Liver Failure: Questions, NSG 2600

Liver Failure: Questions, NSG 2600

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Exam 3: Liver Failure, Hepatitis

24 terms planguitPreview Kidney 23 terms trac A 54-year-old patient admitted with diabetes mellitus, malnutrition, osteomyelitis, and alcohol abuse has a serum amylase level of 280 U/L and a serum lipase level of 310 U/L. To what diagnosis does the nurse attribute these findings?

• Malnutrition
• Osteomyelitis
• Alcohol abuse
• Diabetes mellitus

c RAT: The patient with alcohol abuse could develop pancreatitis as a complication, which would increase the serum amylase (normal 30-122 U/L) and serum lipase (normal 31-186 U/L) levels as shown.The health care provider orders lactulose for a patient with hepatic encephalopathy. The nurse will monitor for effectiveness of this medication for this patient by assessing what?

• Relief of constipation
• Relief of abdominal pain
• Decreased liver enzymes
• Decreased ammonia levels

d RAT: Hepatic encephalopathy is a complication of liver disease and is associated with elevated serum ammonia levels. Lactulose traps ammonia in the intestinal tract. Its laxative effect then expels the ammonia from the colon, resulting in decreased serum ammonia levels and correction of hepatic encephalopathy.

When planning care for a patient with cirrhosis, the nurse will give highest priority to which nursing diagnosis?

• Impaired skin integrity related to edema, ascites, and pruritus

b. Imbalanced nutrition: less than body requirements related to anorexia

• Excess fluid volume related to portal hypertension and hyperaldosteronism
• Ineffective breathing pattern related to pressure on diaphragm and reduced lung volume

d RAT: Although all of these nursing diagnoses are appropriate and important in the care of a patient with cirrhosis, airway and breathing are always the highest priorities.When caring for a patient with liver disease, the nurse recognizes the need to prevent bleeding resulting from altered clotting factors and rupture of varices. Which nursing interventions would be appropriate to achieve this outcome?Select all that apply

• Use smallest gauge needle possible when giving injections or drawing blood.
• Teach patient to avoid straining at stool, vigorous blowing of nose, and coughing.
• Advise patient to use soft-bristle toothbrush and avoid ingestion of irritating food.
• Apply gentle pressure for the shortest possible time period after performing venipuncture.
• Instruct patient to avoid aspirin and NSAIDs to prevent hemorrhage when varices are present.

a, b, c, e RAT: Using the smallest gauge needle for injections will minimize the risk of bleeding into the tissues. Avoiding straining, nose blowing, and coughing will reduce the risk of hemorrhage at these sites. The use of a soft-bristle toothbrush and avoidance of irritating food will reduce injury to highly vascular mucous membranes. The nurse should apply gentle but prolonged pressure to venipuncture sites to minimize the risk of bleeding. Aspirin and NSAIDs should not be used in patients with liver disease because they interfere with platelet aggregation, thus increasing the risk for bleeding.A patient with type 2 diabetes and cirrhosis asks the nurse if it would be okay to take silymarin (milk thistle) to help minimize liver damage. The nurse responds based on what knowledge?

• Milk thistle may affect liver enzymes and thus alter drug metabolism.
• Milk thistle is generally safe in recommended doses for up to 10 years.
• There is unclear scientific evidence for the use of milk thistle in treating cirrhosis.
• Milk thistle may elevate the serum glucose levels and is thus contraindicated in diabetes.

a RAT: There is good scientific evidence that there is no real benefit from using milk thistle to protect the liver cells from toxic damage in the treatment of cirrhosis. Milk thistle does affect liver enzymes and thus could alter drug metabolism. Therefore patients will need to be monitored for drug interactions. It is noted to be safe for up to 6 years, not 10 years, and it may lower, not elevate, blood glucose levels.

When caring for a patient with a biliary obstruction, the nurse will anticipate administering which vitamin supplements?Select all that apply

• Vitamin A
• Vitamin D
• Vitamin E
• Vitamin K
• Vitamin B

a, b, c, d RAT: Biliary obstruction prevents bile from entering the small intestine and thus prevents the absorption of fat-soluble vitamins. Vitamins A, D, E, and K are all fat-soluble and thus would need to be supplemented in a patient with biliary obstruction.The condition of a patient who has cirrhosis of the liver has deteriorated. Which diagnostic study would help determine if the patient has developed liver cancer?

• Serum α-fetoprotein level
• Ventilation/perfusion scan
• Hepatic structure ultrasound
• Abdominal girth measurement

c RAT: Hepatic structure ultrasound, CT, and MRI are used to screen and diagnose liver cancer. Serum α-fetoprotein level may be elevated with liver cancer or other liver problems. Ventilation/perfusion scans do not diagnose liver cancer. Abdominal girth measurement would not differentiate between cirrhosis and liver cancer.The patient with cirrhosis has an increased abdominal girth from ascites. The nurse should know that this fluid gathers in the abdomen for which reasons?Select all that apply

• There is decreased colloid oncotic pressure from the liver's inability to synthesize albumin.
• Hyperaldosteronism related to damaged hepatocytes increases sodium and fluid retention.
• Portal hypertension pushes proteins from the blood vessels, causing leaking into the peritoneal cavity.
• Osmoreceptors in the hypothalamus stimulate thirst, which causes the stimulation to take in fluids orally.
• Overactivity of the enlarged spleen results in increased removal of blood cells from the circulation, which decreases the vascular pressure.

a, b, c RAT: The ascites related to cirrhosis is caused by decreased colloid oncotic pressure from the lack of albumin from the liver's inability to synthesize it and the portal hypertension that shifts the protein from the blood vessels to the peritoneal cavity, and hyperaldosteronism which increases sodium and fluid retention. The intake of fluids orally and the removal of blood cells by the spleen do not directly contribute to ascites.

The patient with cirrhosis is being taught self-care. Which statement indicates the patient needs more teaching?

• "If I notice a fast heart rate or irregular beats, this is normal for cirrhosis."
• "I need to take good care of my belly and ankle skin where it is swollen."
• "A scrotal support may be more comfortable when I have scrotal edema."
• "I can use pillows to support my head to help me breathe when I am in bed."

a RAT: If the patient with cirrhosis experiences a fast or irregular heart rate, it may be indicative of hypokalemia and should be reported to the health care provider, as this is not normal for cirrhosis. Edematous tissue is subject to breakdown and needs meticulous skin care. Pillows and a semi-Fowler's or Fowler's position will increase respiratory efficiency. A scrotal support may improve comfort if there is scrotal edema.The nurse provides discharge instructions for a 64-year-old woman with ascites and peripheral edema related to cirrhosis. Which statement, if made by the patient, indicates teaching was effective?

• "It is safe to take acetaminophen up to four times a day for pain."
• "Lactulose (Cephulac) should be taken every day to prevent constipation."
• "Herbs and other spices should be used to season my foods instead of salt."
• "I will eat foods high in potassium while taking spironolactone (Aldactone)."

c RAT: A low-sodium diet is indicated for the patient with ascites and edema related to cirrhosis. Table salt is a well-known source of sodium and should be avoided. Alternatives to salt to season foods include the use of seasonings such as garlic, parsley, onion, lemon juice, and spices. Pain medications such as acetaminophen, aspirin, and ibuprofen should be avoided as these medications may be toxic to the liver. The patient should avoid potentially hepatotoxic over-the-counter drugs (e.g., acetaminophen) because the diseased liver is unable to metabolize these drugs.Spironolactone is a potassium-sparing diuretic. Lactulose results in the acidification of feces in bowel and trapping of ammonia, causing its elimination in feces.The patient with advanced cirrhosis asks why his abdomen is so swollen. The nurse's response is based on the knowledge that:

• A lack of clotting factors promotes the collection of blood in the abdominal cavity.
• Portal hypertension and hypoalbuminemia cause a fluid shift into the peritoneal space.
• Decreased peristalsis in the GI tract contributes to gas formation and distention of the bowel.
• Bile salts in the blood irritate the peritoneal membranes, causing edema and pocketing of fluid.

b RAT: Ascites is the accumulation of serous fluid in the peritoneal or abdominal cavity and is a common manifestation of cirrhosis. With portal hypertension, proteins shift from the blood vessels through the larger pores of the sinusoids (capillaries) into the lymph space. When the lymphatic system is unable to carry off the excess proteins and water, those substances leak through the liver capsule into the peritoneal cavity.Osmotic pressure of the proteins pulls additional fluid into the peritoneal cavity. A second mechanism of ascites formation is hypoalbuminemia, which results from the inability of the liver to synthesize albumin. Hypoalbuminemia results in decreased colloidal oncotic pressure. A third mechanism is hyperaldosteronism, which occurs when aldosterone is not metabolized by damaged hepatocytes. The increased level of aldosterone causes increases in sodium reabsorption by the renal tubules. Sodium retention and an increase in antidiuretic hormone levels cause additional water retention.