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MS3 EXAM 2 STUDY GUIDE
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MS3 EXAM 2 STUDY GUIDE
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MS3 EXAM 2 STUDY GUIDEEsophageal varices management/nursing management - - cirrhosis
E.V.- fragile, swollen blood vessels in esophagus (from portal hypertension)
in cirrhosis blood flow is impaired in liver causing pressure in portal vein that causes
blood to back up into surrounding blood vessels.
-Maintain safe environment; prevent injury, bleeding and infection
-Administer prescribed treatments and monitor for potential complications
-Encourage deep breathing and position changes
-Education and support of patient and family
monitoring the patient's physical condition and evaluating emotional responses and
cognitive status. The nurse monitors and records vital signs and assesses the patient's
nutritional and neurologic status.
because of bleeding, parenteral nutrition is initiated.
Gastric suction usually is initiated to keep the stomach as empty as possible and to
prevent straining and vomiting
no alcohol
causes anxiety= pt support
- vitamin K therapy and blood transfusions bc blood loss
monitor BP bc if bleeding= hypotension/ tachycardia
help prevent bleeding:
- vasoconstrictors
- non-selective beta blockeers
-band ligation
-endoscopic sclera therapy
biggest complication with E.V= airway obstruction so turn pt to side
NO ng tube
NO straining bowel movements
if pt vomits after meal= obtain vitals
highest priority= protect airway
once varies pops= explosion of blood= hypovelemic shock or hemorrhage shock from
blood loss
,MONITOR FOR BLEEDING**
Abnormal lab values in a patient with cirrhosis - Increased ALT, AST, bilirubin, ammonia
decreased serum protein, albumin
Ammonia high= hepatic encephalopathy
Albumin low (under 3.5) -> calcium low
bilirubin high= jaundice
clotting time high-> high PT (prothrombin time),PTT, INR
ALT, AST =high in all liver diseases
Clinical manifestations/management/risk factors of Hep C - Pain in the right upper
abdomen.
Abdominal swelling due to fluid (ascites)
Clay-colored or pale stools.
Dark urine.
Fatigue.
Fever.
Itching.
Jaundice.
risk factors:
Children born to women infected with hepatitis C virus
needlestick injuries or mucosal exposure to blood
iv drug use
recipient of blood products
multiple sexual partners, unrpotected sex
Alcohol and medications that may affect the liver should be avoided.
treatment:
antivirals
Patient education for hepatic cirrhosis to reduce risk of injury. - The nurse protects the
patient with cirrhosis from falls and other injuries.
The side rails should be in place and pads used in case the patient becomes agitated or
restless.
To minimize agitation, the nurse orients the patient to time and place and explains all
procedures.
The nurse instructs the patient to ask for assistance to get out of bed.
The nurse carefully evaluates any injury because of the possibility of internal bleeding.
Jaundice - -yellow- or greenish-yellow sclera and skin caused by increased serum
bilirubin levels
-Bilirubin level exceeds 2 mg/dL
, Cirrhosis: Medications for management of symptoms - Management of the patient with
cirrhosis is usually based on the presenting symptoms.
-antacids or H2 antagonists are prescribed to decrease gastric distress and minimize
the possibility of GI bleeding.
-Vitamins and nutritional supplements
-Potassium-sparing diuretic agents= decrease ascites
Many medications possess antifibrotic activity for the treatment of cirrhosis. Some of
these medications include colchicine, angiotensin system inhibitors, statins, diuretics
including spironolactone, immunosuppressants, and glitazones such as pioglitazone or
rosiglitazone. Angiotensin receptor blocker (ARB) medications also have antifibrogenic
properties and may also be prescribed
Hepatic encephalopathy manifestations/nursing management - -Early signs: mental
changes and motor disturbances
-restlessness and insomnia at night.
-Asterixis, an involuntary flapping of the hands
-fetor hepaticus, a sweet, slightly fecal odor to the breath
- twitching extremeties
-In the early stages of hepatic encephalopathy, the deep tendon reflexes are
hyperactive; with worsening of the encephalopathy, these reflexes disappear and the
extremities may become flaccid.
cirrhosis- ammonia becomes elevated, build up of ammonia- build up in brain and cause
confusion, low protein diet)
- tell client to extend arms, monitor for twitching
for H.E- not assessing for jaundice or spider veins, assessing mental status
-lactulose: laxative that helps bring ammonia levels down
lose= loose stools, lose ammonia via loose bowels
- lose potassium (hypokalemia)
management:
- safe environment to prevent injury/ bleeding/ infection
-protein restriction
-lactulose
-discontinue sedatives/ analgesics
-monitor/treat infections/ complications
-support
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