PrepU Review Hepatic

Non-viral hep can be caused by

- alcohol - over the counter pain meds - industrial chemicals - herbals

Additional Liver Diagnostic Studies: Liver Biopsy

- at bedside -long needle -nursing teaching

Complications of Hep B

- cirrhosis - liver failure - liver cancer

What is the incubation period for Hep B?

1-6 months but can still be infectious to other people

Hepatic Dysfunction Manifestations: Esophageal Varices

Blakemore

Hepatic Dysfunction Manifestations: Portal Hypertension

Blood flow obstructed through liver, portal vein going into liver the blood flow builds uo

The primary hepatitis for food is?

Hep A

What hepatitis can cause 8 weeks with diarrhea?

Hep A

You don't know you have Hep ____ until you get diarrhea

Hep A

A hepatitis that is big for healthcare workers is?

Hep B

What hepatitis is a major worldwide cause of cirrhosis and liver cancer?

Hep B

Hep _____ is not curable

Hepatitis B

Hep _____ is now curable

Hepatitis C

Hep _____ is the most common blood born infection?

Hepatitis C

What hepatitis cause 1/3 of cases of liver cancer?

Hepatitis C

Hepatic Dysfunction Manifestations: Jaundice

Yellow or green tinged sclera and skin caused by increased serum bilirubin --> eyes especially

A client with cirrhosis is at risk for developing esophageal varices. Which of the following instructions should a nurse provide the client to minimize such risk? a. abstain from drinking alcohol b. increase intake of potassium-rich food c. avoid intake of sodium-rich food d. use aspirin at least once a day

a. abstain from drinking alcohol

A nurse completeing a plan of care for a client with cirrhosis who has ascites and 4+ pitting edema of the feet and legs identifies a nursing diagnosis of risk for impaired skin intergrity. Which nursing intervention is appropriate for this problem? a. arrange for a low air loss bed b. reposition the client every 4 hours c. perform passive range-of-motion exercises four times a day d. restrict dietary protein intake

a. arrange for a low air loss bed

The nurse identifies which type of jaundice in an adult experiencing transfusion reaction? a. hemolytic b. obstructive c. nonobstructive d. hepatocellular

a. hemolytic

Which assessments are important in a client diagnosed with ascites? a. measurement of abdominal girth b. abdomen for fluid shift c. foul smelling breath d. clients weight

a. measurement of abdominal girth

Which medication is used to decrease portal pressure, halting bleeding of esophageal varices? a. vasopressin b. nitroglycerin c. cimetidine d. spironolactone

a. vasopressin

A client is suspected of having cirrhosis of the liver. What diagnostic procedure will the nurse prepare the client for in order to obtain a confirmed diagnosis? a. a prothrombin time b. a liver biopsy c. a CT scan d. platelet count

b. a liver biopsy

A client with liver and renal failure has severe ascites. On initial shift rounds, his primary nurse finds his indwelling urinary catheter collection bag too full to store more urine. The nurse empties more than 2,000 ml from the collection bag. One hour later, she finds the collection bag full again. The nurse notifies the physician, who suspects that a bladder rupture is allowing the drainage of peritoneal fluid. The physician orders a urinalysis to be obtained immediately. The presence of which substance is considered abnormal? a. creatinine b. albumin c. chloride d. urobilinogen

b. albumin

NAFLD is

build up of fat in the liver

A client with esophageal varices is scheduled to undergo injection sclerotherapy which of the following client statements indicates that the teaching was successful? a. The physician will use a balloon to compress the vessels b. It seems odd that a rubber band can block off the vessels c. I might need to have this procedure done again d. a catheter will be inserted through my belly to fix the vessels

c. I might need to have this procedure done again

When caring for a client with advanced cirrhosis and hepatic encephalopathy, which assessment finding should the nurse report immediately a. weight loss of 2 pounds in 3 days b. anorexia for more than 3 days c. change in the client's handwriting and or cognitive performance d. constipation for more than 2 days

c. change in the client's handwriting and or cognitive performance

A client with cirrhosis has portal hypertension, which is causing esophageal varices. What is the goal of the interventions that the nurse will provide? a. cure the cirrhosis b. treat the esophageal varices c. reduce fluid accumulation and venus pressure d. promote optimal neurologic function

c. reduce fluid accumulation and venus pressure

What initial measure can the nurse implement to reduce risk of injury for a client with liver disease? a. prevent visitors, so as not to agitate the client b. raise all four side rails on the bed c. apply soft wrist restraints d. pad the side rails on the bed

d. pad the side rails on the bed

What is the most common cause of esophageal varices? a. asterixis b. ascites c. jaundice d. portal hypertension

d. portal hypertension

The nurse is caring for a client with cirrhosis. Which assessment findings indicate that the client has deficient vitamin K absoprtion caused by this hepatic disease? a. dyspnea and fatigue b. ascities and orthopnea c. gynecomastia and testicular atrophy d. purpura and petechia

d. purpura and petechia

Hep B is insidious meaning?

slow onset

Main complications of Cirrhosis

- portal hypertensive - spleen issues ( if fluid can't get back to the liver will back up into the spleen) may need splenomegly

Anytime you have liver issues: Blood Vessels

- spider like blood vessels

Treatment of non-viral hep

- supportive care - liver transplant

Hep C testing

- test in blood work - liver biopsy - do MRE

Treatment of Cirrhosis

- try and stop alcohol - treat symptoms - liver transplant

Additional Liver Diagnostic Studies: MRE (magnetic residence elastography)

combines MRI with sound waves, and more specific to the liver

Which symptoms will a nurse observe most commonly in clients with pancreatitis a. black, tarry stools and dark urine b. increased and painful urination c. increased appetite and weight gain d. severe, radiating abdominal pain

d. severe, radiating abdominal pain

Additional Liver Diagnostic Studies: Ultrasonography

fluid build up

Cautions to take with Hep B in hospital

gowning and gloving

Ascites: Fluid wave

push on one side and it waves on other side, how you know its fluid and not fat

Hepatic Cirrhosis is

the late stage of scarring fibrosis of the liver

Liver Function studies

- ALT, AST--> BIG ONES - usually look at cholesterol - LDL, HDL - Bilirubin--> if issue is pre-liver, intra-liver, or post-liver

Hep A & E

- Always think food - When people don't wash hands after pooping - Passed by feces

Types of Hepatic Cirrhosis

- Chronic Hep B & C - alcoholic - nonalcoholic version ( NASH--> fatty liver, NAFLD--> build up of fat in the liver

Anytime you have liver issues: fluid build up

- JVD - swollen legs - ascities

Signs and Symptoms of Hep B

- abdominal pain - joint pain - fever

Management of Hep B

- acute (less than 6 months or chronic (longer than 6 months) - the younger you are when you get it the more likely it is to be chronic

Ascities: Fluid in Peritoneal Cavity Causes

- all tied into pressure build up not getting into liver properly - screws up anything the liver would normally metabolize - increase in fluid retention - albumin--> screwed up fluid in wrong place

What are concerns for liver issues?

- ascites - poor metabolism - wastes are backing up -all electrolytes - toxins go to the brain (ammonia)

Other complications of Cirrhosis

- bleeding stuff - esophageal varices - hepatic encephalopathy - increased risk for liver cancer - malnutrition - high risk for infections

Hep B is transmitted through

- blood - saliva - semen - vaginal secretions - sexually transmitted - transmitted to infant at time of birth

Hep B & C

- blood borne - bad ones - sexually - needle sticks - mother to baby - drug users

Acute Liver Failure can be

- cancer - autoimmune - patients that are in shock

Complications from acute liver failure

- cerebral edema - can lead to kidney failure/ infections

Anytime you have liver issues you get

- cerebral edema - encephalopathys - fluid build up - blood vessel stuff

Complications of Hep C

- cirrhosis - cancer - liver failure

Nursing Diagnosis for Cirrhosis

- decreased activities - imbalanced nutrition - impaired skin integrity - risk for injury

Concerns with Hepatitis A in kids and elderly

- dehydration - fluid and electrolyte imbalances

Prevention of Cirrhosis

- don't drink - healthy diet - healthy weight - anything to decrease getting HEP

Causes of liver issues?

- drug and alcohol use -toxins

Treatment of Hep B

- exposed but are not sure if you have it immunoglobulin and vaccine - diagnosed with it start on antivirals

Signs and Symptoms of Hep C

- fatigue - decreased appetite - weight loss

General symptoms of liver issues

- fatigue (BIG ONE) - jaundice - decreased appetite - weight loss

Treatment of symptoms of Hep B

- fatigue --> bed rest, take breaks - fever - if liver is not working well be careful what you take for med (no tylenol)

Anytime you have liver issues: cerebral edema/ encephalopathys

- fluid in brain - slurred speech - drowsiness

Treatment of acute liver failure

- if reversible from tylenol - go on liver transplant list

Hepatic Dysfunction Manifestations

- jaundice - portal hypertension - ascites - esophageal varices - hepatic encephalopathy or coma -nutritional deficiences

Prevention of non-viral hep

- limit over the counter stuff - don't overuse tylenol

Complications of non-viral hep

- liver damage - cirrhosis

Risk factors for non-viral hep

- liver disease - being female - industrial job - drinking a lot of alcohol

Treatment of Ascites

- low sodium diet--> get rid of any fluid you have - diuretics--> get rid of fluid - bed rest--> want them moving so they won't get pneumonia - they will have sever fatigue (a huge liver symptom) - paracentesis - administration of salt- poor-albumin

Assessment of Ascites

- measure girth on daily basis - daily weights - striae (stretch marks) - distended veins from fluid build up - hernias - fluid wave - monitor electrolyte imbalances

Symptoms of Hepatitis A

- mild like flu symptoms - low- grade fever - anorexia - later jaundice - dark urine - indigestion - epigastric distress - enlargement of liver and spleen

Hep D

- only people that have hepatitis B are at risk

Hep B Vaccines

- passive immunizations (given the antibodies get the actual vaccine - active (get sick like the chicken pox

Non-viral Hep

- toxic hepatitis - drug induced hepatitis (tylenol overdose) - fulminant hepatitis

Prevention of Hep B

- vaccine - know your status - know your partners status - don't share needles - use new latex condoms

Management of Hepatitis A

- vaccine (if you travel) - once you come in contact they recommend immunoglobulin

What do you do to cure Hep C

- viral infection - curable with meds - taken 2-6 months on daily basis orally ---> worried about compliance

Additional Liver Diagnostic Studies

-Liver Biopsy -Ultrasonography -MRE (magnetic residence elastography)

For non-viral hep if you overdose on Tylenol you

-Mucomist--> NAC - oral liquid that smells like rotten eggs

A nurse is caring for a patient with cirrhosis of the liver and observes that the patient is having hand-flapping tremors. What does the nurse document this finding as? a. constructional apraxia b. asterixis c. ataxia d. fector hepaticus

b. asterixis

Total parental nutrition (TPN) should be used cautiously in client with pancreatitis because such clients: a. are at risk for gallbladder contraction b. cannot tolerate high-glucose concentration c. can digest high-fat foods d. are at risk for hepatic encephalopathy

b. cannot tolerate high-glucose concentration

What test should the nurse prepare the client for that will locate stones that have collected in the common bile duct? a. colonoscopy b. endoscopic retrograde cholangiopancreatography c. abdominal x-ray d. cholecystectomy

b. endoscopic retrograde cholangiopancreatography

A client is being prepared to undergo laboratory and diagnostic testing to confirm the diagnosis of cirrhosis. Which test would the nurse expect to be used to provide definitive confirmation of the disorder? a. coagulation studies b. liver biopsy c.magnetic resonance imaging d. radioisotope liver scan

b. liver biopsy

A client with cirrhosis has a massive hemorrhage from esophageal varices. Balloon tamponade is used temporarily to control hemorrhage and stabilize the client. In planning care, the nurse gives the highest priority to which goal? a. relieving the client's anxiety b. maintaining the airway c. controlling bleeding d. maintaining fluid volume

b. maintaining the airway

A patient with severe chronic liver dysfunction comes to the clinic with bleeding of the gums and blood in the stool. What vitamin deficiency does the nurse suspect the patient may be experiencing? a. folic acid deficiency b. vitamin K deficiency c. riboflavin deficiency d. vitamin A deficiency

b. vitamin K deficiency

The nurse is providing care to a patient with gross ascites who is maintaining a position of comfort in the high semi-fowlers position. What is the nurse's priority assessment of this patient? a. peripheral vascular assessment related to immobility b. urinary output related to increased sodium retention c. skin assessment related to increase in bile salts d. respiratory assessment related to increased thoracic pressure

d. respiratory assessment related to increased thoracic pressure

A student accepted into a nursing program must begin receiving the hepatitis B series of injections. The student asks when the next two injections should be administered. What is the best response by the instructor? a. you must have the second one 1 year and the third the following year b. you must have the second one in 2 weeks and the third in 1 month c. you must have the second one in 6 months and the third in 1 year d. you must have the second on in 1 month and the third in 6 months

d. you must have the second on in 1 month and the third in 6 months

NASH is

fatty liver

Hep A & E are passed by?

feces

Hepatic Dysfunction Manifestations: Ascites

fluid build-up leaking into areas where it's not supposed to be

Ascities can be

liver, kidney or heart

Hepatic Cirrhosis causes

permanent damage but you can stop it from getting worse just can't fix the damage that is done