HESI Case Study: Cirrhosis
1. Meet the Client A client is brought to the Emergency Department following an auto-
mobile accident. The car the client was driving swerved off the road
into the median, where the car's front end hit a highway bridge.
The client is treated for minor injuries, and several lab tests are
ordered. The client's blood alcohol level (ethyl alcohol) is 20 mg/dL
(4.34 mmol/L), and liver enzymes are elevated. Assessment findings
include lethargy, an enlarged liver on palpation, jaundiced skin and
sclera, and ascites. The client is admitted for further evaluation with a
medical diagnosis of cirrhosis. The following morning when the client
is more alert and the nurse is able to obtain a more thorough history.
2. Etiologic Factors During the focused nursing assessment, the client's spouse ask the
nurse if it is true that only alcoholics get cirrhosis.
3. 1. Which nursing interven- Explain that there are several types of cirrhosis.
tion best promotes accu-
rate and effective commu- There are several types of cirrhosis with differing etiologies. Cirrhosis
nication? can have a variety of etiologies including viral hepatitis, non-alcoholic
fatty liver disease, hemochromatosis, Wilson's disease, cystic fibrosis,
biliary atresia, infections, and medications.
4. 2. The nurse continues the Previous diagnosis of Hepatitis C.
focused risk assessment
by asking about etiolog- Hepatitis C is directly linked to cirrhosis, as well as Hepatitis B and D.
ic factors related to cir-
rhosis. Which assessment
finding provides the most
likely indication that the
client is at high risk for cir-
rhosis?
5. Diagnostic Tests Several tests are ordered to confirm the diagnosis of cirrhosis and
to assess the degree of liver damage and related complications.
, HESI Case Study: Cirrhosis
The client is scheduled for a liver biopsy, paracentesis, and hepatic
angiography.
6. 3. Which nursing interven- -Ensure the client has signed a consent.
tions are important prior This is an invasive procedure. The client should have instructions
to a paracentesis? about the procedure and sign a consent form.
(Select all that apply. One, -Instruct the client to empty their bladder.
some, or all options may Paracentesis involves the removal of peritoneal fluid for evaluation,
be correct.) and it is also performed to drain excess peritoneal fluid. Prior to the
procedure, the client should be instructed to void to reduce the risk
for accidental rupture of the bladder during the procedure. After the
procedure, the client should be assessed for signs of peritonitis or
peritoneal bleeding.
-Position the client in an upright position.
This positioning is used for a paracentesis. If the client is in the bed,
a Fowler's position can be used.
-Apply sphygmomanometer to monitor blood pressure.
The client's blood pressure should be monitored during the proce-
dure.
7. 4. After the client un- Increasing abdominal pain
dergoes the paracentesis,
which nursing assessment This may be the result of diaphragmatic, liver, or spleen perforation
warrants immediate inter- and may be life threatening.
vention?
8. 5. In the client with cirrho- Total serum bilirubin
sis, which lab values does The diseased liver is not able to metabolize bilirubin efficiently, re-
the nurse anticipate will sulting in an increase in total serum bilirubin.
be increased from the nor-
1. Meet the Client A client is brought to the Emergency Department following an auto-
mobile accident. The car the client was driving swerved off the road
into the median, where the car's front end hit a highway bridge.
The client is treated for minor injuries, and several lab tests are
ordered. The client's blood alcohol level (ethyl alcohol) is 20 mg/dL
(4.34 mmol/L), and liver enzymes are elevated. Assessment findings
include lethargy, an enlarged liver on palpation, jaundiced skin and
sclera, and ascites. The client is admitted for further evaluation with a
medical diagnosis of cirrhosis. The following morning when the client
is more alert and the nurse is able to obtain a more thorough history.
2. Etiologic Factors During the focused nursing assessment, the client's spouse ask the
nurse if it is true that only alcoholics get cirrhosis.
3. 1. Which nursing interven- Explain that there are several types of cirrhosis.
tion best promotes accu-
rate and effective commu- There are several types of cirrhosis with differing etiologies. Cirrhosis
nication? can have a variety of etiologies including viral hepatitis, non-alcoholic
fatty liver disease, hemochromatosis, Wilson's disease, cystic fibrosis,
biliary atresia, infections, and medications.
4. 2. The nurse continues the Previous diagnosis of Hepatitis C.
focused risk assessment
by asking about etiolog- Hepatitis C is directly linked to cirrhosis, as well as Hepatitis B and D.
ic factors related to cir-
rhosis. Which assessment
finding provides the most
likely indication that the
client is at high risk for cir-
rhosis?
5. Diagnostic Tests Several tests are ordered to confirm the diagnosis of cirrhosis and
to assess the degree of liver damage and related complications.
, HESI Case Study: Cirrhosis
The client is scheduled for a liver biopsy, paracentesis, and hepatic
angiography.
6. 3. Which nursing interven- -Ensure the client has signed a consent.
tions are important prior This is an invasive procedure. The client should have instructions
to a paracentesis? about the procedure and sign a consent form.
(Select all that apply. One, -Instruct the client to empty their bladder.
some, or all options may Paracentesis involves the removal of peritoneal fluid for evaluation,
be correct.) and it is also performed to drain excess peritoneal fluid. Prior to the
procedure, the client should be instructed to void to reduce the risk
for accidental rupture of the bladder during the procedure. After the
procedure, the client should be assessed for signs of peritonitis or
peritoneal bleeding.
-Position the client in an upright position.
This positioning is used for a paracentesis. If the client is in the bed,
a Fowler's position can be used.
-Apply sphygmomanometer to monitor blood pressure.
The client's blood pressure should be monitored during the proce-
dure.
7. 4. After the client un- Increasing abdominal pain
dergoes the paracentesis,
which nursing assessment This may be the result of diaphragmatic, liver, or spleen perforation
warrants immediate inter- and may be life threatening.
vention?
8. 5. In the client with cirrho- Total serum bilirubin
sis, which lab values does The diseased liver is not able to metabolize bilirubin efficiently, re-
the nurse anticipate will sulting in an increase in total serum bilirubin.
be increased from the nor-
