URDANETA CITY UNIVERSITY

San Vicente West, Urdaneta City, Philippines-2428

COLLEGE OF ARTS AND SCIENCES

Name: Cruz Mary Ruth D. Date: April 29, 2022

Course and Year Level: BSN-3 Code: N110
Block: 1 Subject: MS

ASSESSMENT AND MANAGEMENT OF PATIENTS WITH HEPATIC DISORDER

CRITICAL THINKING

1. A 56- year- old woman is at high risk for hepatitis B and C due to a history of IV drug abuse.
What laboratory testing is likely to be done first for this patient? If laboratory testing is positive
for either or both diseases, what invasive and non-invasive testing is warranted next? Describe
the education a nurse working with this patient should provide about these tests.

Answer:

The laboratory testing likely to be done first is:

 HBcAg- hepatitis B core antigen (antigenic material in an inner core)

 HBsAg - hepatitis B surface antigen (antigenic material on the surface of HBV)
 HBeAg - an independent protein circulating in the blood
 HBxAg - gene product of X gene of HBV/DNA.

Invasive test HBcAg and HBsAg, non-invasive test fibro scan, and liver biopsy. During this stage,
gradual resumption of physical activity is encouraged after jaundice has resolved. Even if not
hospitalized, the patient will be unable to work and most avoid sexual contact.

2. A 68-year-old man is admitted to the hospital with a diagnosis of ESLD with hepatic
encephalopathy. What is the evidence base for meeting the nutritional needs of this patient? What
are the most appropriate caloric and protein intake recommendations? Identify the criteria used to
evaluate the strength of the evidence for the treatment practices you have identified.

Answer:

Evidence bases for meeting the nutritional needs of this patient counseling to oral nutritional
supplements, enteral tube feeding, or parenteral nutrition as appropriate. Keep daily protein intake
between 1.0 and 1.5 g/kg, depending on the degree of decomposition. Substitute vegetable protein for
animal protein in as high a percentage as possible. For a patient who is truly protein intolerant, provide
additional nitrogen in the form of an amino acid supplement. The criteria used to evaluate the strength
of the evidence for the treatment practices I have identified is providing highly rich protein food
 URDANETA CITY UNIVERSITY
San Vicente West, Urdaneta City, Philippines-2428
COLLEGE OF ARTS AND SCIENCES

Name: Cruz Mary Ruth D. Date: April 2, 2022

Course and Year Level: BSN-3 Code: N110
Block: 1 Subject: MS

3. A 66-year-old man underwent an orthotopic liver transplant for decompensated cirrhosis. He is

placed on an immunosuppressant regimen including corticosteroids, mycophenolate mofetil,
and tacrolimus. On day 10 postoperatively, he develops an acute change in mental status with
confusion and severe extremity tremors. As this patient’s nurse, you are in attendance when
the patient appears to have a generalized clonic seizure. Identify the priorities, approach, and
techniques you would use to provide immediate interventions for this patient. What are your
concerns regarding the potential causes of these neurologic abnormalities? What testing would
you anticipate? Could his medication regimen have a role in the symptomatology? What
laboratory testing would be important in identifying a cause for the seizure?

Answer:

Priority intervention the nurse must be doing was, making sure that the patient is safe and just
waiting until the patient stops a seizure sure. The nurse should also be calm in caring for the patient
after the seizure stops. The nurse should notify the physician after the patient stops having seizures
and inform the guardian of the patient to be with their loved one in case there is a recurrence of
seizure again, it’s better to be safe. Tests that nurses would anticipate are EEG/electroencephalogram,
and MRI. I think the medication does not cause any role in the symptomatology EEG, electrodes are
placed on your scalp closely spaced together. Like conventional EEG, high-density EEG records brain
activity. A high-density EEG test can help your doctor locate the area in your brain where seizures
occur.

4. A 44-year-old woman with obesity is diagnosed with NAFLD and is symptomatic with jaundice
and fatigue. What are the best risk reduction tactics for this patient? How should the nurse
prepare and educate the patient to achieve specific evidence-based management goals and
potentially control the disease?

Answer:

The best risk reduction tactics for this patient are to consume less bad fat and more good fat.

• Consume less processed and sugary foods.

• Eat more servings of vegetables and fruits.

• Eat plenty of dietary fiber.

 URDANETA CITY UNIVERSITY
San Vicente West, Urdaneta City, Philippines-2428
COLLEGE OF ARTS AND SCIENCES

Name: Cruz Mary Ruth D. Date: April 29, 2022

Course and Year Level: BSN-3 Code: N110
Block: 1 Subject: MS

• Focus on eating low–glycaemic index foods.

• Get the family involved in your journey.

• Engage in regular aerobic activity.

The nurse should prepare the client to have a better lifestyle change, like food preferences must be
changed to nutritious food/diet-friendly food.