Chapter 35 Nursing Care of Patients with Liver, Pancreatic, and Gallbladder Disorders

Answers CHAPTER 35 NURSING CARE OF PATIENTS WITH LIVER, PANCREATIC, AND GALLBLADDER DISORDERS LIVER Across Down 2. HB 6. Caput medusae 9. TIPS 10. Asterixis 11. HAV 1. Encephalopathy 2. Hepatorenal 3. Portal 4. Hepatitis 5. RUQ 6. Cirrhosis 7. Ascites 8. Varices AUDIO CASE STUDY Kelsey and Cirrhosis 1. There are 10 possible causes of cirrhosis, such as alcohol use (but not always), hepatitis B or C, right-sided heart failure, hepatotoxic drugs or toxins, and nonalcoholic steatohepatitis. 2. Cirrhosis signs include jaundiced sclerae and skin, several bruises, itching, a much-distended abdomen, and pitting ankle edema. Hepatic encephalopathy signs include lethargy, confusion, and difficulty communicating, all of which indicate the involvement of the central nervous system. 3. Ammonia level. 4. Lactulose GALLBLADDER 1. (4) 2. (6) 3. (7) 4. (5) 5. (1) 6. (8) 7. (9) 8. (3) 9. (2) 10. (10) VOCABULARY PANCREAS 1. (4) 2. (3) 3. (10) 4. (5) 5. (7) 6. (11) 7. (12) 8. (1) 9. (8) 10. (2) 11. (9) 12. (6) 1. (A) Serum glucose may elevate because damage to the islets of Langerhans causes decreased insulin production. 2. (A) The digestive enzyme amylase is released in large quantities by an inflamed pancreas. 3. (N) 4. (A) Pleural effusion is caused by a local inflammatory reaction to the irritation from pancreatic enzymes. 5. (N) 6. (A) Gallstones may plug the pancreatic duct, causing jaundice. 1 2 Chapter 35 Answers 7. (A) Presence of Cullen sign indicates extensive hemorrhagic destruction of the pancreas. 8. (A) Turner sign, a purplish discoloration of the flanks, indicates extensive hemorrhagic destruction of the pancreas. 9. (A) Chvostek sign indicates neuromuscular irritability from decreased serum calcium levels. 10. (A) Foul-smelling, fatty stools indicate malabsorption of dietary fats from decreased lipase. CRITICAL THINKING 1. The data collected about Ms. Smythe that support the diagnosis of cirrhosis include a grossly distended abdomen, jaundiced sclerae and skin, multiple bruises, and pitting edema of the lower extremities. Ms. Smythe also scratches her arms and legs frequently, indicating pruritus. Her laboratory data indicate that her serum bilirubin, ammonia, and prothrombin time are elevated and that her serum albumin, total protein, and potassium are below normal. 2. The nurse notes that Ms. Smythe is irritable, has difficulty answering questions, and appears to doze off often during the interview. Other observations the nurse might make include asterixis, increasing difficulty in arousing the patient, muscle twitching, and fetor hepaticus. 3. The pitting edema and abdominal distention are due to the decreased amount of serum albumin being produced by the impaired liver. Reduced levels of this protein permit fluid to seep into the abdominal cavity and other body tissues. 4. The health care provider (HCP) may order lactulose or neomycin to rid the patient’s body of excess ammonia. 5. The HCP may order vasoconstrictors such as vasopressin, octreotide (Sandostatin), beta-blockers or nitrates, and endoscopic variceal ligation (banding) or sclerotherapy. 6. Monitor the patient’s emesis, stool, and urine at least every 8 hours for blood. Observe for any increase in bruising or bleeding from the gums. Monitor blood clotting laboratory studies such as the international normalized ratio as well as the complete blood count for excess blood loss. 7. Measure and record Ms. Smythe’s abdomen and weigh her daily. Report any weight gain or increase in circumference promptly. Because Ms. Smythe will usually be ordered a low-sodium diet and will have fluids restricted, carefully monitor and record intake and output. Monitor Ms. Smythe’s vital signs and mental status every 4 hours and report changes promptly. Administer diuretics as ordered. 8. Teach Ms. Smythe that acetaminophen (Tylenol) is to be avoided because it is toxic to the liver and may cause further damage. REVIEW QUESTIONS—CONTENT REVIEW The correct answers are in boldface. 1. (2) is correct. Standard precautions protect the nurse from exposure to disease. (1) is incorrect. Reverse isolation protects the patient, not the nurse. (3, 4) are incorrect. These precautions do not protect from blood exposure. 2. (4) is correct. Acetaminophen is the most common cause. (1, 2, 3) are not the most common causes. 3. (1, 2, 5) are correct. Banding of varices with rubber bands during endoscopy stops bleeding. The synthetic hormone octreotide (Sandostatin) intravenously may vasoconstrict; a transjugular intrahepatic portosystemic shunt may reduce the pressure in the portal vein and stop the bleeding varices. (3, 4) are incorrect. Diet does not treat varices. With bleeding, the patient would be NPO (nothing by mouth). 4. (1) is correct. These are symptoms of hepatic encephalopathy. (2, 3, 4) are not symptoms of hepatic encephalopathy. 5. (3) is correct. Excessive alcohol intake is often associated with pancreatitis. (1, 2, 4) are not associated with pancreatitis. REVIEW QUESTIONS—TEST PREPARATION The correct answers are in boldface. 6. (1) is correct. Patients describe their pain as dull, boring, and beginning in the mid-epigastrium and radiating to the back. (2, 3, 4) are not characteristic of pancreatitis. 7. (3) is correct. This is a low-sodium meal. (1, 2, 4) are all high in sodium. 8. (2, 3, 4, 5, 6) are correct. Females are more at risk for gallbladder disease, so (1) is not a risk factor. 9. (2, 3, 6) are correct. Straining and heavy lifting will further increase pressure, which may cause bleeding, as could aspirin use. (1, 4, 5) are not appropriate. Coughing could rupture a varix (enlarged tortuous vein), and increasing fluid intake can further increase pressure. Vitamin K supplements will not alter portal hypertension. 10. (3, 4, 6) are correct. They require further teaching as there is no vaccine for hepatitis C or D and personal grooming items should not be shared. (1, 2, 5) are appropriate for prevention. 11. (1, 2, 4, 6) are correct. These drugs contain acetaminophen, which can be toxic to the liver. (3, 5) do not contain acetaminophen. Chapter 35 12. (1, 2) are correct. Bruising can indicate bleeding, which can become serious without intervention. Fever can indicate infection which requires prompt treatment. (3, 4, 5) do not require immediate reporting. 13. The area where the nurse would look for the presence of Cullen sign on a patient with acute pancreatitis. Answers 3