EXAM 3 Liver Chapter 58

biliary cirrhosis

result of obstruction of the bile duct -gallbladder disease or primary biliary cirrhosis

Four stages of hepatic encephalopathy

1) prodromal 2) impending 3) stuporous 4) comatose then they die

A 55-year-old patient with a history of alcohol abuse spanning 10 years has been diagnosed with cirrhosis. The patient will be undergoing abdominal paracentesis on the medical unit today. Which assessment finding would alert the nurse that the paracentesis has been successful? A. Decrease in post-procedure weight B. No residual obtained during procedure C. Substantial decrease in blood pressure D. Immediate sensation of a need to urinate

A

What is a primary reason for a higher incidence of liver cancer in the United States? A. Incidence of hepatitis C B. Incidence of HIV infection C. Incidence of illicit drug use D. Increased Asian population

A

Esophageal variceal bleeds interventions

screened for varices placed on preventative therapy if they are found (Inderal, vasopressin) if bleeding occurs get on it quickly and probably need to go into GI for an intervention position: head up high, oxygen, beta blocker, prepare patient for endoscopy

The patient's assessment reveals yellowish coloration of skin and sclerae. Which laboratory values would the nurse anticipate? A. Increased urine bilirubin, decreased direct bilirubin B. Increased direct bilirubin, increased indirect bilirubin C. Decreased direct bilirubin, increased indirect bilirubin D. Increased direct bilirubin, decreased indirect bilirubin

B

What is the priority nursing intervention in the management of a patient with decompensated cirrhosis? A. Limiting protein intake B. Managing nausea and vomiting C. Monitoring fluid intake and output D. Elevating the head of bed >30 degrees

B

When a complete assessment of this patient is performed, what other manifestations would the nurse expect? (Select all that apply.) A. Muscle twitching B. Dry skin with rash C. Personality changes D. Peripheral dependent edema E. Ecchymosis, spider angiomas

B,D,E

The patient tells the nurse that once he is discharged to home, he has no intention to stop drinking alcohol. What is the appropriate nursing response? A. "Why do you continue to drink?" B. "It's your choice to drink or not to drink." C. "Does it frighten you to consider quitting?" D. "If you continue to drink, you are going to die."

C

Which assessment finding requires immediate nursing intervention in a patient with severe ascites? A. Confusion B. Temperature 38.2º C C. Tachycardia, rate 110 beats/min D. Shallow respirations, rate 32 breaths/min

D

"end-stage liver failure assess for

Obvious yellowing of the skin dry skin rashes purpuric lesions warm bright red palms lesions with red center "spider angiomas" ascites dependent edema

Diagnostic Tests

Paracentesis Laboratory blood tests: BUN Creatinine Liver studies: (AST)(ALT)and (LDH) elevated Bilirubin (patients have light- or clay-colored stools) Increased (GGT) RBC/Low H/H indicative of anemia WBC PT/PTT/INR Platelets/indicative of thrombocytopenia X-ray- see the megalogys MRI, CT ultrasound

IMPORTANT DRUG for liver disease

acetaminophen! reversal is mucomist (smells like rotten eggs)

Hepatitis B symptoms

anorexia, N/V fever fatigue right upper quadrant pain dark urine with light stool joint pain jaundice

hepatitis C in depth

blood to blood not really sexual contact spread by: illicit drug needlesticks blood needlesticks unsanitary tattoo equipment cocaine not transmitted by causal contact

Hepatitis B

can be passed by sexual contact needlesticks blood transfusions mom to baby open cuts of sores three step vaccine

laennec's cirrhosis

caused by chronic alcoholism

liver dysfunction

decrease of vit K: necessary for clotting (bruise and bleed easily) jaundice obstructive often report pruritus rising ammonia level

physical assessment clinical manifestations

early manifestations are vague and non specific fatigue significant change in weight GI symptom, anorexia/vomiting abdominal pain liver tenderness

complications of hepatitis

failure of liver cells to regenerate- results in severe acute fatal form of fulminant hepatitis chronic hepatitis usually occurs because of B and C sometimes D chronic hepatitis can lead to cirrhosis and liver cancer

spontaneous bacterial peritonitis (SBP) manifestations

fever chills abdominal pain and tenderness

compensated cirrhosis

first sign may be present before the onset of symptoms usually through tests that indicate abnormal liver function or thrombocytopenia

hepatitis E

foreign countries fecal-oral route resolves on its own outbreaks after heavy rains and flooding

most common causes of cirrhosis

hepatitis C alcoholism biliary obstruction (gall stone)

other liver complications

hepatorenal sundrome (HRS)- messes with kidneys often the cause of death in these patients

hepatic encephalopathy factors

high-protein diet infections hypovolemia hypokalemia constipation GI bleed Drugs (hypnotics, opioids, sedatives, diuretics)

Assessment of liver disease patients

history exposure to alcohol and illicit drugs sex and work history military or police tattoos previous med conditions viral infections blood transfusions jaundice viral hepatitis liver injury

complications of cirrhosis

hypertension splenomegaly ascites esophageal varices hematemesis (vomiting blood) melena (black tarry stool) hypertensive gastropathy

cirrhosis

irreversible scarring of liver results in end stage lier disease

Liver

largest organ digestion, nutrition, and metabolism

end-stage liver failure

late signs GI bleed, jaundice, ascites, spontaneous bruising assess for liver dysfunction

hepatitis C

leading cause of cirrhosis and liver failure in US bloodbourne illness goal for hep C is remission inflammation caused by infection leads to scarring of liver flu like symptoms and you don't realize you have it until you present with cirrhosis or bad liver enzyme count

hepatic encephalopathy (PSE)

liver dysfunction raises ammonia level with leads to hepatic encephalopathy lactulose pulls ammonia from the blood results from liver fail and cirrhosis may be reversible

spontaneous bacterial peritonitis (SBP)

may develop after cirrhosis and ascites leakage of organ bacteria in the fluid low concentrations of proteins pull a sample of the bacteria fluid to diagnose

People who should be immunized

more than one sexual partner people with STDs men on men action people with chronic liver disease HIV blood or body fluids at work correctional facilities immunosuppressant drugs anyone with HBV

Interventions for acities

nutrition therapy drug therapy paracentesis respiratory support patient's fluid and electrolyte status is also carefully monitored watch for itching because of jaundice

signs of hepatic encephalopathy

sleep disturbances mood disturbance mental status change speech problems

hepatorenal sundrome (HRS) manifestations

sudden decrease in urine flow elevated BUN elevated creatinine levels decreased urine sodium excretion increased urine osmolarity

Hepatitis A

survives on human hands destroyed by chlorine and high temperatures similar to flu like infections fecal-oral route

TIPS- Transjugular intrahepatic portal systemic shunt

used to control ascites attach a drain to move ascites into blood stream endoscopic therapy

Health Promotion

vaccines hand washing especially after handling shellfish avoid contaminated food and water ****RECIEVEING IMMUNOGLOBULIN WITHIN 14 DAYS if exposed to the virus

hepatitis patho

widespread inflammation viral is most common if it has a vowel it comes from the bowel A and E are fecal oral routes B, C, and D are bloodbourne

hepatitis D

without the B you can't get the D usually develops into chronic HDV primarily by parenteral routes, IV drug abusers sexual contact is high risk factor