Robert is a 68-year-old who has dealt with alcoholism for over 30 years. He has cirrhosis and is anemic
His appetite has declined, and he regularly complains of abdominal pain. Recently, while preparing himself a sandwich, he cut his finger deeply with a knife. The wound bled profusely, and he used a kitchen towel to stop the flow. Refusing to go and seek medical assistance, he put ice on his finger and wrapped the towel around it. He sat down in his recliner with his hand over his head and fell asleep.
Anemia and clotting disorders are common features of alcoholic liver disease. What are the mechanisms that cause these hematological disorders?
What gastrointestinal bleed is associated with a high mortality rate in those with advanced cirrhosis? What is the pathophysiology of this condition?
Why are women more predisposed to alcoholic liver disease than men?
Liver disease contributes to anemia and clotting disorders in a number of ways. Fibrinogen and clotting factor production is decreased with impaired liver function. Malabsorption of vitamin K contributes to clotting insufficiency. Alterations in fat metabolism affect the phospholipid cell membrane of red blood cells and cause hemolysis. The development of splenomegaly and hypersplenism results in the decrease of all formed elements of the blood; anemia, thrombocytopenia and leukopenia are all manifestations of hypersplenism. Finally, folic acid deficiency produces megaloblastic anemia.
Esophageal varices occur in those with liver disease and are associated with a high mortality rate due to hemorrhage. Varices develop as a result of portal hypertension. The increased portal vein pressure encourages the development of portosystemic shunts. A collateral circulation between the portal vein and coronary vein produces dilation of the esophageal veins.
Acute pancreatitis is sometimes seen in the alcoholics, particularly after binge drinking. Why are tachycardia and hypotension indications of this condition?
Acute pancreatitis causes a fluid shift into the retroperitoneal and abdominal cavity, including the peripancreatic spaces. The lowered blood volume results in hypotension and compensatory tachycardia.
Three pathways exist in the liver for the metabolism of alcohol, and all mechanisms produce the toxic metabolite acetaldehyde. One such mechanism is the alcohol dehydrogenase (ADH) system. In males, the ADH system is depressed by testosterone. Women therefore produce more acetaldehyde and are more likely to receive alcohol-induced liver damage than men.
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Which of the following interventions should the nurse perform to prevent drying of the oral mucous membranes and lips in a dying client?
A) Place the client in a cool temperature. B) Provide water to the client at regular intervals. C) Provide the client with absorbent pads. D) Provide oral care, ice chips, and petroleum jelly.
What is true about instruments to assess for depression in older adults?
a. Older adults tend to score inaccurately low (indicating less depression) than younger adults on the Zung Self-Rating Depression Scale. b. The shortened Geriatric Depression Scale does not contain a question to eval-uate suicide potential. c. The Beck Depression Inventory is designed for gerontological patients. d. The Geriatric Depression Scale is administered by a health care provider in an interview with the older adult
When assessing abdominal pain in a college-age woman, one must include:
a. history of interstate travel. b. food likes and dislikes. c. age at completion of toilet training. d. the first day of the last menstrual period.
When seeking knowledge, which of the following would a nurse typically do first?
A) Search for appropriate evidence B) Critically analyze the literature C) Question a practice D) Apply the search findings