Hepatitis Flashcards
Pathophysiology of Hepatitis
Widespread inflammation and infection of liver cells
Complications of Hepatitis
- Fulminant Hepatitis: failure of the liver cells to regenerate, with progression of the necrotic process, results in a severe acute and is often fatal
- Chronic Hepatitis: Liver inflammation last longer than 6 months (Hep B, C); can lead to cirrhosis and liver cancer
- Superimposed infection (Hep D)
- Depression
- Polyarthritis
- Myalgia
- Renal Insufficiency
- Cognitive Impairment
- Cardiovascular problem (vasculitis and heart disease)
Signs and Symptoms
- Abdominal Pain
- Icterus (yellow sclera)
- Arthralgia (joint pain) or Myalgia (muscle pain)
- Diarrhea/Constipation
- Light-gray colored stool
- Dark yellow to brown urine
- Jaundice (results from intraphepatic obstruction caused by edema of the liver’s bile channels)
- Fever
- Fatigue
- Malaise
- Anorexia
- Nausea/vomiting
- Dry Skin
- Pruritus
Nursing Assessment: History
- Ask about exposure to hepatitis
Nursing Assessment: Physical Assessment
- Assess Sign and Symptoms
- Lightly palpate the right upper quadrant to assess for liver tenderness
- Inspect skin, sclerae and mucous membranes for jaundice
- Obtain a urine and stool specimen
Nursing Assessment: Psychosocial
- Allow patients to verbalize feelings and explore the reasons for these fears
- Educate the patient and family members about modes of transmission and clarify information as needed
Laboratory Assessment
- ALT and AST: ELEVATED
- Alkaine phosphatase levels: normal or elevated
- Bilirubin: Elevated and consistent with clinical appearance of jaundice
- Hep A
> immunoglobulin M antibodies (indicated; 4-6 weeks)
> immunoglobulin G (previous infection)
> HAV antibodies - Hep B
> HBV antibodies - Hep C
> HCV antibodies - Hep D
> Delta antigen or rise in HDV antibodies - Hep E
> HEV antibodies
Diagnostic Testing
- Liver Biopsy- diagnosis of hep and establish the stage of liver damage or cancer
- CT-guided or transjugular route (reduce risk of pneumothorax or hemothorax)
- Ultrasound
Nursing Intervention: Promoting Nutrition
- General symptoms (malaise, anorexia, abdominal discomfort, nausea) may have the client declining food
- Diet should be HIGH in CARBOHYDRATES and CALORIES, mod. amount of fat and protein (not high protein because they can’t break it down)
- Small frequent meals
- Patient food preferences: what is appealing to them? Tolerated?
- High calorie snacks may be needed
- Supplemental vitamins may be needed/prescribed
Nursing Intervention: Managing Fatigue
1.Rest is needed to reduce liver’s metabolic demands and increase its blood supply
2. Rest also promotes hepatic cell regeneration
3. Alternate rest periods with period of activity
Nursing Intervention: Drug Therapy
- Used sparingly so that liver can rest
- Antiemetics used for nausea
- Hepatitis B treatment: interferon alfa preparations and nucleoside analogs
-can help fight the virus and slow it ability to damage the liver - Hepatitis C treatment: second generation protease inhibitors
-dependent upon the genotype of the hepatitis C
-newer drugs can clear the virus from the body - Complementary & Integrative Therapies
-Herbs and vitamin supplements: silymarin (milk thistle plant), green tea, vitamin E
Patient Teaching
- Prevent infection transmission
- Avoid use of alcohol and check with PCP before taking medication or vitamin, supplement, or herbal preparation
- Increase activity gradually to prevent fatigue
- Eat small, frequent meals of high-carbohydrate foods and plan frequent rest periods
- Collaborate with certified infection control practitioner and infectious disease specialist
Hepatitis A
Signs and Symptoms:
1. Flu-like
> Fatigue
> Nausea/vomiting
> Abdominal pain
> Loss of appetite
> Jaundice
> Low-grade fever
Mode of Transmission:
1. Fecal-oral
2. Shellfish caught in contaminated water, food contaminated by food handler that has HAV
Incubation Period
> 15-50 days with peak of 25-30 days
Acute of Chronic?
> ACUTE
Prevention:
1. Hand Hygiene
2. Safe Food Handling
3. Vaccine
Hepatitis B
Signs and Symptoms
1. Anorexia
2. Nausea/vomiting
3. Fatigue
4. Fever
5. RUQ pain
6. Dark urine
7. Light-colored stool
8. Joint pain
9. Jaundice
Modes of Transmission
1. Blood and Bodily Fluids
2. Unprotected sex
3. Sharing Needles/syringes
4. Accidental Needlesticks
5. Blood Transfusion before 1992
6. Birth
Incubation Period:
> 25-180 days
Acute or Chronic?
> CHRONIC
Prevention:
1. Safe Sex Practices
2. Handwashing
3. Needle Safety
4. Blood Screening
5. Vaccine
Hepatitis C
Signs and Symptoms:
1. Bleeding Easily
2. Bruising Easily
3. Fatigue
4. Poor Appetite
5. Jaundice
6. Dark colored urine
7. Itchy skin
8. Ascites
9. Edema
10. Weight loss
11. Confusion
12. Drowsiness
13. Slurred Speech
14. Spider Angiomas
Mode of Transmission
1. Blood
2. Multiple sexual partners
3. Men that have unprotected sex with other men
4. Illicit IV drug needle sharing
5. Blood/blood products and organ transplants before 1992
6. Incarcerated individuals
7. Hemodialysis
8. Needlestick injuries
Incubation Period
1. 2 weeks to 6 months
Acute or Chronic?
> CHRONIC
Prevention:
1. Handwashing
2. Needle safety
3. Blood screening
