Adult chronic exam 2 office questions with complete solutions

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Bolded answer = said in office hours Yellow
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highlight = getting more detail
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Cirrhosis- 7 questions
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● What is the best confirmatory test to diagnose cirrhosis?
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○ Liver biopsy is the gold standard h, h, h, h, h,




● What are physical exam findings for hepatic encephalopathy?
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○ Hepatic encephalopathy is the neuropsychiatric manifestation of liver
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disease w neurotoxic effects of pneumonia that can result in
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■ asterixis - flapping tremors h, h, h,




■ Apraxia- inability to construct simple figures, perform tasks when asked h, h, h, h, h, h, h, h, h,




■ Fetor hepaticus- musty sweet odor of the patient's breath
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● What treatments would be used for hepatic encephalopathy and why?
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○ Lactulose to trap ammonia in the gut and cause a laxative effect h, h, h, h, h, h, h, h, h, h, h,




resulting in removal of ammonia from the body
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○ Antibiotics if pt is unresponsive to lactulose (don't think we need to know this tho) h, h, h, h, h, h, h, h, h, h, h, h, h, h,




● What behavioral changes might we see in a patient with hepatic encephalopathy?
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○ Change in neurologic or mental status, inappropriate behavior, sleep
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disturbances, coma h, h,

,
, ● What are nursing interventions that we would incorporate for a pt who has
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esophageal varices and got a balloon tamponade, what do we need at the
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bedside?
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○ Esophageal varices are a complex of tortuous, enlarged veins at the h, h, h, h, h, h, h, h, h, h,




lower end of the esophagus and/or stomach. If we require a balloon
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tamponade we need…
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■ Scissors at the bedside to cut it in case it blocks the airway h, h, h, h, h, h, h, h, h, h, h, h,




■ Suction & oral care if on ventilator in ICU h, h, h, h, h, h, h, h,




● What medication would we use to treat ascites?
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○ Diuretics to remove excess fluid from the body h, h, h, h, h, h, h,




○ “Dont need to know specific name” h, h, h, h, h,




● After a paracentesis to treat ascites what are concerning findings we would look out for?
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○ Expected: weight loss, slight decrease in BP, easier to breathe d/t h, h, h, h, h, h, h, h, h, h,




decrease in pressure
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○ Unexpected: fever, s/s infection, sudden decrease in UO, chest pain, h, h, h, h, h, h, h, h, h,




cloudy fluid, hypovolemic S/S (tachycardia, tachypnea, low BP),
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excessive bleeding from the site of aspiration, monitor for FE imbalance
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(loss of sodium & potassium ions), spontaneous bacterial peritonitis
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○ “Its a rather simple question” h, h, h, h,




GERD/HH- 3 questions
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● What are lifestyle recommendations for someone with GERD/HH?
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○ Don't eat late h, h,




○ Eat smaller more frequent meals h, h, h, h,




○ Foods to avoid: spicy, caffeine, citrus, ETOH, tomato based,
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chocolates, peppermits
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○ Stay upright for 2-3 hours after eating
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○ Stop smoking h,




○ Weight loss h,




○ No restrictive clothing h, h,