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(2) Exam 3- Liver Flashcards

0
Q

Disorders of the Liver

Hepatitis can be caused by drugs (alcohol), chemicals, autoimmune diseases, and metabolic abnormalities, but is most commonly caused by

A

Viruses

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1
Q

Disorders of the Liver

What is hepatitis

A

Inflammation of the liver

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2
Q

Disorders of the Liver

Hepatitis A virus is primarily transmitted through

A

Fecal oral route

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3
Q

Disorders of the Liver

Hepatitis A virus frequently occurs and small outbreaks caused by

A

Fecal contamination of food or drinking water

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4
Q

Disorders of the Liver

What is a situation that puts children at risk for hepatitis A virus

A

Day care centers

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5
Q

Disorders of the Liver

How far in advance can hepatitis a virus be found in feces before the onset of symptoms

A

Two or more weeks

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6
Q

Disorders of the Liver

How long after the onset of jaundice is hepatitis A virus found in feces

A

Up to a week after

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7
Q

Disorders of the Liver

What does detection of hepatitis A IgM indicate

A

Acute hepatitis

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8
Q

Disorders of the Liver

Although not commonly tested clinically, hepatitis A IgG indicates

A

Past infection

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9
Q

Disorders of the Liver

What antibody provides lifelong immunity for hepatitis a virus

A

IgG antibody

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10
Q

Disorders of the Liver

What type of symptoms can hepatitis a viral infection cause

A

Mild flulike illness

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11
Q

Disorders of the Liver

Does hepatitis B virus cause acute or chronic disease

A

Both. Acute or chronic disease can occur

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12
Q

Disorders of the Liver

Why has the incidence of hepatitis B virus infection decreased since the 1990s

A

Widespread use of the hepatitis B vaccine

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13
Q

Disorders of the Liver

How does the transmission of hepatitis B virus occur

A

When infected blood or body fluids enter the body of an infected person who has not received the appetite is B vaccine

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14
Q

Disorders of the Liver

Besides percutaneously, mucosal exposure to infectious blood, blood products, or other body fluids (semen, vaginal secretions, saliva), what is another way hepatitis B virus can be transmitted

A

Perinatally by mothers infected with hepatitis B virus

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15
Q

Disorders of the Liver

How long can hepatitis B virus live on a dry surface

A

For at least seven days

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16
Q

Disorders of the Liver

Is hepatitis B virus less or more infectious than HIV

A

More infectious

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17
Q

Disorders of the Liver

What does the presence of hepatitis B surface antibody he (anti-HB’s) in the blood indicate

A

Immunity from the hepatitis B virus vaccine or from past hepatitis B virus infection

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18
Q

Disorders of the Liver

Why is acute hepatitis C difficult to detect

A

Is usually asymptomatic

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19
Q

Disorders of the Liver

What is the most common causes of acute hepatitis C

A

Injection drug use and outbreaks among HIV-positive man who have sex with men

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20
Q

Disorders of the Liver

What is the most common cause of chronic liver disease

A

Hepatitis C

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21
Q

Disorders of the Liver

What is the most common mode of hepatitis C virus transmission

A

Sharing of contaminated needles and equipment among IV drug users

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22
Q

Disorders of the Liver

What are patients given blood or blood products before 1992 at risk for

A

Chronic hepatitis C infection

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23
Q

Disorders of the Liver

What is the patient at greater risk for with co-infection of HIV and hepatitis C virus

A

Progression of cirrhosis

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24
Q

Disorders of the Liver

Hepatitis D virus is a defective Single strand RNA virus that cannot survive on its own. What does it require to replicate

A

Hepatitis B

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25
Q

Disorders of the Liver

How is hepatitis D virus transmitted

A

Percutaneously

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26
Q

Disorders of the Liver

Although there is no vaccine for hepatitis D virus, what vaccination can be given to reduce the risk

A

Hepatitis B vaccination

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27
Q

Disorders of the Liver

How is hepatitis E virus transmitted

A

Fecal oral route. Usually due to drinking contaminated water

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28
Q

Disorders of the Liver

Where does hepatitis A.B. infection primarily occur

A

In developing countries

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29
Q

Disorders of the Liver
Hepatitis – clinical manifestations

How long does the acute phase usually last

A

1 to 4 months

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30
Q

Disorders of the Liver
Hepatitis – clinical manifestations

What phase is the period of maximal infectivity

A

The acute phase

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31
Q

Disorders of the Liver
Hepatitis – clinical manifestations

During the incubation period, what symptoms may occur

A

Malaise, anorexia and weight loss, fatigue, nausea, occasional vomiting, abdominal (RUQ) discomfort, headache, low-grade fever, skin rashes, and arthralgias

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32
Q

Disorders of the Liver
Hepatitis – clinical manifestations

What is jaundice

A

A yellowish discoloration of body tissues

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33
Q

Disorders of the Liver
Hepatitis – clinical manifestations

Why does jaundice occur

A

Results from an alteration in normal Bilirubin metabolism or flow of bile into the hepatic or biliary duct systems

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34
Q

Disorders of the Liver
Hepatitis – clinical manifestations

In jaundice, what clinical manifestation may occur because of excess Bilirubin being excreted by the kidneys

A

Urine may darken

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35
Q

Disorders of the Liver
Hepatitis – clinical manifestations

If conjugated bilirubin cannot flow out of the liver because of obstruction or inflammation of the bile duct, what happens to stool

A

Stools will be light or clay colored

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36
Q

Disorders of the Liver
Hepatitis – clinical manifestations

Due to the accumulation of bile salts been eat the skin what may occur with jaundice

A

Pruritus (intense chronic itching)

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37
Q

Disorders of the Liver
Hepatitis – clinical manifestations

Following the acute phase, when does the convalescent phase begin

A

As jaundice fades

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38
Q

Disorders of the Liver
Hepatitis – clinical manifestations

On average, how long does the convalescent phase last

A

2 to 4 months

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39
Q

Disorders of the Liver
Hepatitis – clinical manifestations

What is the patients major complaint in the convalescent phase

A

Malaise and easily fatigability

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40
Q

Disorders of the Liver
Hepatitis – Complications

Although most patients with acute viral hepatitis recover completely, what complications can occur

A

Acute liver failure or, chronic hepatitis, cirrhosis of the liver, and hepatocellular carcinoma

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41
Q

Disorders of the Liver
Hepatitis – Complications

Does the disappearance of jaundice indicate that the patient has totally recovered

A

No, the disappearance of jaundice does not mean the patient has totally recovered

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42
Q

Disorders of the Liver
Hepatitis – Complications

What do some hepatitis B virus infections and the majority of hepatitis C virus infections result in

A

Chronic viral infection

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43
Q

Disorders of the Liver
Hepatitis – Complications

What are the risk factors for progression of cirrhosis

A

Male gender, alcohol consumption, and excess iron deposition in the liver

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44
Q

Disorders of the Liver
Hepatitis – Diagnostic Studies

What is the only definitive way to distinguish among the various forms of viral hepatitis

A

Testing the patient’s blood for specific antigen or anybody

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45
Q

Disorders of the Liver
Hepatitis – Diagnostic Studies

If the initial hepatitis C virus antibody testing is positive, what test should be obtained to assess for chronic infection

A

Hepatitis C virus RNA testing

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46
Q

Disorders of the Liver
Hepatitis – Diagnostic Studies

And what patients is viral genotype testing done

A

Patients undergoing drug therapy for hepatitis B or hepatitis C virus infection

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47
Q

Disorders of the Liver
Hepatitis – Diagnostic Studies

What may a physical assessment reveal

A

Hepatic tenderness, hepatomegaly, splenomegaly

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48
Q

Disorders of the Liver
Hepatitis – Diagnostic Studies

What is palpable in chronic hepatitis

A

The liver

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49
Q

Disorders of the Liver
Hepatitis – Diagnostic Studies

To determine the degree of inflammation, fibrosis, or cirrhosis that may be present, what may be done

A

A liver biopsy

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50
Q

Disorders of the Liver
Hepatitis – Collaborative Care

For acute Hepatitis, what seems to be the most beneficial for healing and liver cell regeneration

A

Adequate nutrition and rest

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51
Q

Disorders of the Liver
Hepatitis – Collaborative Care

When teaching the patient with acute hepatitis, counseling should include the importance of

A

Avoiding alcohol

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52
Q

Disorders of the Liver
Hepatitis – Collaborative Care

What is the drug therapy treatment for acute hepatitis A

A

There is no drug therapies for the treatment of acute hepatitis A

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53
Q

Disorders of the Liver
Hepatitis – Collaborative Care

When is drug therapy treatment of acute hepatitis B indicated

A

Only in patients with severe hepatitis or liver failure

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54
Q

Disorders of the Liver
Hepatitis – Collaborative Care

In patients with acute hepatitis C, what drug therapy treatment is used within the first 12 to 24 weeks of infection to decrease the development of chronic hepatitis C

A

Pegylated interferon

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55
Q

Disorders of the Liver
Hepatitis – Collaborative Care

What is the drug therapy for chronic hepatitis B virus focused on

A

Decreasing the viral load and liver enzymes and slowing the rate of disease progression

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56
Q

Disorders of the Liver
Hepatitis – Collaborative Care

The process of conjugating a standard interferon with polyethylene glycol (PEG) is know as

A

Pegylation

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57
Q

Disorders of the Liver
Hepatitis – Collaborative Care

Because of their convenience and superior efficiency, PEG products are preferred to standard interferon and are used for the treatment of

A

Hepatitis B and hepatitis C

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58
Q

Disorders of the Liver
Hepatitis – Collaborative Care

Inpatients receiving interferon, what test should be performed every 4 to 6 weeks

A

Blood counts and liver function tests

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59
Q

Disorders of the Liver
Hepatitis – Collaborative Care

What drugs fool the HBV into thinking they are normal building blocks for DNA, making the virus unable to reproduce

A

Nucleoside and nucleotide analogs

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60
Q

Disorders of the Liver
Hepatitis – Collaborative Care

Due to development severe exacerbations of hepatitis B after discontinuation of treatment, if drugs are discontinued, what needs to be monitored closely for several months

A

Liver function

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61
Q

Disorders of the Liver
Hepatitis – Collaborative Care

What is pegylated interferon given with for the treatment of hepatitis C virus

A

Ribavirin (Rebotol, Copegus)

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62
Q

Disorders of the Liver
Hepatitis – Collaborative Care

In addition to Pegylated interferon and ribavirin, what is given to patients who have hepatitis C virus genotype 1

A

Telaprevir (Incivek) or boceprevir (Victrelis)

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63
Q

Disorders of the Liver
Hepatitis – Collaborative Care

How is pegylated interferon and ribavitin given and how often

A

Pegylated interferon is injected once a week

Ribavirin- PO twice daily

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64
Q

Disorders of the Liver
Hepatitis – Collaborative Care

What needs to be avoided during treatment with Ribivirin

A

Pregnancy must be avoided both by women taking the drug and by women who is male partners are taking the drug

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65
Q

Disorders of the Liver
Hepatitis – Collaborative Care

Many patients with HIV also have hepatitis C virus. Patients who have stable HIV and relatively intact immune system’s are treated for hepatitis C virus with the goal of

A

Eradicating hepatitis C virus and reducing the risk of progression to cirrhosis

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66
Q

Disorders of the Liver
Hepatitis – Nutritional Therapy

What nutritional therapy is important for patients with thorough hepatitis

A

Adequate calories (due to weight loss), vitamin supplements (B complex and vitamin K)

If fat content is poorly tolerated because of decreased bowel production, it should be reduced

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67
Q

Disorders of the Liver
Hepatitis – Nutritional Therapy

What nutritional therapy may be used if anorexia, nausea, and vomiting or severe

A

IV solutions of glucose or subliminal Enteral nutrition therapy

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68
Q

Viral Hepatitis
Nursing Implementation

What are preventative measures for hepatitis A virus

A

Personal and environmental hygiene

Health education

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69
Q

Viral Hepatitis
Nursing Implementation

What is the most important preventative measure for hepatitis A virus

A

Handwashing

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70
Q

Viral Hepatitis
Nursing Implementation

What is the best protection against hepatitis A virus

A

Vaccination

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71
Q

Viral Hepatitis
Nursing Implementation

At what age should children receive the hepatitis A vaccine

A

All children at one year of age

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72
Q

Viral Hepatitis
Nursing Implementation

When is a booster recommended for hepatitis A virus vaccination to ensure adequate antibody tighter’s and long-term protection

A

6 to 12 months after the primary dose

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73
Q

Viral Hepatitis
Nursing Implementation

What is the combined hepatitis A and hepatitis B vaccine that is available for people over 18 years of age

A

Twinrix

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74
Q

Viral Hepatitis
Nursing Implementation

Twinrix immunization consist of three doses that are scheduled as that used for the single hepatitis B virus vaccination. in what time frame are these vaccinations given

A

0-, 1-, and 6- month schedule

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75
Q

Viral Hepatitis
Nursing Implementation

Isolation is not required for hepatitis A virus infection, but when is it indicated for the patient to have a private room

A

If the patient is in continent of stool or has poor personal hygiene

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76
Q

Viral Hepatitis
Nursing Implementation

What is used to prevent hepatitis a virus infection after exposure to an infected person (Postexposure prophylaxis)

A

Hepatitis a vaccine and immune globulin (IG)

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77
Q

Viral Hepatitis
Nursing Implementation

What provides temporary (1 to 2 months) passive immunity and is effective for preventing hepatitis A if given within two weeks after exposure

A

Immune globulin (IG)

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78
Q

Viral Hepatitis
Nursing Implementation

What is the best means of prevention of hepatitis B virus

A

Hepatitis B vaccine

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79
Q

Viral Hepatitis
Nursing Implementation

How is the hepatitis B vaccine administered

A

IM injections in the deltoid muscle

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80
Q

Viral Hepatitis
Nursing Implementation

The first dose of hepatitis B vaccine should be given at birth with a vaccine series completed by what age

A

6 to 18 months

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81
Q

Viral Hepatitis
Nursing Implementation

Household members of the patient with hepatitis B virus should be tested and vaccinated if they have what negative test results

A

HBsAg and antibody negative

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82
Q

Viral Hepatitis
Nursing Implementation

For postexposure to hepatitis B virus, what prophylaxis are used

A

Hepatitis B virus vaccine and hepatitis B immune globulin (HBIG)

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83
Q

Viral Hepatitis
Nursing Implementation

Screening of blood, organ, and tissue donors; use of infection control precautions; and modification of high-risk behavior are the primary measures to prevent what hepatitis transmission

A

Measures to prevent hepatitis C virus transmission

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84
Q

Viral Hepatitis
Nursing Implementation

What testing should be done after an acute exposure (example: needlestick) to hepatitis C virus

A

Anti-HCV testing

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85
Q

Viral Hepatitis
Nursing Implementation

For the person exposed to HCV, when should follow-up testing be done to Measure anti-HCV testing and ALT levels

A

4 to 6 months

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86
Q

Viral Hepatitis
Nursing Implementation

What do you want to interventions for in patients with hepatitis

A

Assess for Jaundice

Comfort measures to relieve Pruritus

Adequate nutrition

Adequate fluid and take

Assess response to the rest and activity plan

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87
Q

Viral Hepatitis
Nursing Implementation

In patients with hepatitis, what meal plan may be preferred to prevent nausea rather than three large meals

A

Small frequent meals

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88
Q

Viral Hepatitis
Nursing Implementation

What is the adequate fluid intake for patients with hepatitis

A

2500 to 3000 mL/ day

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89
Q

Viral Hepatitis
Nursing Implementation

After the diagnosis of hepatitis, how often should you instruct the patient to have follow-ups

A

For at least one year after the diagnosis of hepatitis

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90
Q

Viral Hepatitis
Nursing Implementation

Due to relapse, with what forms of hepatitis do you need to teach the patient the symptoms of reoccurrence and the need for follow-up evaluation’s

A

Hepatitis B and C

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91
Q

Viral Hepatitis
Nursing Implementation

Since it can accelerate disease progression, what should patients with chronic hepatitis B or C be instructed to avoid

A

Alcohol

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92
Q

Viral Hepatitis
Nursing Implementation

What should be taught about side effects and administration to the patient who is receiving interferon for the treatment of hepatitis B or hepatitis C virus

A

It is administered subcutaneously and side effects include flulike symptoms

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93
Q

Drug and Chemical Induced Liver Disease

What may be considered if liver function does not recover after abstaining from alcohol for several months or longer

A

Liver transplant

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94
Q

Drug and Chemical Induced Liver Disease

What is the most common cause of drug induced liver injury (DILI)

A

Acetaminophen

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95
Q

Autoimmune, Genetic, and Metabolic Diseases
Autoimmune Hepatitis

Untreated autoimmune hepatitis can progress to

A

Cirrhosis

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96
Q

Autoimmune, Genetic, and Metabolic Diseases
Autoimmune Hepatitis

What is the recommended treatment for active autoimmune hepatitis

A

Prednisone

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97
Q

Autoimmune, Genetic, and Metabolic Diseases
Wilsons Disease

Wilson’s disease is an autosomal recessive defect in what cellular transport

A

Copper

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98
Q

Autoimmune, Genetic, and Metabolic Diseases
Wilsons Disease

A defect in biliary excretion leads to The accumulation of what in the liver

A

Copper

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99
Q

Autoimmune, Genetic, and Metabolic Diseases
Wilsons Disease

What is the hallmark of Wilson’s disease

A

Corneal Kayser-Fleischer rings

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100
Q

Autoimmune, Genetic, and Metabolic Diseases
Wilsons Disease

What are Corneal Kayser-Fleischer rings

A

Brownish red rings that can be seen in the cornea on eye examination

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101
Q

Autoimmune, Genetic, and Metabolic Diseases
Wilsons Disease

To promote the excretion of urinary copper, what is the recommended initial treatment of symptomatic patients or those with active disease

A

Chelating agents such as

penicillamine (Cuprimine)

trientine (Syprine)

102
Q

Autoimmune, Genetic, and Metabolic Diseases
Hemochromatosis

What is Hemochromatosis

A

An Iron overload disorder

103
Q

Autoimmune, Genetic, and Metabolic Diseases
Primary Biliary Cirrhosis

Primary biliary cirrhosis is a chronic disease of the

A

Small bile ducts of and deliver

104
Q

Autoimmune, Genetic, and Metabolic Diseases
Primary Biliary Cirrhosis

What does primary biliary cirrhosis lead to overtime

A

Liver fibrosis and cirrhosis

105
Q

Autoimmune, Genetic, and Metabolic Diseases
Primary Biliary Cirrhosis

Most patients diagnosed with PBC are women between the ages of

A

30 and 65

106
Q

Autoimmune, Genetic, and Metabolic Diseases
Primary Biliary Cirrhosis

What is the only approved drug for primary biliary cirrhosis

A

Ursodeoxycholic (Actigall)

107
Q

Autoimmune, Genetic, and Metabolic Diseases
Primary Biliary Cirrhosis

Management of primary biliary cirrhosis focuses on

A

Malabsorption, skin disorders, hyperlipidemia, vitamin deficiencies, anemia, and fatigue

108
Q

Autoimmune, Genetic, and Metabolic Diseases
Primary Biliary Cirrhosis

What medication is used to treat pruritus

A

Cholestyramine (Questran)

109
Q

Autoimmune, Genetic, and Metabolic Diseases
Primary Sclerosing Cholangitis

Primary Sclerosing Cholangitis is characterized by chronic inflammation, fibrosis, and strictures of which ducts

A

Medium and large bile ducts

110
Q

Autoimmune, Genetic, and Metabolic Diseases
Primary Sclerosing Cholangitis

The majority of patients with PSC also have ulcerative colitis. Due to the high incidence of ulcerative colitis, what screening could be beneficial

A

Screening for colorectal cancer

111
Q

Autoimmune, Genetic, and Metabolic Diseases
Nonalcoholic Fatty Liver Disease and Nonalcoholic Steatohepatitis

NAFLD affects about 10 to 20% of the US but is increasing due to

A

Obesity

112
Q

Autoimmune, Genetic, and Metabolic Diseases
Nonalcoholic Fatty Liver Disease and Nonalcoholic Steatohepatitis

NAFLD Should be considered in patients with risk factors such as

A

Obesity, diabetes, hyperlipidemia, and hypertension

113
Q

Autoimmune, Genetic, and Metabolic Diseases
Nonalcoholic Fatty Liver Disease and Nonalcoholic Steatohepatitis

How do you get a definitive diagnosis of NAFLD

A

Liver biopsy

114
Q

Autoimmune, Genetic, and Metabolic Diseases
Nonalcoholic Fatty Liver Disease and Nonalcoholic Steatohepatitis

What is the treatment for NAFLD

A

There is no definitive treatment, and therapy is directed at reduction of risk factors including treatment of diabetes, reduction in bodyweight, and management of hyperlipidemia

115
Q

Disorders of the Liver
Cirrhosis

What is cirrhosis

A

Chronic progressive disease of the liver characterized by extensive degeneration and destruction of liver cells

116
Q

Disorders of the Liver
Cirrhosis

What is the most common cause of Cirrhosis is in the United States

A

Hepatitis C infection and alcohol induced liver disease

117
Q

Disorders of the Liver

What ethnic group has a higher incidence of hepatitis, cirrhosis, and liver and pancreatic cancer

A

African-Americans

118
Q

Disorders of the Liver

What ethnic group has a higher incidence of gallbladder disease

A

Whites and Native Americans

119
Q

Disorders of the Liver

In what liver disorder does the liver cells attempt to regenerate, but the regenerative process is is organized, resulting in abnormal blood vessel and bile duct architecture

A

Cirrhosis

120
Q

Disorders of the Liver
Cirrhosis

What is an early manifestation of cirrhosis

A

Fatigue

121
Q

Disorders of the Liver
Cirrhosis

What are later manifestations of cirrhosis that may be severe and result from liver failure and portal hypertension

A

Jaundice, peripheral edema, and ascites develop gradually.

Other late symptoms include skin lesions, hematologic disorders, endocrine disturbances, and peripheral neuropathic so

122
Q

Disorders of the Liver
Cirrhosis

In advanced stages of cirrhosis, how does the liver appear

A

Small and nodular

123
Q

Disorders of the Liver
Cirrhosis

What occurs as a result of the decreased ability to conjugate excrete Bilirubin

A

Jaundice

124
Q

Disorders of the Liver
Cirrhosis

Due to an increase in circulating estrogen, what skin lesions are commonly seen in cirrhosis

A

Spider angiomas- nose, cheeks, upper trunk, neck, shoulders

Palmar erythema- palms of hands

125
Q

Disorders of the Liver
Cirrhosis

What hematologic problems may occur with cirrhosis

A

Thrombocytopenia, leukopenia, anemia, and coagulation disorders

126
Q

Disorders of the Liver
Cirrhosis- Endocrine problems

What does the liver failed to metabolize resulting in subsequent sodium and water retention and potassium loss

A

Aldosterone – hyperaldosteronism

127
Q

Disorders of the Liver
Cirrhosis- Complications

What are the major complications of cirrhosis

A

Portal hypertension, peripheral edema, hepatic encephalopathy, and hepatorenal syndrome

128
Q

Disorders of the Liver
Cirrhosis- Complications

What is compensated cirrhosis

A

Patients without complications of cirrhosis

129
Q

Disorders of the Liver
Cirrhosis- Complications

What is it called when patients have one or more complications of their liver

A

Decompensated cirrhosis

130
Q

Disorders of the Liver
Cirrhosis- Complications

What is characterized by increased venous pressure in the portal circulation, splenomegaly, large collateral veins, ascites, and gastric and esophageal varices

A

Portal hypertension

131
Q

Disorders of the Liver
Cirrhosis- Complications

What are a complex of tortuous veins at the lower end of the esophagus, which are enlarged and swollen as a result of portal hypertension

A

Esophageal varices

132
Q

Disorders of the Liver
Cirrhosis- Complications

What varices are located in the upper portion of the stomach and bleed easily do to intolerance of high-pressure

A

Gastric varices

133
Q

Disorders of the Liver
Cirrhosis- Complications

What bleeding varices are the most life-threatening complication of cirrhosis

A

Bleeding Esophageal varicies

134
Q

Disorders of the Liver
Cirrhosis- Complications

What is an accumulation of serous fluid in the peritoneal or abdominal cavity

A

Ascites

135
Q

Disorders of the Liver
Cirrhosis- Complications

In ascites, low potassium levels can result from

A

Hyperaldosteronism and diuretic therapy used to treat ascites

136
Q

Disorders of the Liver
Cirrhosis- Complications

What is hepatic encephalopathy

A

A neuropsychiatric manifestation of liver disease

137
Q

Disorders of the Liver
Cirrhosis- Complications

With hepatic encephalopathy, Ammonia crosses the blood brain barrier and produces

A

Neurologic toxic manifestations

138
Q

Disorders of the Liver
Cirrhosis- Complications

Changes in neurologic and mental responsiveness; impaired consciousness; and inappropriate behaviors, ranging from sleep disturbances to lethargy to deep coma are clinical manifestations of

A

Encephalopathy

139
Q

Disorders of the Liver
Cirrhosis- Complications

What is a characteristic manifestation of hepatic encephalopathy

A

Asterixis

140
Q

Disorders of the Liver
Cirrhosis- Complications

With Asterixis, what happens when the patient is asked to hold the arms and hands stretched out

A

Unable to hold this position and performs a series of rapid flexion and extension movements of the hands

141
Q

Disorders of the Liver
Cirrhosis- Complications

What is apraxia, the characteristic manifestation of hepatic encephalopathy

A

Impairments in writing. Difficulty moving the pen from left to right

142
Q

Disorders of the Liver
Cirrhosis- Complications

What is fetor hepaticus that occurs in patients with encephalopathy

A

Musty, sweat odor of the patients breath

143
Q

Disorders of the Liver
Cirrhosis- Complications

In what patients does hepatorenal syndrome occur

A

In patients with decompensated cirrhosis

144
Q

Disorders of the Liver
Cirrhosis- Complications

How can renal failure due to hepatorenal syndrome be reversed

A

Liver transplantation

145
Q

Disorders of the Liver
Cirrhosis- Collaborative Care

Management of ascites focuses on

A

Sodium restriction, diuretics, and fluid removal

146
Q

Disorders of the Liver
Cirrhosis- Collaborative Care

With ascites what is the initial sodium restrictions and what are the sodium restrictions for severe ascites

A

Initially- 2 g/day

Severe ascites – 250 to 500 mg/day

147
Q

Disorders of the Liver
Cirrhosis- Collaborative Care

The patient with ascites is usually not unrestricted fluids unless

A

Severe ascites develops

148
Q

Disorders of the Liver
Cirrhosis- Collaborative Care

With ascites, what may be used to help maintain intravascular volume and adequate urine output

A

Albumin infusion

149
Q

Disorders of the Liver
Cirrhosis- Collaborative Care

What procedure may be performed for the patient with impaired respiration or abdominal pain caused by severe ascites

A

Paracentesis

150
Q

Disorders of the Liver
Cirrhosis- Collaborative Care

What is used to alleviate ascites that does not respond to diuretics

A

TIPS

151
Q

Disorders of the Liver
Cirrhosis- Collaborative Care

What should the patient who has esophageal varices avoid

A

Alcohol, aspirin, and nonsteroidal anti-inflammatory drugs (NSAIDs)

152
Q

Disorders of the Liver
Cirrhosis- Collaborative Care

To screen for varices, all patients with cirrhosis should have what procedure done

A

EGD

153
Q

Disorders of the Liver
Cirrhosis- Collaborative Care

What procedure needs to be done to diagnose esophageal gastric variceal bleeding

A

Endoscopic examination

154
Q

Disorders of the Liver
Cirrhosis- Collaborative Care

Patients with varices at risk of bleeding should be started on what drugs to reduce the incidence of hemorrhage

A

B-Blocker or propranolol

155
Q

Disorders of the Liver
Cirrhosis- Collaborative Care

What is the first step when variceal bleeding occurs

A

Stabilize the patient and manage the airway

IV therapy is initiated and may include administration of blood products

156
Q

Disorders of the Liver
Cirrhosis- Collaborative Care

Drug therapy for bleeding varices

A

Sandostatin or vasopressin

157
Q

Disorders of the Liver
Cirrhosis- Collaborative Care

What are the side effects of vasopressin

A

Decreased coronary bloodflow, dysrhythmias, and increased blood pressure

158
Q

Disorders of the Liver
Cirrhosis- Collaborative Care

Due to the side effects of vasopressin, what is given in combination with it

A

IV nitroglycerin

159
Q

Disorders of the Liver
Cirrhosis- Collaborative Care

What is used to control hemorrhage by mechanical compression of the varices in patients with acute esophageal or gastric varices hemorrhage that cannot be controlled on initial endoscopy

A

Balloon Tamponade (Sengstaken-Blakemore)

160
Q

Disorders of the Liver
Cirrhosis- Collaborative Care

At the time of endoscopy, what maybe used to prevent rebleeding

A

Band ligation or sclerotherapy

161
Q

Disorders of the Liver
Cirrhosis- Collaborative Care

What is performed by placing a small river band around the base of the varix

A

Endoscopic variceal ligation (EVL or Banding)

162
Q

Disorders of the Liver
Cirrhosis- Collaborative Care

What involves injection of the sclerosant solution into the varices through an injection needle that is placed through the endoscope

A

Sclerotherapy

163
Q

Disorders of the Liver
Cirrhosis- Collaborative Care

What needs to be kept at bedside for patients with balloon tamponade

A

Scissors

164
Q

Disorders of the Liver
Cirrhosis- Collaborative Care

To prevent tissue necrosis, how long do the balloons need to stay deflated every 8 to 12 hours

A

Five minutes

165
Q

Disorders of the Liver
Cirrhosis- Collaborative Care

What are supportive measures during an acute variceal bleed

A

Administration of fresh frozen plasma and packed RBCs, vitamin K, and proton pump inhibitor’s

166
Q

Disorders of the Liver
Cirrhosis- Collaborative Care

Long-term management of patients who have had an episode of bleeding

A

B-Blockers, repeated band ligation of the varices, and portosystemic shunt in patients who develop recurrent bleeding

167
Q

Disorders of the Liver
Cirrhosis- Collaborative Care

What is a non-surgical procedure in which a tract (shunt) between the systemic and portal venous systems is created to redirect portal blood flow

A

Transjugular intrahepatic portosystemic shunt (TIPS)

168
Q

Disorders of the Liver
Cirrhosis- Collaborative Care

How does the TIPS procedure control bleeding

A

Reduces portal venous pressure and decompress is the varicies

169
Q

Disorders of the Liver
Cirrhosis- Collaborative Care

What shunting procedure is contraindicated in patients with severe hepatic encephalopathy, hepatocellular carcinoma, severe hepatorenal syndrome, and portal vein thrombosis

A

TIPS

170
Q

Disorders of the Liver
Cirrhosis- Collaborative Care

What drug is used for hepatic encephalopathy to reduce ammonia formation in the intestines and expels the ammonia from the colon

A

Lactulose

171
Q

Disorders of the Liver
Cirrhosis- Collaborative Care

How is lactulose administered

A

Orally, as an enema, or through a nasogastric (NG) tube

172
Q

Disorders of the Liver
Cirrhosis- Collaborative Care

What should be prevented in patients taking Lactulose?

A

Constipation

173
Q

Disorders of the Liver
Cirrhosis- Nutritional Therapy

Diet for the patient who has cirrhosis without complications

A

⬆️ calories (3000 cal/day), carb

Moderate to low levels of fat

174
Q

Disorders of the Liver
Cirrhosis- Nutritional Therapy

So that protein is more easily metabolized by the liver, what type of nutritional therapy may be needed for patients with alcoholic cirrhosis

A

Parenteral or enteral nutrition

175
Q

Disorders of the Liver
Cirrhosis- Nutritional Therapy

Diet for patient with ascites and edema

A

⬇️ sodium

176
Q

Disorders of the Liver
Cirrhosis- Nutritional Therapy

What are some foods that are high in sodium content

A

Canned soups and vegetables, many frozen foods, salted snacks, nuts, smoked meats and fish, crackers, bread, olives, pickles, ketchup, and beer

177
Q

Nursing Management
Cirrhosis - Nursing Diagnosis

Nursing diagnoses for cirrhosis

A

Imbalance nutrition

Impaired skin integrity

Excess fluid volume

178
Q

Nursing Management
Cirrhosis - Assessment

Elimination changes with cirrhosis

A

Dark urine, decreased urine output it; light colored or black stools, change in bowel habits

179
Q

Nursing Management
Cirrhosis - Assessment

Cognitive perceptual changes with cirrhosis

A

Bill, right upper quadrant or epigastric pain; numbness, tingling of extremities; pruritus

180
Q

Nursing Management
Cirrhosis - Assessment

General objective data of patient was cirrhosis

A

Favor, wasting of extremities, cachexia

181
Q

Nursing Management
Cirrhosis - Assessment

Integumentary changes in patient with cirrhosis

A

Icteric sclera, jaundice, petechiae, ecchymosis, spider angiomas, palmar erythema, alopecia, loss of auxiliary her pubic hair, peripheral edema

182
Q

Nursing Management
Cirrhosis - Assessment

Respiratory changes in patient with cirrhosis

A

Shallow, rapid respirations, epistaxis

183
Q

Nursing Management
Cirrhosis - Assessment

Gastrointestinal changes in patient was cirrhosis

A

Abdominal distention, ascites, distended abdominal wall veins, palpable liver and spleen, foul breath, hemorrhoids

184
Q

Nursing Management
Cirrhosis - Diagnostic Findings

What lab results with the patient was cirrhosis have

A

⬇️ total protein, albumin, protein, WBC (leukopenia), RBC (anemia), platelets, cholesterol levels

⬆️ bilirubin, INR, ammonia, globulin levels

185
Q

Nursing Management
Cirrhosis - Nursing Implementation

What are the risk factors for cirrhosis

A

Alcoholism, malnutrition, viral hepatitis, biliary obstruction, obesity, and right-sided heart failure

186
Q

Nursing Management
Cirrhosis - Nursing Implementation

For individuals at risk for cirrhosis, what is he sensual to promote liver regeneration

A

Adequate nutrition and alcoholism must be treated

187
Q

Nursing Management
Cirrhosis - Nursing Implementation

For the patient with cirrhosis, nursing care focuses on

A

Conserving the patient strength while maintaining muscle strength in tone

188
Q

Nursing Management
Cirrhosis - Nursing Implementation

Anorexia, nausea and vomiting, pressure from ascites, and poor eating habits all interfere with adequate intake for nutrients. What intervention may be done to improve the patient’s taste sensation

A

Oral hygiene

189
Q

Nursing Management
Cirrhosis - Nursing Implementation

What measures can be taken to alleviate pruritus

A

Baking soda or Alpha Keri baths, lotions containing calamine, antihistamines, soft or old linens, control the temperature, and keep patients nails short and clean

190
Q

Nursing Management
Cirrhosis - Nursing Implementation

What is the appearance of urine and stool when jaundice is present

A

Your aunt is often dark brown and found me when shaken.

The stool is gray or tan

191
Q

Nursing Management
Cirrhosis - Nursing Implementation

Nursing assessment and interventions you when manifestations of edema and ascites are present with cirrhosis

A

Accurate I&O

Daily weights

Measurements of extremities and abdominal girth

192
Q

Nursing Management
Cirrhosis - Nursing Implementation

What do you instruct the patient to do immediately before a paracentesis

A

void to prevent a puncture of the bladder

193
Q

Nursing Management
Cirrhosis - Nursing Implementation

What is the patient’s position during a paracentesis

A

Sits on the side of the bed or is in high Fowlers position

194
Q

Nursing Management
Cirrhosis - Nursing Implementation

What do you want to monitor for after a paracentesis

A

Hypokalemia and electrolyte and balances and check the dressing for bleeding and leakage

195
Q

Nursing Management
Cirrhosis - Nursing Implementation

What is a frequent problem for the patient with severe ascites

A

Dyspnea

196
Q

Nursing Management
Cirrhosis - Nursing Implementation

Because the edematous tissues are subject to break down, what meticulous skin care interventions are essential

A

Alternating air pressure mattress

Turning schedule (Q2 hr)

Support abdomen with pillows

ROM Exercises

Elevate lower extremities

197
Q

Nursing Management
Cirrhosis - Nursing Implementation

What measures should be implemented to prevent respiratory problems

A

Coughing and deep breathing

198
Q

Nursing Management
Cirrhosis - Nursing Implementation

What do you want to monitor when the patient is taking diuretics

A

Serum levels of sodium, potassium, chloride, bicarbonate, BUN, creatinine

199
Q

Nursing Management
Cirrhosis - Nursing Implementation

Muscle cramping, weakness, Lafar G, and confusion, are manifestations of

A

Water excess

200
Q

Nursing Management
Cirrhosis - Nursing Implementation

What do you do if hematemesis occurs

A

Assess the patient for hemorrhage

Call the physician

Be ready to assist with treatment used to control bleeding

Admitted to ICU

Maintain airway

201
Q

Nursing Management
Cirrhosis - Nursing Implementation

What is the initial nursing task when balloon tamponade is used

A

Explain the use of the tube and how will be inserted

202
Q

Nursing Management
Cirrhosis - Nursing Implementation

How is the balloon tamponade procedure done

A

Check balloons for patency

Usually inserted by physician through either the nose or the mouth

Balloon inflated with approximately 250 ml of air

Tube is retracted until resistance is felt

Placement is secured by nasal cuff

203
Q

Nursing Management
Cirrhosis - Nursing Implementation

For continued bleeding, the esophageal balloon is then inflated. A sphygmomanometer is used to measure and maintain the balloon at what desired pressure

A

20-40 mm Hg

204
Q

Nursing Management
Cirrhosis - Nursing Implementation

How is the position of the balloon verified

A

By x-ray

205
Q

Nursing Management
Cirrhosis - Nursing Implementation

Nursing care of varices includes monitoring for complications of

A

Rupture or erosion of the esophagus, regurgitation and aspiration, and occlusion of the airway by the balloon

206
Q

Nursing Management
Cirrhosis - Nursing Implementation

It’s a gastric balloon breaks or is deflated, the esophageal balloon will slip upward, obstructing the airway and causing asphyxiation. What action needs to be taken if this happens

A

Cut the tube or deflate the esophageal balloon

207
Q

Nursing Management
Cirrhosis - Nursing Implementation

How do you minimize regurgitation

A

Oral and pharyngeal suctioning

Semi Fowler’s position

208
Q

Nursing Management
Cirrhosis - Nursing Implementation

What do you want to encourage the patient to do if they are unable to swallow saliva

A

Expectorate

209
Q

Nursing Management
Cirrhosis - Nursing Implementation

What do you want to assess for inpatients with hepatic encephalopathy

A

Level of responsiveness

Sensory and motor abilities

Fluid and electrolyte and balances

Acid-base imbalances

Effective treatment measures

210
Q

Nursing Management
Cirrhosis - Nursing Implementation

With hepatic encephalopathy and how often do you want to assess the neurologic status, including the exact description of the patients behavior

A

At least every two hours

211
Q

Nursing Management
Cirrhosis - Nursing Implementation

What measures do you want to Institute to prevent constipation to reduce ammonia production

A

Give drugs, laxatives, and enemas as ordered. Encourage fluids if not contraindicated

212
Q

Nursing Management
Cirrhosis - Ambulatory and Home Care

Supportive measures to include upon discharge

A

Proper diet, rest, avoidance of potentially hepatotoxicity OTC drugs such as acetaminophen (NSAIDs), abstinence from alcohol, avoid activities that increase portal pressure (straining to stole, coughing, sneezing, retching and vomiting)

213
Q

Nursing Management
Cirrhosis - Ambulatory and Home Care

Because patients may find abstinence from alcohol difficult, what do you want to provide

A

Information regarding community and support programs

214
Q

Disorders of the Liver
Acute Liver Failure

Acute liver failure is characterized by severe impairment of liver function associated with

A

Hepatic encephalopathy

215
Q

Disorders of the Liver
Acute Liver Failure

What is the most common cause of acute liver failure

A

Drugs, usually acetaminophen in combination with alcohol

216
Q

Disorders of the Liver
Acute Liver Failure

Acute liver failure is characterized by

A

Rapid onset of severe liver dysfunction and someone with no prior history of liver disease

217
Q

Disorders of the Liver
Acute Liver Failure

How long does acute liver failure last

A

8-26 weeks

218
Q

Disorders of the Liver
Acute Liver Failure- Clinical Manifestations & Diagnostic Studies

Manifestations of acute liver failure

A

Jaundice, coagulation abnormalities, and encephalopathy

219
Q

Disorders of the Liver
Acute Liver Failure- Clinical Manifestations & Diagnostic Studies

What is the first clinical sign of acute liver failure

A

Changes in mentation

220
Q

Disorders of the Liver
Acute Liver Failure- Clinical Manifestations & Diagnostic Studies

Patients with acute liver failure are susceptible to what complications

A

Cerebral edema, renal failure, hypoglycemia, metabolic acidosis, sepsis, multiorgan failure

221
Q

Disorders of the Liver
Acute Liver Failure- Clinical Manifestations & Diagnostic Studies

Laboratory test for acute liver failure

A

⬆️ serum bilirubin, liver enzymes

Glucose

CBC

Acetaminophen level and strain for other drugs and toxins

Viral hepatitis serologic

222
Q

Disorders of the Liver
Acute Liver Failure- Nursing and Collaborative Management

Since acute liver failure my progress rapidly, with our by our changes in consciousness, what transfer is preferred one is the diagnosis is made

A

Transfer to ICU

223
Q

Disorders of the Liver
Acute Liver Failure- Nursing and Collaborative Management

Why should you plans for transfer to a transplant center begin in patients with grade one or two encephalopathy

A

Because they may worsen rapidly

224
Q

Disorders of the Liver
Acute Liver Failure- Nursing and Collaborative Management

What is a frequent complication in patients with liver failure and maybe due to dehydration, hepatorenal syndrome, or acute tubular necrosis

A

Renal failure

225
Q

Disorders of the Liver
Acute Liver Failure- Nursing and Collaborative Management

How do you protect renal function

A

By maintaining adequate fluid balance

226
Q

Disorders of the Liver
Acute Liver Failure- Nursing and Collaborative Management

What is the treatment of choice and increases your bowel rates in patients with liver failure

A

Liver transplantation

227
Q

Disorders of the Liver
Acute Liver Failure- Nursing and Collaborative Management

What are the most common causes of death with acute liver failure

A

Cerebral edema, cerebellar herniation, brainstem compression

228
Q

Disorders of the Liver
Acute Liver Failure- Nursing and Collaborative Management

What monitoring is critical in patients with acute liver failure

A

Hemodynamic in renal function, glucose, electrolytes, and acid-base status

229
Q

Disorders of the Liver
Acute Liver Failure- Nursing and Collaborative Management

Conduct frequent neurologic evaluations for signs of

A

Elevated intracranial pressure

230
Q

Disorders of the Liver
Acute Liver Failure- Nursing and Collaborative Management

How is a patient with acute liver failure are positioned

A

Head elevated at 30°

231
Q

Disorders of the Liver
Acute Liver Failure- Nursing and Collaborative Management

Because of their effects on mental status, what drugs need to be avoided

A

Sedatives

232
Q

Disorders of the Liver
Acute Liver Failure- Nursing and Collaborative Management

What factor influences weather enteral nutrition is initiated

A

Coagulation problems. NG tube maybe irritating to the nasal or esophageal mucosa, thus causing bleeding

233
Q 
Disorders of the Liver
Liver Cancer (Hepatocellular Cancer)

Liver cancer is the most common cause of death in patients with

A

Cirrhosis

234
Q

Disorders of the Liver
Acute Liver Failure- Clinical Manifestations and Diagnostic Studies

Liver cancer can be difficult to diagnose and differentiate from cirrhosis because of what similar clinical manifestations

A

Hepatomegaly, splenomegaly, jaundice, weight loss, peripheral edema, ascites, portal hypertension

235
Q

Disorders of the Liver
Acute Liver Failure- Clinical Manifestations and Diagnostic Studies

Tests used to screen and diagnose liver cancer

A

Ultrasound, CT, MRI

236
Q

Disorders of the Liver
Acute Liver Failure- Clinical Manifestations and Diagnostic Studies

When is a biopsy performed for acute liver failure

A

Results of diagnostic imaging studies are inconclusive or tissue is needed to guide treatment

237
Q

Disorders of the Liver
Acute Liver Failure- Nursing Collaboration and Management

What is prevention of liver cancer focused on

A

Identifying and treating chronic hepatitis B and C viral infections

238
Q

Disorders of the Liver
Acute Liver Failure- Nursing Collaboration and Management

For treatment of liver cancer, what is performed when there is no evidence of invasion of hepatic blood vessels

A

Surgical excision (partial hepatectomy)

239
Q

Disorders of the Liver
Acute Liver Failure- Nursing Collaboration and Management

When can a liver transplant be performed as treatment for liver cancer

A

When tumor is localized

240
Q

Disorders of the Liver
Acute Liver Failure- Nursing Collaboration and Management

Other treatment options for liver cancer

A

Radiofrequency ablation, chemeobolizarion, and alcohol injections

241
Q

Disorders of the Liver
Acute Liver Failure- Nursing Collaboration and Management

What is radiofrequency ablation

A

Thin needle inserted into core of tumor

Electric energy creates heat in specific location

Destruction of tumor

242
Q

Disorders of the Liver
Acute Liver Failure- Nursing Collaboration and Management

At what size tumor can you use radiofrequency ablation

A

<5 cm

243
Q

Disorders of the Liver
Acute Liver Failure- Nursing Collaboration and Management

What is chemoembolization

A

Catheter is placed in the arteries to the tumor

Embolic agent administered mixed with 1 or more chemotherapy agents

244
Q

Disorders of the Liver
Acute Liver Failure- Nursing Collaboration and Management

What is alcohol injection technique

A

Needle inserted into tumor

High concentration of alcohol injected

Alcohol kills cells, mostly liver cancer cells

245
Q

Disorders of the Liver
Acute Liver Failure- Nursing Collaboration and Management

What size tumor is alcohol injections most effective in treating

A

<3cm

246
Q

Disorders of the Liver
Acute Liver Failure- Nursing Collaboration and Management

Interventions are the same as cirrhosis, but intervention for the patient with liver cancer focuses on

A

Keeping the patient comfortable

247
Q

Disorders of the Liver
Acute Liver Failure- Nursing Collaboration and Management

As a result of hepatic encephalopathy or massive blood loss from GI bleeding, death may occur within how many months

A

6-12 months

248
Q

Disorders of the Liver
Acute Liver Failure- Liver Transplantation

Postoperative assessment and monitoring for liver transplant

A

Assess: Neuro status

Monitor: Signs of hemorrhage, drainage, electrolyte levels, urine output, s/s of infection or rejection

Prevent: Pulmonary complications

249
Q

Disorders of the Liver
Acute Liver Failure- Liver Transplantation

Common postoperative respiratory problems

A

Pneumonia, atelectasis, and pleural effusion

250
Q

Disorders of the Liver
Acute Liver Failure- Liver Transplantation

The first 2 months after surgery are critical for monitoring for

A

Infection

251
Q

Disorders of the Liver
Acute Liver Failure- Liver Transplantation

What may be the only sign of infection

A

Fever

252
Q

Disorders of the Liver
Acute Liver Failure- Gerontologic Considerations

In older adults with liver disease, hepatic encephalopathy may be misdiagnosed as

A

Dementia

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