Exam 3 - Cancer of Liver and Cirrhosis

Question 1

What is some post-diagnostic nursing care after a liver biopsy?

Answer 1

Lie on affected side after procedure
Monitor Hgb, Hct, aPTT, PT/INR
High calories, mod fat intake, no alcohol
Low sodium diet with ascites
Low protein with encephalopathy
Monitor for abd discomfort, increase in ascites, anorexia, jaundice, pain, failing hepatic status
Administer meds sparingly

Question 2

Post-liver transplant education

Answer 2

Immunosppressants are given so organ isn't rejected, but increases risk of cancer recurring or metastasizing
Teach how to empty drains
Drainage will be green
Teach how to clean and access port
Teach manifestations of issues with port

Question 3

Results from chronic alcoholism

Answer 3

Alcoholic cirrhosis

Question 4

Late result of acute viral hepatitis

Answer 4

Postnecrotic cirrhosis

Question 5

Results from chronic biliary obstruction

Answer 5

Biliary cirrhosis

Question 6

Right-sided heart failure leads to central venous congestion

Answer 6

Cardiac cirrhosis

Question 7

Examples of liver function tests

Answer 7

ALT, AST, ALP, bilirubin, ammonia

Question 8

Diagnostic values for serum electrolytes

Answer 8

Low sodium, potassium, phosphate, magnesium

Question 9

Diagnostic values for CBC

Answer 9

Low RBC d/t bone marrow suppression, bleeding deficiencies

Low platelets

Question 10

What will an abd ultrasound reveal if pt has cirrhosis?

Answer 10

Increased liver size

Question 11

Can a biopsy be used to diagnose cirrhosis?

Answer 11

Yes

Question 12

Hepatic encephalopathy assessment - Normal LOC, periods of lethargy/ euphoria; sleep during day, awake at night, asterixis, impaired writing and ability to draw line figures; normal EEG

Answer 12

Grade 1

Question 13

Hepatic encephalopathy assessment - Increasingly drowsy, disoriented; inappropriate, mood swings, agitation. Asterixis, fetor hepaticus (musty odor), abnormal EEG (generalized slowing)

Answer 13

Grade 2

Question 14

Hepatic encephalopathy assessment - Stuporous; difficult to rouse; sleeping most of time; marked confusion; incoherent speech, Asterixis; increased deep tendon reflexes; rigidity of extremities EEG markedly abnormal

Answer 14

Grade 3

Question 15

Hepatic encephalopathy assessment - Comatose; absent pain response, absence of asterixis; absence of deep tendon reflexes; flaccidity of extremities. EEG markedly abnormal

Answer 15

Grade 4

Question 16

Medications for cirrhosis

Answer 16

Aldactone to prevent potassium loss
Loop diuretic (maybe)
Lactulose – reduce serum ammonia levels

Question 17

Manifestations of portal hypertension

Answer 17

Ascites and varices

Question 18

Medications for varices

Answer 18

Beta blockers for prevention - Inderal (propranolol)

Acute phase - vasoconstrictor, such as vasopressin