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Exam2 NRS 202 > Hepatic Disorders > Flashcards

Hepatic Disorders Flashcards

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1
Q

Functions of the liver

A

glucose metabolism
ammonia conversion
protein metabolism
fat metabolism
vitamin and iron storage
bile formation
bilirubin excretion
drug metabolism

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2
Q

The majority of the blood supply to the liver, which is poor in nutrients, comes from the portal vein. T or F

A

False - majority of supply that is rich in nutrients from the GI tract comes from the portal vein

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3
Q

What LFTs are associated with liver disorders and are known to increase with hepatitis, cirrhosis, and liver cancer?

A

serum aminotransferases, ALT, AST

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4
Q

What LFT is associated with cholestasis and alcoholic liver disease?

A

GGT

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5
Q

What does the nurse assess in the patient with liver dysfunction?

A

H&P - exposure to toxins, travel, alcohol and drug use; skin - yellow and dry, LOC, palpation - liver inflammation

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6
Q

What manifestations are seen with liver dysfunction?

A

Jaundice
Poral hypertension
Ascites, varices
Hepatic encephalopathy or coma
Nutritional deficiencies

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7
Q

Yellow - ish coloring of sclera or skin caused by increased serum bilirubin

A

jaundice

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8
Q

Jaundice occurs when bilirubin exceeds

A

> 2 mg/dL

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9
Q

Types of jaundice

A

hemolytic, hepatocellular, obstructive

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10
Q

Signs and symptoms of jaundice

A

**dark orange-brown urine
**clay colored stools
anorexia/N/V
weight loss
fatigue, weakness, malaise
headache, chills, fever, infection
dyspepsia
pruritus

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11
Q

Complication occurring from obstructed blood flow through the liver resulting in increased pressure through the portal venous system

A

portal hypertension

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12
Q

Portal hypertension can result in?

A

Ascites
Esophageal tears

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13
Q

What protein draws fluid in resulting in ascites?

A

albumin

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14
Q

s/ of ascites include

A

pain
infection
SOB
pressure on vital organs

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15
Q

What can be performed as a comfort measure for ascites?

A

regular paracentesis

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16
Q

How does the nurse assess ascites?

A

Record abdominal girth
Daily weight
Assess for fluid in cavity by percussion
Monitor for F&E imbalances

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17
Q

How is ascites managed?

A

Low sodium diet
Diuretics - spirolactone
Bed rest
Paracentesis- VS, fevers, redness@ site

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18
Q

What emergent condition is caused by the accumulation of ammonia and other toxins in the blood?

A

Hepatic Encephalopathy

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19
Q

What two major alterations affect the development of hepatic encephalopathy?

A

Hepatic insufficiency
Portosystemic shunting

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20
Q

The inability of the liver to detoxify toxic by-products of metabolism

A

hepatic insufficiency

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21
Q

Disorder where collateral vessels develop in the liver allowing toxic portal blood to enter systemic circulation

A

portosystemic shunting

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22
Q

What are the earliest signs of hepatic encephalopathy?

A

severe mental changes like hallucinations and motor distrubances

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23
Q

How does the nurse assess the patient for hepatic encephalopathy?

A

EEG - brain damage
Changes in LOC - hallucinations
Seizure precautions
Monitor F&E, ammonia levels**

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24
Q

What is the most important thing to monitor in hepatic encephalopathy?

A

ammonia levels

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25
How is hepatic encephalopathy managed?
Stop offending cause - drinking, drugs Lactulose to reduce serum ammonia IV glucose to minimize protein catabolism Protein restricted diet - hard to metabolize in liver failure Reduce ammonia by gastric suction, abx, enemas Discontinue sedatives, analgesics, and tranquilizer - nothing metabolized by liver Monitor/treat complications - fever, change in VS, SOB, GI beed, change in BP, I&O
26
The first bleeding episode of an esophageal varices has what percentage of mortality?
10-30% depending on severity
27
Manifestations of esophageal varices
hematemesis, melena, general deterioration, shock
28
How often should patients with esophageal varices and cirrhosis undergo endoscopy?
Every 2-3 years
29
How are esophageal varices managed?
Treat for shock - admin O2 IV fluids, blood and blood products, volume expanders to pull fluid where it needs to go Vasopressin Nitroglycerin Propranolol to decrease portal pressure Balloon tamponade Maintain safe environment, prevent injury, bleeding and infection Administer prescribed treatments Monitor for complications Encourage deep breathing and position changes
30
A systemic viral infection that causes necrosis and inflammation of liver cells
viral hepatitis
31
A disorder that is toxic to the liver and is drug induced
nonviral hepatitis
32
What types of hepatitis are transmitted via fecal-oral route?
A and E
33
What types of hepatitis are blood borne pathogens?
B and C
34
What type hepatitis only affects those who already have hep B?
Hep D
35
Hepatitis A is transient lasting 4-8 weeks. T or F
True
36
S/s of Hepatitis A
flu-like symptoms low grade fever jaundice w dark urine indigestion epigastric distress enlarged liver and spleen
37
How is hep A managed?
Good hygiene - hand washing, safe water, proper sewage disposal Vaccinate Immunoglobulin for contacts to provide passive immunity Bed rest Nutritional support - anorexia
38
How is hep B transmitted?
blood, saliva, semen, vaginal secretions, STD, mother to baby during birth
39
Hep B has a long incubation period of 1-6 months. T or F
True
40
S/s of hep B
insidious and variable anorexia dyspepsia abdominal pain generalized aches malaise weakness fatigue **jaundice may or may not be present
41
How is hep B managed?
Meds - interferon, antivirals: entecavir and tenofovir Bed rest Nutritional support - anorexia Vaccine
42
How is hep C transmitted?
Blood and sexual contact, needles
43
What is the most common blood borne infection?
hep C
44
Hep C is curable. T or F
False
45
How is hep C managed?
Antiviral medications Avoid alcohol Avoid meds that effect liver Prevention is key Safe needle use
46
How is hep D transmitted?
Blood and sexual contact, needles, hemodialysis, transfusions
47
What is the only drug available to treat hep D?
interferon alfa
48
How is hep E transmitted?
fecal - oral route; contaminated water
49
How is hep D managed?
good hygiene, handwashing
50
Types of hepatic cirrhosis
Alcoholic Postnecrotic Biliary
51
Type of cirrhosis involving scar tissue that surrounds the portal areas of the liver
alcoholic cirrhosis
52
Type of cirrhosis that involves bands of scar tissue
postnecrotic cirrhosis
53
Type of cirrhosis that involves scarring around the bile ducts of the liver
biliary
54
Manifestations of cirrhosis
liver enlargement portal obstruction ascites infection and peritonitis varices GI varices edema vitamin deficiency anemia mental deterioration
55
How is cirrhosis managed?
Promote rest Improve nutritional status - restrict protein, supplement vitamins Provide skin care Reduce risk for injury - risk for bleeding
56
Potential complications of cirrhosis
Bleeding and hemorrhage Hepatic encephalopathy Fluid volume excess
57
Primary liver tumors are associated with what?
Hep B and C Hepatocellular carcinoma
58
Manifestations of liver cancer
dull persistent RUQ pain weight loss anemia anorexia weakness jaundice ascites obstructed portal veins
59
How is liver cancer managed?
Radiation therapy Chemotherapy Percutaneous biliary drainage Surgery - lobectomy, cyrosurgery, transplant
60
Preoperative nursing care for liver transplant
support educatoin encouragement
61
Postoperative nursing care for liver transplant
monitor for infection, vascular complications, respiratory and liver dysfunction Caregiver stress

Exam2 NRS 202 (7 decks)

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