A nurse is caring for a client with end-stage liver disease. Which hematological alterations might the nurse anticipate with this client?
Select all that apply.
A) Elevated serum albumin levels due to increased protein synthesis
B) Decreased clotting factor levels due to impaired clotting mechanisms
C) Hyperglycemia due to disrupted glucose metabolism
D) Increased serum vitamin K due to impaired clearance of fat-soluble vitamins
E) Increased plasma oncotic pressure due to impaired protein metabolism
Answer: B, C
Impaired function of liver cells has multiple effects. Impaired protein metabolism with decreased production of albumin and clotting factors occurs. Low albumin levels contribute to edema in peripheral tissues and ascites (accumulation of fluid in the abdomen), as plasma oncotic pressure is reduced, not increased. Impaired clotting-factor production increases the risk for bleeding. Disrupted glucose metabolism and storage may result in hyperglycemia. Also, serum vitamin K is decreased due to impaired absorption of fat-soluble vitamins.
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