NCLEX RN Practice Question # 570

NCLEX Examination.

Practice Question # 570.


 

Nclex

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.

Symptoms of CIRRHOSIS

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).

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