Advanced Nursing Quiz: Hepatic And Gastrointestinal care

Hematocrit and hemoglobin are the best laboratory indicators of a gastrointestinal (GI) bleed. Hematocrit measures the percentage of red blood cells in the blood, while hemoglobin measures the amount of oxygen-carrying protein in the red blood cells. In a GI bleed, there is a loss of blood, leading to a decrease in both hematocrit and hemoglobin levels. Therefore, monitoring these levels can help in diagnosing and assessing the severity of a GI bleed. BUN (blood urea nitrogen) and albumin levels may also be affected in a GI bleed, but they are not as specific or sensitive indicators as hematocrit and hemoglobin. PT/INR (prothrombin time/international normalized ratio) is a test used to assess blood clotting and is not directly related to GI bleeding.

In a patient with hepatic encephalopathy, the most critical aspect to assess and treat is the levels of ammonia in the body. Hepatic encephalopathy is caused by liver dysfunction, which leads to the accumulation of ammonia in the blood. High levels of ammonia can cause neurological symptoms and can be life-threatening. Therefore, the primary focus should be on reducing ammonia levels through interventions such as medications, dietary changes, and potentially dialysis. Treating other factors such as jaundice, nutritional deficiencies, and electrolyte abnormalities may also be necessary, but addressing ammonia levels is the most critical aspect.

Elevated ammonia levels are associated with encephalopathy. Encephalopathy is a condition characterized by brain dysfunction that can result from various causes, including liver disease. In liver disease, the liver is unable to effectively process ammonia, leading to its accumulation in the blood. Elevated ammonia levels can then lead to neurological symptoms, such as confusion, disorientation, and impaired cognitive function, which are characteristic of encephalopathy. Therefore, monitoring ammonia levels is important in the diagnosis and management of encephalopathy.

The best indication of hepatic function in a patient with hepatic cirrhosis is the PT (prothrombin time) and INR (international normalized ratio). These laboratory values assess the liver's ability to produce clotting factors, with prolonged PT and increased INR indicating impaired hepatic function. This is because the liver is responsible for synthesizing clotting factors, and in hepatic cirrhosis, liver function is compromised. Monitoring PT and INR levels helps in assessing the severity of liver disease and guiding treatment decisions.

Benzodiazepines are the most critical medication to administer in order to prevent seizures in a patient with Alcohol Withdrawal Syndrome (AWS). A CIWA score of 19 indicates severe withdrawal symptoms, and seizures are a potential complication of AWS. Benzodiazepines are the first-line treatment for AWS and are effective in reducing the risk of seizures by suppressing excitability in the brain. Opioids, sympathetic nervous system suppressants, and Haldol are not specifically indicated for preventing seizures in AWS.

Gastric ulcers are often associated with weight loss because eating worsens the pain. This is because the act of eating stimulates the production of stomach acid, which can further irritate and worsen the ulcer. The pain caused by gastric ulcers is typically relieved by taking antacids or acid-reducing medications. Unlike duodenal ulcers, gastric ulcers are more likely to perforate (create a hole) in the stomach lining rather than bleed. They are also associated with increased acid secretion, which contributes to their development and symptoms.

In liver failure, the liver is unable to properly process and metabolize proteins, leading to a buildup of toxic byproducts in the body. Therefore, it is important to restrict protein intake in order to prevent further damage to the liver. Additionally, sodium restriction is necessary in liver failure as the liver is responsible for maintaining fluid balance in the body, and excessive sodium intake can lead to fluid retention and worsening of symptoms.

A WBC count >20,000/mm3 and >5% bands suggests a surgical emergency because it indicates a severe infection or inflammation in the body. An elevated WBC count with a high percentage of bands (immature white blood cells) suggests that the body is actively trying to fight off an infection, which is commonly seen in cases of appendicitis. This combination of findings indicates a more severe and urgent condition that may require immediate surgical intervention.

Early management of ascites typically involves sodium restriction and the use of spirolactone (Aldactone), which is a potassium-sparing diuretic. This is because ascites is often caused by liver disease, which leads to an imbalance of fluid and electrolytes in the body. Sodium restriction helps to reduce fluid retention, while spirolactone helps to increase urine production and reduce potassium loss. Loop diuretics may be added if there is inadequate response to spirolactone alone. IV administration of Bumex or Lasix and paracentesis are other treatment options for ascites, but they are not typically considered as first-line management strategies.

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In a patient with hepatic cirrhosis, the liver function is impaired, leading to a decrease in the production of clotting factors. This results in prolonged coagulation times, as indicated by increased PT/INR and PTT values. Other laboratory values, such as albumin levels, conjugated bilirubin, hematocrit, and hemoglobin, may be affected in hepatic cirrhosis, but the question specifically asks for the values that are expected to increase. Therefore, the correct answer is coagulation (PT/INR and PTT) times.

Based on the information provided, the patient is at risk for alcohol withdrawal. Monitoring his CIWA (Clinical Institute Withdrawal Assessment) score at least every 4 hours, along with vital sign checks, is the appropriate course of action. This will allow the healthcare team to assess the severity of withdrawal symptoms and determine if medication intervention is necessary.

A duodenal ulcer is a type of peptic ulcer that occurs in the first part of the small intestine called the duodenum. The statement "Food soothes" is true for a duodenal ulcer because eating can temporarily relieve the pain and discomfort caused by the ulcer. This is because food helps to neutralize the stomach acid and provide a protective layer over the ulcer, reducing irritation and inflammation.

The CIWA scale is a tool used to assess and monitor alcohol withdrawal symptoms in patients. A score of >10 on the CIWA scale indicates a need for a symptom-triggered response, such as the administration of benzodiazepines, to manage the withdrawal symptoms. The assessment of the CIWA score should be continued to evaluate the effectiveness of the treatment.

A gastric ulcer is a type of peptic ulcer that forms in the lining of the stomach. Pyloric obstruction occurs when the pylorus, the opening between the stomach and small intestine, becomes blocked. This can be caused by inflammation or scarring from a gastric ulcer. High residuals, which refer to undigested food or liquid remaining in the stomach after a meal, can indicate a blockage in the pylorus. Therefore, the patient's high residuals suggest a risk of pyloric obstruction as a complication of the gastric ulcer.

PT/INR (prothrombin time/international normalized ratio) is the best marker of chronic hepatic failure because it measures the liver's ability to produce clotting factors. In chronic hepatic failure, the liver is unable to produce these factors effectively, leading to prolonged clotting times and an increased PT/INR value. AST (aspartate aminotransferase) and ALT (alanine aminotransferase) are markers of liver cell damage, but they do not specifically indicate chronic hepatic failure. Albumin is a protein synthesized by the liver, but its levels can be affected by factors other than liver function.

Ulcerative colitis can be completely cured by surgery, specifically through a procedure called colectomy. Colectomy involves the removal of the entire colon and rectum, which eliminates the source of inflammation and symptoms associated with ulcerative colitis. This surgical intervention offers a potential cure for the condition, as it removes the affected area and allows the body to heal. However, it is important to note that surgery is typically considered as a last resort when other treatment options have failed to provide relief or manage symptoms effectively.

In hepatic failure with no renal involvement, the liver is not able to properly metabolize and excrete waste products, leading to an increase in blood urea nitrogen (BUN) levels. Sodium (Na+), chloride (Cl-), and bicarbonate (Bicarb) levels may also be altered due to the liver's role in maintaining electrolyte balance. However, creatinine levels are not typically affected in hepatic failure as creatinine is primarily excreted by the kidneys. Calcium levels may or may not be altered in hepatic failure, so it is not included in the answer.

In liver failure, the liver is unable to produce enough glucose through glycogenolysis and gluconeogenesis. This leads to low serum glucose levels, which is a classic finding in patients with liver failure.

In hepatic failure, the liver is unable to properly metabolize glucose, leading to a decrease in glucose levels. The liver plays a crucial role in maintaining glucose homeostasis by storing excess glucose as glycogen and releasing it when needed. However, in hepatic failure, this process is disrupted, resulting in decreased glucose production and increased glucose utilization by other organs. As a result, the overall glucose levels in the blood decrease.

In chronic hepatic failure, the liver is unable to properly metabolize bilirubin, resulting in an increase in unconjugated bilirubin levels. Unconjugated bilirubin is the form of bilirubin that is produced by the breakdown of heme in red blood cells and is normally processed by the liver to become conjugated bilirubin. However, in chronic hepatic failure, the liver's ability to conjugate bilirubin is impaired, leading to an accumulation of unconjugated bilirubin in the blood. This can result in jaundice, a common symptom of liver disease.

The correct answer is "Patient is increasingly combative and trying to climb out of bed." This is an indication that therapy is working because it suggests that the patient's mental status is improving. Encephalopathy from liver disease can cause altered mental status and confusion, and lactulose is often used to treat this condition by reducing ammonia levels in the blood. The fact that the patient is becoming more combative and alert suggests that the lactulose is effectively reducing the ammonia levels and improving the patient's mental function.

D10 is the appropriate IV fluid for a patient with end stage liver disease and cirrhosis because it provides a higher concentration of glucose compared to other options. Patients with liver disease often have impaired glucose metabolism, so providing a higher concentration of glucose can help meet their energy needs. Additionally, D10 provides a balanced solution of glucose and electrolytes, making it suitable for patients with cirrhosis.

The questions asked are relevant in determining if the patient needs to be fed enterally. The first question assesses the patient's ability to eat in the next 2 days, which helps determine if enteral feeding is necessary. The second question about the patient's albumin levels on admission is important as low albumin levels can indicate malnutrition and the need for enteral feeding. The third question assesses the patient's current condition, specifically if they are febrile, tachycardic, or healing from a major wound, which can impact their ability to eat and require enteral feeding.

The Child Pugh score is used to assess the severity of liver disease in patients with cirrhosis. It includes various clinical and laboratory parameters. PT/INR is included in the score as it reflects the liver's ability to produce clotting factors. Clinical indicators of ascites and encephalopathy are included as they indicate the presence and severity of liver dysfunction. Albumin levels are included as they reflect the liver's synthetic function. Bilirubin levels are included as they indicate impaired liver function and can be used to assess the severity of liver disease. Glucose levels and cholesterol levels are not included in the Child Pugh score.