hepatic disorders

Question 1

functional cells of the liver

Answer 1

hepatocytes

Question 2

portal vein

Answer 2

carries absorbed products of digestion directly to the liver; branches in the liver where it comes into contact with each lobule

Question 3

functions of the liver

Answer 3

prevents shortages of nutrients by storing vit, minerals, sugar

produces most proteins needed by body

produces bile, a compound needed to digest fat and absorb vit A, D, E, K

produces most of the substances that regulate blood clotting

helps body fight infection by removing bacteria

metabolizes nutrients from food to produce energy

removes toxic byproducts of medications

Question 4

causes of hepatitis

Answer 4

viral (most common)
drugs (alcohol)
chemicals
autoimmune diseases
metabolic abnormalities

Question 5

route of transmission for hep A

Answer 5

fecal-oral (a lot of people in small area)

Question 6

incubation period for hep A

Answer 6

15-50 days; most infectious 2 weeks before symptoms and 1-2 weeks after

Question 7

risk factors for hep A

Answer 7

crowded conditions (family members, institutionalized, workers at day care)
poor sanitation
contaminated food products

Question 8

route of transmission for hep B

Answer 8

percutaneous
sexual contact
perinatal

Question 9

incubation period for hep B

Answer 9

45-180 days

Question 10

route of transmission for hep C

Answer 10

percutaneous
sexual contract
perinatal

Question 11

incubation period for hep C

Answer 11

14-180 days

Question 12

risk factors for hep C

Answer 12

contaminated needles
blood products
sex with infected partner
men having sex with men

Question 13

hep A

Answer 13

mild flu-like symptoms, acute with jaundice
incidence decreased with vaccination
RNA virus transmitted via fecal-oral route
contaminated food or drinking water

Question 14

hep A education

Answer 14

good hygiene, proper handling of food, cautious in crowds, sanitary conditions

Question 15

hep B

Answer 15

acute or chronic
incidence decreased with vaccination
DNA virus transmitted perinatally, percutaneously, mucosal exposure
can live in saliva

Question 16

at risk for hep B

Answer 16

men who have sex with men
household contact of chronically infected
patients underdoing hemodialysis
health care workers
transplant recipients
immunosuppressed

Question 17

hep C

Answer 17

acute (asymptomatic) and chronic (liver damage)
RNA virus transmitted percutaneously
common cause of liver disease and indication for liver transplant

Question 18

clinical manifestations of hepatitis

Answer 18

acute or chronic phases
many patients can be asymptomatic
symptoms can be intermittent or ongoing
malaise
fatigue
myalgias/arthalgias 
hepatomegaly

Question 19

acute phase of hepatitis

Answer 19

maximal inefectivity lasts 1-4 months

Question 20

symptoms during incubation (acute)

Answer 20

malaise
anorexia
weight loss
fatigue
N/V
abdominal discomfort
distaste for cigarettes
decreased sense of smell
headache
low grade fever
arthralgias
skin rashes

Question 21

physical exam findings (acute)

Answer 21

hepatomegaly
lymphadenopathy
splenomegaly

Question 22

icteric

Answer 22

jaundice (abnormal bilirubin levels)
dark urine
light or clay-colored stools
pruritis

Question 23

anicteric

Answer 23

non-jaundice

Question 24

convalescent phase

Answer 24

hepatitis starts to get better
begins as jaundice is disappearing
lasts weeks to months

Question 25

major complaints during convalescent phase

Answer 25

malaise easy fatigue hepatomegaly persists splenomegaly subsides

Question 26

liver function tests

Answer 26

AST, ALT, GGT

Question 27

diagnostic findings of hepatitis

Answer 27

``` AST - increased ALT - increased GGT - increased alkaline phosphatase - increased serum proteins - normal or increased albumin - normal or decreased serum bilirubin - increased prothrombin time - prolonged ```

Question 28

collaborative care for acute viral hepatitis

Answer 28

``` no specific therapy NUTRITION and REST prevention of disease progression med therapy supportive drug therapy - antiemetics ```

Question 29

prevention for HAV

Answer 29

``` handwashing personal hygiene environmental sanitation infection control early immune globulin (1-2 wks after exposure) prophylaxis HAV vaccine ```

Question 30

pre-exposure vaccine for children ____ to ____ months of age

Answer 30

12; 23

Question 31

short term goals of care for HBV

Answer 31

decrease viral load decrease liver enzymes decrease disease progression

Question 32

long term goals of care for HBV

Answer 32

prevention of cirrhosis prevention of liver failure prevention of hepatocellular cancer

Question 33

prevention for HBV

Answer 33

disposable needles and syringes - standard precautions prevention prophylaxis (HBV vaccine) HBIG for needle stick and infants born from hep B avoid toothbrushes and razors (body fluids)

Question 34

goal for care of HCV

Answer 34

eradicate the virus prevent HCV complications individualized

Question 35

drug therapies for HCV

Answer 35

pegylated interferon with ribavirin

Question 36

side effects of pegylated interferon

Answer 36

fatigue, fever, malaise, myalgia, psych symptoms (depression, suicide, headache, alopecia), GI upset, anorexia

Question 37

acute management of hepatitis

Answer 37

``` rest nutrition avoid hepatotoxic meds supportive care education follow up care ```

Question 38

nursing diagnoses for hepatitis

Answer 38

imbalanced nutrition activity intolerance risk for impaired liver function

Question 39

for dark complexions of jaundice look at

Answer 39

eyes, palms, palate

Question 40

management of pruritis

Answer 40

use knuckles, not fingernails and make sure skin is moist

Question 41

adequate nutrition

Answer 41

small, frequent meals measures to stimulate appetite carbonated beverages (stimulates appetite) adequate fluid intake (2500-3000 mL/day)

Question 42

acute care management of hepatitis

Answer 42

``` assess for jaundice comfort measures (pruritis) adequate nutrition physical rest psychological and emotional rest diversional activities (hobbies) ```