1. Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. Chapter 61 Care of Patients with Liver Problems

2. Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.  Viral hepatitis – A, B, C, D, E  Transmission mode  Onset  Incubation  Laboratory tests  Nonsurgical management  Follow-up care  Plan of care for home

3. Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.  Survives on human hands  Destroyed by chlorine and high temperatures  Fecal – oral route  15 to 50 days incubation time  Not life threatening

4. Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.  Hand-washing  HAV vaccine  Havrix  Vaqta  Avoid contaminated food or water

5. Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. Modes of Transmission  Unprotected sex  Sharing needles  Needle sticks / injuries  Blood transfusions  Hemodialysis  Maternal - fetal

6. Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.  25 to 180 days  Blood tests confirm disease  Carrier

7. Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. Symptoms  Anorexia  Nausea / Vomiting  Fever  Fatigue  RUQ pain  Dark urine  Joint pain  Jaundice

8. Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.  HBV vaccine  Engerix-B  Recombivax-HB

9. Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. Modes of Transmission  Sharing needles  Needle sticks / injuries  Blood transfusions  Tattoo  Intranasal cocaine paraphernalia

10. Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.  7 weeks  Asymptomatic  Liver issues occur  Causes liver to scar – can progress to cirrhosis

11. Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.  Routine laboratory evaluation  ELISA – HCV antibodies  Within 4 weeks  RIBA  Been exposed and developed antibodies  HCV PCR RNA  Active virus and viral load  OraQuick HCV  Point of care testing

12. Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.  Goes along with HBV  Parenteral routes  IV drug abusers  14 to 56 days

13. Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.  Fecal contamination of food and water  15 to 64 days  Clinical course resembles HAV  Self limiting, resolves on own

14. Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.  Liver enzymes  AST  ALT  Alk Phosphatase  Bilirubin  IgM antibodies  IgG antibodies  HBsAg  Anti-HBcAg IgM  Anti-HDV  Anti-HEV

15. Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.  Liver biopsy  Stage and grading  Percutaneous procedure  CT guided imagery

16. Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. Interventions  Rest the liver  Promote cellular regeneration  Prevent complications  High calorie, carbohydrates  Supplemental vitamins  Small, frequent meals

17. Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. Medications  Tenofovir – first line therapy  Interferon – first line therapy  Adefovir dipivoxil – second line therapy  Lamivudine (Epivir-HBV)  Telbivudine (Tyzeka)

18. Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. A 55-year-old patient with a history of alcohol abuse spanning 10 years has been diagnosed with cirrhosis. The patient will be undergoing abdominal paracentesis on the medical unit today. Which assessment finding would alert the nurse that the paracentesis has been successful? A. Substantial decrease in blood pressure B. Decrease in post-procedure weight C. No residual obtained during procedure D. Immediate sensation of a need to urinate

19. Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. The patient’s assessment reveals yellowish coloration of skin and sclerae. Which laboratory values would the nurse expect to find with this patient? A. Increased direct bilirubin, decreased indirect bilirubin B. Decreased direct bilirubin, increased indirect bilirubin C. Increased direct bilirubin, increased indirect bilirubin D. Increased urine bilirubin, decreased direct bilirubin (cont’d)

20. Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. When a complete assessment of this patient is performed, what other manifestations would the nurse expect? (Select all that apply.) A. Ecchymosis B. Spider angiomas C. Personality changes D. Peripheral dependent edema E. Muscle twitching F. Dry skin with rash (cont’d)

21. Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. The patient tells the nurse that once he is discharged to home, he has no intention to stop drinking alcohol. Which is the appropriate nursing response? A. “Why do you continue to drink?” B. “Does it frighten you to consider quitting?” C. “It’s your choice to drink or not to drink.” D. “If you continue to drink, you are going to die.” (cont’d)

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23. Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. Which assessment parameter requires immediate intervention in a patient with severe ascites? A.Shallow respirations, rate 32 breaths/min B.Temperature 38.2° C C.Confusion D.Tachycardia, rate 110 beats/min

24. Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. What is the priority intervention in the management of a patient with decompensated cirrhosis? A.Limiting protein intake B.Monitoring fluid intake and output C.Managing nausea and vomiting D.Elevating the head of bed >30 degrees

25. Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. What is a primary reason for a higher incidence of liver cancer in the United States? A.Incidence of illicit drug use B.Rising obesity C.Incidence of hepatitis C D.Increased Asian population