Cirrhosis Overview and Laennec's Stages

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Questions and Answers

Which of the following should be avoided in patients with liver problems?

Low protein diet

Rigid abdomen assessment

Beer

Acetaminophen (correct)

What characterizes an emergency situation in liver patients related to abdomen assessment?

Trickling sounds upon auscultation

Increased albumin levels

Soft abdomen

Rigid board-like abdomen (correct)

Which of the following is a common assessment technique in liver patients?

Measuring blood pressure before diet changes

Inspecting the nails for clubbing

Assessment of sclera (correct)

Checking heart rate during bowel training

What should be monitored closely considering the risk factors in liver patients?

Risk for falls due to hepatic encephalopathy Signup and view all the answers

What is an appropriate room assignment for a patient with liver problems?

AIDS & liver patient Signup and view all the answers

What is the primary effect of cirrhosis on liver tissue?

Destruction and replacement with fibrous scar tissue Signup and view all the answers

Which of the following symptoms may occur during the early stage of cirrhosis?

Vague symptoms with RUQ pain Signup and view all the answers

What is one of the major complications associated with cirrhosis?

Portal hypertension Signup and view all the answers

What causes the development of esophageal varices in cirrhosis patients?

Increased pressure in the portal venous system Signup and view all the answers

Which of the following is a metabolic consequence of cirrhosis?

Accumulation of metabolic toxins Signup and view all the answers

What symptom is associated with impaired plasma protein synthesis in cirrhosis?

Ascites Signup and view all the answers

Which of the following factors contributes to the increased risk of bleeding in cirrhosis patients?

Decreased clotting factor synthesis Signup and view all the answers

How does cirrhosis impact hormone metabolism?

Alters sex hormone metabolism Signup and view all the answers

What is the primary purpose of administering K (Aquamephyton) in patients with cirrhosis?

To reduce the risk of bleeding Signup and view all the answers

Which medication is specifically indicated to improve liver function in patients with cirrhosis?

Ursodeoxycholic acid Signup and view all the answers

What is a significant indication for considering liver transplantation?

Increasing bilirubin levels Signup and view all the answers

Which nursing diagnosis addresses the risk for injury in patients with cirrhosis?

Risk for injury R/T altered clotting mechanism Signup and view all the answers

In managing a patient with cirrhosis, what type of dietary intake is recommended?

High-calorie, moderate protein diet Signup and view all the answers

What is a key nursing intervention to prevent injury through bleeding?

Teach the client to use soft toothbrush Signup and view all the answers

Which symptom may indicate gastrointestinal (GI) bleeding in a patient with cirrhosis?

Weakness Signup and view all the answers

What nursing action should be taken to promote activity tolerance in patients with cirrhosis?

Encourage periods of rest and ambulation Signup and view all the answers

What is the primary characteristic of cirrhosis?

Diffuse destruction and fibrotic regeneration of hepatic cells Signup and view all the answers

Which type of cirrhosis is primarily caused by long-term high-risk alcohol consumption?

Laennec's/Alcoholic/Portal cirrhosis Signup and view all the answers

What is a common symptom seen in the early stages of biliary cirrhosis?

Pruritus Signup and view all the answers

What is a defining feature of post-hepatic cirrhosis?

Significant liver cell loss and fibrosis along with shrinkage of the liver Signup and view all the answers

Which stage of Laennec's cirrhosis is characterized by alcoholic hepatitis?

2nd stage: Alcoholic hepatitis Signup and view all the answers

Which condition can lead to cardiac cirrhosis?

Severe chronic right-sided heart failure Signup and view all the answers

What should be closely monitored in a client to prevent dehydration and hypokalemia?

Fluid intake and output Signup and view all the answers

What metabolic change does alcohol cause in the liver during the first stage of Laennec's cirrhosis?

Increased fatty infiltration of hepatocytes Signup and view all the answers

Which position is recommended for clients experiencing impaired gas exchange related to ascites?

Semi-Fowler's with feet elevated Signup and view all the answers

Which of the following indicates the end stage of alcoholic cirrhosis?

Fibrotic tissue replacing normal tissue, with little function remaining Signup and view all the answers

Which intervention should be avoided to prevent rectal manipulation in client care?

Performing digital rectal exams Signup and view all the answers

What is an appropriate nursing intervention for promoting skin integrity?

Turn the client every 2 hours Signup and view all the answers

What should be assessed to maintain adequate tissue perfusion in clients with bleeding esophageal varices?

Vital signs and monitoring for hypovolemia Signup and view all the answers

What dietary restriction is recommended if serum ammonia levels are elevated?

High-protein diet Signup and view all the answers

Which of the following interventions promotes improved thought processes in clients?

Reorienting the client frequently Signup and view all the answers

In clients receiving vasopressin infusion, which complication should be monitored?

Hypertension Signup and view all the answers

Study Notes

Cirrhosis

Chronic liver disease characterized by replacement of liver cells with scar tissue, leading to impaired liver function.
Classified into four types:
- Laennec's/Alcoholic/Portal Cirrhosis: Most common type, often associated with long-term heavy alcohol consumption.
- Biliary Cirrhosis: Caused by bile duct obstruction, leading to bile accumulation and liver damage.
- Post-Hepatic Cirrhosis: Advanced form of chronic hepatitis B or C, or unknown causes, characterized by shrunken & nodular liver.
- Cardiac Cirrhosis: Results from chronic heart failure, leading to liver congestion and cell death.

Laennec's Cirrhosis Stages

Progresses through three stages:
- Stage 1: Fatty liver characterized by fat accumulation in liver cells. Reversible with alcohol abstinence.
- Stage 2: Alcoholic hepatitis, involving inflammation, necrosis, and fibrosis.
- Stage 3: End stage, fibrosis replaces normal tissue, leading to severe liver dysfunction.

Pathophysiology of Cirrhosis

Liver tissue replaced by fibrotic scar tissue.
Abnormal nodules form, restricting blood, lymph, and bile flow.

Clinical Manifestations of Cirrhosis

Often develop gradually over years.
Early: Enlarged liver, vague symptoms like pain in upper right abdomen, fever, nausea, diarrhea, loss of appetite, and fatigue.
Later:
- Edema & ascites: Caused by low albumin, fluid retention, and increased portal pressure.
- Bleeding & bruising: Due to decreased clotting factors, increased platelet destruction, and impaired vitamin K absorption.
- Esophageal varices & hemorrhoids: Caused by increased portal pressure, leading to dilated veins.
- Gastritis, anorexia, diarrhea: Caused by congested veins in gastrointestinal tract and impaired bile production.
- Abdominal wall vein distention (caput medusae): Result of portal hypertension.
- Jaundice: Due to impaired bilirubin metabolism.
- Malnutrition, muscle wasting: Caused by impaired nutrient & fat absorption, and hormone metabolism.
- Anemia, leukopenia, increased risk of infection: Due to bleeding and blood cell destruction.
- Asterixis, encephalopathy: Caused by accumulated toxins and impaired ammonia metabolism.
- Gynecomastia, infertility, impotence: Result of altered sex hormone metabolism.

Major Complications of Cirrhosis

Portal hypertension: Increased pressure in portal vein due to impaired blood flow. Leading to:
- Bleeding esophageal varices - life-threatening due to rupture of veins.
- Hemorrhoids & caput medusae.
- Peripheral edema and ascites.

Management of Cirrhosis

Nursing Diagnosis:
- Activity intolerance.
- Altered nutrition: less than body requirement.
- Risk for injury (bleeding).
- Disturbed thought processes.
- Risk for impaired skin integrity.
- Risk for fluid volume excess.
Nursing Interventions:
- Promote activity tolerance by encouraging rest and gradual exercise.
- Improve nutritional status with high-calorie, moderate protein diet, small frequent meals, and antiemetics.
- Prevent bleeding by monitoring stools, observing for symptoms of gastrointestinal bleeding, administering vitamin K, and teaching client to avoid trauma.
- Promote improved thought processes by restricting high-protein diet, monitoring ammonia levels, and protecting from infection.
- Manage fluid volume excess by measuring weight and abdominal girth, restricting fluids, and providing a low sodium diet.
- Promote gas exchange by positioning the client in semi-Fowler's with feet elevated, administering oxygen, and monitoring oxygen saturation.
- Promote skin integrity by using warm water, preventing dry skin, applying mittens, and turning frequently.
- Manage bleeding esophageal varices by assessing vital signs, monitoring for hypovolemia, observing for straining, gagging or vomiting, monitoring gastrointestinal secretions, administering blood products and vitamin K.

Additional Notes

Diet: Low-protein diet for patients with liver problems.
Alcohol: Beer is less harmful than whiskey.
Assessment: Observe sclera, tongue, skin, and abdominal distention.
Bleeding: Any GI bleeding is an emergency.
Hepatic encephalopathy: Can increase ICP and lead to impaired consciousness.
Room assignments:
- Avoid placing liver patients with patients who have pneumonia, TB, or active infections.
Fall risk: Patients with hepatic encephalopathy are at high risk for falls.
Medication: Avoid acetaminophen in liver patients.

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Description

This quiz covers the basics of cirrhosis, including its definition, four types, and the stages specific to Laennec's cirrhosis. Understand the causes, progression, and implications of this chronic liver disease. Test your knowledge on liver health and disease management.