HESI Case Study- Cirrhosis

PN’s response?
There are several types of cirrhosis with differing causes
What additional questions should PN ask?
-Have you ever been told that you have Hep C?
-Have you been exposed to toxic substances at work?
-Have you ever been diagnosed with Hep B?
-Do you have any cardiovascular disorders?
What action should PN take prior to paracentesis?
Instruct the client to empty the bladder
PN will maintain the client on bedrest for 24-48hrs following what procedure?
Angiography with portal measurements
PN will look for decrease from the normal value in what laboratory test for a client with cirrhosis?
serum albumin

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PN should observe for which clinical manifestations as the result of the prolonged APTT and PTT/INR?
epistaxis
PN knows which other clinical manifestation is a result of cirrhosis?
fruity breath
PN should observe for hyperkalemia because of which med Roberta is taking?
Spironolactone
Which action?
document the finding in the client’s record
What approach should the PN use?
challenge Roberta about her denial in a nonjudgemental manner
What response?
The type of liver damage that you have occurs after years of drinking, and that is what makes me think you are an alcoholic
Who should the PN notify regarding Roberta’s action to leave AMA?
Client’s HCP
What action?
Document that the client left the hospital AMA
What is the primary underlying cause of hepatic encephalopathy?
increased serum albumin
Which outcome indicates to the PN that the lactulose and neomycin are having desired effect?
increased mental altertness
PN initiates which activity-level during the acute phase of Roberta’s cirrhosis?
bedrest
What intervention?
measure abdominal growth daily
What intervention?
position Roberta in the bed with her feet slightly elevated
What action?
apply O2
When should NS be completed?
4:30PM
What selections?
-baked chicken sandwich and fruit smoothie
-grilled fish, spinach salad, apple, and iced tea
Lifestyle management choices?
-stop alcohol consumption
-stop aspirin containing meds
-talk to HCP before taking OTC meds
Best choice for PN to contact?
social worker
How should PN respond?
I really need you to find a way to help the client
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