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Questions and Answers
What is the best response by the instructor regarding the hepatitis B vaccine schedule?
What is the best response by the instructor regarding the hepatitis B vaccine schedule?
A nurse is caring for a client with cirrhosis who is difficult to arouse and has an elevated serum ammonia level. What should the nurse suspect?
A nurse is caring for a client with cirrhosis who is difficult to arouse and has an elevated serum ammonia level. What should the nurse suspect?
Which medication is used to decrease portal pressure and halt bleeding of esophageal varices?
Which medication is used to decrease portal pressure and halt bleeding of esophageal varices?
What potassium-sparing diuretic may be ordered for a patient with ascites and edema?
What potassium-sparing diuretic may be ordered for a patient with ascites and edema?
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What condition should the nurse suspect in a client with elevated serum ammonia concentration and changes in mental status?
What condition should the nurse suspect in a client with elevated serum ammonia concentration and changes in mental status?
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What vitamin deficiency might a patient with severe chronic liver dysfunction presenting with bleeding gums and blood in stool be experiencing?
What vitamin deficiency might a patient with severe chronic liver dysfunction presenting with bleeding gums and blood in stool be experiencing?
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Which vitamin is most likely deficient in a client with severe liver disease experiencing night blindness?
Which vitamin is most likely deficient in a client with severe liver disease experiencing night blindness?
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What does portal hypertension treatment aim to reduce? (Select all that apply)
What does portal hypertension treatment aim to reduce? (Select all that apply)
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What diagnostic procedure is most conclusive for confirming cirrhosis?
What diagnostic procedure is most conclusive for confirming cirrhosis?
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What is the recommended daily alcohol use limit for women to avoid hepatic disorders?
What is the recommended daily alcohol use limit for women to avoid hepatic disorders?
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What early hallmark signs and symptoms should the nurse expect in a client diagnosed with hepatitis A?
What early hallmark signs and symptoms should the nurse expect in a client diagnosed with hepatitis A?
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After a liver biopsy, which position should the nurse place the client?
After a liver biopsy, which position should the nurse place the client?
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Which of the following is an age-related change of the hepatobiliary system?
Which of the following is an age-related change of the hepatobiliary system?
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What diagnostic information best explains a client's declining level of consciousness in acute liver failure?
What diagnostic information best explains a client's declining level of consciousness in acute liver failure?
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What treatment should a client diagnosed with liver cancer confined to one lobe expect?
What treatment should a client diagnosed with liver cancer confined to one lobe expect?
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What type of jaundice results from increased destruction of red blood cells in adults?
What type of jaundice results from increased destruction of red blood cells in adults?
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What assessment finding would indicate hepatic encephalopathy in a conscious client?
What assessment finding would indicate hepatic encephalopathy in a conscious client?
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What is the best response for a client asking how they contracted hepatitis A?
What is the best response for a client asking how they contracted hepatitis A?
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What type of jaundice should a nurse identify in an adult experiencing a transfusion reaction?
What type of jaundice should a nurse identify in an adult experiencing a transfusion reaction?
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What clinical manifestations of hepatic cirrhosis can a nurse correctly identify? (Select all that apply)
What clinical manifestations of hepatic cirrhosis can a nurse correctly identify? (Select all that apply)
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What sign indicates obstructive jaundice in a client with cholelithiasis?
What sign indicates obstructive jaundice in a client with cholelithiasis?
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What intervention should a nurse consider for a client with an enlarged abdomen due to cirrhosis?
What intervention should a nurse consider for a client with an enlarged abdomen due to cirrhosis?
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What is the nurse's best response to the assessment of dark green fluid in the collection container for a patient with a biliary drainage system?
What is the nurse's best response to the assessment of dark green fluid in the collection container for a patient with a biliary drainage system?
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Which of the following is a primary function of the liver?
Which of the following is a primary function of the liver?
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What intervention should the nurse anticipate for a patient with ascites to correct decreased effective arterial blood volume?
What intervention should the nurse anticipate for a patient with ascites to correct decreased effective arterial blood volume?
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What should the nurse document when observing hand-flapping tremors in a patient with cirrhosis?
What should the nurse document when observing hand-flapping tremors in a patient with cirrhosis?
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In planning care for a client with hemorrhage from esophageal varices, which goal should have the highest priority?
In planning care for a client with hemorrhage from esophageal varices, which goal should have the highest priority?
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What type of jaundice occurs when the liver cannot excrete bilirubin as quickly as it is formed?
What type of jaundice occurs when the liver cannot excrete bilirubin as quickly as it is formed?
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What is the mode of transmission for hepatitis A virus (HAV)?
What is the mode of transmission for hepatitis A virus (HAV)?
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Which test provides definitive confirmation of cirrhosis diagnosis?
Which test provides definitive confirmation of cirrhosis diagnosis?
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Which clinical manifestations are consistent with ascites? Select all that apply.
Which clinical manifestations are consistent with ascites? Select all that apply.
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In what location should the nurse palpate for the liver?
In what location should the nurse palpate for the liver?
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Which test should the nurse prepare the client for that will locate stones in the common bile duct?
Which test should the nurse prepare the client for that will locate stones in the common bile duct?
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What type of cirrhosis is due to chronic alcoholism?
What type of cirrhosis is due to chronic alcoholism?
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Which interventions should the nurse provide to monitor a client with ascites? Select all that apply.
Which interventions should the nurse provide to monitor a client with ascites? Select all that apply.
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Which finding indicates that spironolactone is producing a therapeutic effect for a patient with fluid retention?
Which finding indicates that spironolactone is producing a therapeutic effect for a patient with fluid retention?
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How will the physician likely proceed with a paracentesis if coagulation studies are abnormal?
How will the physician likely proceed with a paracentesis if coagulation studies are abnormal?
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When can a client scheduled for a laparoscopic cholecystectomy expect to resume normal activities?
When can a client scheduled for a laparoscopic cholecystectomy expect to resume normal activities?
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Which assessment finding should be reported immediately when caring for a client with advanced cirrhosis and hepatic encephalopathy?
Which assessment finding should be reported immediately when caring for a client with advanced cirrhosis and hepatic encephalopathy?
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Which skin findings would alert the nurse to the likelihood of liver problems? Select all that apply.
Which skin findings would alert the nurse to the likelihood of liver problems? Select all that apply.
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What term describes involuntary flapping movements of the hands associated with metabolic liver dysfunction?
What term describes involuntary flapping movements of the hands associated with metabolic liver dysfunction?
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To evaluate the effectiveness of lactulose treatment for increased serum ammonia levels, the nurse should monitor which parameter?
To evaluate the effectiveness of lactulose treatment for increased serum ammonia levels, the nurse should monitor which parameter?
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What laboratory study result would indicate the presence of a primary malignant liver tumor?
What laboratory study result would indicate the presence of a primary malignant liver tumor?
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What should the nurse assess for after administering vasopressin for an acute esophageal bleed?
What should the nurse assess for after administering vasopressin for an acute esophageal bleed?
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A client with carcinoma of the head of the pancreas is scheduled for surgery. Which of the following should a nurse administer to the client before surgery?
A client with carcinoma of the head of the pancreas is scheduled for surgery. Which of the following should a nurse administer to the client before surgery?
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Which of the following is the most effective strategy to prevent hepatitis B infection?
Which of the following is the most effective strategy to prevent hepatitis B infection?
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An important message for any nurse to communicate is that drug-induced hepatitis is a major cause of acute liver failure. The medication that is the leading cause is:
An important message for any nurse to communicate is that drug-induced hepatitis is a major cause of acute liver failure. The medication that is the leading cause is:
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The nurse is assessing a client with cirrhosis of the liver. Which stool characteristic would the nurse expect the client to report?
The nurse is assessing a client with cirrhosis of the liver. Which stool characteristic would the nurse expect the client to report?
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Which type of deficiency results in macrocytic anemia?
Which type of deficiency results in macrocytic anemia?
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The nurse is administering medications to a client that has elevated ammonia due to cirrhosis of the liver. What medication will the nurse give to detoxify ammonium and to act as an osmotic agent?
The nurse is administering medications to a client that has elevated ammonia due to cirrhosis of the liver. What medication will the nurse give to detoxify ammonium and to act as an osmotic agent?
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A client with liver cirrhosis develops ascites. Which medication will the nurse prepare teaching for this client?
A client with liver cirrhosis develops ascites. Which medication will the nurse prepare teaching for this client?
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Which is the most common cause of esophageal varices?
Which is the most common cause of esophageal varices?
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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 client with cirrhosis has portal hypertension, which is causing esophageal varices. What is the goal of the interventions that the nurse will provide?
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The presence of which substance is considered abnormal in a routine urine specimen for a client with liver and renal failure?
The presence of which substance is considered abnormal in a routine urine specimen for a client with liver and renal failure?
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A client is admitted to the hospital with acute hemorrhage from esophageal varices. What medication should the nurse anticipate administering that will reduce pressure in the portal venous system and control esophageal bleeding?
A client is admitted to the hospital with acute hemorrhage from esophageal varices. What medication should the nurse anticipate administering that will reduce pressure in the portal venous system and control esophageal bleeding?
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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:
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:
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While conducting a physical examination of a client, which of the following skin findings would alert the nurse to the likelihood of liver problems? Select all that apply.
While conducting a physical examination of a client, which of the following skin findings would alert the nurse to the likelihood of liver problems? Select all that apply.
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The single modality of pharmacologic therapy for chronic type B viral hepatitis is:
The single modality of pharmacologic therapy for chronic type B viral hepatitis is:
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A previously healthy adult's sudden and precipitous decline in health has been attributed to fulminant hepatic failure, and the client has been admitted to the intensive care unit. The nurse should be aware that the treatment of choice for this client is what?
A previously healthy adult's sudden and precipitous decline in health has been attributed to fulminant hepatic failure, and the client has been admitted to the intensive care unit. The nurse should be aware that the treatment of choice for this client is what?
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What is the recommended dietary treatment for a client with chronic cholecystitis?
What is the recommended dietary treatment for a client with chronic cholecystitis?
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Which of the following diagnostic studies definitely confirms the presence of ascites?
Which of the following diagnostic studies definitely confirms the presence of ascites?
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Which nursing assessment is most important in a client diagnosed with ascites?
Which nursing assessment is most important in a client diagnosed with ascites?
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A client is actively bleeding from esophageal varices. Which medication would the nurse most expect to be administered to this client?
A client is actively bleeding from esophageal varices. Which medication would the nurse most expect to be administered to this client?
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The compensatory stage is the first stage of shock. During this stage, what responses should be reported to the healthcare provider?
The compensatory stage is the first stage of shock. During this stage, what responses should be reported to the healthcare provider?
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Which of the following would a nursing student correctly identify as a function of the liver? Select all that apply.
Which of the following would a nursing student correctly identify as a function of the liver? Select all that apply.
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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 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?
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After a liver biopsy, the client is placed in which position?
After a liver biopsy, the client is placed in which position?
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The assessment of a client admitted with increased ascites related to cirrhosis reveals the following: pulse 86 beats per minute and weak, respirations 28 breaths per minute, blood pressure 130/88 mm Hg, and pulse oximetry 90%. Which nursing diagnosis should receive top priority?
The assessment of a client admitted with increased ascites related to cirrhosis reveals the following: pulse 86 beats per minute and weak, respirations 28 breaths per minute, blood pressure 130/88 mm Hg, and pulse oximetry 90%. Which nursing diagnosis should receive top priority?
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What should the nurse carefully monitor for that may indicate a medication overdose while administering Cephulac (lactulose)?
What should the nurse carefully monitor for that may indicate a medication overdose while administering Cephulac (lactulose)?
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Which medication is known to cause gynecomastia as a common side effect?
Which medication is known to cause gynecomastia as a common side effect?
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Study Notes
Hepatitis B Vaccination
- The hepatitis B vaccine requires three doses administered intramuscularly: the second dose is given 1 month after the first, and the third dose is given 6 months after the first.
Hepatic Dysfunction and Assessments
- An increased serum ammonia level indicates hepatic dysfunction, typically resulting in a decreased level of consciousness in patients with liver disease.
- In clients with cirrhosis, difficulty arousing the patient and elevated serum ammonia levels suggest declining hepatic function.
Medications for Portal Hypertension
- Vasopressin is the initial therapy for esophageal varices, as it constricts the splanchnic arterial bed and reduces portal hypertension.
- Spironolactone is preferred for managing ascites because it is a potassium-sparing diuretic, minimizing fluid and electrolyte disturbances.
Hepatic Encephalopathy
- Characterized by central nervous system dysfunction due to liver disease, hepatic encephalopathy presents with elevated ammonia levels, altered mental status, and asterixis, which is an involuntary hand tremor.
Vitamin Deficiencies in Liver Dysfunction
- Patients with severe chronic liver dysfunction may experience vitamin K deficiency, leading to spontaneous bleeding and ecchymoses.
- Vitamin A deficiency can cause night blindness and is common in individuals with liver disease.
Portal Hypertension Management
- Treatment for portal hypertension aims to reduce venous pressure and fluid accumulation in the body.
Liver Diagnostics
- A liver biopsy is the conclusive procedure for diagnosing cirrhosis, revealing hepatic fibrosis.
- Prothrombin time and platelet counts are used to assess bleeding risk prior to the biopsy.
Alcohol Consumption Guidelines
- The CDC defines moderate alcohol consumption as up to 1 drink per day for women and up to 2 drinks per day for men to minimize liver toxicity.
Symptoms of Hepatitis A
- Early symptoms of hepatitis A include anorexia, nausea, vomiting, fatigue, and weakness, while abdominal pain is not typical unless severe.
Post-biopsy Care
- Following a liver biopsy, the patient should lie on the right side to facilitate compression of the liver capsule and prevent bleeding.
Age-Related Changes in the Hepatobiliary System
- Aging can lead to decreased blood flow, reduced drug clearance, and increased presence of gallstones, contributing to various hepatic issues.
Acute Liver Failure Indicators
- Acute liver failure is indicated by elevated serum ammonia and decreased glucose levels, which can affect the patient's consciousness.
Treatment for Liver Cancer
- Surgical resection is the preferred treatment for liver cancer if localized to one lobe, as chemotherapeutic outcomes are typically poor in advanced cases.
Types of Jaundice
- Hemolytic jaundice occurs from increased destruction of red blood cells, while obstructive jaundice results from bile duct obstruction.
Clinical Manifestations of Cirrhosis
- Patients with cirrhosis may present with muscle wasting, an enlarged liver, ascites, and varices due to portal vein obstruction.
Liver-Related Assessments
- Routine measurement of abdominal girth is crucial in monitoring ascites in cirrhosis.
- Any notable changes in mental status or gastrointestinal bleeding must be documented promptly.
Preoperative Care for Pancreatic Cancer
- Vitamin K may be administered before surgery for head of the pancreas carcinoma to correct coagulation deficiencies.
Hepatitis B Prevention
- Vaccination is the most effective strategy for preventing hepatitis B infection. Other preventive measures include practicing safe sex and avoiding sharing personal items.
Medications Affecting Liver Function
- Acetaminophen is identified as a leading cause of acute liver failure, underscoring the need for caution when using over-the-counter pain relievers.### Drug-Induced Hepatitis
- Leading cause of acute liver failure; acetaminophen is the major culprit among medications.
Stool Characteristics in Liver Disease
- Clay-colored or whitish stools indicate absence of bile, signaling potential obstructive jaundice.
- Other stool colors may indicate different gastrointestinal disorders.
Nutritional Deficiencies and Anemia
- Folic acid deficiency results in macrocytic anemia.
- Vitamin C deficiency leads to scurvy, while Vitamin K deficiency can cause spontaneous bleeding.
Lactulose Administration
- Lactulose is an osmotic agent used to detoxify ammonium and stimulate bowel movement.
- Important in managing elevated ammonia levels in patients with liver cirrhosis.
Treatment for Ascites
- Spironolactone is the first-line diuretic therapy for ascites due to cirrhosis.
- It effectively prevents potassium loss when combined with other diuretics like furosemide.
Portal Hypertension and Esophageal Varices
- Portal hypertension, due to liver damage, is the primary cause of esophageal varices.
- The management of portal hypertension focuses on reducing fluid accumulation and venous pressure.
Urine Analysis in Liver Failure
- The presence of albumin in urine is considered abnormal and indicates potential bladder rupture in patients with ascites.
Acutely Bleeding Esophageal Varices
- IV octreotide is preferred for managing acute hemorrhage from esophageal varices due to its efficiency in reducing portal pressure.
Ammonia Production Sources
- The primary source of ammonia in the body is from the digestion of dietary and blood proteins in the GI tract.
Signs of Liver Problems
- Skin findings indicative of liver issues include jaundice, ecchymoses, and petechiae.
- Regular assessment of patients for these signs is crucial.
Primary Treatment for Hepatitis B
- Alpha-interferon is the main pharmacologic therapy for chronic type B viral hepatitis.
Treatment for Fulminant Hepatic Failure
- Liver transplantation is the optimal treatment for patients with fulminant hepatic failure.
Dietary Considerations in Gallbladder Dysfunction
- A low-fat diet is recommended for clients with chronic cholecystitis to prevent complications related to fat digestion.
Confirming Ascites Diagnosis
- Ultrasound of the liver and abdomen is the definitive diagnostic tool for confirming ascites.
Monitoring Patients with Ascites
- Daily measurements of weight and abdominal girth are critical for assessing the management of ascites.
Medication for Active Hemorrhage
- Octreotide is the medication anticipated to be administered for clients actively bleeding from esophageal varices.
Compensatory Stage of Shock
- Tachycardia and tachypnea are key indicators during the compensatory stage of shock requiring medical attention.
Liver Function
- The liver is essential for glucose metabolism, ammonia conversion, and protein metabolism but does not store zinc.
Albumin Infusion for Ascites
- Administering albumin infusions can help correct decreases in effective arterial blood volume in patients with ascites.
Asterixis Observation
- Asterixis, characterized by hand-flapping tremors, is a sign of metabolic dysfunction often seen in liver disease.
Prioritizing Nursing Goals
- Maintaining an open airway is the top priority for patients with massive hemorrhage from esophageal varices.
Hemolytic Jaundice
- Hemolytic jaundice occurs when bilirubin formation exceeds the liver’s excretion capacity, often due to hemolytic reactions.### Hepatitis A and B Transmission
- Hepatitis A virus (HAV) is primarily transmitted through the fecal-oral route, often via contaminated food and water or person-to-person contact.
- Hepatitis B virus (HBV) is mainly transmitted through blood, found in blood, saliva, and semen, and can enter via mucous membranes or skin breaks.
Liver Biopsy and Diagnostic Tests
- A liver biopsy is the most conclusive diagnostic tool for hepatic fibrosis and cirrhosis.
- Coagulation studies inform on liver function but do not confirm cirrhosis.
- Imaging techniques like MRI and radioisotope scans can support a diagnosis by assessing liver size and blood flow patterns.
Clinical Manifestations of Ascites
- Signs of ascites include increased abdominal girth, rapid weight gain, visible distended veins, and stretch marks.
- Percussion of the abdomen helps assess for fluid accumulation; flanks bulge when lying supine.
Palpation of the Liver
- The liver can be palpated in the right upper quadrant as a firm, smooth ridge.
Tests for Gallstones
- Endoscopic retrograde cholangiopancreatography (ERCP) is used to locate stones in the common bile duct.
- Abdominal x-ray is not reliable for detecting gallstones, while colonoscopy visualizes the large intestine.
Types of Cirrhosis
- Alcoholic cirrhosis is the most common type, resulting from chronic alcohol use.
- Other forms include postnecrotic cirrhosis with broad scar bands from prior acute hepatitis and biliary cirrhosis due to scarring around bile ducts.
Monitoring Ascites in Patients
- To assess worsening ascites, nurses should measure daily abdominal girth, urine output every 8 hours, and perform daily weights.
- Monitoring respiratory status is crucial as large ascites can compress the thoracic cavity.
Therapeutic Effects of Spironolactone
- A loss of 2.2 pounds (1 kg) in 24 hours indicates effective diuresis from spironolactone, equating to a fluid loss of 1 liter.
Paracentesis Procedure
- In cases of abnormal coagulation, ultrasound guidance may be used during paracentesis to minimize bleeding risks.
Recovery from Laparoscopic Cholecystectomy
- Clients typically resume normal activities within one week post laparoscopic cholecystectomy.
Signs of Hepatic Encephalopathy
- Changes in handwriting or cognitive performance are early signs of hepatic encephalopathy, necessitating immediate reporting.
Skin Manifestations of Liver Dysfunction
- Signs such as jaundice, petechiae, and ecchymoses are indicators of potential liver issues that need monitoring.
Asterixis and Liver Dysfunction
- Asterixis, or involuntary flapping movements, is associated with metabolic liver dysfunction.
Monitoring for Lactulose Effectiveness
- The level of consciousness (LOC) is a key indicator of cerebral function to evaluate the effectiveness of lactulose treatment in cirrhosis.
Alpha-Fetoprotein and Liver Tumors
- Elevated levels of alpha-fetoprotein can suggest the presence of a primary malignant liver tumor.
Complications of Vasopressin Administration
- Nurses should monitor for electrocardiogram changes after administering vasopressin due to potential cardiac ischemia risks.
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This quiz features flashcards focused on the assessment and management of patients with hepatic disorders, specifically addressing the vaccination schedule for hepatitis B. Improve your understanding of nursing responsibilities and patient education regarding hepatitis B vaccinations and related health issues.
