Diagnostics
What are three enzyme test you would expect to increase in Mr. Nader's situation?
AST, ALT, GGT
Where would you check contraindicated medications regarding AHS?
- Lexicomp
- AHS guidelines
Why would you give Mr. Nader a low protein diet?
Mr. Nader has cirrhosis. A low protein diet will help keep his ammonia levels normal preventing hepatic encephalopathy.
Why would you give a patient with cirrhosis the medication lactulose?
Lactulose lossens bowel movements decreasing straining. Additionally, decreases potassium levels and ammonia.
What are the vitamins decreased in cirrhosis?
Vitamin A, D, E, and K.
Why is Mr. Nader at risk for anemia?
Mr Nader is at risk for anemia because chronic kidney disease stops the production of EPO which stimulates the production of RBC's at the red bone marrow.
What two health alterations must be managed in people with CKD according to AHS guidelines.
- DM1/2
-Hypertension
Should you give Mr. Nader an increased or decreased sodium diet and why?
A low sodium diet should be given to prevent water retention causing swelling and ascetics.
What medication is Mr. Nader on that would help manage his ascities?
Lasix (Furosemide) - Loop Diruetic
What three key actions does albumin play?
Albumin transports drugs in the body.
Albumin attracts water in the body to prevent fluids from seeping out of the client’s bloodstream.
Albumin binds with calcium to make bones stronger
Should the nurse assess eGFR or creatinine levels for Mr. Nader?
The nurse should assess eGFR as this lab value is the key measurement for renal failure.
What are some contraindications for liver transplant?
- Malignancy
- Cardiacpulmonary Disease
- Neuropsychiatric (uncontrolled) Disease
- Uncontrolled infections (HIV)
- ETOH continued abuse
The nurse has completed client teaching with the hemodialysis client about self-monitoring between hemodialysis treatments. The nurse determines that the client best understands the information if the client states to record daily the:
a. Amount of activity.
b. Pulse and respiratory rate.
c. Intake and output and weight.
d. Blood urea nitrogen and creatinine levels.
C.
The client on hemodialysis should monitor fluid status between hemodialysis treatments by recording intake and output and measuring weight daily.
Why would you use non-selective beta blockers for a a patient with esophageal varices?
medication like propanalol causes vasoconstriction which decreases circulation and pressure decreasing portal hypertension and risk of rupturing esophageal varices.
What symptoms would you monitor for in a patient with splenomegaly?
- Thrombocytopenia
- Increased PTT and INR
- Leukopenia
Because the spleen stores platelets and WBC's causing leukopenia. The large spleen can develop due to portal hypertension causing platelets and WBC to become stuck in the spleen.
Would you check INR, aPTT, or PTT for a patient with cirrhosis.
aPPT and INR are the two best measurements for cirrhosis.
Mr. Nader is currently an R1 goal of care but reported he wants full life saving measures but doesn’t want to be kept alive on machines. Which goal of care would meet his wishes?
Mr. Nader is an R3.
R3 allows the use of chest compressions, ICU admit, Surgery, Transfer, and symptoms control. Although R3's dont allow for intubation.
Why would the Valsalva Maneuver or difficult bowel movements be a cause for concern for a patient with cirrhosis?
Valsalva Maneuver or difficult bowel movements (bearing down) increase blood pressure and may cause esophageal varices too rupture.
What are some medications what would be contraindicated in a patient with cirrhosis.
- Acetaminophen
- NSAID
- Opioids
Why would it be a priority nursing intervention to trim Mr. Naders finger nails?
Mr. Nader is jaundice. Increased bile salts will cause pruritus. Because patients with cirrhosis have low vitamin K they are at risk for bleeding. Therefore pruritus is dangerous as it may cause increased bleeding.