exam 2

A patient's abdominal ultrasound indicates cholelithiasis. When the nurse is reviewing the patient's laboratory studies, what finding is most closely associated with this diagnosis? A. Increased bilirubin B. Decreased serum cholesterol C. Increased BUN D. Decreased lipase

Answer: A—Increased bilirubin Rationale: If the flow of blood is impeded, bilirubin does not enter the intestines due to the stone blocking it from flowing properly. As a result, bilirubin levels will increase.

A nurse is assessing a patient who has advanced cirrhosis. The nurse should identify which of the following findings as indicators of hepatic encephalopathy? Select all that apply. A) Anorexia B) Change in orientation C) Asterixis D) Ascites E) Fetor hepaticus

Answer: B, C,E Anorexia is from ascites not hepatic encephalopathy Ascites is from cirrhosis not hepatic encephapathy

The public health nurse is discussing hepatitis B with a group in the community. Which health promotion activities should the nurse discuss with the group? Select all that apply. A. Do not share needles. B. Use barrier protection during sex. C. Get the hepatitis B vaccine. D. Obtain immune globulin injections. E. Avoid carbohydrates in the diet.

Answer: A, B, C—Do not share needles, Use barrier protection during sex, Get the hepatitis B vaccine Rationale: Hepatitis B can be transmitted through sharing of needles and through sexual activity—nurse should recommend abstinence but can be helped with barrier protection. The hepatitis B vaccine helps provide immunity.

The nurse is assessing a patient with liver cancer. Which findings would the nurse expect to find upon assessment? Select all that apply. A. Jaundice B. Weight loss C. Constipation D. Dull RUQ pain E. Numbness on one side of the body

Answer: A, B, D—Jaundice, Weight loss, Dull RUQ pain Rationale: Clients who have liver cancer will have excessive secretion of bilirubin and will be jaundiced. Clients who have liver cancer will have weight loss resulting from an impaired digestion of fats, which is usually conducted by the liver enzymes. They will also have dull abdominal pain that results from the proliferation of abdominal cells and improper digestion. Constipation and numbness are not associated with liver cancer.

The nurse is caring for a client who has been diagnosed with obstructive jaundice. Which of the following symptoms would you expect? A. Clay-colored stools B. Urticaria C. Intolerance of carbohydrates D. Clear urine

Answer: A—Clay-colored stools Rationale: Signs and symptoms of obstructive jaundice include dark orange-brown urine, clay-colored stools, dyspepsia, intolerance of fats, impaired digestion and pruritis. Signs and symptoms of hepatocellular jaundice include lack of appetite, nausea/vomiting, weight loss, malaise, fatigue, weakness, headache, chills, and fever.

A client has an elevated serum ammonia level and is exhibiting mental status changes. The nurse should suspect which of the following conditions? A. Hepatic encephalopathy B. Portal hypertension C. Cirrhosis D. Asterixis

Answer: A—Hepatic encephalopathy Rationale: Hepatic encephalopathy is a central nervous system dysfunction resulting from liver disease. It is frequently associated with elevated ammonia levels that produce changes in mental status, altered level of consciousness, and coma. Portal hypertension is an elevated pressure in the portal circulation resulting from obstruction of venous flow into and through the liver. Asterixis is an involuntary flapping movement of the hands associated with metabolic liver dysfunction.

A nurse is caring for a client who has cirrhosis and a prothrombin time of 30 seconds. Which of the following medications should the nurse plan to administer? A. Vitamin K B. Heparin C. Warfarin D. Ferrous sulfate

Answer: A—Vitamin K Rationale: A prothrombin time of 30 seconds indicates the clotting time is prolonged and bleeding could occur. Vitamin K injection increases the synthesis of prothrombin by the liver; therefore, the nurse should plan to administer vitamin k.

A client has ascites. Which of the following interventions would the nurse implement to help the client control this condition? Select all that apply. A. Weighing the client every 3 to 4 days B. Instructing the client to remove salty foods from the diet C. Mobilizing the client every 2 hours D. Administering spironolactone E. Encourage bed rest

Answer: B, D, E—Instructing the client to remove salty foods from the diet, Administering spironolactone, Encourage bed rest Rationale: The goal of treatment for the client with ascites is a negative sodium balance to reduce fluid retention. Table salt, salty foods, salted butter and margarine, and all ordinary canned and frozen foods that are not specifically prepared for low-sodium diets should be avoided. Spironolactone (Aldactone), an aldosterone-blocking agent, is most often the first-line therapy in clients with ascites from cirrhosis. In clients with ascites, an upright posture is associated with activation of the renin-angiotensin-aldosterone system and sympathetic nervous system. This causes reduced renal glomerular filtration and sodium excretion and a decreased response to loop diuretics. Therefore, bed rest may be a useful therapy, especially for clients whose condition is refractory to diuretics. Other measures include assessment and documentation of intake and output, abdominal girth, and daily weight to assess fluid status.

A nurse is caring for a patient 24 hours following a liver lobectomy for hepatocellular carcinoma. Which of the following laboratory reports should the nurse monitor? A. urine specific gravity B. blood glucose C. serum amylase D. D-dimer

Answer: B. blood glucose should be monitored during the first 24-48 hours following a liver lobectomy due to decreased gluconeogenesis and stress to the liver from surgery.

The nurse is teaching a patient recovering from a laparoscopic cholecystectomy. Which statement indicates the discharge teaching is effective? A. "I will take my lipid-lowering medicine at the same time each night." B. "I may experience some discomfort when I eat a high-fat meal." C. "I need someone to stay with me for about a week after surgery." D. "I should not splint my incision when I deep breathe and cough."

Answer: B—"I may experience some discomfort when I eat a high-fat meal." Rationale: This surgery does not require lipid-lowering medications, but eating high-fat meals may cause discomfort. Laparoscopic surgery is usually performed same day surgery and does not require assistance for a week. Using a pillow to splint the abdomen should be continued.

A patient has just been diagnosed with hepatitis A. What early assessment findings would a nurse expect to find in a patient with hepatitis A? A. Severe abdominal pain radiating to the shoulder B. Anorexia, nausea, and vomiting C. Constipation D. Abdominal ascites

Answer: B—Anorexia, nausea, and vomiting Rationale: Early signs of hep A include anorexia, nausea, fatigue and weakness. Abdominal pain may occur but doesn't radiate to the shoulder. Constipation is common in gallbladder disease but not hep A. Abdominal ascites is a sign of advanced hepatic disease, not early.

A patient is being evaluated for hepatitis A. Which activity places the patient at greatest risk for the development of hepatitis A? A. helping his roommate with an epistaxis episode. B. receiving an elective blood transfusion after surgery. C. eating a shrimp platter at a local restaurant. D. having sexual intercourse with his fiancée.

Answer: C Hepatitis A is transmitted fecal-oral. Epistaxis is a nose bleed.

A nurse is preparing dietary instructions for a client who has episodes of biliary colic from chronic cholecystitis. Which of the following instructions should the nurse include in the teaching plan? A. Include foods high in starch and proteins. B. Include foods high in fiber. C. Avoid foods high in fat. D. Avoid foods high in sodium

Answer: C—Avoid foods high in fat Rationale: Foods high in starch and proteins do not affect the episodes of biliary colic. A high-fiber diet does not affect the episodes of biliary colic. The nurse should instruct the client to follow a low-fat diet to decrease episodes of biliary colic. A client who has chronic cholecystitis has intolerance to fatty foods. A low-sodium diet does not affect the episodes of biliary colic.

The nurse is administering medications to a client that has elevated ammonia due to cirrhosis of the liver. What medication will the nurse give to detoxify ammonium and to act as an osmotic agent? A. Spironolactone B. Cholestyramine C. Lactulose D. Kanamycin

Answer: C—Lactulose Rationale: Lactulose (Cephulac) is administered to detoxify ammonium and to act as an osmotic agent, drawing water into the bowel, which causes diarrhea in some clients. Potassium-sparing diuretics such as spironolactone (Aldactone) are used to treat ascites. Cholestyramine (Questran) is a bile acid sequestrant and reduces pruritus. Kanamycin (Kantrex) decreases intestinal bacteria and decreases ammonia but does not act as an osmotic agent.

The nurse is completing a morning assessment of a client with cirrhosis. Which information obtained by the nurse will be of most concern? A. The client's hands flap back and forth when the arms are extended. B. The client reports nausea and anorexia. C. The client has gained 2 kg from the previous day. D. The skin on the client's abdomen has multiple spider-shaped blood vessels.

Answer: A—The client's hands flap back and forth when the arms are extended. Rationale: Asterixis, an involuntary flapping of the hands, may be seen in stage II encephalopathy. It indicates that the client has hepatic encephalopathy and, if untreated, a hepatic coma may occur.

What is the most important information for the nurse to teach a patient who has been diagnosed with hepatitis C? Select all that apply. A. This disease is spread by airborne transmission. B. Hepatitis C can cause liver failure. C. You should not drink alcohol if you have this diagnosis. D. constipation is a common manifestation of this disorder. E. Rest, vitamins, and diet will prompt remission.

Answer: B, C Rest, vitamins, and diet will be beneficial but will not prompt remission.

The nurse is caring for a client with cirrhosis. Which assessment findings indicate that the client has deficient vitamin K absorption caused by this hepatic disease?

Answer: C A hepatic disorder, such as cirrhosis, may disrupt the liver's normal use of vitamin K to produce prothrombin (a clotting factor). Consequently, the nurse should monitor the client for signs of bleeding, including purpura and petechiae. Dyspnea and fatigue suggest anemia. Ascites and orthopnea are unrelated to vitamin K absorption. Gynecomastia and testicular atrophy result from decreased estrogen metabolism by the diseased liver.

A nurse on a medical-surgical unit is admitting a patient who has hepatitis B with ascites. Which of the following actions should the nurse include in the plan of care? A) Initiate contact precautions B) Weigh the patient weekly C) Measure abdominal girth 7.5 cm above the umbilicus D) Provide a high calorie, high carbohydrate diet

Answer: D The patients abdominal girth is measured over the largest part of the abdomen, which will vary by the client.

A group of nurses have attended an in-service on the prevention of occupationally acquired diseases that affect healthcare providers. What action has the greatest potential to reduce a nurse's risk of acquiring hepatitis C in the workplace? A. Performing meticulous hand hygiene at the appropriate moments in care B. Wearing an N95 mask when providing care for patients on airborne precautions C. Adhering to the recommended schedule of immunizations D. Disposing of sharps appropriately and not recapping needles

Answer: D—Disposing of sharps appropriately and not recapping needles Rationale: Hepatitis C is blood-borne. Consequently, prevention of needle-stick injuries is paramount. Hand hygiene, immunizations and appropriate use of masks are important aspects of overall infection control, but these actions do not directly mitigate the risk of HCV.

A nurse is teaching a client about causes of biliary cirrhosis. Which of the following information should the nurse include in the teaching? A. Excessive alcohol consumption B. Hepatitis C C. Hepatotoxic medications D. Obstruction of the bile duct

Answer: D—Obstruction of the bile duct Rationale: Excessive alcohol consumption can cause liver cirrhosis. Hepatitis C can cause liver cirrhosis. Hepatotoxic medication can cause liver cirrhosis. Prolonged obstruction of the common bile duct is the most common cause of biliary cirrhosis.

A client with cirrhosis is at risk for developing esophageal varices. Which of the following instructions should a nurse provide the client to minimize such risk? a. Abstain from drinking alcohol. b. Use aspirin at least once a day. c. Avoid intake of sodium-rich food. d. Increase intake of potassium-rich food.

Answer: a A soft diet and elimination of alcohol, aspirin, and other locally irritating substances minimize the risk for developing esophageal varices. Intake of sodium- or potassium-rich food has no effect on the formation of varices.

The nurse is educating a patient with cirrhosis about the importance of maintaining a low-sodium diet. What food item would be permitted on a low-sodium diet? a. Peanut butter b. A pear c. Hot dog d. Sliced ham

Answer; B The goal of treatment for the patient with ascites, a complication of cirrhosis, is a negative sodium balance to reduce fluid retention. Table salt, salty foods, salted butter and margarine, and all canned and frozen foods that are not specifically prepared for low-sodium (2-g sodium) diets should be avoided (Dudek, 2010). Peanut butter, a hot dog, and ham are all high in sodium. A pear is not.

Cirrhosis complications

Bleeding and hemorrhage Hepatic encephalopathy Fluid volume excess

pancreatitis manifestations

-Epigastric pain radiating to the -back -Fever and leukocytosis -Hypotension and hypovolemia

Cirrhosis Risk Factors

-Excess alcohol: 32-45% -Persistant hep C infection: 25% -Mould toxins (aflatoxins) -Non-alcoholic fatty liver disease -obesity `

Glucose metabolism in liver

After a meal, glucose is taken in by the liver and converted into glycogen glycogen is stored in hepatocytes glycogen is converted back into glucose and released into the blood stream as needed to maintain normal blood glucose levels In hypoglycemia, the liver uses amino acids from protein breakdown to synthesize and release glucose to increase blood glucose levels

The nurse is caring for a client with cirrhosis. Which assessment findings indicate that the client has deficient vitamin K absorption caused by this hepatic disease? Dyspnea and fatigue Ascites and orthopnea Purpura and petechiae Gynecomastia and testicular atrophy

Answer: C A hepatic disorder, such as cirrhosis, may disrupt the liver's normal use of vitamin K to produce prothrombin (a clotting factor). Consequently, the nurse should monitor the client for signs of bleeding, including purpura and petechiae. Dyspnea and fatigue suggest anemia. Ascites and orthopnea are unrelated to vitamin K absorption. Gynecomastia and testicular atrophy result from decreased estrogen metabolism by the diseased liver.

Cirrhosis treatment

Avoidance of alcohol or specific cause Supportive or symptomatic treatment Dietary restrictions Balancing serum electrolytes Paracentesis Antibiotics to reduce intestinal flora Emergency treatment if esophageal varices rupture Liver transplantation

Medical Management of Hepatic encephalopathy

Eliminate precipitating cause Administration of lactulose Goals Reduce serum ammonia levels Create 2-3 soft stools per day Maintain protein intake 1.2-1.5 g/kg per day Discontinue sedatives, analgesics, and tranquilizers Monitor or treat complications and infections

Client preparation for a liver biopsy

Empty bladder prior to procedure to avoid accidental perforation Administer Vitamin K to decrease chance of hemorrhage if indicated NPO morning of procedure (6 hours before) Sedative administration just prior to procedure Expose the client's right side of the upper abdomen Check VS frequently for hemorrhage and/or infection

Complications of the TIPS procedure may include:

Encephalopathy. Up to 20 out of 100 people who have TIPS surgery develop encephalopathy after the surgery.1 Malfunction of the stent, such as narrowing (stenosis) or closing (occlusion).

Pancreatitis risk factors

EtOH abuse, cholecystitis, specific meds

Noninfectious Hepatitis causes

Excessive alcohol use Autoimmune disorders Biliary obstruction Medications Acetaminophen (Tylenol)

Infectious Hepatitis

Highly contagious Classified according to specific infecting agent and corresponding serology markers Hepatitis A, B, C, D, E Present with nonspecific flu-like symptoms Fatigue Decreased appetite with nausea Abdominal pain Joint pain Symptoms more severe in hepatitis B

Cirrhosis s/sx

Liver enlargement Portal obstruction Ascites Varices Edema Vitamin deficiency Anemia Mental status changes or deterioration Pruritis Abdominal pain, distention

Expected Findings of Esophageal Varices that have not Ruptured

No manifestations until the varices begin to bleed. Activities that precipitate bleeding: Valsalva maneuver Lifting heavy objects Coughing Sneezing Alcohol consumption.

esophageal varices risk factors

Portal hypertension is the primary risk factor for the development of esophageal varices. Portal hypertension (elevated blood pressure in veins that carry blood from the intestines to the liver) is caused by impaired circulation of blood through the liver. Collateral circulation is subsequently developed creating varices in the upper stomach and esophagus. Varices are fragile and can bleed very easily; Alcoholic cirrhosis; Viral hepatitis; Older adult clients frequently have depressed immune function, decreased liver function, and cardiac disorders that make them especially vulnerable to bleeding.

Liver Transplantation

Portions of healthy liver from deceased donors (most commonly trauma victims) or living donors can be used for transplant The transplanted liver portion will regenerate and grow in size based on the needs of the body The patient must meet the transplant criteria to be eligible Patients who have severe cardiac and respiratory disease, metastatic malignant liver cancer, or alcohol substance use disorder are not candidates for liver transplantation.

portal hypertension treatment

Splenorenal shunt: connects splenic vein to left renal vein in patients with bleeding from esophageal varices End-to-side shunt: connects end of portal vein to side of IVC Side-to-side shunt: connects side of portal vein to side of IVC Portocaval H graft: synthetic graft from portal vein to IVC Mesocaval H graft: synthetic graft from SMV to IVC Transplant

Manifestations of Ascites

Sudden weight gain Distended abdomen Difficulty breathing when lying down Diminished appetite Abdominal pain Bloating Nausea and vomiting Heartburn

Protein metabolism in the liver

Synthesizes plasma proteins -Albumin, alpha-globulins, beta-globulins, blood clotting factors, transport proteins, plasma lipoproteins Amino acids are used by the liver for protein synthesis

Ammonia conversion in the liver

The liver converts ammonia into urea which is then excreted in the urine

GGTP (gamma glutamyl transpeptidase) increase

abuse of alcohol long term

Hepatocellular jaundice

accumulation of conjugated bilirubin in the serum due to hepatocyte dysfunction Hepatocellular and obstructive jaundice are most associated with liver disease

Globulin Decrease

acute viral Hep chronic obstructive jaundice

Pancreatitis causes

alcoholism biliary tract disease trauma viral infection drugs metabolic disorders vascular disorders GI surgery The etiologic factors cause injury to the pancreatic cells or activation of the pancreatic enzymes in the pancreas rather than intestine (where they are supposed to be activated)

Albumin decreased

ascites, cirrosis, hepatitis, necrosis

Angiomas

benign tumors composed of blood vessels

ERCP used for what

bile duct pathology -strictures, putting in stents -cholangiocarcinoma -emergent biliary structure decompression (cholangitis) -choledocholithiasis -cholangitis -gallstone pancreatitis with bile duct dilation (if not dilated, then no ERCP).

obstructive jaundice

bile ducts are obstructed (by gall stones) so bile cannot drain out of the liver and overflows into the blood Hepatocellular and obstructive jaundice are most associated with liver disease

cholesterol increase

biliary obstruction

Hepatitis C transmission

blood and body fluids

Spiralactone (Aldactone)

causes Na to decrease causes an increase in chloride increases phosphate

Vasopressin:

causes constriction of the esophageal and gastric veins and reduces portal pressure.

LDH (lactate dehydrogenase) increase

damage to the body tissues

AST increased

damage to tissues and cells

Hepatitis B transmission

direct contact with infected blood or other body secretions, sexual contact and blood-to-blood contact

ERCP

endoscopic retrograde cholangiopancreatography

Hepatitis A transmission

fecal-oral route

Bile by-products—leave body via

feces

Bile formation in the liver

formed by the hepatocytes and collected in the bile ducts Stored in the gallbladder Greenish-yellow or brownish-yellow in color Function of bile: excretion

Bilirubin

from hemoglobin released by red blood cells at the end of their life cycle

cholelithiasis

gallstones in the gallbladder

ALP increase

liver, gallbladder, bone problems, malnutrition, kidney tumors

choleycystitis diet

low fat

Hepatic encephalopathy diet

low protein

Bilirubin

made from RBC increased in impaired liver/bile duct obstructions

A nursing student is reviewing for an upcoming anatomy and physiology examination. Which of the following would the student correctly identify as a function of the liver? Select all that apply. A. Glucose metabolism B. Ammonia conversion C. Protein metabolism D. Carbohydrate metabolism E. Zinc storage

A,B,C Functions of the liver include the metabolism of glucose, protein, fat, and drugs; conversion of ammonia; storage of vitamins and iron; formation of bile; and excretion of bilirubin. The liver is not responsible for the metabolism of carbohydrates or the storage of zinc.

Balloon Tamponade

An esophagogastric tube with balloon is used to compress blood vessels. Traction is applied and then gradually released when bleeding is stopped Risks: Tube migration—can lead to airway obstruction Aspiration of gastric contents into lungs Patients often intubated to protect airway Can cause necrosis of tissue if left in place for extended period of time Balloon should be in place no longer than 12 hours.

The nurse is performing an assessment on a patient being evaluated for viral hepatitis. Which symptom will the nurse most likely assess on this patient? A. arthralgia B. irritability C. headache D. polyphagia

Answer: A Arthralgia=joint pain Polyphagia=excessive hunger and increased appetite

Which condition indicates an overdose of lactulose? A. Constipation B. Fecal impaction C. Watery diarrhea D. Hypoactive bowel sounds

Answer: C—Watery diarrhea Rationale: The goal of lactulose treatment is to decrease ammonia levels by creating 2-3 soft stools per day. Watery diarrhea is indicative of a lactulose overdose.

GGT (gamma glutamyl transferase) increase

Biliary tract obstruction seen in alcoholics

liver cancer manifestations

Malaise, anorexia, lethargy, weight loss fever feeling abdominal fullness painful RUQ s/s of liver failure

Jaundice manifestations

Characterized by yellow or green-tinged skin and whites of the eyes Caused by increased levels of bilirubin in the blood (hyperbilirubinemia)

obstructive jaundice s/sx

Dark orange-brown urine, clay-colored stools Dyspepsia and intolerance of fats, impaired digestion Pruritus

hemolytic jaundice

Excessive destruction of red blood cells or absorption of a hematoma

Bile formation in liver

Excreted into the bile and carried to the duodenum then converted into urobilinogen within the small intestine then excreted in feces or reabsorbed

Manifestations of Hepatic Dysfunction

Jaundice Portal hypertension Ascites Varices Hepatic encephalopathy or coma Nutritional deficiencies Malnutrition related to alcoholism Vitamin deficiencies

Fat metabolism in the liver

Liver is very active in fat metabolism Fatty acids are broken down for the production of energy and ketone bodies Fatty acids are used for the synthesis of: Cholesterol Lecithin Lipoproteins Complex lipids

Drug metabolism in the liver

Liver metabolizes many medications Results in drug inactivation Can be excreted in the feces or urine

cirrhosis diet

Low sodium Low potassium Low fat High carbohydrate Encourage food with high biologic protein (restrict protein if hepatic coma) Administer vitamin supplements (A, B complex, C, K)

Treatment of Ascites

Low-sodium diet Diuretics Bed rest in fowler's position to facilitate breathing Paracentesis Administration of salt poor albumin Transjugular intrahepatic portosystemic shunt (TIPS)

Albumin Nursing Implications

Monitor for peripheral edema Assess skin integrity if edema present Collaborative interventions to increase protien intake (enteral or parenteral)

Bleeding Varices: Nursing Management

Monitor frequently for: Aspiration Changes in vital signs Emotional responses Cognitive status changes Monitor for associated complications Hepatic encephalopathy resulting from blood breakdown in the GI tract and delirium related to alcohol withdrawal Provide oral care, tube care, and GI suctioning Implement measures to reduce anxiety and agitation Provide education to patient and family Provide support to patient and family

Treatment of Bleeding Varices

Treat for shock Administer oxygen IV fluids Electrolyte replacement Volume expanders Blood and blood products Vasopressin: causes constriction of the esophageal and gastric veins and reduces portal pressure. Nitroglycerin in combination with vasopressin to reduce coronary vasoconstriction Monitor for fluid retention and hypernatremia, as vasopressin has an antidiuretic effect Octreotide (Sandostatin) Decreases bleeding from esophageal varices but does not affect the blood pressure Propranolol and Nadolol to decrease heart rate and consequently reduce portal pressure; used in combination with other treatment Used prophylactically to prevent a first bleeding episode and to prevent rebleeding Not used for emergency management

Infectious Hepatitis: Management

Treatment is supportive Hold harmful medications Monitor hemodynamic status Monitor lab results Liver enzymes Electrolytes Monitor I&O—very strict Daily weight Measure abdominal girth Maintain bedrest High-calorie, low-protein diet Monitor for bleeding Avoid: Alcohol Narcotics Barbiturates Treat encephalopathy as prescribed

Ultrasound, CT, MRI of the liver

Used to identify normal structures and abnormalities of the liver and biliary tree

Vitamin and iron storage in the liver

Vitamin A Vitamin B Vitamin D B-complex vitamins Iron Copper

the liver also assists in the breakdown of

harmful substances which are then excreted into the bile or blood

Cirrhosis nursing interventions

high protein/carb diet: early stages fiber, protein, fat & Na restriction: late/advanced stages small frequent feedings fluid restriction avoid alcohol maintain skin integrity- avoid soap promote rest assess respiratory function & jaundice degree check gums, stool, skin & vomitus for bleeding

Diuretics to treat ascites

hydrocholothiazide lasix spiralactone

Hepatic encephalopathy

impaired ammonia metabolism causes cerebral edema. s/s: change in LOC, memory loss, asterixis (flapping tremor) impaired handwriting, hyperventilation w/ resp alkalosis. Rx: lactulose, low protein, safety, rest

cholesterol decrease

liver disease

ammonia increase

liver failure

ALT increased

more indicative of liver function

Petechiae

pinpoint purple or red spots from minute hemorrhages under the skin

Liver biopsy

removal of liver tissue for microscopic examination Usually through needle aspiration Permits examination of liver cells Client in supine position or lateral with upper arms elevated

what position is best for a client who has just undergone a liver biopsy

right-side lying with the bed flat. A patient who has gone through a liver biopsy may be getting it because the body's mobility is already affected. Placing the person lying on his right side will prevent bleeding and will lessen the pressure on the biopsy site.

TIPS) is a procedure that

that may be used to reduce portal hypertension and its complications, especially variceal bleeding. Inserted through the Transjugular route A TIPS procedure may be done by a radiologist, who places a small wire-mesh coil (stent) into a liver vein. The stent is then expanded using a small inflatable balloon (angioplasty). The stent forms a channel, or shunt, that bypasses the liver. This channel reduces pressure in the portal vein. By reducing portal hypertension, enlarged veins (varices) are less likely to rupture and bleed. And other complications of cirrhosis called ascites (fluid in the abdomen) and hepatic hydrothorax (fluid between the lungs and the chest wall) may improve or go away. The doctor uses the stent to connect your portal vein to one of your hepatic veins. This new pathway will allow blood to flow better. It will ease pressure on the veins of your stomach, esophagus, intestines, and liver.

T-tube

tube placed in the bile duct for drainage into a small pouch (bile bag) on the outside of the body

Blood by-products—leave body via

urine

A nurse is teaching a patient who has hepatitis B about home care. Which of the following instructions should the nurse include in the teaching? Select all that apply. A) Limit physical activity B) Avoid alcohol C) Take acetaminophen for comfort D) Wear a mask when in public places E) Eat small frequent meals

A B E

A client with end-stage liver disease is scheduled to undergo a liver transplant. The client tells the nurse, "I am worried that my body will reject the liver." Which statement is the nurse's best response to the client? "You will need to take daily medication to prevent rejection of the transplanted liver. The new liver had a good chance of survival with the use of these drugs." "The problem of rejection is not as common in liver transplants as in other organ transplants." "It is easier to get a good tissue match with liver transplants than with other types of transplants." "You would not be scheduled for a transplant if there was a concern about rejection."

Answer: A 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 attach and destroy the transplanted liver. Immunosuppressive agents are used as long-term therapy to prevent this response and rejection of the transplanted liver

Preprocedural Nursing Actions for a liver biopsy

Check that results of coagulation tests (prothrombin time, partial thromboplastin time, and platelet count) are available and that compatible donor blood is available Check for signed consent Obtain VS and weight Patient education -Steps of the procedure -What to expect (sensations) -Restrictions of activity -Postprocedural monitoring

biliary cirrhosis

Cirrhosis develops from chronic biliary obstruction, bile stasis, and inflammation, resulting in severe obstructive jaundice.

Hepatic Cirrhosis: Nursing Interventions

Encourage rest Supportive measures Positioning for respiratory efficiency Administer oxygen as needed Planned mild exercise and rest periods Address nutritional status to improve strength Measures to prevent hazards of immobility Monitor I&O Encourage small frequent meals High-calorie diet, sodium restriction Protein modified or restricted if patient is at risk for encephalopathy Supplemental vitamins, minerals, B complex Provide water-soluble forms of fat-soluble vitamins if patient has steatorrhea Consider patient preferences Impaired skin integrity Frequent position changes Gentle skin care Reduce scratching related to pruritus Risk for injury Prevent falls and trauma Related to risk for bleeding

functions of the liver

Glucose metabolism Ammonia conversion Protein metabolism Fat metabolism Vitamin and iron storage Bile formation Bilirubin excretion Drug metabolism Assists in the breaking down of harmful substances which are then excreted into the bile or blood

cirrhosis of the liver causes

Most common cause is malnutrition related to alcoholism Infection Metabolic disorders Medications and other toxins Nutritional deficiencies Hypersensitivity states

Hepatitis: Nursing Interventions

Stay home while acutely ill Provide high carb, high calorie, low to moderate fat, low protein diet Small frequent meals Promote hepatic rest and the regeneration of tissue Administer only necessary medications Avoid over the counter meds or herbal supplements Avoid alcohol Limit physical activity Educate patient and family regarding measures to prevent transmission Avoid sexual intercourse until testing is negative Use proper hand hygiene

TIPS may be used to:

Treat fluid buildup that continues to occur in the abdominal cavity despite medical therapy (refractory ascites). Treat acute variceal bleeding that is not controlled by standard treatment. Prevent recurrent episodes of variceal bleeding when sclerotherapy or band ligation has failed. Treat variceal bleeding while someone is waiting for a liver transplant.