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NSG 2200 > Hepatitis > Flashcards

Hepatitis Flashcards

1
Q

The liver is unusual in that it

A

has a double blood supply; the right and left hepatic arteries carry oxygenated blood to the liver, and the portal vein carries venous blood from the GI tract to the liver

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2
Q

Functions of the liver

A
  • Bile synthesis
  • Metabolic: CHO, protein fat, detoxification, steroid metabolism
  • Storage: Glucose as glycogen, Vitamins, fatty acids, minerals, amino acids
  • Mononuclear Phagocyte System:Kupffer cells
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3
Q

Bile synthesis in the liver

A
  • Bilirubin is a byproduct of RBC breakdown
  • Released bilirubin is not water soluble (unconjugated). Binds to albumin
  • Liver extracts the unconjugated bilirubin from the blood and makes it water soluble (conjugated)
  • Excreted in bile
  • Reduced bile to urobilinogen by intestinal bacteria
  • Most recycled back through the blood stream. Some excreted in stool (brown color). Very small amount excreted in urine
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4
Q

Metabolic functions of the liver: CHO

A

*glucose to glycogen to glucose

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5
Q

Metabolic functions of the liver: Protein

A

*synthesis of nonessential amino acids, clotting factors, urea formation from ammonia

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6
Q

Metabolic function of the liver: Fat

A

*lipoproteins, triglyceride breakdown, synthesis of fatty acids, cholesterol synthesis and breakdown

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7
Q

Metabolic functions of the liver: Detoxification

A

*inactive drugs and harmful substances. Excretion of their breakdown products

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8
Q

Metabolic functions of the liver: Steroid metabolism

A

*gonadal and adrenal corticosteroid hormones

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9
Q

Storage in the liver

A
  • glucose as glycogen
  • Vitamins: Fat soluble: A,D,E,K Water soluble: B1, B2, cobalamin, folic acid
  • Minerals: copper, iron
  • Amino acids
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10
Q

Mononuclear Phagocyte System: Kupffer cells

A
  • Breakdown of old RBC’s, WBC’s, bacteria

* Breakdown of hemoglobin to bilirubin

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11
Q

Hepatitis

A
  • Inflammatory of the liver
  • Immunologic Damage
  • Infections: viruses, bacteria, fungi, protozoa
  • Toxic Damage: alcohol, drugs, poisons/chemicals
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12
Q

Etiology of hepatitis:

A
  • Viral: A, B, C, D, E, G cytomegalovirus, herpes virus
  • Drugs: alcohol, acetaminophen, isoniazid, statins, sulfonamides, thiazide diuretics etc.
  • Autoimmune
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13
Q

Hepatitis A

A
  • Fecal- oral transmission. Hep A rap
  • Occurs in small outbreaks
  • Contamination of food or water
    • virus in feces during 2 week incubation period
  • Prevention: Hep A vaccine for pre-exposure
  • Hep A immune globulin before or after exposure
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14
Q

Hepatitis B/C

A
  • Perinatal, percutaneoulsy, sexual contact
  • Hep B prevention: vaccine 3 IM injections: Titer, post-op exposure vaccine and immune globulin
  • Hep C: Nothing
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15
Q

Vaccine that protects against Hep A and B

A

Twinrix: hepatitis A and B combination vaccine manufactured by GlaxoSmithKline, was licensed for use in the US in 2001 for people 18 years of age and older.
**Three doses of Twinrix are necessary for full protection against both hep A and B

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16
Q

Signs and Symptoms of Viral Hepatitis:

A
  • Dark urine
  • Loss of appetite
  • Fatigue
  • Abdominal distention
  • Generalized itching
  • Jaundice
  • Nausea/vomiting
  • Low grade fever
  • Pale or clay color stools
  • Hepatic tenderness
  • Hepatomegaly
  • Splenomegaly
  • 30% with acute B- no symptoms
  • 80% with acute C- no symptoms
17
Q

Complications of Hepatitis

A
  • Can recover completely with no complications
  • Fulminant hepatic failure
  • Chronic hepatitis (B,C)
  • Cirrhosis of the liver
  • Hepatocellular carcinoma
18
Q

Diagnostic tests for Hepatitis

A
  • Hepatitis antibodies, antigens
  • AST, ALT, GGT increased
  • Alkaline phosphates increased
  • Serum protein varies
  • Total bilirubin increased
  • Urinary bilirubin increased
  • Urinary urobilinogen increased
  • Prothrombin time prolonged
19
Q

Three phases of Hepatitis: lasts 1-4 months

A
  • Incubation period
  • Icteric phase
  • Convalescent phase
20
Q

Incubation period

A
  • Non-specific complaintsof fatigue, anorexia, nausea, cough, joint pain, loss of appetite
  • **Labs increase with ALT & AST, urine bilirubin levels, presence of viral antibodies, antigens, or virus particles
21
Q

Icteric Phase:

A
  • Appearance of jaundice, dark urine, stools clay colored due to decreased urobilinogen.
  • Right upper quadrant pain and increasing pruitus
  • Labs: elevated direct bilirubin levels
  • Anicteric hapatitis :no symptoms
22
Q

Post Icteric

A
  • Malaise
  • Fatigue
  • Jaundice fades
  • Lasts 2-4 months
23
Q

Collaborative Care:Acute Hepatitis

A
  • Tx at home usually
  • Decreased transmission
  • Medications: Antihistamines given for pruritus and jaundice, antiemetics for nausea. Must eval. hepatic drug clearance
  • Diet- well balanced- no ETOH, small meals 6X a day
  • Activity- rest
  • Bedrest if symptoms are severe
24
Q

Collaborative Care: Chronic Hepatitis B and C

A
  • Interferon: effect viral replication

* Nucleoside analogs: suppress viral replication

25
Q

Chronic Hepatitis: Nursing Diagnoses

A
  • Fatigue
  • Imbalanced nutrition
  • Activity Intolerance
  • Pain
  • Ineffective therapeutic regimen management
  • Body Image
26
Q

Chronic Hepatitis: Planning

A
  • Relief from discomfort
  • Resume normal activities
  • Return to normal liver function
27
Q

Chronic Hepatitis: Interventions

A
  • Monitoring fatigue
  • Increasing Activity Tolerance
  • Maintaining fluid intake and nutritional status
  • Providing comfort measures and promoting skin integrity
  • Correcting deficient knowledge
  • Promoting social interaction
28
Q

Health teaching with hepatitis:

A
  • No alcohol
  • Avoid all medications and OTC medications…especially tylenol
  • Get adequate rest (decrease work load on liver)
  • Nutritious diet of high CHO, low fat foods (altered nutrition: less than body requirements)
  • Avoid sex until antibody testing results are negative
29
Q

Percutaneous Liver Biopsy: Nursing Management Preprocedure:

A
  • Check coags before procedure
  • Type and crossmatch done
  • Witness concent
  • Pt. will need to be instructed to hold their breath and remain still when the needle is introduced
30
Q

Percutaneous Liver Biopsy: Nursing Management Post procedure:

A
  • Monitor for hpovolemia and bleeding, peritonitis, shock, pneumothorax
  • Lie on right side for at least 2 hours
  • Bedrest for 12-14 hrs
31
Q

Ascires

A
  • Sodium restriction, diuretics such as spirolactone
  • Paracentesis
  • Peritoneovenous Shunt (LaVeen shunt)
  • Transjugular intrahepatic shunt (TIPS)
32
Q

Paracentesis or Peritoneal Tap:

A
  • Removal of peritoneal fluid
  • Perform when patient with liver disease is having problems with breathing, abdominal discomfort related to ascites
  • Place on left side after procedure
  • Measure abdominal girth and weight before and after procedure
  • Monitor for bleeding post procedure
33
Q

Peritoneovenous Shunt:

A

Abdominal cavity to jugular vein or superior vena cava

34
Q

Transjugular Intrahepatic Portosystemic Shunt (TIPS)

A

Goes from liver to hepatic vein

35
Q

Esophageal and gastric varices

A
  • Emergency bleeding:protect airway, administer blood products, sclerotherapy or banding in endoscopy, Vasopressin, Nitroglycerin, balloon tamponade
  • Shunts
  • Propranolol (Inderol)
36
Q

Sclerotherapy

A

a solution that causes thrombosis and scaring is injected into the bleeding varices to stop or control the risk of bleeding

37
Q

Hepatic Encephalopathy

A
  • Lactalose: decrease GI pH then decreases bacterial growth. Laxative effects expels the ammonia
  • Antibiotics to decrease bacterial GI
  • Control GI bleed
  • Liver transplant
  • Monitor LOC
38
Q

Nursing Diagnosis for Cirrhosis

A
  • Imbalanced nutrition
  • Impaired skin integrity
  • Dysfunctional family processes
  • Excess fluid volume
39
Q

Planning for Cirrhosis

A
  • Relief of discomfort
  • Minimal to no complication
  • Normal lifestyle as possible

NSG 2200 (4 decks)

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