New confusion, asterixis, or rising ammonia signals hepatic encephalopathy and needs prompt reporting.
Before you read
Test yourself first: 5 questions
Question 1 of 5
A client with chronic liver disease has prolonged bleeding after a venipuncture. The nurse understands this occurs because the diseased liver cannot adequately perform which function?
Answer: A. The liver synthesizes most clotting factors and activates vitamin K dependent factors. In liver disease, decreased production of clotting factors prolongs bleeding times. The other functions are not the cause of impaired clotting.
Question 2 of 5
When using an automated external defibrillator (AED), what must the rescuer ensure before the device delivers a shock?
Answer: B. Before an AED delivers a shock, the rescuer must ensure that no one is touching the client (clear the patient) to prevent injury to rescuers and ensure proper energy delivery.
Question 3 of 5
A nurse assesses cranial nerve function. The client is unable to shrug the shoulders against resistance. Which cranial nerve is impaired?
Answer: C. Shoulder shrug and head turning against resistance test the spinal accessory nerve (CN XI), which innervates the trapezius and sternocleidomastoid muscles.
Question 4 of 5
A nurse tests for nuchal rigidity in a client with suspected meningeal irritation. Which finding indicates a positive Brudzinski's sign?
Answer: B. Brudzinski's sign is positive when passive flexion of the neck causes involuntary flexion of the hips and knees, indicating meningeal irritation.
Question 5 of 5
What is the correct rate for delivering chest compressions during adult CPR?
Answer: C. Chest compressions should be delivered at a rate of 100 to 120 per minute for adults, children, and infants.
Keep the streak going with more questions like these, each with a full rationale.
What is liver function tests?
AST and ALT rise with liver cell damage, bilirubin and alkaline phosphatase rise with biliary obstruction, and albumin and PT/INR reflect how well the liver is making proteins and clotting factors. They guide monitoring of hepatotoxic drugs and chronic liver disease.
Key points to remember
- ALT is more specific to the liver than AST, which also appears in muscle and other tissues.
- Elevated bilirubin causes jaundice and signals impaired bile processing or biliary obstruction.
- Low albumin reflects poor liver synthetic function and contributes to edema and ascites.
- A prolonged PT/INR in liver disease reflects reduced production of clotting factors.
- A rising ammonia level in liver failure can produce confusion and hepatic encephalopathy.
- Many medications, including acetaminophen and statins, require LFT monitoring for hepatotoxicity.
Nursing priorities
- Assess for jaundice, ascites, easy bruising, bleeding, and changes in mental status.
- Monitor for bleeding risk given impaired clotting factor production in liver disease.
- Review and question hepatotoxic medications and limit acetaminophen dosing.
- Implement bleeding and fall precautions in patients with significant liver dysfunction.
- Trend LFTs and coagulation values to evaluate progression or drug toxicity.
Labs & values
Patient teaching
- Avoid alcohol and limit acetaminophen, and tell providers about all medications and supplements.
- Report yellowing of the skin or eyes, increasing abdominal swelling, or confusion.
Red flags: report now
- New confusion, asterixis, or rising ammonia signals hepatic encephalopathy and needs prompt reporting.
- Signs of GI bleeding such as hematemesis or melena are emergencies in liver disease.
- Never exceed maximum acetaminophen dosing, especially with existing liver impairment.
References
Clinical references for this topic
