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nursing 3 Exam

Cirrhosis

QuestionAnswer
Cirrhosis End stage of liver disease
progressive, irreversible, leads to liver failure cirrhosis
cirrhosis 10th leading cause of death
Alcoholic's(Laennec's) cirrhosis most common type in North America
Other causes of cirrhosis include: chronic Hep B or C, prolonged biliary drainage obstruction(bile), severe right sided heart failure, other uncommon liver disorders, maybe unknown cause
pathophysiology of cirrhosis functional liver tissue is destroyed and replaced by fibrous scar tissue
metabolic functions are lost in cirrhosis as _______ and ________ are gradually destroyed hepatocytes, liver lobes
hepatocytes liver cells
fibrous nodules form and causes... disruption of blood flow and bile
types of cirrhosis alcoholic, biliary, posthepatic, and cardiac
alcoholic cirrhosis alcohol causes metabolic changes in liver
alcoholic cirrhosis causes increased triglycerides and fatty acid synthesis and decreased formation and release of lipoproteins
abstinence of this can cause liver to heal alcohol
continuance of this causes liver to become inflamed alcohol
alcoholic hepatitis continued alcohol use causes this
Patient has shrunken liver/nodular, client malnourished in this cirrhosis alcoholic cirrhosis
biliary cirrhosis alot of jaundice, bile flow obstruction within liver/biliary tree leads to inflammation, fibrosis and nodule formation
posthepatic cirrhosis most commonly results from chronic hepatitis B or C; possible results from an unknown cause(liver shrunken, nodular, fibrotic)
cardiac cirrhosis results from severe, long-standing right-sided heart failure
early cirrhosis few manifestations, liver enlarged and possible tender, possible dull aching pain RUQ, anorexia & wt loss, diarrhea & constipation may vary, fever and palpable liver possible
portal hypertension increase pressure in portal venous system which causes shunting of blood to adjoining vessels w/a lower pressure within them
portal hypertension usually affects veins in esophagus, rectum and abdomen: engorged or congested
what happens during portal hypertension tha causes ascites the increased hydrostatic pressure within th portal system vessels causes fluid leaking through the capillaries
ascites plasma-rich fluid accumulates in the abdominal cavity and portal hypertension is the main cuase
splenomegaly due to portal hypertension; removes and destroyes RBC's and WBC's faster: anemia, leukopenia, thrombocytopenia occur
hypoalbuminemia causes decreased plasma colloidal osmotic pressure which allows fluid to escape into extravascular compartments
hyperaldoosteronism causes sodium and H2O retentino which leads to ascites and general edema
esophageal and gastric varices enlarged, thin-walled, collateral veins that develop in lower esophagus and upper stomach from portal hypertension
varices may rupture and cause massive hemorrhage which can be precipitated by... eating high-roughage foods, spicy foods, straining at BM, coughing, sneezing, retching, vomiting, etc.
Patient is already at risk for hemorrhage from _________, decreased _________, and decreased ____________________ throbocytopenia, platelets, clotting factors
hepatic encephalopathy liver destruction causes ammonia accumulation in vlood; acts as a neurotoxin
normally liver converts this to urea which is then excreted by the kidneys ammonia
other precipitating factors of hepatic encephalopathy sedatives, tranquilizers, narcotics, anesthetics, dehydration, constipation, GI bleeding, blood transfusions, high-protein diet, hypoxia, severe infection, surgery
early signs of hepatic encephalopathy asterixis, changes in personality and mentation, agitation, restlessness, impaired judgement, slurred speech
asterixis liver flap; flapping tremor of hands when arms extended; can also affect legs, arms, face, and eyelids
late signs of hepatic encephalopathy confusion, disorientation, incoherence; final stage is deep coma
hepatorenal syndrome renal failure with azotemia(increased nitrogen), sodium retention, oliguria, and hypotension; cause unclear
fetor hepaticus a musty, sweet breath odor from accumulation of digestive by-products that liver can't break down
jaundice skin/sclera is yellow color to varying degrees; body can't conjugated/excrete bilirubin; skin itching from bile salts
palmar erythema a red area on palm that blanches with pressure: secondary to increased estrogen levels
spider angiomas small dilated blood vessels with bright red center and spiderlike branches
spider angiomas are seen nose, cheeks, upper trunk, neck, shoulders; secondary to increased estrogen levels
endocrine problems cause amenorrhea, testicular atrophy, gynecomastia, impotence
peripheral neuropathy most likely due to dietary deficiencies, ex:thiamine, folic acid
diagnostic tests for cirrhosis liver enzymes(increased levels may decrease as body compensates), serum bilirubin & globulin levels elevated, cholesterol level decreased secondary to abn. fat metanolism, PT increased secondary to liver damage, liver bx, ascites fluid analyzed
globulins antiodies produced by B lymphocytes
liver enzyme tests alkaline phosphatase, AST, ALT, GGT
liver biopsy is used to ID liver cells & structural changes
analysis of ascites fluid is to establish diagnosis
medications: Diuretics Aldactone and Furosemide(Lasix)
Aldactone choice tx drug; a potassium-sparing diuretic that competes w/aldosterone; reduces ascites and aldosterone levels; must monitor for hyperkalemia
furosemide(Lasix) loop diuretic; not passium-sparing; must monitor for hypokalemia; may bew used in combo with Aldactone if serum postassium levels WNL
Nursing Responsibilities:Diuretic Therapy Monitor I&O, daily wt before breakfast, fluid restriction if ordered:divide fluids, monitor labs:potassium, BUN, creatinine, monitor hyponatremia(confusion,lethargy, apprehension), admin meds in AM to avoid nocuturia, admin by 6pm
Medications: Hepatic Encephalopathy lactulose and neomycin sulfate
lactulose decreases ammonia-forming organisms in bowel and increases colon acidity to prevent ammonium absorption: PO liquid
ammonium is excreted in feces
lactulose pulls water into bowels and ____________ the number of stools increases
monitor these when taking lactulose bowel sounds, # stools, abdominal girth, hydration, and electrolytes
take lactulose with... crackers/soft-drink PRN nausea
neomycin sulfate an aminoglycoside antibiotic; reduces # ammonia-forming bacteria in bowel; oral or rectal routes
toxic effects of neomycin sulfate ototoxic, nephrotoxic, and neurotoxic
monitor these when on neomycin sulfate I&O, BUN/creatinine levels
neomycin sulfate causes decreases absorption of... digitalis
No protein restriction unless ___________ levels high serum ammonia
Paracentesis aspiration of fluid from peritoneal cavity to treat severe ascites that does not respond to diuretic therapy
goal of paracentesis relieve respiratory distress + preserve F&E balance, may removed 500ml to 4-6 liters
IV albumin is administered with paracentesis to... maintain intravascular volume
Nursing Responsibilites of paracentesis consent, teach, weight, VS, void, positioning, dressing, labs
which diagnostic test would assist to confirm a suspected diagnosis of hepatitis? serum bilirubin
The client says to the nurse, "I think I got this case of Hep A from giving blood a few months ago.". The nurse realizes that Hep A is most often contracted through: contaminated food
Which info obtained from a client would suggest the most probable cause of Hep B diagnosis? "I got my belly button pierced last month"
When teaching a community class about Hep C, the nurse would stress which characteristic about the virus It is a very virulent virus with no cure
A client with Hep C asks the nurse about life-style modifications he could make to decrease the progression of his illness to chronic Hep C. The nurse understands that the most important life-style modification is: abstinence from alcohol
The client with cirrhosis is ordered a very low protein diet. What is the scientific rationale for this? Dietary restriction will reduce the breakdown of protein by the intestinal bacteria in the GI tract, thereby decreasing serum ammonia levels.
Portal Hypertension is caused by: increased hepatic portal system pressure from scar tissue contraction around hepatic blood vessels
Asterixis an accumulation of nitrogenous wastes in the body
The client with esophageal varices is eating snacks brought to his room by visitors. Which of the following foods would be contraindicated? peanut brittle
Failure of the liver to remove ammonia and metabolic wastes from the blood leads to: mental confusion
The nurse caring for a client with cirrhosis notes that the physician has written new orders. Which of the following orders would the nurse question? rectal temperature every four hours
The bedridden client with ascites is experiencing sternal retractions, dyspnea, and restlessness. Rank each of the following nursing interventions in order of priority. 1. Sit client up in semi-fowler's position 2. Assess pulse oximetry 3.Assess Vitals 4. Assess breath sounds 5. Reassess abdominal girth
The client with chronic cirrhosis has just completed a bedside liver bx 15mins ago. The nurse assesses the bx site dressing consisting of 2 4x4 gauze pads, & notes that it is semi-saturated w/sero-sanguinous drainage. What action should the nurse take? Put pressure on the site for 5 mins and reassess
The client is about to have a bedside paracentesis. In what position would the client be placed? Fowler's
The client with an elevated ammonia level is ordered Lactulose 30ml PO BID. What expected drug action should the nurse explain to the client? "You will move your bowels 2-3 times a day"
The nurse is expecting a client w/chronic cirrhosis, bleeding esophageal varices, and a minnesota tube to be admitted to the nursing unit. What equipment should the nurse have in the client's room before they arrive? A suction machine
The client w/cirrhosis has a high ammonia level. Which portion of the diet prescription should the nurse question? High Protein
A client who is jaundiced and is suspected of having contracted Hep B has been admitted to the hospital. Which of the following nursing interventions would be most appropriate for this client? Encourage bed rest to reduce the liver's metabolic demands
A client is suspected of having hepatitis. Which diagnostic test will assist in confirming this diagnosis? elevated serum bilirubin
Created by: jbittner