Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

NURS 240 Exam 3 > Liver > Flashcards

Liver Flashcards

1
Q

serum aminotransferases

A
  • indicators of injury to the liver cells
  • useful in detecting hepatitis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

alanine aminotransferase (ALT)

A
  • levels increase primarily in liver disorders
  • used to monitor course of hepatitis, cirrhosis, the effects of treatments that may be toxic to the liver
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

asparte aminotransferase (AST)

A
  • not specific to liver diseases
  • levels of AST may be increased in cirrhosis, hepatitis, and liver cancer
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Gamma-glutamyl transferase (GGT)

A
  • levels are associated with cholestasis
  • alcoholic liver disease
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Diagnostic Studies

A
  • liver biopsy
  • US
  • CT
  • MRI
  • LFTs
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

S/S Physical Manifestations of Hepatic Dysfunction

A
  • jaundice
  • portal HTN
  • ascites and varices
  • hepatic encephalopathy or coma
  • nutritional deficiencies
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Jaundice

A
  • yellow or green sclera and skin caused by increased serum bilirubin levels
  • bilirubin level exceeds 2mg/dL
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

S/S of Hepatocellular Jaundice

A
  • mild or severely ill
  • lack of appetite, n/v, weight loss
  • malaise, fatigue, weakness
  • HA, chills, fever, infection
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

S/S of Obstructive Jaundice

A
  • dark orange-brown urine, clay-colored stools
  • dyspepsia and intolerance of fats, impaired digestion
  • pruritus (itchy)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Portal HTN results in…

A
  • ascites
  • varices
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Ascites Assessment

A
  • record abdominal girth and weight daily
  • assess for fluid in abdominal cavity (percussion or fluid wave)
  • monitor for potential fluid and electrolyte imbalances
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Ascites Treatment

A
  • low sodium diet
  • diuretics
  • bed rest
  • paracentesis
  • administration of salt-poor albumin
  • TIPS
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

The nurse is caring for a patient immediately after paracentesis. It is most important for the nurse to ask what question?

A

Are you feeling dizzy?

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Bleeding Varices Treatment

A
  • treat for shock
  • O2 administration
  • IV fluids, electrolytes, volume expanders, blood and blood products
  • VASOPRESSIN, SOMATOSTATIN, OCTREOTIDE to decrease bleeding
  • nitroglycerin in combination with vasopressin to reduce coronary vasoconstriction
  • PROPANOLOL and NADOLOL to decrease portal pressure (used in combo with other tx)
  • balloon tamponade
  • endoscopic sclerotherapy
  • TIPS
  • surgical bypass procedures
  • devascularization and transection
  • AVOID alcohol, NSIADS, and aspirin
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

The purpose of an H2 receptor blocker for a patient with bleeding esophageal varices is…

A

to prevent irritation of enlarged veins

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

A patient is being treated for bleeding esophageal varices with balloon tamponade. What nursing action will be included in the plan of care?

A

monitor patient for SOB

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Early S/S of Hepatic Encephalopathy

A
  • mental changes (confusion)
  • motor disturbances (asterixis)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Assessment of Hepatic Encephalopathy

A
  • EEG
  • changes in LOC
  • potential seizures
  • fetor hepaticus
  • monitor fluid, electrolyte, and ammonia levels
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Stage 1 of Hepatic Encephalopathy and Nursing Dx

A
  • normal LOC with periods of lethargy and euphoria
  • reversal of day-night sleep patterns
  • impaired writing and ability to draw line figures
  • normal EEG
  • Nursing Dx: activity intolerance, impaired ability to manage regime, impaired sleep pattern
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Stage 2 of Hepatic Encephalopathy and Nursing Dx

A
  • increased drowsiness
  • disorientation
  • inappropriate behavior, mood swings
  • agitation
  • asterixis
  • fetor hepaticus
  • abnormal EEG w/ generalized slowing
  • Nursing Dx: impaired socialization, impaired role performance, risk for injury, acute confusion
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Stage 3 of Hepatic Encephalopathy and Nursing Dx

A
  • stuporous
  • difficult to rouse
  • sleeps most of time
  • marked confusion
  • incoherent speech
  • asterixis
  • increased deep tendon reflexes
  • rigidity of extremities
  • EEG markedly abnormal
  • Nursing Dx: impaired nutritional intake, impaired mobility, impaired verbal communication
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Stage 4 of Hepatic Encephalopathy and Nursing Dx

A
  • comatose
  • may not respond to painful stimuli
  • absence of asterixis
  • absence of deep tendon reflexes
  • flaccidity of extremities
  • EEG markedly abnormal
  • Nursing Dx: risk for aspiration, exchange impaired tissue integrity
23
Q

Medical Management of Hepatic Encephalopathy

A
  • eliminate precipitating cause
  • LACTULOSE, RIFAXIMIN OR NEOMYCIN to reduce serum ammonia levels
  • IV glucose to minimize protein catabolism
  • protein intake 1.2-1.5g/kg/day
  • reduction of ammonia from GI tract by gastric suction, enemas, oral ABX
  • d/c sedatives, analgesics, and tranquilizers
  • monitor or treat complications of infection
24
Q

Which action should the RN take to evaluate treatment effectiveness for a patient who has hepatic encephalopathy?

A

ask the patient to extend both arms forward (assess for asterixis)

25
Q

Hepatitis A Pathophysiology

A
  • fecal-oral
  • spread by poor hand hygiene
  • incubation: 2-6 weeks
  • illness may last 4-8 weeks
26
Q

Hep A S/S

A
  • mild flu-like s/s
  • low-grade fever
  • anorexia
  • later: jaundice and dark urine
  • indigestion and epigastric distress
  • enlargement of liver and spleen
27
Q

Hep A Management

A
  • Bed rest during acute stage
  • nutritional support
28
Q

Hep A Prevention

A
  • good hand washing, safe water, and proper sewage disposal
  • vaccination (HAVRIX AND VAQTA)
  • immune globulin for contacts to provide passive immunity
  • health promotion
29
Q

Hepatitis B Pathophysiology

A
  • transmitted through blood, saliva, semen, and vaginal secretions
  • sexually transmitted
  • transmitted to infant at the time of birth
  • long incubation period: 1-6 months
30
Q

Hep B Risk Factors

A
  • close contact with carrier of Hep B
  • frequent exposure to blood, blood products, or other body fluids
  • health care workers
  • hemodialysis
  • IV/injection drug use
  • gay men and bisexual activity
  • mother-to-child transmission
  • multiple sex partners
  • receipt of blood or blood products
  • recent hx of STI
  • tattooing
  • travel to residence in area w/ uncertain sanitary conditions
31
Q

Hep B S/S

A
  • insidious and variable
  • similar to HAV
  • loss of appetite
  • dyspepsia
  • abdominal pain
  • generalized aching
  • malaise
  • weakness
  • jaundice may or may not be evident
32
Q

Hep B Complications

A
  • liver failure
  • chronic liver disease
  • cirrhosis
  • primary liver cancer
33
Q

Hep B Surface Antigen (HBsAg)

A
  • Active disease
  • screening test for Hep B
  • presence of antigen means either an acute infection or chronic Hep B infection
34
Q

Hep B Surface Antibody (Anti-HBs)

A
  • resolving illness
  • past infection
  • immunized with vaccine for HBV
35
Q

Hep B Core Antibody (Anti-HBc)

A
  • appears at the onset of s/s in acute Hep B and persists for life
  • the presence of anti-HBc indicates previous or ongoing infection with HBV in an undefined time frame
36
Q

Hep B e-antigen (HBeAg)

A
  • indicates active viral replication
  • may be highly infectious
37
Q

Antibody to Hep B e-antigen (Anti-HBe)

A
  • lower levels of virus, less infectivity
38
Q

Hep B Prevention

A
  • HBV screening
  • safe sex practices
  • HBV Vaccine
  • hand washing
  • standard precautions
39
Q

Management of Hep B

A
  • Acute HBV –> bed rest and nutritional support
  • Chronic HBV –> medications include ALPHA INTERFERON AND ANTIVIRAL AGENS: ENTECAVIR (ETV) AND TENOFOVIR (TDF)
  • Vaccine (ENGERIX-B, RECOMBIVAX HB): for persons at high risk, routine vaccination of infants
  • new HEPLISAV-B for people over 18
  • passive immunization for those exposed but not vaccinated (HBIG)
  • standard precautions and infection control measures
  • screening of blood and blood products
40
Q

Hepatitis C Pathophysiology

A
  • transmitted by blood and sexual contact (including needle sticks and sharing of needles)
  • most common blood borne infection
  • Incubation period: 15-160 days
  • chronic carrier state frequently occurs
41
Q

Hep C S/S

A

usually mild

42
Q

Hep C Risk Factors

A
  • children born to women infected with HCV
  • health care and public safety workers after needlestick injuries or mucosal exposure to blood
  • multiple contacts with a person infected with HCV
  • multiple sex partners, hx of STI, unprotected sex
  • past/current illicit IV/injection drug use
  • recipient of blood products or organ transplant before 1992 or clotting factor concentrates before 1987
43
Q

Hep C Dx Sequence

A

HCV Antibody + –> HCV RNA + –> Current HCV Infection

44
Q

Hep C Prevention

A
  • universal screening for all persons born between 1945 and 1965
  • universal screening for all persons given blood products before 1992
  • screening at least once in a lifetime for ALL ADULTS aged 19 years and older
  • screening for ALL PREGNANT WOMEN DURING EACH PREGNANCY
  • screening of blood, organ, and tissue donors
  • using infection control precautions
  • modifying high risk behaviors
  • avoid sharing needles, razors, and toothbrushes
45
Q

Hep C Management

A
  • Antiviral medications:
    - DIRECT-ACTING ANTI-VIRAL (DAA) PREFERRED TX: can cure HCV
    - COMBINATION THERAPY: ombitasvir + paritaprevir + ritonvir + dasabuvir (Viekira Pak) + ribavirin
  • alcohol potentiates disease
  • medications that effect liver should be avoided
46
Q

Cirrhosis of the Liver S/S

A

THE LIVER IS SCARRED
- Tremors of hands
- Hepatic fetor
- Eye and skin yellowing

  • Loss of appetite
  • Increased bilirubin
  • Varices
  • Edema in legs
  • Reduced platelets
  • Itchy Skin
  • Spider angiomas
  • Splenomegaly
  • Confusion or Coma
  • Ascites
  • Redness on the palms
  • Renal failure
  • Enlarged breasts in men
  • Deficient vitamins
47
Q

What finding indicates to the nurse that lactulose is effected for an older adult who has advanced cirrhosis?

A

patient is alert and oriented

48
Q

Nursing Interventions for Cirrhosis of the Liver

A
  • promoting rest
  • improving nutritional status
  • providing skin care
  • reducing risk of injury
  • monitoring and managing potential complications
49
Q

Liver Cancer S/S

A
  • dull persistent pain, RUQ, back, or epigastrum
  • weight loss, anemia, anorexia, weakness
  • jaundice, bile ducts occluded, ascites, or obstructed portal veins
50
Q

Nonsurgical Management of Liver Cancer

A
  • underlying cirrhosis –> increases risks of surgery
  • radiation therapy
  • chemotherapy
  • percutaneous biliary drainage
51
Q

Surgical Management of Liver Cancer

A
  • Tx of choice if confined to one lobe and liver function is adequate
  • lobectomy
  • cryosurgery
  • liver transplant
52
Q

Post-Op Care of Patient Undergoing Liver Transplant

A
  • monitory for infection, vascular complications, respiratory and liver dysfunction
  • constant close monitoring
53
Q

Which action should the RN in the Ed take FIRST for a new patient who is vomiting blood?

A

check BP and HR

NURS 240 Exam 3 (8 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions