Domestic Violence/Abuse/Addiction/Liver Disease

Early manifestations of cirrhosis

-gi disturbances -full heavy feeling in RUQ -enlarged liver/spleen -fever, lethargy, weight loss

INR

0.8-1.11

PT

11-13

PTT

21-35

Hep B tx

Alpha inerferon rest & nutrition

Hep B transmission

Blood

Hepatitis Preicteric

Contagious - flu like S/S precedes jaundice hepatomegaly

Routine nursing care of a client receiving a diuretic would include which of the following?

Daily weighing Periodic electrolyte evaluations Monitoring of urinary output Teaching the patient to report muscle cramping

the inability of damaged liver cells to clear normal amounts of bilirubin from the blood. Diseased or damaged liver. Increased unconjugated & conjugated bilirubin

Hepatocellular jaundice

Spironalactone

K sparing diuretic for pt w cardiac arrhythmias / receiving digitalis & hyperaldosteronism ^ risk of hypokalemia can cause loss of Na

Hep C tx

NO BENEFIT FROM REST/NUTRITION antiretroviral- interferon Pegasys

A patient with a liver mass is undergoing a percutaneous liver biopsy. What action should the nurse perform when assisting with this procedure?

Position the patient on the right side with a pillow under the costal margin after the procedure.

The nurse would anticipate an order for a loop diuretic as the drug of choice for a patient with

Pulmonary edema

Serology is negative

Toxic Hepatitis

joint pain

arthralgia

Autoimmune hepatitis is tx with

corticosteroids immunosuppressive agents- immuran

The most common adverse effect of potassium-sparing diuretics

hyperkalemia

hepatic obstruction may be caused by occlusion of the bile duct form a gall stone, inflammatory process, a tumor, or pressure from an enlarged organ. Increased unconjugated & conjugated bilirubin

obstructive jaundice

urine output less than 0.5 mL/kg/h

oliguria

itching of skin

pruritus

What Stage of Encephalopathy would you find: Euphoria, depression, apathy, irritability, memory loss, confusion, drowsiness, insomnia, agitation

stage 0-1

What Stage of Encephalopathy would you find: Slurred speech, emoitional liability, impaired judgement, hyperative reflexes

stage 2

DX hepatocellular destruction w elevated values before jaundice

Diagnostic LFT ALT

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)

Hyperaldosteronism causes

^ BP ^ fluid sodium

increased nitrogen levels in the blood

azotemia

Diet guidelines for Hep.

moderate to high protein

Diet guidelines for cirrhosis

moderate to high protein

Lab test levels increase primarily in liver disorders and may be used to monitor the course of hepatitis or cirrhosis or the effects of treatments that may be toxic to the liver.

ALT (elevated enzymes)

Lab test present in tissues that have high metabolic activity; therefore, the level may be increased if there is damage to or death of tissues of organs such as the heart, liver, skeletal muscle, and kidney.

AST (elevated enzymes)

A patient complaining of shortness of breath is admitted with the diagnosis of cirrhosis. A nursing assessment reveals an enlarged abdomen with striae, an umbilical hernia, and 4+ pitting edema of the feet and legs. What is the most important data for the nurse to monitor?

Albumin

Hep C transmission

Blood

Levels of free bilirubin exceeding 20 to 25 mg/dL poses a risk for

CNS damage

Hepatitis Posticteric

Malaise fatigue hepatomegaly

Hep D transmission

Only able to get D if you have B Blood

Which liver cells perform most of the liver's metabolic functions?

Parenchymal cells

How to manage cirrhosis

REST! B vitamins

Which of the following liver function studies is used to show the size of the liver and hepatic blood flow and obstruction

Radioisotope liver scan

RADAR meaning

Routine screening Ask direct questions Document findings Assess immediate safety Review options & refer

Burn out serotonin receptors

Stimulants/ amphetamines

kupffer cells do-

destroy bacteria

Sereology is used to ____

determine if youve developed antibodies

Peripheral Neuropathy

dietary deficiency of thiamine folic acid cobalamin

Examples of battery

emotional abuse economic abuse verbal abuse intimidation using the children isolation

Thiazide diuretics are considered mild diuretics because

they cause loss of sodium and chloride but little water

When caring for a patient with cirrhosis, which of the following symptoms should the nurse report immediately?

Change in mental status

Earliest detection of liver damage (faster than S/S & other tests)

Diagnostic LFT

Which of the following will his healthcare provider consider ordering to treat the large amount of protein-rich fluid that has been released into his tissues and peritoneal cavity?

Diuretics Albumin

Lab test levels are associated with cholestasis but can also be due to alcoholic liver disease. Although the kidney has the highest level of the enzyme, the liver is considered the source of normal serum activity. The test determines liver cell dysfunction and is a sensitive indicator of cholestasis. Its main value in liver disease is confirming the hepatic origin of an elevated alkaline phosphatase level

GGT (elevated enzymes)

Hep D tx

High dose of alfa interferon & rest for long term (1 year)

Diuretics are currently recommended for the treatment of which of the following (SAP)

Hypertension Renal disease Severe liver disease Heart Failure

Hep A tx

If exposed - IM immune globulin bed rest & good nutrition

A nurse is caring for a patient with liver failure and is performing an assessment in the knowledge of the patient's increased risk of bleeding. The nurse recognizes that this risk is related to the patient's inability to synthesize prothrombin in the liver. What factor most likely contributes to this loss of function?

Inability of the liver to use vitamin K

Med for Encephalopathy

Lactulose

What med is given to get rid of ammonia in the blood

Lactulose

Jaundice occurs with hepatitis

Nonobstructive

A nurse is assessing a postoperative client for hemorrhage. What responses associated with the compensatory stage of shock should be reported to the healthcare provider?

Tachycardia and tachypnea

Med for Varices

Vasopressin, B-Blockers

A patient with severe glaucoma who is about to undergo eye surgery would benefit from a DECREASE IN INTRAOCULAR FLUID. This is often best accomplished by giving the patient

a potassium sparing diuretic.

acites

excess abdominal fluid

Hep A transmission

fecal-oral

Hep E transmission

fecal-oral

sudden, severe onset of acute liver failure that occurs within 8 weeks after the first symptoms of jaundice

fulminant hepatic failure

Alcohol tx

gastric lavage / dialysis

types of jaundice in an adult experiencing a transfusion reaction

hemolytic

jaundice is the result of increased destruction of red blood cells- unconjugated bilirubin

hemolytic jaundice

encephalopathy

loss of brain function when damaged liver doesnt remove ammonia

Diet guidelines for hepatic failure acute hepatic encephalopathy

low protein - high carbs bc of ammonia in protein

What Stage of Encephalopathy would you find: 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.

stage 3

What Stage of Encephalopathy would you find: Coma - there is an absence of asterixis, absence of deep tendon reflexes, flaccidity of extremities, and EEG abnormalities.

stage 4

Hepatitis icteric

still contagious if no jaundice called ANICTERIC pruriti hepatomegaly

Why is a pt with portal HTN on beta blockers?

they decrease hepatic blood flow which decreases hepatic pressure