NUR 245 EXAM 2 UPDATED ACTUAL QUESTIONS AND CORRECT ANSWERS
Cirrhosis -Scar tissue replaces liver tissue
How is a person's sodium level who has Cirrhosis -LOW
-They are hyponatremic
How is a person's blood pressure who has Cirrhosis -Very low BP
-Very low Venous pressure
-Very low preload
Cardiac cirrhosis -Long-standing severe right-sided heart failure
Early Symptoms of Cirrhosis -Fatigue
-Enlarged liver
-Normal ALT and AST
How is aPTT with a person with Cirrhosis -ELEVATED PROLONGED
,Late signs of Cirrhosis -Jaundice
-Peripheral edema
-Ascites
-Skin lesions
-Hematologic problems
-Endocrine problems
-Peripheral neuropathies
-Liver becomes smaller and nodular
-Astrexis
-Spider angiomas
What do we assess for when we give a patient Lactulose? -Decreased ammonia levels
-Neuro checks
Astrexis -Flapping tremor of the hand while being confused or sleepy
What are the complications of Cirrhosis? -Portal HTN
-Esophageal & Gastric varices
-Peripheral edema
-Abdominal ascites
-Hepatic encephalopathy
-Hepatorenal syndrome
Esophageal Varices Background -Dilated veins that develop within the lining of the lower esophagus
-Variceal bleeding is the most common complication
-25-40% of individuals with Varices
Esophageal Varices Diagnosis -Upper endoscopy
-Graded based on size and risk of bleeding
Esophageal Varices Causes -Direct complication of PORTAL HYPERTENSION
-Usually Cirrhosis
-Portal vein thrombosis
-Right-sided heart failure
-Schistosomiasis (a parasitic disease caused by blood flukes, primarily
Schistosoma species, transmitted through freshwater contaminated by infected
snails)
Interprofessional care: Varices -Upper endoscopy
-Prevent bleeding
-Prevent variceal rupture
-Decrease portal pressure
-Avoid NSAIDS, alcohol, and aspirin
Priorities during hemorrhage of varices 1.) Stabilize the patient
2.) Protect the airway
3.)Administer blood products
4.) Stop the bleeding
5.) Prevent further bleeding
, Bleeding Varices -Monitor for bleeding
-Hematemesis
-Melena
-If hematemesis occurs, monitor patient for hemorrhage
-Call the HCP, and be ready to transfer patient to OR
-Maintain patients airway
-Patient will be admitted/ transferred to ICU
Pharmacological intervention for Esophageal Varices -Beta blocker (Propanolol)
-Decreases portal pressure, reducing risk for hemorrhage
-Vasoconstrictor
-Decreases portal blood flow
-Fresh Frozen plasma
-Packed RBC's
-Vitamin K
-Reverse clotting dysfunction
Esophageal Varices management -Endoscopic band ligation and sclerotherapy
-Placing small rubber band around base of the varix
-Injection of sclerosis solution into swollen veins
-Balloon tamponade
-Used when endoscopy does not control hemorrhage
-Mechanical compression of the varices by inflation of balloon
-Segstaken-Blakemore tube
-Transjugular intrahepatic portosystemic shunt
-Non surgical procedure
-Tract is created between systemic and portal venous systems
-Redirect portal blood flow
-Catheter placed in jugular vein and threaded through vena cavas
-Stents are placed along passageways
Peripheral edema -Swelling of lower extremities and pre sacral area
-Can occur before, with, or after ascites
Ascites -Accumulation of serous fluid in peritoneal cavity
-Mechanisms:
-Portal hypertension
-Hypoalbuminemia
-Hyperaldosteronism
-Increases sodium retention
Signs and symptoms -Abdominal distention
-Weight gain
-Umbilical eversion
-Abdominal striae
-Dehydration
-Dry tongue and skin
-Sunken eyeballs
-Muscle weakness
-Decrease in urine output
-Hypokalemia
-Increased risk of bacterial peritonitis
Cirrhosis -Scar tissue replaces liver tissue
How is a person's sodium level who has Cirrhosis -LOW
-They are hyponatremic
How is a person's blood pressure who has Cirrhosis -Very low BP
-Very low Venous pressure
-Very low preload
Cardiac cirrhosis -Long-standing severe right-sided heart failure
Early Symptoms of Cirrhosis -Fatigue
-Enlarged liver
-Normal ALT and AST
How is aPTT with a person with Cirrhosis -ELEVATED PROLONGED
,Late signs of Cirrhosis -Jaundice
-Peripheral edema
-Ascites
-Skin lesions
-Hematologic problems
-Endocrine problems
-Peripheral neuropathies
-Liver becomes smaller and nodular
-Astrexis
-Spider angiomas
What do we assess for when we give a patient Lactulose? -Decreased ammonia levels
-Neuro checks
Astrexis -Flapping tremor of the hand while being confused or sleepy
What are the complications of Cirrhosis? -Portal HTN
-Esophageal & Gastric varices
-Peripheral edema
-Abdominal ascites
-Hepatic encephalopathy
-Hepatorenal syndrome
Esophageal Varices Background -Dilated veins that develop within the lining of the lower esophagus
-Variceal bleeding is the most common complication
-25-40% of individuals with Varices
Esophageal Varices Diagnosis -Upper endoscopy
-Graded based on size and risk of bleeding
Esophageal Varices Causes -Direct complication of PORTAL HYPERTENSION
-Usually Cirrhosis
-Portal vein thrombosis
-Right-sided heart failure
-Schistosomiasis (a parasitic disease caused by blood flukes, primarily
Schistosoma species, transmitted through freshwater contaminated by infected
snails)
Interprofessional care: Varices -Upper endoscopy
-Prevent bleeding
-Prevent variceal rupture
-Decrease portal pressure
-Avoid NSAIDS, alcohol, and aspirin
Priorities during hemorrhage of varices 1.) Stabilize the patient
2.) Protect the airway
3.)Administer blood products
4.) Stop the bleeding
5.) Prevent further bleeding
, Bleeding Varices -Monitor for bleeding
-Hematemesis
-Melena
-If hematemesis occurs, monitor patient for hemorrhage
-Call the HCP, and be ready to transfer patient to OR
-Maintain patients airway
-Patient will be admitted/ transferred to ICU
Pharmacological intervention for Esophageal Varices -Beta blocker (Propanolol)
-Decreases portal pressure, reducing risk for hemorrhage
-Vasoconstrictor
-Decreases portal blood flow
-Fresh Frozen plasma
-Packed RBC's
-Vitamin K
-Reverse clotting dysfunction
Esophageal Varices management -Endoscopic band ligation and sclerotherapy
-Placing small rubber band around base of the varix
-Injection of sclerosis solution into swollen veins
-Balloon tamponade
-Used when endoscopy does not control hemorrhage
-Mechanical compression of the varices by inflation of balloon
-Segstaken-Blakemore tube
-Transjugular intrahepatic portosystemic shunt
-Non surgical procedure
-Tract is created between systemic and portal venous systems
-Redirect portal blood flow
-Catheter placed in jugular vein and threaded through vena cavas
-Stents are placed along passageways
Peripheral edema -Swelling of lower extremities and pre sacral area
-Can occur before, with, or after ascites
Ascites -Accumulation of serous fluid in peritoneal cavity
-Mechanisms:
-Portal hypertension
-Hypoalbuminemia
-Hyperaldosteronism
-Increases sodium retention
Signs and symptoms -Abdominal distention
-Weight gain
-Umbilical eversion
-Abdominal striae
-Dehydration
-Dry tongue and skin
-Sunken eyeballs
-Muscle weakness
-Decrease in urine output
-Hypokalemia
-Increased risk of bacterial peritonitis
