MS exam 3: Chapter 58
what are the S&S of hepatitis?
-Abdominal pain -Changes in skin or sclera (icterus) -Arthralgia (joint pain) or myalgia (muscle pain) -Diarrhea/constipation -Changes in color of urine or stool -Fever -Lethargy -Malaise -Nausea/vomiting -Pruritus (itching) -Anorexia
what is steatosis?
-Accumulation of fats in or around hepatic cells -Faulty fat metabolism in the liver -Many are asymptomatic
what is hepatitis D?
-IV drug use, sex -virus: usually becomes chronic
what are the symptoms of liver trauma?
-RUQ pain with abd tenderness -abd distention and rigidity -guarding of the abd -increased abd pain exaggerated by deep breathing and referred to the right shoulder (Kehr's sign)
what are the symptoms of hepatitis B?
-anorexia, N/V -fever -fatigue -RUQ pain -dark urine with light stool -joint pain -jaundice
what is hepatitis A?
-fecal, oral route -mild, patient will have flu-like symptoms
what are the S&S of hemorrhage and hypovolemic shock?
-hypotension -tachycardia -tachypnea -pallor -diaphoresis -cool, clammy skin -confusion or other changes in mental state
what is decompensated?
-liver function is impaired -S&S of liver failure
what do you need to know about hepatorenal syndrome (complication of cirrhosis)?
-often the causes of death (poor prognosis) -causes decreased urine output, increased BUN and creatinine, decreased urine sodium excretion, and increased urine osmolarity -patient often goes into this stage after they have had GI bleeding or onset of encephalopathy -if patient experiences GI bleeding and starts to get confused, need to look at kidney function
what are the non-surgical interventions for esophageal varices that bleed?
-they will need vasoactive drugs and endoscopy -variceal litigation (use small O bands, placed to decrease blood supply to varices) -endoscopic sclerotherapy: inject sclerosing agent to stop bleeding (complications: mucosal ulceration and further bleeding)
A client who was awaiting liver transplantation is excluded from the procedure after the presence of which condition is discovered? a. Colon cancer with metastasis to the liver b. Hypertension c. Hepatic encephalopathy d. Ascites and shortness of breath
A
When caring for a client with hepatic encephalopathy, in which situation does the nurse question the use of neomycin (Mycifradin)? a. Kidney failure b. Refractory ascites c. Fetor hepaticus d. Paracentesis scheduled for today
A
When caring for a client with Laennec's cirrhosis, which of these does the nurse expect to find on assessment? Select all that apply. a. Prolonged partial thromboplastin time b. Icterus of skin c. Swollen abdomen d. Elevated magnesium e. Currant jelly stool f. Elevated amylase level
A, B, C
A nurse assesses a male patient who has symptoms of cirrhosis. Which questions would the nurse include in this patient's plan of care? SATA a. How frequently do you drink alcohol? b. Have you ever had sex with a man? c. Do you have a family history of cancer? d. Have you ever worked as a plumber? e. Were you previously incarcerated?
A, B, E
When caring for a client with portal hypertension, the nurse assesses for which potential complications? Select all that apply. a. Esophageal varices b. Hematuria c. Fever d. Ascites e. Hemorrhoids
A, D, E
A client is scheduled to undergo a liver transplantation. Which nursing intervention is most likely to prevent the complications of bile leakage and abscess formation? a. Preventing hypotension b. Keeping the T-tube in a dependent position c. Administering antibiotic vaccinations d. Administering immune-suppressant drugs
B
A nurse cares for a patient who has cirrhosis of the liver. What action would the nurse take to decrease the presence of ascites? a. Monitor I&O b. Provide a low-sodium diet c. Increase oral fluid intake d. Weigh the patient daily
B
A client with a history of esophageal varices has just been admitted to the emergency department after vomiting a large quantity of blood. Which action does the nurse take first? a. Obtain the charts from the previous admission. b. Listen for bowel sounds in all quadrants. c. Obtain pulse and blood pressure. d. Ask about abdominal pain.
C
A nurse assesses patients on the med-surg unit. Which patient is at greatest risk for the development of carcinoma of the liver? a. 22 yo with a history of blunt liver trauma b. 48 yo with a history of DM c. 66 yo who has a history of cirrhosis d. 82 yo who has chronic malnutrition
C
When assessing a client for hepatic cancer, the nurse anticipates finding an elevation in which laboratory test result? a. Hemoglobin and hematocrit b. Leukocytes c. Alpha-fetoprotein d. Serum albumin
C
Which problem for a client with cirrhosis takes priority? a. Insufficient knowledge related to the prognosis of the disease process b. Discomfort related to the progression of the disease process c. Potential for injury related to hemorrhage d. Inadequate nutrition related to an inability to tolerate usual dietary intake
C
the nurse is caring for four clients. which client is at the highest risk for hepatitis B infection? a. 24-year-old with abdominal pain who just returned from Central America b. 40-year-old who is 2 days postpartum and is breastfeeding c. 65-year-old who reports using street drugs 10 year ago when homeless d. 81-year-old who donated own blood before a surgical procedure
C
When assessing a client with hepatitis B, the nurse anticipates which assessment findings? Select all that apply. a. Recent influenza infection b. Brown stool c. Tea-colored urine d. Right upper quadrant tenderness e. Itching
C, D, E
what are the palliative approaches for liver cancer?
Chemo, ablation, radiation, end-of-life care, and hospice
A health care worker believes that he may have been exposed to hepatitis A. Which intervention is the highest priority to prevent him from developing the disease? a. Requesting vaccination for hepatitis A b. Using a needleless system in daily work c. Getting the three-part hepatitis B vaccine d. Requesting an injection of immunoglobulin
D
A nurse assesses a patient who is prescribed an infusion of vasopressin for bleeding esophageal varices. Which clinical manifestation would alert the nurse to a serious adverse effect? a. N/V b. Frontal headache c. Vertigo and syncope d. mid-sternal chest pain
D
A nurse cares for a patient who is hemorrhaging from bleeding esophageal varices and has an esophagogastric tube. What action would the nurse take first? a. Sedate the patient to prevent tube dislodgement b. Maintain balloon pressure at 15 and 20 mm Hg c. Irrigate the gastric lumen with NS d. Assess the patient for airway patency
D
The RN is caring for a client with end-stage liver disease who has ascites. Which action does the RN delegate to unlicensed assistive personnel (UAP)? a. Assessing skin integrity and abdominal distention b. Drawing blood from a central venous line for electrolyte studies c. Evaluating laboratory study results for the presence of hypokalemia d. Placing the client in a semi-Fowler's position
D
The nurse asks a client with liver disease to raise the arms to shoulder level and dorsiflex the hands. A few moments later, the hand begins to flap upward and downward. How does the nurse correctly document this in the medical record? a. Positive Babinski's sign b. Hyperreflexia c. Kehr's sign d. Asterixis
D
what is biliary cirrhosis?
caused by chronic biliary obstruction or autoimmune disease
what increases the risk of liver cancer?
cirrhosis
what is the action alert for cirrhosis?
for skin irritation and pruritus associated with jaundice, teach the patient to use cool rather than warm water on the skin and to use a small amount of soap. teach UAPs to use lotion to soothe the skin. assess for open skin areas from scratching, which could become infected
what is the action alert for liver transplantations?
for the patient who has had a liver transplantation, monitor the temperature frequently per hospital protocol and report elevations, increased abd pain, distention, and rigidity, which are indicators of peritonitis. nursing assessment also includes monitoring for a change in neurologic status that could indicate encephalopathy from a non-functioning liver. report signs of clotting problems (bloody oozing from a catheter, petechiae, ecchymosis) to the surgeon immediately because they may indicate impaired function of the transplanted liver
what do liver complications depend on?
the amount of damage
how do you administer platelets?
through gravity tubing
A nurse delegates hygiene care for a patient who has advances cirrhosis to a UAP. Which statements would the nurse include when delegating this task to the UAP? SATA a. Apply lotion to the patient's dry skin areas b. Use a basin with warm water to bathe the patient c. For the patient's oral care, use a soft toothbrush d. Provide clippers so the patient can trim the fingernails e. Bathe with antibacterial and water-based soaps
A, C, D
An ER nurse assesses a patient with potential liver trauma. Which clinical manifestations would alert the nurse to internal bleeding and hypovolemic shock? SATA a. Hypertension b. Tachycardia c. Flushed skin d. Confusion e. Shallow respirations
B, D
Following paracentesis, during which 2500 mL of fluid was removed, which assessment finding is most important to communicate to the health care provider (HCP)? a. The dressing has a 2-cm area of serous drainage. b. The client's platelet count is 135,000/mm3 (135 × 109/L). c. The client's albumin level is 2.8 g/dL (28 g/L). d. The client's heart rate is 122 beats/min.
D
what assessments need to be done for cirrhosis?
-Assess for exposure to alcohol and drugs, herbs, chemicals. -Determine if there has ever been a needle stick injury, tattoo placement, imprisonment, or employment as a healthcare worker, firefighter, or police officer. -Assess sexual history (especially MSM- males with males) and orientation. -Inquire about family history. -Collect previous medical history and ask about any blood transfusions
how do you prevent and manage hepatic encephalopathy?
-Goal= slow or stop accumulation of ammonia in the body -Dietary limitations -Drug therapy: restrict some (such as opioids, sedatives, barbiturates)
what is compensated?
-scarring -cellular regulation is impaired, but liver can still function -no major symptoms
Which activity by the nurse will best relieve symptoms associated with ascites? a. Administering oxygen b. Elevating the head of the bed c. Monitoring serum albumin levels d. Administering intravenous fluids
B
what is liver disease?
-can range from mild inflammation (caused by toxins- alcohol or disease- hepatitis) to chronic end-stage cirrhosis -early stage: liver is enlarged, firm, and hard -as disease progresses, the liver shrinks (can occur in weeks to years)- some patients have no symptoms until it is serious
what are the causes of steatosis?
-diabetes -obesity -alcohol use -genetics -elevated lipids
who is not a good candidate for liver transplant?
-advanced cardiac disease -severe respiratory disease -metastatic tumors (starts somewhere other than the liver and spreads to the liver) -inability to follow directions (due to lots of drug therapy and self-management)
what is the CIWA assessment?
-alcohol withdrawal assessment -score on assessment determines amount of Ativan you can give your patient
how do you care for a patient undergoing a paracentesis?
-explain the procedure and answer patient questions -obtain VS, including weight -ask the patient to void before the procedure to prevent injury to the bladder -position the patient in bed with the HOB elevated -monitor VS per protocol or physician's request -measure the drainage and record accurately -describe the collected fluid -label and send the fluid for lab analysis; document in the patient record that specimens were sent -after the physician removes the catheter, apply a dressing to the site; assess for leakage -maintain bedrest per protocol -weigh the patient after the paracentesis; document in the patient record weight both before and after paracentesis
A nurse assesses a patient who is recovering from a paracentesis 1 hour ago. Which assessment finding requires action by the nurse? a. Urine output via indwelling urinary catheter is 20 mL/hr b. BP increases from 110/58 to 120/62 mm Hg c. RR decreases from 18 to 14 breaths/min d. A decrease in the patient's weight by 3 lbs (1.4 kg)
A
A nurse assesses patients at a community health fair. Which patient is at greatest risk for the development of hepatitis B? a. 20 yo college student who has had several sexual partners b. 46 yo woman who takes acetaminophen daily for headaches c. 63 yo businessman who travels frequently across the country d. 82 yo woman who recently ate raw shellfish for dinner
A
A nurse cares for a patient with hepatopulmonary syndrome who is experiencing dyspnea with O2 sats at 92%. The patient states "I do not want to wear the O2 because it causes my nose to bleed. Get out of my room and leave me alone" what action would the nurse take? a. Instruct the patient to sit in as upright a position as possible b. Add humidity to the oxygen and encourage the patient to wear it c. Document the patient's refusal, and call the health care provider d. Contact the provider to request an extra dose of the patient's diuretic
A
a nurse teaches a patient with hepatitis C who is prescribed ribavirin. which statement would the nurse include in this patien'ts discharge education? a. Use a pill organizer to ensure you take this medication as prescribed b. Transient muscle aching is common side effect of this medication c. Follow up with your provider in 1 week to test your blood for toxicity d. Take your radial pulse for 1 min prior to taking this medication
A
A nurse plans care for a patient who has hepatopulmonary syndrome. Which interventions would the nurse include in this patient's plan of care? SATA a. Oxygen therapy b. Prone position c. Feet elevated on pillows d. Daily weights e. Physical therapy
A, C
An infection control nurse develops a plan to decrease the number of healthcare professionals who contract viral hepatitis at work. Which ideas would the nurse include in this plan? SATA a. Policies related to consistent use of standard precautions b. Hepatitis vaccination mandate for workers in high-risk areas c. Implementation of a needleless system for IV therapy d. Number of sharps used in patient care reduced where possible e. Postexposure prophylaxis provided in a timely manner
A, C, D, E
how do you diagnose steatosis?
ALT/AST, MRI, US, nuclear medicine are used to diagnose
What teaching does the home health nurse give the family of a client with hepatitis C to prevent the spread of the infection? a. The client must not consume alcohol. b. Avoid sharing the bathroom with the client. c. Members of the household must not share toothbrushes. d. Drink only bottled water and avoid ice.
C
A nurse assesses a patient who has liver disease. Which laboratory findings would the nurse recognize as potentially causing complications of this disorder? SATA a. Elevated aspartate transaminase b. Elevated INR c. Decreased serum globulin levels d. Decreased serum alkaline phosphatase e. Elevated serum ammonia f. Elevated PT
B, E, F
A nurse cares for a patient who has chronic cirrhosis from substance abuse. The patient states "all of my family hates me" how would the nurse respond? a. You should make peace with your family b. This is not unusual, my family hates me too c. I will help you identify a support system d. You must attend AA
C
After teaching a patient who has plans to travel to a nonindustrialized country, the nurse assesses the patient's understanding regarding the prevention of viral hepatitis. Which statement made by the patient indicates a need for additional teaching? a. I should drink bottled water during my travels b. I will not eat another's plate or share utensils c. I should eat plenty of fresh fruits and vegetables d. I will wash my hands frequently and thoroughly
C
How does the home care nurse best modify the client's home environment to manage side effects of lactulose (Evalose)? a. Provides small frequent meals for the client b. Suggests taking daily potassium supplements c. Elevates the head of the bed in high-Fowler's position d. Requests a bedside commode for the client
D
It is essential that the nurse monitor the client returning from hepatic artery embolization for hepatic cancer for which potential complication? a. Right shoulder pain b. Polyuria c. Bone marrow suppression d. Bleeding
D
When providing discharge teaching to a client with cirrhosis, it is essential for the nurse to emphasize avoidance of which of these? a. Vitamin K-containing products b. Potassium-sparing diuretics c. Nonabsorbable antibiotics d. Nonsteroidal anti-inflammatory drugs (NSAIDs)
D
Which statement by a client with cirrhosis indicates that further instruction is needed about the disease? a. "Cirrhosis is a chronic disease that has scarred my liver." b. "The scars on my liver create problems with blood circulation." c. "Because of the scars on my liver, blood clotting and blood pressure are affected." d. "My liver is scarred, but the cells can regenerate themselves and repair the damage."
D
what is hepatitis C?
IV drug use, tattoos, sharing of intranasal cocaine equipment, blood to blood, multiple sex partners, and needle stick injuries
how do you measure pressure in the portal vein?
through transhepatic or transvenous catheterization of the portal vein
what are the interventions for steatosis?
weight loss, glucose control, lipid-lowering agents
what are the common complications of a liver transplant?
rejection, infection, bleeding
what is hepatitis B?
sex, needles, razors, toothbrushes, healthcare workers, blood transfusions, dialysis, birth, and compromised immunity
what is hepatitis E?
international traveler, dirty water, heavy rains and flooding, and fecal contamination
what are the non-surgical interventions for hepatitis?
-Need vitamins and rest -Use drugs sparingly to allow the liver to rest -Hand washing, sometimes isolation to prevent the spread -Consult with infection disease specialist -Antiemetic
what do you need to know about peritonitis (complication of cirrhosis)?
-more susceptible to peritonitis (Due to low proteins- proteins normally protect against bacteria) -bacteria in the bowel finds its way to ascitic fluid causing peritonitis -S&S: fever, chills, uncomfortable and tender abdomen -paracentesis (needle insertion to drain the fluid and sent to lab for cell count- look for leukocytes and get a culture)
what are the non-surgical interventions for cirrhosis?
-paracentesis -watch fluid and electrolytes -watch skin (jaundice, itching) -late stage cirrhosis may need vitamins (thiamine, folate, and multivitamins- added to IV bag then oral) -respiratory support -low-sodium diet (1-2 g)
what are the complications of cirrhosis?
-portal HTN -portal hypertensive gastropathy -biliary obstruction -hepatic encephalopathy (PSE- portosystemic encephalopathy) -acute liver dysfunction -hepatorenal syndrome (HRS) -ascites and esophageal varices -coagulation defects -jaundice -spontaneous bacterial peritonitis -hepatic coma
what do you need to know about portal hypertensive gastropathy (complication of cirrhosis)?
-slow gastric bleeding -can be a chronic -stools positive for blood -anemia -splenomegaly destroys platelets so they may have thrombocytopenia (decreased platelets, messes up coagulation, increased risk for bleeding, often the first sign of liver dysfunction) -platelets need to be given through gravity tubing
A nurse cares for a patient who is prescribed lactulose. The patient states "I do not want to take this medication because it causes diarrhea" how would the nurse respond? a. Diarrhea is expected, that's how your body gets rid of ammonia b. You may take Kaopectate liquid daily for loose stools c. Do not take any more of the medication until your stools firm up d. We will need to send a stool specimen to the laboratory
A
The nurse is caring for clients in the outclient clinic. Which of these phone calls would the nurse return first? a. Client with hepatitis A reporting severe and ongoing itching b. Client with severe ascites who has a temperature of 101.4°F (38°C) c. Client with cirrhosis who has had a 3-pound (1.4 kg) weight gain over 2 days d. Client with esophageal varices and mild right upper quadrant pain
B
The nurse administers lactulose (Evalose) to a client with cirrhosis for which purpose? a. To aid in digestion of dairy products b. To reduce portal pressure c. To promote gastrointestinal (GI) excretion of ammonia d. To reduce the risk of GI bleeding
C
The nursing team consists of an RN, an LPN/LVN, and a nursing assistant. Which client should be assigned to the RN? a. Client who is taking lactulose and has diarrhea b. Client with hepatitis C who requires a dressing change c. Client with end-stage cirrhosis who needs teaching about a low-sodium diet d. Obtunded client with alcoholic encephalopathy who needs a blood draw
C
what is the etiology and genetic risk for cirrhosis?
-Hepatitis C (especially Hep C): infectious blood borne illness (inflammation) that leads to scarring of the liver, can take decades for cirrhosis to develop -Hepatitis B and D: inflammation, damage over decades, can lead to cirrhosis -Non-alcoholic fatty liver disease (NAFLD) can lead to cirrhosis, associated with obesity and type 2 diabetes; most common cause of liver disease in the world -Alcoholic hepatitis: reversible if alcohol is withheld; long-term use of cocaine has similar effects on the liver
what do you need to know about liver trauma?
-Observe for early signs of hypovolemic shock. -May require enhanced critical care monitoring, surgery, blood replacement, volume infusion -Steering wheels in a car accident are a common cause (whenever there is abdominal trauma or lower chest trauma, investigate the liver) -Most common organ to be damaged by abdominal trauma -Liver can have lacerations, tears, crush injuries -Liver is highly vascular (can have rapid, massive blood loss); patient may require blood products (Packed RBCs, FFP) -watch for hypovolemic shock
what assessments need to be done for liver cancer?
-May be asymptomatic early in disease process -Later signs include weight loss, anorexia, weakness, abdominal discomfort (RUQ). -Jaundice, bleeding, ascites, and edema develop -Palpation: enlarged, nodular liver -US and contrast-enhanced CT are used.
The nurse is caring for a client who has cirrhosis of the liver. The client has exhibited hand flapping and mental confusion for several weeks. Although the mental confusion is worsening, the client has stopped exhibiting hand flapping movements. How will the nurse interpret these findings? a. The client's symptoms are progressing and getting worse. b. The client's serum ammonia levels are decreasing. c. The client probably has a decrease in serum proteins. d. The client is showing signs of improvement.
A
A nurse cares for a patient with hepatic portal-systemic encephalopathy. The patient is thin and cachectic in appearance, and the family expresses distress that the patient is receiving little dietary protein, how would the nurse respond? a. A low-protein diet will help the liver rest and will restore liver function b. Less protein in the diet will help prevent confusion associated with liver failure c. Increasing dietary protein will help the patient gain weight and muscle mass d. Low dietary protein is needed to prevent fluid from leaking into the abdomen
B
A telehealth nurse speaks with a patient who is recovering from a liver transplant 2 weeks ago. The patient states "I am experiencing right flank pain and have a temperature of 101 degrees F. how would the nurse respond? a. The anti-rejection drugs you are taking make you susceptible to infection b. You should go to the hospital immediately to have your new liver checked out c. You should take additional dose of cyclosporine today d. Take acetaminophen every 4 hours until you feel better
B
After teaching a patient who has alcohol-induced cirrhosis, a nurse assesses the patient's understanding. Which statement made by the patient indicates a need for additional teaching? a. I cannot drink any alcohol at all anymore b. I need to avoid protein in my diet c. I should not take OTC medication d. I should eat small, frequent balanced meals
B
After teaching a patient who has been diagnosed with hepatitis A, the nurse assesses the patient's understanding. Which statement by the patient indicates a correct understanding of the teaching? a. Some medications have been known to cause hepatitis A b. I may have been exposed when we ate shrimp last weekend c. I was infected with hepatitis A through a recent blood transfusion d. My infection with Epstein=Barr virus can co-infect me with hepatitis A
B
When preparing a client to undergo paracentesis, which action is necessary to reduce potential injury as a result of the procedure? a. Encourage the client to take deep breaths and cough b. Ask the client to void prior to the procedure c. Position the client with the head of the bed flat d. Assist the physician to insert a trocar catheter into the abdomen
B
what laboratory assessments are associated with cirrhosis?
-elevated AST and ALT (because they are released when there is hepatic inflammation) -AST and ALT are elevated in the beginning, but as the disease progresses, they will be normal (liver is unable to create inflammatory response) -Bilirubin will be increased because liver is unable to excrete it (can be found in urine and feces- this is why they will have a light or clay colored stool) -Prolonged PT, INR -Thrombocytopenia, anemia, increased ammonia, increased creatinine -decreased albumin -dilutional hyponatremia
what is the drug therapy for cirrhosis?
-Combination of Lasix and Aldactone (balance between sodium and potassium) -Give IV antibiotics for peritonitis: cefotaxime, cephalosporins (Ancef, cefazolin, Rocephin, maxipime), fluroquinolones (Cipro, Levaquin) -Inderal: beta blocker that helps decrease HR and hepatic pressure (helps to prevent bleeding if they have varices) -Lactulose: slow or stop accumulation of ammonia -Restrict some drugs (opioids, sedatives, barbiturates) -Vasoactive drugs for esophageal varices that bleed
what is the surgical treatment for liver cancer?
-Surgical resection and liver transplantation are only treatments -If considering liver transplant, need to make sure you are a good candidate -Can have a living donor (spouse or close family member)- removes one of the lobes and replace diseased liver (both donor and recipient's livers will regenerate) -PleurX: abdominal drain, used at home to remove excess ascitic fluid
what imaging assessments are used for cirrhosis?
-Ultrasound is often first -Liver ultrasound with Doppler will assess portal vein blood flow and detects portal vein thrombosis -Biopsy is risky because of risk for bleeding -May do EGD to look for esophageal varices, stomach irritation and ulcers, and duodenal ulceration and bleeding -ERCP: determines cause and location of obstructions
what do you need to know about esophageal varices (complication of cirrhosis)?
-distended, fragile veins in the esophagus that can bleed or rupture- life-threatening -patient can have severe blood loss and go into shock -may be vomiting blood or have dark, tarry stools (variceal bleeding) -can occur spontaneously or from lifting, exercise, trauma, and hard food passing through the esophagus
A nurse cares for a patient with hepatitis C. the patient's brother states "I do not want to contract this infection, so I will not go into his hospital room" how would the nurse respond? a. If you wear a gown and gloves, you will not get this virus b. Viral hepatitis is not spread through casual contact c. This virus is only transmitted through a fecal specimen d. I can give you an update on your brother's status from here
B
A nurse obtains a patient's health history at a community health clinic. Which statement alerts the nurse to provide health teaching to this patient? a. I drink 2 glasses of red wine each week b. I take a lot of Tylenol for my arthritis pain c. I have a cousin who died of liver cancer d. I got a hepatitis vaccine before traveling
B
When providing community education, the nurse emphasizes that which group needs to receive immunization for hepatitis B? a. Clients who work with shellfish b. Men who engage in sex with men c. Clients traveling to a third-world country d. Clients with elevations of aspartate aminotransferase and alanine aminotransferase
B
When providing dietary teaching to a client with hepatitis, what practice does the nurse recommend? a. Having a larger meal early in the morning b. Consuming increased carbohydrates and moderate protein c. Restricting fluids to 1500 mL/day d. Limiting alcoholic beverages to once weekly
B
what do you need to know about acute liver dysfunction (complication of cirrhosis)?
-encephalopathy can occur rapidly (portal venous blood is shunting into circulation, liver is bypassed, causes an increase in ammonia) -lactulose causes patients to have diarrhea, gets rid of ammonia buildup
what do you need to know about hepatic encephalopathy/PSE (complication of cirrhosis)?
-happens from liver failure and cirrhosis -cognitive syndrome -early on might have sleep disturbances, insomnia, mood changes, mental changes, speech problems -encephalopathy is reversible if caught early -advanced encephalopathy will have altered LOC, impaired thinking process, and neuromuscular problems -can develop slowly and can go undetected until later stages
what is hepatitis?
-inflammation of liver cells -viral hepatitis is most common (A, B, C, D, E) -secondary infection can lead to hepatitis -hepatitis needs to be reported to the health department, they will report it to the CDC -a patient can be a hepatitis carrier (can affect others, but have no symptoms); at risk for cirrhosis and liver cancer; they can infect others
what is cirrhosis?
-irreversible scarring of the liver -develops slowly -most common causes are chronic alcoholism, chronic viral hepatitis (especially hepatitis C), NASH (non-alcoholic steatohepatitis), bile duct disease, and genetic diseases
what do you need to know about portal HTN (complication of cirrhosis)?
-portal vein supplies blood to liver, there is an increased pressure in the portal vein (greater than 5 mmHg), which creates resistance or blockage and blood can back up into the spleen (causes splenomegaly) -veins become dilated in the esophagus, stomach, intestine, and rectum -portal hypertension can lead to ascites (extra fluid on the belly, fluid shifts can cause edema and hypovolemia simultaneously; massive ascites can cause renal issues and sodium and water retention) -prominent abdominal veins and hemorrhoids and esophageal varices
what do you need to know about biliary obstruction (complication of cirrhosis)?
-prevents absorption of fat soluble vitamins (vitamin K- puts at increased risk for bleeding) -may see bruising, jaundice, itching (bile salts that accumulate on skin- do a careful skin assessment, apply lotion, monitor patient, trim fingernails) -decreased bile with cirrhosis -some have genetic predisposition to obstruction (leads to biliary cirrhosis, usually from gallbladder disease, or autoimmune (PBC))
how do you care for cirrhosis?
-Self-manage at home -Hospital for immediate concerns -Rehabilitative care -Community setting -Cirrhosis- chronic, repeated hospitalizations are common
The RN has just received the change-of-shift report for the medical unit. Which client should the RN see first? a. Client with ascites who had a paracentesis 2 hours ago and is reporting a headache b. Client with portal-systemic encephalopathy (PSE) who has become increasingly difficult to arouse c. Client with hepatic cirrhosis and jaundice who has hemoglobin of 10.9 g/dL (109 mmol/l) and thrombocytopenia d. Client with hepatitis A who has elevated alanine aminotransferase (ALT) and aspartate aminotransferase (AST)
B
the nurse is caring for a client who is jaundiced and reports pruritus. which intervention will the nurse include in the plan of care? a. monitor the client's vital signs and intake and output b. instruct the client to scratch with knuckles instead of nails c. assist the client with a hot bath and apply moisturizer d. encourage the client to eat a high-protein, high-cholesterol diet
B
the nurse is caring for a client who has had paracentesis performed. which nursing intervention is appropriate? select all that apply. a. keep HOB flat b. measure, describe, and record drainage c. ambulate 30 min post-procedure d. weigh client e. label fluid container and send for laboratory analysis
B, D, E
