CNUR 204 Exam Questions With 100%
Verified Solutions
Compensated vs uncompensated cirrhosis - ANSWER -Compensated- Liver able
to perform functions, liver function tests normal: albumin, bilirubin, prothrombin
time
No symptoms or non-specific symptoms (i.e., abdominal discomfort; fatigue;
malaise), Uncompensated- Liver unable to function normally and clinical
manifestations of cirrhosis appear
One or more of the complications from cirrhosis
Symptoms can be abrupt with anorexia; dyspepsia; N&V; weakness; muscle loss
diarrhea or constipation.
Complications of cirrhosis - ANSWER -•Portal hypertension- top complication
•Esophageal varices
•Ascites & Peripheral edema
-Spontaneous bacterial peritonitis
•Hepatic encephalopathy
•Hepato-renal syndrome
Portal Hypertension - ANSWER -Increased venous pressure to portal system
(portal hypertension) as the portal and hepatic veins and sinusoids are compressed
related to obstruction of the flow (increased resistance) because of
Structural changes
Dynamic changes
Also, characterized by
-splenomegaly,
-ascites,
-systemic hypertension
-large collateral veins,
-and esophageal varices, Large collateral veins-
,Venous, arterial, lymphatic system in liver- can develop little circulation if
obstruction
Treat them to prevent other complications- constipation when lifting heavy objects,
cough and sneeze can precipitate bleeding in esophageal varices
Esophageal varices - ANSWER -Ø
•Develop as a result of portal hypertension.
•Esophageal varices are tortuous, inelastic veins converging from systemic
circulation at the lower end of esophagus that are swollen and enlarged
•Over dilated vessels are fragile, rupture and bleed.
•Bleeding esophageal varices are the most life threatening complication of
cirrhosis.
•Engorged veins can rupture and bleed when person coughs, sneezes, vomits, or
there is trauma or erosion to vein- lifting heavy objects, bearing down can cause
rupture
•May have melena or hematemesis, •Prevent respiratory infection
•When blood is digested- black
Rehab phase of burns- nursing and collaborative management - ANSWER -•The
most common complications are skin and joint contractures and hypertrophic
scarring
-Positioning, splinting, and exercise should be instituted
-Should be aimed at the extension of body parts
-Continue/consult with OT/PT
•Patient teaching
-Custom fitted pressure garments never be worn over unhealed wounds. The
garments are worn up to 24 hours a day (12-18 months)- take off for bath
-May use antihistamine or water based moisturizers to relieve itching
-Direct sunlight should be avoided about 3-6 months
-Wear tensor or elastic bandages to burned leg to improve circulation before
ambulating
-Arrange homecare nursing if necessary (e.g., dressing changes)- treatment centre,
early takes time for referral
•
•Emphasis on PT/OT/exercise
,•Apply an emollient water based cream
•Patients with burn injuries have a significant need to receive information about
sexuality and intimacy- change personality- see themselves as unattractive
•Provide constant encouragement and reassurance
•Assess for psychosocial and emotional needs
•Offer counseling services, patient & family support group
•Refer to psychiatric services if required- suicide attempt
Ascites and Peripheral Edema (Fluid imbalance) - ANSWER -•Peripheral edema
-Caused by decreased colloidal oncotic pressure associated with impaired albumin
synthesis & increased portacaval pressure
•Ascites
-Can occur when pressure of blood is increased
-Protein & fluids move out of blood vessels due to decreased vascular oncotic
pressure
-fluid leaks from liver spaces into peritoneum
-Results in accumulation of serous fluid
-Hypoalbuminemia; hyperaldosteronism
-?Spontaneous bacterial peritonitis (SBP), Edema in the back (sacral area) is
indicative of cirrhosis, leg edema can be anything
Colloidal oncotic pressure- pressure pulls, albumin pulls the fluid
Hydrostatic pressure- pushing, fluid goes out of vessel
Hepatic Encephalopathy - ANSWER -Altered neurological status from buildup of
circulating ammonia
Ammonia is normally excreted by the kidneys after converting into urea in the
liver
Ammonia is a neurotoxin and it can cross the blood-brain barrier which will causes
lethargy, confusion, cerebral edema, and coma
Other clinical manifestations include asterixis- flapping; fetor hepaticus- fruity
breath, impairement in writing; hyperventilation; hypothermia..
Can also occur after trans-jugular intrahepatic portosystemic shunt (TIPS), Liver
failure symptoms- may need to code
Coma, confused
, Hepato- Renal Syndrome (HRS) - ANSWER -•Serious complication of cirrhosis
•A type of kidney failure with advancing azotemia- high nitrogen levels, oliguria-
urine output less than 100 mL per day, and intractable ascites
•No apparent structural problems of the kidneys
•Caused by portal hypertension and liver compensation
-Leads to splanchnic and systemic vasodilation
-Decrease arterial blood volume- renal failure
-Result in impaired renal perfusion - renal failure
•HRS often follows diuretic therapy, GI hemorrhage or paracentesis- •watch for
output
Collaborative Care: Acute Esophageal bleeding - ANSWER -1.ABC's & V/S
2.Initiate IV x2 (large bore)- transfusion, cannot give medication in the same spot
•IV bolus/fluid resuscitation/blood product (FFP; RBC) administration
•IV Medications-vasopressin- be careful in older adults; octreotide; beta blocker-
may not be initial treatment but you need to stop the bleeding; vit K- not given
often; PPI- pantoprazole, continuous infusion
3.Prepare patient for endoscopic procedure (eg., sclerotherapy/ligation
(banding)/ballon tamponade
4.Shunting procedures (e.g., trans-jugular intrahepatic portosystemic shunt - TIPS)
5.Continuously reassess patient -watch for hypovolemic shock, Typically
esophageal bleeding is out patient until they it happens again
Health teaching-Esophageal varices - ANSWER -•Avoid aspirin, alcohol,
NSAIDs- risk for bleeding
•Avoid irritating foods
•Avoid coughing -seek HCP
•Avoid vomiting/constipation
•Control BP- beta blockers, control bleeding first
•Monitor S&S of bleeding- melena
•Follow-up with blood work regularly as recommended
Collaborative Care:Fluid Imbalance (Ascites) - ANSWER -ABC's and V/S
Sodium restriction (limit to 2 g/day)
Diuretics & fluid removal (Lasix +spironolactone)
Verified Solutions
Compensated vs uncompensated cirrhosis - ANSWER -Compensated- Liver able
to perform functions, liver function tests normal: albumin, bilirubin, prothrombin
time
No symptoms or non-specific symptoms (i.e., abdominal discomfort; fatigue;
malaise), Uncompensated- Liver unable to function normally and clinical
manifestations of cirrhosis appear
One or more of the complications from cirrhosis
Symptoms can be abrupt with anorexia; dyspepsia; N&V; weakness; muscle loss
diarrhea or constipation.
Complications of cirrhosis - ANSWER -•Portal hypertension- top complication
•Esophageal varices
•Ascites & Peripheral edema
-Spontaneous bacterial peritonitis
•Hepatic encephalopathy
•Hepato-renal syndrome
Portal Hypertension - ANSWER -Increased venous pressure to portal system
(portal hypertension) as the portal and hepatic veins and sinusoids are compressed
related to obstruction of the flow (increased resistance) because of
Structural changes
Dynamic changes
Also, characterized by
-splenomegaly,
-ascites,
-systemic hypertension
-large collateral veins,
-and esophageal varices, Large collateral veins-
,Venous, arterial, lymphatic system in liver- can develop little circulation if
obstruction
Treat them to prevent other complications- constipation when lifting heavy objects,
cough and sneeze can precipitate bleeding in esophageal varices
Esophageal varices - ANSWER -Ø
•Develop as a result of portal hypertension.
•Esophageal varices are tortuous, inelastic veins converging from systemic
circulation at the lower end of esophagus that are swollen and enlarged
•Over dilated vessels are fragile, rupture and bleed.
•Bleeding esophageal varices are the most life threatening complication of
cirrhosis.
•Engorged veins can rupture and bleed when person coughs, sneezes, vomits, or
there is trauma or erosion to vein- lifting heavy objects, bearing down can cause
rupture
•May have melena or hematemesis, •Prevent respiratory infection
•When blood is digested- black
Rehab phase of burns- nursing and collaborative management - ANSWER -•The
most common complications are skin and joint contractures and hypertrophic
scarring
-Positioning, splinting, and exercise should be instituted
-Should be aimed at the extension of body parts
-Continue/consult with OT/PT
•Patient teaching
-Custom fitted pressure garments never be worn over unhealed wounds. The
garments are worn up to 24 hours a day (12-18 months)- take off for bath
-May use antihistamine or water based moisturizers to relieve itching
-Direct sunlight should be avoided about 3-6 months
-Wear tensor or elastic bandages to burned leg to improve circulation before
ambulating
-Arrange homecare nursing if necessary (e.g., dressing changes)- treatment centre,
early takes time for referral
•
•Emphasis on PT/OT/exercise
,•Apply an emollient water based cream
•Patients with burn injuries have a significant need to receive information about
sexuality and intimacy- change personality- see themselves as unattractive
•Provide constant encouragement and reassurance
•Assess for psychosocial and emotional needs
•Offer counseling services, patient & family support group
•Refer to psychiatric services if required- suicide attempt
Ascites and Peripheral Edema (Fluid imbalance) - ANSWER -•Peripheral edema
-Caused by decreased colloidal oncotic pressure associated with impaired albumin
synthesis & increased portacaval pressure
•Ascites
-Can occur when pressure of blood is increased
-Protein & fluids move out of blood vessels due to decreased vascular oncotic
pressure
-fluid leaks from liver spaces into peritoneum
-Results in accumulation of serous fluid
-Hypoalbuminemia; hyperaldosteronism
-?Spontaneous bacterial peritonitis (SBP), Edema in the back (sacral area) is
indicative of cirrhosis, leg edema can be anything
Colloidal oncotic pressure- pressure pulls, albumin pulls the fluid
Hydrostatic pressure- pushing, fluid goes out of vessel
Hepatic Encephalopathy - ANSWER -Altered neurological status from buildup of
circulating ammonia
Ammonia is normally excreted by the kidneys after converting into urea in the
liver
Ammonia is a neurotoxin and it can cross the blood-brain barrier which will causes
lethargy, confusion, cerebral edema, and coma
Other clinical manifestations include asterixis- flapping; fetor hepaticus- fruity
breath, impairement in writing; hyperventilation; hypothermia..
Can also occur after trans-jugular intrahepatic portosystemic shunt (TIPS), Liver
failure symptoms- may need to code
Coma, confused
, Hepato- Renal Syndrome (HRS) - ANSWER -•Serious complication of cirrhosis
•A type of kidney failure with advancing azotemia- high nitrogen levels, oliguria-
urine output less than 100 mL per day, and intractable ascites
•No apparent structural problems of the kidneys
•Caused by portal hypertension and liver compensation
-Leads to splanchnic and systemic vasodilation
-Decrease arterial blood volume- renal failure
-Result in impaired renal perfusion - renal failure
•HRS often follows diuretic therapy, GI hemorrhage or paracentesis- •watch for
output
Collaborative Care: Acute Esophageal bleeding - ANSWER -1.ABC's & V/S
2.Initiate IV x2 (large bore)- transfusion, cannot give medication in the same spot
•IV bolus/fluid resuscitation/blood product (FFP; RBC) administration
•IV Medications-vasopressin- be careful in older adults; octreotide; beta blocker-
may not be initial treatment but you need to stop the bleeding; vit K- not given
often; PPI- pantoprazole, continuous infusion
3.Prepare patient for endoscopic procedure (eg., sclerotherapy/ligation
(banding)/ballon tamponade
4.Shunting procedures (e.g., trans-jugular intrahepatic portosystemic shunt - TIPS)
5.Continuously reassess patient -watch for hypovolemic shock, Typically
esophageal bleeding is out patient until they it happens again
Health teaching-Esophageal varices - ANSWER -•Avoid aspirin, alcohol,
NSAIDs- risk for bleeding
•Avoid irritating foods
•Avoid coughing -seek HCP
•Avoid vomiting/constipation
•Control BP- beta blockers, control bleeding first
•Monitor S&S of bleeding- melena
•Follow-up with blood work regularly as recommended
Collaborative Care:Fluid Imbalance (Ascites) - ANSWER -ABC's and V/S
Sodium restriction (limit to 2 g/day)
Diuretics & fluid removal (Lasix +spironolactone)
