Liver failure Flashcards
A client with cirrhosis has portal hypertension, which is causing esophageal varices. What is the goal of the interventions that the nurse will provide?
a. Treat the esophageal varices.
b. Reduce fluid accumulation and venous pressure.
c. Promote optimal neurologic function.
d. Cure the cirrhosis.
b. reduce fluid accumulation and venous pressure.
Methods of treating portal hypertension aim to reduce fluid accumulation and venous pressure. There is no cure for cirrhosis; treating the esophageal varices is only a small portion of the overall objective. Promoting optimal neurologic function will not reduce portal hypertension.
A client with bleeding esophageal varices has had pharmacologic therapy with Octreotide (Sandostatin) and endoscopic therapy with esophageal varices banding, but the client has continued to have bleeding. What procedure that will lower portal pressure does the nurse prepare the client for?
a. Sclerotherapy
b. Balloon tamponade
c. Transjugular intrahepatic portosystemic shunting (TIPS)
d. Vasopressin (Pitressin)
c. Transjugular intrahepatic portosystemic shunting (TIPS)
A TIPS procedure (see Fig. 49-8) is indicated for the treatment of an acute episode of uncontrolled variceal bleeding refractory to pharmacologic or endoscopic therapy. In 10% to 20% of clients for whom urgent band ligation or sclerotherapy and medications are not successful in eradicating bleeding, a TIPS procedure can effectively control acute variceal hemorrhage by rapidly lowering portal pressure.
The nurse is caring for a client with ascites due to cirrhosis of the liver. What position does the nurse understand will activate the renin-angiotensin aldosterone and sympathetic nervous system and decrease responsiveness to diuretic therapy?
a. Upright
b. Prone
c. Left-lateral Sims’
d. Supine
a. upright
In clients with ascites, an upright posture is associated with activation of the renin–angiotensin–aldosterone system and sympathetic nervous system (Porth & Matfin, 2009). This causes reduced renal glomerular filtration and sodium excretion and a decreased response to loop diuretics.
The nurse is caring for a client with cirrhosis. Which symptom(s) should the nurse report immediately? Select all that apply.
a. diarrhea or constipation
b. anorexia and dyspepsia
c. change in mental status
d. nonadherence with prescribed diet
e. signs of GI bleeding
c, e
The nurse reports any change in mental status or signs of GI bleeding immediately because they indicate secondary complications. Anorexia, dyspepsia, diarrhea, constipation, and nonadherence with the prescribed diet may be significant findings, but do not need to be reported immediately, because these are not signs of secondary complications.
The nurse is assessing a client with hepatic cirrhosis for mental deterioration. For what clinical manifestations will the nurse monitor? Select all that apply.
a. Report of headache
b. Agitation
c. Insomnia
d. Decreased deep tendon reflexes
e. Alterations in mood
b, c, e
The earliest symptoms of hepatic encephalopathy include both mental status changes and motor disturbances. The client appears confused and unkempt and has alterations in mood and sleep patterns. The client tends to sleep during the day and has restlessness and insomnia at night. To assess for mental deterioration, the nurse will assess general behavior, orientation, and speech as well as cognitive abilities and speech patterns.
A client with hepatitis who has not responded to medical treatment is scheduled for a liver transplant. Which of the following most likely would be ordered?
a. Ursodiol
b. Chenodiol
c. Tacrolimus
d. Interferon alfa-2b, recombinant
c. tacrolimus
In preparation for a liver transplant, a client receives immunosuppressants to reduce the risk for organ rejection. Tacrolimus and cyclosporine are two immunosuppressants that may be used. Chenodiol and ursodiol are agents used to dissolve gallstones. Recombinant interferon alfa-2b is used to treat chronic hepatitis B, C, and D to force the virus into remission.
A client with liver cirrhosis develops ascites. Which medication will the nurse prepare teaching for this client?
a. Acetazolamide
b. Spironolactone
c. Furosemide
d. Ammonium chloride
b. spironolactone
The use of diuretic agents along with sodium restriction is successful in 90% of clients with ascites. Spironolactone, an aldosterone-blocking agent, is most often the first-line therapy in clients with ascites from cirrhosis. When used with other diuretic agents, spironolactone helps prevent potassium loss. Oral diuretic agents such as furosemide may be added but should be used cautiously because long-term use may induce severe hyponatremia (sodium depletion). Acetazolamide and ammonium chloride are contraindicated because of the possibility of precipitating hepatic encephalopathy and coma.
Which medication is used to decrease portal pressure, halting bleeding of esophageal varices?
a. Spironolactone
b. Cimetidine
c. Vasopressin
d. Nitroglycerin
c. Vasopressin
Vasopressin may be the initial therapy for esophageal varices because it produces constriction of the splanchnic arterial bed and decreases portal hypertension. Nitroglycerin has been used to prevent the side effects of vasopressin. Spironolactone and cimetidine do not decrease portal hypertension.
A health care provider orders spironolactone (Aldactone), 50 mg by mouth four times daily, for a client with fluid retention caused by cirrhosis. Which finding indicates that the drug is producing a therapeutic effect?
a. Serum potassium level of 3.5 mEq/L
b. Serum sodium level of 135 mEq/L
c. Blood pH of 7.25
d. Loss of 2.2 lb (1 kg) in 24 hours
d. Loss of 2.2 lb (1kg) in 24 hours
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. This client’s serum potassium and sodium levels are normal. A blood pH of 7.25 indicates acidosis, an adverse reaction to spironolactone.
The nurse is providing care to a client with gross ascites who is maintaining a position of comfort in the high semi-Fowler’s position. What is the nurse’s priority assessment of this client?
a. Peripheral vascular assessment related to immobility
b. Respiratory assessment related to increased thoracic pressure
c. Urinary output related to increased sodium retention
d. Skin assessment related to increase in bile salts
b. respiratory assessment related to increased thoracic pressure.
If a client with ascites from liver dysfunction is hospitalized, nursing measures include assessment and documentation of intake and output (I&O;), abdominal girth, and daily weight to assess fluid status. The nurse also closely monitors the respiratory status because large volumes of ascites can compress the thoracic cavity and inhibit adequate lung expansion. The nurse monitors serum ammonia, creatinine, and electrolyte levels to assess electrolyte balance, response to therapy, and indications of encephalopathy.
The nurse completing a plan of care for a client with cirrhosis who has ascites and 4+ pitting edema of the feet and legs identifies a nursing diagnosis of risk for impaired skin integrity. Which nursing intervention is appropriate for this problem?
a. Reposition the client every 4 hours.
b. Restrict dietary protein intake.
c. Perform passive range-of-motion exercises four times a day.
d. Arrange for a low air loss bed.
d. arrange for a low air loss bed.
Initiating the use of an alternating-pressure mattress or low air loss bed decreases the risk for skin breakdown due to prolonged pressure on bony prominences. The other answers do not apply.
After being in remission from Hodgkin’s disease for 18 months, a client develops a fever of unknown origin. A health care provider orders a liver biopsy to rule out advancing Hodgkin’s disease and infection. Twenty-four hours after the biopsy, the client has a fever, reports severe abdominal pain, and seems increasingly confused. What should the nurse suspect?
a. An allergic reaction to the contrast media used during the liver biopsy
b. Normal postprocedural pain, with a change in the level of consciousness resulting from the pre-existing fever
c. Peritonitis from bleeding in the liver caused by the liver biopsy
d. Perforation of the colon caused by the liver biopsy
c. peritonitis from bleeding in the liver caused by liver biopsy.
After any invasive procedure, the nurse must stay alert for complications in the affected region—in this case, the abdomen. This client exhibits classic signs and symptoms of peritonitis caused by blood or bile after the liver biopsy. There is a reason to suspect bleeding resulting from the liver biopsy. It is rare to have a perforation of the colon after a biopsy. Liver biopsy doesn’t involve the use of contrast media. The client’s symptoms are not normal for a liver biopsy.
