalopathy. • For patients who are truly protein intolerant, provide additional nitrogen in the form of an amino acid supplement. The use of branched-chain amino acids should be a consideration in patients with cirrhosis. It has improved outcomes in varied populations with the disease. • Provide small, frequent meals and 3 small snacks per day in addition to a late-night snack before bed.
A patient with end-stage liver disease who is scheduled to undergo a liver transplant tells the nurse, "I am worried that my body will reject the liver." Which of the following statements is the nurse's best response to the patient? a) "You would not be scheduled for a transplant if there was a concern about rejection." b) "The problem of rejection is not as common in liver transplants as in other organ transplants." c) "You will need to take daily medication to prevent rejection of the transplanted liver. The new liver has a good chance of survival with the use of these drugs." d) "It is easier to get a good tissue match with liver transplants than with other types of transplants."
"You will need to take daily medication to prevent rejection of the transplanted liver. The new liver has a good chance of survival with the use of these drugs." Rejection is a primary concern. A transplanted liver is perceived by the immune system as a foreign antigen. This triggers an immune response, leading to the activation of T lymphocytes that attack and destroy the transplanted liver. Immunosuppressive agents are used as long-term therapy to prevent this response and rejection of the transplanted liver. These agents inhibit the activation of immunocompetent T lymphocytes to prevent the production of effector T cells. Although the 1- and 5-year survival rates have increased dramatically with the use of new immunosuppressive therapies, these advances are not without major side effects. The other statements are inaccurate or will not decrease the patient's anxiety.
When inspecting the abdomen of a client with cirrhosis, the nurse observes that the veins over the abdomen are dilated. The nurse documents this finding as which of the following?
Caput medusae Caput medusa is a term used to denote the appearance of dilated veins over the client's abdomen. Gynecomastia refers to enlarged breasts in a male, which may occur because the dysfunctional liver is unable to metabolize estrogen. Palmer erythema refers to the bright pink appearance of the palms and cutaneous spider angiomata refers to tiny, spider-like blood vessels that may be apparent in a client with cirrhosis due to the liver's inability to inactivate estrogen.
Which of the following is an age-related change of the hepatobiliary system?
Decreased blood flow Age-related changes of the hepatobiliary system include decreased blood flow, decreased drug clearance capability, increased presence of gall stones, and a steady decrease in size and weight of the liver.
Which type of deficiency results in macrocytic anemia? a) Folic acid b) Vitamin A c) Vitamin K d) Vitamin C
Folic acid Folic acid deficiency results in macrocytic anemia. Vitamin C deficiency results in hemorrhagic lesions of scurvy. Vitamin A deficiency results in night blindness and eye and skin changes. Vitamin K deficiency results in hypoprothrombinemia, which is characterized by spontaneous bleeding and ecchymosis.
A nurse is preparing a presentation for a local community group about hepatitis. Which of the following would the nurse include? a. Hepatitis B is transmitted primarily by the oral-fecal route. b. Hepatitis A is frequently spread by sexual contact. c. Hepatitis C increases a person's risk for liver cancer. d. Infection with hepatitis G is similar to hepatitis A.
Hepatitis C increases a person's risk for liver cancer. Infection with hepatitis C increases the risk of a person developing hepatic (liver) cancer. Hepatitis A is transmitted primarily by the oral-fecal route; hepatitis B is frequently spread by sexual contact and infected blood. Hepatitis E is similar to hepatitis A whereas hepatitis G is similar to hepatitis C.
A client is scheduled to have a laparoscopic cholecystectomy as an outpatient. The client asks the nurse when he will be able to resume normal activities. What information should the nurse provide? a)Normal activities may be resumed in 1 month. b)Normal activities may be resumed in 2 weeks. c)Normal activities may be resumed in 1 week. d)Normal activities may be resumed the day after surgery.
Normal activities may be resumed in 1 week. A prolonged recovery period usually is unnecessary. Most clients resume normal activities within 1 week.
Which of the following terms describes the passage of a hollow instrument into a cavity for the withdrawal of fluid?
Paracentesis Paracentesis may be used to withdraw ascitic fluid if the fluid accumulation is causing cardiorespiratory compromise. Asterixis refers to involuntary flapping movements of the hands associated with metabolic liver dysfunction. Ascites refers to accumulation of serous fluid within the peritoneal cavity. Dialysis refers to a form of filtration to separate crystalloid from colloid substances.
Gynecomastia is a common side effect of which of the following diuretics? A. Vasopressin B. Furosemide C. Nitroglycerin IV D. Spironolactone
Spironolactone (Aldactone) Gynecomastia is a common side effect caused by spironolactone. Pitressin is used for bleeding esophageal varices and is not a diuretic. Nitroglycerin (IV) may be used with vasopressin to counteract the effects of vasoconstriction from the vasopressin.
The nurse is assessing a patient with hepatic cirrhosis for mental deterioration. For what clinical manifestations will the nurse monitor? Select all that apply. a) Insomnia b) Complaints of headache c) Decreased deep tendon reflexes d) Agitation e) Alterations in mood
a, d, e • Alterations in mood • Agitation • Insomnia The earliest symptoms of hepatic encephalopathy include both mental status changes and motor disturbances. The patient appears confused and unkempt and has alterations in mood and sleep patterns. The patient tends to sleep during the day and has restlessness and insomnia at night. To assess for mental deterioration, the nurse will assess general behavior, orientation, and speech as well as cognitive abilities and speech patterns
A client with acute liver failure exhibits confusion, a declining level of consciousness, and slowed respirations. The nurse finds him very difficult to arouse. The diagnostic information which best explains the client's behavior is: a.Elevated liver enzymes and low serum protein level b.Subnormal serum glucose and elevated serum ammonia levels c.Subnormal clotting factors and platelet count. d.Elevated blood urea nitrogen and creatinine levels andhyperglycemia. Rationale: declining level of consciousness- encephalopathy (hepatic) due to inc
subnormal serum glucose and elevated serum ammonia levels. Explanation: In acute liver failure, serum ammonia levels increase because the liver can't adequately detoxify the ammonia produced in the GI tract. In addition, serum glucose levels decline because the liver isn't capable of releasing stored glucose. Elevated serum ammonia and subnormal serum glucose levels depress the level of a client's consciousness. Elevated liver enzymes, low serum protein level, subnormal clotting factors and platelet count, elevated blood urea nitrogen and creatine levels, and hyperglycemia aren't as directly related to the client's level of consciousness.
A client is given a diagnosis of hepatic cirrhosis. The client asks the nurse what findings led to this determination. Which of the following clinical manifestations would the nurse correctly identify? Select all that apply. a. Hemorrhoids b. Accelerated behaviors and mental processes Excess storage of vitamin C c. Enlarged liver size d. Ascites
• Enlarged liver size • Ascites • Hemorrhoids Early in the course of cirrhosis, the liver tends to be large, and the cells are loaded with fat. The liver is firm and has a sharp edge that is noticeable on palpation. Portal obstruction and ascites, late manifestations of cirrhosis, are caused partly by chronic failure of liver function and partly by obstruction of the portal circulation. The obstruction to blood flow through the liver caused by fibrotic changes also results in the formation of collateral blood vessels in the GI system and shunting of blood from the portal vessels into blood vessels with lower pressures. These distended blood vessels form varices or hemorrhoids, depending on their location. Because of inadequate formation, use, and storage of certain vitamins (notably vitamins A, C, and K), signs of deficiency are common, particularly hemorrhagic phenomena associated with vitamin K deficiency. Additional clinical manifestations include deterioration of mental and cognitive function with impending hepatic encephalopathy and hepatic coma, as previously described.
