Medical-surgical Nursing Demystified

(Sean Pound) #1

(^292) Medical-Surgical Nursing Demystified



  • Spider veins—spider angiomas or telangiectasias on cheeks, nose, shoulders
    or upper chest

  • Redness of palms—palmar erythema

  • Glossitis due to vitamin deficiency

  • Peripheral edema

  • Dyspnea due to pressure on diaphragm from ascites

  • Encephalopathy (asterixis, tremors, delirium, drowsiness, dysarthria, coma)


INTERPRETING TEST RESULTS



  • Aspartate aminotransferase (AST) elevated.

  • Alanine aminotransferase (ALT) elevated.

  • Lactate dehydrogenase (LDH) elevated.

  • Bilirubin direct (conjugated) and indirect (unconjugated) elevated.

  • Urinary bilirubin elevated.

  • Fecal urobilinogen decreased with biliary tract obstruction.

  • Serum protein decreased.

  • Serum albumin decreased.

  • Anemia with elevated MCV, MCH.

  • White blood cell (WBC) count low.

  • Prothrombin time is prolonged due to changes in hepatic production of clot-
    ting factors.

  • Platelet count low (thrombocytopenia).

  • Ammonia level elevated as the disease advances.

  • Abdominal x-rays show hepatomegaly.

  • Abdominal CT scan shows hepatomegaly, ascites.

  • Ultrasound shows hepatomegaly, ascites, portal vein blood flow.

  • Liver biopsy shows fibrosis and regenerative nodules.

  • Esophagogastroduodenoscopy (EGD) to detect esophageal varices.


TREATMENT



  • Low-sodium diet; adequate calorie intake.

  • Restrict fluid intake if hyponatremic (low serum sodium) or fluid overloaded.

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