liver conditions

med/surg II exam 3

What is the anatomical and cellular progression of chronic liver disease (CLD) leading to cirrhosis?

Acute or chronic inflammation (hepatitis) causes hepatocellular necrosis, which leads to progressive tissue scarring (fibrosis). Advanced, irreversible fibrosis is termed cirrhosis.

What is the clinical distinction between compensated and decompensated cirrhosis?

Compensated cirrhosis means the damaged liver still maintains function without overt physical signs. Decompensated cirrhosis is marked by severe complications: ascites, hepatic encephalopathy, gastrointestinal bleeding, and jaundice.

What is the only definitive cure for terminal decompensated liver failure?

An organ transplant (liver transplantation).

How does liver failure lead to severe thrombocytopenia in up to 70% of cirrhosis clients?

Reduced hepatic synthesis of thrombopoietin (the glycoprotein hormone regulating platelet production) impairs bone marrow platelet production.

What causes the formation of esophageal and rectal varices in clients with liver failure?

Portal hypertension congests hepatic blood flow, forcing blood into fragile collateral veins that can rupture and cause massive GI bleeding.

What metabolic condition leads to severe muscle wasting in liver failure clients, and why does it occur?

Sarcopenia, caused by severe protein depletion, metabolic dysfunction, and early satiety.

How should nutritional energy needs be calculated for a client presenting with massive ascites?

Energy needs must be calculated using the client's ideal body weight, excluding the extra weight from ascites fluid.

What percentage of cirrhosis-related deaths in the U.S. is caused by alcohol-associated liver disease (ALD)?

Approximately 48% of all cirrhosis-related deaths.

What primary metabolic risk factors drive Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD)?

Central obesity, dyslipidemia, hypertension, and type 2 diabetes mellitus.

What primary liver cancer develops from chronic ongoing hepatic inflammation, and what demographic is most affected?

Hepatocellular carcinoma (HCC), which predominantly affects males between ages 45 and 65.

How are Hepatitis A (HAV) and Hepatitis E (HEV) transmitted?

Via the fecal-oral route through ingestion of food or water contaminated by infected feces.

How are Hepatitis B (HBV) and Hepatitis D (HDV) transmitted?

Through exposure to infected blood or bodily fluids (such as unprotected sexual contact or contaminated needles).

How is Hepatitis C (HCV) transmitted, and what long-term health risks does it carry?

Transmitted strictly through infected blood; HCV is a leading cause of chronic cirrhosis and primary liver cancer (HCC).

What common over-the-counter medication causes toxic hepatitis when taken in excessive doses?

Acetaminophen (Tylenol).

What physiological mechanism causes jaundice (yellowing of skin, sclera, and mucous membranes)?

Systemic accumulation of elevated serum bilirubin caused by hepatic dysfunction or biliary obstruction.

What causes urine to turn dark amber, brown, or cola-colored in liver disease?

Renal excretion of excess conjugated bilirubin into the urine.

What causes clay-colored (light gray or pale) stools in clients with liver conditions?

Blocked biliary excretion preventing bilirubin from entering the intestinal tract.

What is ascites, and what primary vascular complication causes it?

Accumulation of serous fluid in the peritoneal cavity secondary to portal hypertension and low serum albumin.

What skin manifestation causes severe, generalized itching unrelieved by scratching in liver failure?

Pruritus, caused by the accumulation of bile salts under the skin.

What are spider angiomas (spider nevi), and where do they typically appear?

Small, dilated, spider-like vascular lesions visible on the face, neck, upper chest, arms, and fingers.

What is palmar erythema, and how does it present on physical examination?

Distinct, symmetrical redness over the palms of the hands.

Why can constipation be particularly dangerous for older adult clients with rectal varices?

Straining during bowel movements can rupture fragile rectal varices (which are often misdiagnosed as hemorrhoids), causing severe lower GI bleeding.

Why is hepatic encephalopathy in adults > 65 years frequently misdiagnosed?

Its neurocognitive symptoms (confusion, memory loss, lethargy) are easily mistaken for age-related dementia or delirium.

What diagnostic procedure is considered the gold standard for staging liver fibrosis?

A liver biopsy.

Which liver function test (LFT) enzymes indicate hepatocellular injury when elevated?

AST (Aspartate Aminotransferase) and ALT (Alanine Aminotransferase).

What coagulation lab parameter is prolonged in liver failure due to impaired clotting factor synthesis?

Prothrombin Time (PT) / International Normalized Ratio (INR).

What serum protein level is decreased in cirrhosis, contributing to third-spacing and ascites?

Serum Albumin.

What laboratory test evaluates for hyperammonemia in clients suspected of hepatic encephalopathy?

Serum Ammonia (NH3).

What non-invasive imaging techniques are used to evaluate hepatic tissue stiffness and fibrosis?

Ultrasound, CT scan, and Magnetic Resonance Elastography (MRE).

What diagnostic procedure involves inserting a needle into the peritoneal cavity to remove excess ascites fluid?

A paracentesis.

How is hyponatremia specifically defined in clients with cirrhosis?

A serum sodium level less than 130 mEq/L.

Why is severe hyponatremia (< 125 mEq/L) a life-threatening medical emergency in liver failure?

It causes fluid shifts into brain tissue, leading to cerebral edema and permanent neurological damage.

What is the first-line intervention for managing hyponatremia in a cirrhosis client?

Initiate a fluid restriction of 1 to 1.5 L/day, HOLD ALL DIURETICS, and closely monitor serum potassium.

Why must rapid sodium overcorrection be avoided when treating hyponatremia?

Rapid overcorrection can cause central pontine myelinolysis (osmotic demyelination syndrome), leading to severe, irreversible neurological harm or death.

What dietary sodium restriction is recommended to manage ascites fluid accumulation?

A moderate sodium restriction of 5 to 6.5 g/day (or 2 to 3 g of elemental sodium).

What non-pharmacological positioning measure maximizes lung expansion in a client with severe ascites?

Elevating the head of the bed (HOB) or placing the client in a recliner chair to relieve diaphragm pressure.

What toxin buildup causes hepatic encephalopathy, and how does it affect the brain?

Failure to convert ammonia (NH3) into urea leads to hyperammonemia; ammonia crosses the blood-brain barrier, impairing cerebral function.

What classic motor sign characterizes hepatic encephalopathy on physical assessment?

Asterixis (a flapping tremor of the hands when wrists are extended).

What medication is prescribed to treat hepatic encephalopathy, and how does it lower ammonia?

Lactulose, an osmotic laxative that traps ammonia in the colon and eliminates it through frequent bowel movements.

NCLEX CRITICAL SAFETY: What specific bleeding precautions must the nurse enforce for a cirrhosis client?

Use an electric razor, use a soft-bristled toothbrush, avoid flossing, avoid invasive procedures, and hold direct pressure on venipunctures until bleeding stops completely.

NCLEX STRICT MEDICATION CONTRAINDICATION: What over-the-counter pain/fever medications must a cirrhosis client avoid completely?

Aspirin, NSAIDs (increases GI bleeding risk), and acetaminophen / Tylenol (hepatotoxic).

What infection precaution and monitoring are critical for a client undergoing paracentesis for ascites?

Maintain strict sterile technique during the procedure and monitor for spontaneous bacterial peritonitis (fever, abdominal pain, cloudiness of drained fluid).

What antiviral medication is administered as a weekly injection for 6 months to treat Hepatitis B?

Interferon.

What drug class is used to treat chronic Hepatitis C, and what are two specific drug examples?

Direct-Acting Antivirals (DAAs), such as Ledipasvir-sofosbuvir (Harvoni) and Sofosbuvir (Sovaldi).

US BOXED WARNING: What safety screening MUST be performed before starting Direct-Acting Antivirals (DAAs) for Hepatitis C?

All clients MUST be screened for current or prior Hepatitis B (HBV) infection because DAAs can trigger severe Hepatitis B reactivation!

What dietary schedule prevents muscle breakdown (sarcopenia) in liver failure clients?

Eating small, frequent, low-fat meals throughout the day and a bedtime snack.

NCLEX Recognize Cues: What physical cues indicate decompensated cirrhosis during nursing assessment?

Jaundice, dark urine, clay-colored stools, ascites, spider angiomas, palmar erythema, asterixis, and confusion.

NCLEX Analyze Cues: What lab combination signals imminent risk for severe complications in cirrhosis?

Low platelets (thrombocytopenia), elevated PT/INR, high ammonia (NH3), low sodium (< 130 mEq/L), and low albumin.

NCLEX Prioritize Hypotheses: What are the top two nursing priorities for a client with decompensated cirrhosis?

1: Prevention/early recognition of acute GI hemorrhage (ruptured varices). #2: Prevention of neurological injury (hepatic encephalopathy and cerebral edema from severe hyponatremia).

NCLEX Evaluate Outcomes: What clinical findings indicate effective nursing management in a client with liver failure?

Intact skin/mucosa without overt bleeding, improving serum sodium (> 130 mEq/L), declining serum ammonia, baseline cognitive function, and controlled ascites girth.