NSG 3800 Exam 4 Final

· on there

· Jones

· Ml




UNIT 9
LAB VALUES TO KNOW:
● ↑ PT (11-12.5sec)
● ↑ PTT (20-30 sec)
○ ↓ PLATELETS (150,000-400,000)
○ ↓ FIBRINOGEN w/liver dysfunction
● ↑ AMMONIA (15-110 mcg/dL)
● CALCIUMO G
9-10.5, GLUCOSE 70-110, ALT 4-36 IU/mL, AST 0-35 IU/L
● ALBUMIN 3.5-5 **HYPOALBUMINEMIA = <3.5 MEANS JAUNDICE IF HAVE LIVER DISEASE
fluid retention
HEPATITIS A + ↳


● RNA virus Transmitted via FECAL-ORAL route
○ usually ingestion of contaminated foods/WATER
■ Make sure you have clean sources of food & water
○ Oral-anal sexual contact
○ Incubation period: 2-6wks
○ Illness lasts 4-8wks
● Manifestations:
○ Anicteric: w/o jaundice
○ HA, malaise, fatigue, anorexia, fever [preicteric phase]
○ Dark urine, jaundice, tender liver [icteric phase]
○ Epigastric distress, heartburn, flatulence,
○ Aversion to tasting or being in the presence of cigarettes
● Assessment & DX:
○ HAV+ antigen in the stool 7-10 days b4 s/s and 2-3wks after
○ HAV AB in the serum
● Prevention:
○ HH, safe water supply, HAV vaccine(3 doses)
○ Immune globulin for household members/sexual contacts**
● Medical Management:
○ IV fluids w/ glucose (for anorexia period)
○ Bed rest
○ Small frequent meals
○ Avoid drugs that affect liver function + St. John's wort
○ Monitor fluid balance
○ Immunization: IgA + = check whole family and admin Hep A vaccine
● Nursing management:
○ Rest, follow up blood work, NO ALCOHOL+ acetaminophen, HH!
HEPATITIS B bleeding perc

O
● Transmitted via BLOOD, SALIVA, SEMEN, VAGINAL SECRETIONS
○ Seen more in ppl with MULTIPLE SEXUAL partners (college age)**
○ Need to be on STANDARD PRECAUTIONS!! WEAR PPE B/C BODY & BLOOD FLUIDS**
○ Healthcare provider at risk = phlebotomist, dialysis & accu checks
● Geriatric considerations: Hep B is more severe in OLDER ADULTS
● Incubation period: 1-6mo
● Manifestations:
○ Arthralgias, rash, RR s/s
○ Loss of appetite, dyspepsia
○ Abdominal pain, general aching
○ Malaise, weakness
○ Muscle aches
○ Jaundice, splenomegaly(palpable)

, ● Medical Management:
○ Alpha interferon (given by injection)
■ SE: fever, chills, anorexia, nausea, myalgias,& fatigue
■ Severe SE= discontinue: bone marrow suppression, thyroid dysfunction,
alopecia, bacterial infections
○ ENTECAVIR(ETV) & TENOFOVIR(TDF) = antivirals
○ Lomudavine adverse effect = pancreatitis**
● Nursing Management:
○ Resume physical activity after jaundice resolves *TAKE REST PERIODS***
○ Active immunization HBV (3 doses)
○ Passive immunization HepB immunoglobulin IF EXPOSED TO IT**
○ Rest + diet + hydration to support convalescence
HEPATITIS C bleeding perc.
heatcarea
↳

S
● Transmitted via BLOOD and SEXUAL contact
○ Usually contaminated needles
○ DON'T SHARE toothbrushes
● Incubation period is 15-160 days
● Risk factor: being born from an infected Hep C mom
● *CAN BE ASYMPTOMATIC*
- Loc change from
encephalopathy
● Medications:
○ SVR therapy
○ Direct acting antivirals (DAA) sofosbuvir, ledipasvir, (basically -vir meds)
■ Antiviral meds / adhere to these meds **HAVE TO TAKE ANTIVIRALS**
● DX:
○ Test for anti-HCV antibodies**

HEPATITIS D bleedinga
O
● Only happens in ppl with existing Hep B
● Incubation period: 30-150 days
● COMMON IN:
○ IV drug users
○ Hemodialysis pts
○ Blood txfn pts
○ Sexual contact with Hep B pts
● Pts are more likely to progress to chronic/failure
● Interferon therapy is the only drug available
○ Recommended 1yr (high-dose long-duration therapy)
HEPATITIS E
● Transmitted via FECAL-ORAL route
○ Usually in contaminated water
■ Make sure you have clean sources of food & water
● Incubation period: 15-65 days
● Does not develop into chronic; it has abrupt onset
● *jaundice will always be present*
○ SKIN INTEGRITY: mild soaps, moisturize AFTER baths, cool compress, emollients, NO
ALCOHOL products**
● AVOID THROUGH HH*
ALCOHOLIC/TOXIC HEPATITIS
● Manifestations:
○ Anorexia
○ N/V/diarrhea
○ Jaundice + hepatomegaly
○ Hemorrhages under the skin