NR 325 – Exam 2 | Hepatic, Neurological, and Immune Disorders – Clinical
Summary & CM Guide
Hepatitis C Most serious form; can lead to cirrhosis, transmitted through IV drug use, high
risk sexual behavior, occupational exposure, dialysis, perinatal exposure, blood transfusions
before 1992.
Hepatitis D Can't survive on it's own, requires Hep. B virus to replicate, no vaccine
Hepatitis E Transmitted fecal oral route, contaminated drinking water (most common),
occurs primarily in developing countries.
CM of Hepatitis Malaise, fatigue, myalgia, arthalgias, hepatomegaly, jaundice/pruritis, RUQ
discomfort, anorexia/weight loss, fever/chills, dark urine or clay colored stools, N/V.
Cirrhosis of the liver Scarring/hardening of the liver, end stage liver failure, chronic
progressive disease (takes years to develop)
common causes: alcohol abuse and Hep. C
CM of cirrhosis Jaundice, peripheral edema, ascites, spider angiomas, palmar erythema,
coagulation disorders
Hepatic encephalopathy Neurotoxic effects of ammonia, liver breaks down protein into
ammonia but can't change it to urea to be excreted by the kidneys and causes a build up of
ammonia.
Causes confusion when ammonia gets into the brain, impaired LOC and inappropriate behavior,
sleep disturbances, asterixis (tremor of the hand), fector hepaticus (musty odor to breath)
Treatment is lactulose; patient excretes ammonia in their stool.
, Hepatotoxic drugs Anticoagulants, aspirin, NSAIDS, acetaminophen (tylenol)
Acute pancreatitis Acute inflammation of the pancreas
CM: abdominal tenderness, decreased/absent bowel sounds, severe LUQ or mid epigastric
abdominal pain/pain radiates to the back, crackles, aggravated when eating and not relieved by
vomiting, flushing, cyanosis/dyspnea, N/V, low grade fever, hypotension, jaundice, abdominal
skin discoloration (grey turners spots, cullen's sign)
Keep patient NPO to minimize pain.
Chronic pancreatitis Continuous inflammation of the pancreas caused by alcohol, gallstones,
or acute pancreatitis.
CM: abdominal pain, malabsorption or weight loss, contipation, steatorrhea (fatty stool), DM
Stroke ischemic o hemorrhage into the brain that results in death of brain cells.
TIA Symptoms typically last less than 1 hour, warning sign, pt on anticoagulants for the rest
of their life.
Right brain stroke Paralyzed left side, left sided neglect, spatial perceptual deficit, tends to
deny minimize problems, rapid performance and short attention span, impulsive, impaired
judgement, impaired time concepts.
Left brain stroke Paralyzed right side, impaired speech/language aphasias, impaired
right/left discrimination, slow performance/cautious, aware of deficits (depression/anxiety),
impaired comprehension related to language/math
Summary & CM Guide
Hepatitis C Most serious form; can lead to cirrhosis, transmitted through IV drug use, high
risk sexual behavior, occupational exposure, dialysis, perinatal exposure, blood transfusions
before 1992.
Hepatitis D Can't survive on it's own, requires Hep. B virus to replicate, no vaccine
Hepatitis E Transmitted fecal oral route, contaminated drinking water (most common),
occurs primarily in developing countries.
CM of Hepatitis Malaise, fatigue, myalgia, arthalgias, hepatomegaly, jaundice/pruritis, RUQ
discomfort, anorexia/weight loss, fever/chills, dark urine or clay colored stools, N/V.
Cirrhosis of the liver Scarring/hardening of the liver, end stage liver failure, chronic
progressive disease (takes years to develop)
common causes: alcohol abuse and Hep. C
CM of cirrhosis Jaundice, peripheral edema, ascites, spider angiomas, palmar erythema,
coagulation disorders
Hepatic encephalopathy Neurotoxic effects of ammonia, liver breaks down protein into
ammonia but can't change it to urea to be excreted by the kidneys and causes a build up of
ammonia.
Causes confusion when ammonia gets into the brain, impaired LOC and inappropriate behavior,
sleep disturbances, asterixis (tremor of the hand), fector hepaticus (musty odor to breath)
Treatment is lactulose; patient excretes ammonia in their stool.
, Hepatotoxic drugs Anticoagulants, aspirin, NSAIDS, acetaminophen (tylenol)
Acute pancreatitis Acute inflammation of the pancreas
CM: abdominal tenderness, decreased/absent bowel sounds, severe LUQ or mid epigastric
abdominal pain/pain radiates to the back, crackles, aggravated when eating and not relieved by
vomiting, flushing, cyanosis/dyspnea, N/V, low grade fever, hypotension, jaundice, abdominal
skin discoloration (grey turners spots, cullen's sign)
Keep patient NPO to minimize pain.
Chronic pancreatitis Continuous inflammation of the pancreas caused by alcohol, gallstones,
or acute pancreatitis.
CM: abdominal pain, malabsorption or weight loss, contipation, steatorrhea (fatty stool), DM
Stroke ischemic o hemorrhage into the brain that results in death of brain cells.
TIA Symptoms typically last less than 1 hour, warning sign, pt on anticoagulants for the rest
of their life.
Right brain stroke Paralyzed left side, left sided neglect, spatial perceptual deficit, tends to
deny minimize problems, rapid performance and short attention span, impulsive, impaired
judgement, impaired time concepts.
Left brain stroke Paralyzed right side, impaired speech/language aphasias, impaired
right/left discrimination, slow performance/cautious, aware of deficits (depression/anxiety),
impaired comprehension related to language/math
