Mollie hit Wafic in the RLE with a baseball bat. His physical exam is as follows: Neuro: GCS 15 Pulm: grossly CTA Cardiac: regular rate and rhythm Gi: soft non-tender + BS Extremities: +2 pulses L DP/PT. Absent pulse R DP/PT. Doppler pulse R popliteal. Cold R foot.  Ian the nurse immediately contacts the provider with a concern for:

A patient with cirrhosis and an elevated INR secondary to alcoholic hepatitis arrives in the emergency department with a blood pressure of 82/40 and severe back pain. Which provider order will the nurse implement first?

A 37M is being treated for a duodenal ulcer. He asks the nurse to explain why an ulcer would require antibiotics. 

Which subjective data given by a 53M indicates to the nurse that the patient should be screened for hepatitis C?

23M patient with a PMHx of ulcerative colitis is admitted for severe diarrhea. Which nursing assessment is the highest priority?

49M is in fulminent liver failure secondary to NASH. The nurse would expect which series of deranged labs?

34F is admitted with weakness and malaise 90 days s/p gastric sleeve surgery. Her labs are as follows: Na+ 129 mEq/L (135 – 145 mEq/L) BUN 28 mg/dL (8 – 20 mg/dL) Creat 1.8 mg/dL (0.7 – 1.1 mg/dL) Hgb 16.4 g/dL (11 – 15 g/dL) Total Protein 4.1 g/dL (6 – 8 g/dL) Albumin 2.2 g/dL (3.4 – 5.4 g/dL) The patient asks the nurse why she’s feeling so unwell. The nurse suspects this patient is exhibiting which gastric sleeve complications?

49F with PMHx non-Hodgkin’s lymphoma and severe GERD is admitted with multifactorial distributive (septic) and cardiogenic shock. Work-up reveals an EF of 13% by echocardiogram and vegetation on the mitral valve.  Physical exam reveals: Neuro: atraumatic, PERRLA, + cough + gag, moves all extremities, + commands. Obvious dental erosion.  Pulm: bilateral fine crackles and diminished bases Cardiac: regular rate and rhythm, no murmurs, rubs or gallops GI: soft, nontender, + bowel sounds Ext: +1 BLE pulses, +1 BLE pitting edema Common things being common, the nurse knows the most likely explanation for her shock is:

39F with PMHx of ETOH abuse and cirrhosis presents to the ED with hematemesis and melena. Her VS and labs are as follows: Temp 36.1 C HR 128 RR 24 BP 86/49 SpO2 98% on RA Hgb 6.3 g/dL (12-15 g/dL) What is true?  (Select all that apply.)

Which type of hepatitis is a DNA virus, can be trasnmitted via exposure to infectious blood or body fluids, is required for HDV to replicate, and increases the risk of the chronic carrier for hepatocellular cancer?