Anatomy
What is the volume of blood that the liver can hold?
One liter
What are three complications that you should assess for with cirrhosis?
portal hypertension, esophageal varices, peripheral edema, ascites, hepatic encephalopathy, hepatorenal syndrome
What is the incubation period of Hep D?
Bonus 100: what must you have in order to have Hep D?
2-26 weeks.
Bonus: Hep B
When teaching the male patient with acute hepatitis C (HCV), the patient demonstrates understanding when the patient makes which statement?
a. "I will use care when kissing my wife to prevent giving it to her."
b. "I will need to take adofevir to prevent chronic HCV."
c. "Now that I have had HCV, I will have immunity and not get it again."
d. "I will need to be checked for chronic HCV and other liver problems."
D
The majority of patients who acquire HCV usually develop chronic infection, which may lead to cirrhosis or liver cancer. HCV is not transmitted via saliva, but percutaneously and via high-risk sexual activity exposure. The treatment for acute viral hepatitis focuses on resting the body and adequate nutrition for liver regeneration. Adofevir is taken for severe hepatitis B (HBV) with liver failure. Chronic HCV is treated with pegylated interferon with ribavirin. Immunity with HCV does not occur as it does with hepatitis A virus (HAV) and HBV, so the patient may be reinfected with another type of HCV.
A patient admitted to the hospital with cirrhosis of the liver suddenly starts vomiting blood. What is the priority action that the nurse should take in this situation?
a. Send for endoscopic variceal ligation.
b. Give propronalol orally.
c. Stabilize the patient and manage the airway.
d. Check for signs of cirrhosis
C.
Individuals with cirrhosis of the liver are at risk of bleeding from esophageal and gastric varices. Hematemesis in the patient with cirrhosis of the liver is likely to be variceal bleeding. In this case, the nurse should first stabilize the patient and manage the airway. Once the patient is stable, other steps in treatment can be initiated, such as assessing further and administering necessary medications.
Name 5 functions of the liver
Metabolism of fat, carbs, proteins
• Vitamin and Mineral
• Blood filter, blood volume reservoir, clotting Factors
• Drug metabolism and
detoxification
What color should the fluid of paracentesis be?
yellow
Name four drugs that can cause toxic or drug induced hepatitis.
Hepatitis • Tylenol • Thiazide diuretics • Statins • Methotrexate • Chloroform • Carbamazepin/tegretol
A patient with cancer that has metastasized to the liver manifests symptoms of fluid retention, including edema and ascites. To determine the effectiveness of the diuretic therapy that has been prescribed, what should the nurse assess?
a. Breath sounds
b. Bowel sounds
c. Abdominal girth
d. Recent blood work
C.
Daily measurement of the abdominal girth provides a direct indication of ascitic fluid increase or decrease. Breath and bowel sounds are usually not affected by liver metastasis until the late stages, when fluid overload and multisystem organ involvement occur. Reviewing the results of the most recent blood work will not show direct measurement of the effectiveness of diuretic therapy.
Which medication is most commonly used to lower ammonia levels in hepatic encephalopathy?
A. Lactulose
B. Furosemide
C. Omeprazole
D. Acetaminophen
Answer: A. Lactulose
Rationale: Lactulose helps reduce ammonia levels by promoting its excretion through the intestines.
What are the functions of bile production?
Bile production aids in digestion and absorption of salt and fat. Excretes things that cant be excreted by urine
What happens when the bile salts leak out on the surface of skin?
White, hazy, crusty, smelly. Makes them itch. Skin breakdown and risk of infection
what five risk factors increase the risk of Hep A?
poor hygeine, improper food handling, homelessness, crowding, poor sanitation, countries wth poor drinking water, family members of ppl who have been infected, daycare centers
A patient with hepatitis A asks whether other family members are at risk for "catching" the disease. The nurse's response will be based on the knowledge that hepatitis A is transmitted primarily:
a. During sexual intercourse
b. By contact with infected body secretions
c. Through fecal contamination of food or water
d. Through kissing that involves contact with mucous membranes
C.
Hepatitis A is primarily transmitted through ingestion of organisms on fecally contaminated hands, food, or water. Care should be taken in the handling of food and water, as well as contaminated items such as bed linens, bedpans, and toilets. Hand hygiene and personal protective equipment such as gloves are important in preventing the spread of infection for hospital personnel. In the home, hand hygiene and good personal hygiene are important in decreasing the risk of transmission. Sexual intercourse, contact with infected body secretions, and contact through mucous membranes all present higher risk for hepatitis B and C than for hepatitis A.
The patient with advanced cirrhosis asks why his or her skin is so yellow. The nurse's response is based on the knowledge that:
a. Decreased peristalsis in the gastrointestinal tract contributes to a buildup of bile salts.
b. Jaundice results from the body's inability to conjugate and excrete bilirubin.
c. A lack of clotting factors promotes the collection of blood under the skin surface.
d. Decreased colloidal oncotic pressure from hypoalbuminemia causes the yellowish skin discoloration.
B.
Jaundice results from the functional derangement of liver cells and compression of bile ducts by connective tissue overgrowth. Jaundice occurs as a result of the decreased ability to conjugate and excrete bilirubin Jaundice is not caused by a build-up of bile salts, a lack of clotting factors, or decreased colloidal oncotic pressure.
What two proteins does the liver excrete?
Bonus 100: what does ammonia convert to in the liver?
Albumin, fibrinogen
Bonus 100: urea
Name the three types of jaundice and what they're caused by.
Hemolytic: blood cells are getting destroyed
Hepatocellular: caused by a liver problem
Obstructive: blockage of the common bile duct
What labs will be altered with hepatitis and which direction will they go in?
Albumin will be LOW
Ammonia will be HIGH
Clotting studies low: spontaneous bleed risk.
Electrolytes will be low
The nurse recalls that hepatic coma results primarily from accumulation of which substance in the blood?
a. Sodium
b. Calcium
c. Ammonia
d. Potassium
C.
A high ammonia level in the blood is a late manifestation of liver failure that results in hepatic coma, causing neurologic dysfunction and brain damage. Sodium, calcium, and potassium are not directly affected by liver dysfunction or hepatic coma.
A patient with a 3-year history of liver cirrhosis is hospitalized for treatment of recently diagnosed esophageal varices. What is the most important information for the nurse to include in the teaching plan for this patient?
a. Decrease fluid intake to avoid ascites.
b. Eat foods quickly so they do not get cold and cause distress.
c. Avoid exercise because it may cause bleeding of the varices.
d. Avoid straining during defecation to keep venous pressure low
D.
Straining during a bowel movement increases venous pressure and could cause rupture of the varices. Fluid restrictions may be a recommendation for ascites but are not directly associated with esophageal varices. If the patient is able to eat, meals should be soft or liquid, and the patient should be instructed to eat slowly and avoid extremes in food temperature to prevent irritation. Excessive exercise and activity should be avoided in a patient with esophageal varices to prevent hypertension, however, avoiding straining and other activities that cause the Valsalva maneuver is still a higher-priority recommendation.
If a dark-skinned patient has jaundice, what places would you find their jaundice?
mucous membranes and sclera
What are five signs and symptoms of early stage cirrhosis?
– Anorexia, dyspepsia, flatulance, nausea, vomiting, diarrhea or constipation, may have abd pain which is dull or heavy feeling in the RUQ, or Epigastrium. Fever, wt loss, hepatomegaly, spleenomegaly
What are four symptoms of the preicteric phase or Prodromal period of hepatitis?
malaise, anorexia, nausea, (flu like symptoms). Have weight loss. Mild RUQ pain. Low grade fever. Distaste for cigarettes. Discomfort.
A patient has an increased ammonia level associated with hepatic encephalopathy. What assessment finding does the nurse expect?
a. Aphasia
b. Asterixis
c. Hyperactivity
d. Acute dementia
B.
Asterixis is a twitching spasm of the hands and wrists seen in patients with increased ammonia levels in conditions such as hepatic encephalopathy. Aphasia, hyperactivity, and acute dementia are manifestations not associated with hepatic encephalopathy. Besides asterixis, an increased serum ammonia level causes sedation and confusion that progress to a comatose state.
What are the precautions that nurses and hospital staff should follow while handling patients suffering from hepatitis infections? Select all that apply.
a. The patient must be in a private room, and door should be closed.
b. Dispose of the needles and syringes used on the patient carefully.
c. Wear gloves while handling articles contaminated by urine or feces.
d. Always wear a mask, gown, and gloves when entering the patient's room.
e. Follow infection control precautions while injecting the patient, and avoid getting pricked by the used needle.
B, C, E
Hepatitis A spreads through the fecal-oral route, and hepatitis B spreads through blood. Hence the virus can spread through needles and syringes used by the patient. Also, the virus can spread while the nurse is handling the urine or fecal material of the patient; hence it is necessary to wear gloves. Hepatitis does not spread through air; hence a mask is not required. A private room is required in respiratory diseases, not in hepatitis.