A nurse observes palmar erythema and she understands that it is met within

Appeared in: JIPMER Nursing Officer-2017

Explanation

Palmar erythema, a reddening of the palms, is a classic cutaneous sign of chronic liver disease and hepatic failure.
The underlying cause is hyperestrogenemia, which results from the failing liver's inability to metabolize estrogen.
This hormonal imbalance leads to local vasodilation in the palms, causing the characteristic redness, particularly in the thenar and hypothenar eminences.

Clinical Relevance

Nursing practice connection: Knowing Association of a clinical sign (palmar erythema) with systemic disease helps nurses interpret findings accurately and avoid errors in routine assessment, medication administration, and patient teaching.
Recognizing palmar erythema as a potential sign of underlying liver disease is a crucial nursing assessment skill, prompting further investigation into liver function tests (LFTs) and patient history.
This sign, along with others like spider angiomas and jaundice, helps build a clinical picture of chronic liver disease, allowing for earlier intervention.
What if? If the patient with palmar erythema also exhibited confusion and a flapping tremor of the hands (asterixis), the nurse should suspect hepatic encephalopathy, a severe complication of hepatic failure, and escalate care immediately.

How to Approach the Question

First, identify the key clinical sign presented in the question: 'palmar erythema'.
Second, recall or deduce the pathophysiology of this sign. What systemic process could cause localized redness in the palms?
Third, evaluate each option by linking it to its known primary clinical manifestations. Does cardiac failure cause this? Does renal failure?
Fourth, consider the hormonal functions of the organs listed. The liver is central to hormone metabolism.
Select the option where palmar erythema is a recognized and classic sign. In this case, it's a well-known manifestation of impaired estrogen metabolism in liver disease.

Concept Tested & Keywords

Concept Tested: Association of a clinical sign (palmar erythema) with systemic disease.
Stem keywords: palmar erythema
Lead-in keywords: understands that it is met with

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E6 Pathology- ROBBINS & COTRAN PATHOLOGIC BASIS OF DISEASE 10TH Ed p. 828-830

E6 Pathology-Textbook of PATHOLOGYHarsh Mohan Part 3 (515-969) p. 95-97

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