Liver, Biliary, Pancreatitis Prep U
The nurse is assessing a client who is in the early stages of cirrhosis of the liver. Which focused assessment is appropriate?
anorexia: Early clinical manifestations of cirrhosis are subtle and usually include gastrointestinal symptoms, such as anorexia, nausea, vomiting, and changes in bowel patterns. These changes are caused by the liver's altered ability to metabolize carbohydrates, proteins, and fats. Peripheral edema, ascites, and jaundice are later signs of liver failure and portal hypertension.
Which precautions should the health care team observe when caring for clients with hepatitis A?
wearing gloves when giving direct care: Contact precautions are recommended for clients with hepatitis A. This includes wearing gloves for direct care. A gown is not required unless substantial contact with the client is anticipated. It is not necessary to wear a mask. The client does not need a private room unless incontinent of stool.
The nurse is developing a teaching plan the client with viral hepatitis. What information should the nurse include in the plan?
Obtain adequate bed rest: Treatment of hepatitis consists primarily of bed rest with bathroom privileges. Bed rest is maintained during the acute phase to reduce metabolic demands on the liver, thus increasing its blood supply and promoting liver cell regeneration. When activity is gradually resumed, the client should be taught to rest before becoming overly tired. Although adequate fluid intake is important, it is not necessary to force fluids to treat hepatitis. Antibiotics are not used to treat hepatitis. Electrolyte imbalances are not typical of hepatitis.
When the nurse is providing care for a client hospitalized with acute pancreatitis who has severe abdominal pain, which nursing interventions would be most appropriate for this client? Select all that apply.
Place the client in a side-lying position. Administer morphine sulfate for pain as needed. Monitor the client's respiratory status. Obtain daily weights. The client with acute pancreatitis usually experiences severe abdominal pain. The client will likely receive an opioid such as morphine to treat the pain. Placing the client in a side-lying position relieves the tension on the abdominal area and promotes comfort. A semi-Fowler's position is also appropriate. The nurse should also monitor the client's respiratory status because clients with pancreatitis are prone to develop respiratory complications. Daily weights are obtained to monitor the client's nutritional and fluid volume status. During the acute phase of the illness while the client is experiencing pain, the pancreas is rested by withholding food and drink. When the diet is reintroduced, it is a high-carbohydrate, low-fat, bland diet.
The nurse is providing discharge instructions for a client with cirrhosis. Which statement best indicates that the client has understood the teaching?
"I should avoid constipation to decrease chances of bleeding." Clients with cirrhosis should be instructed to avoid constipation and straining at stool to prevent hemorrhage. The client with cirrhosis has bleeding tendencies because of the liver's inability to produce clotting factors. A low-protein and high-carbohydrate diet is recommended. Clients with cirrhosis should not take acetaminophen, which is potentially hepatotoxic. Aspirin also should be avoided if esophageal varices are present. Cirrhosis is a chronic disease.
A client recently diagnosed with hepatitis C states: "Now that you know what's wrong with me, you can just get me those new drugs to take care of it, right?" What should the nurse tell the client?
"There are new antiviral drugs available that may make treatment more effective and help you tolerate it better." The nurse should explain to the client that current therapy includes the use of antiviral agents which may be administered over a course of 8 to 12 weeks and usually cure the disease. Although the other answers choices may be true, it is not appropriate for the nurse to make judgments about a client's health insurance or lifestyle choices.
A client one day postoperative cholecystectomy reports severe pain radiating to the shoulder. What should be the first nursing action?
Assess the patency of the T-tube: Commonly, clients will have pain from the irritation to the phrenic nerve from the CO2 that is injected during a laproscopic cholecystectomy. The first and least restrictive action is to place the client in Sim's position to help remove the air pocket away from the diaphragm. Assessing the T-tube is important to determine the cause of the pain. Hydromorphone aggravates gallbladder pain and should be avoided, and range of motion of the arms may aggravate the pain.
When caring for a client with hepatitis B, the nurse should monitor closely for the development of which finding associated with a decrease in hepatic function?
Increased drowsiness: Although all the options are associated with hepatitis B, the onset of drowsiness suggests a decrease in hepatic function. To detect signs and symptoms of disease progression, the nurse should observe for disorientation, behavioral changes, and a decreasing level of consciousness and should monitor the results of liver function tests, including the blood ammonia level. If hepatic function is decreased, the nurse should take safety precautions. Yellow sclera, pruritus, and fatigue are expected with hepatitis B infection and do not indicate worsening of liver function.
A client plans to travel to a country where hepatitis B is common. What should the nurse advise the client about the most effective way to prevent the disease?
Observe safe sex practices: Hepatitis B is considered a sexually transmitted disease, and students should observe safe-sex practices. Poor sanitary conditions in underdeveloped countries relate to spread of hepatitis A and E. Focusing on routes of transmission and avoidance of infection can prevent the spread of hepatitis; isolation in single rooms is not required. There is no vaccine for hepatitis D.
Which finding is normal for a client during the icteric phase of hepatitis A?
Yellowed sclera: Liver inflammation and obstruction block the normal flow of bile. Excess bilirubin turns the skin and sclera yellow and the urine dark and frothy. Profound anorexia is also common. Tarry stools are indicative of gastrointestinal bleeding and would not be expected in hepatitis. Light- or clay-colored stools may occur in hepatitis owing to bile duct obstruction. Shortness of breath would be unexpected.
During the first few weeks after a cholecystectomy, the client should follow a diet that includes:
a limited intake of fat distributed throughout the day so that there is not an excessive amount in the intestine at any one time: Bile flows almost continuously into the intestine for the first few weeks after gallbladder removal. Limiting the amount of fat in the intestine at any one time ensures that adequate bile will be available to facilitate digestion. Eating large amounts of meat, cheese, and peanut butter would be undesirable because these foods are often high in fat. There is no need to eliminate high-fiber foods, and doing so would tend to increase pressure within the large intestine, not decrease pressure in the small intestine. Removing the gallbladder does not decrease pancreatic secretions.
A client with a diagnosis of cirrhosis and hepatic encephalopathy is receiving lactulose. Which assessment finding indicates a therapeutic effect of lactulose?
improved cognition: Although lactulose is given to remove ammonia in the stool, as a laxative that will increase stool, the expected outcome is to improve client cognition. Liver enzymes do not improve when a client has cirrhosis, an irreversible form of liver dysfunction.
A client comes to the emergency department with suspected cholecystitis. Which data collection findings are characteristic of this diagnosis? Select all that apply.
transient epigastric pain radiating to the back and right shoulder burning in the chest after eating fried foods flatulence nausea Cholecystitis (inflammation of the gallbladder) is characterized by epigastric pain that radiates to the back and right shoulder. This pain commonly occurs after eating foods high in fat, especially those that are fried. A client with cholecystitis may also experience nausea, vomiting, and flatulence. Urticaria is not commonly associated with cholecystitis.
A client with cirrhosis should be encouraged to follow which diet?
well-balanced normal nutrients, low-sodium diet: Cirrhosis is a slowly progressive disease. Inadequate nutrition is the primary ongoing problem. Clients are encouraged to eat normal, well-balanced diets and to restrict sodium to prevent fluid retention. There is no need to increase calories or potassium or to adopt a bland diet. Protein is not restricted until the liver actually fails, which is usually late in the disease.
A client has advanced cirrhosis of the liver. The client's spouse asks the nurse why his abdomen is swollen, making it very difficult for him to fasten his pants. How should the nurse respond to provide the most accurate explanation of the disease process?
"Blood is not able to flow readily through the liver now, and the liver cannot make protein to keep fluid inside the blood vessels." Portal hypertension and hypoalbuminemia as a result of cirrhosis cause a fluid shift into the peritoneal space causing ascites. In a cardiac or kidney problem, not cirrhosis, sodium can promote edema formation and subsequent decreased urine output. Edema does not migrate upward toward the heart to enhance its circulation. Although diuretics promote the excretion of excess fluid, occasionally forgetting or omitting a dose will not yield the ascites found in cirrhosis of the liver.
The nurse is providing discharge instructions to a client newly diagnosed with the hepatitis C virus (HCV). When evaluating the teaching, which statement made by the client indicates a need for further teaching? Select all that apply.
"I will make sure that my family has had the vaccine against hepatitis C." "Having an occasional alcoholic beverage will not be a problem." The Centers for Disease Control (CDC) has released a 2017-2020 National Viral Hepatitis Action Plan to prevent new infections and improve the lives of those with the chronic disease. Hepatitis C is the most common chronic liver disease. Hepatitis C clients may have no symptoms until later stages of the disease. There is no vaccine for the disease ,which leaves the clients fatigued after minimal exertion. Periods of rest are needed throughout the day. The primary mode of transmission is through blood exposure such as through bleeding from the oral mucosa or blood on razors. Meticulous care to prevent cross contamination is needed. Epigastric pain is a common symptom due to the enlarging liver. A client should not have alcoholic beverages due to the impact on the liver.
Which statement indicates that the client with hepatitis B has understood the nurse's discharge teaching?
"I won't drink alcohol for at least 1 year." It is important that the client understand that alcohol should be avoided for at least 1 year after an episode of hepatitis. Sexual intercourse does not need to be avoided, but the client should be instructed to use condoms until the hepatitis B surface antigen measurement is negative. The client will need to restrict activity until liver function test results are normal; this will not occur within 1 to 2 weeks. Jaundice will subside as the client recovers; it is not a permanent condition.
A client who is recovering from hepatitis A has fatigue and malaise. The client asks the nurse, "When will my strength return?" Which response by the nurse is most appropriate?
"It is normal for you to feel fatigued. The fatigue should go away in the next 2 to 4 months." During the convalescent or posticteric stage of hepatitis, fatigue and malaise are the most common problems. These symptoms usually disappear within 2 to 4 months. Fatigue and malaise are not evidence of a secondary infection. Hepatitis A is not treated by drug therapy. It is important that the client continue to balance activity with periods of rest.
A client with viral hepatitis A is being treated in an acute care facility. Because the client requires enteric precautions, the nurse should
wash their hands after touching the client: To maintain enteric precautions, the nurse must wash their hands after touching the client or potentially contaminated articles and before caring for another client. A private room is warranted only if the client has poor hygiene — for instance, if the client is unlikely to wash the hands after touching infective material or is likely to share contaminated articles with other clients. For enteric precautions, the nurse need not wear a mask and must wear a gown only if soiling from fecal matter is likely.
