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NURSING 241 (Fall 2018) > Liver Disorders > Flashcards

Liver Disorders Flashcards

Digestion, Hepatitis

1
Q

what is the role of Albumin

A

maintains intravascular colloid os­motic pressure

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2
Q

phases of hepatitis

A
  • PRODROMAL PHASE
  • ICTERIC PHASE - (5-10 DAYS AFTER INTIAL S/S)
  • CONVALESCENT PHASE-(2-3 WEEKS OF ACUTE ILLNESS)
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3
Q

The “TIPS” procedure is completed to relieve______

A

Portal Hypertension

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4
Q

Hematologic problems often seen with cirrhosis

A

Thrombocytopenia

Neutropenia

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5
Q

TOTAL BILIRUBIN

normal lab values

A

0.1 - 1.2 mg/dl

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6
Q

NORMAL LAB VALUES FOR :
ALT…
AST…
BILIRUBIN…

A

ALT 4-36 units/L
AST 0-35 units/L
BILI 0.1 - 1.2 mg/dL

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7
Q

Three (3) medications that can cause liver damage and require sporadic liver function testing be performed

A

1) ALLOPURINOL
2) ISONIAZID
3) DILANTIN

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8
Q

Vitamin Deficiencies of Cirrhosis (3)

A

1) Decreased Vitamin K
2) Decreased Vitamin A
3) Decreased Folic Acid

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9
Q

NORMAL BILIRUBIN VALUES

A

0.1 - 1.2

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10
Q

S/S of Spontaneous Bacterial Peritonitis

A
  • increased abdominal pain
  • Increased ascites
  • fever
  • worsening encephalopathy
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11
Q

HEMATOLOGICAL PROBLEMS with CIRRHOSIS (2)

A

1) THROMBOCYTOPENIA (platelets <150,000)

2) NEUTROPENIA (ANC <1,500)

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12
Q

_____________ is the byproduct of protein metabolism

A

ammonia

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13
Q

Four (4) signs of Esophageal Varices

A

1) Distended vessels in esophagus
2) Hematemesis
3) Melena (dark tarry stools)
4) S/S of shock

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14
Q

acute bacterial infection of ascetic fluid

A

Spontaneous Bacterial Peritonits (SBP)

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15
Q

HGB

normal lab values

A

12 - 18

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16
Q

NURSING INTERVENTIONS FOR:

HEPATIC ENCEPALOPATHY

A
  • ASSESS LOC
  • LOW PROTEIN DIET
  • SERUM AMMONIA LEVEL
  • LACTULOSE
  • SAFETY PRECAUTIONS
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17
Q

WITH CIRRHOSIS—-what labs do we expect to be DECREASED?

A
  • -Albumin
  • -Total Protein
  • -RBC
  • -HGB
  • -HCT
  • -PLTS
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18
Q

daily max dose of Tylenol for patient with healthy liver

A

4 grams

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19
Q

PLATELETS

normal lab values

A

150 - 400

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20
Q

NURSING INTERVENTIONS FOR:

BALANCE FLUID OVERLOAD

A
  • DAILY WEIGHT
  • I / O
  • MEASURE ABDOMINAL GIRTH
  • FOCUSED REPIRATORY ASSESSMENT
  • ADMINISTER DIURETICS
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21
Q

Functions of Liver (7)

A

GAACVDB
“Girls Are Always Chasing Very Dumb Boys”

G---Glucose Metabolism/Storage
A---Albumin production
A---Ammonia to Urea
C---Clotting factor production
V---Vitamin absorption
D---Drug Metabolism
B---Bilirubin excretion
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22
Q

Absorption of _______ vitamins are decreased with liver disease

A

fat soluble

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23
Q

What is Melena?

A

Tarry Stool typically seen with UPPER GI bleeds (ie, esophagus, stomach, duodenum)

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24
Q

NORMAL SERUM AMMONIA VALUES

A

15-45

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25
Q

Why does ascites cause SOB?

A

-increased pressure on diaphragm causing pleural effusion of lungs leading to SOB

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26
Q

Four (4) risk factors for developing Cirrhosis

A

1) ETOH abuse
2) Chronic Hepatitis B or C
3) Acetaminophen use
4) IV Drug use

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27
Q

Cirrhosis typically caused by (3) things:

A

1) ETOH abuse
2) Viral Hepatitis
3) Medication

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28
Q

Medications used in the management of cirrhosis

A

Spironolactone (aldactone)-diuretic
Furosemide (LASIX)-diuretic
Lactulose (Cephulac)-Reduces ammonia level
Vitamin K-Fat soluble vitamin

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29
Q

Assessment of Hepatic Encephalopathy (4)

A

1) Increased Ammonia (15-45)
2) Mental Status Changes
3) Asterixis (AKA: Liver Flap of hands)
4) Fetor Hepaticus (Sour-fecal smell to breath)

30
Q

Liver converts ________ to urea to be excreted by the kidneys

31
Q

S/S of SBP (4)

(Spontaneous Bacterial Peritonitis)

A

1) Increased abdominal pain
2) Increased ascites
3) FEVER
4) Worsening Encephalopathy

32
Q

Three (3) main problems to assess in patient with liver disease…and why?

A

1) Bleeding problems (r/t decreased clotting factors)
2) Toxin problems (r/t elevated ammonia & bilirubin)
3) Fluid problem (r/t increased fluid retention)

33
Q

NORMAL PT LAB VALUES

A

10-13 SECONDS

34
Q

(True/False) Lactulose can only be given PO

A

False. It can be administered rectally and PO

35
Q

CLIENT EDUCATION WITH CIRRHOSIS

A
  • AVOID ETOH
  • SODIUM, PROTEIN, FLUID RESTRICTIONS
  • REPORT S/S OF GI BLEEDING
  • SKIN CARE
36
Q

NURSING INTERVENTIONS FOR:

SKIN INTEGRITY

A
  • WARM WATER
  • LOTION FOR DRY SKIN
  • ANTIHISTAMINES
37
Q

PROTHROMBIN (PT)

normal lab values

A

10 - 13 seconds

38
Q

AMMONIA (normal lab values)

39
Q

Portal HTN can cause _________ and ______ and______

A

Esophageal Varices
Ascites
Spleenomegaly

40
Q

NORMAL PROTEIN LAB VALUES

41
Q

The scar tissue in the liver blocks blood flow through the liver causing backup the venous system known as__________________

A

Portal HTN

42
Q

TOTAL PROTEIN (Normal lab Values)

43
Q

ALT

normal lab values

A

4 - 36 units/L

44
Q

RBC

normal lab values

45
Q

Assessment of ascites

A 
Increased Abdominal Girth
Weight Gain
Dyspnea
3rd spacing (NA and water retention)
decreased serum albumin
46
Q

Ammonia levels are typically _______ with liver disease

NORMAL VALUES?

A

elevated

(NORMAL) = 15-45

47
Q

acute bacterial infection of ascitic fluid is called_____

A

Spontaneous Bacterial Peritonitis (SBP)

48
Q

ammonia is the byproduct of ___________metabolism

49
Q

INFLAMMATION OF THE LIVER

50
Q

NORMAL ALBUMIN LAB VALUES

A

3.5 - 5 g/dl

51
Q

__________ is produced by the breakdown of RBC’s which then get excreted by the liver

52
Q

ALBUMIN LAB VALUES (Normal)

A

3.5 - 5 g/dl

53
Q

Assessment of patient with Esophageal Varices (4)

A

1) Distended vessel in esophagus (r/t yo Portal HTN)
2) Hematemesis (vomiting blood)
3) Melena (Tarry Stool-seen with upper GI bleeding)
___Esophagus, Stomach, Duodenum
4) S/S of Shock
**Rapid breathing/pulse
**cool, pale, clammy skin
**N/V
**Enlarged Pupils

54
Q

decreased excretion of bilirubin leads to a condition called ___________

55
Q

NURSING INTERVENTIONS FOR:

NUTRITION

A
  • WEIGH DAILY
  • SMALL MEALS W/SNACKS
  • VITAMIN SUPPLEMENTS
  • DIET: HIGH CARBS-LOW PROTEIN-LOW SODIUM
56
Q

How is albumin affected by a diseased liver?

Normal lab values for Albumin?

A

decreased albumin

(NORMAL)= 3.5 - 5 g/dl

57
Q

Complications of CIRRHOSIS (2)

A

1) Hepatic Encephalopathy

2) Esophageal Varices

58
Q

why is the patient with liver disease at an increased risk for bleeding?

A

decreased production of clotting factors

59
Q

End stage chronic liver disease is known as _________

60
Q

Fat Soluble Vitamins (BAD FOLK)

A
  • Vitamin B-12
  • Vitamin A
  • Vitamin D
  • Folic Acid
  • Vitamin K
61
Q

NURSING INTERVENTIONS FOR:

BLEEDING RISK

A
  • MONITOR VSS
  • INSTITUTE BLEEDING PRECAUTIONS
  • CHECK COAGULATION PROFILES
  • TEST STOOL-EMESIS FOR BLOOD
62
Q

___________ is produced by the breakdown of RBC’s

63
Q

Four (4) signs of Hepatic encepalopathy

A

1) elevated ammonia level
2) Mental Status change
3) Asterixis
4) fetor hepaticus

64
Q

HCT

normal lab values

65
Q

This medication is given to decrease the amount of ammonia absorbed into the blood

A

Lactulose (Cephulac)

66
Q

ASSESSMENT OF CIRRHOSIS (14)

A 
Jesse and shanna palmer, finally shanna gray found               HAPPE (JASPFSGFHAPPE)
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
Jaundice
Ascites
Spider Angiomas
Palmar Erythema
Fetor Hepaticus
Striae on abdomen
Gynecomastia/Hirsuism
Fatigue
Hepatosplenomegaly
Altered LOC
Pruritis
Petchiae
Edema
Esophageal Varices
67
Q

Tylenol is contraindicated for which two patients?

A

RENAL or HEPATIC patients

68
Q

RISK FACTORS FOR CIRRHOSIS (4)

A

1) etoh abuse
2) chronic viral HEP C/HEP B
3) acetaminophen abuse (4grams/day is max)
4) IV DRUG USE

69
Q

AST

normal lab values

A

0 - 35 units/L

70
Q

WHY IS THE LIVER BIOPSY PERFORMED?

A

To rule out other types of liver disease- It does NOT DX cirrhosis

NURSING 241 (Fall 2018) (10 decks)

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