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Liver Disease and Hepatitis: Lab Values, Complications, and Treatments, Study notes of Nursing

Harrisburg Area Community College (HACC) - LancasterNursing

Comprehensive information on liver disease and hepatitis, including abnormal lab values, fluid and electrolyte balances, treatments, complications, and risk factors. It also covers topics such as ankle sprains, overuse syndrome, rotator cuff tears, meniscal injuries, carpal tunnel syndrome, stress fractures, fractures, amputations, pancreatic cancer, and brain injury. Concept maps, patient education, nursing interventions, and diagnostic tests.

Typology: Study notes

2023/2024

Available from 04/22/2024

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2024/2025 Nursing III Final Review Question Guide
Module 10 review:
1. What is hepatitis? Hepatitis is inflammation of the liver.
a. Who is at risk for:
i. Hepatitis A: Individuals living with infected people, sex partners of
infected people, traveling to other countries
ii. Hepatitis B: Health care workers or people exposed to blood and body
fluids, inmates in prisons, drug users, multiple sex partners, hemodialysis
patients, recipients of clotting factor concentrates
iii. Hepatitis C: IV drug users, recipients of blood products or tissue
transplants before 1992, tattoos and piercings
iv. Hepatitis D: "Same as Hepatitis B"
b. What vaccinations are available?
c. What are the causes of hepatitis?
▪Hepatitis A: Fecal/oral route, contaminated food or water
▪Hepatitis B: Body fluids (semen, saliva, vaginal), blood through skin and
mucous membranes
▪Hepatitis C: Blood and plasma through skin and mucous membranes
▪What is the most common cause? IV Drug use, multiple sex partners
d. What abnormal lab values are expected with hepatitis?
oLiver Enzyme Assessments:
▪Include albumin, total and direct bilirubin, alkaline phosphatase, aspartate
transaminase (also known as AST or serum glutamic oxaloacetic transaminase
[SGOT]), and alanine transaminase (also known as ALT, glutamic pyruvate
transaminase [GPT], or serum glutamic pyruvate transaminase [SGPT]).
Further testing could include prothrombin time (PT) after receiving vitamin K,
gamma glutamyl transpeptidase (GGT), ammonia (NH3), amylase, viral studies
for hepatitis antigens, isocitrate dehydrogenase (ICD), copper, and iron.
▪Liver enzymes can be elevated with conditions such as diabetes, obesity,
autoimmune disorders, some viral infections (especially hepatitis), and
some genetic diseases.
▪Prothrombin and hemoglobin prior to liver biopsy
oHow are fluid and electrolyte balances affected?
oAre there any treatments specific to the abnormal labs?
e. What other diagnostics are available for hepatitis?
i. What risks are associated with any of these diagnostics?
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Download Liver Disease and Hepatitis: Lab Values, Complications, and Treatments and more Study notes Nursing in PDF only on Docsity!

2024/2025 Nursing III Final Review Question Guide

Module 10 review:

  1. What is hepatitis? Hepatitis is inflammation of the liver. a. Who is at risk for : i. Hepatitis A: Individuals living with infected people, sex partners of infected people, traveling to other countries ii. Hepatitis B: Health care workers or people exposed to blood and body fluids, inmates in prisons, drug users, multiple sex partners, hemodialysis patients, recipients of clotting factor concentrates iii. Hepatitis C: IV drug users, recipients of blood products or tissue transplants before 1992, tattoos and piercings iv. Hepatitis D: " Same as Hepatitis B" b. What vaccinations are available? c. What are the causes of hepatitis? ▪ Hepatitis A: Fecal/oral route, contaminated food or water ▪ Hepatitis B: Body fluids (semen, saliva, vaginal), blood through skin and mucous membranes ▪ Hepatitis C: Blood and plasma through skin and mucous membranes ▪ What is the most common cause? IV Drug use, multiple sex partners d. What abnormal lab values are expected with hepatitis? o Liver Enzyme Assessments: ▪ Include albumin, total and direct bilirubin, alkaline phosphatase, aspartate transaminase (also known as AST or serum glutamic oxaloacetic transaminase [SGOT]), and alanine transaminase (also known as ALT, glutamic pyruvate transaminase [GPT], or serum glutamic pyruvate transaminase [SGPT]). Further testing could include prothrombin time (PT) after receiving vitamin K, gamma glutamyl transpeptidase (GGT), ammonia (NH3), amylase, viral studies for hepatitis antigens, isocitrate dehydrogenase (ICD), copper, and iron. ▪ Liver enzymes can be elevated with conditions such as diabetes, obesity, autoimmune disorders, some viral infections (especially hepatitis), and some genetic diseases. ▪ Prothrombin and hemoglobin prior to liver biopsy o How are fluid and electrolyte balances affected? o Are there any treatments specific to the abnormal labs? e. What other diagnostics are available for hepatitis? i. What risks are associated with any of these diagnostics?

f. There is a lot of focus on chronic hepatitis, but what types of hepatitis are acute and evolve through the three phases of hepatitis? ▪ Acute Hepatitis:

  • Acute viral hepatitis occurs in the initial period after infection and symptoms are clinically similar for all viral types.

▪ Three phases and Signs/Symptoms:

2. Differentiate the causes of primary vs secondary liver cancer: o Primary Liver Canc er : - People with cirrhosis have 40 times greater risk - HBV and HCV are associated with increased incidence - Cholangiocarcinoma or intrahepatic cholangiocarcinoma account for 10-20% - Ascending inflammation from the gallbladder, ulcerative colitis or chronic parasitic infection can predispose a person o Secondary Liver Cancer:

  • The liver is a major site for metastases, harboring and growing cancerous cells that originated in some other part of the body, such as the breast or colon. In most developed countries, this secondary type of liver cancer is more common than cancer that originates in the liver itself. This is not true for developing countries, where people may be exposed to more nutritional deficiencies, fungal infections, parasites, pesticides, and other carcinogenic agents
  1. What is portal hypertension? Is the constant pressure of the blood, bile, and lymphatics within the liver. a. What is treatment? ▪ Shunts to relieve the pressure in the portal vein ▪ Shunts diverted blood from the portal vein to the inferior vena cava, thus bypassing the fibrotic blockage that caused congestion in the liver. distal splenorenal shunt (DSRS) ▪ Transjugular intrahepatic portosystemic shunt (TIPS) What are potential complications of shunt surgery? o Pulmonary edema, disseminated intravascular coagulopathy (DIC), thrombosis of the superior vena cava, infection and blockage or dislodgment of the shunts. 4. What risks are associated with applying a cast for a fracture? o For unstable fractures casts may not be adequate in maintaining bone alignment. Complications of not maintaining proper alignment include nonunion, delayed union, or displacement of the fracture segments. Casts also immobilize the muscles and joints next to the fracture site, and may cause neurovascular compromise, malunion, skin breakdown, and compartment syndrome a. How do you assess for these complications?
  2. What is carpal tunnel syndrome? A median nerve entrapment neuropathy, the most common compression neuropathy of the upper extremity a. What are the different types of treatment, beginning with least invasive? ▪ Splinting of the affected wrist to maintain it in neutral position, NSAIDs to decrease inflammation of the tendon and help with pain. Corticosteroid injection. 6. When educating a patient with a sprain, what exactly should be taught about RICE therapy? o The immediate goal of treatment are to prevent swelling and to maintain ROM, immediate interventions include Rest, Ice, Compression and Elevation RICE **Reading Guides Chapter 51: Hepatic, biliary tract, and pancreatic dysfunction
  • Define:** o Ascites: The accumulation of fluid in the peritoneal cavity.

▪ Biliary Cirrhosis: ▪ Cardiac Cirrhosis: Occurs when blood flow out of the liver is restricted by severe right sided-sided failure. Tricuspid regurgitation can be associated with cardiac cirrhosis. A large amount of blood is delivered to the liver each minute. When that blood is not able to exit at a predictable rate, liver engorgement occurs and the pressure in the liver vasculature increases, causing venous congestion, anoxia or hypoxia, and hepatic cell necrosis and subsequent fibrosis. o Complications and treatment:

  • Hepatitis o Types, associated transmission and prevention o Phases
  • Liver Cancer o Significance of metastasis
  • Liver Transplantation o Indications
  • Pancreatic dysfunction o Diagnosis and associated complications **Chapter 60: Musculoskeletal Trauma
  • Define:** o Ankle sprain: When the ankle is displaced or a sudden force is applied, the ligaments are stretched beyond their normal stretching capacity and a sprain of the ligament occurs. o Arthroscopy: A diagnostic test performed in the knee joint; an arthroscopy is an endoscopic procedure used to diagnose and repair meniscal, patellar, extrasynovial, and synovial diseases o Closed reduction: External manipulation of a fracture, which forces it into alignment. o Compartment syndrome: Swelling in the soft tissues and muscles that in turn cause compromised circulation to that area o Cryotherapy: The use of ice or cold water over an injury site to decrease inflammation. o Fascia: An inelastic connective tissue that covers and separates muscles, tendons, and ligaments o Fasciotomy: Incision through a fibrous layer that separates muscles o Fracture: A break in a bone o Occult fracture: clinical symptoms of a fracture but no evidence on x-ray o Overuse syndrome: An injury to musculoskeletal tissues affecting the upper extremity or cervical spine, resulting from repeated movement, temperature extremes, overuse, incorrect posture, or sustained force or vibration. Also called repetitive motion injuries or cumulative trauma disorders. o Phantom limb sensation: When the patient has the perception of a limb that is no longer there. If the patient feels pain it is known as phantom limb pain.

o Prosthesis: A replacement of a missing body part, such as an extremity. o Radiculopathy: A term used to specifically describe pain and other symptoms, like numbness, tingling, and weakness, in arms or legs that are caused by a problem with nerve roots o RICE: The acronym used for Rest, Ice, Compression, and Elevation when treating a sprain. o Rotator cuff tears: Refers to tears in one or more of the four muscles that form a single tendon in the shoulder. The rotator cuff is responsible for circumduction and internal and external rotation of the shoulder. o Sports medicine: The application of professional knowledge to the understanding, prevention, treatment, and rehabilitation of sports- and exercise-related problems.

  • Overuse syndrome/Repetitive Motion Injuries o Causes ▪ i.e. typing
  • Rotator cuff tears o Causes
  • Meniscal injuries o Patient education ▪ r/t over use
  • Ankle sprain o Treatment/education ▪ barrier with ice and skin, 20 mins on/off ▪ ACE bandage, don’t over compress
  • Carpal Tunnel Syndrome o Treatment
  • Stress Fractures o Prevention
  • Fractures o Treatment/education o Assessment for potential complications o Nursing interventions
  • Pathological fractures o Causes ▪ r/t osteoporosis
  • Hip fractures o Treatment and associated complications
  • Amputations o Post-operative care ▪ infection ▪ phantom pain ▪ Use stocking to mold stump for prosthesis ▪ patient to lay prone to avoid contraction ▪ assess skin for pressure ulcers r/t device

o Monitor vital signs (especially blood pressure for hypertension), assess all physiologic systems, and frequently review laboratory test results o Increased fall risk

  • Patient Education o Pain from PC is manageable; palliative treatment may involve experimenting with more than one pain management option before pain relief occurs o Seek immediate medical attention for adverse effects of medication, new or worsening pain, or the occurrence of new or worsening signs and symptoms Concept Map for Hepatitis:
  • Medical Diagnosis o Hepatitis: inflammation of the liver
  • Patient Data/Risk Factors: o Drug use o Autoimmune o Unsafe sex practices o Traveling o Tattoos/piercings o Alcohol use
  • Clinical Manifestations: o Subjective: ▪ Failure to take personal precautions with blood and body fluid ▪ Influenza like symptoms ■ Fatigue ■ Decreased appetite with nausea ■ Abdominal pain ■ Joint pain o Objective: ■ Fever ■ Vomiting ■ Dark-colored urine ■ Clay-colored stool ■ Jaundice
  • Pathophysiology: o "ICT": Means Jaundice

o

  • Possible Medications: o Vaccines for Hep A and Hep B o Treatment medications ▪ Antivirals ▪ Anti-inflammatory drugs ▪ Steroids ▪ Immune globulin
  • **Diagnostic Data
  • Medical Interventions**
  • Possible Nursing Diagnosis Activity intolerance r/t fatigue Disturbed body image r/t jaundice Imbalanced nutrition: less than body requirements r/t nausea Knowledge, deficient related to lifestyle changes and medications
  • Nursing Interventions: T reatment and nursing interventions focus on reducing the causative agent and addressing bothersome symptoms.
  • Patient Education: Good health practice to prevent viral infection that can lead to various types of hepatitis. Promote adequate physical and physiological rest **Concept Map for Cirrhosis:
  • Medical Diagnosis** o Cirrhosis: irreversible and chronic liver disease characterized by diffuse inflammation and fibrosis of liver tissue causing scarring and obstruction of hepatic blood flow.
  • Patient Data/Risk Factors o Alcohol use o Hereditary o Gender
  • Diagnostic Data: o No laboratory tests will diagnose cirrhosis o Liver biopsy is the only way to diagnose the type of cirrhosis o Liver Ultrasound may reveal an enlarged fibrofatty liver or a small fibrotic and nodular liver
  • Possible Nursing Diagnosis o
  • Nursing/Medical Interventions o Fluid restriction of 1000-1500 mL per day o Sodium restriction of 200-500 mg per day o Diuretic therapy ▪ Spironolactone is the diuretic of choice o Paracentesis o Surgery ▪ Peritoneovenous Shunt ▪ Transjugular intrahepatic portosystemic shunt o Vital signs o Level of Consciousness o Abdominal Girth o Head of bed at least 30 degrees ▪ Respiratory support o Monitor nutritional status ▪ Monitor blood sugar o Daily weight o Monitor I & O o Bleeding precautions o Maintain skin integrity
  • Patient Education o Lifestyle changes ▪ dietary restrictions, no alcohol, fluid restrictions, nutrition consultation o Avoid taking OTC medications without physician approval o Educate about signs and symptoms that require medical attention ▪ weight gain, increased abdominal girth, respiratory distress, bleeding gums, blood in stool or urine, fever, abdominal pain o Medication education o Concept Map for Fatty Liver:
  • Medical Diagnosis: Hepatic Steatosis
  • Patient Data/Risk Factors: Obesity, pregnancy, poorly controlled diabetes, malnutrition, corticosteroids, prolonged treatment with TPN, side effect of bariatric surgeries, or chronic alcohol ingestion
  • Clinical Manifestations: o Subjective: Enlarged liver than can be palpated below the ribs, right upper quadrant pain, tenderness, jaundice, fatigue, nausea, vomiting, hypoglycemia, coma, DIC
  • Pathophysiology: Alcohol interferes with fat metabolism by causing lipidemia (especially triglycerides), stimulating lipolysis, and increasing the output of VLDL. Alcohol also can cause further damage through lipid peroxidation, which releases free radicals and impairs membrane integrity of organelles within the hepatocytes as well as the membrane surrounding the cell.
  • Possible Medications
  • Diagnostic Data: Liver biopsy, specific serum tests such as LFT, SGOT, SGPT, and alkaline phosphatese, CT and ultrasound can also be ordered
  • **Medical Interventions
  • Possible Nursing Diagnosis**
  • Nursing Interventions
  • Patient Education: Avoid alcohol, follow a low fat diet, provide education on the performance of liver biophy( this is not a word) Final Review:
  • CVA/Stroke o Risk factors o Prevention including medications o Clinical manifestations o Diagnostic tests: Stoke: CT scan right away to see if hemorrhagic (instant, severe headache) or ischemic (speech impairment, unilateral neglect) o Treatment and associated contraindications
  • Brain Injury o Common causes o Indicators of alteration in intracranial regulation o Glasgow Coma Scale o Levels of severity and examples/types of injury o Increased intracranial pressure ▪ Treatment ▪ Nursing interventions o Complications of TBIs o Patient education regarding TBIs o Government involvement in traumatic brain injuries
  • Brain tumors o Treatment: Chemo, radiation, surgery main interventions. o Potential complications: increased intracranial pressure
  • Hepatic dysfunction o Clinical manifestations of liver disease o Diagnostics and associated risk factors

o Clinical manifestations ▪ dyspnea r/t left sided ▪ pulmonary edema r/t right o Medical and nursing interventions ▪ lasix

  • Fluid, electrolyte, and acid-base balance o Hypocalcemia ▪ Associated risks ▪ Clinical manifestations o Hyponatremia ▪ Causes ▪ Clinical manifestations o Hypokalemia ▪ Potential implications ▪ Nursing interventions ▪ Safety precautions o Metabolic Alkalosis ▪ Expected ABGs: ▪ Causes: ▪ Manifestations: ▪ Treatment: o Metabolic Acidosis ▪ Expected ABGs: ▪ Causes: ▪ Manifestations ▪ Treatment: o Respiratory Alkalosis ▪ Expected ABGs: ▪ Causes: ▪ Manifestations: ▪ Treatment: o Respiratory Acidosis ▪ Expected ABGs: ▪ Causes: ▪ Manifestations: ▪ Treatment:
  • Cancer o Risk factors o Primary, secondary, tertiary prevention o Colon cancer ▪ Clinical manifestations o Chemotherapy ▪ Side effects and related nursing interventions o Bone marrow transplant

▪ Potential complications and manifestations

  • Cardiac dysfunction o Arrhythmias ▪ What is the normal route of electrical conduction? ▪ Atrial fibrillation - Manifestations - Potential complications - Treatment - Pharmacological management and associated patient education ▪ Bradycardia - Manifestations - Treatment ▪ Ventricular tachycardia - Manifestations - Interventions o Myocardial infarction ▪ Prioritizing nursing interventions
  • Gas exchange o Define gas exchange o Indications of adequate gas exchange o Indications of impaired gas exchange o Body systems involved in gas exchange o List 5 physiological causes of impaired gas exchange and an example of an associated medical diagnosis: o How do the following concepts relate to gas exchange? ▪ Acid-base balance: ▪ Perfusion: ▪ Metabolism: ▪ Mobility: ▪ Cardiovascular/Coagulation Integrity:
  • Hematological dysfunction o Anemia ▪ Types ▪ Causes ▪ Manifestations o Thrombocytopenia ▪ Clinical manifestations including labs ▪ Patient education o DVT ▪ Manifestations ▪ Prevention
  • Collaborative patient care and communication o Tracking and reporting of critical events o Role of the nurse in Joint Commission compliance and surveys