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NUR 213 > UNIT 3 - CIRRHOSIS > Flashcards

UNIT 3 - CIRRHOSIS Flashcards

1
Q

extensive scarring of the liver caused by necrotic injury or a chronic reaction to inflammation over a prolonged period of time. Normal liver tissue is replaced with fibrotic tissue that lacks function.

A

cirrohosis

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2
Q

portal and periportal areas of the liver are primarily involved, affecting the liver’s ability to handle the flow of bile by nodules blocking the bile ducts and normal blood flow throughout the liver. The development of new bile channels causes an overgrowth of tissue and liver scarring/enlargement. _____ is often a result

A

Jaundice

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3
Q

caused by viral hepatitis, or some medications or toxins

A

postnecrotic

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4
Q

caused by chronic alcohol use disorder

A

laennec’s

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5
Q

caused by chronic biliary obstruction or autoimmune disease

A

Biliary

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6
Q

what are the risk factors for cirrohosis?

A
  • alcohol use disorder
  • chronic viral hepatitis (hepatitis B, C, D)
  • steatohepatitis (fatty liver disease causing chronic inflammation)
  • damage to the liver caused by medications, substances, toxins, and infections.
  • chronic biliary cirrhosis (bile duct obstruction, bile stasis, hepatic fibrosis)
  • cardiac cirrhosis resulting from severe right heart failure inducing necrosis and fibrosis due to lack of blood flow.
  • employment (chemcial toxins and drugs: herbicides, carbon tetrachloride (dry cleaning), valerian, kava leaves, mushrooms) also those that work with tar and create roads
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7
Q

what are the expected early findings for someone with cirrhosis ?

A
  • weight change, weakenss
  • anorexia, fatigue, NV
  • abdominal pain, distention
  • right upper quadrant tenderness
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8
Q

what are the expected late findings for someone with cirrhosis?

A
  • jaundice
  • esophageal varices
  • ascites
  • hepatomegaly
  • splenomegaly
  • hemorrhoids
  • changes in mental responsiveness and memory
  • spider angiomas (related to estrogen) face, neck, and shoulders
  • anemia
  • thrombocytopenia (coagulation disorders)
  • collateral veins visible on abdominal wall
  • palmar erythema
  • ## sexual characterstics changes, hirsuitism, gynecomastia
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9
Q

what is the normal range of AST? and what does it indicate?

A

10 - 40 U/L ; an enzyme found in the liver, heart and skeletal muscle. an increased level indicates muscle damgge

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10
Q

what is the normal range of ALT ? and what does it inidicate?

A

7 - 56 U/L ; an enzyme primarily found in the liver. more specific lab to collect in regards to the liver. when liver cells are damaged ALT is released into the bloodstream.

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11
Q

what is the normal range of bilirubin? and what does it indicate?

A

0.1 - 1.2 is normal range and > 1.8 mg/dL = jaundice, and dark urine. bilirubin a yellowish substance made during the process of the breakdown of heme. bilirubin is found in bile, a fluid in your liver that helps digest food.

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12
Q

protein made in your liver that helps keep fluid in the bloodstream so it doesn’t leak into other tissues. It also carries various substances throughout the body. A low level would be indicative of malnutrition. Normal level is between 3.5 - 5.4

A

albumin

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13
Q

what is ascites?

A

a buildup of fluid in your belly often due to liver disease

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14
Q

what is the normal range for PT?

A

11 - 13.5 ; evaluates the body’s ability to clot.

- if this is high it means that there isn’t vitamin K to help out.

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15
Q

what is the normal range for INR?

A

1 to 2 ; ensures that the results from a PT test are the same from one lab to another

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16
Q

a waste product formed primarily by bacteria in the intestines during the digestion of protein. If not processed and cleared from the body appropriately, excess ______ can accumulate in the blood.

A

ammonia ; normal range 15 - 66 mg/dL ; increased level indicates a problem with the liver.

17
Q

the METABOLIZER is working when expected outcomes are met!

A

M - malnutrition: nutrition status adequate to maintain energy and prevent protein catabolism
E - edema ; decrease/ no edema
E - evaluate pain; no pain or pain controlled with medication or alternative methods of relief
T - tissue/skin integrity: skin and tissue intact, no decubitus ulcers, wounds healing
A - ascites: no ascites or decreased ascites
B - bleeding: no bleeding, HCT, HGB, and platelets WDL
O - Oxygenation: RR, SaO2 WDL, lungs sounds clear to auscultation
L - labs WDL for client
I - infection; no signs of infection
Z - Zzz(s) no decrease in LOC, ammonia levels WDL
E - excrete and rid of toxins, no adverse side of effects from medications or toxins

18
Q

what are the dietary needs or someone with liver disease ?

A

“GO NUTSO”
G - green leafy vegetables (includes avocado)
O - orange fruits and vegetables (other fruits are good too)

N - nuts, seeds (sunflower and sesame) and peanut buttter too
U - u need to eat beans a lot 
T - tuna, salmon
S - sunflower and olive oils, soy milk
O - oatmeal and whole grains
19
Q

inflammation of the liver that is caused by viruses, toxins, or chemicals (drugs). Hepatocytes undergo pathologic changes and are damaged two ways: through the direct action of the virus or through cell mediated response to the virus. Inflammation of the liver with necrosis occurs and results in decrease liver function.

A

hepatitis

20
Q

due to ingestion of contaminated food or water. It is transmitted through close personal contact via the fecal-oral route. Clients at risk are children and adults in day care centers or long-term living facilities.

A

Hepatitis A (HAV)

21
Q

can be an acute or chronic infection that is transmitted through blood. Risk factors include unprotected sex, contact with infected blood, contaminated needles (ie drug users), and infants born to an infected mother

A

Hepatitis B (HBV)

22
Q

is transmitted through the blood. It has the same risk factors as hepatitis B.

A

hepatitis (HCV)

23
Q

is a co-infection with hepatitis B (HBV). the risk factors are clients with injectable drug abuse or clients who have received clotting factor concentrates.

A

hepatits D ; delta agent (HDV)

24
Q

is transmitted via the fecal oral route and comes from contaminated food or water. It mostly affects pregnant women in developing countries.

A

hepatitis E (HEV)

25
Q

acute hepatitis can lead to chronic hepatitis (___ ,___,___), cirrohosis of the liver and fulminant hepatitis. Cirrhosis and fulminant hepatitis both can lead to increased necrosis and inability of liver cells to regenerate. this results in hepatic encephalopathy and eventually irreversible liver failure and death.

A

B, C, D

26
Q

the type of cirrhosis that is caused by consumption of a pint or more of alcohol per day.

A

alcoholic

27
Q

the type of cirrhosis that is caused by obstruction of the bile duct and can be a result of heart failure.

A

biliary

28
Q

the type of cirrhosis that caused by chronic hepatitis B and C.

A

post hepatic

29
Q

the type of cirrhosis that is caused secondary to heart failure

A

cardiac secondary

30
Q

the systemic assessment for cirrhosis can be easy just think “ASCITES”

A

A - Assess airway (b/c of ascites, bleeding, hematemesis, and melena)
- Asterixis (clients appear to flap due to release of the dorsflexion of the wrist (can’t write)
S - Splenomegaly swelling, peripheral edema
C - Complain of abdominal pain, weight loss
- confusion/personality changes, changes in LOC with increase ammonia levels
I - Inspect lab work (bilirubin, serum protein, albumin, CBC, PT, PTT, INR, ammonia: increase ammonia levels indicate liver is unable to breakdown protein metabolic waste products.
T - trend other s/sx: fetor hepaticus (liver breath), caput medusae (enlarged visible blood vessels that radiate from umbilicus)
E - evaluate liver enzymes for elevation
S - skin: pruritus, jaundice, petechiae, palmar erythema, spider angiomas, ecchymosis, edema and ascites.

31
Q

what kind of diet is one “prescribed” with liver disease?

A
  • increase carbohydrates
  • increase calorie (goal is 2500 - 3000 cal/day)
  • vitamin supplements (thiamine and folic acid)
  • decrease fat (moderate level)
  • decrease protein (moderate to none with low progression of liver damage)
  • small frequent meals
  • TPN when nutritionally indicated
32
Q

what position should you place a patient with ascites?

A

semi-fowler’s

33
Q

what are the system specific assessments related to the medical emergency of esophageal varices ruptured? (the D’s)

A

D - decrease in vascular volume leads to tachycardia
D - drop in postural blood pressure leading to syncope
D - decrease too much in BP can lead to shock
D - decrease weight (sudden loss)
D - dry mucous membranes
D - decrease in neck vein size (flat)
D - decrease in urine output (oliguria)
D - decrease in skin turgor

34
Q

what are the first-do priority interventions for someone that had a esophageal varcies rupture?

A

“FLUIDS”
F - fluid (blood) replacement, administer medications to help stop bleeding: give non selective beta blockers, vasopressors and vitamin K per order
L - level of consciousness, (safety), report to physician
U - urine less than 30 mL/ hour, report trends
I - intake and output
D - document daily weight and vital signs
S - safety

35
Q

what are the system specific s/sx of an exacerbation of hepatic encephalopathy?

A

think “ammonia”
A - ammonia blood levels increase (early)
M - musty or sweet odor to breath (fetor hepaticus) (early)
M - mental fogginess, changes in LOC, mild confusion (early)
O - orientation decreases, drowsiness, confusion, coma (late)
N - need assistance, sluggish movement, poor judgement (late)
I - inappropriate behavior or severe personality change (late)
A - agitation, asterixis (late: flapping of hands)

NUR 213 (20 decks)

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