Adult Chronic Exam 2 - Office Hours
Compiled by Denny
Year: 2025
,Bolded answer = said in office hours
Yellow highlight = getting more detail
Cirrhosis- 7 questions
● What is the best confirmatory test to diagnose cirrhosis?
○ Liver biopsy is the gold standard
● What are physical exam findings for hepatic encephalopathy?
○ Hepatic encephalopathy is the neuropsychiatric manifestation of liver disease w
neurotoxic effects of pneumonia that can result in
■ asterixis - flapping tremors
d
ve
er
es
R
s
ht
■ Apraxia- inability to construct simple figures, perform tasks when asked
ig
lR
■ Fetor hepaticus- musty sweet odor of the patient's breath
Al
–
5
02
,2
ny
en
D
©
● What treatments would be used for hepatic encephalopathy and why?
○ Lactulose to trap ammonia in the gut and cause a laxative effect resulting in
removal of ammonia from the body
○ Antibiotics if pt is unresponsive to lactulose (don't think we need to know this tho)
● What behavioral changes might we see in a patient with hepatic encephalopathy?
○ Change in neurologic or mental status, inappropriate behavior, sleep
disturbances, coma
, ● What are nursing interventions that we would incorporate for a pt who has esophageal
varices and got a balloon tamponade, what do we need at the bedside?
○ Esophageal varices are a complex of tortuous, enlarged veins at the lower end of
the esophagus and/or stomach. If we require a balloon tamponade we need…
■ Scissors at the bedside to cut it in case it blocks the airway
■ Suction & oral care if on ventilator in ICU
d
ve
er
es
● What medication would we use to treat ascites?
R
s
○ Diuretics to remove excess fluid from the body
ht
ig
lR
○ “Dont need to know specific name”
Al
–
5
02
● After a paracentesis to treat ascites what are concerning findings we would look out for?
,2
ny
○ Expected: weight loss, slight decrease in BP, easier to breathe d/t decrease in
en
D
pressure
©
○ Unexpected: fever, s/s infection, sudden decrease in UO, chest pain, cloudy
fluid, hypovolemic S/S (tachycardia, tachypnea, low BP), excessive bleeding
from the site of aspiration, monitor for FE imbalance (loss of sodium & potassium
ions), spontaneous bacterial peritonitis
○ “Its a rather simple question”
GERD/HH- 3 questions
● What are lifestyle recommendations for someone with GERD/HH?
○ Don't eat late
○ Eat smaller more frequent meals
○ Foods to avoid: spicy, caffeine, citrus, ETOH, tomato based, chocolates,
peppermits
○ Stay upright for 2-3 hours after eating
○ Stop smoking
○ Weight loss
○ No restrictive clothing
Compiled by Denny
Year: 2025
,Bolded answer = said in office hours
Yellow highlight = getting more detail
Cirrhosis- 7 questions
● What is the best confirmatory test to diagnose cirrhosis?
○ Liver biopsy is the gold standard
● What are physical exam findings for hepatic encephalopathy?
○ Hepatic encephalopathy is the neuropsychiatric manifestation of liver disease w
neurotoxic effects of pneumonia that can result in
■ asterixis - flapping tremors
d
ve
er
es
R
s
ht
■ Apraxia- inability to construct simple figures, perform tasks when asked
ig
lR
■ Fetor hepaticus- musty sweet odor of the patient's breath
Al
–
5
02
,2
ny
en
D
©
● What treatments would be used for hepatic encephalopathy and why?
○ Lactulose to trap ammonia in the gut and cause a laxative effect resulting in
removal of ammonia from the body
○ Antibiotics if pt is unresponsive to lactulose (don't think we need to know this tho)
● What behavioral changes might we see in a patient with hepatic encephalopathy?
○ Change in neurologic or mental status, inappropriate behavior, sleep
disturbances, coma
, ● What are nursing interventions that we would incorporate for a pt who has esophageal
varices and got a balloon tamponade, what do we need at the bedside?
○ Esophageal varices are a complex of tortuous, enlarged veins at the lower end of
the esophagus and/or stomach. If we require a balloon tamponade we need…
■ Scissors at the bedside to cut it in case it blocks the airway
■ Suction & oral care if on ventilator in ICU
d
ve
er
es
● What medication would we use to treat ascites?
R
s
○ Diuretics to remove excess fluid from the body
ht
ig
lR
○ “Dont need to know specific name”
Al
–
5
02
● After a paracentesis to treat ascites what are concerning findings we would look out for?
,2
ny
○ Expected: weight loss, slight decrease in BP, easier to breathe d/t decrease in
en
D
pressure
©
○ Unexpected: fever, s/s infection, sudden decrease in UO, chest pain, cloudy
fluid, hypovolemic S/S (tachycardia, tachypnea, low BP), excessive bleeding
from the site of aspiration, monitor for FE imbalance (loss of sodium & potassium
ions), spontaneous bacterial peritonitis
○ “Its a rather simple question”
GERD/HH- 3 questions
● What are lifestyle recommendations for someone with GERD/HH?
○ Don't eat late
○ Eat smaller more frequent meals
○ Foods to avoid: spicy, caffeine, citrus, ETOH, tomato based, chocolates,
peppermits
○ Stay upright for 2-3 hours after eating
○ Stop smoking
○ Weight loss
○ No restrictive clothing
