ASSESSMENT
A patient with liver failure presents with confusion and asterixis (flapping tremor). What complication is most likely?
Hepatic encephalopathy.
What is the priority nursing intervention for hepatic encephalopathy?
Reduce ammonia levels.
How does Lactulose help in hepatic encephalopathy?
It traps ammonia in the gut and promotes its excretion through stool.
What is the most serious complication of hepatic encephalopathy?
Coma.
Why should protein intake sometimes be limited in hepatic encephalopathy?
Protein breakdown increases ammonia production.
A patient has abdominal distention with fluid accumulation. What is this condition called?
Ascites.
A patient with ascites is experiencing shortness of breath. What is the priority intervention?
Position upright and prepare for possible paracentesis.
Why is Spironolactone used for ascites?
Reduces fluid retention by blocking aldosterone.
Why does ascites increase risk for infection?
Fluid accumulation can become infected (spontaneous bacterial peritonitis).
Why is daily weight important in patients with ascites?
Best indicator of fluid retention.
A patient has yellowing of the skin and sclera. What is this finding?
Jaundice.
Why should patients with liver disease avoid alcohol?
Alcohol worsens liver damage.
Why is Furosemide often given with spironolactone?
Enhances diuresis while balancing potassium levels.
What is portal hypertension?
Increased pressure in the portal venous system.
A patient on Lactulose has 4 bowel movements per day. Is this expected?
Yes — goal is 2–3 soft stools daily to remove ammonia.
A patient with cirrhosis has bruising and bleeding. What is the underlying cause?
Decreased production of clotting factors by the liver.
A patient with hepatic encephalopathy becomes combative. What is the priority action?
Ensure safety and monitor neurologic status.
What is the purpose of Octreotide in liver disease?
Reduces portal hypertension and controls variceal bleeding.
Why are esophageal varices dangerous?
They can rupture and cause massive bleeding.
Why should sedatives be avoided in liver failure?
They worsen CNS depression and encephalopathy.
A patient becomes increasingly lethargic and confused. What lab value should the nurse expect to be elevated?
Ammonia.
A patient with cirrhosis develops sudden confusion. What is the FIRST action?
Assess ammonia level and neurologic status.
Why must opioids like Morphine be used cautiously in liver disease?
Impaired metabolism increases risk of toxicity and encephalopathy.
A patient vomits large amounts of blood. What complication is this?
Ruptured esophageal varices.
A patient becomes increasingly drowsy and difficult to arouse. What is the priority concern?
Progression to hepatic coma.