Liver (Med Surg)

Measure abdominal girth daily. Perform daily weights. Increased abdominal girth and rapid weight gain are common presenting symptoms of ascites. 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.

The nurse is caring for a patient who has ascites as a result of hepatic dysfunction. What intervention can the nurse provide to determine if the ascites is increasing? (Select all that apply.) Perform daily weights. Measure abdominal girth daily. Measure urine output every 8 hours. Assess and document vital signs every 4 hours. Monitor number of bowel movements per day.

A. Pancakes with butter and honey, and orange juice Teach clients to select a diet high in carbohydrates with protein intake consistent with liver function. The client should identify foods high in carbohydrates and within protein requirements (moderate to high protein in cirrhosis and hepatitis, low protein in hepatic failure). The client with acute hepatic encephalopathy is placed on a low-protein diet to decrease ammonia concentration. The other choices are all higher in protein. The client's ascites indicates that a low-sodium diet is needed, and the other choices are all high in sodium.

The nurse is teaching a client who was admitted to the hospital with acute hepatic encephalopathy and ascites about an appropriate diet. The nurse determines that the teaching has been effective when the client chooses which food choice from the menu? A. Pancakes with butter and honey, and orange juice B. Omelet with green peppers, onions, mushrooms, and cheese with milk C. Ham and cheese sandwich, baked beans, potatoes, and coffee D. Baked chicken with sweet potato french fries, cornbread, and tea

Jaundice, ascites, clubbing of the fingers

The nurse assesses a patient who is diagnosed with decompensated cirrhosis. Which of the following are clinical indicators consistent with that diagnosis? Select all that apply. Jaundice Ascites Splenomegaly Vascular spiders A firm, enlarged liver Clubbing of the fingers

D. Albumin infusion Albumin infusions help to correct decreases in effective arterial blood volume that lead to sodium retention. The use of this colloid reduces the incidence of postparacentesis circulatory dysfunction with renal dysfunction, hyponatremia, and rapid reaccumulation of ascites associated with decreased effective arterial volume.

What intervention does the nurse anticipate providing for the patient with ascites that will help correct the decrease in effective arterial blood volume that leads to sodium retention? A. Therapeutic paracentesis B. Platelet infusions C. Diuretic therapy D. Albumin infusion

Hemorrhoids, enlarged liver, ascites. Early in the course of cirrhosis, the liver tends to be large, and the cells are loaded with fat. The liver is firm and has a sharp edge that is noticeable on palpation. Portal obstruction and ascites, late manifestations of cirrhosis, are caused partly by chronic failure of liver function and partly by obstruction of the portal circulation. The obstruction to blood flow through the liver caused by fibrotic changes also results in the formation of collateral blood vessels in the GI system and shunting of blood from the portal vessels into blood vessels with lower pressures. These distended blood vessels form varices or hemorrhoids, depending on their location. Because of inadequate formation, use, and storage of certain vitamins (notably vitamins A, C, and K), signs of deficiency are common, particularly hemorrhagic phenomena associated with vitamin K deficiency. Additional clinical manifestations include deterioration of mental and cognitive function with impending hepatic encephalopathy and hepatic coma, as previously described.

A client is given a diagnosis of hepatic cirrhosis. The client asks the nurse what findings led to this determination. Which of the following clinical manifestations would the nurse correctly identify? Select all that apply. Hemorrhoids Accelerated behaviors and mental processes Excess storage of vitamin C Enlarged liver size Ascites

D. cryoprecipitate and fresh frozen plasma. The liver is vital in the synthesis of clotting factors, so when it's diseased or dysfunctional, as in hepatitis C, bleeding occurs. Treatment consists of administering blood products that aid clotting. These products include fresh frozen plasma containing fibrinogen and cryoprecipitate, which have most of the clotting factors. Although administering whole blood, albumin, and packed cells will contribute to hemostasis, these products aren't specifically used to treat hemostasis. Although platelets may be helpful, the best answer is cryoprecipitate and fresh frozen plasma.

A female client with hepatitis C develops liver failure and GI hemorrhage. The blood products that would most likely bring about hemostasis in the client are: A. Whole blood and albumin. B. Platelets and packed red blood cells. C. Fresh frozen plasma and whole blood. D. Cryoprecipitate and fresh frozen plasma.

C. Assessment for variceal bleeding Esophageal varices are a major cause of mortality in patients with uncompensated cirrhosis. Consequently, this should be a focus of the nurse's assessments and should be prioritized over the other listed assessments, even though each should be performed.

A nurse is caring for a patient who has been admitted for the treatment of advanced cirrhosis. What assessment should the nurse prioritize in this patient's plan of care? A. Measurement of abdominal girth and body weight B. Monitoring of results of liver function testing C. Assessment for variceal bleeding D. Assessment for signs and symptoms of jaundice

Glucose metabolism Ammonia conversion Protein metabolism 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.

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. Carbohydrate metabolism B. Ammonia conversion C. Zinc storage D. Protein metabolism E. Glucose metabolism

Alanine aminotransferase (ALT) Gamma-glutamyl transferase (GGT) Aspartate aminotransferase (AST) Liver function testing includes GGT, ALT, and AST. CRP addresses the presence of generalized inflammation and BNP is relevant to heart failure; neither is included in a liver panel.

A patient's physician has ordered a "liver panel" in response to the patient's development of jaundice. When reviewing the results of this laboratory testing, the nurse should expect to review what blood tests? Select all that apply. A. Alanine aminotransferase (ALT) B. Aspartate aminotransferase (AST) C. Gamma-glutamyl transferase (GGT) D. B-type natriuretic peptide (BNP) E. C-reactive protein (CRP)

B. low platelet count. Prolonged prothrombin time (PT) and low platelet count place the client at high risk for hemorrhage. The client may receive intravenous (IV) administration of vitamin K or infusions of platelets before liver biopsy to reduce the risk of bleeding.

A physician has ordered a liver biopsy for a client with cirrhosis whose condition has recently deteriorated. The nurse reviews the client's recent laboratory findings and recognizes that the client is at risk for complications due to: A. low sodium level. B. low platelet count. C. low hemoglobin. D. decreased prothrombin time.