Hepaatitis

• What are the acute symptoms of hepatitis?

  • RUQ discomfort, dull ache;
  • Flu-like Sx [malaise, joint/muscle pain, anorexia, N/V]
• How long does the acute phase of hepatitis last?

  1 - 4 months
• What are the later symptoms that appear in acute hepatitis?

  Jaundice, clay stools, dark urine, pruritus
• How long does the convalescent phase of hepatitis last?

  2 - 4 months; appears as resolving symptoms and are more vague
• What type of diagnostic tests are done for hepatitis?

  Blood tests that show antigens, antibodies, and immunoglobulins
• What do antigens in the blood mean in a Hep Dx test?

  active disease
• What are examples of antigens that indicate active disease in hep Dx test?

  Hepatitis A/B/C surface antigen (HBsAg)

  • HBeAg
  • HBV DNA
• What do these antibodies mean in a hepatitis Dx test?

  anti-HBs, antiHBe = past exposure

  anti-HBcIgM = current infection

  anti-HBcIgG = past infection
• What types of labs will you see in hepatitis?

  increased LFTs and bilirubin
• What are the primary risk factors for hepatitis A, B, and C?

  A: unsanitary food/water (fecal-oral route); international travel; household contact

  B: sex

  C: IV drug use/blood
• The nurse is providing teaching for a patient in the acute hepatitis phase, what type of diet should be recommended?

  low protein & fat, high carb
• The nurse is providing teaching for a patient in the convalescent hepatitis phase, what type of diet should be recommended for this patient?

  moderate protein, low fat
• Would it be likely to see a hepatitis patient be highly energized?

  No, hepatitis patients experience severe fatigue and typically have activity intolerance
• What type of medication should be typically given to a patient who has been exposed to Hep A or Hep B within 2 weeks?

  Immunoglobulin
• When should the patient receive the second shot of immunoglobulin after within 2 weeks of exposure to Hep A or Hep B?

  within 1 month of the first
• Immunoglobulins provide passive immunity for how long?

  8 weeks
• When should immunoglobulin treatment begin for a Hep B compared to a Hep C patient?

  Hep B should only be treated if not cleared within 6 months

  Hep C Tx started immediately
• Based on hepatitis transmission, what is the policy that the health department enacts if diagnosed with hepatitis?

  Must report to Health department, if pt does not tell contacts then the health dept will
• What type of teaching should you provide the patient with hepatitis?

  • practices for preventing transmission
  • avoid alcohol and liver toxic meds
  • Recovery will take 3 - 4 months or longer
  • prognosis for chronic hepatitis is not known for at least 6 months
• What type of medication management is considered for the patient with hepatitis?

  Immunoglobulin or Anti-viral
• What are the side effects of interferon alpha?

  • depression/suicide
  • bone marrow toxic [leukopenia, thrombocytopenia]
  • pancreatitis
  • cardiac ischemia
  • Flu-like Sx
• A patient diagnosed with hepatitis is receiving teaching about interferon alpha, how can the nurse describe what this medication is?

  Biological response modifier that acts as an indirect anti-viral the activates macrophages and t-cells to block virus activity
• What are some nursing implications and teaching that should be provided for interferon alpha?

  • Mental Health Assessment = stop or reduce dose if depressed
  • give in the evening to reduce flu-like sx
  • Safe injection practice teaching
  • Monitor site for necrosis or lipodystrophy
• What is sobosvir (Harvoni)?

  Direct anti-viral that has the potential to cure Hepatitis C
• What are the side effects of sobosvir (Harvoni)?

  • Hep B reactivation
  • anemia
  • severe bradycardia that can lead to asystole
• What are some nursing implications and teaching provided for a patient starting to take sobosvir (Harvoni)?

  Screen for HepB before starting

  • Mental Health Assessment
  • Monitor CBC
  • Monitor HR; if client on beta blocker or amiodarone can cause bradycardia/asystole
  • Must be given concurrent w/ other anti-viral or peg interferon
• A patient is getting a liver biopsy in the morning, what type of pre-op nursing care should be provided?

  • NPO
  • blood work [coagulation studies] = INR, PT, PTT
• The patient comes out of post-op liver biopsy, what type of nursing care/teaching should be provided?

  • Bed rest w/ positioned on RIGHT side
  • Monitor VS q15min ~ for hemorrhage or bile leak until stable
  • Assess for peritonitis = new/different severe continuous pain
  • Avoid coughing or straining