Cirrhosis

Question 1

Albumin levels

Answer 1

3.5-5.0

Question 2

Ammonia levels

Answer 2

12.6-46.2

Question 3

Acute Care Management in general for Cirrhosis

Answer 3

1. Rest needed
2. Oral hygiene before meals
3. Between meal nourishment (glucose shakes)
4. Assess for jaundice
5. Measures to relieve pruritus
6. Monitor color of urine & stool
7. I/O
8. Daily weight measurements
9. Abdominal girth measurements using umbilicus

Question 4

Acute Care management of Breathing & Skin issues from Cirrhosis

Answer 4

1. relief of dyspnea = Semi fowlers
2. Skin care = turning at least 2 hours
3. ROM exercise
4. TCDB
5. Elevate lower extremities

Question 5

Implementation after Balloon tamponade

Answer 5

1. Monitor for complications (aspiration pneumonia)
2. Scissors at bedside
3. Semi Fowlers position
4. Oral/Nasal Care

Question 6

Nursing interventions of Hepatic Encephalopathy

Answer 6

1. Maintain safe environment
2. Perform Neurologic assessment checks q2h
3. Prevent falls
4. Minimize constipation
5. Encourage fluids
6. Control factors known to precipitate encephalopathy

Question 7

CHEAP

Answer 7

Complications from Cirrhosis 
Coagulation issues (DIC, Thrombocytopenia)
Hepatorenal Syndrome 
Encephalopathy 
Abdominal Ascites 
Portal Hypertension

Question 8

What is the most lethal issue that portal HTN can cause?

Answer 8

Esophageal and Gastric varices

Question 9

Treatment for Esophageal and Gastric varices that are not bleeding

Answer 9

Prevent bleeding
Avoid alcohol, ASA, NSAIDs
Endoscopy to know where they are 
Nonselective beta blocker 
Long term: Beta blocker, band ligation, shunts

Question 10

Treatment for Esophageal and Gastric varices that are bleeding

Answer 10

Vasoconstriction medication

1. Stablize patient
2. Manage airway
3. Provide IV therapy and blood products
4. Ballon tamponade

Question 11

How do you treat Encephalopathy from Cirrhosis?

Answer 11

1. Lactulose to keep ammonia in the gut
2. Lower protein intake
3. Control GI bleed
4. Remove blood from GI tract
5. Prevent constipation to prevent rupture

Question 12

How do you treat Ascites

Answer 12

1. Na restriction
2. Potassium sparing diuretics
3. Parcentesis
4. TIPS (surgery if needed)

Question 13

Objective data for Cirrhosis

Answer 13

1. Wasting extremities with Ascites
2. Jaundice
3. Spider angiomas, Petechiae, ecchymoses
4. Gynecomastia, Amenorrhea
5. Shallow, rapid respirations
6. Black tarry stools
7. Asterixis (hand flopping)
8. Altered LOC
9. Increase INR & Ammonia
10. Decrease folic acid & Cobalamin (B12)