NCLEX RN Practice Question # 570

NCLEX Examination.

Practice Question # 570.

CIRRHOSIS Review

Description

• A chronic, progressive disease of the liver characterized by diffuse degeneration and destruction of hepatocytes
• Repeated destruction of hepatic cells causes the formation of scar tissue.

Complications

• Portal hypertension: A persistent increase in pressure in the portal vein that develops as a result of obstruction to flow
• Ascites
  • Accumulation of fluid in the peritoneal cavity that results from venous congestion of the hepatic capillaries
  • Capillary congestion leads to plasma leaking directly from the liver surface and portal vein.
• Bleeding esophageal varices: Fragile, thinwalled, distended esophageal veins that become irritated and rupture
• Coagulation defects
  • Decreased synthesis of bile fats in the liver prevents the absorption of fat-soluble vitamins.
  • Without vitamin K and clotting factors II, VII, IX, and X, the client is prone to bleeding.
• Jaundice: Occurs because the liver is unable to metabolize bilirubin and because the edema,
• fibrosis, and scarring of the hepatic bile ducts
• interfere with normal bile and bilirubin secretion
• Portal systemic encephalopathy: End-stage hepatic failure characterized by altered level of consciousness, neurological symptoms, impaired thinking, and neuromuscular disturbances; caused by failure of the diseased liver to detoxify neurotoxic agents such as ammonia.
• Hepatorenal syndrome
  • Progressive renal failure associated with hepatic failure
  • Characterized by a sudden decrease in urinary output, elevated blood urea nitrogen and creatinine levels, decreased urine sodium excretion, and increased urine osmolarity

 Interventions

• Elevate the head of the bed to minimize shortness of breath.
• If ascites and edema are absent and the client does not exhibit signs of impending coma, a high-protein diet supplemented with vitamins is prescribed.
• Provide supplemental vitamins (B complex, vitamins A, C, and K, folic acid, and thiamine) as prescribed.
• Restrict sodium intake and fluid intake as prescribed.
• Initiate enteral feedings or parenteral nutrition as prescribed.
• Administer diuretics as prescribed to treat ascites.
• Monitor intake and output and electrolyte balance.
• Weigh client and measure abdominal girth daily.
• Monitor level of consciousness; assess for precoma state (tremors, delirium).