1. Abnormalities of bilirubin leads to ________
  2. Jaundice of the sclera is also known as ___________
  3. Three types of jaundice:
    • Hemolytic
    • Hepatocellular
    • Cholestatic (Obstructive)
  4. What is hemolytic jaundice?
    Conjugated or Unconjugated?
    Hemolysis of many red cells or sickle cell crisis

    • Unconjugated (Indirect)
    • (Too much for liver to process)
  5. What is hepatocellular jaundice?
    Conjugated or Unconjugated?
    Damage liver cells leak bilirubin

    • Conjugated
    • (Can increase unconjugated if enough cells are damaged)
  6. What is cholestatic jaundice?
    Conjugated or Unconjugated?
    Obstruction of bile flow

    Conjugated (Direct)
  7. 4 etiologies of hepatitis in general:
    • Viral (most common)
    • Alcoholic
    • Drug Toxicity
    • Autoimmune
  8. Hepatitis A-
    Vaccine Preventable?
    28 days

    • Fecal-Oral
    • Contaminated water

    Yes. Two shots.

    Not chronic.

    (IG within 2 weeks = passive immunity)
  9. Hepatitis B-
    Vaccine Preventable?
    60-90 days

    Blood borne

    Yes. 3 shots.

    Yes. 5-10%

    (100x more infectious than HIV)
  10. Hepatitis C-
    Vaccine Preventable?
    56 days

    Blood borne (needle sharing)

    Not vaccine preventable

    Yes. 85%

    (Considered the silent infection)
  11. Viral hepatitis S/S:

    Pre-Icteric phase?
    Icteric phase?
    Post-Icteric phase?
    Malaise, headache, fever

    Jaundice, hepatomegaly, dark urine, clay color stools, pruritis

    Jaundice and heptaomegaly resolves
  12. Tests for Heptatis A:
    • Anti-HAV IgM
    • (acute or currently infected)

    • Anti-HAV IgG
    • (vaccinated or immunity)
  13. Tests for Heptatis B:
    • HBsAg
    • (infected)

    • Anti-HBs
    • (immune)
  14. Tests for Heptatis C:
    • Anti-HCV
    • (exposed)

    • HCV RNA
    • (tells if you have the virus)
  15. What are the best ways to treat hepatitis?
    • Rest
    • Nutrition
    • Hydration
  16. Non-infectious hepatitis can be caused by ___________ or ___________

  17. A chronic progressive destruction of liver cells with fibrosis is called _________
  18. Esophageal varices has an increase in bleeding by what 3 factors?
    • Cough
    • Straining at stool
    • Vomiting
  19. The non-selective beta blocker, Inderal, helps treat esophageal varices by _________
    Lowering the pressure
  20. What does TIPS procedure stand for?
    What does it do?
    Transjugual Intrahepatic Portosystemic Shunt

    Redirects blood flow from portal vein to hepatic vein
  21. Why is Aldactone used for ascites?
    Because it is potassium sparking and opposes aldosterone
  22. What nursing care should be done for a patient with ascites?
    • Semi-fowlers
    • Daily weights
    • Girth measurements
    • No alcohol
    • Low sodium
  23. Why should a patient void before a paracentesis?
    Keep the bladder low, so it doesn't get punctured
  24. What is the major toxin of hepatic encephalopathy?
  25. How do you treat hepatic encephalopathy?
    Lactulose (treatment of choice)

    Control protein

    Monitor neuro and fluid/electrolyte

    Manage diarrhea
  26. Your patient with hepatic encephalopathy refuses Lactulose due to diarrhea. How should you respond?
    That is a common side effect but you must continue to take the medication or your ammonia levels will rise.
  27. Why should AST/ALT not be the sole diagnostic for cirrhosis?
    Because not many cells are destroyed

    (Also confirm with low platelets and albumin)
  28. Why is it important to check the CBC and PT/INR before performing a liver biopsy?
    CBC: For platelet count

    PT/INR: Make sure they can clot
  29. After a liver biopsy, how should you position the patient? Why?
    Right side laying

    Puts pressure on the liver to stop bleeding
  30. If your patient complains of N&V, Fever, and abdominal pain that feels worse when lying down or after eating, they most likely have __________
  31. Why do you want to keep a patient NPO with pancreatitis?
    Because the food will cause more enzyme release
  32. What drug should be held when doing an ERCP?
    • Metformin
    • (reacts with the dye)
  33. What is removed in a Whipple procedure?
    • Pancreas
    • Duodenum
    • Part of stomach
    • Lower common bile duct
  34. What are the risk factor for cholelithiasis?

    Hint: 5 F's
    • Female
    • Fertile
    • Fair
    • Forty
    • Fat
  35. The nurse assesses a patient with cirrhosis and finds 4+ pitting edema of the feet and legs and massive ascites. The nurse recognizes that one factor contributing to edema and ascites in patients with cirrhosis is

    A. increased osmotic pressure caused by elevated blood ammonia levels.
    B. decreased renin-angiotensin response related to decreased renal blood flow.
    C. hyperaldosteronism caused by decreased degradation of the hormone by the liver.
    D. decreased portocaval pressure with development of collateral circulation in the gastrointestinal vessels.
    C. hyperaldosteronism caused by decreased degradation of the hormone by the liver.

    • A - decrease
    • B - increase
    • D - increase
  36. A patient with cirrhosis is being treated with spironolactone (Aldactone) tid and furosemide (Lasix) bid. The patient’s most recent laboratory results indicate a serum sodium of 134 mEq/L (134 mmol/L) and a serum potassium of 3.2 mEq/L (3.2 mmol/L). Before notifying the physician, the nurse should

    A. administer only the furosemide.
    B. administer both drugs as ordered.
    C. administer only the spironolactone.
    D. withhold the furosemide and spironolactone.
    C. administer only the spironolactone.
  37. A patient with cirrhosis has an episode of bleeding esophageal varices that is controlled with administration of vasopressin and endoscopic sclerotherapy. To detect possible complications of the bleeding episode, it is most important for the nurse to monitor

    A. the prothrombin time.
    B. serum bilirubin levels.
    C. serum ammonia levels.
    D. serum potassium levels.
    • C. serum ammonia levels.
    • (tells of developing encephalopathy)

    A - tells of risk bleed and NOT complication
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