Practice Question # 570.
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- Question 1 of 1
The nurse knows that the plan of care for a client with severe liver disease should include which of the following actions?Correct
The Answer is 2
Offer a low-protein, high-carbohydrate diet— CORRECT: hepatic coma caused by increased levels of ammonia from breakdown of protein.Incorrect
The Answer is 2
Offer a low-protein, high-carbohydrate diet— CORRECT: hepatic coma caused by increased levels of ammonia from breakdown of protein.
- 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.
- Portal hypertension: A persistent increase in pressure in the portal vein that develops as a result of obstruction to flow
- 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
- 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).