Hepatitis
Nursing priorities for clients with hepatitis.
Answer: What are monitoring liver function tests, assessing for complications of the disease., and preventing transmission.
Rationale: Monitoring liver function tests and assessing jaundice progression reflect clinical judgment by evaluating the client's condition and guiding further care.
Clients with hepatitis often experience fatigue and should conserve energy.
A well-balanced diet with adequate carbohydrates is recommended. Proteins should not be increased since they can stress the liver.
Medications that are hepatotoxic should be avoided in clients with liver disease.
This sign of cirrhosis involves a yellowish discoloration of the skin and eyes.
Answer: What is Jaundice?
Rationale: Jaundice occurs due to increased bilirubin from impaired liver function
What complication of liver failure can cause alteration in cognition?
Answer: What is Hepatic Encephalopathy?
Rationale: Rapid liver function decline leads to high ammonia levels, affecting brain function.
Hepatic encephalopathy (can lead to confusion or even coma)
Additional Clinical manifestations of liver failure include: Jaundice, ascites, portal hypertension, varices, nutritional deficits, dark urine, and swelling (from fluid build-up).
What is the most common clinical manifestation of cholecystitis?
Answer: What is nausea, vomiting, and abdominal distention and RUQ pain after eating fatty foods.
What are the main components of gallstones?
Answer: What are Cholesterol and Bilirubin?
Rationale: Gallstones primarily consist of cholesterol or pigment from bilirubin breakdown.
Which hepatitis virus has no vaccine available?
Answer: What is Hepatitis C?
Rationale: Despite treatments, no preventive vaccine exists for Hepatitis C.
Prevention is Key: Needlesticks account for a significant number of cases of HCV and needleless systems should be used.
Name a complication of cirrhosis characterized by fluid accumulation in the abdomen.
Answer: What is Ascites?
Rationale: Portal hypertension and hypoalbuminemia cause fluid to accumulate in the peritoneal cavity.
The nurse should restrict fluids for a client who has cirrhosis and ascites due to the client’s risk for increased fluid retention.
Saturated fat and sodium intake should be limited.
Carbohydrates should be increased
Which lab value is most indicative of liver function?
Answer: What is Serum Albumin?
Rationale: Low albumin indicates impaired liver synthesis function.
What is Murphy's sign?
Answer: What is pain on deep palpation under the right rib cage during inspiration?
Rationale: Murphy's sign is a classic finding in acute cholecystitis due to inflamed gallbladder irritation.
Risk factors for cholelithiasis?
Answer: What are female gender, native American or Hispanic ethnicity, obesity/over weight, sedentary lifestyle, rapid weight loss, high-fat/high cholesterol diet, smoking
Rationale: Hormonal changes and obesity increase the risk of cholesterol gallstones.
Which type of hepatitis is known to cause chronic liver disease most frequently?
Answer: What is Hepatitis C?
Rationale: Hepatitis C often leads to chronic hepatitis, cirrhosis, and liver cancer.
What diagnostic test is definitive for confirming cirrhosis?
Answer: What is Liver Biopsy?
Rationale: A liver biopsy allows direct examination of liver tissue to assess fibrosis and cirrhosis.
What dietary adjustment is recommended for hepatic encephalopathy?
Answer: What is a Low-Protein Diet?
Rationale: Reducing protein intake decreases ammonia production from protein metabolism.
Name a common diagnostic imaging technique for cholecystitis.
Answer: What is an Abdominal Ultrasound?
Rationale: Ultrasound is non-invasive and effective at visualizing gallstones and gallbladder inflammation.
What symptom is most commonly associated with cholelithiasis?
Answer: What is Biliary Colic (Right Upper Quadrant Pain)?
Rationale: Pain occurs when gallstones obstruct bile flow, causing gallbladder spasms after eating f
Which hepatitis virus requires Hepatitis B to replicate?
Answer: What is Hepatitis D?
Rationale: Hepatitis D is a defective virus that depends on Hepatitis B for its envelope protein.
Hepatitis B vaccine is recommended for infants.
Name a neurological complication of cirrhosis caused by high ammonia levels.
Answer: What is Hepatic Encephalopathy?
Rationale: The liver’s inability to detoxify ammonia affects brain function, leading to confusion and altered mental status.
Preventing complications after liver biopsy.
Answer: What is Positioning client on right side to apply direct pressure to the biopsy site.
Rationale: A liver biopsy involves inserting a needle into the liver, which carries a risk of bleeding due to the liver’s rich blood supply. Positioning the patient on their right side applies direct pressure to the biopsy site, helping to reduce the risk of hemorrhage.
Which dietary recommendation is given to patients with cholecystitis?
Answer: What is a Low-Fat Diet?
Rationale: Fatty foods stimulate bile release, exacerbating pain and inflammation.
Client education to provide after ESWL
Answer:
What is encourage adequate fluid intake and to stay active after the procedure to help assist in passing the stone fragments.
Hematuria is expected 1-2 days post-procedure, report excessive bleeding or clots.
Pain is common, acetaminophen or ibuprofen is recommended.
Which hepatitis viruses are associated with high maternal mortality if contracted during pregnancy?
Answer: What is Hepatitis E?
Rationale: Hepatitis E, especially genotype 1, can cause fulminant hepatitis in pregnant women.
Life threatening bleeding, hematemesis, and decreased level of consciousness are clinical manifestations of what complication of cirrhosis?
Answer: What is Esophageal varices
Rationale: Clients with Cirrhosis are at risk of developing esophageal varices which are are life threatening. Clinical manifestations include bleeding, hematemesis, decreased level of consciousness, tachycardia, hypotension, and cool, clammy skin.
Major risk factors for impaired liver function (hepatic complication)
Answer: Alcohol abuse, Polypharmacy, obesity, viral hepatitis.
Rationale:
Alcohol use over a long period of time increases the risk of cirrhosis.
Polypharmacy puts clients at risk for liver complications since many medications are metabolized in the liver and the liver drug metabolism decreases with age.
Viral Hep B and C are leading causes of liver disease, drinking alcohol while infected increases even more.
Obesity increases risk of Non-alcoholic fatty liver disease (NAFLD)
What surgical procedure is commonly performed to treat cholecystitis?
Answer: What is Laparoscopic Cholecystectomy?
Rationale: Removal of the gallbladder is the definitive treatment for recurrent or severe cholecystitis.
Educate client on maintaining activity to break up gas and alievate shoulder pain. The gas used to inflate the abdomen for a laparoscopic cholecystectomy can migrate to the right should area causing pain. Heat and time often are the interventions used to treat the pain or discomfort.
What is the nurses priority assessments following Endoscopic Retrograde Cholangiopancreatography (ERCP)?
Answer: What monitoring for serious complications such as perforation or pancreatitis.
Rationale: Severe abdominal pain with absent bowel sounds could indicate a serious complication such as perforation or pancreatitis, both of which require urgent medical intervention. Perforation can lead to peritonitis, and post-ERCP pancreatitis is a known risk that requires close monitoring.
Additional Post procedure complications for the nurse to assess:
A sore throat and mild hoarseness are expected due to the passage of the endoscope and typically resolve on their own.
Bloating and gas may occur from air insufflation during the procedure and are usually not concerning.
Fatigue and drowsiness are common after sedation and should improve as the medication wears off.