diagnostics
A patient is diagnosed with Hepatitis A. The patient asks how a person can become infected with this condition. You know the most common route of transmission is?
Fecal-oral
A physician orders spironolactone (Aldactone), 50 mg by mouth four times daily, for a client with fluid retention caused by cirrhosis. Which assessment tool indicates that the drug is producing a therapeutic effect?
Weight loss -
Daily weight measurement is the most accurate indicator of fluid status; a loss of 2.2 lb (1 kg) indicates loss of 1 L of fluid. Because spironolactone is a diuretic, weight loss is the best indicator of its effectiveness.
What medication would a nurse expect to give to a patient with hepatic encephalopathy to decrease the ammonia level?
Lactulose - Lactulose traps ammonia in the intestinal tract. It's laxative effect then expels ammonia from the colon, resulting in decreased ammonia levels, correcting hepatic encephalopathy.
Your patient with acute pancreatitis is scheduled for a test that will use a scope to assess the pancreas, bile ducts, and gallbladder. The patient asks you, "What is the name of the test I'm going for later today?" You tell the patient it is called:
ERCP (Endoscopic Retrograde Cholangio-Pancreatography) is used to diagnosis and sometimes treat the causes of pancreatitis. It will assess the pancreas, bile ducts, and gallbladder. In addition, the doctor may be able to remove gallstones, dilate the blocked ducts with a stent or balloon, drain presenting cysts etc.
Route for TPN vs PPN
Central line for TPN vs Peripheral Line for PPN
A patient is admitted to the ER with the following signs and symptoms: very painful mid-epigastric pain felt in the back, elevated glucose, fever, and vomiting. During the head-to-toe assessment, you notice bluish discoloration around the belly button. As the nurse, you know this is called?
Cullen's Sign
It represents retroperitoneal bleeding from the leakage of digestive enzymes from the inflamed pancreas into the surrounding tissues which is causing bleeding and it is leaking down to umbilicus tissue. Remember the C in Cullen for "circle" and the belly button forms a circle.
A 36-year-old patient's lab work show anti-HAV and IgG present in the blood. As the nurse you would interpret this blood work as?
The patient has recovered from a previous Hepatitis A infection and is now immune to it.
A patient has undergone a liver biopsy. What post-procedure position is appropriate?
On the right side
Explanation: In this position, the liver capsule at the site of penetration is compressed against the chest wall, and the escape of blood or bile through the perforation made for the biopsy is impeded. Positioning the patient on his left side is not indicated. Positioning the patient in the Trendelenburg position may be indicated if the patient is in shock, but is not the position designed for the patient after liver biopsy. High Fowler's position is not indicated for the patient after liver biopsy.
A patient with Cirrhosis has a high ammonia level, what diet would a nurse expect to be ordered for this patient?
low-protein diet - Protein provided by the diet is transported to the liver via the portal vein. The liver breaks down protein, which results in the formation of ammonia.
Risk with Peg tube feeding vs J-tube feeding?
Aspiration
A client is admitted for suspected GI disease. Assessment data reveal muscle wasting, a decrease in chest and axillary hair, and increased bleeding tendency. The nurse suspects the client has:
cirrhosis.
Explanation: Muscle wasting, a decrease in chest and axillary hair, and increased bleeding tendencies are all symptoms of cirrhosis. The client may also have mild fever, edema, abdominal pain, and an enlarged liver.
A client with the diagnosis of Cirrhosis has the presence of asterixis, how would a nurse test for this?
Ask the patient to extend the arms - Asterixis is irregular flapping movements of the fingers and wrists when the hands and arms are outstretched, with the palms down, wrists bent up, and fingers spread.
A nurse is taking care of a patient with cholecystitis. The lunch tray is delivered and on the tray the nurse finds grilled turkey, baked potato, mixed fruit, and a brownie with nuts. Which item would the nurse remove due to known dietary restrictions with this diagnosis?
Brownie with nuts - foods high in fat can cause cholecystitis
DAILY DOUBLE:
The family of a patient newly diagnosed with hepatitis A asks the nurse what they can do to prevent becoming ill themselves. Which response by the nurse is most appropriate?
A. "The hepatitis vaccine will provide immunity from this exposure and future exposures."
B. "I am afraid there is nothing you can do since the patient was infectious before admission."
C. "You will need to be tested first to make sure you don't have the virus before we can treat you."
D. "An injection of immunoglobulin will need to be given to prevent or minimize the effects from this exposure."
D. "An injection of immunoglobulin will need to be given to prevent or minimize the effects from this exposure."
Immunoglobulin provides temporary (1-2 months) passive immunity and is effective for preventing hepatitis A if given within 2 weeks after exposure.
You're caring for a 45 year old patient who is admitted with suspected acute pancreatitis. The patient reports having extreme mid-epigastric pain that radiates to the back. The patient states the pain started last night after eating fast food. As the nurse, you know the two most common causes of acute pancreatitis are:
Main causes of acute pancreatitis are gallstones and alcohol consumption.
Heavy, long-term alcohol abuse is the main cause of CHRONIC pancreatitis.
While assisting a patient with chronic pancreatitis to the bathroom, you note the patient's stool to be oily/greasy in appearance. In your documentation you note this as:
Steatorrhea - is an oily/greasy appearance of the stool which can occur in chronic pancreatitis. This occurs due to the inability of the pancreas to produce digestive enzymes which help break down fats. Fats are not being broken down; therefore, it is being excreted into the stool.
The nurse is caring for a client with cirrhosis. Which assessment findings indicate that the client has deficient vitamin K absorption caused by this hepatic disease?
Purpura and petechiae
Explanation: A hepatic disorder, such as cirrhosis, may disrupt the liver's normal use of vitamin K to produce prothrombin (a clotting factor). Consequently, the nurse should monitor the client for signs of bleeding, including purpura and petechiae.
A client has a primary problem of inadequate nutrition caused by the effects of chemotherapy. The client is receiving continuous enteral feedings through a nasogastric tube (NG) tube. The client begins to complain of nausea and fullness, the nurse checks residual and finds 580ml. What should the nurse do first?
When teaching the 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 (Hepsera) 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. "I will need to be checked for chronic HCV and other liver problems."
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.
A 26 yo male patient has acetaminophen toxicity and is being monitored for abnormal coagulation, what diagnosis would you anticipate and what assessment tool would you use to monitor for abnormal coagulation?
Acute Liver Failure; Prolonged PT Time
A nurse in a clinic is reviewing the laboratory reports of a client who has suspected cholelithiasis. Which of the following is an expected finding?
A. Serum albumin 4.1 g/dL
B. WBC 9,511/uL
C. Direct bilirubin 2.1 mg/dL
D. Serum cholesterol 171 mg/dL
C: Direct bilirubin 2.1 mg/dL
This finding is outside the expected reference range and is increased in the client who has cholelithiasis.
True or False: A patient with acute pancreatitis is reporting excessive thirst, excessive voiding, and blurred vision. As the nurse, it is priority assess the blood sugar?
TRUE - Patients with acute pancreatitis are at risk for hyperglycemia (the signs and symptoms the patient are reporting are classic symptoms of hyperglycemia). Remember the endocrine function of the pancreas (which is to release insulin/glucagon etc. is insufficient) so the nurse must monitor the patient's blood glucose levels even if the patient is not diabetic.
A nurse is monitoring a client who is receiving an intravenous fat emulsion (IVFE) nutritional supplement. What action does the nurse take in the event that the client develops fever, increased triglycerides, and clotting problems?
A. Discontinues the IVFE infusion
B. Documents the findings and continues to monitor
C. Slows the rate of flow of the IVFE infusion
D. Switches the infusion to total parenteral nutrition (TPN) infusion
A - Discontinues the IVFE infusion
For clients receiving fat emulsions, monitor for manifestations of fat overload syndrome, especially in those who are critically ill. These manifestations include fever, increased triglycerides, clotting problems, and multi-system organ failure. Discontinue the IVFE infusion, and report any of these changes to the health care provider immediately if this complication is suspected.
During a home health visit, you are assessing how a patient takes the prescribed pancreatic enzyme. The patient is unable to swallow the capsule whole, so they open the capsule and mix the beads inside the capsule with food/drink. Which food or drink is safe for the patient to mix the beads with?
The patient should mix the medications with acidic foods like applesauce. It is very important the patient does NOT use alkaline foods for mixing (like dairy products, pudding etc.) because they can damaged the enzyme.
You're providing an in-service on viral hepatitis to a group of healthcare workers. You are teaching them about the types of viral hepatitis that can turn into chronic infections. Which types are known to cause ACUTE infections ONLY?
Hepatitis A and E