Chapter 38

The nurse is caring for a client with hepatitis and jaundice. The nurse recognizes that without sufficient circulating bile salts the client will have intolerance to which ingested substance?

Fats Explanation: Lack of production of bile salts causes malabsorption of fat and fat-soluble vitamins.

When explaining acute pancreatitis to a newly diagnosed client, the nurse will emphasize that the pathogenesis begins with an inflammatory process whereby:

activated pancreatic enzymes escape into surrounding tissues, causing autodigestion of pancreatic tissue. Acute pancreatitis is associated with the escape of activated pancreatic enzymes into the pancreas and surrounding tissues. These enzymes cause fat necrosis, or autodigestion, of the pancreas.

Given the fact that acute pancreatitis can result in severe, life-threatening complications, the nurse should be assessing the client for which complication?

Acute tubular necrosis Explanation: Complications of acute pancreatitis include the systemic inflammatory response, acute respiratory distress syndrome, acute tubular necrosis, and organ failure.

When assessing the client with acute pancreatitis, which of these diagnostic tests—consistent with the disease— does the nurse anticipate will be altered?

Amylase and lipase

A client newly diagnosed with pancreatic cancer is admitted to begin treatment. Which pain descriptors can be associated with adenocarcinomas of the pancreas?

Dull epigastric pain accompanied by back pain, worse when lying flat and relieved by sitting forward. Explanation: The most common pain with pancreatic cancer is a dull, epigastric pain often accompanied by back pain, often worse in the supine position, and relieved by sitting forward.

What manifestations will the nurse expect to find when assessing a client with cholestasis? Select all that apply.

Easy bruising Clay-colored stools Pruritus

A client presents to the emergency department with some vague symptoms. After history and physical exam, the physician is suspecting the client may have viral hepatitis. Which clinical manifestation leads the nurse to suspect the client is in the prodromal period of viral hepatitis?

Muscle aches and pain along with fatigue Explanation: The prodromal period may vary from abrupt to insidious, with general malaise, myalgia, arthralgias, easy fatigability, and severe anorexia out of proportion to the degree of illness. The icterus phase usually follows the prodromal phase within 5 to 10 days. The icterus phase can have the onset of jaundice, followed by severe pruritus and liver tenderness.

One of the jobs the liver performs is to export triglyceride. When the liver's capacity to export triglyceride is exceeded, excess fatty acids accumulate in the liver. To what disease do these excess fatty acids contribute?

Nonalcoholic fatty liver disease Explanation: When the capacity of the liver to export triglyceride is saturated, excess fatty acids contribute to the formation of fatty liver.

When teaching a group of nursing students about the liver, the nurse relates that Kupffer cells function to remove harmful substances or cells from the portal blood and venous sinusoids through which process?

Phagocytosis Explanation: Kupffer cells, which line the venous sinusoids, are reticuloendothelial cells that are capable of removing, engulfing, and phagocytizing old and defective blood cells, bacteria, and other foreign material from the portal blood as it flows through the sinusoid. This phagocytic action removes the enteric bacilli and other harmful substances that have filtered into the blood from the intestine.

While caring for a client undergoing diagnostic testing for possible liver failure, the nurse asks the student nurse what clinical manifestations of liver failure she should assess for. Which answers are accurate? Select all that apply.

Sweet, musty breath. Multiple bruising noted on body Explanation: Fetor hepaticus refers to a characteristic musty, sweetish odor of the breath in the person in advanced liver failure, resulting from the metabolic by-products of the intestinal bacteria. Liver failure can cause anemia, thrombocytopenia, coagulation defects, and leukopenia.

When caring for the client with Laennec cirrhosis, the nurse recognizes which pathophysiologic finding to be an expected etiology of jaundice?

impaired uptake of bilirubin Explanation: The five major causes of jaundice are excessive destruction of red blood cells, impaired uptake of bilirubin by the liver cells, decreased conjugation of bilirubin, and obstruction of bile flow in the canaliculi of the hepatic lobules or in the intrahepatic or extrahepatic bile ducts, and excessive extrahepatic production of bilirubin.

A client has been diagnosed with alcohol-induced liver disease. He admits to the nurse, "I know what the lungs do, and I know what the heart does, but honestly, I have no idea what the liver does in the body." The nurse should tell the client that the liver:

metabolizes most components of food and also cleans the blood of bacteria and drugs. Explanation: Protein, carbohydrate, and fat metabolism are performed by the liver. As well, it metabolizes drugs and removes bacteria by Kupffer cells. Absorption of nutrients takes place in the intestines. The liver does not produce the bulk of fluids secreted in the GI tract.

A client who has been diagnosed with acute symptomatic viral hepatitis is now in the icterus period. The nurse would expect the client to manifest:

severe pruritus and liver tenderness.