Nursing 212

Health Differences Across the Lifespan 2 Study Guide

• Icteric phase: marked by onset of jaundice; occurs about 2 weeks after prodromal phase and lasts 2-6 weeks; includes dark urine and clay colored stools before the appearance of jaundice and pruritus; liver remains enlarged and possible tender to touch • Recovery (posticteric) phase: begins with resolution of jaundice and lasts several weeks during which symptoms improve, energy levels increase, and serum enzymes normalize Diagnostics: • Antibodies to specific virus • Alkaline phosphate (ALP) can be elevated (evaluates liver or bone dysfunction) • Gamma glutamyl transferase (GGT) is acutely elevated with alcohol consumption and hepatotoxic drugs • Transaminases: ALT and AST elevated to a varying degrees • Bilirubin, both direct and indirect levels, may be elevated secondary to liver cell injury • Prothrombin time (PT) is prolonged if liver is injured to the point that it can no longer produce proteins necessary for blood coagulation Interventions: controlling spread of infection; report to local public health department for Hepatitis A and B; for Hepatitis A, patient requires a private bathroom and proper bagging, cleansing, and disposal of contaminated items; provide antiemetic medications as ordered and encourage a high CHO diet, low in fat, with the abstinence from alcohol; if liver function is compromised, protein and salt should be restricted; IV fluids as ordered; encourage bedrest initially and very gradual increase in activity as tolerated; monitor for signs of dehydration and monitor electrolyte status; inform patient they may never donate blood; observe for blood in stool, urine, multiple ecchymosis, petechiae, or oozing blood from gums or minor cuts, which may indicate a complication Medications: symptom relief; Hepatitis B vaccination is a series of three intramuscular injections to adults, children, and infants with the second and third injections given at 1 and 6 months after initial injection; efficacy of vaccination is 95%; for Hepatitis C, combination therapy is used for 12-18 weeks or as long as 48 weeks with interferon alfa-2b and ribavirintherapy; antihistamines can be given for pruritus Inherited diseases that lead to Hepatitis are alpha-1 antitrypsin deficiency, hemochromatosis, Wilson's disease, galactosemia, and glycogen storage diseases. These interfere with the way the liver produces, processes, and stores enzymes, proteins, metals, and other substances the body needs to function properly. Liver biopsy: • Patient is NPO after midnight prior to biopsy; have compatible donor blood available

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