Podcast
Questions and Answers
In the context of viral hepatitis, if a previously asymptomatic patient suddenly develops pronounced jaundice accompanied by encephalopathy, what is the most critical implication for the exposed contacts?
In the context of viral hepatitis, if a previously asymptomatic patient suddenly develops pronounced jaundice accompanied by encephalopathy, what is the most critical implication for the exposed contacts?
- Urgent assessment for fulminant hepatic failure and consideration for liver transplantation. (correct)
- Counseling on long-term management of chronic liver disease progression.
- Initiation of a high-dose corticosteroid regimen to attenuate the inflammatory response.
- Immediate prophylactic treatment with broad-spectrum antibiotics to prevent secondary bacterial infections.
Considering the varied transmission routes of viral hepatitis, what preemptive strategy would be most effective in mitigating nosocomial outbreaks within a high-volume urban emergency department?
Considering the varied transmission routes of viral hepatitis, what preemptive strategy would be most effective in mitigating nosocomial outbreaks within a high-volume urban emergency department?
- Routine prophylactic antiviral therapy for all patients presenting with gastrointestinal symptoms.
- Strict segregation of patients presenting with jaundice into designated isolation wards.
- Mandatory annual vaccination against all strains of hepatitis for all hospital personnel.
- Implementation of universal precautions, coupled with stringent adherence to CDC hand hygiene guidelines. (correct)
Following a needlestick injury involving a patient with confirmed Hepatitis B, an unvaccinated healthcare worker should receive which of the following interventions to achieve maximal protection?
Following a needlestick injury involving a patient with confirmed Hepatitis B, an unvaccinated healthcare worker should receive which of the following interventions to achieve maximal protection?
- A single dose of Hepatitis B immunoglobulin (HBIG) administered within 7 days.
- Oral Tenofovir disoproxil fumarate for 28 days to prevent viral replication.
- Monitoring of liver enzymes for 6 months with no immediate intervention.
- Immediate initiation of the Hepatitis B vaccine series combined with HBIG administration. (correct)
In the context of advanced cirrhosis, what is the most critical pathophysiologic mechanism underlying the development of ascites, informing targeted therapeutic intervention?
In the context of advanced cirrhosis, what is the most critical pathophysiologic mechanism underlying the development of ascites, informing targeted therapeutic intervention?
A patient with cirrhosis develops sudden-onset hepatic encephalopathy. What is the most critical initial intervention to manage this complication?
A patient with cirrhosis develops sudden-onset hepatic encephalopathy. What is the most critical initial intervention to manage this complication?
What is the most relevant rationale for restricting dietary sodium in patients with hepatic ascites?
What is the most relevant rationale for restricting dietary sodium in patients with hepatic ascites?
What is the MOST critical parameter to monitor during large-volume paracentesis in a patient with refractory ascites to prevent circulatory dysfunction?
What is the MOST critical parameter to monitor during large-volume paracentesis in a patient with refractory ascites to prevent circulatory dysfunction?
In managing esophageal varices, what is the PRIMARY pharmacologic mechanism of action of non-selective beta-blockers such as nadolol?
In managing esophageal varices, what is the PRIMARY pharmacologic mechanism of action of non-selective beta-blockers such as nadolol?
What is the MOST appropriate rationale for administering Vitamin K to a patient with cirrhosis and coagulopathy?
What is the MOST appropriate rationale for administering Vitamin K to a patient with cirrhosis and coagulopathy?
Which of the following diagnostic findings is MOST indicative of spontaneous bacterial peritonitis (SBP) in a patient with cirrhosis and ascites?
Which of the following diagnostic findings is MOST indicative of spontaneous bacterial peritonitis (SBP) in a patient with cirrhosis and ascites?
In managing hepatic encephalopathy, why is it crucial to avoid overcorrection of hyponatremia induced by diuretics and fluid restriction?
In managing hepatic encephalopathy, why is it crucial to avoid overcorrection of hyponatremia induced by diuretics and fluid restriction?
What is the MOST sensitive early indicator of hepatorenal sundrome development in a patient with advanced cirrhosis and ascites?
What is the MOST sensitive early indicator of hepatorenal sundrome development in a patient with advanced cirrhosis and ascites?
In a patient with cirrhosis and known esophageal varices, which finding would necessitate IMMEDIATE intervention to prevent potential decompensation?
In a patient with cirrhosis and known esophageal varices, which finding would necessitate IMMEDIATE intervention to prevent potential decompensation?
What is the MOST likely mechanism by which non-absorbable antibiotics, such as rifaximin, improve hepatic encephalopathy in patients with cirrhosis?
What is the MOST likely mechanism by which non-absorbable antibiotics, such as rifaximin, improve hepatic encephalopathy in patients with cirrhosis?
A patient develops hepatorenal syndrome following a large-volume paracentesis. Which intervention is MOST likely to improve renal function in this context?
A patient develops hepatorenal syndrome following a large-volume paracentesis. Which intervention is MOST likely to improve renal function in this context?
Following a transjugular intrahepatic portosystemic shunt (TIPS) procedure, what is the MOST critical long-term complication to monitor for in a patient with cirrhosis?
Following a transjugular intrahepatic portosystemic shunt (TIPS) procedure, what is the MOST critical long-term complication to monitor for in a patient with cirrhosis?
In a patient being evaluated for liver transplantation due to end-stage liver disease, what constellation of laboratory findings would be MOST concerning and potentially contraindicate transplantation?
In a patient being evaluated for liver transplantation due to end-stage liver disease, what constellation of laboratory findings would be MOST concerning and potentially contraindicate transplantation?
A patient with cholelithiasis presents with right upper quadrant pain, fever, and jaundice, with lab results revealing elevated alkaline phosphatase and bilirubin. What is your MOST appropriate next step?
A patient with cholelithiasis presents with right upper quadrant pain, fever, and jaundice, with lab results revealing elevated alkaline phosphatase and bilirubin. What is your MOST appropriate next step?
Which factor is MOST influential in determining the suitability of a patient with hepatocellular carcinoma (HCC) for liver resection?
Which factor is MOST influential in determining the suitability of a patient with hepatocellular carcinoma (HCC) for liver resection?
What is the MOST compelling reason for early surgical intervention (cholecystectomy) in patients with symptomatic cholelithiasis?
What is the MOST compelling reason for early surgical intervention (cholecystectomy) in patients with symptomatic cholelithiasis?
Following laparoscopic cholecystectomy, a patient reports persistent right shoulder pain. What is the MOST appropriate initial intervention to manage this pain?
Following laparoscopic cholecystectomy, a patient reports persistent right shoulder pain. What is the MOST appropriate initial intervention to manage this pain?
In contrast to Hepatitis A, what critical characteristic defines Hepatitis C's infection profile concerning progression?
In contrast to Hepatitis A, what critical characteristic defines Hepatitis C's infection profile concerning progression?
In a patient with a history of heavy alcohol use and recent diagnosis of Hepatitis C, what is the MOST important aspect for preventing further liver damage.
In a patient with a history of heavy alcohol use and recent diagnosis of Hepatitis C, what is the MOST important aspect for preventing further liver damage.
Which mechanism is most responsible in the development of chronic liver disease if a patient contracts hepatitis B?
Which mechanism is most responsible in the development of chronic liver disease if a patient contracts hepatitis B?
What is the most accurate definition of asterixis?
What is the most accurate definition of asterixis?
What is the MOST critical risk factor for patients who develop hepatocellular carcinoma (HCC)?
What is the MOST critical risk factor for patients who develop hepatocellular carcinoma (HCC)?
A patient with ascites from cirrhosis has dyspnea. What intervention is MOST appropriate?
A patient with ascites from cirrhosis has dyspnea. What intervention is MOST appropriate?
What is the MOST important action for a nurse to perform during paracentesis to prevent further complications?
What is the MOST important action for a nurse to perform during paracentesis to prevent further complications?
Cirrhosis of the liver puts the patient at high risk for esophageal vein bleeding from varices? What is the most important aspect of preventing this life-threatening condition?
Cirrhosis of the liver puts the patient at high risk for esophageal vein bleeding from varices? What is the most important aspect of preventing this life-threatening condition?
The doctor orders lactulose for a patient with cirrhosis. What intervention by the nurse is most appropriate?
The doctor orders lactulose for a patient with cirrhosis. What intervention by the nurse is most appropriate?
What teaching point regarding Hep A is most appropriate?
What teaching point regarding Hep A is most appropriate?
What is the most appropriate action when providing discharge teaching after laparoscopic cholecystectomy to prevent discomfort?
What is the most appropriate action when providing discharge teaching after laparoscopic cholecystectomy to prevent discomfort?
If a patient is born between 1945 and 1965 (baby boomer), there are increased risks for which condition?
If a patient is born between 1945 and 1965 (baby boomer), there are increased risks for which condition?
Which dietary concern is highest priority when addressing Cholelithiasis?
Which dietary concern is highest priority when addressing Cholelithiasis?
The nurse is caring for all of the following patients. Which one needs the Hep B vaccine?
The nurse is caring for all of the following patients. Which one needs the Hep B vaccine?
During cholcystitis what subjective symptom is highest priority to ask about?
During cholcystitis what subjective symptom is highest priority to ask about?
In a patient with Hepatitis B, what is the MOST critical implication of detecting elevated levels of Hepatitis B e-antigen (HBeAg) during routine follow-up?
In a patient with Hepatitis B, what is the MOST critical implication of detecting elevated levels of Hepatitis B e-antigen (HBeAg) during routine follow-up?
Considering the complexities of Hepatitis C genotypes, which baseline assessment is MOST critical for tailoring antiviral therapy to achieve sustained virologic response (SVR)?
Considering the complexities of Hepatitis C genotypes, which baseline assessment is MOST critical for tailoring antiviral therapy to achieve sustained virologic response (SVR)?
In the context of managing a patient with hepatitis-induced coagulopathy before a liver biopsy, which factor is MOST important to consider when determining the appropriate pre-procedure correction strategy?
In the context of managing a patient with hepatitis-induced coagulopathy before a liver biopsy, which factor is MOST important to consider when determining the appropriate pre-procedure correction strategy?
A patient with decompensated cirrhosis presents with acute kidney injury. Which invasive hemodynamic monitoring technique would MOST accurately differentiate between prerenal azotemia and hepatorenal syndrome?
A patient with decompensated cirrhosis presents with acute kidney injury. Which invasive hemodynamic monitoring technique would MOST accurately differentiate between prerenal azotemia and hepatorenal syndrome?
In managing refractory ascites unresponsive to diuretics and sodium restriction, what is the MOST critical consideration when evaluating a patient for a transjugular intrahepatic portosystemic shunt (TIPS) procedure?
In managing refractory ascites unresponsive to diuretics and sodium restriction, what is the MOST critical consideration when evaluating a patient for a transjugular intrahepatic portosystemic shunt (TIPS) procedure?
In a patient with known esophageal varices who is started on non-selective beta-blockers for primary prophylaxis, what assessment finding would MOST warrant a reduction in the beta-blocker dosage?
In a patient with known esophageal varices who is started on non-selective beta-blockers for primary prophylaxis, what assessment finding would MOST warrant a reduction in the beta-blocker dosage?
A patient with cirrhosis presents with a clinical picture suggestive of spontaneous bacterial peritonitis (SBP). What is the MOST crucial modification to the standard paracentesis technique to maximize diagnostic yield?
A patient with cirrhosis presents with a clinical picture suggestive of spontaneous bacterial peritonitis (SBP). What is the MOST crucial modification to the standard paracentesis technique to maximize diagnostic yield?
In a patient with hepatic encephalopathy receiving lactulose, which laboratory finding, if trended over several days, would MOST strongly suggest the need to adjust the lactulose dosage?
In a patient with hepatic encephalopathy receiving lactulose, which laboratory finding, if trended over several days, would MOST strongly suggest the need to adjust the lactulose dosage?
Which intervention is MOST critical in preventing the progression of hepatorenal syndrome in a patient with advanced cirrhosis who develops a large-volume paracentesis?
Which intervention is MOST critical in preventing the progression of hepatorenal syndrome in a patient with advanced cirrhosis who develops a large-volume paracentesis?
Following a transjugular intrahepatic portosystemic shunt (TIPS) procedure, which clinical manifestation is MOST suggestive of hepatic encephalopathy directly related to the shunt?
Following a transjugular intrahepatic portosystemic shunt (TIPS) procedure, which clinical manifestation is MOST suggestive of hepatic encephalopathy directly related to the shunt?
In a patient with end-stage liver disease being evaluated for liver transplantation, which psychosocial factor is MOST critical to assess to ensure optimal post-transplant outcomes?
In a patient with end-stage liver disease being evaluated for liver transplantation, which psychosocial factor is MOST critical to assess to ensure optimal post-transplant outcomes?
A patient with known cholelithiasis presents with acute, severe right upper quadrant pain radiating to the back, accompanied by nausea and vomiting. Initial labs show elevated amylase and lipase. What is the MOST appropriate IMMEDIATE intervention?
A patient with known cholelithiasis presents with acute, severe right upper quadrant pain radiating to the back, accompanied by nausea and vomiting. Initial labs show elevated amylase and lipase. What is the MOST appropriate IMMEDIATE intervention?
When evaluating a patient with hepatocellular carcinoma (HCC) for potential curative resection, which imaging modality provides the MOST critical information regarding tumor resectability and overall liver function?
When evaluating a patient with hepatocellular carcinoma (HCC) for potential curative resection, which imaging modality provides the MOST critical information regarding tumor resectability and overall liver function?
In managing persistent right shoulder pain following a laparoscopic cholecystectomy, what intervention demonstrates the MOST comprehensive understanding of the underlying pathophysiology?
In managing persistent right shoulder pain following a laparoscopic cholecystectomy, what intervention demonstrates the MOST comprehensive understanding of the underlying pathophysiology?
What is the MOST compelling argument supporting universal screening for Hepatitis C virus (HCV) infection, especially among asymptomatic individuals?
What is the MOST compelling argument supporting universal screening for Hepatitis C virus (HCV) infection, especially among asymptomatic individuals?
In a patient with Hepatitis C and known alcohol use disorder who has achieved sustained virologic response (SVR) with antiviral therapy, what is the MOST important long-term management strategy?
In a patient with Hepatitis C and known alcohol use disorder who has achieved sustained virologic response (SVR) with antiviral therapy, what is the MOST important long-term management strategy?
Which immunopathological mechanism is MOST directly implicated in the progression from acute Hepatitis B infection to chronic liver disease and potential cirrhosis?
Which immunopathological mechanism is MOST directly implicated in the progression from acute Hepatitis B infection to chronic liver disease and potential cirrhosis?
How would you BEST describe asterixis in a patient with hepatic encephalopathy, regarding its underlying neurophysiological mechanisms?
How would you BEST describe asterixis in a patient with hepatic encephalopathy, regarding its underlying neurophysiological mechanisms?
What is the PRIMARY molecular mechanism by which chronic Hepatitis C infection significantly elevates the risk for hepatocellular carcinoma (HCC)?
What is the PRIMARY molecular mechanism by which chronic Hepatitis C infection significantly elevates the risk for hepatocellular carcinoma (HCC)?
A patient with ascites experiences worsening dyspnea despite elevation of the head of the bed and supplemental oxygen. What intervention requires the MOST sophisticated understanding of potential complications?
A patient with ascites experiences worsening dyspnea despite elevation of the head of the bed and supplemental oxygen. What intervention requires the MOST sophisticated understanding of potential complications?
What is the MOST critical nursing action immediately following a paracentesis to mitigate the risk of post-paracentesis circulatory dysfunction (PPCD)?
What is the MOST critical nursing action immediately following a paracentesis to mitigate the risk of post-paracentesis circulatory dysfunction (PPCD)?
In a patient with cirrhosis and esophageal varices, what is the MOST critical long-term strategy to prevent variceal hemorrhage, considering the underlying pathophysiological mechanisms?
In a patient with cirrhosis and esophageal varices, what is the MOST critical long-term strategy to prevent variceal hemorrhage, considering the underlying pathophysiological mechanisms?
When administering lactulose to a patient with hepatic encephalopathy, which nursing intervention requires the MOST nuanced understanding of the drug's mechanism and potential complications?
When administering lactulose to a patient with hepatic encephalopathy, which nursing intervention requires the MOST nuanced understanding of the drug's mechanism and potential complications?
In providing discharge teaching to a patient newly diagnosed with Hepatitis A, what information is MOST crucial for preventing further transmission, considering the virus's specific route of infection?
In providing discharge teaching to a patient newly diagnosed with Hepatitis A, what information is MOST crucial for preventing further transmission, considering the virus's specific route of infection?
What is the MOST important instruction to give a patient after a laparoscopic cholecystectomy to minimize post-operative referred pain?
What is the MOST important instruction to give a patient after a laparoscopic cholecystectomy to minimize post-operative referred pain?
Given the increased prevalence of Hepatitis C among individuals born between 1945 and 1965, targeted screening efforts in this population are MOST likely to achieve which public health outcome?
Given the increased prevalence of Hepatitis C among individuals born between 1945 and 1965, targeted screening efforts in this population are MOST likely to achieve which public health outcome?
When providing dietary education to a patient with cholelithiasis, what specific recommendation demonstrates the MOST advanced understanding of the condition's relationship to bile composition?
When providing dietary education to a patient with cholelithiasis, what specific recommendation demonstrates the MOST advanced understanding of the condition's relationship to bile composition?
Which patient population warrants the MOST urgent Hepatitis B vaccination, given their occupational or medical risk factors?
Which patient population warrants the MOST urgent Hepatitis B vaccination, given their occupational or medical risk factors?
During the initial assessment of a patient presenting with suspected acute cholecystitis, what specific subjective symptom is MOST critical to evaluate to differentiate it from other potential abdominal pathologies?
During the initial assessment of a patient presenting with suspected acute cholecystitis, what specific subjective symptom is MOST critical to evaluate to differentiate it from other potential abdominal pathologies?
Which of the following assessment findings would MOST strongly suggest progression from compensated cirrhosis to decompensated cirrhosis?
Which of the following assessment findings would MOST strongly suggest progression from compensated cirrhosis to decompensated cirrhosis?
In the management of a patient with acute hepatic encephalopathy, what specific neurological assessment finding would necessitate immediate intervention beyond standard medical therapy?
In the management of a patient with acute hepatic encephalopathy, what specific neurological assessment finding would necessitate immediate intervention beyond standard medical therapy?
When caring for a patient with ascites undergoing sodium restriction, what physiological parameter provides the MOST sensitive measure of adherence and effectiveness of the dietary intervention?
When caring for a patient with ascites undergoing sodium restriction, what physiological parameter provides the MOST sensitive measure of adherence and effectiveness of the dietary intervention?
What is the MOST important consideration when managing spontaneous bacterial peritonitis in a patient with cirrhosis and ascites regarding antibiotic selection?
What is the MOST important consideration when managing spontaneous bacterial peritonitis in a patient with cirrhosis and ascites regarding antibiotic selection?
Why is it MOST critical to avoid aggressive correction of hyponatremia in the management of hepatic encephalopathy, even if the patient is severely symptomatic?
Why is it MOST critical to avoid aggressive correction of hyponatremia in the management of hepatic encephalopathy, even if the patient is severely symptomatic?
What specific biomarker BEST differentiates between acute tubular necrosis (ATN) and hepatorenal syndrome (HRS) in a patient with advanced cirrhosis and acute kidney injury?
What specific biomarker BEST differentiates between acute tubular necrosis (ATN) and hepatorenal syndrome (HRS) in a patient with advanced cirrhosis and acute kidney injury?
In a patient with cirrhosis and known esophageal varices, what clinical scenario represents the HIGHEST priority for immediate intervention to prevent potential decompensation?
In a patient with cirrhosis and known esophageal varices, what clinical scenario represents the HIGHEST priority for immediate intervention to prevent potential decompensation?
Rifaximin improves hepatic encephalopathy primarily by targeting which mechanism?
Rifaximin improves hepatic encephalopathy primarily by targeting which mechanism?
Which pathophysiologic mechanism underlies the benefit of terlipressin (Glypressin) in treating hepatorenal syndrome following large-volume paracentesis?
Which pathophysiologic mechanism underlies the benefit of terlipressin (Glypressin) in treating hepatorenal syndrome following large-volume paracentesis?
Following a TIPS procedure, which monitoring parameter is MOST critical to follow long-term to identify potential shunt stenosis or dysfunction?
Following a TIPS procedure, which monitoring parameter is MOST critical to follow long-term to identify potential shunt stenosis or dysfunction?
In a patient with cirrhosis secondary to chronic Hepatitis C, who has now developed hepatocellular carcinoma (HCC), what constitutes the MOST critical determinant when evaluating their candidacy for curative liver transplantation?
In a patient with cirrhosis secondary to chronic Hepatitis C, who has now developed hepatocellular carcinoma (HCC), what constitutes the MOST critical determinant when evaluating their candidacy for curative liver transplantation?
A patient with long-standing cirrhosis presents with new-onset ascites, jaundice, and altered mental status. Diagnostic paracentesis reveals an ascitic fluid absolute neutrophil count (ANC) of 200 cells/mm3 and a serum-ascites albumin gradient (SAAG) of 1.4 g/dL. The MOST appropriate next diagnostic step would be:
A patient with long-standing cirrhosis presents with new-onset ascites, jaundice, and altered mental status. Diagnostic paracentesis reveals an ascitic fluid absolute neutrophil count (ANC) of 200 cells/mm3 and a serum-ascites albumin gradient (SAAG) of 1.4 g/dL. The MOST appropriate next diagnostic step would be:
In the management of a patient with acute esophageal variceal bleeding refractory to endoscopic banding and octreotide infusion, the decision to proceed with a transjugular intrahepatic portosystemic shunt (TIPS) should be MOST influenced by:
In the management of a patient with acute esophageal variceal bleeding refractory to endoscopic banding and octreotide infusion, the decision to proceed with a transjugular intrahepatic portosystemic shunt (TIPS) should be MOST influenced by:
A patient with decompensated cirrhosis and refractory ascites is undergoing evaluation for a transjugular intrahepatic portosystemic shunt (TIPS). Which hemodynamic parameter, obtained during right heart catheterization, would be MOST indicative of an increased risk of post-TIPS hepatic encephalopathy and mortality?
A patient with decompensated cirrhosis and refractory ascites is undergoing evaluation for a transjugular intrahepatic portosystemic shunt (TIPS). Which hemodynamic parameter, obtained during right heart catheterization, would be MOST indicative of an increased risk of post-TIPS hepatic encephalopathy and mortality?
A patient with alcoholic cirrhosis develops sudden onset abdominal pain and fever. Paracentesis reveals cloudy ascitic fluid. Gram stain is negative, but the ascitic fluid white blood cell count is 1200/µL with 90% neutrophils. Ascitic fluid cultures are pending. Beyond empiric antibiotics, what is the MOST critical element in the IMMEDIATE management of this patient?
A patient with alcoholic cirrhosis develops sudden onset abdominal pain and fever. Paracentesis reveals cloudy ascitic fluid. Gram stain is negative, but the ascitic fluid white blood cell count is 1200/µL with 90% neutrophils. Ascitic fluid cultures are pending. Beyond empiric antibiotics, what is the MOST critical element in the IMMEDIATE management of this patient?
A patient with end-stage liver disease secondary to Hepatitis B is listed for liver transplantation. Pre-transplant imaging reveals a single hepatocellular carcinoma (HCC) nodule measuring 2.8 cm. Six months post-transplant, surveillance imaging demonstrates multiple new HCC lesions throughout the allograft. What immunomodulatory strategy is MOST likely to provide a survival benefit in this setting?
A patient with end-stage liver disease secondary to Hepatitis B is listed for liver transplantation. Pre-transplant imaging reveals a single hepatocellular carcinoma (HCC) nodule measuring 2.8 cm. Six months post-transplant, surveillance imaging demonstrates multiple new HCC lesions throughout the allograft. What immunomodulatory strategy is MOST likely to provide a survival benefit in this setting?
A patient with cirrhosis presents with hematemesis and melena. After initial resuscitation and stabilization, endoscopy reveals actively bleeding esophageal varices. Following successful endoscopic band ligation, what pharmacologic agent would provide the GREATEST synergistic benefit in reducing the risk of early variceal rebleeding?
A patient with cirrhosis presents with hematemesis and melena. After initial resuscitation and stabilization, endoscopy reveals actively bleeding esophageal varices. Following successful endoscopic band ligation, what pharmacologic agent would provide the GREATEST synergistic benefit in reducing the risk of early variceal rebleeding?
A patient with cirrhosis and ascites develops acute kidney injury (AKI). After excluding pre-renal causes with appropriate fluid resuscitation, the physician suspects hepatorenal syndrome (HRS). What intervention is MOST likely to significantly improve renal function and survival in this patient?
A patient with cirrhosis and ascites develops acute kidney injury (AKI). After excluding pre-renal causes with appropriate fluid resuscitation, the physician suspects hepatorenal syndrome (HRS). What intervention is MOST likely to significantly improve renal function and survival in this patient?
A liver transplant recipient on chronic immunosuppression with tacrolimus develops new onset right upper quadrant pain, jaundice, and elevated liver enzymes four months post-transplant. All of the following should be included in the differential diagnosis EXCEPT:
A liver transplant recipient on chronic immunosuppression with tacrolimus develops new onset right upper quadrant pain, jaundice, and elevated liver enzymes four months post-transplant. All of the following should be included in the differential diagnosis EXCEPT:
Following a laparoscopic cholecystectomy, a patient reports persistent right shoulder pain that is unresponsive to opioid analgesics. An understanding of the underlying mechanism can provide the MOST effective relief from this pain. Which intervention addresses the underlying physiological mechanism?
Following a laparoscopic cholecystectomy, a patient reports persistent right shoulder pain that is unresponsive to opioid analgesics. An understanding of the underlying mechanism can provide the MOST effective relief from this pain. Which intervention addresses the underlying physiological mechanism?
Flashcards
Hepatitis
Hepatitis
Inflammation of liver caused by virus, alcohol, chemicals, medication, autoimmune diseases, metabolic abnormalities.
Hepatitis A Virus (HAV)
Hepatitis A Virus (HAV)
Ranges from mild to acute liver failure, not chronic. RNA virus transmitted via fecal-oral route.
Hepatitis B Virus (HBV)
Hepatitis B Virus (HBV)
Bodily fluids = cuts, internal tears, pregnancy. Can be acute or chronic disease. DNA virus transmitted.
Hepatitis C Virus (HCV)
Hepatitis C Virus (HCV)
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Clinical Manifestations of HEP
Clinical Manifestations of HEP
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Hepatomegaly
Hepatomegaly
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Icteric
Icteric
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Encephalopathy
Encephalopathy
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GI bleeding
GI bleeding
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Asterixis
Asterixis
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Fetor hepaticus
Fetor hepaticus
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Ascites
Ascites
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Acute & chronic
Acute & chronic
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Chronic hepatitis
Chronic hepatitis
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Postexposure prophylaxis
Postexposure prophylaxis
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Cirrhosis
Cirrhosis
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Portal hypertension
Portal hypertension
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Enlarged esophageal veins
Enlarged esophageal veins
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Hepatic encephalopathy
Hepatic encephalopathy
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Cholelithiasis (gall stones)
Cholelithiasis (gall stones)
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gall stones Manifestations
gall stones Manifestations
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Labs for cholelithiasis
Labs for cholelithiasis
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Laparoscopic cholecystectomy
Laparoscopic cholecystectomy
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Postoperative care Laparoscopic cholecystectomy
Postoperative care Laparoscopic cholecystectomy
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Benign Prostatic Hypertrophy (BPH)
Benign Prostatic Hypertrophy (BPH)
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Irritative Manifestations
Irritative Manifestations
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Obstructive Manifestations
Obstructive Manifestations
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Prostate-specific antigen (PSA) level
Prostate-specific antigen (PSA) level
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Timed voiding schedule
Timed voiding schedule
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Teach Diuretics
Teach Diuretics
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Transurethral resection of the prostate (TURP)
Transurethral resection of the prostate (TURP)
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Health Promotion
Health Promotion
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Restore urinary drainage
Restore urinary drainage
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Hemorrhage
Hemorrhage
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Urinary incontinence
Urinary incontinence
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Avoid substances
Avoid substances
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symptoms of metastasis
symptoms of metastasis
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Pain
Pain
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PSA-55-65 yrs.
PSA-55-65 yrs.
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Cancerous lesions
Cancerous lesions
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Interprofessional
Interprofessional
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Prognosis
Prognosis
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Postop radical prostatectomy
Postop radical prostatectomy
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Postop radical prostatectomy Major adverse outcomes
Postop radical prostatectomy Major adverse outcomes
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Nerve-sparing procedure
Nerve-sparing procedure
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Erectile Dysfunction (ED)
Erectile Dysfunction (ED)
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Interprofessional Management
Interprofessional Management
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Sildenafil (Viagra), tadalafil (Cialis)
Sildenafil (Viagra), tadalafil (Cialis)
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Perimenopause
Perimenopause
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Menopause
Menopause
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Endometrial Cancer
Endometrial Cancer
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Ovarian Cancer Clinical Manifestations
Ovarian Cancer Clinical Manifestations
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Chronic Illness & Older Adults
Chronic Illness & Older Adults
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Secondary prevention
Secondary prevention
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Tertiary prevention
Tertiary prevention
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Five barriers to health care access
Five barriers to health care access
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Fluid, Electrolyte, & Acid-Base Balanc
Fluid, Electrolyte, & Acid-Base Balanc
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Hyperkalemia
Hyperkalemia
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Hypercalcemia
Hypercalcemia
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Urethritis
Urethritis
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Nephrotic Syndrome
Nephrotic Syndrome
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Nephrosclerosis
Nephrosclerosis
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Renal Artery Stenosis
Renal Artery Stenosis
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Aspiration precautions
Aspiration precautions
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Type 1 Diabetes
Type 1 Diabetes
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Type 2 Diabetes
Type 2 Diabetes
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tx
tx
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Late signs = Lack of glucose available to brain
Late signs = Lack of glucose available to brain
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Somagyi effect (rapid acting inhaled insulin)
Somagyi effect (rapid acting inhaled insulin)
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Testing graves
Testing graves
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Addisons
Addisons
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anmeia Symtoms
anmeia Symtoms
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Study Notes
Hepatitis
- Inflammation of the liver is caused by:
- Virus
- Alcohol
- Chemicals
- Medication
- Autoimmune diseases
- Metabolic abnormalities
- Patients are often asymptomatic first, while contagious
- Viral hepatitis types include:
- A
- B
- C
- D
- E
Hepatitis A Virus (HAV)
- Hepatitis A comes from anus
- Range is mild to acute liver failure, not chronic
- Incidence decreases with vaccination
- It is an RNA virus, transmitted via the fecal-oral route
- Sources of contamination include:
- Food from restaurants
- Drinking water
- Silverware
- Washing hands is absolutely essential
- Hepatitis A is very preventable
- Symptoms include flu-like symptoms with acute liver failure
Hepatitis B Virus (HBV)
- Hepatitis B comes from bodily fluids like:
- Cuts
- Internal tears
- Pregnancy
- Disease can be acute or chronic
- Incidence decreases with vaccination, a 3 series vaccine in 6-12 months
- HBV is a DNA virus transmitted:
- Perinatally from birth
- Percutaneously
- Via small cuts on mucosal surfaces
- Exposure to infectious blood, blood products, or other body fluids
- Those at risk include:
- People who engage in intercourse
- People living with chronically infected individuals
- Health care personnel
- Public safety workers
- IV drug users
- Individuals who have received blood products that are not commonly seen now
- When exposed, in the absence of a vaccine:
- Get a Hepatitis B vaccine, which is not a live vaccine
- Test Hepatitis B titer antibodies
- If lacking antibodies, get a Hepatitis B immunoglobulin injection
- If exposed to bodily fluids, wash the area with soap and water
Hepatitis C Virus (HCV)
- Hepatitis C comes from contaminated blood
- Most common type of hepatitis
- Acute phase: unaware, asymptomatic, and contagious until chronic
- Chronic phase: liver damage
- It is an RNA virus transmitted percutaneously via:
- IV drug use
- Needle sticks
- Tattoo parlors
- Unprotected sexual behaviors
- Occupational exposure
- Perinatal exposure
- Blood transfusions before 1992
- Always use PPE
Clinical Manifestations of Hepatitis
- Hepatitis is classified as acute and chronic
- Many patients are asymptomatic
- Symptoms are intermittent or ongoing, RAMM:
- Right upper quadrant tenderness, affecting the liver
- Anorexia
- Malaise, fatigue, lethargy (flu-like symptoms)
- Myalgias/arthralgias indicating pain
- Acute phase: maximal infectivity, lasts 1-6 months
- Symptoms occur during incubation:
- Nausea/vomiting
- RUQ tenderness
- Heightened sense of smell
- Finding food repugnant
- Distaste for cigarettes
- Physical examination findings may include:
- Hepatomegaly with abdominal pain, lymphadenopathy, and splenomegaly
- Icteric, jaundice, or anicteric
- Icteric patients also have:
- Dark urine affecting the kidneys
- Light or clay colored stools
- Pruritus from bile salts
- Jaundice can cause death if it builds up in the brain
- Convalescent phase: begins as jaundice disappears
- Lasts weeks to months
- Major complaints
- Malaise
- Easy fatigability
- Hepatomegaly persists
- Splenomegaly subsides
Hepatitis Recovery
- Most patients recover completely with no complications, unless multiple comorbidities exist
- Most cases of acute hepatitis A resolve
- Some HBV and the majority of HCV result in chronic hepatitis
Hepatitis Complications
- Acute liver failure
- Fulminant hepatic failure
- Manifestations may include:
- Encephalopathy affecting the brain
- GI bleeding due to the liver affecting clotting
- Disseminated intravascular coagulation causes patient to bleed out to death
- Fever with leukocytosis
- Renal manifestations
- A liver transplant is usually a cure for hepatitis
Chronic Hepatitis
- HBV and the majority of HCV infections can turn into chronic hepatitis
- Cirrhosis with scar tissue on the liver
- Hepatic encephalopathy is life-threatening with neurological, psychiatric, and motor disturbances, as well as coma
- Asterixis causes flapping tremors in arms and hands
- Apraxia causes writing impairment
- Fetor hepaticus causes a musty, sweet odor
- Ascites is fluid in the abdomen
Hepatitis Diagnostic Studies
- Specific antigen and/or antibody for each type of viral hepatitis
- Liver biopsy. Position patient on their right side, putting pressure over the biopsy site
Hepatitis Treatment
- Acute and chronic treatment includes:
- Adequate nutrition, reduced fat content
- Well-balanced diet
- Vitamin supplements, B complex and K
- Balance rest for a degree and strictness that varies with activity
- No alcohol intake and drugs detoxified by liver including acetaminophen
- Notification of the health department
- Supportive drug therapy includes:
- Antihistamines for itching
- Antiemetics for nausea
- Vaccine three-series in 6-12 months
Interprofessional Care (Hepatitis)
- Health promotion for Hepatitis A:
- Personal and environmental hygiene
- Active immunization using the HAV vaccine
- Vaccination for children at one year old as well as at-risk adults
- Precautions for health care personnel
- Health promotion for Hepatitis B:
- General measures
- Immunization vaccines include Recombivax HB and Engerix-B
- Post-exposure prophylaxis with vaccine and Hepatitis B immune globulin, (HBIG)
Cirrhosis
- Cirrhosis arises from chronic liver failure
- Characterized by extensive degeneration and destruction of liver cells
- Few symptoms are present in early stages: fatigue and enlarged liver
- Symptoms in late stages include:
- Jaundice, peripheral edema, skin lesions, hematologic problems like clotting issues, endocrine problems such as hormone and impaired glucose levels, and peripheral neuropathy
- Ascites leads to breathing concern
Clinical Manifestations of Cirrhosis
- Complications include:
- Portal hypertension, portal vein causing pressure and damage
- Enlarged esophageal veins, which form varices that are life-threatening if ruptured, leads to vomiting and bleeding out
- Ascites from the increase in osmotic pressure
- Hepatic encephalopathy: Asterixis, apraxia
Interprofessional Care for Cirrhosis
- Rest
- B-complex vitamins
- No alcohol
- No ASA, Acetaminophen, and NSAIDs
- Nutrition: High calorie and carb, low fat
- Ascites management includes:
- Sodium restriction, albumin, diuretics
- Paracentesis, with a needle to deflate
- Shunts, a tube to drain fluid
- Esophageal varices are managed with:
- No alcohol, ASA, or NSAIDs
- Airway concern
- IV fluids, using a large bore needle, and blood replacement
- Band ligation, sclerotherapy, and balloon tamponade
- Vitamin K
- Hepatic encephalopathy is treated using lactulose to excrete waste products into stool, this causes diarrhea
- Check bowel sounds! If not present or hypoactive, lactulose cannot be given
- Check level of consciousness. Administer lactulose via NG tube or orally
Nursing Management of Cirrhosis
- Paracentesis: a procedure to drain ascitic fluid by inserting a needle into the patients peritoneal cavity
- Have clients void immediately before, to empty the bladder
- High Fowler's position or sitting on the side of the bed assists fluid to drain
- Monitor for hypovolemia & electrolyte imbalances
- Monitor BP and HR during the procedure
- Monitor dressing for bleeding or leakage
- Relief of dyspnea from paracentesis includes:
- Semi- or high Fowler's position
- Skin care
- Special mattresses
- Turning schedule every 2 hours at least
- ROM exercises
- Coughing/deep breathing exercises
- Elevating lower extremities/scrotum promotes blood return
- Paracentesis is not a cure, it just relieves symptoms
- Managing hepatic encephalopathy includes:
- Assessing level of consciousness to identify symptoms
- Toxins build inside the brain that the liver is not filtering
- Maintain a safe environment
- Maintain siderails, non-skid socks to prevent falls
- Assess carefully:
- Level of responsiveness
- Sensory and motor abnormalities
- Fluid and electrolyte imbalances
- Acid-base imbalances
- Assess neurological status every 2 hours
- Prevent falls & injuries
- Minimize constipation to reduce waste buildup
- Encourage fluids
- Control factors known to precipitate encephalopathy
- Raise the head of the bed 30-45 degrees to help blood-flow to the brain
- Decrease stimuli to help the brain
Nursing Considerations
- Prevent Valsalva- Decreases BP in the brain
- Support ABC's
Cholelithiasis
- Cholelithiasis, gall stones, is associated with:
- Fat
- Female
- Fair skin
- Forty
- Risk factors- female, multiparity, over 40, obesity, ethnicity fair skin
- Manifestations include:
- Excruciating steady pain, tachycardia, diaphoresis, prostration lasting 3 to 6 hours after eating a high-fat meal or when reclining
- Obstruction presents as EMERGENCY with dark amber urine due to bile salts, clay-colored stools, pruritus, intolerance to fatty foods, bleeding tendencies, and steatorrhea, fatty stools
- Indigestion, fever, chills, jaundice, right upper quadrant tenderness referred to the right shoulder and scapula, nausea and vomiting, restlessness, diaphoresis, and abdominal rigidity
- The patient may be hunched over in the position
Diagnostic Studies for Cholelithiasis
- Ultrasound
- ERCP
- Percutaneous transhepatic cholangiography
- Labs show increased WBC counts, serum bilirubin, liver enzymes, and serum amylase
Treatment Options for Cholelithiasis
- ERCP-Endoscopic Retrograde Cholangiopancreatography dilates the common bile duct and allow stones to come out. It is the least invasive option
- Stone dissolving drugs are made from bile acids to dissolve stones, including:
- Ursodeozycholic acid (Ursodiol)
- Chenodeozycholic acid (Chenodiol)
- Best for small stones but can cause mild diarrhea and elevate blood cholesterol levels
- Can take weeks or months to work, so used for small stones
Surgical Therapy for Cholelithiasis
- Laparoscopic cholecystectomy requires 3-4 small incisions under general anesthesia
- The procedure is less invasive and more common. Patients experience:
- A short stay or going home the same day
- Minimal abdominal muscle damage for less pain and quicker return to work
- A return back to work in about a week
- The open cholecystectomy includes:
- Right subcostal incision, and is large
- T-tube or drain placement in common bile duct to ensure duct patency, allowing excess bile to drain
Postoperative Care for Laparoscopic Cholecystectomy
- Monitor for complications: Infection, deep vein thrombosis and pneumonia
- Focus on patient comfort including:
- Referred pain to shoulder pain from CO2
- Sims’ position
- Deep breathing and ambulation to remove gas
- Analgesia
- No coughing
- Clear liquids
- Patients may need to restrict fats for 4-6 weeks due to dumping syndrome if eating fatty foods
- Discharge occurs same day
Nursing Care for Open Cholecystectomy
- Patient experiences longer stay
- All issues are associated with general anesthesia
- The priority is to prevent pneumonia from hurting to deep breathe.
- Ensure using:
- Incentive spirometry (IS)
- Turn, cough & deep breathing exercises (TCDB)
- Early ambulation
- Ensure using:
- Significant pain is treated with patient controlled analgesia (PCA) can be helpful
- Check Ins and Outs via:
- T-tube
- Foley catheter
- IV
- Monitor bowel function because you would have lost of GI manipulation in the OR
- After bowel sounds return, gradually advance from liquids to a regular diet
- Advance diet slowly and clamp the T-tube during meals so digestive enzymes stay in the body to digest the food
- No heavy lifting for 4-6 weeks
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