Chapter 43 + 44 (hepatic and biliary disorders)

A nurse is caring for a client with cirrhosis. The nurse assesses the client at noon and discovers that the client is difficult to arouse and has an elevated serum ammonia level. The nurse should suspect which situation?

The decreased level of consciousness caused by an increased serum ammonia level indicates hepatic dysfunction

A nurse is caring for a client with cholelithiasis. Which sign indicates obstructive jaundice?

clay-colored stools

-Obstructive jaundice develops when a stone obstructs the flow of bile in the common bile duct. When the flow of bile to the duodenum is blocked, the lack of bile pigments results in a clay-colored stool. In obstructive jaundice, urine tends to be dark amber (not straw-colored)

hepatitis A is spread through the ________ route

fecal-oral

The nurse is assessing a client with hepatic cirrhosis for mental deterioration. For what clinical manifestations will the nurse monitor? Select all that apply.

-alterations in mood

-agitation

-insomnia

The earliest symptoms of hepatic encephalopathy include both mental status changes and motor disturbances

What does the nurse recognize as clinical manifestations consistent with ascites? Select all that apply.

-increased abdominal girth

-distended veins

-rapid weight gain

-stretch marks

The nurse is caring for a client with nonalcoholic fatty liver disease. The nurse assesses the client's abdomen and detects a fluid wave. What should the nurse add to the plan of care based on this finding?

daily weights

Daily measurement and recording of abdominal girth and body weight are essential to assess the progression of ascites and the response to treatment

Which is the most common cause of esophageal varices?

portal HTN

Esophageal varices are almost always caused by portal hypertension, which results from obstruction of the portal circulation within the damaged liver

After undergoing a liver biopsy, a client should be placed in which position?

right lateral decubitus position

In what location would the nurse palpate for the liver?

right upper quadrant

What is the recommended dietary treatment for a client with chronic cholecystitis?

low-fat

The bile secreted from the gallbladder helps the body absorb and break down dietary fats. If the gallbladder is not functioning properly, then it will not secrete enough bile to help digest the dietary fat. This can lead to further complications; therefore, a diet low in fat can be used to prevent complications

Which condition indicates an overdose of lactulose?

watery-diarrhea

The nurse is caring for a client with a diagnosis of portal hypertension. What should the nurse anticipate after the client begins treatment? Select all that apply.

-lower venous pressure

-reduced fluid accumulation

A client is given a diagnosis of hepatic cirrhosis. The client asks the nurse what findings led to this determination. Which of the following clinical manifestations would the nurse correctly identify? Select all that apply.

-ascites

-enlarged liver size

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?

TIPS (transjugular intrahepatic portosystemic shunting)

A client seeks medical attention for a new onset of mid-back pain that is worse at night when lying supine. Which additional symptom(s) may the nurse use to determine if the client has pancreatic cancer? Select all that apply.

-ascites

-jaundice

-weight loss

-epigastric pain

A client is admitted to the health care facility suspected of having acute pancreatitis and undergoes laboratory testing. Which of the following would the nurse expect to find?

elevated urine amylase levels

Elevated serum and urine amylase, lipase, and liver enzyme levels accompany significant pancreatitis. If the common bile duct is obstructed, the bilirubin level is above normal. Blood glucose levels and white blood cell counts can be elevated. Serum electrolyte levels (calcium, potassium, and magnesium) are low

A client with chronic pancreatitis reports persistent upper abdominal pain, poor appetite, and a 12-pound unintentional weight loss over the past month. The nurse also notes greasy, foul-smelling stools. Which concern should the nurse prioritize in this client's plan of care?

Addressing progressive weight loss and malnutrition

A client with calculi in the gallbladder is said to have

Cholelithiasis

Serum amylase and lipase concentrations are used to make the diagnosis of ________

acute pancreatitis

A nurse discusses risk factors of cholelithiasis with a client. Which risk factors will the nurse include in the teaching? Select all that apply.

-changes in weight

-obesity

-diabetes

-cystic fibrosis

A client with acute gallbladder inflammation has been admitted to the medical unit. What order should the nurse question?

Provide soft diet, advance as tolerated

(patient should be NPO and given IV fluids for hydration)

A nurse is teaching a client and the client's family about chronic pancreatitis. Which are the majorcauses of chronic pancreatitis?

Alcohol consumption and smoking

A client calls the surgical nurse the day after a laparoscopic cholecystectomy. The client states that they have right shoulder pain. The client denies having any fever or vomiting. What is the bestresponse from the nurse?

If pain occurs in the right shoulder or scapular area (from migration of the carbon dioxide used to insufflate the abdominal cavity during the procedure), the nurse may recommend a heating pad for 15 to 20 minutes hourly

A nurse admits a female client reporting severe right upper quadrant pain after eating dinner. What client risk factors lead the nurse to suspect gallbladder disease? Select all that apply.

-older than 40 years old

-obese

-multiparous

-hx of DM

A client with a history of pancreatitis seeks medical attention for increasing episodes of abdominal pain. Which assessment finding(s) indicate to the nurse that the client is experiencing chronic pancreatitis? Select all that apply.

-foul-smelling stools

-anorexia

-weight loss

Which condition is most likely to have a nursing diagnosis of fluid volume deficit?

pancreatitis

Hypovolemic shock from fluid shifts is a major factor in acute pancreatitis

A client with acute pancreatitis has been started on total parenteral nutrition (TPN). Which action should the nurse perform after administration of the TPN?

measure blood glucose levels every 4-6 hours

Which is a clinical manifestation of cholelithiasis?

clay-colored stools

Hepatitis:

WHAT: an inflammatory condition of the liver, commonly caused by a viral infection

Non-viral causes--> alcohol, or autoimmunity

RISKS: IV drug use, unprotected sex, sharing razors, blood/body fluids

S/S: headache, fever, fatigue/malaise, N/V, elevated ALT/AST and bilirubin levels

DIAGNOSTICS: liver biopsy ( lay on RIGHT side after)

TREATMENT: Hep. A usually resolves on it's own just needs bedrest, B/C treated with antivirals

Cirrhosis:

WHAT: normal healthy tissues get replaced with scar tissue, making the liver hard

CAUSES: alcohol use, chronic hepatitis, cystic fibrosis

S/S: jaundice, portal HTN, ascites, esophageal varices, and hepatic encephalopathy

DIAGNOSTICS: liver biopsy

TREATMENT: for ascites--> paracentesis, empty bladder, daily weights, HOB raised, for itching--> cool moist cloth, trim fingernails, moisturizing cream, lactulose (to reduce ammonia/potassium levels), bleeding precautions, and avoid bearing down/straining

Pancreatitis:

WHAT: inflammation within the pancreas that happens when enzymes begin to digest the pancreas (autodigestion)

CAUSES: alcohol use, gallbladder disease, CF, or ERCP procedure

S/S: epigastric pain, LUQ pain that radiates to back, bruising (turner's/cullen's signs), elevated amylase/lipase, hyperglycemia, elevated WBC's, elevated PT/PTT, elevated bilirubin, jaundice, and low BP

TREATMENT: NPO, NG tube, IV pain meds (hydromorphon, NOT morphine), IV fluids, monitor glucose, antacids or PPI's

Cholecystitis:

WHAT: inflammation of the gallbladder due to gallstones that block the ducts leading out of the gallbladder which causes a backup of bile

S/S: RUQ pain that radiates to right shoulder, fever, tachycardia

RISKS: high-fat diet, obesity, older than 40 years old

PT. ED: lose wight and avoid high fat foods

TREATMENT: NPO, lithotripsy procedure or cholecystectomy (removal of gallbladder)

most common liver disease signs/symptoms:

-pruritus

-elevated bilirubin (causes jaundice, dark-colored urine, clay-colored stools)

-elevated PT/PTT (easy bruising/bleeding)

-low albumin levels (leads to edema)

education for patients with hepatitis:

-SMALL, FREQUENT meals to prevent N/V

-low protein and low fat diet

-rest often

-avoid drinking alcohol/tylenol

-avoid sharing razors and toothbrushes

types of hepatitis and their transmission routes:

Hepatitis A--> fecal-oral route

Hepatitis B--> blood/body fluids

Hepatitis C--> blood/body fluids

Hepatitis D--> co-infection with type B

Hepatitis E--> fecal-oral

Post-op care for a cholecystectomy patient:

-early ambulation

-prevent pneumonia (deep breathing)

-prevent infections (no baths, report redness/swelling)