Cirrhosis

Which of the following statements made by the patients shows they may need more teaching on the effects of lactulose? " When taking this medication I should expect to have multiple loose stools with each dose" " Because of my liver damage I will have to take this drug every day for the rest of my life" " I can expect to have some stomach cramping and urgency when taking this medication" " My doctor says I have to much ammonia in my body and this will help get rid of that"

Because of my liver damage I will have to take this drug every day for the rest of my life With each dose the patient should have between 3-5 loose stools. The patient will only need to take this drug until their ammonium levels return to normal. This is a true statement as lactulose is a laxative and will cause urgency and frequency. With strong enough dosing lactulose does rid the body of ammonia

Assessing a patient with liver cirrhosis should especially include monitoring for: (Select all that apply) Bleeding Fluid retention Musculoskeletal status Level of consciousness

Bleeding, fluid retention, level of consciousness Bleeding CORRECT: Liver damage will cause increased risk of internal bleeding due to elevated INR. Fluid retention CORRECT: It is important to weigh the client daily and measure abdominal girth to assess fluid retention. Musculoskeletal status INCORRECT: Although musculoskeletal weakness can occur with worsening liver failure, it is not a priority assessment. Level of consciousness CORRECT: Observe closely for changes in personality and demeanor, as increased levels of ammonia may lead to disorientation.

What is the most common intra-hepatic cause of portal hypertension? Cirrhosis Schistosomiasis Sarcoidosis Thrombus in hepatic portal vein

Cirrhosis Cirrhosis due to alcohol intake is the most common cause of intrahepatic portal HTN. Schistosomiasis is when flatworms invade the liver and sarcoidosis is when inflammatory cells form granulomas in the liver. Neither of these are very common. A thrombus in the hepatic portal vein is a pre-hepatic cause of portal HTN, not an intra-hepatic cause.

Which of the following would be included in the plan of care for a patient with Hepatitis B with ascites? Initiate droplet precautions Encourage diet high in calories and carbohydrates Administration of antiviral medication for acute infections Measure abdominal girth at the base of the ribcage

Encourage a diet high in calories and carbohydrates A diet high in calories and carbohydrates will promote healing for a client with Hepatitis B. Hep B is transmitted via blood so standard precautions apply. Antivirals are used for chronic Hepatitis. Abdominal girth should be measured at the largest part, which varies by client.

A nurse is assessing a patient with cirrhosis. Which of the following manifestations should the nurse expect? Petechiae Hypertension Diarrhea Positive Chvostek's Sign

Petechiae Petechiae occur due to decreased blood clotting Hypotension, not hypertension, is a manifestation of cirrhosis. Diarrhea is not a manifestation of cirrhosis. However, a patient may have clay-colored stool due to reduced bile output. Positive Chvostek's sign is associated with hypocalcemia, not cirrhosis. However, the patient may have asterixis.

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? Give the patient Vitamin K Restrict protein Plan to give lactulose/ gastric suction or enemas Plan to give comfort cares

Plan to give lactulose/gastric suction or enemas High amounts of ammonia in the body is a sign of liver disease. One of the ways to treat high amounts of ammonia in the GI tract is the suction or give an emema to reduce the amount of ammonia and lactulose reduces ammonia in the body.

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? Presence of Immunoglobulin G antibodies (IgG) Positive EIA test Aspartate Aminotransferase (AST) 35 units/L Alanine aminotransferase (ALT) 15 IU/L

Positive EIA test A positive EIA test is an expected laboratory finding in a client who has a new diagnosis hep C infection

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 ways to evaluate the effectiveness of this procedure? Assess for Trousseau's sign Weigh the client Check the client's glucose level Check the clients CBC

Weight the client a) False. Trousseau's sign is indicative of hypocalcemia. Although the use of diuretics in the treatment of ascites can cause electrolyte imbalances like hypocalcemia, there is a better way to evaluate the effectiveness of the TIPS procedure. b) True. A TIPS procedure shunts fluids from the hepatic vein to the portal vein to help alleviate the accumulation of fluid. Ascites is the build up of this fluid in the peritoneal cavity. The best way to monitor if fluid has stopped accumulating is to weight the client and compare this to his previous admission and discharge weight. c) False. Although the liver metabolizes glucose, this is not the best way to determine the effectiveness of a TIPS procedure. d) False. While a CBC may be ordered for a patient with a recent admission of ascites, there are more pertinent labs like a chemistry panel and comprehensive metabolic panel. This is not the best way to evaluate for the effectivenss of the TIPS procedure.

Which patient should the nurse assess first after receiving the end of shift report? A patient who has been crying after receiving a diagnosis of esophageal cancer. A patient is experiencing nausea and vomiting who needs an antiemetic. A postoperative appendectomy patient who needs to be discharged soon. A patient with esophageal varices who has a blood pressure of 90/55 mm/Hg.

A patient with esophageal varices who had a blood pressure of 90/55 mm/Hg The patient's history and blood pressure indicate a possible hemodynamic instability caused by a GI bleed. This is the most important issue due to its potential life-threatening complications.

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. Decrease albumin Decrease in fetor hepaticus Patient is stuporous Decreased ammonia blood level Presence of asterixis

Decrease in fetor hepaticus, decreased ammonia blood level A patient with cirrhosis may experience hepatic encephalopathy. Patients may become confused, have pungent, smelly breath (fetor hepaticus), asterixis (involuntary flapping of the hands). This is due to a buildup of ammonia in the blood. Lactulose helps decrease the ammonia levels. Therefore, if it's working you would see an improvement in mental status, absence of asterixis and decreased ammonia blood level.

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 Folic acid Decrease Iron Increase water-soluble forms of vitamin A, D, and E Increase Sodium

Increase water-soluble forms of vitamin A, D, and E Steatorrhea is a common finding in liver disorders. Excretion of fat soluble vitamins leads clients to have deficiencies. Water soluble forms of fat soluble vitamins will help correct these deficiencies. Folic acid and iron are ordered to prevent anemia and each would be increased in that instance. An increase in sodium would cause the client to be at higher risk of ascites, further complicating their original diagnosis.

You are a nurse caring for a patient with cirrhosis of the liver; term-15which of the following labs would most accurately indicate this? albumin 5.8 g/dL bilirubin 0.1 mg/dL albumin 3.0 g/dL ALT 24 U/L AST 40 U/L

Albumin 3.0 mg/dL Low albumin levels are usually indicative of chronic issues such as liver disease, kidney disease, or infection. The most common cause of low albumin is chronic liver disease caused by cirrhosis. Higher albumin may be caused by acute infections, burns, and stress. Normal albumin range is 3.4-5.4 g/dL.

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 Keep client active and moving administer opioids Elevate HOB

Daily weights, restrict sodium intake, monitor for asterixis, elevate head of bed When working with clients diagnosed with liver cirrhosis it is important to take daily weights, restrict sodium intake, monitor for asterixis, and elevate the HOB to prevent SOB. Rest should be promoted for clients with cirrhosis and opioids should be avoided as they are processed through the liver.

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 Avoiding acidic foods Reducing sodium intake Taking vitamin D

Eating less meat Clinical observation has shown that high protein intake may worsen encephalopathy. The low protein diet can reduce intestinal ammonia production and prevent exacerbation of hepatic encephalopathy

Which statement by the nurse indicates a need for further teaching for proper nutrition in clients with cirrhosis? Provide the client with a high-calorie diet Encourage the client to eat two large meals per day Provide the client with a low sodium diet Protein restriction or modification may be necessary in clients at risk for encephalopathy

Encourage the client to eat two large meals per day The nurse should encourage small, frequent meals

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? D-Dimer Fibrinogen Bilirubin Prothrombin Time

Bilirubin A bilirubin test measures the levels of bilirubin in your blood. Bilirubin is a yellowish pigment that is made during the normal breakdown of red blood cells. It passes through the liver and is eventually excreted out of the body. If a patient is experiencing jaundice, their Bilirubin level should be elevated (>2.5 mg/dL).

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? yellow sclera decreased level of consciousness weight loss decreased albumin

Decreased level of consciousness Rationale: decreased LOC is a sign of hepatic encephalopathy, a priority life threatening complication caused by buildup of ammonia, a toxin that can cross the blood-brain barrier. The nurse should monitor for weight gain, (not loss) that is a sign of ascites. Although yellow sclera and decreased albumin are consistent with hepatic dysfunction, hepatic encephalopathy is a higher priority complication.

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? Administer lactulose Elevate the head of the bed Nothing, this is expected for a patient with cirrhosis Tell the provider immediately Give the patient a Vitamin K supplement, as ordered

Give the patient a vitamin K supplement, as ordered Patients with cirrhosis can be found to experience problems with coagulation. Vitamin K supplements have been shown to be beneficial in preventing excessive bleeding.

A nurse is assessing a patient for hepatic encephalopathy. Which of the following would not be an expected finding: Asterixis Cognitive impairment Altered sleep patterns Hematemesis

Hematemesis Asterixis is an involuntary flapping of the hands that can be seen in patients with hepatic encephalopathy. Cognitive impairment can be found as the patient's mental status changes and they become completely disoriented to time and place Altered sleep patterns can occur because the patient tends to sleep during the day and has insomnia at night Hematemesis is not an expected finding for HE, but can be found in esophageal varices

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? (SATA) Give a bolus of Sandostatin IV Prepare patient for endoscopic variceal ligation Administer Solu-Medrol Perform swallow study Continuous vital sign monitoring Blood transfusion

Give a bolus of Sandostatin IV, prepare patient for endoscopic variceal ligation, continuous vital sign monitoring, blood transfusion Correct: Sandostatin (octreotide) is the preferred treatment for an acute esophageal varices hemorrhage. This medication causes a selective splanchnic vasoconstriction (Hinkle & Cheever, 2018). Correct: Endoscopic variceal ligation is one of the procedures that can be used during an acute hemorrhage. This procedure places a ligating band over the tissue around the bleeding varix. This will cause necrosis, ulceration, and eventual sloughing of the varix (Hinkle & Cheever, 2018). This specific procedure not only is effective to control an acute hemorrhage, but also has been shown to significantly reduce rebleeding rate, mortality, low rate of procedure related complications, and decreased number of sessions required to eradicate the varices (Hinkle & Cheever, 2018). Incorrect: Solu-medrol is a corticosteroid that is not indicated for use during acute esophageal varices hemorrhage. Incorrect: A swallow study is not appropriate during an acute esophageal hemorrhage Correct: Continuous vital sign monitoring is indicated due to the critical nature of the patient. With significant blood loss, there is concern for hemorrhagic shock. Correct: A blood transfusion is indicated during significant blood loss due to blood volume depletion. Additionally, fluid resuscitation will also occur due to fluid volume depletion but there needs to be caution that overhydration does not occur because that would raise portal pressures which would in turn increase the 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: Alanine aminotransferase (ALT) serum level of 120 Orthostatic blood pressure of 170/110 Histological analysis of liver biopsy Aspartate aminotransferase (AST) level of 37

Histological analysis of liver biopsy Incorrect. ALT level of 120 is abnormally high and signals liver inflammation but does not provide enough evidence to determine fatty liver. Incorrect. High orthostatic blood pressure could be indicative of many conditions and does not suggest a fatty liver. Correct. A liver biopsy and histology would be able to detect the relative amount of fat in liver cells. The patient reports abusing alcohol so that is likely the cause of their fatty liver. Incorrect. AST is in normal range and not indicative of fatty liver.

Which of the following clinical signs describe asterixis? A sweet, slightly fecal odor to the breath Involuntary wrist flapping Change in speech and difficulty swallowing An abnormal cluster of blood vessels with radiating branches near the surface of the skin

Involuntary wrist flapping Incorrect. A sweet, slightly fecal odor to the breath is describing fetor hepaticus. The odor can also be described as freshly mowed grass, acetone, or old wine. It is prevalent for patients with chronic liver disease. Correct. Asterixis occurs when there is a loss of motor function and results in irregular jerking motions. This disorder is most commonly seen in the wrist and hands. Asterixis is known as the "flapping hand tremor" since this irregular hand movement may resemble flapping of a bird's wings. It's important to note that the "flap" can also be assessed for at the hip joint. Liver disease, including cirrhosis and hepatitis, can cause asterixis because scarring makes the liver less effective at filtrating. Incorrect. Incoherent speech can be a sign of hepatic encephalopathy. This can happen alongside asterixis. Incorrect. This is describing spider angioma. This is something to look for when completing a physical assessment for a patient with a hepatic disorder.

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? Hgb: 13 g/dL Sodium: 150 mEq/L BUN: 28 mg/dL PT/INR: 2.1 nmol/L

PT/INR: 2.1 nmol/L Because this client has liver cirrhosis and possible worsening of symptoms and lab values may occur it is important to continue to keep an eye on these values. The PT/INR, which is elevated, is a common progression of liver damage and cirrhosis in which the liver can no longer make enough clotting factors and therefore the patient is at risk for bleeding and a cause for concern that could be reported to the doctor.

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? Restrict sodium intake to 2g/day. Limit oral fluids to 1500 mL/day. Decrease the daily fat intake. Reduce protein intake to 60 to 80g/day

Reduce protein intake to 60 to 80g/day Ammonia is a by-product of protein metabolism and contributes to hepatic encephalopathy. Reducing protein intake should decrease ammonia levels.

Which of the following would indicate the need to modify a patient's lactulose dosage? Decreased serum ammonia levels. The development of watery diarrhea stools. Two or three soft stools per day. Intestinal bloating and cramps.

The development of watery diarrhea stools Serum ammonia levels are monitored closely to determine effectiveness of the medication. Decreased ammonia levels are an intended effect of lactulose administration. The development of watery diarrhea stools indicates a medication overdose. Two or three soft stools per day are desirable and indicate that lactulose is performing as intended. Intestinal bloating and cramps are a possible side effect of lactulose, but they typically disappear within a week.

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. Apply a barrier cream to the skin. Start the patient on phototherapy. Administer IM epinephrine

Wash the skin with cool water Pruritus (itchy skin) is commonly associated with jaundice. Appropriate interventions would include washing with cold water and applying lotion. Barrier cream would not be beneficial. Phototherapy is used in newborns with jaundice, not adults. Epinephrine is used for anaphylaxis and would not be appropriate in this situation.

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? Troponin 0.06 ng/mL Ammonia 123 mcg/dL WBC 7x10^3/μL Sodium 137 mEq/L

Ammonia 123 mcg/dL Although this lab is slightly elevated, it is unlikely to be causing the symptoms he presents with today. A normal ammonia level is 15-45 mcg/dL. buildup of ammonia can cause neurologic symptoms including altered level of consciousness, combativity, tremulousness, somnolence, coma, and mood swings. This lab is out of the reference range. The patient's current presentation and PMHx (alcoholism) are concurrent with an elevated ammonia level. A normal liver breaks down ammonia (a toxin) into urea to be excreted via uring. As liver impairment advances, it is less able to break down ammonia so there is a buildup of the toxin causing these symptoms. This is a normal WBC count and is not likely contributing to the patient's presentation. This is a normal sodium level.

A nurse is evaluating their teaching to a client with a history of alcohol abuse who was newly diagnosed with liver cirrhosis. What statement by the client indicates a need for further education? "I can continue drinking alcohol so long as I limit it to 1-2 drinks per day" "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 because my liver can no longer store them"

I can continue drinking alcohol so long as I limit it to 1-2 drinks per day Avoiding alcohol and joining an alcohol recovery program is critical to the patients health. Abstaining from alcohol prevents further damage to the patients liver, allows damaged hepatocytes to regenerate, prevents irritation to the patients GI tract, and decreases the patients bleeding risks. Patients with cirrhosis have a decreased ability to digest fats and are prone to ascites and fluid retention with increased sodium consumption. They require increased carbohydrates to provide calories for energy. Consuming smaller and more frequent meals decreases feelings of fullness and bloating. Patients with liver damage/cirrhosis have limited capacity to store needed vitamins and minerals and thus may require supplementation.

A nurse is evaluating teaching for a client who has been diagnosed with Hepatitis B. Which of the following questions indicates an understanding? "I am not at risk for cirrhosis or liver cancer" "I cannot transmit Hepatitis B to my infant at the time of birth" "There is not a vaccination to prevent this disease" "I can treat my illness with antiviral medications, like enetcavir and tenofovir, along with bed rest and nutritional support"

I can treat my illness with antiviral medications, like enetcavir and tenofovir, along with bed rest and nutritional support Hepatitis B is a major cause of cirrhosis and liver cancer. Hepatitis B is transmitted through body fluids, including blood, saliva, semen, and vaginal secretions. It can be transmitted to the infant through the birthing process if the mother is infected with Hepatitis B. There is a vaccination available for people at risk. It is also included as a routine vaccination of infants. Hepatitis B is treated with antiviral agents, like the ones listed, and bed rest and nutritional support. Nutritional support involves a diet high in carbohydrates.

Which of the following statements made by the patient after the RN performs dietary teaching for a patient with cirrhosis indicates a need for further teaching? I will weigh myself every day to monitor my intake and output. I will eat more canned vegetables for the fiber. I will eat smaller meals, more frequently I will eat more calorie dense foods with lower protein content.

I will eat more canned vegetables for the fiber A low sodium diet can help prevent fluid buildup common in liver disease such as dependent edema and ascites. Canned vegetables are very high in sodium due to its preservative properties. People with fluid balance issues should take daily weights to ensure they are not taking on too much fluid. More frequent, smaller meals help the liver to digest smaller amounts of food at a time more effectively. Foods high in protein may not be properly digested by a diseased liver and can cause metabolic encephalopathy.

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 1 PT 10 INR 2 PT 20

INR 2 PT 20 The PT to INR ratio in a healthy patient without liver damage is 10:1. This would rule out A and B as 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, so the PT and INR ratio should be elevated from 10:1 to 20:2 or some higher value.

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 gain Nausea Malaise Orange colored urine Fatigue

Lack of appetite Nausea Malaise Fatigue Lack of appetite, nausea, malaise, and fatigue are all symptoms of hepatocellular jaundice. Illness may be mild or severe. Weight gain is wrong because in hepatocellular jaundice it usually leads to weight loss. In prolonged obstructive jaundice, cell damage eventually develops and both types (hepatocellular and obstructive jaundice) appear together resulting in orange colored urine.

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) Renal function tests (BUN, GFR, Creatinine) Cardiovascular tests Urine sample

Liver function tests (ALT, AST, bilirubin, albumin) This client is presenting to the ED with S&S of liver failure, you'd want to test the patients bilirubin d/t symptoms of jaundice, ALT & AST to test for damage of the liver cells that could be causing the abdominal pain, as well as presence of abdominal swelling indicates presence of ascites which can also be concluded through an albumin test

While assessing a 78-year old man with a h/x of liver failure, which finding warrants further investigating by the primary nurse? LLQ pain Reported increased ab girth Tachycardia Arthralgias

Reported increased abdominal girth In patient reporting with chronic or h/x of liver failure one of the most common presenting s/s of this liver condition is increased ab girth due r/t portal HTN and vasodilation in the splenic circulation, supplying the GI system to leak from the surface of the liver and intestine and to accumulate within the abdomen.

A patient is receiving Lactulose for the treatment of hepatic encephalopathy. Which of the following findings would require additional follow up? (Select all that apply) Serum potassium of 3.1 mmol/L Involuntary flapping of the hands Impaired writing and ability to draw line figures The patient is also prescribed Senna.

Serum potassium of 3.1 mmol/L, the patient is also prescribed Senna Lactulose can cause hypokalemia. Electrolyte status should be monitored and corrected if abnormal. This is an expected finding of someone who has hepatic encephalopathy. This is an expected finding of someone who has hepatic encephalopathy. Other laxatives are not prescribed during lactulose administration because their effects disturb dosage regulation.

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 perform vigorous exercises while in the hospital." "The client should be repositioned frequently to avoid skin breakdown or infection." "It is safe for the client to get out of bed independently." "The client does not need to be on any dietary restrictions."

The client should be repositioned frequently to avoid skin breakdown or infection The nurse should promote client rest to reduce stress on the liver. The client should be repositioned frequently to avoid skin issues due to immobility. The nurse should request that the client ask for help when getting out of bed due to fall and bleeding risks. The client should be on a sodium-restricted diet to avoid the development of ascites.

You are teaching a new nurse about PT/INR for patients with cirrhosis of the liver. Which should you include in the teaching? Acute alcohol intoxication thins the blood leading to an increased risk of bleeding. The liver damage sustained through cirrhosis affects the synthesis of important clotting factors which leads to increased PT/INR times. Cirrhosis causes an increase in RBC production, leading to an increased hematocrit. Many clients who have cirrhosis need lifelong anticoagulation therapy therefore are at risk of bleeding.

The liver damage sustained through cirrhosis affects the synthesis of important clotting factors which leads to increased PT/INR times Clotting factors are made within the liver. When someone has cirrhosis, these clotting factors are not made which leads to increased PT/INR times.

A nurse is assessing a patient for ascites. What findings indicate that the patient has this condition? SATA Weight gain and abdominal girth increase Change in level of consciousness Shifting dullness or fluid wave upon percussion Mild flu like symptoms Fluid and electrolyte imbalance

Weight gain and abdominal girth increase, shifting dullness or fluid wave upon percussion, fluid and electrolyte imbalance Correct. Increased abdominal girth and rapid weight gain are common in ascites. Incorrect. Changes in LOC for a patient with liver issues is seen in patients with hepatic encephalopathy. Correct. Upon percussion, the nurse would feel a shifting dullness or fluid wave which would indicate ascites. Incorrect. Flu-like symptoms are commonly seen in patients who have Hepatitis A. Correct. In patients with ascites, fluid and electrolyte imbalance is common due to fluid retention in the abdominal cavity.

In preparing to provide care for a patient who presents to you with grade C liver disease and severe ascites, identify appropriate interventions. SATA Encourage mild exercise Administration of spironolactone (Aldactone) IV colloid therapy NPO status Administration of acetazolamide (Diamox) Low sodium (2g) diet Record daily weights

Administration of spironolactone, IV colloid therapy, low sodium (2g) diet, record daily weights Incorrect. This is contraindicated in patients with severe ascites due to the risk of upright posture which is associated with reduced glomerular filtration and sodium excretion. Additionally it decreases the body's response to diuretics. Bed rest is often an implemented nursing intervention. Correct Diuretic therapy is an important therapy for the treatment of ascites. Spironolactone is the common first-line choice. Other options, such as furosemide are avoided and used cautiously as they can induce severe sodium loss with long term use. Correct. IV therapy using colloid substances such as sodium-poor albumin is used to correct the total ECF overload associated with cirrhosis and ascites Incorrect. While fluid intake should be closely monitored, complete fluid restriction or NPO status is not required and places the patient at risk for nutritional or electrolyte deficiencies. Fluid restriction is not attempted unless sodium is VERY low. Incorrect. Acetazolamide (Diamox, a drug used to treat glaucoma and edema is contraindicated in patients with ascites due to the increased risk of hepatic encephalopathy and coma. Correct. Nutritional management, mainly sodium restriction, is a key therapy for treatment of ascites. Correct. Close records of the patient's fluid status should be kept. Daily weight loss should not exceed 1kg (2.2lb).

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? (select all that apply) Decreased asterixis Patient is becoming more confused. Decreased ammonia blood level Improved mental status.

Decreased asterixis, decreased ammonia blood level, improved mental status CORRECT!-After a patient receives lactulose it helps decrease the ammonia in their blood which can be the cause of a patient showing signs of asterixis. When these symptoms decrease then it can be an indicator the medication is working. incorrect-If a patient was confused this would show that there are neurological changes that are not improving and could potentially be getting worse which would mean the lactulose isn't working. If a patient is confused this could potentially lead to a coma. CORRECT!-Ammonia levels are critical to know when it comes to patients with cirrhosis. If a patient has elevated ammonia levels it is a sign that their cirrhosis is progressing and the lactulose isn't working. If the Lactulose is working then ammonia levels in blood would decrease because they are properly exiting the body. CORRECT!-When a patient has hepatic encephalopathy ammonia isn't properly being metabolized into urea and more of it is reaching astrocytes in the brain. This can cause mental changes like severe confusion. If the lactulose is working properly then the patient would have lower levels of ammonia and their mental status would improve to be less confused,dizzy, lethargic, etc.

A group of nurses have attended an inservice 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 Performing meticulous hand hygiene at the appropriate moments in care Adhering to the recommended schedule of immunizations Wearing an N95 mask when providing care for patients on airborne precautions.

Disposing of sharps appropriately and not recapping needles HCV is bloodborne, consequently prevention of needlestick injuries is paramount. Hand hygiene, immunizations and appropriate use of masks are important aspects of overall infection control but these actions do not directly mitigate the risk of HCV.

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? (Select all that apply) High Carbohydrate diet Potassium restriction Diuretic medications Administer lactulose Weight client daily Maintain supine position when the client is in bed

High carbohydrate diet, diuretic medications, administer lactulose, weight client daily A nurse should anticipate that the client will have dietary orders for a high carbohydrate intake, daily weight recording, and lactulose and diuretic medications for liver cirrhosis and ascites. They should also anticipate sodium/fluid restrictions, not potassium, and elevate the head of the bed to alleviate SOB symptoms (fluid overload) instead of supine positioning.

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. The nurse should understand that The patient has an attitude problem and the ammonia levels are WNLs Increased aggression and fatigue are expected findings with high ammonia levels and are indications for hepatic encephalopathy. The ammonia level is critically low and the patient is likely going into shock The nursing assistant did not need to report this information because it is arbitrary

Increased aggresion and fatigue are ecpected findigns with high ammonia levels and are indications for hepatic encephalopathy Ammonia is a waste product that's normally processed in your liver and excreted in urine. Liver cirrhosis can cause high ammonia levels. Symptoms of high ammonia levels in the blood include confusion, disorientation, excessive sleepiness, change in consciousness, and mood swings. An increase of ammonia to 100 mcg/dL can lead to changes in consciousness. A blood ammonia level of 200 mcg/dL is associated with coma and convulsions.

A nurse is providing care to a client with ascites. What interventions should she expect to perform? SATA Maintain a low-sodium diet Administer diuretics Administer beta-blockers Place the patient on bed rest Allow the patient 1 hour per day to exercise in order to help lose weight

Maintain a low-sodium diet, administer diuretics, place the patient on bed rest, Correct Excess sodium can cause further water retention leading to complications such as edema and increased blood pressure. Correct Administering diuretics will help drain the fluid from the ascites. Most common diuretic for ascites is Spironolactone followed by furosemide. Incorrect Beta blockers are not given as treatment for ascites. Correct Resting is important to help the body recover, as well as to not agitate the liver which has portal hypertension. Incorrect Patients should not exercise vigorously when they have ascites and are in the hospital.

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 Hypotension Peripheral edema Increased serum albumin Elevated potassium levels

Weight gain, dyspnea, peripheral edema Weight gain CORRECT: patient's often gain 5-10lbs. When in fluid volume overload. It is important to weigh the patient daily. Dyspnea CORRECT: fluid volume overload can cause fluid in the lungs and pneumonia. It is important to pay close attention to the patient's breathing and lung sounds. Hypotension INCORRECT: patients with fluid volume overload are likely to become hypertensive. Peripheral edema CORRECT: peripheral edema is a common sign of fluid volume overload. Weighing the patient daily and checking for pitting edema is important. Increased serum albumin INCORRECT: patients with fluid volume overload and liver cirrhosis often experience decreased levels of serum albumin. Elevated potassium levels INCORRECT: patients with fluid volume overload often have to take potassium-wasting diuretics to help offload the fluidl. This causes a decrease in potassium levels, and many patients have to take a potassium supplement.