Exam 2- Hepatitis Flashcards
3 categories of functions of the liver
Storage, production, and metabolism
What do we include in an assessment, regarding health history, for liver disorders?
- Exposure to hepatotoxins
- Alcohol and drug use
- Lifestyle behaviors
What do we include in an assessment, regarding physical examination, for liver disorders?
- Skin inspection (jaundice)
- Abdominal assessment
- Liver palpation
Main diagnostic evaluation
Liver biopsy
Diagnostic evaluations for liver disease
Liver function tests
- Direct and indirect bilirubin
- Serum protein and albumin
- Prothrombin time
- Alk phos (obstruction)
- AT and ALT (liver cell damage)
- Serum ammonia
Hepatic dysfunctions
- Jaundice
- Portal hypertension
- Ascites
- Esophageal varices
What does an AT or ALT test indicate?
Liver cell damage
Waat does an alk phos test indicate?
Obstruction
Jaundice may be caused by…
- Hemolytic dysfunction (RBC or transfusion reaction)
- Hepatocellular reaction
- Obstruction (GS or tumor)
- Hereditary
Different types of hepatitis
- Viral Hepatitis
- Hepatitis A Virus
- Hepatitis B Virus
- Hepatitis C Virus
- Hepatitis D Virus
- Hepatitis E Virus
- Hepatitis G and GB Virus-C
Which Hepatitis is typically short-term?
HAV
Which Heps have vaccines?
A and B
What Hep causes acute inflammation of the liver?
Hep A
How is HAV usually transmitted?
Fecal-oral contamination and with food that is contaminated with the virus
With HAV, passive immunity is available with…
Gamma globulin
Hep A incubation period
2-6 weeks
When is Hep A most contagious?
10-14 days prior to symptoms
Diagnostics of Hep A include…
- Enlarged liver and spleen
- Jaundice
- HAV antigen in stool 7-10 days before s/s
- HAV antibodies (2-3 weeks after symptoms)
Hep A is often mistaken for…
Acute gastroenteritis
Which Hep may be mild or asymptomatic?
Hep A
What does Hep A start as?
Mild, flu-like URI
What hep includes early and severe anorexia?
Hep A
Manifestations of Hep A
- Mild, flu-like symptoms
- Anorexia
- Jaundice and durk urine
- Indigestion (vague epigastric distress, nausea, heartburn, flatulence)
- Strong aversion to cigarette smoke/other strong odors
Patient education for Hep A
- Disease progression
- Prevention of transmission
Disease progression for Hep A
- Avoid alcohol and drugs that may be hepatotoxic (acetaminophen)
- Best rest, nutrition, IV fluid if needed (home care)
Prevention of transmission for Hep A
- Meticulous hand washing
- Proper sewage disposal
- Vaccination (HAV)
- Avoid sharing eating utensils, bath towels, and other personal care items
- Safe sexual practices
HAV is from what virus?
RNA virus
HBV is from what virus?
DNA virus
What hep is transmitted in blood and body fluids?
Hep B
What are the main transmission issues for HBV?
- Contaminated equipment (dialysis)
- IV drug abuse
- Sexual activity
- Blood products
Risk factors for HBV
- Healthcare workers
- Exposure to blood products
- Close contact with carrier
- IV injection drug use
- Multiple partners
- Mom-child
- STD
- Tattoo
- Travel
Hep B diagnostics
- HBsAG
- Anti-HBs
When is HBsAG detectable?
1-10 weeks after exposure
We call the patient a carrier of Hep B is the HBsAG..
Shows that the antigen persists longer than 6 months
Anti-HBs indicate…
Immune state (some people require more than the 3 shots, myself being one of them)
With about 90% of exposed people to Hep B, how do they recover?
People develop antibodies and recover spontaneously in 6 months
What happens to about 10% of Hep B exposures?
They progress to carrier state or develop chronic hepatitis
What does chronic Hep B look like?
Hepatocellular injury and inflammation
HBV is a major cause of what?
Cirrhosis (scarring of the liver caused by many conditions) and hepatocellular carcinoma (primary liver cancer)
Prevention and management of Hep B
- Blood donor screening
- Needless IV systems, disposable needles
- Active immunity (vaccination)
- Passive immunity (immune globin)
What active immunity do we use for prevention of Hep B?
Vaccination
What passive immunity do we use for prevention of Hep B?
Immune globin
When do we used passive immunity for Hep B?
- If exposed to HBV and not previously vaccinated
- Needle stick injury, splashes in contact with mucosa, sexual contact with person who is positive, and perinatal exposure
Hep B med & management
- Alpha interferon
- Antiviral agents for chronic HBV
- Bed rest
- Adequate nutrition (continuing care with home health nurse)
For Hep B management, how is Alpha interferon administered?
IM injection (10 million U 3x week for 16-24 weeks)
- Numerous side effects
SE for Alpha interferon?
Fever
Chills
Malaise
What does Alpha interferon do?
Reduces inflammation of the liver, reduces the s/s
What antiviral agents are used for chronic HBV?
Enecavir ETV
Tenofovir TDF
What virus does Hep C come from?
RNA virus
What hep is transmitted via blood contact with skin/mucous membranes?
HCV
Which hep has no effective treatment?
Hep C
What percentage of people develop chronic form of HCV?
85%
What is the leading cause of liver cancer and cirrhosis?
HCV
Hep C is the major reason for…
Most transplants
Which treatment is best for prevention of relapses and s/s of Hep C?
Combo of antiviral agents (Olysio, Sovaldil, Harvoni and Viekira Pak)
Nursing care for Hepatitis
- UNIVERSAL PRECAUTIONS ALWAYS
- Prevent when possible
- Rest liver and promote cell regeneration
- Symptom management
How do we prevent hepatitis?
Careful assessment and risk identification
What kind of diet do we want for hepatitis?
- High CHO diet
- Small frequent feedings
What symptom management do we use for hepatitis? What do we check?
- Meds for itching and nausea
- Check metabolism of drug
Patient teaching of Hepatitis
- Sexuality
- Liver toxins
-0 May be chronic carrier - No sharing of food items, razors, toothbrushes, etc.
- Proper disposal of instruments/sharps- Cannot be blood donor if HBsAG+
You cannot be a blood donor if…
HBsAG is positive
