1
Q
Where does the liver receive blood from?
A
Receives blood from GI tract via the portal vein and from the hepatic artery
2
Q
What are the metabolic functions of the liver?
A
- Glucose metabolism
- Ammonia conversion - if dysfunction this will accumulate in blood stream and lead to confusion.
- Protein metabolism
- Fat metabolism
- Vitamin and iron storage
- Bile formation - liver creates bile and gallbladder store it.
- Bilirubin excretion - too much leads to jaundice
- Drug metabolism
3
Q
Is the following statement true or false?
The majority of blood supply to the liver, which is poor in nutrients, comes from the portal vein.
A
False
Rationale: The majority of blood supply to the liver, which is rich in nutrients from the gastrointestinal tract, comes from the portal vein.
4
Q
If patients are having liver issues, what labs are expected to be ordered?
A
- Serum aminotransferase: AST, ALT, GGT, GGTP, LDH
- Serum protein studies
- Direct and indirect serum bilirubin, urine bilirubin, and urine bilirubin and urobilinogen
- Clotting factors & platelets
- Serum alkaline phosphatase
- Serum ammonia
- Lipids
5
Q
Elevated bilirubin levels are commonly associated with what clinical condition? (Table 43-1)
A
Jaundice
6
Q
Why is albumin important in liver disease? (Table 43-1)
A
Albumin is produced by the liver; low levels indicate impaired liver function.
7
Q
Low albumin levels are commonly seen in which liver conditions? (Table 43-1)
A
Cirrhosis
Chronic hepatitis
Ascites
8
Q
Why does PT/INR increase in liver disease? (Table 43-1)
A
The liver produces clotting factors, so damage impairs clotting factor synthesis.
9
Q
What do elevated AST and ALT indicate? (Table 43-1)
A
Liver cell injury or hepatocellular damage.
10
Q
Elevated GGT is commonly associated with what condition? (Table 43-1)
A
Alcohol abuse and biliary obstruction.
11
Q
Elevated alkaline phosphatase usually indicates what condition? (Table 43-1)
A
Biliary tract obstruction.
12
Q
Why does ammonia increase in liver disease? (Table 43-1)
A
The liver cannot convert ammonia to urea.
13
Q
Elevated ammonia levels can lead to what serious complication? (Table 43-1)
A
Hepatic encephalopathy.
14
Q
Which lab value best indicates liver synthetic function?
A
PT/INR and albumin
15
Q
Which lab suggests biliary obstruction?
A
Alkaline phosphatase
16
Q
Which lab is associated with hepatic encephalopathy?
A
Ammonia
17
Q
Alanine aminotransferase (ALT) levels increase primarily in :
A
Liver disorders.
Used to monitor the course of hepatitis, cirrhosis, and the effects of treatments/drugs that may be toxic to the liver
18
Q
True / False
Aspartate aminotransferase (AST) is specific to liver diseases.
A
False
Not specific to liver diseases; however, levels of AST may be increased in cirrhosis, hepatitis, and liver cancer
19
Q
Apart from Labs, what additional diagnostic studies of the liver can we do?
A
- Liver biopsy - liver transplant will have biopsy of donated liver to assess functioning.
- US
- CT
- MRI
20
Q
When assessing a patient w/ suspected liver disease, what physical assessments should we do?
A
- Skin: is it Jaundiced? Skin is also very thin and delicate - ensure no skin tearing.
- Cognitive status: Think Wernicke’s Encephalopathy
- Palpation, percussion - assess for ascites
21
Q
In patients w/ suspected liver disease, what health history do we want to know about in our assessment?
A
- Previous exposure to hepatotoxic substances or infectious agents
- Travel (Hep a,b,c,d) alcohol and drug use (IV drug use often related to Hep C infection)
- Lifestyle
22
Q
Why do patients with liver disease look Jaundice?
A
Due to elevated bilirubin in the blood.
Liver excrete bilirubin.
Bilirubins is attempting to get into the bile duct and GI, to be excreted in feces, however if there is a blockage in the ducts bilirubin will build up
23
Q
What is Portal HTN assiciated with?
A
Hepatic cirrhosis.
Caused by backflow and obstruction.
This will eventually lead to Ascites and Esophageal varices
24
Q
What can hepatic encephalopathy lead to?
A
Coma
25
What deficiencies may hepatic dysfunction lead to?
Nutritional deficiencies such as protein, iron and vitamins.
26
What is Jaundice?
Presents as yellow- or greenish-yellow sclera and skin caused by increased serum bilirubin levels > 2mg/dl
27
What type of Jaundice is not liver related?
Hemolytic Jaundice.
Caused by destruction of RBC's
And unconjugated bilirubin, bilirubin not yet processed by liver
28
If Hepatic in origin, what are the two causes of Jaundice?
Hepatocellular: damaged liver cells cannot clear bilirubin
Obstructive: bile duct occlusion (eg, gallstones)
Hepatocellular and obstructive jaundice are most associated with liver disease
29
What is Gilbert Syndrome?
Hereditary hyperbilirubinemia
Liver doesn’t process bilirubin effectively
30
What are the S/S of Hepatocellular Jaundice?
When cell of the liver starts to get damaged.
* Mild or severely ill
* Lack of appetite, nausea or vomiting, weight loss
* Malaise, fatigue, weakness
* Headache, chills, fever, infection
31
What are the S/S of Obstructive Jaundice?
Bile duct in is involved.
s/s:
* Dark orange-brown urine - kidneys trying to do the job of liver to get rid of bilirubin
* Clay-colored stools (due to bilirubin not being excreted in the GI tract)
* Dyspepsia and intolerance of fats (bile duct involvement)
* Impaired digestion (bile duct involvement)
* Pruritus - make sure we assess skin for tears.
32
What is Portal Hypertension?
Obstructed blood flow through the liver results in increased pressure throughout the portal venous system.
Results in Ascites and Esophageal varices
Often associated with hepatic cirrhosis
33
Explain why Portal Hypertension may result in Ascites.
(long answer)
Portal hypertension results in increased capillary pressure and obstruction of venous blood flow. will eventually lead to vasodilation of splanchnic circulation (blood flow to the major abdominal organs).
This also changes the ability to metabolize aldosterone which will ↑ fluid retention.
There will also be ↓ synthesis of albumin and a ↓ in osmotic pressure - pt at risk for falling.
Albumin moves into the peritoneal cavity and consequently water follows.
Decreased circulating arterial blood volume activates the RAAS system, SNS and ADH.
Kidneys will retain sodium and water due to aldosterone causing hypervolemia
34
How do we assess for Ascites?
* Record daily weight and abdominal girth
* Patients may have striae, distended veins, and umbilical hernia
* Percuss abdomen
* Monitor for potential fluid and electrolyte imbalances due to large fluid shift.
35
How do we treat Ascites?
* Low sodium diet - due to already retaining more sodium due to Aldosterone and RAAS
* Diuretics - Spironolactone
* Bed rest
* Paracentesis
* Administration of salt-poor albumin via IV to pull fluid out of the cavity and into the bloodstream.
* Transjugular intrahepatic portosystemic shunt (TIPS)
36
Which diuretic medication would most often be used for a patient with ascites?
a) Acetazolamide
b) Ammonium chloride
c) Furosemide
d) Spironolactone
d) Spironolactone
Rationale:
Spironolactone is most often the first-line therapy in patients with ascites from cirrhosis. Oral diuretics such as furosemide may be added but should be used cautiously. Ammonium chloride and acetazolamide are contraindicated because of the possibility of precipitating hepatic coma.
37
What is Hepatic Encephalopathy?
Life-threatening complication caused by accumulation of ammonia and other toxic metabolites in the blood, will eventually affect the brain.
May lead to coma.
38
What are the two causes of Hepatic Encephalopathy?
Hepatic insufficiency: the inability of the liver to detoxify toxic by-products of metabolism - toxins will build up
Portosystemic shunting: collateral vessels develop allowing elements of the portal blood (laden with potentially toxic substances usually extracted by the liver) to enter the systemic circulation
39
What are early signs of Hepatic Encephalopathy?
Mental changes
Motor disturbances
40
What assessments should we be doing when we suspect or are assessing patients w/ Hepatic Encephalopathy?
* EEG
* Changes in LOC
* Potential seizures
* Fetor hepaticus: sweet, slight fecal odor in breath
* Monitor fluid, electrolyte, and ammonia levels
41
What level of consciousness occurs in Stage 1 hepatic encephalopathy? (Table 43-3)
Normal consciousness with periods of lethargy and euphoria.
42
What sleep disturbance is characteristic of Stage 1 hepatic encephalopathy? (Table 43-3)
Reversal of the day–night sleep pattern.
43
What early cognitive changes occur in Stage 1 hepatic encephalopathy? (Table 43-3)
Difficulty writing and drawing line figures.
44
What EEG finding occurs in Stage 1 hepatic encephalopathy? (Table 43-3)
Normal EEG.
45
What nursing diagnoses are associated with Stage 1 hepatic encephalopathy? (Table 43-3)
Activity intolerance
Impaired ability to manage regimen
Impaired sleep pattern
46
What mental status changes occur in Stage 2 hepatic encephalopathy? (Table 43-3)
Increased drowsiness
Disorientation
Inappropriate behavior
Mood swings
Agitation
47
What is asterixis? (Table 43-3)
A flapping tremor of the hands, a hallmark sign of hepatic encephalopathy.
48
What is fetor hepaticus? (Table 43-3)
A musty, sweet breath odor caused by liver failure.
49
What EEG change occurs in Stage 2 hepatic encephalopathy? (Table 43-3)
Generalized slowing of brain activity.
50
What nursing diagnoses may occur in Stage 2 hepatic encephalopathy? (Table 43-3)
Impaired socialization
Impaired role performance
Risk for injury
Acute confusion
51
What level of consciousness occurs in Stage 3 hepatic encephalopathy? (Table 43-3)
Stupor with difficulty arousing the patient.
52
What communication problems occur in Stage 3 hepatic encephalopathy? (Table 43-3)
Incoherent speech and severe confusion.
53
What neurologic findings occur in Stage 3 hepatic encephalopathy? (Table 43-3)
Asterixis - hand tremor
Increased deep tendon reflexes
Rigidity of extremities
54
What EEG change occurs in Stage 3 hepatic encephalopathy? (Table 43-3)
Markedly abnormal EEG.
55
What nursing diagnoses may occur in Stage 3 hepatic encephalopathy? (Table 43-3)
Impaired nutritional intake
Impaired mobility
Impaired verbal communication
56
What level of consciousness occurs in Stage 4 hepatic encephalopathy? (Table 43-3)
Coma with little or no response to painful stimuli.
57
What happens to asterixis in Stage 4 hepatic encephalopathy? (Table 43-3)
It disappears.
58
What happens to deep tendon reflexes in Stage 4 hepatic encephalopathy? (Table 43-3)
They are absent.
59
What happens to muscle tone in Stage 4 hepatic encephalopathy? (Table 43-3)
Flaccid extremities.
60
What EEG change occurs in Stage 4 hepatic encephalopathy? (Table 43-3)
Markedly abnormal EEG.
61
What nursing diagnoses are associated with Stage 4 hepatic encephalopathy? (Table 43-3)
Risk for aspiration
Impaired gas exchange
Impaired tissue integrity
62
What is the earliest sign of hepatic encephalopathy?
Sleep pattern reversal and mild confusion.
63
How is Hepatic Encephalopathy medically managed?
* Eliminate precipitating cause
* Lactulose to reduce serum ammonia levels by eliminating it in feces. Order usually 3-4 BM's/day - ensure patient doesn't refuse.
* IV glucose to minimize protein catabolism - by product of protein metabolism is NH4 (ammonia)
* Protein 1.3-1.5g/kg/day
* Reduction of ammonia from GI tract by gastric suction, enemas, oral antibiotics - Rifaximin, Neomycin, or Metronidazole to reduce ammonia forming bacteria in colon
* Discontinue sedatives, analgesics, and tranquilizers
* Monitor or treat complications and infections
64
What are the clinical manifestations of Esophageal Varices?
* Hematemesis,
* Melena,
* General deterioration
* Shock
65
Esophageal Varices most often happen in patients with what diagnosis?
Decompensated cirrhosis
66
How often should patients w/ cirrhosis undergo endoscopy screening?
Every 2-3 years.
67
Explain the Patho behind Esophageal Varices.
1) Portal HTN - too much resistance to portal flow in and through the liver
2) Development of pressure gradient of > 12 mm Hg between portal veins and IVC
3) Venous collaterals ( Venous collaterals are alternate pathways of venous blood flow that develop when a normal vein is blocked or under high pressure.) develop from high portal system pressure to systemic veins in esophageal plexus, hemorrhoidal plexus and retroperitoneal veins
4) Abnormal varicoid vessels form in any of above locations
5) Vessels may rupture causing life- threatening hemorrhage.
68
How do we treat patients going into shock from bleeding varices.
If patient is going into shock - admin oxygen, IV fluids, electrolytes, volume expanders, blood and blood products.
69
What medication would we give for bleeding varices?
* Octreotide to decrease bleeding, may also be given prophylactically.
* Vasopressin once we're able to increase fluid volume.
70
What medication would we give to reduce coronary vasoconstriction when treating bleeding varices?
Nitroglycerin in combination with vasopressin to reduce coronary vasoconstriction.
71
Why would we give Propranolol and nadolol to patients with bleeding varices?
To decrease portal pressure; used in combination with other treatment
72
What is a balloon tamponade?
Balloon tamponade is an emergency procedure used to stop severe bleeding from esophageal or gastric varices (usually caused by portal hypertension in liver cirrhosis).
It works by inflating balloons inside the esophagus and stomach to compress bleeding veins, temporarily stopping the hemorrhage.
73
What is Endoscopic variceal ligation (esophageal banding therapy) ?
place bands around varices to stop the bleeding.
74
What is a Transjugular intrahepatic portosystemic shunt?
A Transjugular Intrahepatic Portosystemic Shunt (TIPS) is a minimally invasive procedure that creates a channel inside the liver connecting the portal vein to the hepatic vein using a stent.
This reduces portal hypertension by allowing blood to bypass the scarred liver and flow directly into systemic circulation.
75
What are our nursing managements for patients with Esophageal Varices?
* Maintain safe environment; prevent injury, bleeding and infection
* Administer prescribed treatments and monitor for potential complications
* Encourage deep breathing and position changes
* Education and support of patient and family
76
Is the following statement true or false?
Bleeding esophageal varices result in an increase in renal perfusion.
False
Rationale:
Bleeding esophageal varices do not result in an increase in renal perfusion. Bleeding esophageal varices result in a decrease in renal perfusion due to loss of blood
77
What is viral Hepatitis?
A systemic viral infection that causes necrosis and inflammation of liver cells with characteristic symptoms and cellular and biochemical changes
78
How is Hep A & E transmitted?
fecal–oral route
79
How is Hep B & C transmitted?
B and C: bloodborne
80
True/False
Only people with Hepatitis B are at risk for infection of Hep D
True
81
How does a person get non viral hepatitis?
Hepatitis is toxic and drug induced.
Tylenol may cause this.
82
Define Hepatitis A.
Spread by poor hand hygiene; fecal–oral
Travelling to 3rd world countries carries increased risk.
Incubation period 2 - 6 weeks
Illness may last 4-8 weeks
Mortality rate 0.5 % if < 40 y.o and 1-2% >40 y.o
83
How does Hep A manifest itself?
* mild flu-like symptoms
* low-grade fever
* anorexia
* later s&s : jaundice and dark urine
* indigestion and epigastric distress
* enlargement of liver and spleen
84
What are the best ways to prevent Hep A?
Good handwashing, safe water, and proper sewage disposal and vaccination.
Immunoglobulin for contacts to provide passive immunity
85
True / False
Patients should be on bed rest during acute stage of Hep A
True.
86
Why is safe food preparation important in preventing Hepatitis A? (Chart 43-5)
Hep A is commonly spread through contaminated food handling.
87
What community measure helps prevent Hepatitis A outbreaks? (Chart 43-5)
Proper sanitation and public health reporting.
88
At what age is Hepatitis A vaccination recommended for children? (Chart 43-5)
12–23 months of age.
89
Which groups are recommended to receive the Hepatitis A vaccine? (Chart 43-5)
Travelers to developing countries
Injection and noninjection drug users
Men who have sex with men
People with chronic liver disease
People working with Hep A in labs or animals
Recipients of pooled plasma products (e.g., hemophiliacs)
90
Why is health supervision important in schools and dormitories for Hep A prevention? (Chart 43-5)
Hep A spreads easily in crowded environments.
91
How is Hepatitis B primarily transmitted? (Chart 43-5)
Through blood, sexual contact, or body fluids.
92
What behavioral intervention helps prevent Hepatitis B? (Chart 43-5)
Avoid high-risk behaviors (e.g., unprotected sex, sharing needles).
93
Why should multidose vials be avoided in patient care settings? (Chart 43-5)
They increase the risk of bloodborne infection transmission.
94
What infection control practice helps prevent Hepatitis B transmission in healthcare settings? (Chart 43-5)
Standard precautions and barrier protection.
95
Why are needleless IV systems recommended? (Chart 43-5)
To reduce needlestick injuries and bloodborne transmission.
96
Who should receive the Hepatitis B vaccine? (Chart 43-5)
All infants in the U.S.
Travelers to high-risk areas
People with HIV
People with chronic liver disease
Individuals at risk of blood or sexual exposure
97
What is the most common transmission route for Hepatitis C? (Chart 43-5)
Blood exposure, especially IV drug use.
98
What infection control measures help prevent Hepatitis C in healthcare settings? (Chart 43-5)
Standard precautions
Barrier precautions
Proper sterilization of equipment
99
Which hepatitis virus spreads primarily by fecal-oral transmission?
Hepatitis A
100
Which hepatitis viruses are bloodborne infections?
Hepatitis B and Hepatitis C
101
Which hepatitis viruses have vaccines available?
Hepatitis A and Hepatitis B
102
Which hepatitis virus does NOT have a vaccine?
Hepatitis C
103
Define Hepatitis B.
Transmitted through blood, saliva, semen, and vaginal secretions; sexually transmitted; transmitted to infant at the time of birth
A major worldwide cause of cirrhosis and liver cancer
104
What is the incubation period for Hep B?
1 to 6 months
105
How does Hep B manifest itself?
Insidious and variable; similar to Hep A,
loss of appetite,
dyspepsia,
abdominal pain,
generalized aching,
malaise, and weakness
Jaundice may or may not be evident
106
What herbal supplement should be avoided in patients taking hepatitis C protease inhibitors? (Chart 43-6)
St. John’s wort.
107
When might enteral feedings be necessary in hepatitis patients? (Chart 43-6)
When anorexia, nausea, or vomiting persist.
108
Why must nurses monitor fluid balance in hepatitis patients? (Chart 43-6)
Liver dysfunction can lead to fluid imbalance and complications such as ascites.
109
How long should patients abstain from alcohol after recovering from hepatitis? (Chart 43-6)
During acute illness and for at least 6 months after recovery.
110
Why should long periods without food be avoided in hepatitis? (Chart 43-6)
The liver needs consistent energy intake for healing and metabolism.
111
Why are hemodialysis patients at risk for Hepatitis B? (Chart 43-7)
They have frequent blood exposure and invasive procedures.
112
What type of drug use is a major risk factor for Hepatitis B? (Chart 43-7)
IV/injection drug use.
113
How can Hepatitis B be transmitted from mother to child? (Chart 43-7)
Vertical transmission during pregnancy or childbirth.
114
Why is a recent sexually transmitted infection a risk factor for Hepatitis B? (Chart 43-7)
It indicates high-risk sexual behaviors.
115
Why does tattooing increase the risk of Hepatitis B? (Chart 43-7)
It may involve non-sterile needles and blood exposure.
116
How is Hep B managed medically?
Medications for chronic hepatitis type B include alpha interferon and antiviral agents: entecavir (ETV) and tenofovir (TDF)
Bed rest and nutritional support
117
True / False
Hep B vaccine is routine for infants.
True
118
True/False
Healthcare workers are high risk profession for contracting Hep B & C, and workers should be vaccinated.
True. Although no vaccination for Hep C
119
Define Hep C.
* Transmitted by blood and sexual contract, including needle sticks and sharing of needles
* The most common bloodborne infection
* A cause of one third of cases of liver cancer and the most common reason for liver transplant
* Incubation period is variable: ranging from 15 to 160 days
* Symptoms are usually mild
* Chronic carrier state frequently occurs - Hep C but non-symptomatic
120
Why are healthcare workers at risk for Hepatitis C? (Chart 43-8)
Because of needlestick injuries or mucosal exposure to infected blood.
121
What sexual behaviors increase risk for Hepatitis C infection? (Chart 43-8)
Multiple sexual partners
History of sexually transmitted infections
Unprotected sex
122
What is the most common risk factor for Hepatitis C infection? (Chart 43-8)
Past or current IV/injection drug use.
123
Why do blood transfusions before 1992 increase the risk of Hepatitis C? (Chart 43-8)
Blood was not routinely screened for HCV before 1992.
124
What are our medical managements of Hep C?
* Antiviral medications
* Alcohol potentiates disease;
* Medications that effect the liver should be avoided
125
What are ways to prevent Hep C?
* Public health programs to decrease needle sharing among drug users
* Screening of blood supply
* Safety needles for health care workers
126
Define Hep D.
* Only persons with hepatitis B are at risk
* Blood and sexual contact transmission
* Use of IV or injection drugs, patients undergoing hemodialysis, and recipients of multiple blood transfusions
* Incubation period between 30 and 150 days
127
Patient with Hep D are likely to develop what?
Fulminant liver failure or chronic active hepatitis and cirrhosis
128
Which drug is the only licensed drug available for treatment of Hep D?
Interferon alfa
129
Define Hep E.
* Transmitted by fecal–oral route, contaminated water
* Incubation period: 15 to 65 days
* Resembles hepatitis A; self-limiting, abrupt onset, not chronic
* Prevention: good hygiene, handwashing
130
What is the typical outcome of Hepatitis A infection? (Table 43-4)
Usually mild with complete recovery and no chronic carrier state.
131
What additional symptoms may occur in Hepatitis B? (Table 43-4)
Joint pain (arthralgia)
Skin rash
132
What serious complications are associated with Hepatitis B? (Table 43-4)
Chronic hepatitis
Cirrhosis
Hepatocellular carcinoma
133
How do symptoms of Hepatitis C usually compare to Hepatitis B? (Table 43-4)
Similar but often less severe and sometimes without jaundice.
134
How severe is Hepatitis D compared with Hepatitis B? (Table 43-4)
Similar symptoms but greater risk of chronic hepatitis and cirrhosis.
135
What population is at high risk for severe Hepatitis E complications? (Table 43-4)
Pregnant women.
136
Which hepatitis viruses usually do NOT cause chronic infection?
Hepatitis A and Hepatitis E.
137
What are the 3 types of Hepatic Cirrhosis?
* Alcoholic: scar tissue characteristically surrounds the portal areas
* Postnecrotic: broad bands of scar tissue, late result of viral hepatitis
* Biliary: scarring occurs in the liver around the bile ducts
138
What are the medical manifestations of Hepatic Cirrhosis?
* liver enlargement,
* portal obstruction,
* ascites,
* infection and peritonitis,
* varices, GI varices,
* edema,
* vitamin deficiency,
* anemia,
* mental deterioration
139
What are nursing intervention for patients w/ hepatic cirrhosis?
* Promoting rest - important
* Improving nutritional status
* Providing skin care due to thin skin w/ easy tearing.
* Reducing risk of injury - Ascites have low BP and may have orthostatic hypotension and fall risk. Or may have confusion.
* Monitoring and managing potential complications
140
Why should patients rest when fatigued or when abdominal discomfort occurs? (Chart 43-10)
Rest conserves energy and protects the liver.
141
What diet supports energy and healing in liver disease? (Chart 43-10)
High-carbohydrate diet with 1.2–1.5 g/kg/day protein.
142
Why are vitamins A, B-complex, C, and K administered in liver disease? (Chart 43-10)
To provide additional nutrients and support metabolic processes.
143
What symptoms contribute to impaired nutrition in liver disease? (Chart 43-10)
Abdominal distention, discomfort, and anorexia.
144
Why should the head of the bed be elevated during meals? (Chart 43-10)
It decreases abdominal pressure and improves comfort while eating.
145
Why should medications for nausea, vomiting, and constipation be administered? (Chart 43-10)
To reduce GI symptoms that interfere with eating.
146
What causes skin problems in liver disease? (Chart 43-10)
Pruritus from jaundice and edema.
147
Why are patients with liver disease at risk for injury? (Chart 43-10)
Because clotting mechanisms are impaired and mental status may change.
Also fall risk if albumin is decreased.
148
What neurological assessment is important in liver failure? (Chart 43-10)
Level of consciousness and cognitive function.
149
What environmental modifications reduce injury risk? (Chart 43-10)
Padding side rails
Removing obstacles
Preventing falls
150
Why should stool and emesis be tested for occult blood? (Chart 43-10)
To detect gastrointestinal bleeding early.
151
Why must vital signs be monitored frequently? (Chart 43-10)
To detect hypovolemia and hemorrhagic shock.
152
What is a banana bag?
Yellow IV bag with vitamins such as thiamine (Vit B1) to help with nutritional deficiencies in hepatic patients.
153
What diet should be restricted if patients are at risk for encephalopathy?
High sodium and high protein.
Protein should be 1.2-1.5g/kg/day
154
How often should we be doing I&O's for patients w/ cirrhosis?
At least q4h
155
Hepatic patients are at an increased risk for :
Bleeding due to reduced clotting abilities and reduced production of thrombopoietin.
156
What medication should be given to reduce risk of encephalopathy?
Lactulose/rifaximin
157
Primary liver tumors are associated with which viral infections?
Hep B & C
158
What is cancer originating in the liver called?
Hepatocellular carcinoma (HCC)
159
True / False
Few cancers originate in the liver
True - However it is a frequent site of metastatic cancer
160
How does hepatic cancer manifest itself?
* Dull persistent pain, RUQ, back, or epigastrium
* Weight loss, anemia, anorexia, weakness
* Jaundice, bile ducts occluded, ascites, or obstructed portal veins
161
What are non-surgical managements of liver cancer?
Surgery is risky, benefits must outweigh risk - cirrhosis increases this risk f surgery .
Major effect of nonsurgical therapy may therefore be palliative.
Radiation therapy
Chemotherapy
Percutaneous biliary drainage
162
Surgical management is treatment of choice in which type of cancer?
If hepatocellular carcinoma (HCC) if confined to one lobe and liver function is adequate
163
True / False
The liver has regenerative capacity
True - the liver will grow back to normal if a piece is cut out. This cannot happen when the liver have cirrhosis.
164
What are the 3 types of liver surgery that we can do?
Lobectomy - regenerative
Cryosurgery
Liver transplant
165
What are the pre-op managements of patients undergoing a liver transplant?
Support, education, and encouragement are provided to help prepare psychologically for the surgery
Collaborative teamwork.
166
What are the post-op managements of patients undergoing a liver transplant?
Usually ICU
Monitor for infection, vascular complications (due to being a very vascular organ) , respiratory and liver dysfunction, constant close monitoring.
Will be on anti rejection medication which will make them immunosuppressed and increase their risk of infection.
167
The nurse is caring for a client with cirrhosis. Which assessment findings indicate that the client has deficient vitamin K absorption caused by this hepatic disease?
a) dyspnea and fatigue
b) ascites and orthopnea
c) purpura and petechiae
d) gynecomastia and testicular atrophy
c) purpura and petechiae
168
Ammonia, the major etiologic factor in the development of encephalopathy, inhibits neurotransmission. Increased levels of ammonia are damaging to the body. The largest source of ammonia is from :
a) the digestion of dietary and blood proteins
b) excessive diuresis and dehydration
c) severe infections and high fevers
d) excess potassium loss subsequent to prolonged use of diuretics
a) the digestion of dietary and blood proteins
169
A client has developed drug-induced hepatitis from a drug reaction to antidepressants. What treatment does the nurse anticipate the client will receive to treat the reaction?
a) paracentesis
b) liver transplant
c) high-dose corticosteroids
d) Azathioprine
c) high-dose corticosteroids
