Nursing 213

N213: Health Differences Across the Lifespan 3 Study Guide

Nursing assessment for Hepatitis B and C: • Pre-icteric phase: Day 1 through 21 o Head to toe general assessment o

Inquire about fatigue level, appetite (anorexia), and GI symptoms o Take temperature o Inquire about muscle and joint pain, headaches, rash, and sensitivity to light (photophobia) o Assess for swelling (edema) to extremities, angioedema, weight loss, and lossof muscle tone • Icteric phase: Weeks two through four o Palpate liver for enlargement and tenderness o Assess skin for itching and dryness (pruritis) and jaundice o Check urine for color o Check stools for light colored bowel movements • Post-Icteric phase (convalescent phase): Two to Four months o Skin assessments show disappearance of jaundice, but it may return o Assess for fatigue and activity intolerance o Palpate for enlarged and tender liver • For all three phases review laboratory and radiology reports: o CBC with differential o Clotting analysis PT, PTT, and Platelets o Liver panels; liver enzymes, AST (SGOT), ALT (SGPT) o Testing for hepatitis antigens; HBsAg, HBsAb, andHbe-Ab o Urinalysis o Liver biopsies o Ultrasound of liver and spleen Nursing diagnosis for Hepatitis B and C: • Altered comfort levels related to inflammation and pain • Altered nutritional status; less than body requirements related to anorexia • Altered body temperature related to fever • Activity intolerance related to fatigue, pain, and nutritional status secondary to viral infection • Knowledge deficit related to disease process, medications, and disease transmission • Fluid volume deficit related to gastrointestinal symptoms; nausea, vomiting, and pain

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