Nursing Considerations
What nutritional modifications are ordered when a patient has ascites?
Low-sodium diet
We perform a liver biopsy if______
Performed if enzymes & coagulation studies abnormal, ascites present
this medication is an aldosterone-blocking agent; a first line therapy in patients with ascites from cirrhosis
Spironolactone (Aldactone)
A nurse is caring for an adolescent client who has pneumonia and a prescription for cefpodoxime 5 mg/kg PO every 12 hr for 5 days. The client weighs 88 lb. How many mg should the nurse administer per dose? (Round the answer to the nearest whole number. Use a leading zero if it applies. Do not use a trailing zero.)
200 mg
A nurse is preparing to administer a dose of lactulose to a client who has cirrhosis. The client states, "I don't need this medication. I am not constipated." The nurse should explain that in clients who have cirrhosis, lactulose is used to decrease levels of which of the following components in the bloodstream?
A. Glucose
B. Ammonia
C. Potassium
D. Bicarbonae
B. Ammonia
What clotting factors could I administer for esophageal variceal bleeding?
Vitamin K, FFP
What are the 3 common complications of liver transplatation?
Bleeding, infection, and rejection
This medication bind with ammonia to excreted through stool
Lactulose
A provider prescribes dextrose 5% in water IV to infuse at 100 mL/hr. The drop factor on the manual IV tubing is 60 gtt/mL. The nurse should set the IV flow rate to deliver how many gtt/min? (Round the answer to the nearest whole number.)
100 gtt/min
A nurse is planning care for a client who has end-stage cirrhosis of the liver with encephalopathy. Which of the following interventions should the nurse plan to implement to decrease the client's ammonia level?
A. Administer diuretics
B. Restrict intake of fluids
C.Reduce intake of protein
D. Administer vitamin K.
C. Reduce protein in take.
Ammonia is formed in the gastrointestinal tract by the action of bacteria on protein. Limiting dietary protein intake can assist with decreasing the client's ammonia level. Protein is necessary for healing, so strict limitation of dietary protein is not recommended.
In a patient with liver disorders, what would the nurse expect to be reflected in the CBC? What should the nurse then monitor for?
thrombocytopenia (low platelets); bleeding
This procedure is a method of treating ascites in which a cannula is threaded into the portal bein by the transjugular route.
Transjugular Intrahepatic
Portosystemic Shunt (TIPS)
this medication prevents spontaneous bacterial peritonitis and bacteria that produces ammonia
Rifaximin
A nurse is caring for a client who has a pulmonary embolism and has a new prescription for enoxaparin 1.5mg/kg/dose subcutaneous every 12 hr. The client weighs 245 lbs. How many mg should the nurse administer per dose? (Round the answer to the nearest whole number. Use a leading zero if it applies. Do not use a trailing zero.)
167 mg
A nurse is planning care for a client who has cirrhosis and ascites. Which of the following interventions should the nurse include in the plan of care?
A. Decrease fluid intake
B. Increase saturated fat intake
C. Increase sodium intake
D. Decrease carbohydrate intake
A. Decrease the client's fluid intake.
The nurse should restrict fluids for a client who has cirrhosis and ascites due to the client’s risk for increased fluid retention.
Your patient has hepatic encephalopathy; besides serum electrolytes, what serum lab should the nurse monitor? What body system should the nurse assess frequently?
Serum ammonia level; neurological status is assessed frequently.
BONUS QUESION!
Professor Fedge listed 5 labs under "serum enzyme activity" when describing LFTs. What are they?
Need to get 3/5 to get full points :)
ALT, AST, GGT, alkaline phophatase, lactic dehydrogenase
This medication should be used cautiously; long-term use ca lead to hyponatremia.
Lasix
A nurse is preparing to administer hydrocortisone 100 mg IM daily to a client. Available is hydrocortisone 250 mg/2 mL. How many mL should the nurse administer per dose? (Round the answer to the nearest tenth number. Use a leading zero if it applies. Do not use a trailing zero.)
0.8 mL
A nurse is caring for a client who has cirrhosis and a new prescription for lactulose. Which of the following manifestations indicates an adverse effect of the medication?
A. Dry mouth
B. Vomiting
C. Headache
D. Peripheral Edema
B. Vomiting
What is the most important treatment in liver transplantation?
Immunosuppression
A paracentesis is performed under_____ technique; can be diagnostic for cell count, albumin and total protein levels, etc. What colloid is administered with a paracentesis? Why?
sterile; albumin to increase cardiac function and decrease arterial vasodilation. Albumin decreases risk of developing post-paracentesis ascites.
What is the drug of choice for the management of esophageal bleeding? Why?
Ocreotide gtt; it control bleeding from esophageal varices and other parts of the GI tract.
A nurse is preparing to administer digoxin 8 mcg/kg/day PO to divide equally every 12 hr for a preschooler who weighs 33 lb. Available is digoxin elixir 0.05 mg/mL. How many mL should the nurse administer per dose? (Round the answer to the nearest tenth. Use a leading zero if it applies. Do not use a trailing zero.)
1.2 mL
A nurse is planning care for a client who has cirrhosis of the liver. Which of the following actions should the nurse include in the plan? (Select all that apply.)
A. Administer furosemide.
B. Measure the client's abdominal girth.
C. Encourage weight lifting during physical therapy.
D. Implement a low-sodium diet.
E. Administer warfarin.
A, B, D