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Focus on Hepatitis (Relates to Chapter 44, “Nursing Management: Liver, Pancreas, and Biliary Tract Problems” in the textbook) Copyright © 2010, 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved. Hepatitis • Inflammation of the liver • Viral hepatitis Most common cause Copyright © 2010, 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved. Hepatitis (Cont’d) • Types of infectious viral hepatitis A B C D E G Copyright © 2010, 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved. Hepatitis (Cont’d) • Other possible causes Drugs (alcohol) Chemicals Autoimmune liver disease Bacteria (rarely) Copyright © 2010, 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved. Hepatitis (Cont’d) • 61,000 cases of hepatitis A occur annually in the United States • 10 million cases of hepatitis A occur worldwide Nearly universal during childhood in developing countries Copyright © 2010, 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved. Hepatitis (Cont’d) • Nearly 400 million people infected with hepatitis B 50% to 75% active vial replication • 73,000 new cases of hepatitis B annually in United States Incidence decreased due to HBV vaccine Copyright © 2010, 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved. Hepatitis (Cont’d) • Approximately 170 million people are infected with the hepatitis C virus (HCV) • Estimated 30,000 new cases diagnosed annually Copyright © 2010, 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved. Hepatitis (Cont’d) • 8000 to 10,000 people in the United States die each year from complications of end-stage liver disease secondary to HCV • Approximately 30% to 40% of HIV-infected patients also have HCV Copyright © 2010, 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved. Etiology • Causes A, B, C, D, E, and G virus Cytomegalovirus Epstein-Barr virus Herpes virus Coxsackievirus Rubella virus Copyright © 2010, 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved. Etiology (Cont’d) • Hepatitis A virus (HAV) RNA virus Transmitted fecal-oral route, parenteral (rarely) Frequently occurs in small outbreaks Copyright © 2010, 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved. Etiology • Hepatitis A virus (HAV) (cont’d) Found in feces 2 or more weeks before the onset of symptoms and up to 1 week after the onset of jaundice Present in blood briefly No chronic carrier state Copyright © 2010, 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved. Serologic Events in HAV Infection Fig. 44-2 Copyright © 2010, 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved. Etiology • Hepatitis A virus (HAV) (cont’d) Anti-HAV immunoglobulin M (IgM) • Appears in the serum as the stool becomes negative for the virus • Detection of IgM anti-HAV indicates acute hepatitis Copyright © 2010, 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved. Etiology • Hepatitis A virus (HAV) (cont’d) Anti-HAV immunoglobulin G (IgG) • IgG anti-HAV: Indicator of past infection • Presence of IgG antibody provides lifelong immunity Copyright © 2010, 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved. Etiology • Hepatitis B virus (HBV) DNA virus Transmission of HBV • Perinatally by mothers infected • Percutaneously (IV drug use) • Horizontally by mucosal exposure to infectious blood, blood products, or other body fluids Copyright © 2010, 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved. Etiology • Hepatitis B virus (HBV) (cont’d) Transmission occurs when infected blood or other body fluids enter the body of a person who is not immune to the virus Copyright © 2010, 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved. Etiology • Hepatitis B virus (HBV) (cont’d) Sexually transmitted disease Can live on a dry surface for 7 days Kissing/sharing food items may spread the virus via saliva More infectious than HIV Copyright © 2010, 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved. Serologic Events in HBV Infection Fig. 44-3 Copyright © 2010, 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved. Etiology • Hepatitis B virus (HBV) (cont’d) Complex structure with three antigens • Surface antigen (HBsAg) • Core antigen (HBcAg) • E antigen (HBeAg) Each antigen—a corresponding antibody may develop in response to acute viral hepatitis B Copyright © 2010, 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved. Etiology • Hepatitis B virus (HBV) (cont’d) Presence of hepatitis B surface antibodies • Indicates immunity from HBV vaccine • Past HBV infection With chronic infection, liver enzyme values may be normal or ↑ 15% to 25% of chronically infected persons die from chronic liver disease Copyright © 2010, 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved. Etiology • Hepatitis C virus (HCV) RNA virus Transmitted percutaneously Copyright © 2010, 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved. Etiology • Hepatitis C virus (HCV) (cont’d) Risk factors • IV drug use • Most common mode of transmission in United States and Canada • Blood transfusions • Transmission <1 per 1 million blood transfusions Copyright © 2010, 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved. Etiology • Hepatitis C virus (HCV) (cont’d) Risk factors (cont’d) • High-risk sexual behavior • Hemodialysis • Occupational exposure • Perinatal transmission Copyright © 2010, 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved. Etiology • Hepatitis C virus (HCV) (cont’d) Up to 10% of patients with HCV cannot identify a source Additional data needed regarding risk of body piercings, tattooing, and intranasal drug use in transmission of HCV Copyright © 2010, 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved. Etiology • Hepatitis D virus (HDV) Also called delta virus Defective single-stranded RNA virus Cannot survive on its own Requires the helper function of HBV to replicate Copyright © 2010, 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved. Etiology • Hepatitis D virus (HDV) (cont’d) HBV-HDV co-infection • ↑ Risk of fulminant hepatitis • More severe acute disease Copyright © 2010, 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved. Etiology • Hepatitis E virus (HEV) RNA virus Transmitted fecal-oral route Most common mode of transmission is drinking contaminated water Occurs primarily in developing countries Copyright © 2010, 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved. Etiology (Cont’d) • Hepatitis G virus (HGV) RNA virus Poorly characterized parenterally and sexually transmitted virus Found in some blood donors Can be transmitted by blood transfusion Copyright © 2010, 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved. Etiology • Hepatitis G virus (HGV) (cont’d) Coexists with other hepatitis viruses and HIV Does not appear to cause liver damage Copyright © 2010, 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved. Pathophysiology • Acute infection Liver damage mediated by • Cytotoxic cytokines • Natural killer cells Liver cell damage results in hepatic cell necrosis Copyright © 2010, 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved. Pathophysiology • Acute infection (cont’d) Proliferation and enlargement of Kupffer cells Inflammation of the periportal areas may interrupt bile flow Cholestasis may occur Copyright © 2010, 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved. Pathophysiology • Widespread inflammation of the liver tissue • Pathophysiologic changes in the various types of viral hepatitis are similar Copyright © 2010, 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved. Pathophysiology (Cont’d) • Liver cells can regenerate with time and, if no complications occur, resume their normal appearance and function Copyright © 2010, 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved. Pathophysiology (Cont’d) • Antigen-antibody complexes • Systemic effects of this activation include • Rash • Angioedema • Arthritis • Fever • Malaise Copyright © 2010, 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved. Pathophysiology • Systemic effects (cont’d) Fever Malaise Cryoglobulinemia • Abnormal proteins in blood Glomerulonephritis Vasculitis Copyright © 2010, 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved. Clinical Manifestations • 30% of patients with HBV are asymptomatic • 80% of patients with acute HCV will be asymptomatic Copyright © 2010, 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved. Clinical Manifestations (Cont’d) • Acute phase Lasts from 1 to 4 months May be icteric (symptomatic) or anicteric During incubation, symptoms include • Malaise • Anorexia • Fatigue • Nausea Copyright © 2010, 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved. Clinical Manifestations • Acute phase (cont’d) Symptoms (cont’d) • Nausea • Occasional vomiting • Abdominal discomfort • Headache • Low-grade fever Copyright © 2010, 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved. Clinical Manifestations • Acute phase (cont’d) Symptoms (cont’d) • Arthralgias • Skin rashes Physical exam may reveal hepatomegaly, lymphadenopathy, and splenomegaly Maximal infectivity period for hepatitis A Copyright © 2010, 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved. Clinical Manifestations • Jaundice Results when bilirubin diffuses into tissues • Urine darkens due to excess bilirubin being excreted • If bilirubin cannot flow out of liver, stool will be light or clay-colored Copyright © 2010, 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved. Severe Jaundice Fig. 44-1 Copyright © 2010, 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved. Clinical Manifestations • Pruritus can accompany jaundice Accumulation of bile salts beneath the skin • When jaundice occurs, fever subsides • Liver usually enlarged and tender Copyright © 2010, 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved. Clinical Manifestations (Cont’d) • Convalescent phase Begins as jaundice is disappearing Lasts weeks to months Major complaints • Malaise • Easy fatigability Copyright © 2010, 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved. Clinical Manifestations (Cont’d) • Almost all cases of hepatitis A resolve • Absence of jaundice does not mean recovery Copyright © 2010, 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved. Clinical Manifestations (Cont’d) • General considerations Not all patients with hepatitis virus have jaundice • Termed anicteric hepatitis Copyright © 2010, 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved. Clinical Manifestations (Cont’d) • General considerations Hepatitis A virus • Acute onset • Mild, flu-like manifestations Copyright © 2010, 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved. Clinical Manifestations • General considerations (cont’d) Hepatitis B virus • Insidious onset • Symptoms more severe • Fewer GI symptoms Copyright © 2010, 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved. Clinical Manifestations • General considerations (cont’d) Hepatitis C virus • Majority of cases are asymptomatic or mild • High rate of persistence • Leads to chronic liver disease Copyright © 2010, 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved. Complications • Most patients with acute viral hepatitis recover completely with no complications • Overall mortality rate <1% Copyright © 2010, 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved. Complications (Cont’d) • • • • Fulminant hepatic failure Chronic hepatitis Cirrhosis Hepatocellular carcinoma Copyright © 2010, 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved. Complications (Cont’d) • Fulminant hepatitis Results in severe impairment or necrosis of liver cells and potential liver failure Copyright © 2010, 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved. Complications • Fulminant hepatitis (cont’d) Develops in small percentage of patients Occurs because of • Complications of hepatitis B • Toxic reactions to drugs and congenital metabolic disorders Copyright © 2010, 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved. Diagnostic Studies • Hepatitis C Several tests available Antibodies to HCV are not protective May be indicator of chronic disease Anti-HCV antibody test by immunoassay • If positive • Confirmatory testing must be done Copyright © 2010, 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved. Diagnostic Studies • Hepatitis C (cont’d) HCV recombinant immunoblot assay may be used if false-positive HCV antibody test HCV RNA polymerase chain reaction performed • Document viremia if antibody positive • To detect active disease Copyright © 2010, 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved. Diagnostic Studies • Hepatitis C (cont’d) 6 genotypes and 50 subtypes of HCV Genotyping: Important role in managing infection • One of the strongest predictors of response to therapy and influences duration of treatment • Should be determined before drug therapy started Copyright © 2010, 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved. Diagnostic Studies • History • Physical assessment findings Hepatic tenderness Hepatomegaly Splenomegaly Palpable liver Copyright © 2010, 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved. Diagnostic Studies (Cont’d) • • • • Aspartate aminotransferase (AST) Alanine aminotransferase (ALT) -Glutamyl transpeptidase (GGT) Alkaline phosphatase Copyright © 2010, 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved. Diagnostic Studies (Cont’d) • • • • Serum proteins Serum bilirubin Urinary bilirubin Urinary urobilinogen Copyright © 2010, 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved. Diagnostic Studies (Cont’d) • Prothrombin time • Biopsy If diagnosis is in doubt Chronic hepatitis • Sonograms (Fibroscan) Determining degree of liver scarring Copyright © 2010, 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved. Collaborative Care • No specific treatment or therapy for acute viral hepatitis • Most patients can be managed at home • Emphasis on resting the body and receiving adequate nutrients Copyright © 2010, 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved. Collaborative Care (Cont’d) • Drug therapy No specific drug therapies Support therapy • Antiemetics • • • • Dimenhydrinate (Dramamine) Trimethobenzamide (Tigan) Phenothiazines should not be used If requires sedative or hypnotic, diphenhydramine (Benadryl) or chloral hydrate may be used Copyright © 2010, 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved. Collaborative Care • Drug therapy (cont’d) Chronic hepatitis B • Focused on • • • • ↓ Viral load ↓ Liver enzyme levels ↓ Rate of disease progression ↓ Rate of drug-resistant HBV Copyright © 2010, 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved. Collaborative Care • Drug therapy (cont’d) Chronic hepatitis B (cont’d) • Long-term goals • Prevention of cirrhosis and liver cancer • Not all patients respond to current therapeutic regimens Copyright © 2010, 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved. Collaborative Care • Drug therapy (cont’d) Chronic hepatitis B (cont’d) • α-Interferon • Multiple effects on viral replication cycle • Must be administered subcutaneously • Side effects: Flu-like symptoms, depression, hair thinning, diarrhea, insomnia Copyright © 2010, 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved. Collaborative Care • Drug therapy (cont’d) Chronic hepatitis B (cont’d) • Nucleoside analogs • When active viral replication exists • Inhibit viral DNA synthesis • Lamivudine (Epivir) • Taken for 1 year • Adefovir (Hepsera) Copyright © 2010, 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved. Collaborative Care • Drug therapy (cont’d) Chronic hepatitis C • Directed at eradicating virus • Reducing viral load • Decreasing progression of disease Copyright © 2010, 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved. Collaborative Care • Drug therapy (cont’d) Chronic hepatitis C (cont’d) • Treatment • Pegylated α-interferon with ribavirin (Rebetol, Copegus) • Ribavirin side effects: Anemia, anorexia, cough, rash, pruritus, dyspnea, insomnia, teratogenicity Copyright © 2010, 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved. Collaborative Care Prevention • Hepatitis A Hepatitis A vaccine • Preexposure prophylaxis • IM in deltoid Immune globulin (IG) • Pre-/post-exposure • Temporary passive immunity Copyright © 2010, 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved. Collaborative Care (Cont’d) Prevention • Hepatitis B Immunization • Most effective method • Part of routine vaccination schedules for newborns, adolescents, and adults in major risk groups • Recombivax HB, Engerix-B Copyright © 2010, 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved. Collaborative Care Prevention • Hepatitis B (cont’d) Immunization (cont’d) • Recombinant DNA using HBsAg • Promotes synthesis of specific antibodies against hepatitis B • Series of three IM injections given at 0, 1, and 6 months • More than 95% effective Copyright © 2010, 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved. Copyright © 2010, 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved. Collaborative Care Prevention • Hepatitis B (cont’d) Hepatitis B immune globulin (HBIG) • Used for postexposure with vaccine • Contain antibodies to HBV • Should be given within 24 hours of exposure Copyright © 2010, 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved. Collaborative Care (Cont’d) Prevention • Hepatitis C No vaccine to prevent HCV CDC does not recommend IG or antiviral agents for postexposure prophylaxis Copyright © 2010, 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved. Collaborative Care Nutritional Therapy • No special diet • Vitamins (B-complex and vitamin K) • Low-fat • Adequate calories Copyright © 2010, 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved. Nursing Management Nursing Assessment • Past health history Hemophilia Exposure to infected persons Ingestion of contaminated food or water Past blood transfusion (before 1992) Copyright © 2010, 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved. Nursing Management (Cont’d) Nursing Assessment • Medications (use and misuse) Acetaminophen Phenytoin Halothane Methyldopa Copyright © 2010, 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved. Nursing Management (Cont’d) Nursing Assessment • IV drug and alcohol abuse • Weight loss • Dark urine • Fatigue • Right upper quadrant pain • Pruritus Copyright © 2010, 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved. Nursing Management (Cont’d) Nursing Assessment • Low-grade fever • Jaundice • Abnormal laboratory values Copyright © 2010, 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved. Nursing Management (Cont’d) Nursing Diagnoses • Imbalanced nutrition: Less than body requirements • Activity intolerance • Ineffective therapeutic regimen management Copyright © 2010, 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved. Nursing Management (Cont’d) • Overall goals: Planning Relief of discomfort Resumption of normal activities Return to normal liver function without complications Copyright © 2010, 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved. Nursing Management (Cont’d) Nursing Implementation • Health Promotion Hepatitis A and B • Education • Vaccination • Good hygiene practices Copyright © 2010, 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved. Nursing Management Nursing Implementation • Health Promotion (cont’d) Hepatitis C • Education • Infection control precautions • Modification of high-risk behavior Copyright © 2010, 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved. Nursing Management Nursing Implementation • Acute Intervention Rest Jaundice • Assess degree of jaundice • Small, frequent meals Copyright © 2010, 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved. Nursing Management Nursing Implementation • Ambulatory and Home Care Dietary teaching Assessment for complications Regular follow-up for at least 1 year after diagnosis Copyright © 2010, 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved. Nursing Management Nursing Implementation • Ambulatory and Home Care (cont’d) Avoid alcohol Medication education • α-Interferon administered subcutaneously • Side effects Copyright © 2010, 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved. Nursing Management Evaluation • Expected outcomes Adequate nutritional intake Increased tolerance for activity Verbalization of understanding of follow-up care Copyright © 2010, 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved. Nursing Management Evaluation • Expected outcomes (cont’d) Able to explain methods of transmission and methods of preventing transmission to others Copyright © 2010, 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved. Case Study Copyright © 2010, 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved. Case Study • 30-year-old male admitted to the hospital with general fatigue, lack of appetite, headaches, and yellowish complexion Copyright © 2010, 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved. Case Study (Cont’d) • Symptoms became progressive during the past few days • One month ago he was in Guadalajara, Mexico, where he ate a lot of seafood and Mexican food Copyright © 2010, 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved. Case Study (Cont’d) • Physical examination indicates an enlarged tender liver and icterus Copyright © 2010, 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved. Case Study (Cont’d) • Laboratory results show Hemoglobin 12 g/dl Bilirubin (direct) 5.6 mg/dl Bilirubin (indirect) 3.4 mg/dl Alkaline phosphatase 600 U/ml AST 1200 U/ml ALT 1510 U/ml • Urine positive for bilirubin Copyright © 2010, 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved. Discussion Questions 1. What type of hepatitis does he probably have? 2. How did he get infected? Copyright © 2010, 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved. Discussion Questions (Cont’d) 3. What is the treatment for the type of hepatitis he has? 4. What is the priority of his care? 5. What teaching topics are important to discuss with him? Copyright © 2010, 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved.