Cirrhosis

Question 1

What are 4 major functions of the liver?

Answer 1

• Detoxifying the body
• Helps blood to clot
• Metabolize drugs
• Liver synthesizes albumin

Question 2

What is the pathophysiology or cirrhosis? (142)

Answer 2

Liver cells are destroyed & replaced with connective/scar tissue ➜ alters the circulation within the liver ➜ ↑ BP in the liver aka “portal hypertension”

Question 3

What are s/s of cirrhosis?

Answer 3

• Firm, nodular liver; jaundice
• Abdominal pain (liver capsule has stretched)
• Chronic dyspepsia (GI upset)
• Change in bowel habits
• Ascites
• Splenomegaly
• Fatigue (d/t toxins build up; toxins makes you feel tired)
• Peripheral edema
• Anemia (d/t bleeding)
• Can progress to hepatic encepalopathy (d/t ammonia build up)

Question 4

Ammonia acts like a ___.

Answer 4

Sedative

Question 5

If liver is sick, what is number one concern?

Answer 5

Bleeding

Question 6

If liver is sick, ___ the dose of meds.

Answer 6

decrease

Question 7

Never give ___ to people with liver problems.

Answer 7

acetaminophen (tylenol)

Question 8

What is the antidote for acetaminophen?

Answer 8

acetylcysteine (Mucomyst)

Question 9

When the spleen is enlarged, the____ system is involved.

Answer 9

immune

Question 10

What are the lab changes / diagnosis for cirrhosis?

Answer 10

• ↓ serum albumin
• ↑ ALT & AST
• Ultrasound
• CT, MRI
• Liver biopsy

Question 11

What is the confirmatory procedure for a diagnosis of cirrhosis?

Answer 11

Liver biopsy

Question 12

Pre-procedure and post-procedure nursing care for liver biopsy.

Answer 12

Pre-procedure:

• Clotting studies : PT, INR, aPTT
• Vital signs
• Supine, right arm behind the head (to get arm out of the way)
• Exhale and hold breath (to get the diaphgram out of the way)

Post-procedure:

• Lie on right side (to hold pressure)
• Vital signs (worry about hemorrhage)

Question 13

What is the treatment for cirrhosis?

Answer 13

• Antacids, vitamins, diuretics
• No alcohol
• I & O and daily weights
• Rest
• Bleeding precautions (no IM)
• Measure abdominal girth (for ascites)
• PARACENTESIS
• Monitor jaundice and provide good skin care.
• Avoid narcotics
• ↓ protein, ↓ sodium diet

Question 14

What is paracentesis?

Answer 14

Removal of fluid from the peritoneal cavity (ascites)

Question 15

Pre-procedure nursing care for paracentesis.

Answer 15

• Have client void (to avoid bladder puncture).
• Sit up position
• Vital signs (with shocky clients, BP ↓ and pulse ↑)

Question 16

Why should cirrhosis patients avoid narcotics?

Answer 16

B/c liver can’t metabolize drugs well when it’s sick.

Question 17

Why is ↓ protein diet recommended for patients with cirrhosis?

Answer 17

Protein gets broken down to ammonia ➜ liver converts ammonia to urea ➜ kidneys excrete urea.

In cirrhosis, liver can’t do its job so ammonia increases in the body.

Question 18

In which part is jaundice first seen?

Answer 18

Sclera