Critical Thinking Exercise No.

7 (Assessment and Management of Patients

With Hepatic Disorders)
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 noninvasive testing is warranted next? Describe the
education a nurse working with this patient should provide about these tests.
Questions Answer
a) What laboratory testing is  Laboratory tests to screen serum for the presence of
likely to be done first for antibody against Hepatitis B and C viruses; in the case of
this patient? individuals with a history of drug usgae, it is done
through Intravenous modes.

b) what invasive and Invasive Diagnostic Tests

noninvasive testing is  IVD (in-vitro diagnostic test)
warranted next?  RDT (rapid diagnostic tests) - detects HBsAg (antibodies
against surface determinants on hepatitis B virus) and
HCV (hepatitis C virus) antibodies.
Non-invasive tests
 Transient elastography
 Acoustic radiation force impulse imaging (ARFI)
 Serum biomarkers ultrasound
 Magnetic resonance Imaging (MRI)
c) Describe the education a  Invasisve tests (IVD and RDT)
nurse working with this a. Educate the patient about the procedure (amount of
patient should provide blood to be withdrawn in conducting the test)
about these tests. b. Educate the patient about the preparation (does not
need fasting and can be done anytime)
 Non-invasiive tests (Transient elastography, ARFI,
Serum biomarkers ultrasound and, MRI)
a. Inform the patient that fasting for three to five hours
should be done before the procedure.
b. Encourage the patient to verbalize what they feel
(anxious about the test)
c. Explain the procedure to the patient.
d. Provide relaxation methods to reduce anxiety.
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.
Questions Answer
a) What is the evidence base  A study conducted in the year 2012 & 2015 advise
for meeting the nutritional the nutrients to be added in the diet for treating
needs of this patient? hepatic encephalopathy is a high protein diet as the
deficiency of nutrients can lead to complications.
 b) What are the most  Daily calorie intake = 35 to 40 kcal/kg of body weight
appropriate caloric and  Daily protein intake = 1.2 to 1.5 g/kg of body weight
protein intake
recommendations?
c) Identify the criteria used The criteria to assess the strength of evidence are:
to evaluate the strength  Source of collected data
of the evidence for the  Biased nature of the study
treatment practices you  Sample size
have identified.
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?
Questions Answer
 Identify the priorities,  Maintain airway patency
approach, and techniques  Prevent injury (raising siderails, sharp objects must be kept,
you would use to provide restraint are attached if necessary)
immediate interventions for  Avoid giving food or any supplement through oral route to
this patient. prevent aspiration
 Continuously monitor the patient
 Note the conditions before the onset of seizure (auditory,
visual, or olfactory stimuli and psychological distrubances)
 Record the location of stiffness and position of body and head
when the onset of seizure happened
 Record presence of stool and urinary incontinence
 What are your concerns  The nurse should be alert with the usage of
regarding the potential immunosuppressant, though they are essential for patient who
causes of these neurologic underwent transplantation, it is also associated with the
abnormalities? development of various side effects. Immunosuppressive
toxicity can cause neurological symptoms (seizures). Thus, the
nurse should be concerned with the use of this agent as well as
the dosage given to the patient.
 What testing would you  Hematologic examination can be done in order to assess the
anticipate? Could his level of immunosuppressants and ammonia in the blood. The
medication regimen have a administration of immunosuppressant medications enhances
role in the the risk of seizures.
symptomatology?
 What laboratory testing  Electroencephalogram (EEG) is a diagnostic stool which
would be important in reveals an individual’s brain activity. It documents the person’s
identifying a cause for the routine sleep and wake-up cycle. Moreover, it can distinguish
seizure? epileptic movement from non-epileptic movements. In this
case, EEG reflect the generalized slowing and enhancemen in
triphasic wave and brain wave.
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?
Questions Answer

 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?
 Non-alcoholic Fatty Liver Disease (NAFLD) is related to obesity.
Losing weight for approximately 5% to 10% helps control the
disease and the possible complications it may cause. Weight
loss to achieve the BMI of 18.5-24.9 kg/m2 is the best risk
reduction for this patient.
 Educate the patient about the importance of healthy lifestyle,
proper diet, healthy eating habits, and calorie restriction.
 Educate the individual about the importance of weight
management and physical activities for disease prevention.