53 Liver

The nurse is preparing to administer a unit of fresh frozen plasma to a patient with cirrhosis admitted for a transjugular intrahepatic portosystemic shunt (TIPS) procedure. The patient's caregiver asks why the patient will be receiving fresh frozen plasma. What is the nurse's best response?

"Fresh frozen plasma provides the patient with the necessary clotting factors that the liver is not producing." The patient with cirrhosis cannot produce the necessary clotting factors because of liver damage. This patient is being prepared for a procedure that requires insertion of a needle, and a lack of clotting factors increases the patient's risk for bleeding. Therefore fresh frozen plasma is being administered to provide the patient with the clotting factors needed to decrease the risk of complications.

The nurse is providing discharge teaching to a male patient with cirrhosis about managing his care at home. Which statement made by the patient indicates a need for further teaching?

"I will weigh myself every other day." It is important for the patient to weigh himself every day to determine whether he has retained fluid. This statement indicates a need for further teaching.

A nurse is reviewing medications with a patient who is being discharged after having an esophageal variceal bleed. The patient questions why propranolol is being prescribed when blood pressure is low. What is the nurse's best response?

"Propranolol will help decrease the portal pressure to prevent further bleeding from existing varices." Propranolol is the drug of choice to decrease the portal pressure to prevent variceal bleeding. This is the nurse's best response.

Which laboratory values will the nurse expect to be decreased in the patient with cirrhosis?

Albumin The patient with cirrhosis will present with a decreased serum albumin level as a result of malnutrition and increased oncotic pressure. Calcium The calcium level is decreased in a patient with cirrhosis as a result of malnutrition. Potassium The patient with cirrhosis will have a decreased potassium level as a result of hyperaldosteronism.

An elevation in which laboratory value can lead to increased confusion and lethargy in the patient with cirrhosis?

Ammonia A buildup of ammonia happens in cirrhosis as a result of portal hypertension and may cause confusion and lethargy.

Which priority assessments should the nurse make before a patient undergoes a transjugular intrahepatic portosystemic shunt (TIPS) procedure?

Ammonia level A TIPS procedure is contraindicated for patients with elevated ammonia levels. TIPS directs blood flow from the mesentery to the brain and can increase ammonia levels. Therefore the nurse should assess the ammonia level before the patient undergoes this procedure. Prothrombin time A TIPS procedure is an invasive procedure, which requires a needle to be inserted into the jugular vein. The nurse should assess prothrombin time before the patient undergoes this procedure.

Which laboratory value must the nurse assess before administration of lactulose?

Ammonia level Lactulose is given to a patient with hepatic encephalopathy to reduce serum ammonia levels. Therefore the nurse will assess the patient's ammonia level before administration of this drug.

What should the nurse include in a focused assessment when caring for a patient admitted to the hospital with a diagnosis of cirrhosis?

Assess lower extremities; assess skin integrity and color; measure abd circumference;

Which item should the nurse remove from the dinner tray of a patient with cirrhosis?

Bacon Bacon is high in sodium and fat and would not be included in the diet of a patient with cirrhosis.

The nurse is reviewing the admission history and physical examination findings for a patient with a history of cirrhosis who is being admitted for the third time in 6 months. Which laboratory finding would indicate the patient has not followed the plan of care previously discussed at discharge?

Blood alcohol level 160 mg/dL At discharge, the patient with cirrhosis would have been instructed to abstain from alcohol to prevent further hepatic damage. The blood alcohol level is twice the legal limit, which indicates the patient has not followed the plan of care.

The nurse is caring for a patient with cirrhosis and an elevated prothrombin time/international normalized ratio (PT/INR). Which complication is this patient most at risk for developing?

Gastrointestinal hemorrhage A patient with cirrhosis will have impaired clotting as a result of liver damage. The patient may also have esophageal and gastric varices, which can rupture easily with an elevated PT/INR and cause gastrointestinal hemorrhage.

Which intervention should the nurse include when planning care to improve the nutritional status of a patient with cirrhosis?

Give the patient smaller meals and snacks throughout the day. Because of ascites in the abdomen and decreased appetite associated with cirrhosis, the nurse should provide the patient with smaller, more frequent meals throughout the day.

Which pathologic change would cue the nurse to assess for excess fluid volume in a patient with cirrhosis?

Hyperaldosteronism The damaged liver is unable to metabolize aldosterone, so it builds up and causes excess fluid volume.

The nurse is preparing to administer spironolactone to a patient with cirrhosis. Which finding would lead the nurse to withhold the dose of spironolactone?

Hyperkalemia Spironolactone is a potassium-sparing diuretic that places the patient at risk for hyperkalemia. Because the patient's potassium level is already high, the nurse would not administer spironolactone.

The nurse is providing care to a confused patient with hepatic encephalopathy who refuses to stay in bed and is at risk for falling. Which intervention will the nurse implement to keep the patient safe?

Provide a low bed with the wheels locked. The nurse should provide a low bed with locked wheels for a confused patient who refuses to stay in bed. This reduces the risk of injury caused by falls, and helps maintain patient safety.

A nurse is caring for a patient with a long-standing history of cirrhosis. Which findings on admission would cue the nurse to ask for further information from the patient or caregiver?

uses acetaminophen for pain (contraindicated as it is toxic to the liver); lethargic and oriented to person; drinks 1-2 drinks/ week (pt w cirrhosis should abstain from alcohol to prevent further damage).

What should the nurse include in the teaching for a patient with cirrhosis who has an elevated prothrombin time (PT)/international normalized ratio (INR)?

Use an electric razor for shaving. The elevated PT/INR indicates that the patient is at risk for bleeding. Cirrhosis damages the liver and prevents clotting factors from being formed.

Which interventions should the nurse include in the plan of care for a patient with cirrhosis who is experiencing excess fluid volume?

daily weights, auscultate lung sounds, elevate LE to decrease peripheral edema

A nurse is caring for a patient who has been diagnosed with cirrhosis; the disease is in the early stages. Which clinical manifestation would the nurse expect the patient to exhibit?

fatigue, hepatomegaly