Hepatic

Hepatic

by veronica mcintosh

Multiple Choice

A 23-year-old has been admitted with acute liver failure. Which assessment data are most important for the nurse to communicate to the health care provider?

• Asterixis and lethargy

• Jaundiced sclera and skin

• Elevated total bilirubin level

• Liver 3 cm below costal margin

​Common and significant manifestations of liver disease

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​•Hepatocellular

•Obstructive jaundice

 

•staining the skin, mucous membranes, and sclerae.

•Alterations in urine and stool color

•The skin may itch intensely, requiring repeated soothing baths.

• Dyspepsia and intolerance to fatty foods may develop because of impaired fat digestion in the absence of intestinal bile.

•In general, AST, ALT, and GGT levels rise only moderately, but bilirubin and alkaline phosphatase levels are elevated.

​Hepatic Encephalopathy

. Inability of the liver to detoxify toxic by-products of metabolism

. elements of the portal blood (laden with potentially toxic substances usually extracted by the liver) to enter the systemic circulation

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Stages of hepatic encephalopathy​

Multiple Choice

A serum potassium level of 3.2 mEq/L (3.2 mmol/L) is reported for a patient with cirrhosis who has scheduled doses of spironolactone (Aldactone) and furosemide (Lasix). due. Which action should the nurse take?

• Administer both drugs.

• Administer the spironolactone.

• Withhold the spironolactone and administer the furosemide.

• Withhold both drugs until discussed with the health care provider.

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​What manifestation are we talking about? Ascites

​Medical Management:

•Negative sodium balance to reduce fluid retention

•Diuretic agents

•Paracentesis

•Transjugular intrahepatic portosystemic shunt (TIPS)

​Nursing Management:

•intake and output (I&O)

•abdominal girth

•daily weight

•monitor serum ammonia, creatinine,

and electrolyte levels

Multiple Choice

A 49-year-old female patient with cirrhosis and esophageal varices has a new prescription for propranolol (Inderal). Which finding is the best indicator that the medication has been effective?

• The patient reports no chest pain.

• Blood pressure is 140/90 mm Hg.

• Stools test negative for occult blood.

• The apical pulse rate is 68 beats/minute.

bleeding vs no bleeding (what makes it an acute issue)​

​Treatment:

•Beta Blocker PO

•Octreotide (Sandostatin) infusion

•IV fluids, electrolytes,

• Transfusion of blood components also may be required.

•Endoscopy: sclerotherapy, variceal banding

•balloon tamponade

​s/S:

 Hematemesis

melena

 General deterioration in mental or physical status

history of alcohol abuse.

Signs and symptoms of shock (cool clammy skin, hypotension, tachycardia)

Multiple Choice

A 55-year-old patient admitted with an abrupt onset of jaundice and nausea has abnormal liver function studies but serologic testing is negative for viral causes of hepatitis. Which question by the nurse is most appropriate

• "Is there any history of IV drug use?"

• "Do you use any over-the-counter drugs?"

• "Are you taking corticosteroids for any reason?"

• "Have you recently traveled to a foreign country?"

​Non-Viral Hepatitis / drug Induced

​•Medications that can lead to hepatitis include isoniazid (Nydrazid); halothane (Fluothane); acetaminophen; methyldopa (Aldomet); and certain antibiotics, antimetabolites, and anesthetic agents

•S/S: onset is abrupt, with chills, fever, rash, pruritus, arthralgia, anorexia, and nausea. Later, there may be jaundice, dark urine, and an enlarged and tender liver.

•After the offending medication is withdrawn, symptoms may gradually subside.

​Non Viral Hepatitis / Toxic

​•Chemicals: Carbon tetrachloride  was used in refrigeration fluid and propellants for aerosol cans. cleaning fluid (in industry and dry cleaning establishments as a degreasing agent, and in households as a spot remover for clothing, furniture) fire extinguishers and as a fumigant to kill insects in grain. But with regulations less is used

•S/S: Anorexia, nausea, and vomiting are the usual symptoms; jaundice and hepatomegaly are noted on physical assessment. Symptoms are more intense for the more severely toxic patient.

•Management: directed toward restoring and maintaining fluid and electrolyte balance, blood replacement, and comfort and supportive measures.

•Liver transplant

Multiple Choice

A client who has just been diagnosed with hepatitis A asks, "How did I get this disease?" What is the nurse's best response?

• "You could have gotten it by using I.V. drugs."

• "You must have received an infected blood transfusion."

• "You probably got it by engaging in unprotected sex."

• "You may have eaten contaminated restaurant food.

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​HEP A B C D E

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​know how they are transmitted

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​IV drug and unprotected sex. : B make sure you get a vaccine

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​blood tx: C,

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Hep A food, vaccine poor countires sanitation