exam 2 study guide Flashcards
prodromal stage of hepatitis ( PREICTERIC)
- Begins 2 weeks after exposure
clinical manifestations of prodromal stage of hepatitis
- HIGHLY INFECTIOUS
- N/V
- anorexia
- diarrhea
- weight loss
- Fatigue, fever, flu like symptoms ends in ENDS IN JAUNDICE
ICTERIC ( JAUNDICE) phase of hepatitis
- illness, JAUNDICE IS PRESENT
- Begins 1 week after prodromal phase and lasts up to 6 weeks
clinical manifestations of ICTERIC PHASE
- Actual illness, JAUNDICE IS PRESENT
- fatigue
- RUQ pain
- dark urine
- clay colored stools
- yellow sclera
- pruritus
RECOVERY phase of hepatitis (POSTICTERIC)
Can last 2-12 weeks
- Jaundice resolves
- symptoms diminish
- liver function return to normal
Management of hepatitis
REST! REST! REST!
- based on the type they have
- Nursing intervention for all patients with hepatitis: ACTIVITY RESTRICTION, REST AND NUTRITION
- VACCINE: hep A and B = prevention
- NO VACCINE FOR HEP C
- Blood and body fluid precautions—any body fluid needs to be treated as infectious
- antiemetics for nausea
- Corticosteroidd becuase hepatitis can cause inflammation
- Low fat/low sugar/low protein/high fiber/high calorie diet
HEPATITIS B AT RISK POPULATION
- Men who have sex with men
- Household contact of chronically infected = you are dealing with people with chronic illness, touching body fluids
- hemodialysis patients
- Health care and public safety workers
- Transplant recipients
CAN BE TRANSMITTED PARENTALLY DURING BIRTH AND PERCUTANEOULSY
Hepatitis C: HEALTH HISTORY
- Sexual behavior—high risk sexual behavior
- Drug abuse, especially IV
- Occupation exposure
- Dialysis
- Peritoneal exposure—dialysis
- One peritoneal (peritoneum) and one via blood (hemodialysis)—dialysis
- Blood transfusions before 1992
Hepatitis A: Heath teaching
FOCUS ON TRANSMISSION
- THROUGH FOOD: poor preparation, poor sanitary conditions, contaminated food and water
TRANSMITTED: ORAL FECAL ROUTE
- you can get other hepaittis if you have 1- they are not transmitted the same way
- Educate on hand-washing, food preparation, avoiding restaurants
what is cirrhosis
- A chronic liver disease characterized by WIDESPREAD DESTRUCTION OF HEPATIC CELLS REPLACED BY FIBROUS CELLS (SCARING)
- hepatitis can lead to cirrhosis but it doesnt have to
CIRRHOSIS IS MORE SEVERE
early and late cirrhosis
early cirrhosis = liver enlarged, firm and hard
late cirrhosis: shrinks in size
Medications for cirrhosis
Lactulose/CHEPHULAC: PO, NG tube, rectally
- Helps you go to bathroom through diarrhea/bowel movements
Lower ammonia levels
Assess hydration and electrolyte imbalance—> ASSESS NEURO STATUS
- Aldactone/spironolactone: diuretic (K-sparing0
- Maalox/mylanta: coats the stomach
- Questran/cholestyrimine
- Antivirals: if hepatitis is the cause
- Beta blockers for portal hypertension
- Coltrasine (USED FOR GOUT): not given to all patients with cirrhosis—but can help regenerate the liver
• Used for gout - STEROIDS
- Vasopressants for esophageal varices—to help avoid varices from bleeding
Hepatic Encephalopathy: (Hepatic Coma)
ALTERED MENTAL STATUS, FECTOR HEPATICUS, APRAXIA
- liver is unable to covert ammonia (CNS toxin) into glutamine leading to INCREASED SERUM AND CEREBRAL AMMONIA LEVEL
Prodromal stage of hepatic encephalopathy
- Subtle changes-
- FORGETFULLNESS
- DISORIENTED
- CANNOT SLEEP
- SLIGHT TREMOR
- DIMINISHED AFFECT
- SLURRED SPEECH
Impending stage of hepatic encephalopathy
- Tremor progresses into asterixis (hallmark of hepatic coma)
- lethargy
- wandering behavior
- apraxia = loss of ability to carry out learned movements)
Stuporous stage of hepatic encephalopathy
- Hyperventilation
- stunned
- confused
- slow to react
- difficult to arouse but when aroused can be abusive and combative
Comatose stage of hepatic encephalopathy
- Hyperactive reflexes
- positive Babinski sign
- fector hepaticus, coma
Lab values of CAD ACS
cardiac enzymes = troponin
- Ck-MB
- Myoglobin
Modifiable risk factors of CAD AND ACS
- elevated serum lipids
- HTN
- smoking
- obesity
- physical inactivity, - DM
- Diet
Diet for cardiac patients
–↓ Saturated fats and cholesterol
- ↑ Complex carbohydrates and fiber
- ↓ Red meat, egg yolks, whole milk
- ↑ Omega-3 fatty acids.
o Non-modifiable risk factors of CAD ACS
- Age
- Gender
- Ethnicity
- Family history
- Genetic predisposition
treatment of CAD and AC
- 12-lead ECG
- Upright position
- Oxygen – keep O2 sat > 93%
- V access, Nitroglycerin (SubLingual)
- ASA (chewable)
- Statins
- Morphine
• Stable angina intervention
- Medications
- Oxygen
- Reduce and control risk factors
o Medications for CAD
- Nitroglycerin
- Beta-adrenergic blocking agents
- Calcium channel blocking agents
- Antiplatelet and anticoagulant medication
- Aspirin
- Clopidogrel and Heparin
- Lipid lowering drugs
- Sodium current inhibitor