Viral Hepatitis: Types, Diagnosis, Prevention

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Questions and Answers

Viral hepatitis is caused by several different viruses. Which of the following hepatitis viruses does not have a vaccine available for prevention?

  • Hepatitis A virus (HAV)
  • Hepatitis C virus (HCV) (correct)
  • Hepatitis D virus (HDV)
  • Hepatitis B virus (HBV)

A patient is diagnosed with Hepatitis B. Which of the following is a potential route of transmission that the nurse should educate the patient about?

  • Close contact, such as shaking hands
  • Sharing contaminated needles (correct)
  • Airborne droplets from coughing or sneezing
  • Ingestion of contaminated food or water

A patient presents with symptoms of jaundice, fatigue, and abdominal pain. The doctor suspects a liver disorder. Which diagnostic test would be most helpful in determining the type and extent of liver damage?

  • Urinalysis
  • Liver biopsy (correct)
  • Complete blood count (CBC)
  • Basic metabolic panel (BMP)

Which of the following hepatitis viruses can lead to chronic infection and increase the risk of cirrhosis and liver cancer?

<p>Hepatitis C virus (HCV) (D)</p> Signup and view all the answers

A patient with Hepatitis B is being discharged. Which statement indicates a need for further teaching regarding infection control?

<p>&quot;I can donate blood to help others after I recover.&quot; (A)</p> Signup and view all the answers

In which of the following scenarios is Hepatitis E virus (HEV) infection most likely to be a significant concern?

<p>A traveler who has been consuming water from potentially contaminated sources. (A)</p> Signup and view all the answers

A patient with Hepatitis D is being assessed. Which of the following conditions must also be present for Hepatitis D to exist?

<p>Hepatitis B (C)</p> Signup and view all the answers

A public health nurse is planning a community education program about preventing hepatitis. Which of the following topics should be emphasized to reduce the risk of hepatitis A?

<p>Proper hand hygiene and sanitation (D)</p> Signup and view all the answers

A patient presents with jaundice, dark urine, and right upper quadrant pain. Initial blood tests reveal the presence of anti-HAV IgM. Which of the following is the most likely diagnosis?

<p>Acute Hepatitis A infection (B)</p> Signup and view all the answers

A healthcare worker experiences a needlestick injury while drawing blood from a patient known to have Hepatitis B. Which of the following is the MOST appropriate immediate action for postexposure prophylaxis, assuming the healthcare worker is not already immune?

<p>Administer Hepatitis B immunoglobulin (HBIG) and initiate the Hepatitis B vaccine series. (C)</p> Signup and view all the answers

A patient is diagnosed with Hepatitis C and undergoes treatment. Which diagnostic test is MOST useful for monitoring the effectiveness of antiviral therapy?

<p>HCV viral load (D)</p> Signup and view all the answers

Which of the following is the MOST common mode of transmission for Hepatitis C (HCV) in the United States?

<p>Intravenous drug use (D)</p> Signup and view all the answers

A patient tests positive for HBsAg. What does this result indicate?

<p>Acute or chronic Hepatitis B infection. (D)</p> Signup and view all the answers

A patient with chronic Hepatitis B is diagnosed with Hepatitis D. How does Hepatitis D affect the Hepatitis B infection?

<p>It requires co-infection with Hepatitis B for replication and usually results in a more severe disease. (B)</p> Signup and view all the answers

A traveler returning from an endemic area reports symptoms of anorexia, nausea, and jaundice. Which type of viral hepatitis is MOST likely given the prevalence and transmission route?

<p>Hepatitis E (C)</p> Signup and view all the answers

Which of the following is the MOST important preventative measure against Hepatitis A in areas with poor sanitation?

<p>Practicing good hand hygiene (C)</p> Signup and view all the answers

A patient who has recovered from a Hepatitis A infection is tested for anti-HAV IgG. What does a positive result MOST likely indicate?

<p>Immunity to Hepatitis A (B)</p> Signup and view all the answers

Which of the following Hepatitis viruses has a vaccine currently only available in China?

<p>Hepatitis E (A)</p> Signup and view all the answers

What is the significance of detecting HBeAg in a patient with Hepatitis B?

<p>It indicates high viral replication and infectivity. (A)</p> Signup and view all the answers

A patient with known HBV is found to have anti-HBe. This result suggests which of the following?

<p>Slowed viral replication and lower infectivity. (D)</p> Signup and view all the answers

Which of the following groups is at highest risk of developing chronic hepatitis after being infected?

<p>Adults infected with Hepatitis C. (C)</p> Signup and view all the answers

A patient is suspected of having a hepatitis infection. Which set of tests would be MOST appropriate as an initial screening to determine the type of hepatitis?

<p>Anti-HAV IgM, HBsAg, anti-HCV (C)</p> Signup and view all the answers

A patient is diagnosed with HCV. What key information does the HCV genotype provide for treatment planning?

<p>It identifies the virus strain to guide treatment selection. (B)</p> Signup and view all the answers

Which of the following statements best describes the role of immunoglobulin (IG) in preventing hepatitis?

<p>IG offers short-term, passive protection by providing circulating antibodies without stimulating the immune system. (D)</p> Signup and view all the answers

A patient is diagnosed with hepatitis and is in the icteric stage. Which set of symptoms would the nurse expect to observe?

<p>Jaundice, fatigue, nausea, and vomiting. (B)</p> Signup and view all the answers

Which of the following is the least effective method for preventing the transmission of hepatitis viruses in a healthcare setting?

<p>Routine use of broad-spectrum antibiotics to prevent secondary infections. (D)</p> Signup and view all the answers

What is the primary goal of therapeutic measures for a patient diagnosed with hepatitis?

<p>Managing symptoms and preventing the progression to cirrhosis. (D)</p> Signup and view all the answers

A patient with hepatitis reports taking several over-the-counter medications. Which of the following medications should the nurse be most concerned about regarding potential hepatotoxicity?

<p>Acetaminophen (Tylenol) (D)</p> Signup and view all the answers

A patient with hepatitis C virus (HCV) is prescribed a direct-acting antiviral (DAA). What is the most significant advantage of using DAAs compared to older treatments like interferon?

<p>DAAs have a higher cure rate and fewer side effects. (D)</p> Signup and view all the answers

Which of the following statements accurately describes the implications of being an asymptomatic carrier of Hepatitis B virus (HBV) or Hepatitis C virus (HCV)?

<p>Asymptomatic carriers can infect others and have an increased risk of liver cancer. (C)</p> Signup and view all the answers

A patient with suspected liver dysfunction is undergoing diagnostic testing. Which laboratory test result would be most specific in indicating liver damage?

<p>Alanine aminotransferase (ALT) (B)</p> Signup and view all the answers

During a community health fair, a participant asks about preventing hepatitis A. What is the MOST important advice for the nurse to provide?

<p>Practice careful hand hygiene and sanitation. (A)</p> Signup and view all the answers

A patient with cirrhosis develops ascites. Which laboratory finding best explains the pathophysiology behind ascites?

<p>Decreased albumin levels (D)</p> Signup and view all the answers

A patient with hepatitis is experiencing pruritus. Which nursing intervention is most appropriate to provide relief?

<p>Administering antihistamines as prescribed (B)</p> Signup and view all the answers

A patient's serological test results indicate the presence of viral antigens but absence of antibodies. Which stage of hepatitis infection is this patient most likely in?

<p>Prodromal or acute stage. (B)</p> Signup and view all the answers

In the context of hepatitis infection, what distinguishes the convalescent stage from the icteric stage?

<p>The patient starting to feel better. (B)</p> Signup and view all the answers

A patient is diagnosed with hepatic encephalopathy. Which lab value is the priority to monitor?

<p>Ammonia (B)</p> Signup and view all the answers

A patient with a history of alcohol abuse is admitted with signs of liver failure. The nurse anticipates which of the following metabolic disorders may also be present?

<p>Hemochromatosis (C)</p> Signup and view all the answers

For which types of hepatitis are there currently vaccines available that provide permanent, active immunity in the United States?

<p>HAV and HBV. (C)</p> Signup and view all the answers

Which of the following viruses is least likely to cause hepatitis?

<p>Varicella-zoster virus (D)</p> Signup and view all the answers

Which of the following statements best describes the Healthy People 2030 goals related to viral hepatitis?

<p>Increase awareness, reduce new cases, and lower fatality rates of hepatitis B and C. (A)</p> Signup and view all the answers

A patient with a known history of chronic hepatitis B (HBV) is being considered for treatment. Which factor would be most important for the healthcare provider to consider when selecting an antiviral medication?

<p>The potential for the medication to induce viral resistance. (C)</p> Signup and view all the answers

A patient newly diagnosed with hepatitis asks the nurse about preventing the spread of the disease. Which of the following instructions is most important?

<p>Avoid sharing personal items such as razors and toothbrushes. (B)</p> Signup and view all the answers

What is the primary reason for the implementation of widespread blood supply screening in the United States since 1992?

<p>To reduce the incidence of transfusion-related hepatitis C. (A)</p> Signup and view all the answers

A patient with hepatitis has prolonged prothrombin time (PT). This indicates the liver is no longer able to produce which substance?

<p>Prothrombin (D)</p> Signup and view all the answers

A nurse is caring for a patient with hepatitis and notes the patient's stools are pale. What is the most likely cause of this finding?

<p>Decreased bile production (C)</p> Signup and view all the answers

A patient has been diagnosed with Hepatitis D (HDV) and is also positive for Hepatitis B (HBV). What does the co-infection of HBV and HDV mean for this patient's treatment?

<p>The patient will be treated with pegylated interferon therapy plus ribavirin. (C)</p> Signup and view all the answers

A patient with Hepatitis B is prescribed interferon alpha. Which of the following statements should the nurse include in the teaching plan?

<p>Interferon alpha can cause flu-like symptoms. (D)</p> Signup and view all the answers

Which of the following liver conditions is a potential long-term complication specifically associated with chronic hepatitis B (HBV) and hepatitis C (HCV) infections?

<p>Cancer of the liver. (A)</p> Signup and view all the answers

A patient is suspected of having toxic hepatitis due to occupational exposure. Based on the listed possible causes, which of the following substances in their workplace is the most likely cause?

<p>Carbon tetrachloride (D)</p> Signup and view all the answers

A patient with hepatitis reports right upper quadrant (RUQ) abdominal pain. Which of the following is the most likely cause of this pain?

<p>Liver inflammation and enlargement (D)</p> Signup and view all the answers

A patient is diagnosed with Wilson's disease. The nurse understands that this condition primarily leads to an accumulation of which substance in the liver?

<p>Copper (D)</p> Signup and view all the answers

A patient with hepatitis reports taking Kava-containing herbal supplements. The nurse should counsel the patient regarding the risk of:

<p>Hepatotoxicity (D)</p> Signup and view all the answers

In acute liver failure, what is the immediate nursing priority if hepatic encephalopathy (HE) develops?

<p>Maintaining the airway with head elevated, NPO status, and possible intubation. (D)</p> Signup and view all the answers

Which of the following lab value patterns would be MOST indicative of acute liver failure?

<p>Elevated ALT, AST, and bilirubin; elevated PT; decreased potassium and blood glucose. (B)</p> Signup and view all the answers

A patient with acute liver failure is at risk for bleeding. Which intervention is MOST appropriate to prevent GI bleeding?

<p>Administering proton pump inhibitors. (B)</p> Signup and view all the answers

Why is it important to avoid stimulation and promote bed rest for a patient with acute liver failure?

<p>To reduce the liver's workload and promote healing. (C)</p> Signup and view all the answers

A patient with cirrhosis develops ascites. Which pathophysiological mechanism contributes to this condition?

<p>Low production of albumin by the failing liver, leading to fluid shifts. (C)</p> Signup and view all the answers

Which of the following is an INITIAL symptom commonly associated with cirrhosis?

<p>Often asymptomatic. (A)</p> Signup and view all the answers

A patient with cirrhosis has developed portal hypertension. Which of the following findings would MOST likely be associated with this condition?

<p>Caput medusae and esophageal varices. (A)</p> Signup and view all the answers

Why does cirrhosis lead to impaired blood clotting?

<p>Impaired production of prothrombin and fibrinogen and decreased absorption of vitamin K. (A)</p> Signup and view all the answers

Which of the following is a common cause of cirrhosis?

<p>Chronic hepatitis B and C. (B)</p> Signup and view all the answers

Which nursing diagnosis is MOST appropriate for a patient with cirrhosis experiencing confusion and disorientation?

<p>Acute Confusion. (B)</p> Signup and view all the answers

Which of the following describes the pathophysiology of liver damage in cirrhosis?

<p>Progressive replacement of healthy liver tissue with scar tissue. (C)</p> Signup and view all the answers

Which teaching point is MOST crucial for a young adult regarding alcohol consumption to prevent acute alcohol toxicity?

<p>Drinking a large quantity of ethanol in a short time can be fatal. (B)</p> Signup and view all the answers

A patient with bleeding esophageal varices is at significant risk. What is the MOST immediate nursing intervention?

<p>Preparing for blood transfusions and endoscopic procedures. (A)</p> Signup and view all the answers

What is the primary goal of therapeutic measures for acute liver failure?

<p>Identifying and reversing the cause while supporting liver function. (D)</p> Signup and view all the answers

Which of these conditions is most commonly associated with nonalcoholic steatohepatitis (NASH)?

<p>Diabetes. (D)</p> Signup and view all the answers

A patient with hepatitis is being discharged. Which instruction is MOST important to emphasize to the patient and their family to prevent the spread of the virus?

<p>Ensure family members receive appropriate vaccinations. (D)</p> Signup and view all the answers

A nurse is teaching a caregiver how to handle the laundry of a patient with hepatitis at home. Which of the following instructions is MOST appropriate?

<p>Contaminated linens should be washed separately in hot water and detergent. (D)</p> Signup and view all the answers

A patient with ascites is being cared for at home. Which intervention is MOST important for the home health nurse to implement?

<p>Monitoring and documenting abdominal girth at each visit. (B)</p> Signup and view all the answers

A patient with a history of heavy alcohol use reports taking acetaminophen (Tylenol) for pain relief. What is the MOST important instruction to give this patient regarding acetaminophen use?

<p>The daily dose of acetaminophen should not exceed 3,000 mg. (B)</p> Signup and view all the answers

A patient is admitted to the emergency department with a suspected acetaminophen overdose. What is the MOST important initial intervention the nurse should prepare for if the overdose occurred within 4 hours?

<p>Administering activated charcoal if the patient is alert with an intact or protected airway. (C)</p> Signup and view all the answers

What is the primary physiological mechanism by which the kidneys respond to decreased circulating blood volume in a patient with cirrhosis?

<p>Releasing aldosterone to promote sodium and water retention. (C)</p> Signup and view all the answers

Which statement BEST describes how to accurately monitor a patient's acetaminophen intake in a 24-hour period?

<p>Account for all acetaminophen, including combination drugs, in a rolling 24-hour window. (B)</p> Signup and view all the answers

A patient is diagnosed with acute liver failure. What is the MOST critical immediate concern regarding the potential outcomes of this condition?

<p>The outcome of the disease may be determined within 48 to 72 hours. (B)</p> Signup and view all the answers

A patient with cirrhosis develops a markedly enlarged abdomen due to ascites. Which of the following is the most immediate respiratory complication that can arise from this condition?

<p>Severe respiratory distress as a result of elevation of the diaphragm. (B)</p> Signup and view all the answers

Which of the following best describes the pathophysiology of hepatic encephalopathy (HE) in a patient with cirrhosis?

<p>Elevated levels of ammonia that the damaged liver cannot convert to urea. (A)</p> Signup and view all the answers

What symptoms are commonly associated with the initial stages of liver failure, making early detection challenging?

<p>Vague symptoms like fatigue, gastrointestinal upset, and diarrhea. (A)</p> Signup and view all the answers

A patient with cirrhosis is exhibiting progressive confusion, asterixis, and fetor hepaticus. Which stage of hepatic encephalopathy (HE) is the patient most likely experiencing?

<p>Grade 2 (A)</p> Signup and view all the answers

A patient is being educated on ways to prevent liver failure. Which of the following statements indicates a NEED for further teaching?

<p>&quot;I can drink alcohol in moderation while taking acetaminophen, as long as I follow the dosage.&quot; (B)</p> Signup and view all the answers

When caring for a patient with abdominal ascites at home, which instruction is MOST important for the nurse to provide regarding daily weight monitoring?

<p>Weigh on the same scale first thing in the morning. (B)</p> Signup and view all the answers

A patient in Grade 3 hepatic encephalopathy is somnolent but arousable. Besides disorientation, what other neurological symptom is most indicative of this stage?

<p>Marked confusion and irritability. (C)</p> Signup and view all the answers

A patient with hepatitis reports using herbal supplements to boost their immune system. What is the MOST appropriate nursing intervention?

<p>Educate the patient about potential hepatotoxicity of herbal supplements and encourage them to discuss it with their healthcare provider. (D)</p> Signup and view all the answers

Which of the following best describes the primary cause of hepatorenal syndrome in a patient with cirrhosis?

<p>Secondary failure of the kidneys due to impaired liver circulation and reduced renal blood flow. (D)</p> Signup and view all the answers

A nurse is reviewing a patient's medication list and notes that the patient is taking multiple medications containing acetaminophen. What is the MOST important action for the nurse to take?

<p>Assist the patient in calculating their total daily acetaminophen intake and educate them on safe dosage limits. (D)</p> Signup and view all the answers

A patient with hepatorenal syndrome exhibits oliguria. What other finding is most consistent with this condition?

<p>Reduced glomerular filtration rate (GFR) with negligible urine output and nearly total sodium retention. (A)</p> Signup and view all the answers

A patient with acute liver failure develops hepatic encephalopathy. Which of the following nursing interventions is MOST important to implement?

<p>Monitoring neurologic status frequently and implementing safety precautions. (C)</p> Signup and view all the answers

Which treatment would directly address the reduced intravascular volume and blood flow associated with hepatorenal syndrome?

<p>Vasopressin and albumin (C)</p> Signup and view all the answers

Which of the following is the underlying cause of Wernicke–Korsakoff syndrome?

<p>Thiamine (B1) deficiency. (B)</p> Signup and view all the answers

A patient with a history of IV drug use is being screened for hepatitis. Which type of hepatitis is MOST likely to be associated with this risk factor?

<p>Hepatitis C (B)</p> Signup and view all the answers

A patient is diagnosed with Wernicke encephalopathy secondary to chronic alcohol abuse. Which neurological symptoms are most indicative of this acute condition?

<p>Confusion, delirium, visual disturbances, and ataxia. (B)</p> Signup and view all the answers

A patient with acute liver failure is at risk for bleeding. Which of the following nursing interventions is MOST important to implement to prevent bleeding complications?

<p>Withholding anticoagulants and antiplatelet medications. (A)</p> Signup and view all the answers

A patient with a history of chronic alcohol abuse is diagnosed with Korsakoff psychosis. What is the expected outcome of administering thiamine in this patient?

<p>No reversal of brain damage; the cognitive deficits are permanent. (C)</p> Signup and view all the answers

During an esophagogastroduodenoscopy (EGD) on a patient with cirrhosis, what specific complication is the healthcare provider primarily assessing?

<p>Esophageal varices and bleeding. (A)</p> Signup and view all the answers

A patient with cirrhosis is undergoing a liver biopsy. What is the most critical post-procedure nursing intervention?

<p>Careful observation for bleeding. (B)</p> Signup and view all the answers

A patient with ascites is prescribed spironolactone and furosemide. What primary electrolyte imbalance should the nurse monitor for in this patient?

<p>Hypokalemia (A)</p> Signup and view all the answers

A patient with cirrhosis and refractory ascites undergoes a transjugular intrahepatic portosystemic shunt (TIPS) procedure. What is the intended outcome of this intervention?

<p>Reduce portal pressure by allowing blood to bypass the liver. (C)</p> Signup and view all the answers

A patient with cirrhosis is experiencing anorexia. Which nursing intervention is most appropriate to promote adequate nutrition?

<p>Offering frequent, small, high-calorie meals. (C)</p> Signup and view all the answers

A patient with elevated ammonia levels is at risk for acute confusion. Which nursing intervention is a priority?

<p>Monitoring level of consciousness and orientation frequently. (B)</p> Signup and view all the answers

A patient with hepatic encephalopathy is receiving lactulose. Which assessment finding indicates that the medication is having the desired effect?

<p>Two soft or loose stools per day. (D)</p> Signup and view all the answers

A patient with ascites is experiencing ineffective breathing patterns. What nursing intervention will best promote effective respiration?

<p>Elevating the head of the bed to give the lungs maximum room for expansion. (C)</p> Signup and view all the answers

A patient with esophageal varices is at risk for deficient fluid volume. Which nursing intervention is most important to prevent bleeding?

<p>Administering stool softeners to prevent straining. (B)</p> Signup and view all the answers

Which laboratory finding should the nurse prioritize when assessing a patient at risk for bleeding related to liver dysfunction?

<p>Prothrombin time (PT). (A)</p> Signup and view all the answers

What should the nurse teach a patient with cirrhosis to avoid due to the risk of increasing pressure on esophageal varices?

<p>Forceful coughing or nose blowing. (C)</p> Signup and view all the answers

Which medication should be questioned for a patient with hepatic encephalopathy due to the risk of precipitating further neurological decline?

<p>Sedatives. (B)</p> Signup and view all the answers

Following a liver transplant, what is the most important aspect of patient care that the nurse should emphasize during patient teaching?

<p>Adhering to a strict medication regimen to prevent rejection. (A)</p> Signup and view all the answers

A patient with cirrhosis develops new onset confusion and asterixis. Which lab value is most important for the nurse to review?

<p>Serum ammonia (C)</p> Signup and view all the answers

A patient with cirrhosis and ascites is prescribed spironolactone. Which electrolyte imbalance is the nurse's priority to monitor for?

<p>Hyperkalemia (A)</p> Signup and view all the answers

What dietary modification is most appropriate for a patient with cirrhosis to manage both ascites and hepatic encephalopathy?

<p>Low-sodium, moderate-protein diet (A)</p> Signup and view all the answers

A patient with cirrhosis is prescribed a paracentesis. Which nursing action is most important following the procedure?

<p>Monitoring for bleeding and infection (B)</p> Signup and view all the answers

Which statement by a patient with cirrhosis indicates a need for further teaching regarding the management of their condition?

<p>&quot;I should increase my intake of red meat to improve my albumin levels.&quot; (B)</p> Signup and view all the answers

A patient with cirrhosis is being discharged. Which of the following symptoms should the nurse instruct the patient to report immediately to their healthcare provider?

<p>Increased abdominal girth or swelling in the legs. (D)</p> Signup and view all the answers

A patient with esophageal varices is actively bleeding. After initiating standard interventions, which of the following medications would the nurse anticipate administering first?

<p>Octreotide (Sandostatin) (A)</p> Signup and view all the answers

Which assessment finding in a patient with cirrhosis would indicate the highest risk for hepatic encephalopathy?

<p>Recent initiation of a high-protein diet (A)</p> Signup and view all the answers

A patient with cirrhosis is prescribed lactulose. Which of the following indicates the medication is having the desired therapeutic effect?

<p>Improved orientation and decreased confusion (C)</p> Signup and view all the answers

The nurse is caring for a patient with cirrhosis who has developed ascites. Which dietary modification is most important for managing this condition?

<p>Restricting sodium intake (B)</p> Signup and view all the answers

A patient with cirrhosis is scheduled for a paracentesis to relieve ascites. What nursing intervention is most important immediately after the procedure?

<p>Monitoring blood pressure and heart rate (B)</p> Signup and view all the answers

Which intervention is most appropriate to prevent rebleeding in a patient who had a recent episode of esophageal variceal bleeding?

<p>Administering a beta blocker such as propranolol (C)</p> Signup and view all the answers

A patient with cirrhosis develops hepatic encephalopathy. The family asks why the patient is confused and disoriented. Which explanation by the nurse is most accurate?

<p>The liver is unable to filter toxins from the blood, which affects brain function (A)</p> Signup and view all the answers

A patient with cirrhosis is being discharged. Which of the following instructions is most important regarding medication use?

<p>Avoid alcohol and check with your doctor before taking any new medications. (D)</p> Signup and view all the answers

A patient with cirrhosis and ascites is on spironolactone and furosemide. What electrolyte imbalance should the nurse most closely monitor for?

<p>Hypokalemia (A)</p> Signup and view all the answers

A patient with a history of cirrhosis presents with increased abdominal girth, dyspnea, and peripheral edema. Which nursing diagnosis takes priority?

<p>Excess Fluid Volume related to portal hypertension (D)</p> Signup and view all the answers

A patient with cirrhosis is prescribed rifaximin. What is the primary purpose of this medication in managing the patient's condition?

<p>To reduce ammonia-producing bacteria in the gut (B)</p> Signup and view all the answers

The nurse is teaching a patient with cirrhosis about nutrition. Which of the following statements indicates a need for further teaching?

<p>I should eat a high-protein diet to help my liver heal. (A)</p> Signup and view all the answers

A patient with cirrhosis is undergoing a transjugular intrahepatic portosystemic shunt (TIPS) procedure. What is the main goal of this procedure?

<p>To reduce pressure in the portal vein (B)</p> Signup and view all the answers

The nurse is caring for a patient with cirrhosis who is at risk for bleeding. Which nursing intervention is most important to implement?

<p>Administering stool softeners (A)</p> Signup and view all the answers

The nurse is reviewing the lab results of a patient with cirrhosis. Which of the following findings would the nurse expect to see?

<p>Elevated liver enzymes and decreased platelet count (A)</p> Signup and view all the answers

In Jewish law, under which of the following circumstances is organ transplantation generally considered permissible?

<p>When the recipient's life can be prolonged without considerable risk. (A)</p> Signup and view all the answers

A liver transplant recipient is being monitored for organ rejection. Which of the following assessment findings is an early indicator of potential rejection?

<p>Pulse rate consistently above 100 bpm. (B)</p> Signup and view all the answers

A patient who underwent liver transplantation is being discharged. Which instruction is most important to emphasize to the patient regarding long-term care?

<p>Immediately report any symptoms of infection, bleeding, or RUQ pain. (B)</p> Signup and view all the answers

A patient is diagnosed with liver cancer. The physician explains that the cancer likely originated elsewhere in the body. From which of the following primary sites is liver metastasis most common?

<p>Colon. (C)</p> Signup and view all the answers

Which of the following factors poses the greatest risk for the development of liver cancer?

<p>History of chronic Hepatitis B or C. (C)</p> Signup and view all the answers

A patient with suspected liver cancer undergoes diagnostic testing. Which elevated laboratory value is most indicative of liver cancer?

<p>Alpha-fetoprotein (AFP). (D)</p> Signup and view all the answers

A patient post-operative from liver cancer resection is being cared for. Which of the following nursing interventions would be most appropriate?

<p>Monitoring for signs of bleeding and infection. (C)</p> Signup and view all the answers

A patient is admitted with acute pancreatitis. Which pathophysiological process is primarily responsible for the severe abdominal pain associated with this condition?

<p>Autodigestion of the pancreas by activated enzymes. (D)</p> Signup and view all the answers

Which of the following is a leading cause of acute pancreatitis?

<p>Heavy alcohol consumption. (B)</p> Signup and view all the answers

A patient with acute pancreatitis develops signs of shock. Which pathophysiologic mechanism best explains this development?

<p>Increased capillary permeability and fluid loss into the retroperitoneal space. (A)</p> Signup and view all the answers

Which of the following assessment findings is most indicative of acute pancreatitis?

<p>Severe epigastric pain radiating to the back. (B)</p> Signup and view all the answers

During the assessment of a patient with acute pancreatitis, the nurse notes shallow respirations and abdominal splinting. What is the most likely cause of these findings?

<p>Pain from the inflamed pancreas. (D)</p> Signup and view all the answers

A patient with a history of heavy alcohol use is admitted with acute pancreatitis. What preventative measure should the nurse emphasize during discharge teaching to reduce the patient's risk of future episodes?

<p>Complete abstinence from alcohol. (A)</p> Signup and view all the answers

A patient being evaluated for acute pancreatitis reports nausea, vomiting, and jaundice. Which etiology of pancreatitis should the nurse suspect based on these signs and symptoms?

<p>Biliary obstruction. (B)</p> Signup and view all the answers

A patient with acute pancreatitis is being treated for pain and fluid imbalances. What additional intervention is most important to include in the patient's plan of care to prevent complications?

<p>NPO status to reduce pancreatic stimulation. (B)</p> Signup and view all the answers

Which of the following best describes the typical pain associated with chronic pancreatitis (CP)?

<p>Epigastric or LUQ pain that worsens after eating, along with exacerbations and remissions. (D)</p> Signup and view all the answers

A patient with chronic pancreatitis reports frequent, greasy, foul-smelling stools. Which complication is MOST likely causing this symptom?

<p>Malabsorption syndrome due to decreased pancreatic enzyme production. (C)</p> Signup and view all the answers

Which diagnostic test is typically preferred as the initial radiologic test for chronic pancreatitis?

<p>CT scan (B)</p> Signup and view all the answers

Which of the following therapeutic measures is MOST important in managing pain and preventing further damage in chronic pancreatitis?

<p>Cessation of alcohol use (A)</p> Signup and view all the answers

A patient with chronic pancreatitis is prescribed pancrelipase. What key teaching point should the nurse emphasize regarding the administration of this medication?

<p>Take the medication with meals. (A)</p> Signup and view all the answers

Which of the following assessment findings would be MOST indicative of a risk for injury related to hemorrhage in a patient with pancreatitis?

<p>Presence of Cullen or Turner signs. (C)</p> Signup and view all the answers

A patient with chronic pancreatitis is experiencing persistent itching. Which medication class might be prescribed to relieve this symptom?

<p>Bile acid sequestrants (C)</p> Signup and view all the answers

In a patient with chronic pancreatitis, what is the significance of monitoring the patient's weight every other day?

<p>To monitor nutritional status and detect weight loss. (A)</p> Signup and view all the answers

What is the rationale for advising patients with chronic pancreatitis to stop smoking?

<p>Smoking is a known risk factor for pancreatic cancer and can exacerbate pancreatitis. (D)</p> Signup and view all the answers

Which of the following electrolyte imbalances is MOST likely to occur in a patient with pancreatitis?

<p>Hypocalcemia (B)</p> Signup and view all the answers

Which of the following best explains why serum amylase and lipase levels might be normal or low in a patient with chronic pancreatitis?

<p>The pancreas is gradually losing its ability to produce these enzymes due to chronic damage. (A)</p> Signup and view all the answers

A patient with chronic pancreatitis develops diabetes mellitus. What is the MOST likely cause of this complication?

<p>Destruction of the islets of Langerhans. (A)</p> Signup and view all the answers

A patient with chronic pancreatitis is scheduled for extracorporeal shock-wave lithotripsy. What is the purpose of this procedure?

<p>To remove ductal stones. (D)</p> Signup and view all the answers

A patient with acute pancreatitis has a nasogastric tube in place for enteral feeding. Which nursing intervention is the priority when administering the feeding?

<p>Verifying placement of the tube and assessing for residual volume before feeding (C)</p> Signup and view all the answers

A patient with chronic pancreatitis is being discharged. Which of the following instructions should the nurse emphasize to promote long-term health?

<p>Adhere to prescribed pancreatic enzyme supplements with meals (A)</p> Signup and view all the answers

A nurse is teaching a patient with chronic pancreatitis about self-monitoring for malabsorption syndrome. Which symptom should the nurse emphasize as MOST indicative of this condition?

<p>Fatty stools. (C)</p> Signup and view all the answers

A patient with acute pancreatitis develops a purplish discoloration around the umbilicus. Which of the following complications is MOST likely indicated by this clinical sign?

<p>Hemorrhagic pancreatitis (C)</p> Signup and view all the answers

A patient taking bile acid dissolution agents should be taught to avoid which type of antacid?

<p>Aluminum antacids (D)</p> Signup and view all the answers

Which electrolyte imbalance is MOST likely to occur in a patient with acute pancreatitis due to autodigestion and fat necrosis?

<p>Hypocalcemia (B)</p> Signup and view all the answers

A patient with chronic pancreatitis reports persistent abdominal pain despite taking pain medications. Which intervention is MOST appropriate for the nurse to suggest?

<p>Consult healthcare provider for alternative pain management strategies (D)</p> Signup and view all the answers

A patient with acute pancreatitis is at risk for developing Systemic Inflammatory Response Syndrome (SIRS). Which assessment finding is an EARLY indicator of SIRS?

<p>Fever and increased heart rate (A)</p> Signup and view all the answers

A patient with chronic pancreatitis has significant exocrine insufficiency. What nutritional deficiency is MOST likely to develop as a result?

<p>Fat-soluble vitamin deficiency (A)</p> Signup and view all the answers

A patient with cirrhosis is experiencing ascites. Which dietary modification is MOST appropriate to manage this condition?

<p>Sodium-restricted diet to reduce fluid retention. (B)</p> Signup and view all the answers

A patient is admitted with acute pancreatitis. Which of the following interventions is MOST important in the initial management of pain?

<p>Administering an opioid analgesic, such as morphine. (D)</p> Signup and view all the answers

What is the MOST important teaching point for a patient being discharged after hospitalization for acute pancreatitis related to gallstones?

<p>Avoid alcohol consumption completely (C)</p> Signup and view all the answers

Following an ERCP, a patient reports new onset of severe abdominal pain. What is the nurse's MOST appropriate initial action?

<p>Notify the healthcare provider immediately (B)</p> Signup and view all the answers

A patient with chronic cirrhosis presents with esophageal varices. What is the MOST critical concern related to this condition?

<p>Potential for gastrointestinal hemorrhage. (A)</p> Signup and view all the answers

Which diagnostic result is the MOST specific indicator of acute pancreatitis?

<p>Elevated serum lipase (D)</p> Signup and view all the answers

Following a laparoscopic cholecystectomy, a patient should receive education about which dietary change?

<p>Adhere to a low-fat diet to minimize gallbladder stimulation. (C)</p> Signup and view all the answers

A patient with chronic pancreatitis is at risk for developing diabetes mellitus. Which pathophysiological change leads to this endocrine insufficiency?

<p>Destruction of the islet cells (B)</p> Signup and view all the answers

What is the rationale for using semi-Fowler's position in patients with acute pancreatitis?

<p>To minimize diaphragmatic pressure and improve respiratory function. (A)</p> Signup and view all the answers

A patient with acute pancreatitis is being treated with aggressive intravenous fluid hydration. Which assessment finding indicates effective fluid resuscitation?

<p>Decreased heart rate and increased blood pressure (B)</p> Signup and view all the answers

Which laboratory finding is MOST indicative of acute pancreatitis?

<p>Increased serum lipase. (B)</p> Signup and view all the answers

What is the MOST common cause of chronic pancreatitis?

<p>Alcohol abuse (B)</p> Signup and view all the answers

A patient with cirrhosis develops hepatic encephalopathy. Which dietary modification would be MOST appropriate?

<p>Restrict protein intake to reduce ammonia production. (C)</p> Signup and view all the answers

What is the BEST strategy to prevent hepatitis A infection when preparing food for others?

<p>Thorough hand washing before and after food preparation. (C)</p> Signup and view all the answers

A patient with chronic pancreatitis is experiencing significant steatorrhea. What dietary modification is MOST appropriate to manage this symptom?

<p>Decrease fat intake (C)</p> Signup and view all the answers

A patient with cirrhosis is prescribed diuretics. What electrolyte imbalance is the patient MOST at risk for?

<p>Hypokalemia. (D)</p> Signup and view all the answers

A patient with acute pancreatitis suddenly develops muscle twitching and complains of numbness around the mouth. Which electrolyte imbalance is suspected?

<p>Hypocalcemia (A)</p> Signup and view all the answers

A patient with gallstones is experiencing right upper quadrant pain after eating a high-fat meal. What is the MOST likely cause of this pain?

<p>Gallstone obstruction of bile flow. (C)</p> Signup and view all the answers

Which of the following factors contributes to the formation of cholesterol gallstones?

<p>Bile supersaturated with cholesterol (C)</p> Signup and view all the answers

A patient with cholelithiasis also has sickle cell disease. How does sickle cell disease contribute to the formation of gallstones?

<p>Increased bilirubin production (D)</p> Signup and view all the answers

Following a cholecystectomy, an older adult patient is at higher risk for complications due to:

<p>Higher incidence of complex gallbladder disease and comorbidities (C)</p> Signup and view all the answers

Mrs. Garcia is post-operative following an open cholecystectomy. She has shallow respirations. After ensuring airway patency, what is the most appropriate initial nursing intervention?

<p>Encourage coughing and deep breathing exercises (D)</p> Signup and view all the answers

A patient post-cholecystectomy has a T-tube. Kinking of the T-tube is a concern because it can lead to:

<p>Increased pain and risk for infection (B)</p> Signup and view all the answers

A patient with acute cholecystitis is experiencing severe abdominal pain. Which of the following medications would the nurse most likely administer?

<p>Analgesic (D)</p> Signup and view all the answers

A patient with cholecystitis is at risk for deficient fluid volume. Which assessment finding is the best indicator of dehydration?

<p>Dry mucous membranes (D)</p> Signup and view all the answers

Which of the following nursing interventions is most important for a patient at risk for ineffective breathing pattern following a cholecystectomy?

<p>Encouraging coughing and deep breathing exercises (C)</p> Signup and view all the answers

A patient's stool is clay-colored. This finding is most likely related to:

<p>Obstruction of bile flow (D)</p> Signup and view all the answers

A patient with a history of chronic cholecystitis is admitted. Which dietary instruction is most appropriate for this patient?

<p>Low-fat diet to reduce gallbladder stimulation (D)</p> Signup and view all the answers

What is the primary difference between acute and chronic cholecystitis?

<p>Acute cholecystitis is a sudden inflammation due to obstruction, while chronic cholecystitis results from repeated attacks or irritation. (C)</p> Signup and view all the answers

A nurse is reviewing the laboratory results for a patient suspected of having a gallbladder disorder. Which lab value is most indicative of a bile duct obstruction?

<p>Elevated serum bilirubin (D)</p> Signup and view all the answers

A patient with choledocholithiasis is likely to experience:

<p>Gallstones in the common bile duct (A)</p> Signup and view all the answers

Which of the following conditions is most likely to cause stasis of bile in the gallbladder?

<p>Pregnancy (A)</p> Signup and view all the answers

When teaching a patient about preventing gallstones, which of the following recommendations is most appropriate?

<p>Maintain a healthy weight and eat a balanced diet. (D)</p> Signup and view all the answers

Following a Whipple procedure, a patient exhibits signs of peritonitis. Which of the following complications is the MOST likely cause?

<p>Breakdown of suture lines leading to leakage of pancreatic enzymes and bile. (C)</p> Signup and view all the answers

A patient with pancreatic cancer experiences significant weight loss, fatigue, and generalized weakness. Which nursing intervention is the MOST appropriate initial approach to address these symptoms?

<p>Providing small, frequent meals that are high in calories and protein. (B)</p> Signup and view all the answers

A patient is scheduled for a distal pancreatectomy. What other organ will MOST likely be removed during the procedure?

<p>The spleen. (C)</p> Signup and view all the answers

A patient with advanced pancreatic cancer is experiencing severe, intractable pain. Which intervention should the nurse anticipate as a means to provide longer-term pain relief when pharmacological interventions are insufficient?

<p>Collaboration with the healthcare provider for possible chemical destruction of the celiac plexus. (D)</p> Signup and view all the answers

What dietary modification is most appropriate for a patient immediately following a cholecystectomy?

<p>A high-protein, low-fat diet. (B)</p> Signup and view all the answers

A patient with cholecystitis is experiencing significant pain. Besides medication, what non-pharmacological intervention can the nurse implement to provide additional comfort?

<p>Apply a warm compress to the abdomen. (A)</p> Signup and view all the answers

A patient with pancreatic cancer develops jaundice and pruritus. Which nursing intervention is MOST appropriate to manage the pruritus?

<p>Providing frequent skin care with emollients free of alcohol or soap. (A)</p> Signup and view all the answers

A patient who had an open cholecystectomy, which nursing intervention is most important to prevent pulmonary complications?

<p>Assisting with coughing and deep breathing exercises. (A)</p> Signup and view all the answers

A patient is diagnosed with pancreatic cancer and presents with steatorrhea. Which intervention should the nurse prioritize to address this issue?

<p>Instructing the patient to follow a low-fat diet and take pancreatic enzyme replacements. (B)</p> Signup and view all the answers

A patient with pancreatic cancer is being discharged with drains post-operatively. Which statement indicates a need for further teaching?

<p>I don't need to wash my hands before and after touching the drain as long as I don't feel sick. (B)</p> Signup and view all the answers

Which assessment finding would indicate that the treatment plan for a patient with cholecystitis is effective?

<p>Maintains urinary output greater than 30 mL/hour. (B)</p> Signup and view all the answers

A patient post Whipple reports new onset of anxiety, which intervention should the nurse implement FIRST?

<p>Assess oxygen saturation. (C)</p> Signup and view all the answers

A patient is suspected of having acute cholecystitis. Which diagnostic test would be most useful in confirming this diagnosis quickly and non-invasively?

<p>Abdominal ultrasound. (D)</p> Signup and view all the answers

Which of the following findings suggests a potential complication of cirrhosis related to impaired liver function?

<p>Prolonged prothrombin time (PT). (A)</p> Signup and view all the answers

A patient with pancreatic cancer is on palliative care. Which of the following outcomes should be prioritized by the nurse for the patient's plan of care:

<p>Maximizing comfort and quality of life. (C)</p> Signup and view all the answers

What is the primary purpose of CA 19-9 testing in a patient diagnosed with pancreatic cancer?

<p>To assess response to treatment and monitor for disease progression. (A)</p> Signup and view all the answers

Which condition is most commonly associated with acute pancreatitis?

<p>Heavy alcohol use. (B)</p> Signup and view all the answers

A patient reports epigastric pain, especially after eating fatty meals. Which condition is this patient most likely experiencing?

<p>Cholecystitis. (A)</p> Signup and view all the answers

A patient with known pancreatic cancer reports significant abdominal distention and increased shortness of breath. Which complication should the nurse suspect?

<p>Development of ascites secondary to liver metastasis or portal vein compression. (B)</p> Signup and view all the answers

A patient with pancreatic cancer is receiving chemotherapy. Which of the following nursing interventions is MOST important to prevent infection?

<p>Meticulous hand hygiene and avoidance of exposure to sick individuals. (B)</p> Signup and view all the answers

A patient with cirrhosis develops ascites that is unresponsive to diuretics. What is the next appropriate step?

<p>Prepare the patient for paracentesis. (C)</p> Signup and view all the answers

What is the rationale for performing a laparoscopy with biopsy in a patient diagnosed with pancreatic cancer?

<p>To stage the cancer and guide treatment options. (B)</p> Signup and view all the answers

What is a major long-term complication of cirrhosis that requires ongoing monitoring?

<p>Liver cancer. (B)</p> Signup and view all the answers

A patient with pancreatic cancer presents with a new onset of confusion. The patient's family reports increased sleepiness and forgetfulness over the past few days. Which lab value should the nurse assess first?

<p>Serum glucose. (C)</p> Signup and view all the answers

How does chronic cholecystitis typically develop?

<p>Progressive fibrosis and thickening of the gallbladder. (A)</p> Signup and view all the answers

A patient with chronic pancreatitis is experiencing malabsorption and steatorrhea. What intervention will best address these issues?

<p>Provide pancreatic enzyme replacement therapy. (D)</p> Signup and view all the answers

A patient with pancreatic cancer is having difficulty managing their blood sugar levels. They report that their blood sugars are high after meals. Which education should the nurse provide?

<p>Eat small frequent meals. (D)</p> Signup and view all the answers

Which finding in a patient with end-stage liver disease indicates the most immediate need for possible liver transplant evaluation?

<p>Worsening hepatic encephalopathy. (C)</p> Signup and view all the answers

A patient with cirrhosis is at risk for esophageal varices. What dietary modification is most important to minimize this risk?

<p>Consuming exclusively soft foods. (A)</p> Signup and view all the answers

Which nursing intervention is MOST important for a patient experiencing breakthrough pain despite receiving regular analgesics for acute pancreatitis?

<p>Immediately notifying the healthcare provider and reassessing the pain. (A)</p> Signup and view all the answers

A patient with pancreatic cancer is undergoing palliative care. What is the primary goal of this approach?

<p>To manage symptoms and improve quality of life. (D)</p> Signup and view all the answers

A patient with acute pancreatitis develops a persistent, nonproductive cough and decreased oxygen saturation. Which complication should the nurse suspect?

<p>Atelectasis due to shallow breathing from abdominal pain. (B)</p> Signup and view all the answers

A patient with chronic pancreatitis is being discharged. Which dietary instruction is MOST appropriate to minimize pancreatic stimulation?

<p>Consume a high-protein, low-fat diet in frequent, small meals. (A)</p> Signup and view all the answers

What is the primary rationale for advising a patient with pancreatic cancer to avoid cigarette smoking?

<p>Smoking is a significant risk factor for pancreatic cancer development and progression. (C)</p> Signup and view all the answers

A patient with pancreatic cancer reports that pain is worse at night and radiates to the back. Which position should the nurse suggest to potentially alleviate this discomfort?

<p>Side-lying with knees drawn up to the chest. (A)</p> Signup and view all the answers

Which assessment finding in a pancreatic cancer patient requires the MOST immediate intervention by the nurse?

<p>New onset of dark urine and light-colored stools. (C)</p> Signup and view all the answers

Following a Whipple procedure for pancreatic cancer, a patient develops paralytic ileus. Which nursing intervention is MOST appropriate?

<p>Insert a nasogastric tube and provide comfort measures. (B)</p> Signup and view all the answers

A patient with pancreatic cancer develops thrombophlebitis. Which intervention is MOST important for the nurse to implement?

<p>Elevate the affected extremity and monitor for signs of pulmonary embolism. (A)</p> Signup and view all the answers

After a pancreaticoduodenectomy (Whipple procedure), a patient exhibits signs of hyperglycemia. Which intervention should the nurse prioritize?

<p>Administering prescribed subcutaneous insulin according to the sliding scale. (C)</p> Signup and view all the answers

Which statement BEST describes the significance of CA 19-9 in the management of pancreatic cancer?

<p>It is used primarily to monitor the response to treatment and detect recurrence. (C)</p> Signup and view all the answers

Which of the following is the MOST critical assessment for a patient with acute pancreatitis concerning potential respiratory complications?

<p>Monitoring oxygen saturation and respiratory effort. (D)</p> Signup and view all the answers

A patient with chronic pancreatitis reports persistent steatorrhea despite enzyme replacement therapy. What dietary modification should the nurse recommend FIRST?

<p>Increase intake of medium-chain triglycerides (MCTs). (B)</p> Signup and view all the answers

A patient with pancreatic cancer is undergoing palliative care. Which nursing intervention is MOST appropriate for managing anorexia and cachexia?

<p>Providing small, frequent meals high in calories and protein. (A)</p> Signup and view all the answers

A patient with chronic pancreatitis and diabetes mellitus is prescribed both pancreatic enzyme supplements and insulin. What is the MOST important instruction for the nurse to provide regarding medication administration?

<p>Monitor blood glucose levels closely, as enzyme supplements can affect insulin requirements. (D)</p> Signup and view all the answers

A patient with pancreatic cancer who is receiving chemotherapy reports increased fatigue and malaise. Apart from rest, which intervention is MOST appropriate for the nurse to recommend?

<p>Engaging in moderate exercise to improve energy levels. (B)</p> Signup and view all the answers

Flashcards

Hepatitis

Inflammation of the liver; can result from infection, toxins, or disorders.

HAV

Hepatitis A virus; typically transmitted through contaminated food or water.

HBV

Hepatitis B virus; transmitted through blood and body fluids.

HCV

Hepatitis C virus; commonly spread through sharing needles or other drug paraphernalia.

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HDV

Hepatitis D virus; can cause infection only in people who are also infected with HBV

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HEV

Hepatitis E virus; usually transmitted through contaminated water.

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Cirrhosis

Liver damage with scarring.

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Ascites

Fluid accumulation in the abdomen.

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Viral Hepatitis

Inflammation of the liver, damaging liver cells and function.

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Obstructive Jaundice

Blocks bile flow, causing yellowing of skin/eyes.

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Hepatitis A (HAV)

Spread through fecal-oral route (contaminated food/water).

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Hepatitis B (HBV)

Spread through blood and body fluids.

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Hepatitis C (HCV)

Spread through blood, often IV drug use.

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Hepatitis D (HDV)

Requires HBV co-infection to replicate.

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Hepatitis E (HEV)

Spread through contaminated water or undercooked pork

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Anti-HAV IgM

Indicates acute HAV infection.

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Anti-HAV IgG

Shows recovery and immunity to HAV.

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HBsAg

Surface antigen; indicates HBV infection.

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Anti-HBs IgM

Antibody that attacks HBV.

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Anti-HBc IgM

Antibody to core antigen of HBV.

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HDV-RNA

Detects replicating HDV, indicating active infection

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HBeAg

Associated with high HBV replication.

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Preventing Hepatitis

Infection control and avoiding exposure, vaccinations, and immunoglobulin use.

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Immunoglobulins (IGs)

Plasma donor antibodies that provide short-term passive protection, lasting up to 3 months.

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Public Health Measures for Hepatitis

Health education, facility supervision, and screening blood/organ donors and food handlers

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Prodromal Stage Symptoms

Asymptomatic or fatigue, nausea, and vomiting.

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Convalescent Stage

The patient starts feeling better; liver function tests return to normal.

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Fulminant Hepatitis

Sudden and severe liver failure.

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Serological Tests

Can determine the specific hepatitis virus and identify antibodies to the virus.

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Hepatitis Treatment Goals

Monitor liver, relieve symptoms, and prevent cirrhosis.

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Supportive Care for Hepatitis

Adequate fluid and nutrition intake.

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Substances to Avoid with Hepatitis

Avoid alcohol and liver-toxic medications.

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HAV and HEV Treatment

Supportive care based on signs and symptoms.

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HBV and HDV Coinfection Treatment

Pegylated interferon therapy plus ribavirin.

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Chronic Hepatitis B Treatment

Antivirals such as entecavir and tenofovir.

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Direct-Acting Antivirals (DAAs)

Oral medications with a high cure rate and few side effects.

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Examples of DAA Combinations

Elbasvir plus grazoprevir, sofosbuvir plus ledipasvir, sofosbuvir plus velpatasvir, and glecaprevir plus pibrentasivir.

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Hepatic Inflammation

Inflammation of the liver, which can be caused by medications, metabolic disorders, toxins, vascular disorders, or viruses.

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Alanine Aminotransferase (ALT)

Most specific enzyme for detecting liver damage; elevates significantly when liver cells die.

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Aspartate Aminotransferase (AST)

Enzyme found in both the liver and heart; elevated levels indicate liver or heart damage.

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Alkaline Phosphatase (ALP)

Enzyme found in the liver and other tissues; greatly elevated with severe liver damage.

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Albumin

Protein made by the liver that maintains oncotic pressure; low levels can lead to edema and ascites.

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Ammonia

A product of protein metabolism; increased levels due to liver dysfunction can cause hepatic encephalopathy.

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Total Bilirubin

A substance produced from the breakdown of heme; increased levels indicate the liver's inability to process it for bile production.

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Prothrombin Time (PT)

A measure of how long it takes blood to clot; prolonged in liver disease because the liver can't produce prothrombin.

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Subjective Data in Hepatitis

Malaise, fatigue, pruritus (itching), nausea, anorexia, and right upper quadrant (RUQ) abdominal pain.

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Objective Data in Hepatitis

Weight changes, vomiting, pale stools, dark urine, jaundice, fever, bruising, or bleeding.

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Acute Pain (Hepatitis)

Pain caused by inflammation and enlargement of the liver.

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Imbalanced Nutrition (Hepatitis)

Reduced nutritional intake due to anorexia, nausea, or vomiting.

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Risk for Impaired Liver Function

The risk for liver damage due to viral infection, monitored through liver function tests, ascites, and mental changes.

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Risk for Impaired Skin Integrity

The risk for skin breakdown due to bilirubin deposits causing itching.

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Ineffective Health Management

Insufficient knowledge about hepatitis, its transmission, and treatment, requiring patient education.

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Hepatitis Transmission Prevention

Preventive measures taught to patients and families to halt the spread of hepatitis. Includes things such as vaccination, hand washing, safe sex, and not sharing needles.

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Collecting Blood Ammonia Levels

Using chilled containers, placing them on ice, and delivering them to the lab within 10 minutes.

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Managing Abdominal Ascites

Elevate the head of the bed and measure abdominal girth daily to monitor ascites.

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Hepatitis Home Precautions

Wear gloves when cleaning the patient's bathroom to prevent exposure to bodily fluids.

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Handling Contaminated Linens

Wash contaminated laundry separately in hot water with detergent; presoak in cold water if soiled with blood.

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Assessing Potential Hepatitis

Assess travel history, seafood consumption, lacerations, and medication use.

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Initial Precautions for Hepatitis

Implementing standard precautions.

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Teaching about Tylenol

Reinforce the risk of liver damage and importance of sticking to recommended doses.

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Collaborating on Hepatitis Care

Doctors, dietitians, and pharmacists.

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Acute Liver Failure

A rare condition with rapid liver function decline, potentially leading to liver recovery, transplant, or death.

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Preventing Liver Failure

Avoiding the sharing of personal items, getting vaccinated against hepatitis A and B, and practicing safe hygiene.

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Safe Acetaminophen Dosage

Do not exceed 3,000 mg in 24 hours. Be aware of combination products.

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Activated Charcoal

Given within 4 hours of ingestion for acetaminophen overdose.

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N-acetylcysteine (Acetadote)

Effective if given within 8 hours of acetaminophen overdose.

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Monitoring Acetaminophen Dosage

Monitor the total acetaminophen intake from all sources within a rolling 24-hour period.

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Aldosterone's Role in Kidneys

Hormone released by kidneys to increase sodium (and water) retention in response to decreased blood volume.

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Ascites Definition

A complication of liver disease where excess fluid accumulates in the peritoneal cavity, leading to abdominal enlargement.

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Hepatic Encephalopathy (HE)

Brain dysfunction caused by elevated ammonia levels due to liver damage.

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Signs of Hepatic Encephalopathy

Progressive confusion, asterixis, and fetor hepaticus.

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Asterixis

Flapping tremors in the hands, caused by toxins affecting peripheral nerves.

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Fetor Hepaticus

Foul breath caused by metabolic end products related to sulfur, associated with liver disease.

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Hepatic Encephalopathy Grade 0

Minimal changes in memory, concentration, or intellectual functioning.

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Hepatic Encephalopathy Grade 1

Subtle changes in personality, sleep disturbances, mood changes, and shortened attention span.

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Hepatic Encephalopathy Grade 2

Forgetfulness, lethargy, inappropriate behavior, asterixis, and problems with math/writing.

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Hepatic Encephalopathy Grade 3

Belligerence, irritability, disorientation, somnolence, and marked confusion.

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Hepatic Encephalopathy Grade 4

Loss of consciousness and coma.

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Hepatorenal Syndrome

Kidney failure secondary to cirrhosis, marked by oliguria and sodium retention.

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Wernicke-Korsakoff Syndrome

Brain disorder caused by thiamine (B1) deficiency, often linked to alcohol abuse.

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Wernicke Encephalopathy

Acute condition with confusion, delirium, visual disturbances, and ataxia, often reversible with thiamine.

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Korsakoff Psychosis

Chronic condition with memory and learning deficits, irreversible brain damage from thiamine deficiency.

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Acute Liver Failure Labs

Sudden increase in liver enzymes (ALT, AST), bilirubin, and prolonged PT. Potassium and glucose drop.

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Acute Liver Failure Treatment

IV fluids, proton pump inhibitors or H2 blockers, airway management, nutrition, dialysis (if overdose related).

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Common Cirrhosis Causes

Chronic alcohol use, chronic hepatitis B and C, or nonalcoholic steatohepatitis (NASH).

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Nonalcoholic Steatohepatitis (NASH)

Fat build-up in the liver, common with diabetes, obesity, heart disease, or high cholesterol.

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Cirrhosis Pathophysiology

Liver cells are damaged, infiltrated with fat and WBCs, and replaced by fibrotic tissue.

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Cirrhosis Symptoms

Anorexia, nausea, weight loss, ascites, bruising, muscle cramps, RUQ pain, GI bleeding, itching, jaundice, spider angiomata.

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Cirrhosis Lab Values

Elevated ALT, ALP, AST, ammonia, bilirubin, and PT.

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Cirrhosis Treatment Goals

Prevent disease progression and manage complications.

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Cirrhosis Complications

Blood clotting defects, portal hypertension, ascites.

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Cirrhosis Clotting Defects

Impaired prothrombin and fibrinogen production leads to bleeding.

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Portal Hypertension

Elevated blood pressure in the portal vein due to obstructed blood flow.

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Portal Hypertension Signs

Enlarged abdominal veins, rectal hemorrhoids, splenomegaly, esophageal varices.

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Ascites Cause

Accumulation of serous fluid in the peritoneal cavity due to portal hypertension and low albumin.

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Portal hypertension risk

Bleeding from esophageal varices is a major risk.

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Varices Screening

Screening is crucial due to potential for significant blood loss and mortality.

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Beta-blockers for varices

Propranolol or nadolol can prevent variceal bleeding.

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Variceal Ligation

Endoscopic variceal ligation using rubber bands.

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Treating Bleeding Varices

Octreotide and variceal ligation can immediately stop bleeding.

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TIPS Procedure

It reduces portal vein pressure to stop variceal bleeding.

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Blood Transfusion

May be needed to restore lost blood volume from variceal bleeding.

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Antibiotics for Varices

These reduce risk of infection and rebleeding.

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Balloon Tamponade

Temporarily stops bleeding by direct pressure on varices.

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HE Precipitants

Medications, increased ammonia, dehydration.

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Lactulose

Lactulose lowers colon pH, inhibiting ammonia absorption and production.

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Rifaximin

It reduces ammonia-producing bacteria in the gut.

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Potassium Replacement

Needed because hypokalemia increases renal ammonia production.

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TIPS Meaning

Across jugular vein, within liver, portal to systemic circulation.

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Liver Dysfunction Symptoms

Assess subjective symptoms such as abdominal pain, itching, and RUQ pain.

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Branched-Chain Amino Acids

Branched-chain amino acids do not require oxidation by the liver and are available for direct use by other tissues.

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Organ Transplant in Judaism

Jewish law generally approves organ transplant if it prolongs life without undue risk to the recipient.

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Living Organ Donor (Judaism)

In Judaism, donation from a living donor is considered if the risk to the donor's life is small.

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Cadaver Organ Donation (Judaism)

In Judaism, transplant from a cadaver is generally accepted if it will save a life.

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Signs of Organ Rejection

After liver transplant, monitor for pulse >100 bpm, temp >101°F (38°C), RUQ pain, increased jaundice.

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Post-Liver Transplant: Key Instructions

Following liver transplant, report symptoms of infection, bleeding, or RUQ pain to the HCP.

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Bioartificial Liver

Bioartificial livers offer filtering membranes used as a short-term bridge to liver transplant.

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Hepatocyte Transplantation

Hepatocyte transplantation via splenic artery catheter is under study for long-term support.

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Liver Cancer Cause

Liver cancer often results from metastasis from cancers in other organs.

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Liver Cancer Symptoms

Encephalopathy, abnormal bleeding, jaundice, and ascites are symptoms of liver cancer.

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Liver Cancer Labs

Elevated serum ALP and alpha-fetoprotein may indicate liver cancer.

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Liver Cancer Diagnosis

MRI, CT, or ultrasound are used to diagnose and monitor liver cancer.

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Acute Pancreatitis: Pathophysiology

Autodigestion of the pancreas by its own activated enzymes causes acute pancreatitis.

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Acute Pancreatitis: Common Causes

Heavy alcohol use and cholelithiasis are common causes of acute pancreatitis.

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Acute Pancreatitis: Signs/Symptoms

Severe epigastric/LUQ pain, rigid abdomen, hypotension/shock, and respiratory distress are signs and symptoms of acute pacreatitis.

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Trypsin in Acute Pancreatitis

In acute pancreatitis, trypsin destroys pancreatic tissue causing vasodilation.

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Imbalanced Nutrition

Inadequate nutrient intake to meet metabolic needs, often linked to anorexia or impaired nutrient metabolism.

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Acute Confusion

Altered mental state characterized by disorientation, confusion, and an inability to think clearly, often due to elevated ammonia levels.

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Asterixis (Liver Flap)

A flapping tremor that indicates the presence of elevated ammonia levels.

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Ineffective Breathing Pattern

Ineffective respiration due to excess fluid accumulation in the abdominal cavity, restricting lung expansion.

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Risk for Deficient Fluid Volume

Potential for decreased intravascular fluid due to bleeding from esophageal varices or other GI bleeds.

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Esophageal Varices

Abnormal distended and fragile veins in the esophagus that are prone to bleeding.

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Patient Education

Reinforcing education to avoid alcohol, obtain adequate rest, cautiously use opioids, and report any changes.

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Liver Transplantation

A procedure where a diseased liver is replaced with a healthy one from a donor.

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Organ Matching

The matching of organs with candidates who need transplants.

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Prolonged PT

Prolonged clotting time indicates a risk of bleeding due to liver dysfunction.

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Low Albumin

Low albumin levels may result in edema and ascites and poor transportation of medications.

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Hepatic Encephalopathy

Serious complications of high level of ammonia in the blood, that affects brain function.

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Chronic Pancreatitis (CP)

Recurring inflammation of the pancreas resulting in damage.

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CP Signs/Symptoms

Epigastric or LUQ pain, worsened by eating; greasy stools.

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CP Complications

Abscesses, fistulas, pleural effusion, vitamin deficiencies, diabetes.

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CP Diagnosis

CT scan (initial), MRI, endoscopic ultrasound.

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Amylase/Lipase Levels in CP

Normal or low.

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Fecal Fat Analysis in CP

High amounts.

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CP Treatment Goals

Pain relief, pancreatic function, treat complications.

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CP Pain Management

Low-fat meals, PPIs, NSAIDs, analgesics, enzyme supplements.

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Extracorporeal shock-wave lithotripsy

Stenting ducts or removing stones using shock waves.

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Antiemetics

Reduce Nausea.

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Bile Acid Sequestrants

Relieve itching.

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Bile Acid Dissolution Agents

Prevent/dissolve gallstones.

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Pancreatic Supplements

Replace lipase, protease, amylase.

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Monitoring Weight

Weight every other day.

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Injury Monitoring

Monitor electrolytes, observe for Cullen/Turner signs

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Acute Pancreatitis (AP)

Inflammation of the pancreas that can be caused by gallstones, alcohol abuse, or other factors. Diagnosed with elevated amylase/lipase.

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Symptoms of Pancreatitis

Epigastric or left upper quadrant abdominal pain, nausea, vomiting, and potentially low-grade fever.

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Diagnosing Acute Pancreatitis

Elevated serum amylase and lipase levels that are more than three times the normal value. May be confirmed by CT or MRI of the abdomen.

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Treating Acute Pancreatitis

Aggressive intravenous fluid hydration, pain control, and nutritional support. May require enteral or parenteral feeding based on severity.

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Complications of Acute Pancreatitis

Leakage of fluid/blood, systemic inflammatory response syndrome (SIRS), cardiovascular issues, respiratory distress, and acute kidney injury.

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Turner/Cullen Sign

A purplish discoloration of the flanks or around the umbilicus, indicating hemorrhagic destruction of the pancreas.

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Nutrition in Severe Acute Pancreatitis

Enteral feeding within 24-48 hours; energy 25-30 kcal/kg, glucose 2-4 g/kg, protein 1.2-1.5 g/kg. If not tolerated, parenteral nutrition is used.

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Causes of Chronic Pancreatitis

Alcohol abuse, obstructive biliary disease, hyperlipidemia, or idiopathic/genetic/autoimmune factors.

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Outcomes of Chronic Pancreatitis

Exocrine insufficiency (enzyme deficiency) and endocrine insufficiency (diabetes mellitus).

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Nutritional Deficiencies in CP

Monitor for deficiencies of vitamins A, D, E, and K, plus magnesium, zinc, or calcium.

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Chronic Pancreatitis interventions

Enzymes are prescribed to aid digestion at meal times. Abstinence from alcohol should be encouraged.

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Decreased Calcium Levels

A condition that is indicated by the presence of Chvostek's sign.

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Pain Management in Acute Pancreatitis

Administer medication as prescribed, evaluate the effectiveness of medication, and adjust treatment.

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Systemic Inflammatory Response Syndrome (SIRS)

Inflammation that goes systemic reducing fluid volume due to leakage of fluid and blood from the vessels into the tissues leading to systemic inflammatory response syndrome.

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Effective Pancreatitis Care

Improved nutrition (weight gain/stable weight), no hemorrhage/electrolyte imbalance.

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Pancreatitis: Avoid Alcohol

Complete abstinence is crucial for recovery.

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Pancreatitis: Adequate Nutrition

Maintained by following nutrition guidelines.

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Pancreatitis: Avoid Smoking

Crucial for overall health and recovery.

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Pancreatitis: Expected Pain Outcome

Pain is tolerable within 30 minutes of report.

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Pancreatitis: Acute Pain Cause

Edema and inflammation contribute to this.

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Pancreatitis: Effective Breathing

Unlabored, 12-20 breaths per minute, SaO2 > 94%.

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Pancreatitis: Breathing Difficulty Cause

Inflammation and tissue damage under the diaphragm.

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Pancreatic Cancer: Rank

4th leading cause of cancer deaths in the US.

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Pancreatic Cancer: Type

Ductal adenocarcinomas in the exocrine pancreas.

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Pancreatic Cancer: Risk Factors

Smoking, diet, chemical exposure, diabetes, heredity.

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Pancreatic Cancer: Symptoms

Weight loss, abdominal pain, jaundice.

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Pancreatic Cancer: Pre-Op Complications

Spread of cancer, obstruction, malnutrition.

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Pancreatic Cancer: Post-Op Complications

Pneumonia, ileus, infection, fistula, kidney failure.

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Pancreatic Cancer: Diagnostic Findings

Elevated ALP, glucose, bilirubin, CA 19-9.

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Cholecystitis

Inflammation of the gallbladder.

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Cholelithiasis

Gallstone formation in the gallbladder.

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Biliary Colic

Severe pain due to gallstones, often after fatty meals.

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Post-Cholecystectomy Diet

High-protein, low-fat diet

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Post-Surgical Breathing Exercises

Deep breathing and coughing

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Cholecystitis Pain Location

Epigastric or right upper quadrant pain

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Ultrasound

Diagnostic test for gallbladder issues.

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Cholecystectomy Types

Laparoscopic or open.

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Acute Pancreatitis

Inflammation and infection of pancreas.

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Obstruction of the common bile duct by a stone

Acute cholecystitis

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Common Causes of Cirrhosis

Caused by alcohol, hepatitis B and C, or NASH.

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Discharge Education

Encourage obese patients to lose weight.

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Gallbladder Rupture Prevention

Acute cholecystitis

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Esophageal Varices & Ascites

The two greatest concerns for a patient with portal hypertension.

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Cirrhosis and Albumin

Liver damage impairs protein synthesis, leading to low albumin levels.

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Serum Lipase

Enzyme more specific for acute pancreatitis; elevates longer than amylase.

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Causes of Acute Pancreatitis

Common cause is heavy alcohol intake or recent ERCP.

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Gallstone Pain

Blockage of bile, often due to gallstones, causing pain after high-fat meals.

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Semi-Fowler's Position

Position often preferred by patients experiencing pancreatitis, which often reduces pain.

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Opioids for Pancreatitis

Medications often needed due to intense pain, anxiety increases the production of pancreatic enzymes, increasing pain.

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Liver Health Teaching

Eat clean, avoid raw shellfish, wash your hands, and avoid liver-toxic substances.

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Choledocholithiasis

Gallstones located within the common bile duct.

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Cholesterol Gallstones

Gallstones are commonly made of this substance.

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Supersaturation of Bile

Gallstones are formed when bile becomes overly concentrated with a substance.

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Clay-Colored Stools

Stools that are light in color, often associated with biliary obstruction.

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Tea-Colored Urine

Urine that is dark, often associated with biliary obstruction.

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Cholecystectomy

A surgical procedure for gallbladder removal.

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T-Tube

A tube inserted to drain bile after gallbladder surgery.

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Temperature Monitoring

Monitor vital signs, especially this, to assess for signs of infection.

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Intake and Output (I&O)

Monitor to assess fluid balance.

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Elevated Serum Bilirubin

Lab test elevation indicates inflammation or obstruction of the biliary system.

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Coughing and Deep Breathing

A nursing intervention encourages lung expansion and prevents pneumonia after surgery.

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Post-Cholecystectomy Complications

Older adults may have increased rates of this following cholecystectomy, due comorbidities.

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CA 19-9

A marker used to monitor treatment and progression of pancreatic cancer.

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CT, MRI, PET, and Ultrasound

Imaging techniques used to precisely locate masses in the pancreas.

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ERCP (Endoscopic Retrograde Cholangiopancreatography)

A procedure to visualize the common ducts and to take tissue samples for analysis.

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Pancreatic Biopsy

Necessary for definitive diagnosis of pancreatic cancer.

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Laparoscopy and Biopsy

Used to guide treatment options by staging the cancer.

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Whipple Procedure (Pancreatoduodenectomy)

Surgical removal of the head of the pancreas, duodenum, gallbladder, and part of the stomach.

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Distal Pancreatectomy

Removal of the tail and/or part of the body of the pancreas, often including the spleen.

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Total Pancreatectomy

Complete removal of the pancreas, gallbladder, part of the stomach, small intestine, and spleen.

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Stent Placement

Used to relieve biliary obstruction in pancreatic cancer.

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Celiac Plexus Block

Used to reduce pain by destroying the celiac plexus nerves.

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Palliative Surgery

Surgery intended to promote comfort, not cure, such as stent placement.

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Malnutrition Signs

Observe for weight loss, nausea, vomiting, and fatty stools.

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Signs of Fluid Volume Deficit

Monitor for rapid heart rate, breathing, and low blood pressure.

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Skin Care for Itching

Care for skin with soap-free products and lotions.

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Diabetes Education

Teaching blood glucose monitoring and insulin administration.

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Study Notes

  • These notes cover the nursing care of patients with liver, pancreatic, and gallbladder disorders.

Key Terms:

  • Ascites: Accumulation of fluid in the peritoneal cavity.
  • Asterixis: Flapping tremor of the hands due to metabolic disorders.
  • Cholecystitis: Inflammation of the gallbladder.
  • Choledocholithiasis: Gallstones in the common bile duct.
  • Cholelithiasis: Formation of gallstones in the gallbladder.
  • Cirrhosis: Progressive replacement of healthy liver tissue with scar tissue.
  • Colic: Severe abdominal pain caused by muscle spasms or obstruction in a hollow organ like the bile duct.
  • Fetor Hepaticus: Distinctive breath odor in liver disease caused by volatile substances.
  • Hepatic Encephalopathy: Brain dysfunction due to liver failure and toxin accumulation.
  • Hepatitis: Inflammation of the liver.
  • Hepatorenal Syndrome: Kidney failure caused by liver disease.
  • Laparoscopy: Surgical procedure using a small incision and camera.
  • Pancreatectomy: Surgical removal of the pancreas.
  • Pancreatitis: Inflammation of the pancreas.
  • Portal Hypertension: Elevated blood pressure in the portal vein system.
  • Transjugular Intrahepatic Portosystemic Shunt (TIPS): Artificial channel within the liver that establishes communication between the inflow portal vein and the outflow hepatic vein.
  • Varices: Abnormally enlarged and twisted veins.

Concepts:

  • Cognition
  • Infection
  • Inflammation
  • Nutrition

Disorders of the Liver

Hepatitis

  • Hepatitis is liver inflammation caused by viral/bacterial infections, medications, alcohol/chemicals, or metabolic/vascular disorders.
  • Symptoms range from none to life-threatening.

Viral Hepatitis Etiology

  • Hepatitis A (HAV)
  • Hepatitis B (HBV)
  • Hepatitis C (HCV)
  • Hepatitis D (HDV)
  • Hepatitis E (HEV)
  • Viral agents vary by transmission mode, incubation, symptoms, tests, vaccines, and prophylaxis.
  • Inflammation damages liver cells, impairing function and causing jaundice if bile canaliculi are affected.

Viral Hepatitis Infections: Key Differences Table 35.1

  • Hepatitis A (HAV):
    • Transmitted via the fecal-oral route.
    • Incubation period is 15–50 days.
    • Symptoms include anorexia, fatigue, nausea, jaundice, pale stools, pruritus, dark urine, and RUQ pain.
    • Diagnosed using Anti-HAV IgM and Anti-HAV IgG.
    • Vaccine available.
    • Postexposure prophylaxis includes hepatitis A vaccine or IG.
    • Prognosis is acute onset with a short illness and rarely fatal.
  • Hepatitis B (HBV):
    • Transmitted via blood or body fluids.
    • Incubation period is 60–150 days.
    • Symptoms range from asymptomatic to fatigue, malaise, anorexia, fever, nausea, headache, RUQ pain, myalgia, jaundice, and rashes.
    • Diagnosed using HBsAg, Anti-HBs IgM, Anti-HBc IgM, HBeAg, and Anti-HBe.
    • Vaccine available.
    • Postexposure prophylaxis includes Hepatitis B IG (HBIG) and vaccination.
    • Prognosis can be acute (asymptomatic or ill for weeks) or chronic (leading to cirrhosis, liver failure, or hepatocellular carcinoma).
  • Hepatitis C (HCV):
    • Transmitted via blood or body fluids.
    • Incubation period is 2 weeks to 6 months.
    • Most patients are asymptomatic.
    • Diagnosed using Anti-HCV, HCV-RNA, HCV Viral Load, and HCV genotype.
    • No vaccine available.
    • Postexposure prophylaxis involves follow-up testing for HCV infection.
    • Prognosis has a high cure rate with medication, but chronic infection can develop cirrhosis.
  • Hepatitis D (HDV):
    • Transmitted via blood or body fluids, requiring HBV co-infection.
    • Incubation period is 3–7 weeks.
    • Symptoms are the same as HBV but usually less severe.
    • Diagnosed using HDV-RNA and HDAg.
    • Hepatitis B vaccine provides protection.
    • No specific postexposure prophylaxis is available.
    • Prognosis with HBV co-infection can range from mild to severe illness with recovery, while superinfection with chronic HBV can lead to more severe disease.
  • Hepatitis E (HEV):
    • Transmitted via water contaminated with human feces or raw/undercooked pork, wild boar, or venison.
    • Incubation period is 15–60 days.
    • Symptoms include anorexia, dehydration, myalgia, nausea, RUQ pain, vomiting, fever, jaundice, pale stools, pruritus, and dark urine.
    • Diagnosed using Anti-HEV.
    • Hepatitis E vaccine is available in China only.
    • No postexposure prophylaxis is available in the United States.
    • Prognosis is a self-limiting infection, rarely fatal but risk increases for pregnant women.

Hepatitis C Virus Details

  • Many HCV-infected individuals are unaware and may remain asymptomatic for up to 20 years.
  • HCV can lead to chronic infection, liver disease, cirrhosis, or liver cancer.
  • Before 1992, HCV spread through blood transfusions and organ transplants.

Prevention

  • Hepatitis viruses resist many anti-infective measures.
  • Prevent transmission through hygiene, avoiding exposure, vaccinations, and immunoglobulin (IG).
  • IGs provide short-term passive protection.
  • Vaccines for HAV and HBV offer permanent, active immunity.

Signs and Symptoms of Hepatitis

  • People may be asymptomatic.
  • Acute infection progresses through three stages:
    • Prodromal: fatigue, nausea, vomiting.
    • Icteric: jaundice, continued prodromal symptoms.
    • Convalescent: patient starts feeling better.
  • Recovery depends on the type of hepatitis.
  • Acute hepatitis leads to chronic hepatitis & complications.

Complications

  • Hepatitis can cause rapid liver failure
  • Chronic infections develop with HBV, HCV, and HDV and increase liver cancer risk.

Diagnostic Tests

  • Serological tests identify the specific virus causing hepatitis.
  • Elevated serum liver enzymes and bilirubin is observed.
  • Prothrombin time (PT) may be prolonged in severe cases.

Therapeutic Measures

  • Goals include identifying the cause, monitoring liver status, relieving symptoms, and preventing cirrhosis.
  • Adequate fluid and nutrition intake are important.
  • Avoid extreme exertion, alcohol, and liver-toxic medications (Box 35.1).
  • HAV and HEV infection treatment: supportive care.
  • HBV and HDV coinfection: pegylated interferon therapy plus ribavirin.
  • Treatment for chronic hepatitis B: antivirals
  • Management of HCV: direct-acting antiviral (DAA) oral medications.

Nursing Process

  • Data Collection: Subjective (malaise, fatigue, pruritus, nausea, anorexia, RUQ pain); Objective (weight, vomiting, pale stools, dark urine, jaundice).
  • Nursing Diagnoses, Planning, Implementation:
    • Acute Pain: monitor pain, give analgesics.
    • Imbalanced Nutrition: dietitian referral, monitor weight/intake, antiemetics.
    • Risk for Impaired Liver Function: monitor liver function, review medications.
    • Risk for Impaired Skin Integrity: antihistamines, prevent scratching.
    • Ineffective Health Management: teach about hepatitis, transmission, and treatment.
  • Evaluation: Pain relief, improved lab values, intact skin, understanding of disease and treatment.

Home Health Hints

  • Blood ammonia levels: use chilled vacutainer, place specimen on ice, deliver to lab fast.
  • Abdominal Ascites: hospital bed at home; measure abdominal girth; weigh on the same scale.
  • Hepatitis: caregiver wears gloves when cleaning; wash linens separately.

Acute Liver Failure

  • This is a rare, serious, and rapid condition. Liver function is severely impaired.
  • Possible outcomes: liver recovery, liver transplant, or death.
  • Acetaminophen overdose is a common cause.
  • Symptoms are vague initially but worsen to include jaundice and hepatic encephalopathy.

Therapeutic Measures

  • Treatment: identify & reverse liver damage.
  • Intensive supportive care to maintain airway and reduce stimulation.
  • Discontinue most medications.
  • Dialysis if from overdose of a hepatotoxic substance.

Nursing Process

  • Care is similar to cirrhosis.

Chronic Liver Disease and Cirrhosis

  • Cirrhosis is irreversible, progressive replacement of healthy liver tissue with scar tissue, usually from chronic alcohol use, hepatitis B/C, or nonalcoholic steatohepatitis (NASH).

Pathophysiology

  • Liver cells become inflamed, infiltrated with fat/WBCs, and replaced by fibrotic tissue.
  • Scar tissue disrupts liver lobes and creates nodules, impairing blood flow and causing portal hypertension.

Signs and Symptoms

  • Initial symptoms include loss of appetite and nausea.
  • Progressively loses liver function.
  • Enlarged liver, fluid retention, high ammonia, and jaundice.

Complications of Cirrhosis

  • Clotting Defects: Impaired prothrombin and fibrinogen production, leading to bleeding.
  • Portal Hypertension: Obstructed blood flow in the portal vein, leading to esophageal varices/hemorrhoids.
  • Ascites: Accumulation of fluid in the peritoneal cavity, causing abdominal distention.
  • Hepatic Encephalopathy (HE): Elevated ammonia levels disrupt mental status.
  • Hepatorenal Syndrome: Kidney failure secondary to cirrhosis.
  • Wernicke–Korsakoff Syndrome: Brain disorder caused by thiamine deficiency.

Diagnostic Tests

  • Liver function tests (Table 35.2).
  • Liver biopsy can determine the extent and nature of the liver damage.

Therapeutic Measures

  • Interventions for cirrhosis are to prevent advancement of the disease and treat complications.

Therapeutic Ascites management

  • Diuretics, sodium/fluid restrictions, albumin infusions, paracentesis, TIPS procedure.

Therapeutic Esophageal Varices management

  • Beta blockers to prevent bleeding, endoscopic variceal ligation, vasoconstrictor.

Therapeutic Hepatic Encephalopathy management

  • Avoid precipitants, osmotic laxatives, and antibiotics to reduce ammonia levels.

Nursing Process

  • Data Collection: Pain, anorexia, RUQ pain, jaundice, ascites, altered mental status.
  • Nursing Diagnoses, Planning, and Implementation:
    • Excess Fluid Volume: low-sodium diet, diuretics.
    • Imbalanced Nutrition: dietitian referral, small/high-calorie meals.
    • Acute Confusion: monitor LOC, give lactulose, reorientation.
    • Ineffective Breathing Pattern: elevate HOB, careful analgesics.
    • Risk for Deficient Fluid Volume: monitor secretions, avoid suctioning.
  • Evaluation: Alertness, stable fluid balance, respiratory rate, knowledge and management.

Patient Education

  • Avoid alcohol.
  • Report bleeding/confusion.

Liver Transplantation

  • Considered for end-stage liver failure.
  • Observed closely, prevent tissue rejection with meds.

Cancer of the Liver

  • Metastasis from other primary cancer sites. Chronic HBV/HCV and alcohol use increase risk.
  • Symptoms: encephalopathy, bleeding, jaundice, ascites.
  • Treatments: surgery, chemotherapy, radiation.

Disorders of the Pancreas

Pancreatitis

  • Can be either acute or chronic.

Acute Pancreatitis (AP) Pathophysiology

  • Autodigestion: pancreatic enzymes activate while in the pancreas and digest it. Can cause SIRS, electrolyte imbalance, hemorrhage, shock, and infection.

Acute Pancreatitis Etiology

  • Alcohol consumption or gallstones. Smoking increases the risk.

Acute Pancreatitis Prevention

  • Avoid alcohol and smoking. Treat biliary disease.

Acute Pancreatitis Signs and Symptoms

  • Severe pain, guarding, hypotension/shock, respiratory distress. May report nausea and vomiting, and jaundice may be evident.

Acute Pancreatitis Complications

  • May lead to systemic inflammatory response syndrome (SIRS), cardiovascular, pulmonary (including acute respiratory distress syndrome), and acute kidney injury. Presence of Chvostek/Cullen/Turner sign.

Acute Pancreatitis Diagnostic Tests

  • Elevated serum amylase and lipase. CT and MRI.

Acute Pancreatitis Therapeutic Measures

  • IV hydration, enteral feeding, pain relief, antibiotics.

Chronic Pancreatitis (CP) Pathophysiology

  • Progressive tissue replacement with fibrotic tissue. Progressive destruction of tissue/cells that produce enzymes. May be followed by diabetes.

Chronic Pancreatitis Etiology

  • Alcohol abuse, biliary disease, and hyperlipidemia, as well as idiopathic, genetic, and autoimmune related. Cigarette smoking and repeated attacks of AP are risk factors for developing CP.

Chronic Pancreatitis Signs and Symptoms

  • Asymptomatic or epigastric pain, nausea/vomiting, weight loss, steatorrhea, intolerance of fatty foods. Shows pattern of exacerbations and remissions.

Chronic Pancreatitis Complications

  • Abscesses, fistulas, pleural effusion, vitamin/mineral deficiencies, biliary obstruction, diabetes mellitus.

Chronic Pancreatitis Diagnostic Tests

  • CT scan. Normal or low serum amylase/lipase, and Endoscopic ultrasound.

Chronic Pancreatitis Therapeutic Measures

  • Pain management, pancreatic enzyme supplements, diet modifications, surgery.

Nursing Process

  • Data Collection: Abdominal pain, nausea, vomiting, alcohol use.
  • Nursing Diagnoses, Planning, and Implementation: - Imbalanced Nutrition: enzyme supplements, avoid alcohol. - Risk for Injury: monitor electrolytes/abdomen, antiemetics.
  • Evaluation: Improved nutrition/fluid balance, no injury. Patient Education: Avoid alcohol/smoking.

Cancer of the Pancreas Pathophysiology

  • Tumors spread rapidly to stomach, gallbladder, and duodenum.

Cancer of the Pancreas Etiology

  • Smoking, obesity, diet, chemical exposure, diabetes, pancreatitis, and heredity.

Cancer of the Pancreas Signs and Symptoms

  • Epigastric/back pain, anorexia, nausea, fatigue, weight loss. The pain becomes increasingly severe and unrelenting as the cancer grows. The classic symptom is weight loss.

Cancer of the Pancreas Complications

  • Malnutrition, cancer spread, gastric/duodenal obstruction, thrombophlebitis.

Cancer of the Pancreas Diagnostic Tests

  • Elevated ALP, glucose, bilirubin, CA 19-9.

Cancer of the Pancreas Therapeutic Measures

  • Surgery, chemotherapy, immune therapy, radiation therapy.

Nursing Process for the Patient With Pancreatic Cancer

  • DATA COLLECTION. Signs of malnutrition and fluid imbalance reviewed.
  • NURSING DIAGNOSES: Fluid volume maintenance, skin care for itching.
  • EVALUATION. Normal body weight, and negative symptoms listed above achieved.

PATIENT EDUCATION.

  • Teach self-care measures (blood glucose monitoring and insulin administration).
  • Teach S/S of hypo/hyperglycemia.
  • Teach dressing changes and when to report complications.

Disorders of the Gallbladder

Cholecystitis, Cholelithiasis, and Choledocholithiasis Pathophysiology

  • Acute cholecystitis: gallbladder inflammation.
  • Cholelithiasis: is formation of gallstones in the gallbladder.
  • Choledocholithiasis: gallstones in the common bile duct.

Cholelithiasis Etiology and Incidence

  • Aging, heredity, obesity, stasis of bile, frequent fasting, diabetes mellitus, cirrhosis, pregnancy, estrogen, and other medications.

Cholecystitis/Cholelithiasis Signs And Symptoms

  • Pain after fatty meal, elevated temperature, jaundice.

Cholecystitis Diagnostic Tests

  • Ultrasound, CT scan, ERCP, elevated WBC.

Therapeutic Measures

  • Pain control
  • Laparoscopic or open cholecystectomy
  • Medications
  • Low-fat diet

Nursing Process for the Patient With a Gallbladder Disorder

  • Data Collection: Monitor VS and temperature. Monitor for pain with WHAT'S UP questions.
  • Nursing Diagnoses, Planning, and Implementation:
    • Pain, fluid volume maintenance, respiratory maintenance, nutrition, skin care for pruritus.
  • Evaluation: Tolerable pain, stable weight/hydration, normal respiratory status, intact skin, and normal WBC count.

Patient Education

  • High-protein, low-fat diet. Lose weight. Slowly reintroduce fats.

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