Chapter 49 Assessment Hepatic Disorders Exam 7 NSG 1010

Gamma-glutamyl transferase (GGT) elevated in

alcohol abuse and makers for biliary cholestasis ( a condition where bile cannot flow from the liver to the duodenum)

A client has just been diagnosed with hepatitis A. On assessment, the nurse expects to note:

anorexia, nausea, and vomiting.

The liver manufactures and secretes________ which has a major role in the digestion and absorption of fats in the GI tract.

bile

The liver removes waste products from the bloodstream and secretes them into the________

bile

Liver biopsy percutaneous major complication is

bleeding. Leakage of bile causing peritonitis Pt, Ptt, and platelet count is done prior to biopsy *****

Fatty acids used for the synthesis of

-Cholesterol-LDL, HDL -Lecithin-a fat -Lipoproteins-fat protein -Complex lipids

Functions of bile:

-Excretion of bilirubin -Aid in digestion -Emulsification of fats by bile salts ****************

GGT normal

0-30 u/L gamma-glutamyl transferase

Direct bilirubin normal

0.1-0.4mg/dL

Total bilirubin normal

0.2-1.2mg/dL

Liver biopsy postprocedure

1. Immediately after the biopsy, assist the patient to turn on to the right side; place a pillow under the costal margin, and caution the patient to remain in this position, recumbent and immobile, for several hours. Instruct the patient to avoid coughing or straining. 1. 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 is prevented.

AST normal

10-40 units per liter of serum aspartate aminotransferase

Serum Ammonia normal

15-45mcg/dL elevates in liver failure (liver is unable to convert ammonia to urea

ALT normal

7-56 units per liter of serum alanine aminotransferase

The blood that perfuses the liver comes from two sources:

A very vascular organ that receives blood from GI tract via the portal vein and from the hepatic artery

The liver stores what vitamins?

A,B,D

An important message for any nurse to communicate is that drug-induced hepatitis is a major cause of acute liver failure. The medication that is the leading cause is:

Acetaminophen

Glucose Metabolism

After a meal, glucose is taken up from the portal venous blood by the liver and converted into glycogen, which is stored in the hepatocytes. Subsequently, the glycogen is converted back to glucose (glycogenolysis) and released as needed into the bloodstream to maintain normal levels of blood glucose. (Hinkle 1337) Hinkle, Janice L., Kerry Cheever. Hinkle & Cheever: Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 13th Edition. CoursePoint, 11/2013. VitalBook file.

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?

Asterixis

When assessing a client with cirrhosis of the liver, which of the following stool characteristics is the client likely to report?

Clay-colored or whitish

While conducting a physical examination of a client, which of the following skin findings would alert the nurse to the possibility of liver problems? Select all that apply.

Ecchymoses Petechiae Jaundice

Patients diagnosed with esophageal varices are at risk for hemorrhagic shock. Which of the following is a sign of potential hypovolemia?

Hypotension

The mode of transmission of hepatitis A virus (HAV) includes which of the following?

Fecal-oral

Protein Synthesis

Globulin-alpha & beta Albumin Fibrinogen Amino Acid Vitamin K

The nurse identifies which of the following types of jaundice in an adult experiencing a transfusion reaction?

Hemolytic

A nurse is preparing a presentation for a local community group about hepatitis. Which of the following would the nurse include?

Hepatitis C increases a person's risk for liver cancer.

Minerals that are stored in the liver:

Iron&copper

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?

Maintaining the airway

Assessment:Physical:Liver dysfunction

Pallor, jaundice Petechiae, erythema, spider angiomas Gynecomastia Enlarged liver Neurologic: tremors asterixis, slurred speech, ******

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?

Paracentesis

In actively bleeding patients with esophageal varices, the initial drug of therapy is usually:

Pitressin

The most common cause of esophageal varices includes which of the following?

Portal hypertension

Which of the following symptoms will a nurse observe most commonly in clients with pancreatitis?

Severe, radiating abdominal pain

Ammonia, the major etiologic factor in the development of encephalopathy, inhibits neurotransmission. Increased levels of ammonia are damaging to the body. The largest source of ammonia is from:

The digestion of dietary and blood proteins.

Technique for palpating the liver

The examiner places one hand under the right lower rib cage and presses downward during inspiration with light pressure with the other hand.

Ammonia Conversion

The use of amino acids from protein for gluconeogenesis results in the formation of ammonia as a by-product. Ammonia converts into urea.

Which of the following is the most effective strategy to prevent hepatitis B infection?

Vaccine

Which of the following medications is used to decrease portal pressure, halting bleeding of esophageal varices?

Vasopressin (Pitressin)

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?

Vitamin A

Pallor often seen with

chronic illness and jaundice*****

Drug Metabolism important pathway involves

conjugate (bind) of the medication with compounds glucuronic acid and acetic acid to make more water-soluble substances

Aspartate aminotransferase (AST) indicate

damaged liver cells The studies are based on release of enzymes from damaged liver cells. These enzymes are elevated in liver cell damage.

Alanine aminotransferase (ALT) indicate

damaged liver cells The studies are based on release of enzymes from damaged liver cells. These enzymes are elevated in liver cell damage.

Indirect bilirubin

difference between total and direct bilirubin

A palpable liver presents as a

firm sharp ridge with a smooth surface

The bile produced by the liver is stored temporarily in the _________ until it is needed for digestion, at which time the ______ empties and bile enters the intestine

gallbladder gallbladder

The liver is especially important in the regulation of (Hinkle 1336) Hinkle, Janice L., Kerry Cheever. Hinkle & Cheever: Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 13th Edition. CoursePoint, 11/2013. VitalBook file.

glucose and protein metabolism.

Fatty acids can be broken down for the production of energy and

ketone bodies

Largest glad in the body?

liver

Amino acids are used by the liver for

protein synthesis

Breakdown of fatty acids into ketone bodies occurs primary when the availability of glucose for metabolism is limited as in

starvation or in uncontrolled dibetes

Vitamin K is required by the liver for

synthesis of prothrombin and some of the other clotting factors.

Liver located?

upper right abdomen

ALT, AST, and GGT are the most frequently

used tests of liver damage

Age-Related Changes of the Hepatobiliary System

• Steady decrease in size and weight of the liver, particularly in women • Decrease in blood flow • Decrease in replacement/repair of liver cells after injury • Reduced drug metabolism • Slow clearance of hepatitis B surface antigen • More rapid progression of hepatitis C infection and lower response rate to therapy • Decline in drug clearance capability • Increased prevalence of gallstones due to the increase in cholesterol secretion in bile • Decreased gallbladder contraction after a meal • Atypical clinical presentation of biliary disease • More severe complications of biliary tract disease