How to Answer Chapter Disorders Hepatobiliary Questions (Complete Guide)

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Original Question

Chapter 30, Disorders of Hepatobiliary and Exocrine Pancreas Function A 65-year-old man is admitted to the hospital with the diagnosis of cirrhosis of the liver. During the admission assessment, the nurse collects the following data: The patient has been unable to eat secondary to nausea and vomiting for the past 3 days; he has seen moderate amounts of blood twice in the past 24 hours when he vomited; he has noted a slight yellow color to his skin and has had increased itching of the skin for the past 3 weeks; PMH of increased alcohol intake for 20 years. On exam, the following were noted: BP 90/60, p. 110. r. 20 Skin: moderate jaundice with drying and decrease tugor HEENT: sclera is yellow Lungs: clear to auscultation ABD: distended with increased venous markings. BS present. Liver palpable 1 cm below the costal margin EXT: thin, pulses 1+ present and bilateral, capillary refill decreased 1. How does the cirrhosis of the liver cause the jaundice seen in this patient? Explain physiologically relating to normal bile production and bilirubin metabolism. 2. On physical examination, the nurse noted abdominal distention. If on exam the distension was found to be fluid in the peritoneal cavity, how could you physiologically explain the relationship between the ascites (fluid in the peritoneal cavity) and his cirrhosis? 3. On the third day of hospitalization, the laboratory calls to tell the nurse the patient has very high serum ammonia. Knowing how proteins are normally metabolized by the liver, explain why the elevated serum ammonia is concerning Chapter 46, Disorders of Skin Integrity and Function A 5-year-old girl was admitted to the emergency room after a house fire. She had burns over her trunk, extremities, and back. The physician notes that 60% are the burns are second-degree full-thickness burns. On admission assessment, the nurse finds the patient’s BP was 90/60, P 110, and R 20. 1. Why is it so important in this patient for the nurse to monitor fluid balance? 2. The patient complains of shortness of breath, and the nurse notes an increased respiratory rate. Why is it important for the nurse to monitor carefully respiratory function? 3. Why is infection an important risk in this patient? Chapter 37, Disorders of Brain Function An 8-year-old boy is admitted to the emergency room after being hit by a car. He had a short period of unconsciousness and is currently lethargic but arouseable. He complains of nausea but has not vomited. He does not remember the accident or what happened immediately before. On the initial nursing assessment he is oriented X3, slightly lethargic but responds to name. BP 130/80, P 88, R 16. Pupils are equal and reactive to light. The admitting diagnosis is concussion. 1. On the admission assessment, the nurse notes the physician described the child had a coup-contrecoup injury. Describe what this means and why this could impact the nursing assessment of this patient. 2. On the CT scan, the child is found to have a subdural hematoma. The child was taken to surgery. Describe physiologically what is meant by a subdural hematoma. What nursing assessments would the nurse monitor in this patient?

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