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EXAM 2 - MED SURG II
Hepatitis
| Question | Answer |
|---|---|
| Overall Hepatitis Symptoms | GI Symptoms (nausea, vomiting, stomach pain, loss of appetite), fever, very tired, dark colored urine (caused by bilirubin), clay-colored stool (no bilirubin), arthralgia (joint pain) |
| Hepatitis A | Most common transmission through fecal-oral. Most likely from contaminated food or water. Patients can be contagious two weeks BEFORE signs and symptoms appear, and 1-3 weeks after they disappear |
| Hepatitis B | Transmitted through blood and other body fluids like semen, saliva, amniotic, or vaginal fluids. Most commonly transmitted through sexual intercourse and Intravenous drug use. Can be acute, or chronic. Complications from this type includes cirrhosis, liver failure, or liver cancer. |
| Hepatitis C | Transmitted through blood and body fluids. Often spread via percutaneous (via skin through a puncture) or body fluid with mucosal route. Most commonly from intravenous drug use, sexual contact, donor blood (before 1992), sharp injuries, long-term dialysis |
| Hepatitis D | Only infects a person if they have Hepatitis B. Spread by blood and body fluid, via a puncture in the skin, or with fluids with mucosal route (same as Hep. B). |
| Hepatitis E | Transmitted through fecal-oral. From consuming contaminated food or water, or undercooked meat like pork or wild game. In acute infections it can cause major complications in pregnant women in the 3rd trimester. |
| Hepatitis A Treatment | There is none. It clears on it's own. However, rest and supportive treatment is provided. |
| Hepatitis B Treatment | In acute cases, none other than supportive treatment. In chronic cases, antiviral medications or interferon |
| Hepatitis C Treatment | Antiviral medications like direct acting antivrials (DAAs) |
| Hepatitis D Treatment | Antiviral medications or interferon (Peginterferon alfa-2a [Pegasys]) |
| Hepatitis E Treatment | None, rest and supportive treatment. |
| Hepatitis E Diagnostics | Antibodies to detect HEV |
| Hepatitis D Diagnostics | Presence of HDAg (hepatitis D antigen) and anti-HDV |
| Hepatitis C Diagnostics | Presence of anti-HCV (antibodies) for chronic infections. None for acute infections |
| Hepatitis B Diagnostics | HBsAg (Hepatitis B Surface Antigen) = infectious - educate to avoid sexual intercourse and intimacy like kissing until it is negative. Anti-HBs (Hepatitis B Surface Antibody) = recovered/ had a previous infection and is immune - possibly from hepatitis B vaccine. |
| Hepatitis A Diagnostics | Anti-HAV IgM = active infection (icteric phase). Anti-HAV IgG = past infection and recovered, now has immunity |
| Labs to Monitor in Hepatitis | Liver Enzymes (ALT, AST), Bilirubin, Ammonia Level |
| Alanine Transaminase (ALT) Level | 7-56 U/L (will be elevated) |
| Aspartate Transaminase (AST) Level | 10-40 U/L (will be elevated) |
| Bilirubin Level | <1 mg/dL (will be elevated with hepatitis - causes jaundice and dark urine) |
| Ammonia Level | 15-45 mcg/dL (elevated with hepatitis and will see as mental status changes) |
| Lactulose | administered for high ammonia levels. Causes diarrhea but lowers ammonia level |
| The main medication used for viral hepatitis | Interferons. -- Peginterferon alfa-2a can be given once per week and keeps blood levels constant, it has largely replaced other interferons for combination therapy with ribavirin for hepatitis. |
| Aldesleukin Black Box Warning | Only patients with normal cardiac and pulmonary functions should receive the drug, and administration should occur in a hospital setting with critical care expertise and beds under the supervision of an oncologist |
| Oprelvekin Black Box Warning | risk of allergic or hypersensitivity reactions, including anaphylaxis. |
| Nucleoside Analogs (lamivudine) Black Box Warning | There are reports of lactic acidosis and severe hepatomegaly with steatosis. |
| Preicteric (Prodromal) Phase of Hepatitis | Body symptoms = joint pain, fatigue, nausea, vomiting, abdominal pain, change in taste, liver enzymes and bilirubin increase |
| Icteric Phase of Hepatitis | Decrease in body symptoms but will have jaundice and dark colored urine (build-up of bilirubin) and clay colored stool (bilirubin is not in the stool to give it the normal brown color) and enlarged liver, and pain in this area |
| Posticteric (Convalescent) Phase of Hepatitis | Jaundice and dark color urine start to subside, and stool returns to normal brown color. Liver enzymes and bilirubin decrease to normal |
| Hepatitis A Prevention | Handwashing and vaccine (given two doses, 6 months a part as part of the pediatric vaccine schedule). If traveling out of US, receive immune globin (IG). Ig you come in contact with someone with the virus. You need to receive IG within two weeks of exposure. Provides temporary passive immunity. |
| Hepatitis B Preventing | Handwashing, vaccine for all infants (3-4 doses over 6-18 months) and people at risk |
| Hepatitis C Prevention | Handwashing, NO VACCINE currently available or immune globulin for post-exposure. Follow sharp precautions, strict blood and organ donation screening |
| Hepatitis D Prevention | Handwashing, getting Hepatitis B Vaccine. NO VACCINE for this type or post-exposure immune globulin |
| Hepatitis E Prevention | Handwashing, NO VACCINE, cook meat thoroughly |
| Hepatitis | Viral infection in which necrosis and inflammation of liver cells produced a characteristic cluster of clinical, biochemical, and cellular changes. There are 5 definitive types A, B, C, D, E |
| Nursing Management in Hepatitis | Convalescence may be prolonged, with complete symptomatic recovery sometimes requiring 3-4 months or longer. Gradual resumption of physical activit is encourage fter jaundice is resolved. Identify psychosocial issues and concerns, particullary of separation from family and friends in infective stages. Even if not hospitalized, must avoid sexual contact. |
| Nonviral Hepatitis | Certain chemicals have toxic effects on the liver and produce acute liver cell necrosis or toxic hepatitis when inhaled, injected parenterally, or taken by mouth. Some chemicals commonly implicated in this disease include carbon tetrachloride and phosphorus. These substances are true hepatotoxins. Many medications can induce hepatitis but are only sensitizing rather than toxic. |
| All Hepatitis Treatments | induce significant adverse effects including fever, chills, anorexia, nausea, myalgias, and fatigue. Delayed side effects are more serious and may necessitate dosage reduction or discontinuation including bone marrow suppression, thyroid dysfunction, alopecia, and bacterial infections. |
| Drug-induced hepatitis | similar to acute viral hepatitis, but parenchymal destruction tends to be more extensive. Medications that can lead to hepatitis include isoniazid, halothane, acetaminophen, methyldopa, and certain antibiotics, antimetabolites, and anesthetic agents. |
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