hepatic disorders Flashcards
functional cells of the liver
hepatocytes
portal vein
carries absorbed products of digestion directly to the liver; branches in the liver where it comes into contact with each lobule
functions of the liver
prevents shortages of nutrients by storing vit, minerals, sugar
produces most proteins needed by body
produces bile, a compound needed to digest fat and absorb vit A, D, E, K
produces most of the substances that regulate blood clotting
helps body fight infection by removing bacteria
metabolizes nutrients from food to produce energy
removes toxic byproducts of medications
causes of hepatitis
viral (most common) drugs (alcohol) chemicals autoimmune diseases metabolic abnormalities
route of transmission for hep A
fecal-oral (a lot of people in small area)
incubation period for hep A
15-50 days; most infectious 2 weeks before symptoms and 1-2 weeks after
risk factors for hep A
crowded conditions (family members, institutionalized, workers at day care)
poor sanitation
contaminated food products
route of transmission for hep B
percutaneous
sexual contact
perinatal
incubation period for hep B
45-180 days
route of transmission for hep C
percutaneous
sexual contract
perinatal
incubation period for hep C
14-180 days
risk factors for hep C
contaminated needles
blood products
sex with infected partner
men having sex with men
hep A
mild flu-like symptoms, acute with jaundice
incidence decreased with vaccination
RNA virus transmitted via fecal-oral route
contaminated food or drinking water
hep A education
good hygiene, proper handling of food, cautious in crowds, sanitary conditions
hep B
acute or chronic
incidence decreased with vaccination
DNA virus transmitted perinatally, percutaneously, mucosal exposure
can live in saliva
at risk for hep B
men who have sex with men household contact of chronically infected patients underdoing hemodialysis health care workers transplant recipients immunosuppressed
hep C
acute (asymptomatic) and chronic (liver damage)
RNA virus transmitted percutaneously
common cause of liver disease and indication for liver transplant
clinical manifestations of hepatitis
acute or chronic phases many patients can be asymptomatic symptoms can be intermittent or ongoing malaise fatigue myalgias/arthalgias hepatomegaly
acute phase of hepatitis
maximal inefectivity lasts 1-4 months
symptoms during incubation (acute)
malaise anorexia weight loss fatigue N/V abdominal discomfort distaste for cigarettes decreased sense of smell headache low grade fever arthralgias skin rashes
physical exam findings (acute)
hepatomegaly
lymphadenopathy
splenomegaly
icteric
jaundice (abnormal bilirubin levels)
dark urine
light or clay-colored stools
pruritis
anicteric
non-jaundice
convalescent phase
hepatitis starts to get better
begins as jaundice is disappearing
lasts weeks to months
major complaints during convalescent phase
malaise
easy fatigue
hepatomegaly persists
splenomegaly subsides
liver function tests
AST, ALT, GGT
diagnostic findings of hepatitis
AST - increased ALT - increased GGT - increased alkaline phosphatase - increased serum proteins - normal or increased albumin - normal or decreased serum bilirubin - increased prothrombin time - prolonged
collaborative care for acute viral hepatitis
no specific therapy NUTRITION and REST prevention of disease progression med therapy supportive drug therapy - antiemetics
prevention for HAV
handwashing personal hygiene environmental sanitation infection control early immune globulin (1-2 wks after exposure) prophylaxis HAV vaccine
pre-exposure vaccine for children ____ to ____ months of age
12; 23
short term goals of care for HBV
decrease viral load
decrease liver enzymes
decrease disease progression
long term goals of care for HBV
prevention of cirrhosis
prevention of liver failure
prevention of hepatocellular cancer
prevention for HBV
disposable needles and syringes - standard precautions
prevention prophylaxis (HBV vaccine)
HBIG for needle stick and infants born from hep B
avoid toothbrushes and razors (body fluids)
goal for care of HCV
eradicate the virus
prevent HCV complications
individualized
drug therapies for HCV
pegylated interferon with ribavirin
side effects of pegylated interferon
fatigue, fever, malaise, myalgia, psych symptoms (depression, suicide, headache, alopecia), GI upset, anorexia
acute management of hepatitis
rest nutrition avoid hepatotoxic meds supportive care education follow up care
nursing diagnoses for hepatitis
imbalanced nutrition
activity intolerance
risk for impaired liver function
for dark complexions of jaundice look at
eyes, palms, palate
management of pruritis
use knuckles, not fingernails and make sure skin is moist
adequate nutrition
small, frequent meals
measures to stimulate appetite
carbonated beverages (stimulates appetite)
adequate fluid intake (2500-3000 mL/day)
acute care management of hepatitis
assess for jaundice comfort measures (pruritis) adequate nutrition physical rest psychological and emotional rest diversional activities (hobbies)
