Care of
Patients
with Liver
Problems
Chapter 61
Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.
 Viral
hepatitis – A, B, C, D, E
 Transmission mode
 Onset
 Incubation
 Laboratory tests
 Nonsurgical management
 Follow-up care
 Plan of care for home
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 Survives
on human hands
 Destroyed by chlorine and high temperatures
 Fecal – oral route
 15 to 50 days incubation time
 Not life threatening
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 Hand-washing
 HAV


vaccine
Havrix
Vaqta
 Avoid
contaminated food or water
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Modes of Transmission
 Unprotected
sex
 Sharing needles
 Needle sticks / injuries
 Blood transfusions
 Hemodialysis
 Maternal - fetal
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 25
to 180 days
 Blood
tests confirm disease
 Carrier
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Symptoms
 Anorexia
 Nausea
/ Vomiting
 Fever
 Fatigue
 RUQ
pain
 Dark urine
 Joint pain
 Jaundice
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 HBV


vaccine
Engerix-B
Recombivax-HB
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Modes of Transmission
 Sharing
needles
 Needle sticks / injuries
 Blood transfusions
 Tattoo
 Intranasal cocaine paraphernalia
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7
weeks
 Asymptomatic
 Liver
issues occur
 Causes
liver to scar – can progress to cirrhosis
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 Routine

laboratory evaluation
ELISA – HCV antibodies
 Within

RIBA
 Been

exposed and developed antibodies
HCV PCR RNA
 Active

4 weeks
virus and viral load
OraQuick HCV
 Point
of care testing
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 Goes
along with HBV
 Parenteral
routes
 IV drug abusers
 14
to 56 days
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 Fecal
 15
contamination of food and water
to 64 days
 Clinical
 Self
course resembles HAV
limiting, resolves on own
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 Liver



enzymes
AST
ALT
Alk Phosphatase
 Bilirubin
 IgM
antibodies
 IgG antibodies
 HBsAg
 Anti-HBcAg IgM
 Anti-HDV
 Anti-HEV
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 Liver

biopsy
Stage and grading
 Percutaneous
 CT
procedure
guided imagery
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Interventions
 Rest the liver
 Promote cellular regeneration
 Prevent complications
 High calorie, carbohydrates
 Supplemental vitamins
 Small, frequent meals
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Medications
 Tenofovir – first line therapy
 Interferon – first line therapy
 Adefovir dipivoxil – second line therapy
 Lamivudine (Epivir-HBV)
 Telbivudine (Tyzeka)
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A 55-year-old patient with a history of alcohol
abuse spanning 10 years has been diagnosed with
cirrhosis. The patient will be undergoing abdominal
paracentesis on the medical unit today.
Which assessment finding would alert the nurse
that the paracentesis has been successful?
A. Substantial decrease in blood pressure
B. Decrease in post-procedure weight
C. No residual obtained during procedure
D. Immediate sensation of a need to urinate
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(cont’d)
The patient’s assessment reveals yellowish coloration of
skin and sclerae.
Which laboratory values would the nurse expect to find
with this patient?
A. Increased direct bilirubin, decreased indirect
bilirubin
B. Decreased direct bilirubin, increased indirect
bilirubin
C. Increased direct bilirubin, increased indirect bilirubin
D. Increased urine bilirubin, decreased direct bilirubin
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(cont’d)
When a complete assessment of this patient is
performed, what other manifestations would the
nurse expect? (Select all that apply.)
A. Ecchymosis
B. Spider angiomas
C. Personality changes
D. Peripheral dependent edema
E. Muscle twitching
F. Dry skin with rash
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(cont’d)
The patient tells the nurse that once he is
discharged to home, he has no intention to stop
drinking alcohol.
Which is the appropriate nursing response?
A. “Why do you continue to drink?”
B. “Does it frighten you to consider quitting?”
C. “It’s your choice to drink or not to drink.”
D. “If you continue to drink, you are going to die.”
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22
Which assessment parameter requires immediate
intervention in a patient with severe ascites?
A.
B.
C.
D.
Shallow respirations, rate 32 breaths/min
Temperature 38.2° C
Confusion
Tachycardia, rate 110 beats/min
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What is the priority intervention in the management
of a patient with decompensated cirrhosis?
A.
B.
C.
D.
Limiting protein intake
Monitoring fluid intake and output
Managing nausea and vomiting
Elevating the head of bed >30 degrees
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What is a primary reason for a higher incidence of
liver cancer in the United States?
A.
B.
C.
D.
Incidence of illicit drug use
Rising obesity
Incidence of hepatitis C
Increased Asian population
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