Metabolism: Liver, Cirrhosis, Hepatitis

Which of the following statements made by the patients shows they may need more teaching on the effects of lactulose? Which is wrong?

" Because of my liver damage I will have to take this drug every day for the rest of my life"

The nurse has taught the client about the upcoming endoscopic retrograde cholangiopancreatography. which following statement is WRONG?

"I'm glad some intravenous medication will be given to help me relax." -anesthetic spray instead

A nurse is caring for a client diagnosed with hepatic cirrhosis. Which of the following statements made by the nurse indicates a correct understanding of nursing management for a client with cirrhosis?

"The client should be repositioned frequently to avoid skin breakdown or infection."

fetor hepaticus

A sweet, slightly fecal odor to the breath -freshly mowed grass, acetone, or old wine. -It is prevalent for patients with chronic liver disease.

A nurse is evaluating teaching for a client who has been diagnosed with Hepatitis B. Which of the following questions indicates an understanding?

***"I can treat my illness with antiviral medications, like enetcavir and tenofovir, along with bed rest and nutritional support" -there is a vaccine for those at risk -can be transmitted from mom to child during birth -major cause of cirrhosis and liver cancer

Which of the following would be included in the plan of care for a patient with Hepatitis B with ascites?

***Encourage diet high in calories and carbohydrates, low in protein -use standard precautions = trans through blood -measure abdominal girth around the largest part of pt

A nurse is caring for a client diagnosed with cirrhosis. The nurse notices steatorrhea (fatty stools) while assisting the client to the bathroom. How should the nurse modify this client's diet?

***Increase water-soluble forms of vitamin A, D, and E -Folic acid and iron are ordered to prevent anemia and each would be increased in that instance

The Client diagnosed with end-stage liver failure is admitted with hepatic encephalopathy. Which dietary restriction should be implemented by the nurse to address this complication?

***Reduce protein intake to 60 to 80g/day Low protein in the presence of ascites (High protein in the absence of ascites)

A nurse is caring for a client who was admitted for hepatic dysfunction. Recent labs indicate elevated ALT and AST. The nurse is planning to monitor for complications, which change is a priority for the nurse to address?

***decreased level of consciousness THEN -yellow sclera -weight loss -decreased albumin**

Management of Hepatitis C

*antiviral meds *avoid alcohol *blood supply screening *safe needle handling

Hepatitis B

*spread: blood, saliva, semen, vaginal secretions *can cause cirrhosis + liver cancer *incubation: 1-6 months *s/s: variable, loss of appetite, dyspepsia, abdomen pain, aching, weakness *yes or no jaundice

Hepatitis A

*spread: fecal- oral *incubation: 2-6 weeks *illness: 4-8 weeks *s/s: flu-like, low fever, anorexia, jaundice, dark urine, indigestion, liver/spleen enlargement

Hepatitis D

*trans: blood + sex from people with hepatitis B virus *leads to liver failure, chronic hepatitis + cirrhosis *incubation: 30-150 days

Hepatitis C

*transmit: blood, sexual contact, needles *most common bloodborne infection *leads to liver cancer + transplant *incubation: 15-160 days, varies *mild symptoms

A nurse is evaluating their teaching to a client with a history of alcohol abuse who was newly diagnosed with liver cirrhosis. What statements are correct?

-"I need to adhere to a high calorie, moderate-fat and low-sodium diet" -"I should consume small, frequent meals high in nutritional content" -"I may need to take vitamin supplements." NOT ***"I can continue drinking alcohol so long as I limit it to 1-2 drinks per day"

Which patient should the nurse assess first after receiving the end of shift report?

-***A patient with esophageal varices who has a blood pressure of 90/55 mm/Hg.

The physician orders Lactulose 30mL by mouth per day for a patient with cirrhosis. What findings below demonstrate the medication is working effectively? Select all that apply. therapeutic uses of Lactulose

-***Absent fetor hepaticas -***Normal ammonia blood level -***no confusion

In preparing to provide care for a patient who presents to you with grade C liver disease and severe ascites, identify appropriate interventions:

-***Administration of spironolactone (Aldactone) = diruetics -***IV colloid therapy -encourage fluids -***Low sodium (2g) diet -***record daily weight

You're a nurse in the emergency department and your patient with a history of cirrhosis is presenting with significant hematemesis, melena, hypotension, tachycardia, and cool, clammy skin. What interventions are appropriate?

-***Give a bolus of Sandostatin IV -***Prepare patient for endoscopic variceal ligation -***Continuous vital sign + hemoglobin monitoring -***Blood transfusion

One of the clients assigned to a nurse on their shift has been diagnosed with liver cirrhosis. What nursing interventions should the nurse anticipate for this client if they present with ascites (fluid collects in abdomen)

-***High Carbohydrate diet -***Diuretic medications -***Weigh client daily -sodium/fluid restrictions -elevate HOB

A nurse is assessing a patient for ascites. What findings indicate that the patient has this condition?

-***Increased abdominal girth and rapid weight gain are common in ascites. -***Upon percussion, the nurse would feel a shifting dullness or fluid wave which would indicate ascites. -***In patients with ascites, fluid and electrolyte imbalance is common due to fluid retention in the abdominal cavity.

You the nurse are planning discharge teaching to a patient who was admitted with hepatocellular jaundice from excessive alcohol intake, what symptoms should you advise the patient to be aware of (Select All That Apply)

-***Lack of appetite + weight loss -***Nausea + vomitting -***Malaise -***Fatigue NOT: -weight gain -orange urine

A nurse is assessing a patient with cirrhosis. Which of the following manifestations should the nurse expect?

-***Petechiae = pinpoint, round spots on the skin due to decreased blood clotting -hypotension -clay colored stool -asterixis = loss of motor control

A nurse is caring for a patient with cirrhosis of the liver. The patient is experiencing fluid volume overload. What signs/symptoms would the nurse expect to see related to fluid volume overload? Select all that apply.

-***Weight gain -***Dyspnea -Hypertension -***Peripheral edema -decreased serum albumin -decreased potassium

Assessing a patient with liver cirrhosis should especially include monitoring for:

-***bleeding -***fluid retention -***level of consciousness important but not priority: -musculoskeletal status

A nurse is caring for a client complaining of bright red blood in his stool that started a few hours ago. The client has a diagnosis of cirrhosis from a long history of chronic alcoholism. The client's vital signs are: HR 98, BP 173/96, RR 20, Temp 36.1C. Which of the following medications would the nurse want to administer first?

-1st beta blocker (-olol) - THEN octreotide

hepatic dysfunction

-Acute or chronic, cirrhosis of the liver -cause= malnutrition related to alcohol -Infection -Fatty Liver disease

A nurse is assessing a patient for hepatic encephalopathy. Which of the following would be an expected finding:

-Asterixis -Cognitive impairment -Altered sleep patterns NOT -***hematemesis

Management of Hepatitis A

-Bed rest during the acute stage -Nutritional support

obstructive jaundice

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

A nurse is taking care of a patient with hepatic encephalopathy that just received Lactulose 30 ml for symptoms of asterixis. What findings below would demonstrate the medication is working properly?

-Decreased asterixis -Decreased or normal ammonia blood level -Improved mental status

Treatment of Ascites

-Low-sodium diet -Diuretics -Bed rest -Paracentesis -Administration of salt-poor albumin -Transjugular intrahepatic portosystemic shunt (TIPS)

A nurse is providing care to a client with ascites. What interventions should she expect to perform?

-Maintain a low-sodium diet -Administer diuretics -bed rest

Hepatocellular jaundice

-Mild or severely ill -Lack of appetite, nausea or vomiting, weight loss -Malaise, fatigue, weakness -Headache, chills, fever, infection

portal hypertension

-Obstructed blood flow through the liver results in increased pressure throughout the portal venous system -results in: ascites, varices

Assessment of Ascites

-Record abdominal girth and weight daily -Patient may have striae, distended veins, and umbilical hernia -Assess for fluid in abdominal cavity by percussion for shifting dullness or by fluid wave -Monitor for potential fluid and electrolyte imbalances

The lab technician just called the nurse to report that their patient's INR/PT is critically high. The nurse should modify the plan of care to include all of the following:

-Replace sharp objects (razors) with safer ones -Administer vitamin K as prescribed -Be alert to signs symptoms of anxiety, epigastric fullness, weakness and restlessness NOT: -Note the degree of jaundice and extent of edema***

A patient is receiving Lactulose for the treatment of hepatic encephalopathy. Which of the following findings would require additional follow up?

-Serum potassium of 3.1 mmol/L (LOW) -The patient is also prescribed Senna = another laxative

When working with a client diagnosed with liver cirrhosis, which intervention(s) are the most appropriate? - Select all that apply

-daily weight -restrict sodium intake -Monitor for asterixis -bed rest -elevate HOB

A nurse is caring for a client with end-stage cirrhosis on a day shift. On reviewing the current renal labs that resulted at 6am, the nurse notices a significant change from the previous, WNL renal labs that were drawn the previous day. The nurse knows which of the following changes in the renal panel is an indication that this client could be experiencing Hepatorenal syndrome?

-decrease in urinary output -elevated BUN and creatinine -decreased urine NA excretion -increased urine osmolarity

Treatment of Bleeding Varices #2

-endoscopic sclerotherapy -ligation = banding -shunt -bypass + transection

Prevention of Hepatitis A

-handwashing, safe water, and proper sewage disposal -Vaccine -Immunoglobulin for contacts to provide passive immunity

esophageal varices

-happens in pts with cirrhosis + varices -s/s = hematemesis, melena, deterioration, shock

Most common causes of cirrhosis

-hep c -alcoholism -fatty liver disease (NAFLD) -steatohepatitis (NASH)

Hepatic encephalopathy

-insufficiency: the inability of the liver to detoxify toxic by-products of metabolism -shunting: vessels develop allowing blood to enter circulation early signs: -mental changes -motor disturbances

hepatic dysfunction symptoms

-jaundice -hypertension -ascites and varices -nutritional deficiency -coagulopathies

Treatment of Bleeding Varices #3

-maintain safe environment -admin treatments -monitor for complications -encourage deep breathing and position changes

Management of Hepatitis B

-vaccines -bed rest -nutritional support -standard precautions -screening blood products

You are caring for a patient with a history of alcohol use, hypertension, and GERD in the ED who has become more disoriented over the past few days and you find him to be alert and oriented to self only. He is not acutely intoxicated but on exam he is combative and tremulous. His exam is otherwise largely WNL. Based on these assessment findings and the patient's history, which of the following lab findings is MOST likely causing his symptoms?

Ammonia 123 mcg/dL

The nurse is reviewing the chart of a client with a diagnosis of cirrhosis and notes there is documentation of asterixis. How should the nurse assess for its presence?

Ask the client to extend their arms

You are a nurse caring for a patient with yellow discoloration around their eyes, fever, chills, and nausea. What blood test should you expect to be done?

Bilirubin (above 2 mg/dL)

A patient that you are caring for with cirrhosis has a CBC drawn and is found to have a prolonged prothrombin time and PTT. Which of the following actions should you take in order to address this?

Give the patient a Vitamin K supplement, as ordered

What is the most common intra-hepatic cause of portal hypertension?

Cirrhosis

Which of the following clinical signs describe asterixis?

Involuntary wrist flapping

A group of nurses has 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?

Disposing of sharps appropriately and not recapping needles =tansmitted through bodily fluid

Which statement by the nurse indicates a need for further teaching for proper nutrition in clients with cirrhosis? Which is wrong?

Encourage the client to eat two large meals per day

The client has end-stage liver failure secondary to alcoholic cirrhosis. Which complication indicates the client is at risk for developing hepatic encephalopathy?

Gastrointestinal bleeding.

A nurse is caring for a patient with a history of alcohol abuse and currently suspected of having a fatty liver. Which results would be the most helpful in diagnosing alcoholic fatty liver:

Histological analysis of liver biopsy

Which of the following statements about dietary teaching for a patient with cirrhosis is WRONG:

I will eat more canned vegetables for the fiber

You are the nurse caring for a patient who was diagnosed with cirrhosis of the liver. Which of the following characteristics should you expect? (Select all that apply)

INR = 2 PT = 20

A nursing assistant walks into a patient's room to do nightly cares. Upon doing so the patient wakes up, is drowsy, disoriented, and is becoming combative. The nursing assistant reports this to the RN. The RN checks the patient's recent ammonia levels and finds that it is 100 mcg/dL. This means:

Increased aggression and fatigue are expected findings with high ammonia levels and are indications for hepatic encephalopathy.

You have a 75-year-old patient with a hx of chronic alcohol abuse come into the ED presenting with Jaundice of the eyes, upper right quadrant abdominal pain, and abdominal swelling. Which diagnostic test would be best to do?

Liver function tests (ALT, AST, bilirubin, albumin)

The nurse is monitoring a client admitted to the hospital for appendicitis who is scheduled for surgery in 2 hours. The client begins to complain of increased abdominal pain and begins to vomit. On assessment, the nurse notes that there is increased abdominal distention and bowel sounds are diminished. What is the most appropriate nursing intervention?

Notify the primary care provider

You are a registered nurse (RN) caring for a patient with liver cirrhosis, which laboratory result would you plan on reporting to the doctor for concerns of increased bleeding risk?

PT/INR: 2.1 nmol/L

A patient has labs sent down and you see they have high concentrations of ammonia in their GI tract. What is the best plan of care for this patient?

Plan to give lactulose/ gastric suction or enemas

A nurse is caring for a client who has a new diagnosis of Hepatitis C. Which of the following laboratory findings should the nurse expect?

Positive EIA test

Which of the following would indicate the need to modify a patient's lactulose dosage?

The development of watery diarrhea stools = indicates overdose

You are teaching a new nurse about PT/INR for patients with cirrhosis of the liver. Which should you include in the teaching?

The liver damage sustained through cirrhosis affects the synthesis of important clotting factors which leads to increased PT/INR times = bleeding risk

A patient who has developed jaundice due to cirrhosis related to alcohol use is complaining of pruritus. Which of the following actions should the nurse take?

Wash the skin with cool water.

The nurse is evaluating a client at his 1 week follow up appointment after a recent inpatient stay for ascites. At that time he underwent a TIPS (Transjugular intrahepatic portosystemic shunt) procedure. What is the best way to evaluate the effectiveness of this procedure?

Weight them

You are a nurse caring for a patient with cirrhosis of the liver; which of the following labs would most accurately indicate this?

albumin 3.0 g/dL

The nurse is caring for a client with ascites secondary to alcoholic cirrhosis. The nurse knows which of the following medications will relieve the mainstay symptoms of ascites?

diuretics

Hepatic encephalopathy is deterioration of brain function that occurs because toxic substances normally removed by the liver build up in the blood and reach the brain. As the nurse of a client with Hepatic encephalopathy what education regarding diet will you provide to your client?

eating less meat = lessen protein intake

The nurse is caring for a client with a history of diabetes, obesity, hyperlipidemia, hypertension, and elevated cholesterol. The nurse notes no history of alcohol use. The nurse knows that the client is at risk for the development of which of the following conditions?

fatty liver disease -metabolic syndrome

Management of Hepatitis D

interferon alfa ONLY

viral hepatitis

necrosis + inflammation of the liver

A nurse is caring for a client with severe ascites who is experiencing shortness of breath from the abdominal fluid buildup. The client is not responding to diuretics. The nurse knows that the next choice of treatment would be which of the following?

paracentesis PERITONITIS

-The PT to INR ratio in a healthy patient without liver damage is 10:1

those with liver cirrhosis should have decreased clotting factors due to the inability of the liver to produce them. This would thus increase the time it takes for the body to clot

Nonviral Hepatitis

toxic and drug induced

Treatment of Bleeding Varices #1

treat for shock -IV fluids, electrolytes, blood -vasopressin, somatostatin, octreotide to decrease bleed -nitroglycerin + vasopressin -propranolol + nadolol = decrease pressure -balloon tamponade