Med surg Exam 3 CH: ( 49,50)
Hepatitis E
Hepatitis E virus (HEV) Fecal-oral route; person to person contact may be possible, although risk appears low.
Stage 1 Hepatic Encephalopathy
Normal level of consciousness with periods of lethargy and euphoria; reversal of day-night sleep patterns Asterixis; impaired writing and ability to draw line figures. Normal EEG. Activity intolerance Self-care deficit Disturbed sleep pattern
To reduce risk of injury for a patient with liver disease, what initial measure can the nurse implement? a) Apply soft wrist restraints b) Prevent visitors, so as not to agitate the patient c) Raise all four side rails on the bed d) Pad the side rails on the bed
Pad the side rails on the bed Explanation: Padding the side rails can reduce injury if the patient becomes agitated or restless. Restraints would not be an initial measure to implement. Four side rails are considered a restraint and this would not be an initial measure to implement. Family and friends most generally assist in calming a patient p. 1369
What are the common fat soluble vitamin deficiencies associated with Cholelithiasis?
(vitamins A, D, E, and K) b/c of obstruction of bile duct.
The Care of the Patient With Cholelithiasis—Interventions 1. Bed position 2. Diet
1. Low fowlers 2. NG or NPO until bowel sounds return; then a soft, low-fat, high-carbohydrate diet
Treatment for ascites 1. Diet 2. Medications 3. Activity 4. Invasive interventions ( short term and longterm)
1. low sodium diet, alternates:( lemon juice, thyme. DO NOT use salt substitutes, they contain ammonia 2. Diuretics 3. Bedrest, b/c upright position activates the RAA-system and sympathetic nervous system. 4. Paracentesis- Provides temporary removal of fluid. Transjugular intrahepatic portosystemic shunt (TIPS)
What is a normal serum lipase level?
114-286 units/L
What is a simple was the nurse can ensure lactulose is being effective?
2-3 soft stools is good Watch for diarrhea-watery stools=med overdose.
Pigment stones form from?
25% of cases Form from precipitation of unconjugated bile Can't be dissolved have to be removed
The patient has had a liver biopsy. Which post-procedure intervention should the nurse implement? 1 Instruct to void immediately 2 NPO for 8 hours 3 Place the patient on the right side 4 Monitor BUN & Creatinine
3
Hepatic encephalopathy
A neurologic syndrome of impaired cognitive function, flapping tremor, and EEG changes The condition develops rapidly during fulminant hepatitis or slowly during chronic liver disease Cells in the nervous system are vulnerable to neurotoxins absorbed from the GI tract that, because of liver dysfunction circulate to the brain
What is a physical assessment that can be performed at the bed side to detect ascites?
Abdominal Fluid Wave
Criteria for Predicting Severity of Pancreatitis
Age >55 years White blood cells (WBCs) >16,000 mm3 Serum glucose >200 mg/dL (>11.1 mmol/L) Serum lactose dehydrogenase (LDH) >350 IU/L (>350 U/L) AST >250 IU/L
Cancer of the liver?
Associated with hepatitis B and C Hepatocellular carcinoma (HCC) Few cancers originate in the liver Frequent site of metastatic cancer Manifestations: Dull persistent pain, RUQ, back or epigastrium Weight loss, anemia, anorexia, weakness Jaundice, bile ducts occluded, ascites or obstructed portal veins
Chronic hepatitis
Characterized by continued hepatic disease lasting longer than 6 months
What does the TIPS procedure do?
Diverts blood flow and decreases portal HTN
Is the following statement true or false? The majority of blood supply to the liver, which is poor in nutrients, comes from the portal vein.
False The majority of blood supply to the liver, which is rich in nutrients from the gastrointestinal tract, comes from the portal vein.
Hepatitis A
Fecal-oral route; poor sanitation. Pnersonto-Person contact. Prévention via hygiene, or immune serum globulin
Which of the following would be the least important assessment in a patient diagnosed with ascites? a) Weight b) Measurement of abdominal girth c) Palpation of abdomen for a fluid shift d) Foul-smelling breath
Foul-smelling breath Explanation: Foul-smelling breath would not be considered an important assessment for this patient. Measurement of abdominal girth, weight, and palpation of the abdomen for a fluid shift are all important assessment parameters for the patient diagnosed with ascites. Page 1367
Physical findings due to hormonal changes? 1- in men
Gynecomastia & Testicular atrophy
Hepatitis C
Hepatitis C virus (HCV) Contracted blood to blood. Screen blood transfusions.
Stage 2 Hepatic Encephalopathy
Increased drowsiness; disorientation; inappropriate behavior; mood swings; agitation Asterixis; fetor hepaticus. Abnormal EEG with generalized slowing. Impaired social interaction Ineffective role performance Risk for injury Confusion
A physician orders spironolactone (Aldactone), 50 mg by mouth four times daily, for a client with fluid retention caused by cirrhosis. Which finding indicates that the drug is producing a therapeutic effect? a) Loss of 2.2 lb (1 kg) in 24 hours b) Serum sodium level of 135 mEq/L c) Serum potassium level of 3.5 mEq/L d) Blood pH of 7.25
Loss of 2.2 lb (1 kg) in 24 hours Explanation: Daily weight measurement is the most accurate indicator of fluid status; a loss of 2.2 lb (1 kg) indicates loss of 1 L of fluid. Because spironolactone is a diuretic, weight loss is the best indicator of its effectiveness. This client's serum potassium and sodium levels are normal. A blood pH of 7.25 indicates acidosis, an adverse reaction to spironolactone. Page 1369
Dietary management of Cholelithiasis
Low fat, cooked fruits, rice, tapioca, lean meats. Avoid eggs, cheese, pork, fried fatty foods.
What medication should be held 48hrs prior to the administration of IV contrast?
Metformin
Treatment for bleeding varicies? 1. Medication and fluids
O2, IV fluids, electrolytes, volume expanders, blood and blood products, insert urinary cath. Urinary catheter is used to Vasopressin-(Pitressin)-constricts distal esophageal &proximal gastric veins=decreases inflow into the portal sys & decrease in portal pressure. octreotide(Sandostatin)-selective splanchnic agent-decreases bleeding-decreases portal pressure.
Risk factors for gallbladder disorders?
Obesity, frequent wt changes, rapid wt loss, women, DM, native american, hispanic.
Portal Hypertension 1. Cause 2. Results in
Obstructed blood flow through the liver results in increased pressure throughout the portal venous system Ascites Esophageal varices
What are the most common cause of gallbladder disorders?
Obstruction or inflammation is the most common cause of gallbladder problems
Clinical manifestations of Cholelithiasis?
Pain Upper right abd, radiating to back and R shoulder Biliary colic Associated with N/V Noticeable several hrs after heavy meal-fried/fatty foods Jaundice-due to bile duct obstruction-bile can't go to duodenum
A nurse is gathering equipment and preparing to assist with a sterile bedside procedure to withdraw fluid from a patient's abdomen. The procedure tray contains the following equipment: trocar, syringe, needles, and drainage tube. The patient is placed in a high Fowler's position and a BP cuff is secured around the arm in preparation for which of the following procedures? a) Liver biopsy b) Abdominal ultrasound c) Dialysis d) Paracentesis
Paracentesis Explanation: Paracentesis is the removal of fluid (ascites) from the peritoneal cavity through a puncture or a small surgical incision through the abdominal wall under sterile conditions. Paracentesis may be used to withdraw ascitic fluid if the fluid accumulation is causing cardiorespiratory compromise. Page 1347
Hepatitis D
Parenterally; by intimate contact with carriers or those with acute disease; sexual and oral-oral contact.
Patients with chronic liver dysfunction have problems with insufficient vitamin intake. Which of the following may occur as a result of vitamin C deficiency? a) Beriberi b) Night blindness c) Hypoprothrombinemia d) Scurvy
Scurvy Scurvy may result from a vitamin C deficiency. Night blindness, hypoprothrombinemia, and beriberi do not result from a vitamin C deficiency.
Is the following statement true or false? Only persons with hepatitis B are at risk for hepatitis D
True they co exist together
ascites:
an albumin-rich fluid accumulation in the peritoneal cavity
cholecystojejunostomy:
anastomosis of the jejunum to the gallbladder to divert bile flow
What is the rational for the use of an antibiotic in patients with hepatic encephalopathy?
antibiotics(flagyl or neomycin) ATBX-reduce ammonia forming bacteria in the gut, helping reduce the amount of possible ammonia in the body.
The nurse is concerned about potassium loss when a diuretic is prescribed for a patient with ascites and edema. What diuretic may be ordered that spares potassium and prevents hypokalemia? a) Acetazolamide (Diamox) b) Bumetanide (Bumex) c) Spironolactone (Aldactone) d) Furosemide (Lasix)
c) Spironolactone (Aldactone) Explanation: Potassium-sparing diuretic agents such as spironolactone or triamterene (Dyrenium) may be indicated to decrease ascites, if present; these diuretics are preferred because they minimize the fluid and electrolyte changes commonly seen with other agents. p. 1368
lithotripsy
disintegration of gallstones by shock waves
portal hypertension:
elevated pressure in the portal circulation resulting from obstruction of venous flow into and through the liver
Cholelithiasis
gallstone formation
constructional apraxia:
inability to draw figures in two or three dimensions
Pancreatitis acute:
pancreatic duct becomes obstructed, and enzymes back up, causing autodigestion and inflammation of the pancreas by its own enzymes.
amylase:
pancreatic enzyme; aids in the digestion of carbohydrates
lipase:
pancreatic enzyme; aids in the digestion of fats
choledocholithiasis:
stones in the common bile duct
fulminant hepatic failure
sudden, severe onset of acute liver failure that occurs within 8 weeks after the first symptoms of jaundice
sclerotherapy:
the injection of substances into or around esophagogastric varices to cause constriction, thickening, and hardening of the vessel and stop bleeding
Lactulose:
to reduce serum ammonia levels by expelling in feces.
Types of cirrhosis ( three of them)
Alcoholic-most common Postnecrotic-late result of acute viral hepatitis Biliary-scarring around the bile ducts from infection or obstruction
What diuretic is contraindicated in patients with ascites and why?
Ammonium chloride and acetazolamide (Diamox) are contraindicated because of the possibility of precipitating hepatic coma.
Stage 4 Hepatic Encephalopathy
Comatose; may not respond to painful stimuli Absence of asterixis; absence of deep tendon reflexes; flaccidity of extremities. EEG markedly abnormal. Risk for aspiration Impaired gas exchange Impaired tissue integrity
Stage 3 Hepatic Encephalopathy
Stuporous; difficult to rouse; sleeps most of time; marked confusion; incoherent speech Asterixis; increased deep tendon reflexes; rigidity of extremities. EEG markedly abnormal. Imbalanced nutrition Impaired mobility Impaired verbal communication
endoscopic variceal ligation (EVL):
procedure that uses a modified endoscope loaded with an elastic rubber band passed through an overtube directly onto the varix (or varices) to be banded to ligate the area and stop bleeding
cholecystectomy:
removal of the gallbladder
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) "The problem of rejection is not as common in liver transplants as in other organ transplants." b) "You would not be scheduled for a transplant if there was a concern about rejection." 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." Explanation: 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. Page 1383
Fulminant hepatitis
An uncommon, rapidly progressing form that can quickly lead to liver failure, hepatic encephalopathy, or death within short time. May occur as a complication of Hep B or Hep C Toxic meds and chemicals can also cause.
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? a) Asterixis b) Constructional apraxia c) Ataxia d) Fetor hepaticus
Asterixis Explanation: Asterixis, an involuntary flapping of the hands, may be seen in stage II encephalopathy (Fig. 49-13) 1355
Most common type of gallstones?
Cholesterol (most common)-75% of cases Cholesterol stones form in bile that is supersaturated with cholesterol Theories: Enzyme defect increases cholesterol synthesis Decreased secretion of bile acids to emulsify fats
When assessing a client with cirrhosis of the liver, which of the following stool characteristics is the client likely to report? a) Clay-colored or whitish b) Black and tarry c) Yellow-green d) Blood tinged
Clay-colored or whitish Explanation: Many clients report passing clay-colored or whitish stools as a result of no bile in the gastrointestinal tract. The other stool colors would not be absolute indicators of cirrhosis of the liver but may indicate other GI tract disorders. (less) Page 1344
A client with cirrhosis has been referred to hospice care. Assessment data reveal a need to discuss nutrition with the client. What is the nurse's priority intervention? a) Discuss meals that include low-fat high-carbohydrate content. b) Discuss meals that have a high-fiber, high-protein content. c) Discuss the importance of eliminating caffeine in the diet. d) Discuss the importance of drinking at least 64 oz (1,893 ml) of water daily.
Discuss meals that include low-fat high-carbohydrate content. Explanation: In cirrhosis, the liver's metabolic function is compromised, increasing the client's need for carbohydrates and other energy sources for cellular metabolism. The nurse should limit the client's fat intake to prevent satiation and should restrict protein intake because a cirrhotic liver can't metabolize protein effectively. A client with cirrhosis may have increased edema as a result of reduced plasma albumin, so he should restrict fluid intake rather than drink 64 oz of water daily. Increasing fiber intake isn't a priority intervention for a client with cirrhosis. A client with cirrhosis doesn't need to eliminate caffeine from his diet
Assessment findings for Hepatic Encephalopathy?
EEG Changes in LOC Sleep pattern changes Potential seizures Fetor hepaticus- Sweeet but slightyl fecal smelling breath Monitor fluid, electrolyte, and ammonia levels
Is the following statement true or false? Cholecystitis is when a patient has calculi in the gallbladder.
False Cholecystitis is inflammation of the gallbladder. Cholelithiasis is when a patient has calculi in the gallbladder.
Is the following statement true or false? Bleeding esophageal varices result in an increase in renal perfusion.
False Bleeding esophageal varices do not result in an increase in renal perfusion. Bleeding esophageal varices result in a decrease in renal perfusion.
Which type of jaundice is the result of increased destruction of red blood cells? a) Nonobstructive b) Hemolytic c) Obstructive d) Hepatocellular
Hemolytic Explanation: Hemolytic jaundice is the result of an increased destruction of the red blood cells. Hepatocellular jaundice is caused by the inability of damaged liver cells to clear normal amounts of bilirubin from the blood. Obstructive jaundice resulting from extrahepatic obstruction may be caused by occlusion of the bile duct form a gall stone, inflammatory process, a tumor, or pressure from an enlarged organ. Nonobstructive jaundice occurs with hepatitis.
Hepatitis B
Hepatitis B virus (HBV) route; poor sanitation. Personto-person contact. Waterborne; foodborne. Transmission possible with oral-anal contact during sex. Parenterally; by intimate contact with carriers or those with acute disease; sexual and oral-oral contact. Vaccination available
Patients diagnosed with esophageal varices are at risk for hemorrhagic shock. Which of the following is a sign of potential hypovolemia? a) Bradycardia b) Warm moist skin c) Hypotension d) Polyuria
Hypotension Explanation: Signs of potential hypovolemia include cool, clammy skin, tachycardia, decreased blood pressure, and decreased urine output. Page 1347
In a patient with acute pancreatitis, what is the cause is increased serum lipase?
Increased lipase appears in the blood stream when he pancreases is damaged.
A patient with cirrhosis has a massive hemorrhage from esophageal varices. Balloon tamponade therapy is used temporarily to control hemorrhage and stabilize the patient. In planning care, the nurse gives the highest priority to which of the following goals? a) Relieving the patient's anxiety b) Controlling bleeding c) Maintaining fluid volume d) Maintaining the airway
Maintaining the airway Explanation: Esophageal varices are almost always caused by portal hypertension, which results from obstruction of the portal circulation within the damaged liver. Maintaining the airway is the highest priority because oxygenation is essential for life. The airway is compromised by possible displacement of the tube and the inflated balloon into the oropharynx, which can cause life-threatening obstruction of the airway and asphyxiation
A nurse educator is providing an in-service to a group of nurses working on a medical floor that specializes in liver disorders. Which of the following is an important education topic regarding ingestion of medications? a) The need for more frequently divided doses b) Metabolism of medications c) Medications will no longer be effective in clients with liver disease. d) The need for increased drug dosages
Metabolism of medications Explanation: Careful evaluation of the client's response to drug therapy is important because the malfunctioning liver cannot metabolize many substances. Page 1336
What should the nurse monitor for while a patient is using Lactulose?
Monitor for hypokalemia and dehydration.
A patient has undergone a liver biopsy. Which of the following postprocedure positions is appropriate? a) On the left side b) High Fowler's c) On the right side d) Trendelenburg
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. Positioning the patient on his left side is not indicated. Positioning the patient in the Trendelenburg position may be indicated if the patient is in shock, but is not the position designed for the patient after liver biopsy. High Fowler's position is not indicated for the patient after liver bio Reference: Hinkle, J.L., and Cheever, K.H. Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 13th ed. Philadelphia: Lippincott Williams & Wilkins, 2014, Chapter 49: Assessment and Management of Patients With Hepatic Disorders, p. 1343. Chapter 49: Assessment and Management of Patients With Hepatic Disorders - Page 1343
What type of screening should patients with Esophageal Varices go through and how often?
Patients with cirrhosis should undergo screening endoscopy every 2 years to check for varicies
What type of activity should a patient with cirrhosis be doing?
Planned mild exercise and rest periods
The most common cause of esophageal varices includes which of the following? a) Asterixis b) Ascites c) Jaundice d) Portal hypertension
Portal hypertension Explanation: Esophageal varices are almost always caused by portal hypertension, which results from obstruction of the portal circulation within the damaged liver. Jaundice occurs when the bilirubin concentration in the blood is abnormally elevated. Ascites results from circulatory changes within the diseased liver. Asterixis is an involuntary flapping movement of the hands associated with metabolic liver dysfunction
Which of the following liver function studies is used to show the size of the liver and hepatic blood flow and obstruction a) Angiography b) MRI c) Radioisotope liver scan d) EEG
Radioisotope liver scan Explanation: A radioisotope liver scan assesses liver size and hepatic blood flow and obstuction. A MRI is used to identify normal structures and abnormalities of the liver and biliary tree. An angiography is used to visualize hepatic circulation and detect the presence and nature of hepatic masses. An EEG is used to detect abnormalities that occur with hepatic coma.
Assessment of ascites
Record abdominal girth and weight daily(report > 1-2kg per day) Patient may have striae, distended veins, and umbilical hernia SOB because of the enlarged abd. Assess for fluid in abdominal cavity by percussion for shifting dullness or by fluid wave Monitor for potential fluid and electrolyte imbalances
What is a major symptom of chronic pancreatitis? a. Recurrent attacks of severe upper abdominal and back b. pain accompanied by vomiting c. Fever, jaundice, confusion, and agitation d. Ecchymosis in the flank or umbilical area Abdominal guarding
Recurrent attacks of severe upper abdominal and back pain accompanied by vomiting Chronic pancreatitis has recurrent attacks of severe upper abdominal and back pain accompanied by vomiting. Acute pancreatitis presents with fever, jaundice, confusion, agitation, ecchymosis in the flank or umbilical area, and abdominal guarding.
The nurse is providing care to a patient with gross ascites who is maintaining a position of comfort in the high semi-Fowler's position. What is the nurse's priority assessment of this patient? a) Skin assessment related to increase in bile salts b) Peripheral vascular assessment related to immobility c) Respiratory assessment related to increased thoracic pressure d) Urinary output related to increased sodium retention
Respiratory assessment related to increased thoracic pressure Explanation: If a patient with ascites from liver dysfunction is hospitalized, nursing measures include assessment and documentation of intake and output (I&O;), abdominal girth, and daily weight to assess fluid status. The nurse also closely monitors the respiratory status because large volumes of ascites can compress the thoracic cavity and inhibit adequate lung expansion. The nurse monitors serum ammonia, creatinine, and electrolyte levels to assess electrolyte balance, response to therapy, and indications of encephalopathy. Page 1348
What is one of the major risks and considerations when a patient is using Vasopressin-(Pitressin)?
Risk MI-so given with Nitro-reduces coronary vasoconstriction and angina s/s Nitrites: Isordil-decrease portal pressure by venodilation and decrease cardiac output.
The nurse is asking the client with acute pancreatitis to describe the pain. What pain symptoms does the client describe related to acute pancreatitis? a) Severe midabdominalto upper abdominal pain radiating to both sides and to the back b) Sharp, stabbing pain in the left lower quadrant of the abdomen c) Severe abdominal pain that radiates to the right shoulder d) Dull pain, points to epigastric area
Severe midabdominalto upper abdominal pain radiating to both sides and to the back Explanation: The most common complaint of clients with pancreatitis is severe midabdominalto upperabdominal pain, radiating to both sides and straight to the back. The other answers are not pain that is usually associated with acute pancreatitis. Page 1402
A patient with hepatic cirrhosis questions the nurse about the possible use of an herbal supplement—milk thistle—to help heal the liver. Which of the following would be the most appropriate response from the nurse? a) You should not use herbal supplements in conjunction with medical treatment. b) You can use milk thistle instead of the medications you have been prescribed. c) Herbal supplements are approved by the FDA, so there should be no problem with their usage if you check with your primary care provider. d) Silymarin from milk thistle has anti-inflammatory and antioxidant properties that may have beneficial effects, especially in hepatitis.However, you should always notify your primary care provider of any herbal remedies being used so drug interactions can be evaluated.
Silymarin from milk thistle has anti-inflammatory and antioxidant properties that may have beneficial effects, especially in hepatitis.However, you should always notify your primary care provider of any herbal remedies being used so drug interactions can be evaluated. Many patients who have end-stage liver disease (ESLD) with cirrhosis use the herb milk thistle (Silybum marianum) to treat jaundice and other symptoms. This herb has been used for centuries because of its healing and regenerative properties for liver disease. Silymarin from milk thistle has anti-inflammatory and antioxidant properties that may have beneficial effects, especially in hepatitis. The natural compound SAM-e (s-adenosylmethionine) may improve outcomes in liver disease by improving liver function, possibly through enhancing antioxidant function. Herbal supplements are used in conjunction with medical treatment and medications. Herbal supplements are not approved by the FDA. Their usage should be discussed with the primary care provider to evaluate their effectiveness and interactions with other treatment regimens p. 1368
Which diuretic medication would most often be used for a patient with ascites? a. Actazolamide (Diamox) b. Ammonium chloride c. Furosemide (Lasix) d. Spironolactone (Aldactone)
Spironolactone (Aldactone) an aldosterone blocking agent is most often the first-line therapy in patients with ascites from cirrhosis. Oral diuretics such as furosemide (Lasix) may be added but should be used cautiously. Ammonium chloride and acetazolamide (Diamox) are contraindicated because of the possibility of precipitating hepatic coma.
A nurse is caring for a client with cirrhosis. The nurse assesses the client at noon and discovers that the client is difficult to arouse and has an elevated serum ammonia level. The nurse should suspect which situation? a) The client is relaxed and not in pain. b) The client's hepatic function is decreasing. c) The client didn't take his morning dose of lactulose (Cephulac). d) The client is avoiding the nurse.
The client's hepatic function is decreasing. Explanation: The decreased level of consciousness caused by an increased serum ammonia level indicates hepatic disfunction. If the client didn't take his morning dose of lactulose, he wouldn't have elevated ammonia levels and decreased level of consciousness this soon. These assessment findings don't indicate that the client is relaxed or avoiding the nurse.
Endoscopic Sclerotherapy
Use a firberoptic endoscope to inject the medicaiton. Injection of sclerosing agent to the bleeding esophageal varices Promotes thrombosis and sclerosis.
What are Esophageal Varices cause by?
Varices-varicosities caused by the elevated pressure in the veins that drain into the portal system-prone to rupture and can cause massive bleeds. Occurs in about one third of patients with cirrhosis. First bleeding episode has a mortality rate of 30% to 50%
Which of the following medications is used to decrease portal pressure, halting bleeding of esophageal varices? a) Spironolactone (Aldactone) b) Vasopressin (Pitressin) c) Cimetidine (Tagamet) d) Nitroglycerin
Vasopressin (Pitressin) Explanation: Vasopressin may be the initial therapy for esophageal varices, because it constricts the splanchnic arterial bed and decreases portal hypertension. Nitroglycerin has been used to prevent the side effects of vasopressin. Aldactone and Tagamet do not decrease portal hypertension.
A client with severe and chronic liver disease is showing manifestations related to inadequate vitamin intake and metabolism. He reports difficulty driving at night because he cannot see well. Which of the following vitamins is most likely deficient for this client? a) Vitamin A b) Riboflavin c) Vitamin K d) Thiamine
Vitamin A Explanation: Problems common to clients with severe chronic liver dysfunction result from inadequate intake of sufficient vitamins. Vitamin A deficiency results in night blindness and eye and skin changes. Thiamine deficiency can lead to beriberi, polyneuritis, and Wernicke-Korsakoff psychosis. Riboflavin deficiency results in characteristic skin and mucous membrane lesions. Vitamin K deficiency can cause hypoprothrombinemia, characterized by spontaneous bleeding and ecchymoses
The nurse is administering Cephulac (lactulose) to decrease the ammonia level in a patient who has hepatic encephalopathy. What should the nurse carefully monitor for that may indicate a medication overdose? a) Watery diarrhea b) Ringing in the ears c) Vomiting d) Asterixis
Watery diarrhea Explanation: The patient receiving lactulose is monitored closely for the development of watery diarrhea stools, because they indicate a medication overdose. Serum ammonia levels are closely monitored as well. p. 1365
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? a) "You must have the second one in 1 year and the third the following year." b) "You must have the second one in 6 months and the third in 1 year." c) "You must have the second one in 1 month and the third in 6 months." d) "You must have the second one in 2 weeks and the third in 1 month."
You must have the second one in 1 month and the third in 6 months." Explanation: Both forms of the hepatitis B vaccine are administered intramuscularly in three doses; the second and third doses are given 1 and 6 months, respectively, after the first dose.
cirrhosis:
a chronic liver disease characterized by fibrotic changes, the formation of dense connective tissue within the liver, subsequent degenerative changes, and loss of functioning cells
The nurse identifies which of the following types of jaundice in an adult experiencing a transfusion reaction? a) Hepatocellular b) Hemolytic c) Nonobstructive d) Obstructive
b) Hemolytic Hemolytic jaundice occurs because, although the liver is functioning normally, it cannot excrete the bilirubin as quickly as it is formed. This type of jaundice is encountered in patients with hemolytic transfusion reactions and other hemolytic disorders. Obstructive jaundice is the result of liver disease. Nonobstructive jaundice occurs with hepatitis. Hepatocellular jaundice is the result of liver disease Page 1342
A client is being prepared to undergo laboratory and diagnostic testing to confirm the diagnosis of cirrhosis. Which test would the nurse expect to be used to provide definitive confirmation of the disorder? a) Magnetic resonance imaging b) Liver biopsy c) Coagulation studies d) Radioisotope liver scan
b) Liver biopsy Explanation: A liver biopsy which reveals hepatic fibrosis is the most conclusive diagnostic procedure. Coagulation studies provide information about liver function but do not definitively confirm the diagnosis of cirrhosis. Magnetic resonance imaging and radioisotope liver scan help to support the diagnosis but do not confirm it. These tests provide information about the liver's enlarged size, nodular configuration, and distorted blood flow. Page 1342
cholelithiasis:
calculi in the gallbladder
hepatic encephalopathy:
central nervous system dysfunction frequently associated with elevated ammonia levels that produce changes in mental status, altered level of consciousness, and coma
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: a) cholelithiasis. b) appendicitis. c) peptic ulcer disease. d) cirrhosis.
cirrhosis. Explanation: Muscle wasting, a decrease in chest and axillary hair, and increased bleeding tendencies are all symptoms of cirrhosis. The client may also have mild fever, edema, abdominal pain, and an enlarged liver. Clients with peptic ulcer disease complain of a dull, gnawing epigastric pain that's relieved by eating. Appendicitis is characterized by a periumbilical pain that moves to the right lower quadrant and rebound tenderness. Cholelithiasis is characterized by severe abdominal pain that presents several hours after a large meal
What does a patient with Cholelithiasis stool look like?
clay or putty colored stool b/c of bile pigments excreted out by kidney
cholecystitis
inflammation of the gallbladder which can be acute or chronic
Cholecystitis
inflammation or infection in the biliary system caused by calculi
asterixis:
involuntary flapping movements of the hands
AST and ALT become more elevated when ?
liver cell damage has occurred
trypsin:
pancreatic enzyme; aids in the digestion of proteins
Pancreatitis Chronic:
progressive inflammatory disorder with destruction of the pancreas; cells are replaced by fibrous tissue; pressure within the pancreas increases, obstructing the pancreatic and common bile ducts
fetor hepaticus:
sweet, slightly fecal odor to the breath, presumed to be of intestinal origin; prevalent with the extensive collateral portal circulation in chronic liver disease
Medications to dissolve cholesterol stones/ or make them smaller?
ursodeoxycholic acid and chenodeoxycholic acid-UDCA