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Nursing 272: Final Semester > Unit 3: Hepatitis > Flashcards

Unit 3: Hepatitis Flashcards

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1
Q

The Liver Located

A

-located under the diaphragm; in RUQ of abdominal cavity

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2
Q

The Functions of the Liver

A
  • blood storage
  • blood filtration
  • production of bile
  • synthesis of clotting factors (prothrombin, factors II, VII, IX, and X)
  • removal of clotting factors to prevent clotting
  • metabolism of carbohydrates, fats, and proteins
  • detoxify the blood
  • storage for vitamins A, D, E, and K and Iron
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3
Q

When does hepatic dysfunction occur?

A

liver is no longer able to perform its usual functions

ex: hepatitis; inflammation of the liver

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4
Q

Risk for developing hepatitis is associated with what?

A

individual behavior and exposure

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5
Q

Transmission of Hepatitis

A
  • fecal-oral

- directly through blood and body fluid exposures

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6
Q

Risk Factors for Hepatitis

A
  • alcohol abuse
  • some prescription or OTC medications
  • toxins
  • autoimmune disease
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7
Q

Medication Risk Factors for Hepatitis

A
  • Statins
  • Anabolic steroid
  • Azathioprine
  • Methotrexate
  • Isoniazid
  • Valproic acid
  • Tetracyclines
  • Phenytoin
  • Acetaminophen
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8
Q

Toxin risk factors for Hepatitis

A
  • Industrial chemicals
  • Carbon tetrachloride
  • Phosphorus
  • Mushrooms
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9
Q

Pathophysiology

A

hepatitis is inflammation of the liver cells most commonly caused by a virus that impairs its ability to function normally

  • the inflammation limits the ability of the liver to detoxify substances, limits the production of proteins and clotting factors, and alters the ability to store vitamins, fats, and sugars
  • patients w/ hepatitis may experience a mild or severe illness that can be acute or chronic
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10
Q

Hepatitis

A

inflammation of the liver cells most commonly caused by a virus that impairs its ability to function normally

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11
Q

Modes of Transmission of Viral Hepatitis

A
  • contact w/ blood, blood products, semen, saliva and mucous membranes
  • direct contact w/ infected fluids or objects
  • fecal-oral route w/ contaminated water or food such as shellfish
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12
Q

Most Common Hepatitis Viruses

A

A, B, and C

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13
Q

Table 59.1: Hepatitis A

A

> Route: Fecal-oral, contaminated water or food
Source of virus: Feces, contaminated water or food
Incubation period: 15-50 days
Acute
Vaccine available
Treatment: symptomatic

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14
Q

Table 59.1: Hepatitis B

A 
>Routes: 
-percutaneous or mucosal
-blood, body fluids, needles or sharp instruments
>Source of virus: blood, body fluids
>Incubation period: 45-60 day
>Chronic
>Vaccine available
>Treatment: interferon and antivirals
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15
Q

Table 59.1: Hepatitis C

A 
>Route of Transmission: 
-percutaneous or mucosal
-blood, body fluids, needles, or sharp instruments 
>Source of virus: blood, body fluids, needles, or sharp instruments
>Incubation period: 2-25 weeks
>Chronic
>No available vaccine
-Treatment: interferon and antivirals
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16
Q

Table 59.1: Hepatitis D

A 
>Routes: 
-percutaneous or mucosal
-in conjunction w/ hepatitis B
-blood, body fluids, or sharp instruments
>Source of virus: blood, body fluids, needles, or sharp instruments 
>Incubation period: 2-8 weeks
>HBV vaccine
>Treatment: interferon and antivirals
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17
Q

Table 59.1: Hepatitis E

A 
>Routes: 
-fecal-oral
-contaminated water or food
>Source of virus: feces
>Incubation period: 2-8 weeks
>Acute
>No vaccine
>Treatment: symptomatic
>develop jaundice
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18
Q

Table 59.1: Hepatitis G

A 
>Route:
-infected blood or blood products
>Source of virus: infected blood or blood products
>Incubation period: unknown
>Acute
>No vaccine
>Treatment: symptomatic
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19
Q

Which types of hepatitis are transmitted by fecal-oral?

A
  • Hep A

- Hep E

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20
Q

Which type of Hepatitis is transmitted through blood or blood products?

A

> Hep B
Hep C
Hep D
Hep G

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21
Q

Clinical Manifestations of Hepatitis

A
  • abdominal pain
  • irritability
  • pruritis (itching)
  • malaise
  • fever
  • nausea
  • vomiting
  • jaundice (icterus)/yellowing of skin or sclera
  • clay colored stool
  • dark amber urine
  • hepatomegaly
  • ascites
  • flu-like symptoms
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22
Q

Laboratory Analysis: Abnormalities

A
  • Elevated liver enzymes (AST, ALT)
  • Elevated Bilirubin (total and direct)
  • Elevated serum ammonia
  • Decreased albumin
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23
Q

Clinical Manifestations: Clay colored stool

A

bile acids normally secreted by the liver make stool its brown color
-with an obstruction in the liver, these bile acids are not secreted in the stool, resulting in clay colored stools

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24
Q

Clinical Manifestations: Dark amber urine

A

d/t increased excretion of conjugated bilirubin in the urine

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25
Q

Obstructive Jaundice is caused by?

A
  • scarring
  • edema
  • stone formation
  • any obstruction that interferes w/ normal process of bile flow through the bile ducts
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26
Q

Fulminant viral Hepatitis

A
  • severe, rapidly progressive, life-threatening form of acute liver failure
  • Neurological decline (encephalopathy, insomnia, somnolence, and impaired mentation)
  • GI bleeding
  • Coagulation disorders
  • Thrombocytopenia (low platelet count of less than 150000)
  • Fever
  • Oliguria
  • Edema
  • Ascites
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27
Q

Hepatic Encephalopathy

A

-impaired mentation, altered LOC, confusion, somnolence, insomnia; d/t the accumulation of toxins in the bloodstream that are normally cleared by a healthy liver

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28
Q

Scarring of the Liver

A

d/t scarring, blood bypasses the liver and is not detoxified

-waste products accumulate (ammonia), causing changes in mental status

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29
Q

Complications of Liver Failure

A

-inability of the liver to produce clotting factors

>results in coagulation disorders and thrombocytopenia (low platelet count)

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30
Q

Complications of Liver Failure

A

-inability of the liver to produce clotting factors

>results in coagulation disorders and thrombocytopenia (low platelet count)

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31
Q

Hepatitis A: Phases

A 
>First phase:
-last for about a week
-abrupt onset of fever w/ anorexia, nausea, vomiting, malaise, abdominal pain, myalgia, diarrhea, urticaria (pale red, raised bumps on the skin), cough, and hepatosplenomegaly (enlarged liver and/or spleen)
>Manifestation of later phases:
-clay-colored stools
-elevated bilirubin levels
-jaundice (4 to 30 days after infection)
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32
Q

Hepatitis C is the leading cause of what?

A

liver cirrhosis and hepatocellular cancer

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33
Q

Definitive Diagnosis of Hepatitis A

A

anti-hepatitis A immunoglobulin M (IgM anti-HAV)

-can be elevated for as long as 6 months

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34
Q

Hepatitis B Diagnosis

A
  • detectable serum HBV DNA levels

- persistent elevation of ALT and AST

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35
Q

High-risk patients w/ hepatitis B should do what?

A
  • screened every 6 to 12 months for HCC
  • screening includes an ultrasound and a serum alpha-fetoprotein (protein produced by the liver) level as a marker for liver cancer
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36
Q

Non-Viral Forms of Hepatitis are caused by?

A

ingested, inhaled, or injected toxins or medications

-if it is determined that the patient has been exposed to a liver toxin and the toxin is removed, recovery can be rapid

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37
Q

Clinical Manifestations of non-viral forms of hepatitis

A
  • anorexia
  • N/V
  • jaundice
  • hepatomegaly (enlarged liver)
38
Q

Diagnostic Testing for liver disorders

A
  • ALT
  • AST
  • Alkaline phosphate (total)
  • GGT (Gamma Glutamyl Transferase)
  • LDH (Lactate Dehydrogenase)
  • Bilirubin (total, indirect, direct)
  • Albumin
  • Ammonia
  • Coagulation Tests (prothrombin time, activated partial thromboplastin time (aPTT)
  • Platelets
39
Q

ALT

A

Males: 13 to 40 units/L
Females: 24-36 units/L
>levels can be elevated for 1 to 2 months; can take as long as 3 to 6 months to return back to normal

40
Q

AST

A

Males: 20 to 40 units/L
Females: 15 to 35 units/L
>remain elevated for 1 to 2 months; take as long as 3 to 6 months to return to normal

41
Q

Alkaline Phosphate (total)

A

Males: 35-142 units/L
Females: 24-125 units/L
>enzyme found in bone, intestine, liver, and bile ducts
>elevated = a blockage of bile flow that can be caused by gallstones or scarring in biliary tree

42
Q

Alkaline Phosphate (Liver Fraction)

A

0-93 units/L

43
Q

Gamma Glutamyl Transferase (GGT)

A

Males: 0-30 units/L
Females: 0-24 units/L
>indicate abnormalities of bile flow
>a protein found in the liver and bile ducts
>high levels can indicate inflammation, injury, or blockage of bile ducts (cholestasis)

44
Q

Lactate Dehydrogenase (LDH)

A

90-176 units/L
>is a test for an enzyme that is produced by many organs in the blood as the result of tissue damage
>used as a conjunction w/ other tests to determine presence and severity of liver dysfunction

45
Q

Bilirubin (total)

A
  1. 3 to 1 mg/dL

- by-product of the breakdown of RBCs that is filtered through the liver

46
Q

Bilirubin (indirect)

A
  1. 2 to 0.8 mg/dL
    - “unconjugated bilirubin”
    - measures the serum level of bilirubin before it gets to the liver
47
Q

Bilirubin (Direct)

A
  1. 1 to 0.3 mg/dL
    - once in the liver, indirect bilirubin is changed to direct bilirubin while it binds to certain sugars
    - direct bilirubin is released into the bile and stored in the gallbladder
    - when the liver is unable to conjugate the bilirubin b/c of dysfunction, levels are elevated, and pts develop jaundice
48
Q

Serum Albumin

A
  1. 4 to 5.1 g/dL
    - measures the amount of protein that is made by the liver
    - low serum albumin may be an indicator of liver damage and malnutrition
49
Q

Serum Ammonia

A

15 to 60 mcg/dL

50
Q

Prothrombin time (PT)

A

10 to 13 seconds

51
Q

Activated partial thromboplastin time (aPTT)

A

25 to 35 seconds

52
Q

Platelets

A

150,000 to 450,000 mm3

53
Q

Medications

A
  • oral antiviral agents for viral suppression
  • use of immune globulin is recommended if exposure to the source of hepatitis A was less than 2 weeks
  • hepatitis A vaccine
  • pegylated interferon injections
  • hepatitis B vaccine
54
Q

Pegylated Interferon Injection

A
  • work toward viral suppression

- can be given weekly or multiple times a week for 6 to 12 months

55
Q

Diet and Activity

A
  • low in fat
  • high in fruits, vegetables, and whole grains
  • adequate oral intake to ensure hydration
  • eat small frequent meals
  • avoid alcohol
  • avoid medications toxic to liver (acetaminophen)
  • vitamin supplements of A, D, E, and K
  • walking, resistance training, and low-impact aerobics help maintain strength and minimize fatigue
  • balance of rest and exercise
56
Q 
Connection Check: In reviewing diagnostic results of a patient w/ suspected hepatitis, the nurse correlates which result as consistent with hepatitis A?
A. Prolonged prothrombin time (PT)
B. Decreased WBC count
C. Presence of IgM anti-HAV
D. Detectable serum HBV DNA
A

C. Presence of IgM anti-HAV

57
Q

Surgical Management: Liver Transplant

A
  • Hepatitis C-related cirrhosis is most common reason for liver transplant
  • orthotopic liver transplant
58
Q

Orthotopic Liver Transplant

A

-the native diseased liver is removed, and a cadaver donor liver is transplanted in it space

59
Q

Major Complications after liver transplant

A
  • organ rejection

- infection

60
Q

Complication: Organ rejection

A
  • presents between days 4 and 10 post-op

- fever, RUQ pain, tachycardia, changes in bile, jaundice

61
Q

How to reduce the risk of rejection after liver transplantation?

A
  • placed on immunosuppression medications (cyclosporine and tacrolimus)
  • these meds may increase risk of infection
62
Q

Nursing Management: Assessment and Analysis

A

clinical manifestations in a patient w/ hepatitis are directly associated w/ the inability of the liver to perform its normal functions b/c of inflammation

  • Elevated temperature r/t inflammation
  • Elevated liver enzymes (AST, ALT)
  • Jaundice
  • Fatigue
  • Decreased appetite
63
Q

Nursing Diagnoses

A
  • Activity intolerance associated w/ fatigue, fever, flu-like symptoms
  • Acute pain associated w/ edema of the liver
  • Altered nutrition (less than body requirements) associated w/ decreased liver metabolic function secondary to loss of appetite, nausea, and vomiting
  • Altered thought processes associated w/ elevated serum ammonia levels secondary to liver dysfunction
  • Knowledge deficit associated w/ the disease process
64
Q

Nursing Assessment for Hepatitis

A
  • Vital signs
  • Serum Liver Enzymes
  • Serum Bilirubin
  • Color of skin, sclera
  • Nutritional intake
  • Daily weight
  • Intake and Output
  • Signs of organ rejection in the patient after liver transplantation
65
Q

Assessments: Vital Signs

A

elevation in temperature and pulse (tachycardia) associated w/ infectious process

66
Q

Assessment: Serum Liver Enzymes

A

Elevated levels of liver enzymes indicate that liver injury is present and liver enzymes have entered the blood stream

67
Q

Assessment: Serum Bilirubin

A
  • Bilirubin is a by-product of red blood cell breakdown
  • The Liver is responsible for removing bilirubin in the blood
  • Total bilirubin and direct, or conjugated, bilirubin levels are elevated b/c of inflammation and obstruction of the liver by hepatitis; it cannot remove the bilirubin in the blood
68
Q

Assessment: Color of skin, sclera

A
  • Yellow pigmentation of the eyes and skin occurs b/c of increased bilirubin levels in the blood
  • Deep jaundice may result in a greenish tint to the skin d/t by-products of bilirubin conversion
69
Q

Assessment: Nutritional Intake

A
  • loss of appetite occurs b/c of abdominal fullness or the lack of desire to eat foods the patient previously enjoyed as a result of indigestion
  • occurs frequently w/ fatty foods and alcohol
70
Q

Assessment: Daily Weight

A
  • monitors nutritional intake and evaluates weight loss associated w/ decreased nutritional intake
  • anorexia may develop secondary to abdominal distention and obstruction
  • increase in body weight may be secondary to ascites
71
Q

Assessment: Intake and Output

A
  • fluid volume status, either overload or depletion, may occur
  • fluid overload associated w/ ascites that develops secondary to damage to the liver by the inflammatory and infectious processes seen w/ hepatitis
72
Q

Assessment: Signs of organ rejection in patient after liver transplantation

A

in patients who undergo transplantation for cirrhosis, organ rejection may occur within the first 10 days after procedure
-include RUQ pain, changes in bile drainage, fever, tachycardia, and jaundice

73
Q

Nursing Actions for Hepatitis

A
  • Administer medications as ordered
  • Provide small, frequent meals and supplements (PRN)
  • Administer antiemetics
  • Promote balance between physical activity and rest
  • Encourage rest periods between walking and physical activity; maintains strength/conditioning
74
Q

Actions: Provide small, frequent meals and supplements (as needed)

A

b/c of decreased appetite and feelings of fullness, small frequent meals and nutritional supplements are encouraged to promote adequate nutrition

75
Q

Actions: Administer antiemetics

A
  • decrease symptoms of N/V associated w/ the virus, which may occur for a prolonged period of time
  • Use caution; some antiemetics (phenothiazines) are metabolized by the liver and should not be used
76
Q

Actions: Promote balance between physical activity and rest

A

rest decreases metabolic demands on the liver

77
Q

Nursing Patient Teachings

A
  • Nutritional teaching
  • Good hand hygiene before and after meals and use of the bathroom to decrease transmission from fecal-oral route
  • Avoid behaviors (needle sharing, unprotected sex) that contribute to transmission
  • Importance of Vaccinations to prevent hepatitis A and B
  • Safe public water supply, sewage
78
Q

Nutritional Teachings

A
  • importance of balanced nutrition to promote energy
  • small, frequent meals to increase nutritional intake while minimizing the negative effects of eating
  • patients w/ N/V tend to limit food intake
  • stress calorie intake
  • proteins in moderate doses b/c the liver processes protein
  • vitamins and minerals w/ balanced diet or supplements
  • limit fat intake b/c the liver may not be able to make enough bile to process fats
  • small, frequent meals are indicated b/c the liver cannot store glycogen for energy b/c of inflammation
  • hydration to manage symptoms; dizziness, fatigue, skin and mucus membrane dryness and side effects of any medications
  • alcohol and caffeine avoided b/c they cause dehydration
79
Q

Importance of Vaccinations to prevent Hepatitis A and B

A
  • Hepatitis A vaccine can prevent hepatitis A
  • Recommended for healthcare workers, food handlers, child-care workers, and travelers to endemic hepatitis A areas
  • Series of two injections (initial and booster 6-12 months later)
  • Vaccine effective for as long as 20 years
  • Hepatitis B vaccine can prevent hepatitis B and the serious consequences of HBV infection including liver cancer and cirrhosis
  • given as a series of several injections
  • gives long-term protection from HBV
  • recommended for everyone
80
Q

Teachings: Safe water supply, sewage

A
  • consider the water source and whether the public water supply is safe from sewage
  • infected fecal matter can transmit hepatitis A
81
Q

Evaluating Care Outcomes

A
  • Hepatitis is a manageable disease process when patients have a clear understanding of the disease and are compliant w/ interventions and therapies
  • Expected outcomes = stable vital signs, stable weight, and comprehensive understanding of risk factors, transmission, and treatment of hepatitis
  • Additional outcomes = decrease in liver function test values while the infection is resolving
  • Lifestyle activities that contribute to liver disease should be altered or eliminated to slow the progression of the disease
  • Knowledge of diet, nutritional intake, activity tolerance, and compliance w/ medical interventions
  • Require serial follow-up and monitoring of symptoms
  • Should take a proactive role in their self-care
82
Q

Hepatitis A Vaccine

A

> Recommended for:
-healthcare workers, restaurant workers, food handlers, persons traveling to areas w/ endemic hepatitis A. children and workers in child care, those w/ risky behaviors (illegal injected drug users), and persons with chronic liver disease
One injection followed by a booster dose 6-12 months later
Vaccine effective for 15-20 years
Protection from vaccine occurs 2-4 weeks after vaccination

83
Q

Hepatitis B Vaccine

A
  • Recommended for everyone, including newborns
  • Series of 3 injections over 6 to 12 months
  • Effective for 15 years or longer
84
Q

Approved Agents for Hepatitis A

A

None

-Hep A vaccine

85
Q

Approved Oral Agents for Hepatitis B

A

> tenofovir, entecavir, lamivudine, telbivudine

  • all oral agents are given once a day for 1 year or longer
  • Action: viral suppression and remission
  • Side effects: limited
  • Treatment response: based on serial monitoring of liver enzymes
86
Q

Approved Injection Agent for Hepatitis B

A
  • Interferon-alpha

- Pegylated interferon

87
Q

Injection: Interferon-alpha

A
  • for hepatitis B
  • injection several times a week (6-12 months)
  • Action: viral suppression
  • Side effects: flu-like symptoms, depression, fatigue, headaches, thyroid problems
88
Q

Injection: Pegylated interferon

A
  • for hep B
  • weekly injection (6-12 months)
  • Action: Viral Suppression
  • Side Effect: flu-like symptoms, depression, fatigue, headaches, thyroid problems
89
Q

Approved Agents for Hepatitis C

A
  • Pegylated Interferons
  • Ribavirin
  • Combination therapy; peginterferon w/ ribavirin, interferon w/ ribavirin
  • Harvoni (sofosbuvir + ledipasvir); polymerase inhibitor
90
Q

Interferon Therapy for Hepatitis C

A
  • lasts 12- 8 months
  • Action: viral suppression
  • Treatment response: serum test for presence of Hep C
91
Q

Ribavirin Therapy for Hep C

A
  • lasts 48 weeks
  • action: viral suppression
  • treatment response: serum test for presence for Hep C
92
Q

Polymerase Inhibitor: Harvoni

A
  • for Hep C
  • 8-12 weeks of treatment
  • Action: direct acting antiviral
  • Side Effects: severe forms of anemia, fatigue, headache, nausea, diarrhea, insomnia, weakness

Nursing 272: Final Semester (79 decks)

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