Liver Dysfunction - Exam 2

Question 1

Sources of Hepatitis A

Answer 1

Crowded conditions, poor personal hygiene, poor sanitization, contaminated food, milk, H20, infected food handlers, sexual contact

Question 2

Sources of Hepatitis B

Answer 2

contaminated needles, syringes, and blood products, asymptomatic carriers, sexual contact, tattoos, piercings

Question 3

Sources of Hepatitis C

Answer 3

Blood and blood products, needles, syringes, and blood products, sexual contact with infected partners

Question 4

Toxic sources of Hepatitis

Answer 4

Systemic posions: carbon tetrachloride and gold compounds

Question 5

Toxic/drug/chemical induced hepatitis

Answer 5

acetaminophen, INH, chlorothalazide (Diurill), methotrexate, methyldopa

Question 6

Causes of Cirrhosis

Answer 6

Alcohol abuse

Postnecrotic: complication of viral, toxic, or idiopathic

Biliary: chronic billiary obstruction and infection

Cardiac: long standing, severe right sided heart failure

Question 7

Active Natural Immunity

Answer 7

Natural contact with the antigen through clinical infection

Question 8

Active Artificial Immunity

Answer 8

Immunization with an antigen (vaccine)

Question 9

Passive Natural Immunity

Answer 9

Transplacental and colostrum trasnfer from mother to child

Question 10

Passive Artificial Immunity

Answer 10

Infection of serum from immune human (providing antibodies)

Question 11

Hepatitis A Immunity

Answer 11

1. Active Natural - Contact with the antigen through clinical infection
2. Active Artificial - HAV is inactivated Hepatitis A virus. Route is IM in the deltoid. Booster recommended. All children over the age of 1 should receive the vaccine, as should others at risk. Pre exposure prophylaxis as well as postexposure
3. Passive natural - Mother must have h/o Hep A or is vaccinated against
4. Passive Artificial - Immunoglobulin can be used for either pre or post exposure prophylaxsis. It is temporary immunity. Must be given within 2 weeks after exposure. May be given to household contacts, as well as co-working food handlers and patrons of restaurants

Question 12

Hepatitis B Immunity

Answer 12

1. Active Natural - Natural contact with antigen through clinical infection
2. Active Artificial - HBV uses recombinant DNA to synthesize Hep. B antigen. Route is IM in the deltoid. Booster recommended. Vaccine is routine for all newborns and adolescents, as well as others at risk (health care workers). Used for pre and post exposure prophylaxis.
3. Passive Natural - Mother must be vaccinated or have been exposed through active natural contact with Hep B
4. Passive Artificial - Hepatitis B immune globulin (HBIG) is recommended for post exposure prophylaxis. It is temporary immunity. It is given within 24 hours of exposure. May be given in cases of needle stick mucus membrane contact or sexual exposure, and also to newborns of Hep B positive mothers

Question 13

Hepatitis C Immunity

Answer 13

No vaccine available

Question 14

Bilary Artesia

Answer 14

A progressive inflammatory process that causes both intrahepatic and extrahepatic duct fibrosis, resulting in obstructive bile flow

Question 15

Portal Hypertension

Answer 15

The structural changes in the liver from the cirrhotic process causes obstruction to the normal flow of blood through the portal system. Obstruction leads to increased pressure.

Question 16

Esophageal Varices

Answer 16

Complex, tortuous veins at the lower end of the espophagus, enlarged and swollen as a result of portal hypertension.

Question 17

Hepatic Encephalopathy

Answer 17

Neuro-psychiatric manifestations of the liver damage, considered a terminal complication of liver disease. Occurs with high ammonia levels

Question 18

End Stage Liver Disease

Answer 18

When liver function is so impaired that death is imminent, unless transplantation is performed.

Question 19

Hepatitis

Answer 19

An inflammation of the liver, commonly caused by a virus.

Question 20

Cirrhosis

Answer 20

A chronic, progressive disease of the liver characterized by extensive degeneration and destruction of liver cells

Question 21

Ascites

Answer 21

An accumulation of serous fluid in the peritoneal or abdominal cavity, exacerbated by portal HTN and decreased serum albumin levels

Question 22

Icterus

Answer 22

jaundice

Question 23

Liver Biopsy

Answer 23

Description: Percutaneous procedure uses needle inserted between 6th and 7th or 8th and 9th RIGHT intercostal spaces to obtain a specimen

Purpose: To obtain a specimen of hepatic tissue, follow progress of liver disease, detect rejection, diagnose disease

Pre-Procedure Nursing Considerations: coagulation state (avoid blood thinners), T&C, Informed consent, baseline vitals

Procedure Nursing Considerations: Explain breath holding (liver descends in abdominal cavity and decreases risk of pneumothorax

Post-Procedure Nursing Considerations: Freq VS, Side-lying X 2 hours on RIGHT side to put pressure on site of biopsy, bed flat X 12-14 hours, assess for complications: infection, bleeding, bile, peritonitis, shock, pneumothorax)

Question 24

Parencentesis

Answer 24

Description: To remove ascitic fluid for diagnostic and therapeutic purposes

Diagnostic: To send to the lab for analysis

Therapeutic: Temporary relief of ascites. Can improve ventilation. Reserved for those with impaired R and/or pain.

Palliative: Fluid usually reaccumulates, can have drain implanted for frequent fluid removal during late stages

Pre-Procedure Nursing Considerations: patient teaching, informed consent, urinate before test, check abdominal girth, check weight, check VS, may give albumin before and/or after procedure

Procedure Considerations: High fowler’s, sterile technique, measure volume removed, monitor abnormalities, check for leaks

Post-Procedure Considerations: band aid to site, label specimen, send to lab, observe site, measure girth, measure weight, take VS, monitor albumin, monitor electrolytes, monitor for infection

Question 25

Administration of Serum Albumin

Answer 25

Description: Hyperosmolar-solution acts by moving water from extravascular to intravascular space. Purpose of Procedure: Treats ascites and fluid volume overload Considerations: no crossmatch necessary; these are pooled proteins from numerous donors, administer upon opening as there are no preservatives, administer cautiously in cardiac and pulmonary disease because circulatory overload may result from volume expansion Oncotic Pressure - Is extended by colloids in solution. Protein molecules attract water, pulling fluid from the tissue space into the vascular space. Unlike electrolytes, the large protein molecules stay in the vascular space.

Question 26

lactulose (Cephulac)

Answer 26

Classification: synthetic keto-analog of lactose Mechanism of Action: Acidification of feces in bowel and trapping of ammonia, causing elimination VIA the bowels Use: cirrhosis, to reduce ammonia formation in the liver, ex of hepatic encephalopathy Side/Adverse Effects: Laxative effect Nursing Implications: monitor mental status freq, monitor/record number and consistency of stool (may need to hold if too many stools/day), monitor ammonia levels, monitor bowel sounds, given PO when GI function is normal, also give PR/NG

Question 27

spironolactone (Aldactone)

Answer 27

Classification: Diuretic Mechanism of Action: Blocking of aldosterone, potassium sparing Use: Cirrhosis; effective diuretic in patients with severe sodium retention Side/Adverse effects: hyperkalemia, orthostatic hypotension, diuretics that works in different ways are more effective than single dose therapy

Question 28

Nursing Diagnoses/TNIs for the patient with Cirrhosis

Answer 28

**Imbalanced Nutrition: Less than body requirements r/t anorexia, impaired use and storage, N/V** -Monitor weight, provide oral care before meals, administer antiemetics, provide small freqent meals **Impaired skin integrity r/t edema, ascites, pruritis** -Keep fingernails short, apply medicated creams, support edematous areas, turn q2h **Excess Fluid Volume r/t portal hypertension** - Weight daily, administer diuretics, monitor I&O, monitor edema, provide appropriate diet **Potential Complication Hemorrhage r/t altered clotting factors and rupture of varices** -Monitor for bleeding, gentle nursing care, soft toothbrush, teach to avoid straining **Potential Complication: Hepatic encephalopathy r/t increased formation of ammonia** -Monitor behavior, LOC and ammonia levels

Question 29

Early clinical manifestations of Cirrhosis

Answer 29

* GI Disturbances * Anorexia * Dyspepsia (indigestion) * Flatulence * N/V * Change in bowel habits * Abdominal pain * Fever * Lassitude (fatigue) * Weight loss * Enlarged liver or spleen

Question 30

Late clinical manifestations of Cirrhosis

Answer 30

* Jaundice * Decreased ability to conjugate and excrete bilirubin by liver cells * Functional derangement of liver cells * Compression of bile ducts by overgrowth of connective tissue * Pruritus from accumulation of bile salts * Splenomegaly (enlargement of the spleen) * From backup of blood from portal vein * Bleeding tendencies * Decreased production of hepatic clotting factors * Peripheral neuropathy (nerves to brain are not working properly) * Dietary deficiencies of thiamine, folic acid, and vitamin B12

Question 31

Esophageal and Gastric Varices Care

Answer 31

Goal: Avoid bleeding hemorrhage * Avoid alcohol, aspirin, NSAIDs, and irritating foods * Respiratory infection promptly treated to avoid coughing **If** **bleeding occurs:** * Stabilize patient * Manage the airway * Initiate IV therapy * Endoscopic sclerotherapy * Endoscopic ligation * Balloon tamponade * Fresh frozen plasma * Packed RBCs * Vitamin K * Gastric ulcer prophylaxis