SlideShare una empresa de Scribd logo
1 de 41
Descargar para leer sin conexión
Project: Ghana Emergency Medicine Collaborative
Document Title: Hepatitis
Author(s): Katherine A. Perry (University of Michigan), RN, BSN 2012
License: Unless otherwise noted, this material is made available under the
terms of the Creative Commons Attribution Share Alike-3.0 License:
http://creativecommons.org/licenses/by-sa/3.0/
We have reviewed this material in accordance with U.S. Copyright Law and have tried to maximize your
ability to use, share, and adapt it. These lectures have been modified in the process of making a publicly
shareable version. The citation key on the following slide provides information about how you may share and
adapt this material.
Copyright holders of content included in this material should contact open.michigan@umich.edu with any
questions, corrections, or clarification regarding the use of content.
For more information about how to cite these materials visit http://open.umich.edu/privacy-and-terms-use.
Any medical information in this material is intended to inform and educate and is not a tool for self-diagnosis
or a replacement for medical evaluation, advice, diagnosis or treatment by a healthcare professional. Please
speak to your physician if you have questions about your medical condition.
Viewer discretion is advised: Some medical content is graphic and may not be suitable for all viewers.

1	
  
Attribution Key
for more information see: http://open.umich.edu/wiki/AttributionPolicy

Use + Share + Adapt
{ Content the copyright holder, author, or law permits you to use, share and adapt. }
Public Domain – Government: Works that are produced by the U.S. Government. (17 USC § 105)
Public Domain – Expired: Works that are no longer protected due to an expired copyright term.
Public Domain – Self Dedicated: Works that a copyright holder has dedicated to the public domain.
Creative Commons – Zero Waiver
Creative Commons – Attribution License
Creative Commons – Attribution Share Alike License
Creative Commons – Attribution Noncommercial License
Creative Commons – Attribution Noncommercial Share Alike License
GNU – Free Documentation License

Make Your Own Assessment
{ Content Open.Michigan believes can be used, shared, and adapted because it is ineligible for copyright. }
Public Domain – Ineligible: Works that are ineligible for copyright protection in the U.S. (17 USC § 102(b)) *laws in
your jurisdiction may differ

{ Content Open.Michigan has used under a Fair Use determination. }
Fair Use: Use of works that is determined to be Fair consistent with the U.S. Copyright Act. (17 USC § 107) *laws in your
jurisdiction may differ
Our determination DOES NOT mean that all uses of this 3rd-party content are Fair Uses and we DO NOT guarantee that
your use of the content is Fair.

2	
  
To use this content you should do your own independent analysis to determine whether or not your use will be Fair.
Hepa((s	
  A	
  Virus	
  (HAV)	
  
•  Hepatitis A is an acute infectious disease of the liver
•  Usually spread fecal-oral route; transmitted person-to-person by
ingestion of contaminated food or water or through direct
contact with an infectious person
•  Closely associated with poor sanitation and a lack of personal
hygiene habits, such as hand-washing
•  An estimated 1.4 million cases of hepatitis A occur annually
(WHO)

3	
  
Transmission	
  of	
  HAV	
  
People almost always get hepatitis A from fecal
contamination:
•  Food handlers who have the disease did not wash their hands after having a BM
•  Drinking water or eat raw shellfish (clams, oysters) that came from unclean water
areas
•  You were in a place with poor sanitary conditions (dirty) where the hepatitis A virus is
common
•  There other ways you may get hepatitis A, but these are much less common:
–  Day care workers who do not wash their hands after changing a diaper
–  Men who have sex with men
–  The blood of an infected person getting into your blood
–  Users of both injectable and non-injectable street drugs can get it by using dirty
or used needles.
4	
  
HAV	
  Symptoms	
  
Range from mild to severe including
•  Fever
•  Malaise
•  Loss of appetite
•  Diarrhea
•  Nausea
•  Abdominal discomfort
•  Dark-colored urine, and light-colored BM’s
•  Jaundice (a yellowing of the skin and whites of the eyes)
You are most contagious in the two weeks before getting jaundiced
and the first week after getting jaundice
5	
  
Treatment	
  of	
  HAV	
  
•  There is no specific treatment for hepatitis A
•  Recovery from symptoms following infection may be slow
and take several weeks or months
•  Therapy is aimed at maintaining comfort and adequate
nutritional balance, including replacement of fluids that are
lost from vomiting and diarrhea

6	
  
Preven(on	
  
•  Improved sanitation and Hepatitis A immunization are the
most effective ways to combat the disease
•  Adequate supplies of safe-drinking water and proper disposal
of sewage within communities, combined with personal
hygiene practices, such as regular hand-washing, reduce the
spread of HAV
•  Several hepatitis A vaccines are available internationally. All
are similar in terms of how well they protect people from the
virus and their side-effects. No vaccine is licensed for children
younger than one year of age.
7	
  
Pa(ent	
  Educa(on	
  
•  When you have an appetite again, eat healthy foods from all of the 5 food groups:
fruits, vegetables, breads, dairy products, meat and fish
•  Try to avoid alcohol since it makes your liver work harder
•  Drink 6 to 8 glasses of liquid each day. Limit the amount of caffeine you drink such as
coffee, tea, and soda
•  Your friends and family may need to get a shot to keep them from getting hepatitis A
•  Do not share dishes and eating utensils. Wash dishes and utensils in boiling water or
a dishwasher. You may want to use disposable (throw-away) dishes
•  Do not make food or meals for other people
•  Wash your hands well before eating and after using the toilet
•  Wash clothing and bedding in the hottest water setting
•  Clean toilets with a product that kills germs
8	
  
Pa(ent	
  Educa(on	
  
CONTACT A CAREGIVER IF:
•  You cannot drink liquids or keep food down
•  Your skin is itchy, swollen, or has a rash. Your medicine may be causing these
symptoms. This may mean you are allergic
•  You are bruising easily
SEEK CARE IMMEDIATELY IF:
•  You feel confused or unusually sleepy. The sleepiness may switch with feeling
irritable or jittery
•  You have bad abdominal pain
•  You have BMs that are red or black and sticky
•  Your vomit is red or looks like coffee grounds
•  You are too dizzy to stand up
9	
  
Hepa((s	
  B	
  Virus	
  (HBV)	
  
•  Hepatitis B is irritation and swelling (inflammation) of the liver
due to infection with the hepatitis B virus (HBV)
•  The infection is called acute when a person first becomes
infected with HBV
•  The infection becomes chronic (long-term) when a person
has symptoms, such as liver swelling, for six months or longer
•  Acute HBV infections are more common in adults. Infants and
young children have a higher risk for chronic HBV
10	
  
Transmission	
  HBV	
  
•  Contact with infected blood or body fluids, such as saliva and semen
•  Once HBV is in your blood, it travels to your liver and injures your
liver cells
•  HBV can enter your body through a cut or scratch in your skin or
through your mucous membranes
•  Mucous membranes include your gums and the lining of your rectum
or a woman's vagina
•  HBV can live on objects and surfaces for seven or more days, with or
without visible blood
•  HBV can also spread from a mother to her unborn child.

11	
  
Symptoms	
  of	
  HBV	
  
•  It can take from 1 to 6 months before symptoms occur
•  Some people will have no signs and symptoms and may not know they have been
infected. When signs and symptoms do occur, they may last from a few days to
months:
–  Dark-colored urine or light-colored or gray bowel movements (BMs).
–  Fatigue (feeling more tired than usual) and weakness.
–  Fever (high body temperature).
–  Loss of appetite for food, nausea (upset stomach), and vomiting (throwing up).
–  Jaundice (yellowing of the skin or the whites of the eyes). You may also get skin
rashes.
–  Joint pain and body aches.
–  Pain in the right upper side of the abdomen (stomach)

12	
  
Complica(ons	
  of	
  HBV	
  
•  Liver cirrhosis: scarring of the liver caused by infection and inflammation.
Increased risk for cirrhosis if you drink alcohol or smoke. Increased risk if
you have human immunodeficiency virus (HIV), hepatitis C; or hepatitis D
•  Liver failure: Liver failure occurs when the liver can no longer function as it
should. Risk for liver failure increases if you have cirrhosis.
•  Liver cancer: Chronic HBV may lead to liver cancer. The risk for liver
cancer increases if you are male and if you have other family members with
liver cancer. Your risk also increases if you have liver cirrhosis or if you are
also infected with hepatitis C.
•  Kidney problems: HBV can lead to inflammation and problems with your
kidney function. Your kidneys are organs that remove waste from your body
as urine
13	
  
Diagnosis	
  
•  Blood tests: to give information about how the patients
body is working
•  Abdominal ultrasound: pictures of the liver may be
done to check for signs of HBV and to look for other
liver problems
•  Liver biopsy: a small sample of the liver is removed
and sent to a lab to check for swelling, scarring, and
other damage. A liver biopsy may help caregivers learn
if you need treatment for HBV
14	
  
HBV	
  preven(on	
  
Getting vaccinated against HBV is the best way to decrease your risk and prevent the disease
•  The HBV vaccine is given in three doses over a period of months
•  Some people may not respond to the vaccine as well as others
•  After being vaccinated, some may need a blood test to check his/her response

Photographer's Mate Airman Apprentice Christopher D. Blachly, Wikimedia Commons

15	
  
Treatment	
  of	
  HBV	
  
•  The goal of treatment is to prevent the disease from getting worse and
leading to more serious liver problems
•  Treatment may help improve the function of your liver and decrease
your symptoms of liver disease
•  HBV may last a short time and go away on its own without treatment
•  HBV may become chronic, leading to liver damage and disease

16	
  
Treatment	
  of	
  HBV	
  
Medicines:
•  Antiviral medicines: Antiviral medicine may be given to help stop
the virus from spreading in your body
•  Immune globulin: Hepatitis B immune globulin (HBIG) is medicine
given if you have been exposed to HBV. Immune globulin helps your
body fight the HBV infection. HBIG is also given to newborn babies
who were exposed to HBV while in the womb.
•  Liver transplant: Some patients may need a liver transplant if they
have severe liver disease or liver failure.
•  Hepatitis A vaccination: If you are diagnosed with HBV, your
caregiver may vaccinate you against hepatitis A.
17	
  
HBV	
  preven(on	
  
The following people should be vaccinated against HBV:
•  Any person not already vaccinated against HBV
•  Healthcare workers and workers in other care facilities
•  Newborn babies born to women with HBV - All newborn babies
should be vaccinated shortly after birth and have additional doses as
directed by a caregiver
•  People living in care facilities and inmates of correctional facilities

18	
  
HBV	
  preven(on	
  
•  People who have decreased liver function or who are
infected with hepatitis C, hepatitis D, or HIV
•  People who inject illegal drugs
•  People with kidney failure receiving hemodialysis
treatments. More or higher doses of the vaccine may
be needed for people with kidney failure
•  People with more than one sex partner or men having
sex with other men
•  People who have had a sexually transmitted disease
(STD) before should also be vaccinated
19	
  
HBV	
  Preven(on	
  
Those who are HBV+:
• 
• 
• 
• 
• 

• 
• 

Cover any open cuts or scratches. If blood from a wound gets on a surface, clean the surface
with bleach right away
Dispose of any items with blood or body fluids on them properly
Do not donate blood, sperm, or organs to others
Do not share items that may have infected blood or body fluids on them (includes
toothbrushes, razors, or personal injection items, such as needles)
Tell household and sexual contacts that you have HBV. All close contacts should be
vaccinated. If contacts have not had the vaccination, they may need to start treatment to help
prevent infection.
Also tell medical or dental caregivers you have HBV when getting any kind of treatment
When having sex, always use a condom, even if you have acute HBV and your infection goes
away, you can still spread the virus for up to six months
20	
  
Pa(ent	
  educa(on	
  
Call your caregiver if:
•  The palms of your hands are red
•  You have a fever
•  You have new or increased swelling in your legs,
ankles, or feet
•  Your muscles are getting smaller and weaker
•  You have questions about your condition,
medicines, or care
21	
  
Pa(ent	
  educa(on	
  
Seek help immediately or call 911 if:
•  You have a sudden, severe headache and head pressure
•  You have new or increased bruising or red or purple dots on your
skin. You may also have bleeding that does not stop easily
•  Your abdomen is swollen
•  You have severe nausea or cannot stop vomiting
•  You see blood in your urine or bowel movements, or you vomit
blood
•  You have new or increased yellowing of your skin or the whites of
your eyes
•  You have severe (very bad) pain in your upper abdomen

22	
  
Pa(ent	
  educa(on	
  
•  Limit or avoid alcohol: Alcohol can increase your liver damage and can damage
your brain and heart
•  Quit smoking: Smoking harms your lungs, blood, and heart. You are more likely to
have a heart attack, lung disease, and cancer if you smoke. You will help yourself
and those around you by not smoking
•  Pregnant and have viral hepatitis B?
–  Avoid close or intimate contact with others as directed by your caregiver
–  Avoid injury to your upper abdomen
–  Make sure you eat a healthy diet
–  You may need to limit your daily activities and rest more
–  After your child is born, you should be able to breastfeed your infant

23	
  
GOKLuLe, Wikimedia Commons

Pa(ent	
  educa(on	
  
•  Take your medicine as directed: Call your primary
healthcare provider if you think your medicine is not
working as expected
•  Follow-up visit: tell the patient to ask the caregiver
when to return for a follow-up visit. He/she may need
to have blood tests to check the function of your liver.
Keep all appointments. Write down any questions he/
she may have
24	
  
Hepa((s	
  C	
  Virus	
  (HCV)	
  
•  Hepatitis C is also called non-A or non-B hepatitis
•  Inflammation of the liver due to infection caused by a virus
•  Similar to Hep A & Hep B, Hepatitis C virus (HCV) attacks and
damages your liver
•  CDC estimates worldwide there are 3-4 million people infected with
HCV each year

25	
  
Symptoms	
  HCV	
  
The most common symptom of hepatitis C is fatigue (feeling
more tired than usual) The patient may present with one or
more of the following:
• 
• 
• 
• 
• 
• 
• 

Dark orange-colored urine or clay-colored stool
Fever
Itchy skin
Jaundice (yellowing of the skin or the whites of the eyes)
Joint pain, body aches, or weakness
Loss of appetite, nausea or vomiting
Pain in the right side of the abdomen
26	
  
Complica(ons	
  HVC	
  
Hepatitis C may lead to the following problems:
•  Liver cirrhosis
•  Liver cancer
•  Liver failure
•  Kidney disease
27	
  
Transmission	
  
Hepatitis C virus is carried in the blood and other body fluids, such as semen or vaginal fluids.
Hepatitis C virus may spread by any of the following:
• 
• 
• 
• 
• 
• 
• 
• 

Childbirth: passed from a pregnant woman to her baby during delivery
Needle stick injury
Long-term dialysis
Blood transfusion or an organ transplant before July 1992
Sharing items that may have infected blood on them, such as razors, toothbrushes, or nail
clippers
Sharing infected needles to use illegal or street drugs
Using dirty needles or instruments for tattooing, body piercing, or other procedures
Sex: Some people may not know they have hepatitis C and and could pass the virus to their
sex partner.

28	
  
Diagnosis	
  
• 

Enzyme immunoassay test: EIA checks for hepatitis C antibodies (proteins made by the
immune system that attack viruses or bacteria)

• 

Genotyping: blood test that tests the genotype of the hepatitis C virus that you have

• 

Hepatitis C profile serological test: checks the activity and number of hepatitis C viruses
present in your blood.

• 

Liver biopsy: small piece of the liver is removed and sent to a lab for tests

• 

Liver function tests: to check the enzymes and other substances made in the liver

29	
  
Treatment	
  
•  Anti-viral medicines: These medicines work by
keeping the virus from spreading. This may prevent
or decrease more swelling and damage to the liver.
•  Surgery: A liver transplant may be done if your liver
stops working. Your diseased liver is removed and
replaced with a healthy and donated liver. You may
also have a part of your liver removed.
30	
  
Preven(on	
  
There is no available vaccine to prevent hepatitis C. Following are ways to prevent the spread of hepatitis C:

•  Caregivers should wear gloves, masks, gowns, or safety goggles
when handling blood products and instruments
•  Consider the risks of getting hepatitis C before having tattoos or
body piercing
•  If patients use illegal or street drugs, never reuse or share needles
or syringes
•  Do not share toothbrushes, razors, or other personal care items
•  Mothers infected with hepatitis C should stop breastfeeding if their
nipples are cracked or bleeding
•  Use latex condoms when having sex
31	
  
Nursing	
  management	
  
•  Universal Precautions – Gloves are worn when there is to be contact
with blood and body fluid
•  Goggles/masks are worn when there is a danger of splashing or
aerosol of blood-contaminated secretions
•  Water repellant gown, if there is a danger of splashing
•  Always hand washing before and after contact with blood and body
fluid
•  Specimens are treated as biohazard. Linen & used material are treated
as infectious.
•  Establish if the patient is in the acute phase, a carrier, or not
32	
  
Pa(ent	
  assessment	
  
ACTIVITY/REST
May report:
• 
Fatigue, weakness, general malaise

CIRCULATION
May exhibit:
• 
Bradycardia (severe hyperbilirubinemia)
• 

Jaundiced sclera, skin, mucous membranes

ELIMINATION
May report:
• 
Dark urine
• 
Diarrhea/constipation; clay-colored stools
• 
Current/recent hemodialysis

FOOD/FLUID
May report:
• 
Loss of appetite (anorexia), weight loss or gain (edema) Nausea/vomiting
May exhibit:
• 
Ascites

33	
  
Pa(ent	
  assesment	
  
NEUROSENSORY
May exhibit:
•  Irritability, drowsiness, lethargy, asterixi
PAIN/DISCOMFORT
May report:
•  Abdominal cramping, right upper quadrant (RUQ) tenderness
•  Myalgias, arthralgias; headache
•  Itching (pruritus)
May exhibit:
•  Muscle guarding, restlessness
RESPIRATION
May report:
•  Distaste for/aversion to cigarettes (smokers)
•  Recent flulike URI
SEXUALITY
May report:
•  Lifestyle/behaviors increasing risk of exposure (e.g., sexual promiscuity, sexually active homosexual/
bisexual male)

34	
  
Pa(ent	
  assessment	
  
SAFETY
May report:
•  Transfusion of blood/blood products in the past
May exhibit:
•  Fever
•  Urticaria, maculopapular lesions, irregular patches of erythema
•  Spider angiomas, palmar erythema, gynecomastia in men (sometimes present in alcoholic hepatitis)
•  Splenomegaly, posterior cervical node enlargement
TEACHING/LEARNING
May report:
•  History of known/possible exposure to virus, bacteria, or toxins (contaminated food, water, needles,
•  surgical equipment or blood); recent surgical procedure with halothane anesthesia; exposure to toxic
chemicals; prescription drug use (e.g., sulfonamides, phenothiazines, isoniazid)
•  Travel to/immigration from China, Africa, Southeast Asia, Middle East (hepatitis B [HB] is endemic in these
areas)
•  Street injection drug or alcohol use
•  Concurrent diabetes, HF, malignancy, or renal disease
35	
  
Diagnos(c	
  studies	
  for	
  hepa((s	
  
Liver enzymes:
•  Abnormal (4–10 times normal values)
AST/ALT:
•  Initially elevated. May rise 1–2 wk before jaundice is apparent, then decline.
•  Alkaline phosphatase
Hepatitis A, B, C, D, E panels (antibody/antigen tests):
•  Specify type and stage of disease and determine possible carriers.
CBC:
•  Red blood cells (RBCs) decreased because of shortened life of RBCs (liver enzyme
alterations) or hemorrhage.
WBC count and differential:
•  Leukopenia, leukocytosis, monocytosis, atypical lymphocytes, and plasma cells may be
present.

36	
  
Diagnos(c	
  studies	
  
Serum albumin:
•  Decreased.
Blood glucose:
•  Transient hyperglycemia/hypoglycemia (altered liver function).
Prothrombin time:
•  May be prolonged (liver dysfunction).
Serum bilirubin:
•  Above 2.5 mg/100 mL. (If above 200 mg/100 mL, poor prognosis is probable because of increased cellular
•  necrosis.)
Liver biopsy:
•  Usually not needed, but should be considered if diagnosis is uncertain, of if clinical course is atypical or
unduly
•  prolonged
Urinalysis:
•  Elevated bilirubin levels; protein/hematuria may occur
37	
  
Hepa((s	
  Nursing	
  management	
  	
  
NURSING PRIORITIES
•  1.Reduce demands on liver while promoting physical well-being.
•  2.Prevent complications.
•  3.Enhance self-concept, acceptance of situation.
•  4.Provide information about disease process, prognosis, and treatment
needs.
DISCHARGE GOALS
•  1.Meeting basic self-care needs.
•  2.Complications prevented/minimized.
•  3.Dealing with reality of current situation.
•  4.Disease process, prognosis, and therapeutic regimen understood.
•  5.Plan in place to meet needs after discharge

38	
  
Self	
  care	
  at	
  home	
  
The	
  goals	
  of	
  self-­‐care	
  are	
  to	
  relieve	
  symptoms	
  
and	
  prevent	
  worsening	
  of	
  the	
  disease	
  
• 
• 
• 
• 

• 
• 

Drink	
  plenty	
  of	
  fluids	
  to	
  prevent	
  dehydra(on	
  
Avoid	
  medicines	
  and	
  substances	
  that	
  can	
  cause	
  harm	
  to	
  the	
  liver,	
  such	
  as	
  
acetaminophen	
  (Tylenol)	
  
Avoid	
  drinking	
  alcohol	
  un(l	
  your	
  health	
  care	
  provider	
  OKs	
  it.	
  If	
  your	
  infec(on	
  
becomes	
  chronic,	
  you	
  should	
  avoid	
  alcohol	
  for	
  the	
  rest	
  of	
  your	
  life	
  
Avoid	
  using	
  drugs,	
  even	
  legal	
  drugs,	
  without	
  consul(ng	
  your	
  doctor.	
  Hepa((s	
  can	
  
change	
  the	
  way	
  drugs	
  affect	
  you.	
  Do	
  not	
  start	
  any	
  new	
  medica(on	
  without	
  first	
  
talking	
  to	
  your	
  health	
  care	
  provider	
  
Try	
  to	
  eat	
  enough	
  for	
  adequate	
  nutri(on.	
  Try	
  to	
  maintain	
  a	
  balanced	
  diet.	
  Many	
  
people	
  with	
  hepa((s	
  have	
  the	
  greatest	
  urge	
  to	
  eat	
  early	
  in	
  the	
  day	
  
Take	
  it	
  easy.	
  Your	
  ac(vity	
  level	
  should	
  match	
  your	
  energy	
  level	
  
39	
  
Pa(ent	
  educa(on	
  
CONTACT A CAREGIVER IF:
•  You have a fever.
•  You are vomiting (throwing up) and cannot keep food or liquids down
•  You have a rash, an itch, or swelling of your abdomen (stomach) or legs
•  You are bruising easily
•  You have bad abdominal pain
•  You have questions or concerns about your disease, medicine, or care
SEEK CARE IMMEDIATELY IF:
•  You are too dizzy to stand up
•  You feel confused or are very sleepy
•  Your stools are red, black, or clay-colored
•  Your symptoms are getting worse
•  Your vomit (throw up) has blood in it or looks like coffee grounds

40	
  
Case	
  study	
  
45	
  year	
  old	
  female,	
  who	
  presented	
  to	
  the	
  ER	
  

41	
  

Más contenido relacionado

La actualidad más candente

Hepatitis A, B, and C its management and treatment
Hepatitis A, B, and C its management and treatmentHepatitis A, B, and C its management and treatment
Hepatitis A, B, and C its management and treatmentJack Frost
 
Urinary Tract Infection with Nursing Management
Urinary Tract Infection with Nursing ManagementUrinary Tract Infection with Nursing Management
Urinary Tract Infection with Nursing ManagementSwatilekha Das
 
Cholecystitis cholelithiasis-presentation
Cholecystitis cholelithiasis-presentationCholecystitis cholelithiasis-presentation
Cholecystitis cholelithiasis-presentationAnshu Yadav
 
Intestinal obstruction, BOWEL OBSTRUCTION
Intestinal obstruction, BOWEL OBSTRUCTIONIntestinal obstruction, BOWEL OBSTRUCTION
Intestinal obstruction, BOWEL OBSTRUCTIONpankaj rana
 
Fracture and its nursing management
Fracture and its nursing managementFracture and its nursing management
Fracture and its nursing managementDurga Joshi
 
Nursing care plan on hepatitis B
Nursing care plan on hepatitis B Nursing care plan on hepatitis B
Nursing care plan on hepatitis B Balram Gurjar
 
Tuberculosis-Medical and Nursing Managements
Tuberculosis-Medical and Nursing ManagementsTuberculosis-Medical and Nursing Managements
Tuberculosis-Medical and Nursing ManagementsReynel Dan
 
GEMC - HIV/AIDS - for Nurses
GEMC - HIV/AIDS - for NursesGEMC - HIV/AIDS - for Nurses
GEMC - HIV/AIDS - for NursesOpen.Michigan
 
GEMC - Measles, Mumps, Rubella - for Nurses
GEMC - Measles, Mumps, Rubella - for NursesGEMC - Measles, Mumps, Rubella - for Nurses
GEMC - Measles, Mumps, Rubella - for NursesOpen.Michigan
 
Intestinal obstruction
Intestinal obstructionIntestinal obstruction
Intestinal obstructionVipin Chandran
 
Poliomyelitis Community health nursing 1 kenil
Poliomyelitis Community health nursing 1 kenilPoliomyelitis Community health nursing 1 kenil
Poliomyelitis Community health nursing 1 kenilvhoramahir
 

La actualidad más candente (20)

Hepatitis A, B, and C its management and treatment
Hepatitis A, B, and C its management and treatmentHepatitis A, B, and C its management and treatment
Hepatitis A, B, and C its management and treatment
 
Urinary Tract Infection with Nursing Management
Urinary Tract Infection with Nursing ManagementUrinary Tract Infection with Nursing Management
Urinary Tract Infection with Nursing Management
 
Mumps ppt biju
Mumps ppt bijuMumps ppt biju
Mumps ppt biju
 
Cholecystitis cholelithiasis-presentation
Cholecystitis cholelithiasis-presentationCholecystitis cholelithiasis-presentation
Cholecystitis cholelithiasis-presentation
 
Cholelithiasis
CholelithiasisCholelithiasis
Cholelithiasis
 
Intestinal obstruction, BOWEL OBSTRUCTION
Intestinal obstruction, BOWEL OBSTRUCTIONIntestinal obstruction, BOWEL OBSTRUCTION
Intestinal obstruction, BOWEL OBSTRUCTION
 
Fracture and its nursing management
Fracture and its nursing managementFracture and its nursing management
Fracture and its nursing management
 
Osteomyelitis
OsteomyelitisOsteomyelitis
Osteomyelitis
 
Diarrhea Slide share
Diarrhea Slide shareDiarrhea Slide share
Diarrhea Slide share
 
Nursing care plan on hepatitis B
Nursing care plan on hepatitis B Nursing care plan on hepatitis B
Nursing care plan on hepatitis B
 
Cirrhosis of liver
Cirrhosis of liverCirrhosis of liver
Cirrhosis of liver
 
Tuberculosis-Medical and Nursing Managements
Tuberculosis-Medical and Nursing ManagementsTuberculosis-Medical and Nursing Managements
Tuberculosis-Medical and Nursing Managements
 
Hepatitis B
Hepatitis BHepatitis B
Hepatitis B
 
GEMC - HIV/AIDS - for Nurses
GEMC - HIV/AIDS - for NursesGEMC - HIV/AIDS - for Nurses
GEMC - HIV/AIDS - for Nurses
 
Renal calculi
Renal calculiRenal calculi
Renal calculi
 
GEMC - Measles, Mumps, Rubella - for Nurses
GEMC - Measles, Mumps, Rubella - for NursesGEMC - Measles, Mumps, Rubella - for Nurses
GEMC - Measles, Mumps, Rubella - for Nurses
 
Liver cirrhosis
Liver cirrhosisLiver cirrhosis
Liver cirrhosis
 
Intestinal obstruction
Intestinal obstructionIntestinal obstruction
Intestinal obstruction
 
Poliomyelitis Community health nursing 1 kenil
Poliomyelitis Community health nursing 1 kenilPoliomyelitis Community health nursing 1 kenil
Poliomyelitis Community health nursing 1 kenil
 
Renal Failure
Renal FailureRenal Failure
Renal Failure
 

Similar a GEMC - Hepatitis - for Nurses

GEMC- Typhoid Fever, Infectious Diarrhea, Diphtheria, and Pertussis- for Nurses
GEMC- Typhoid Fever, Infectious Diarrhea, Diphtheria, and Pertussis- for NursesGEMC- Typhoid Fever, Infectious Diarrhea, Diphtheria, and Pertussis- for Nurses
GEMC- Typhoid Fever, Infectious Diarrhea, Diphtheria, and Pertussis- for NursesOpen.Michigan
 
gemc-nursing-2012-perry-id_typhoid_fever_infectious_diarrhea-oer.pptgshajaj
gemc-nursing-2012-perry-id_typhoid_fever_infectious_diarrhea-oer.pptgshajajgemc-nursing-2012-perry-id_typhoid_fever_infectious_diarrhea-oer.pptgshajaj
gemc-nursing-2012-perry-id_typhoid_fever_infectious_diarrhea-oer.pptgshajajayoubhasand1
 
world hepatitis day [ my work ].pptx
world hepatitis day [ my work ].pptxworld hepatitis day [ my work ].pptx
world hepatitis day [ my work ].pptxKhushi292056
 
GEMC - Abdominal Emergencies- For Nurses
GEMC - Abdominal Emergencies- For NursesGEMC - Abdominal Emergencies- For Nurses
GEMC - Abdominal Emergencies- For NursesOpen.Michigan
 
Global Medical Cures™ | What I Need To Know About HEPATITIS C
Global Medical Cures™ | What I Need To Know About HEPATITIS CGlobal Medical Cures™ | What I Need To Know About HEPATITIS C
Global Medical Cures™ | What I Need To Know About HEPATITIS CGlobal Medical Cures™
 
World no hepatitis day
World no hepatitis dayWorld no hepatitis day
World no hepatitis dayVini Mehta
 
Balkeejfinalhepatitis 150711214741-lva1-app6891
Balkeejfinalhepatitis 150711214741-lva1-app6891Balkeejfinalhepatitis 150711214741-lva1-app6891
Balkeejfinalhepatitis 150711214741-lva1-app6891Rachel Aird
 
LIVER [Autosaved](1).pptx
LIVER [Autosaved](1).pptxLIVER [Autosaved](1).pptx
LIVER [Autosaved](1).pptxShubham Shukla
 
LIVER [Autosaved](1).pptx
LIVER [Autosaved](1).pptxLIVER [Autosaved](1).pptx
LIVER [Autosaved](1).pptxShubham Shukla
 
Hepatitis B
Hepatitis BHepatitis B
Hepatitis BShanAta1
 
Counselling HIV/ AIDS patient
Counselling HIV/ AIDS patient Counselling HIV/ AIDS patient
Counselling HIV/ AIDS patient Qurrot Ulain Taher
 

Similar a GEMC - Hepatitis - for Nurses (20)

GEMC- Typhoid Fever, Infectious Diarrhea, Diphtheria, and Pertussis- for Nurses
GEMC- Typhoid Fever, Infectious Diarrhea, Diphtheria, and Pertussis- for NursesGEMC- Typhoid Fever, Infectious Diarrhea, Diphtheria, and Pertussis- for Nurses
GEMC- Typhoid Fever, Infectious Diarrhea, Diphtheria, and Pertussis- for Nurses
 
gemc-nursing-2012-perry-id_typhoid_fever_infectious_diarrhea-oer.pptgshajaj
gemc-nursing-2012-perry-id_typhoid_fever_infectious_diarrhea-oer.pptgshajajgemc-nursing-2012-perry-id_typhoid_fever_infectious_diarrhea-oer.pptgshajaj
gemc-nursing-2012-perry-id_typhoid_fever_infectious_diarrhea-oer.pptgshajaj
 
world hepatitis day [ my work ].pptx
world hepatitis day [ my work ].pptxworld hepatitis day [ my work ].pptx
world hepatitis day [ my work ].pptx
 
Hepatitis C & HIV Co-Infection
Hepatitis C & HIV Co-InfectionHepatitis C & HIV Co-Infection
Hepatitis C & HIV Co-Infection
 
GEMC - Abdominal Emergencies- For Nurses
GEMC - Abdominal Emergencies- For NursesGEMC - Abdominal Emergencies- For Nurses
GEMC - Abdominal Emergencies- For Nurses
 
Hepatitis
HepatitisHepatitis
Hepatitis
 
Hepatits c
Hepatits cHepatits c
Hepatits c
 
Global Medical Cures™ | What I Need To Know About HEPATITIS C
Global Medical Cures™ | What I Need To Know About HEPATITIS CGlobal Medical Cures™ | What I Need To Know About HEPATITIS C
Global Medical Cures™ | What I Need To Know About HEPATITIS C
 
World no hepatitis day
World no hepatitis dayWorld no hepatitis day
World no hepatitis day
 
Balkeejfinalhepatitis 150711214741-lva1-app6891
Balkeejfinalhepatitis 150711214741-lva1-app6891Balkeejfinalhepatitis 150711214741-lva1-app6891
Balkeejfinalhepatitis 150711214741-lva1-app6891
 
LIVER [Autosaved](1).pptx
LIVER [Autosaved](1).pptxLIVER [Autosaved](1).pptx
LIVER [Autosaved](1).pptx
 
LIVER [Autosaved](1).pptx
LIVER [Autosaved](1).pptxLIVER [Autosaved](1).pptx
LIVER [Autosaved](1).pptx
 
Hepatitis B
Hepatitis BHepatitis B
Hepatitis B
 
HEPATITIS
HEPATITISHEPATITIS
HEPATITIS
 
hepatitis
hepatitishepatitis
hepatitis
 
Harvoni
HarvoniHarvoni
Harvoni
 
Counselling HIV/ AIDS patient
Counselling HIV/ AIDS patient Counselling HIV/ AIDS patient
Counselling HIV/ AIDS patient
 
Hepatitis a
Hepatitis aHepatitis a
Hepatitis a
 
Hepatitis c
Hepatitis cHepatitis c
Hepatitis c
 
Hepatitis C Presentation 2014
Hepatitis C Presentation 2014 Hepatitis C Presentation 2014
Hepatitis C Presentation 2014
 

Más de Open.Michigan

GEMC- Test-Taking Skills- Resident Training
GEMC- Test-Taking Skills- Resident TrainingGEMC- Test-Taking Skills- Resident Training
GEMC- Test-Taking Skills- Resident TrainingOpen.Michigan
 
GEMC- Oncologic Emergencies- Resident Training
GEMC- Oncologic Emergencies- Resident TrainingGEMC- Oncologic Emergencies- Resident Training
GEMC- Oncologic Emergencies- Resident TrainingOpen.Michigan
 
GEMC- Cardiac Evalutation- Resident Training
GEMC- Cardiac Evalutation- Resident TrainingGEMC- Cardiac Evalutation- Resident Training
GEMC- Cardiac Evalutation- Resident TrainingOpen.Michigan
 
GEMC- Alterations in Body Temperature: The Adult Patient with a Fever- Reside...
GEMC- Alterations in Body Temperature: The Adult Patient with a Fever- Reside...GEMC- Alterations in Body Temperature: The Adult Patient with a Fever- Reside...
GEMC- Alterations in Body Temperature: The Adult Patient with a Fever- Reside...Open.Michigan
 
GEMC- Rapid Sequence Intubation & Emergency Airway Support in the Pediatric E...
GEMC- Rapid Sequence Intubation & Emergency Airway Support in the Pediatric E...GEMC- Rapid Sequence Intubation & Emergency Airway Support in the Pediatric E...
GEMC- Rapid Sequence Intubation & Emergency Airway Support in the Pediatric E...Open.Michigan
 
GEMC- Ocular Emgercencies- Resident Training
GEMC- Ocular Emgercencies- Resident TrainingGEMC- Ocular Emgercencies- Resident Training
GEMC- Ocular Emgercencies- Resident TrainingOpen.Michigan
 
GEMC- Disorders of the Pleura, Mediastinum, and Chest Wall- Resident Training
GEMC- Disorders of the Pleura, Mediastinum, and Chest Wall- Resident TrainingGEMC- Disorders of the Pleura, Mediastinum, and Chest Wall- Resident Training
GEMC- Disorders of the Pleura, Mediastinum, and Chest Wall- Resident TrainingOpen.Michigan
 
GEMC- Dental Emergencies and Common Dental Blocks- Resident Training
GEMC- Dental Emergencies and Common Dental Blocks- Resident TrainingGEMC- Dental Emergencies and Common Dental Blocks- Resident Training
GEMC- Dental Emergencies and Common Dental Blocks- Resident TrainingOpen.Michigan
 
GEMC- EMedHome Board Review: Procedures- Resident Training
GEMC- EMedHome Board Review: Procedures- Resident TrainingGEMC- EMedHome Board Review: Procedures- Resident Training
GEMC- EMedHome Board Review: Procedures- Resident TrainingOpen.Michigan
 
GEMC- Arthritis and Arthrocentesis- Resident Training
GEMC- Arthritis and Arthrocentesis- Resident TrainingGEMC- Arthritis and Arthrocentesis- Resident Training
GEMC- Arthritis and Arthrocentesis- Resident TrainingOpen.Michigan
 
GEMC- Bursitis, Tendonitis, Fibromyalgia, and RSD- Resident Training
GEMC- Bursitis, Tendonitis, Fibromyalgia, and RSD- Resident TrainingGEMC- Bursitis, Tendonitis, Fibromyalgia, and RSD- Resident Training
GEMC- Bursitis, Tendonitis, Fibromyalgia, and RSD- Resident TrainingOpen.Michigan
 
GEMC- Right Upper Quadrant Ultrasound- Resident Training
GEMC- Right Upper Quadrant Ultrasound- Resident TrainingGEMC- Right Upper Quadrant Ultrasound- Resident Training
GEMC- Right Upper Quadrant Ultrasound- Resident TrainingOpen.Michigan
 
GEMC- Cardiovascular Board Review Session 3- Resident Training
GEMC- Cardiovascular Board Review Session 3- Resident TrainingGEMC- Cardiovascular Board Review Session 3- Resident Training
GEMC- Cardiovascular Board Review Session 3- Resident TrainingOpen.Michigan
 
GEMC- Cardiovascular Board Review Session 2- Resident Training
GEMC- Cardiovascular Board Review Session 2- Resident TrainingGEMC- Cardiovascular Board Review Session 2- Resident Training
GEMC- Cardiovascular Board Review Session 2- Resident TrainingOpen.Michigan
 
GEMC- Cardiovascular Board Review Session 1- Resident Training
GEMC- Cardiovascular Board Review Session 1- Resident TrainingGEMC- Cardiovascular Board Review Session 1- Resident Training
GEMC- Cardiovascular Board Review Session 1- Resident TrainingOpen.Michigan
 
GEMC: Nursing Process and Linkage between Theory and Practice
GEMC: Nursing Process and Linkage between Theory and PracticeGEMC: Nursing Process and Linkage between Theory and Practice
GEMC: Nursing Process and Linkage between Theory and PracticeOpen.Michigan
 
2014 gemc-nursing-lapham-general survey and patient care management
2014 gemc-nursing-lapham-general survey and patient care management2014 gemc-nursing-lapham-general survey and patient care management
2014 gemc-nursing-lapham-general survey and patient care managementOpen.Michigan
 
GEMC: When Kidneys Fail
GEMC: When Kidneys FailGEMC: When Kidneys Fail
GEMC: When Kidneys FailOpen.Michigan
 
GEMC: The Role of Radiography in the Initial Evaluation of C-Spine Trauma
GEMC: The Role of Radiography in the Initial Evaluation of C-Spine TraumaGEMC: The Role of Radiography in the Initial Evaluation of C-Spine Trauma
GEMC: The Role of Radiography in the Initial Evaluation of C-Spine TraumaOpen.Michigan
 
GEMC - Mammal and Human Bite Injuries
GEMC - Mammal and Human Bite InjuriesGEMC - Mammal and Human Bite Injuries
GEMC - Mammal and Human Bite InjuriesOpen.Michigan
 

Más de Open.Michigan (20)

GEMC- Test-Taking Skills- Resident Training
GEMC- Test-Taking Skills- Resident TrainingGEMC- Test-Taking Skills- Resident Training
GEMC- Test-Taking Skills- Resident Training
 
GEMC- Oncologic Emergencies- Resident Training
GEMC- Oncologic Emergencies- Resident TrainingGEMC- Oncologic Emergencies- Resident Training
GEMC- Oncologic Emergencies- Resident Training
 
GEMC- Cardiac Evalutation- Resident Training
GEMC- Cardiac Evalutation- Resident TrainingGEMC- Cardiac Evalutation- Resident Training
GEMC- Cardiac Evalutation- Resident Training
 
GEMC- Alterations in Body Temperature: The Adult Patient with a Fever- Reside...
GEMC- Alterations in Body Temperature: The Adult Patient with a Fever- Reside...GEMC- Alterations in Body Temperature: The Adult Patient with a Fever- Reside...
GEMC- Alterations in Body Temperature: The Adult Patient with a Fever- Reside...
 
GEMC- Rapid Sequence Intubation & Emergency Airway Support in the Pediatric E...
GEMC- Rapid Sequence Intubation & Emergency Airway Support in the Pediatric E...GEMC- Rapid Sequence Intubation & Emergency Airway Support in the Pediatric E...
GEMC- Rapid Sequence Intubation & Emergency Airway Support in the Pediatric E...
 
GEMC- Ocular Emgercencies- Resident Training
GEMC- Ocular Emgercencies- Resident TrainingGEMC- Ocular Emgercencies- Resident Training
GEMC- Ocular Emgercencies- Resident Training
 
GEMC- Disorders of the Pleura, Mediastinum, and Chest Wall- Resident Training
GEMC- Disorders of the Pleura, Mediastinum, and Chest Wall- Resident TrainingGEMC- Disorders of the Pleura, Mediastinum, and Chest Wall- Resident Training
GEMC- Disorders of the Pleura, Mediastinum, and Chest Wall- Resident Training
 
GEMC- Dental Emergencies and Common Dental Blocks- Resident Training
GEMC- Dental Emergencies and Common Dental Blocks- Resident TrainingGEMC- Dental Emergencies and Common Dental Blocks- Resident Training
GEMC- Dental Emergencies and Common Dental Blocks- Resident Training
 
GEMC- EMedHome Board Review: Procedures- Resident Training
GEMC- EMedHome Board Review: Procedures- Resident TrainingGEMC- EMedHome Board Review: Procedures- Resident Training
GEMC- EMedHome Board Review: Procedures- Resident Training
 
GEMC- Arthritis and Arthrocentesis- Resident Training
GEMC- Arthritis and Arthrocentesis- Resident TrainingGEMC- Arthritis and Arthrocentesis- Resident Training
GEMC- Arthritis and Arthrocentesis- Resident Training
 
GEMC- Bursitis, Tendonitis, Fibromyalgia, and RSD- Resident Training
GEMC- Bursitis, Tendonitis, Fibromyalgia, and RSD- Resident TrainingGEMC- Bursitis, Tendonitis, Fibromyalgia, and RSD- Resident Training
GEMC- Bursitis, Tendonitis, Fibromyalgia, and RSD- Resident Training
 
GEMC- Right Upper Quadrant Ultrasound- Resident Training
GEMC- Right Upper Quadrant Ultrasound- Resident TrainingGEMC- Right Upper Quadrant Ultrasound- Resident Training
GEMC- Right Upper Quadrant Ultrasound- Resident Training
 
GEMC- Cardiovascular Board Review Session 3- Resident Training
GEMC- Cardiovascular Board Review Session 3- Resident TrainingGEMC- Cardiovascular Board Review Session 3- Resident Training
GEMC- Cardiovascular Board Review Session 3- Resident Training
 
GEMC- Cardiovascular Board Review Session 2- Resident Training
GEMC- Cardiovascular Board Review Session 2- Resident TrainingGEMC- Cardiovascular Board Review Session 2- Resident Training
GEMC- Cardiovascular Board Review Session 2- Resident Training
 
GEMC- Cardiovascular Board Review Session 1- Resident Training
GEMC- Cardiovascular Board Review Session 1- Resident TrainingGEMC- Cardiovascular Board Review Session 1- Resident Training
GEMC- Cardiovascular Board Review Session 1- Resident Training
 
GEMC: Nursing Process and Linkage between Theory and Practice
GEMC: Nursing Process and Linkage between Theory and PracticeGEMC: Nursing Process and Linkage between Theory and Practice
GEMC: Nursing Process and Linkage between Theory and Practice
 
2014 gemc-nursing-lapham-general survey and patient care management
2014 gemc-nursing-lapham-general survey and patient care management2014 gemc-nursing-lapham-general survey and patient care management
2014 gemc-nursing-lapham-general survey and patient care management
 
GEMC: When Kidneys Fail
GEMC: When Kidneys FailGEMC: When Kidneys Fail
GEMC: When Kidneys Fail
 
GEMC: The Role of Radiography in the Initial Evaluation of C-Spine Trauma
GEMC: The Role of Radiography in the Initial Evaluation of C-Spine TraumaGEMC: The Role of Radiography in the Initial Evaluation of C-Spine Trauma
GEMC: The Role of Radiography in the Initial Evaluation of C-Spine Trauma
 
GEMC - Mammal and Human Bite Injuries
GEMC - Mammal and Human Bite InjuriesGEMC - Mammal and Human Bite Injuries
GEMC - Mammal and Human Bite Injuries
 

Último

Diploma in Nursing Admission Test Question Solution 2023.pdf
Diploma in Nursing Admission Test Question Solution 2023.pdfDiploma in Nursing Admission Test Question Solution 2023.pdf
Diploma in Nursing Admission Test Question Solution 2023.pdfMohonDas
 
Quality Assurance_GOOD LABORATORY PRACTICE
Quality Assurance_GOOD LABORATORY PRACTICEQuality Assurance_GOOD LABORATORY PRACTICE
Quality Assurance_GOOD LABORATORY PRACTICESayali Powar
 
KARNAADA.pptx made by - saransh dwivedi ( SD ) - SHALAKYA TANTRA - ENT - 4...
KARNAADA.pptx  made by -  saransh dwivedi ( SD ) -  SHALAKYA TANTRA - ENT - 4...KARNAADA.pptx  made by -  saransh dwivedi ( SD ) -  SHALAKYA TANTRA - ENT - 4...
KARNAADA.pptx made by - saransh dwivedi ( SD ) - SHALAKYA TANTRA - ENT - 4...M56BOOKSTORE PRODUCT/SERVICE
 
How to Solve Singleton Error in the Odoo 17
How to Solve Singleton Error in the  Odoo 17How to Solve Singleton Error in the  Odoo 17
How to Solve Singleton Error in the Odoo 17Celine George
 
Easter in the USA presentation by Chloe.
Easter in the USA presentation by Chloe.Easter in the USA presentation by Chloe.
Easter in the USA presentation by Chloe.EnglishCEIPdeSigeiro
 
ARTICULAR DISC OF TEMPOROMANDIBULAR JOINT
ARTICULAR DISC OF TEMPOROMANDIBULAR JOINTARTICULAR DISC OF TEMPOROMANDIBULAR JOINT
ARTICULAR DISC OF TEMPOROMANDIBULAR JOINTDR. SNEHA NAIR
 
AUDIENCE THEORY -- FANDOM -- JENKINS.pptx
AUDIENCE THEORY -- FANDOM -- JENKINS.pptxAUDIENCE THEORY -- FANDOM -- JENKINS.pptx
AUDIENCE THEORY -- FANDOM -- JENKINS.pptxiammrhaywood
 
SOLIDE WASTE in Cameroon,,,,,,,,,,,,,,,,,,,,,,,,,,,.pptx
SOLIDE WASTE in Cameroon,,,,,,,,,,,,,,,,,,,,,,,,,,,.pptxSOLIDE WASTE in Cameroon,,,,,,,,,,,,,,,,,,,,,,,,,,,.pptx
SOLIDE WASTE in Cameroon,,,,,,,,,,,,,,,,,,,,,,,,,,,.pptxSyedNadeemGillANi
 
How to Send Emails From Odoo 17 Using Code
How to Send Emails From Odoo 17 Using CodeHow to Send Emails From Odoo 17 Using Code
How to Send Emails From Odoo 17 Using CodeCeline George
 
Unveiling the Intricacies of Leishmania donovani: Structure, Life Cycle, Path...
Unveiling the Intricacies of Leishmania donovani: Structure, Life Cycle, Path...Unveiling the Intricacies of Leishmania donovani: Structure, Life Cycle, Path...
Unveiling the Intricacies of Leishmania donovani: Structure, Life Cycle, Path...Dr. Asif Anas
 
Drug Information Services- DIC and Sources.
Drug Information Services- DIC and Sources.Drug Information Services- DIC and Sources.
Drug Information Services- DIC and Sources.raviapr7
 
3.26.24 Race, the Draft, and the Vietnam War.pptx
3.26.24 Race, the Draft, and the Vietnam War.pptx3.26.24 Race, the Draft, and the Vietnam War.pptx
3.26.24 Race, the Draft, and the Vietnam War.pptxmary850239
 
Education and training program in the hospital APR.pptx
Education and training program in the hospital APR.pptxEducation and training program in the hospital APR.pptx
Education and training program in the hospital APR.pptxraviapr7
 
Patient Counselling. Definition of patient counseling; steps involved in pati...
Patient Counselling. Definition of patient counseling; steps involved in pati...Patient Counselling. Definition of patient counseling; steps involved in pati...
Patient Counselling. Definition of patient counseling; steps involved in pati...raviapr7
 
Work Experience for psp3 portfolio sasha
Work Experience for psp3 portfolio sashaWork Experience for psp3 portfolio sasha
Work Experience for psp3 portfolio sashasashalaycock03
 
The Stolen Bacillus by Herbert George Wells
The Stolen Bacillus by Herbert George WellsThe Stolen Bacillus by Herbert George Wells
The Stolen Bacillus by Herbert George WellsEugene Lysak
 
Department of Health Compounder Question ‍Solution 2022.pdf
Department of Health Compounder Question ‍Solution 2022.pdfDepartment of Health Compounder Question ‍Solution 2022.pdf
Department of Health Compounder Question ‍Solution 2022.pdfMohonDas
 
Over the counter (OTC)- Sale, rational use.pptx
Over the counter (OTC)- Sale, rational use.pptxOver the counter (OTC)- Sale, rational use.pptx
Over the counter (OTC)- Sale, rational use.pptxraviapr7
 
How to Show Error_Warning Messages in Odoo 17
How to Show Error_Warning Messages in Odoo 17How to Show Error_Warning Messages in Odoo 17
How to Show Error_Warning Messages in Odoo 17Celine George
 

Último (20)

Diploma in Nursing Admission Test Question Solution 2023.pdf
Diploma in Nursing Admission Test Question Solution 2023.pdfDiploma in Nursing Admission Test Question Solution 2023.pdf
Diploma in Nursing Admission Test Question Solution 2023.pdf
 
Quality Assurance_GOOD LABORATORY PRACTICE
Quality Assurance_GOOD LABORATORY PRACTICEQuality Assurance_GOOD LABORATORY PRACTICE
Quality Assurance_GOOD LABORATORY PRACTICE
 
KARNAADA.pptx made by - saransh dwivedi ( SD ) - SHALAKYA TANTRA - ENT - 4...
KARNAADA.pptx  made by -  saransh dwivedi ( SD ) -  SHALAKYA TANTRA - ENT - 4...KARNAADA.pptx  made by -  saransh dwivedi ( SD ) -  SHALAKYA TANTRA - ENT - 4...
KARNAADA.pptx made by - saransh dwivedi ( SD ) - SHALAKYA TANTRA - ENT - 4...
 
How to Solve Singleton Error in the Odoo 17
How to Solve Singleton Error in the  Odoo 17How to Solve Singleton Error in the  Odoo 17
How to Solve Singleton Error in the Odoo 17
 
Easter in the USA presentation by Chloe.
Easter in the USA presentation by Chloe.Easter in the USA presentation by Chloe.
Easter in the USA presentation by Chloe.
 
ARTICULAR DISC OF TEMPOROMANDIBULAR JOINT
ARTICULAR DISC OF TEMPOROMANDIBULAR JOINTARTICULAR DISC OF TEMPOROMANDIBULAR JOINT
ARTICULAR DISC OF TEMPOROMANDIBULAR JOINT
 
AUDIENCE THEORY -- FANDOM -- JENKINS.pptx
AUDIENCE THEORY -- FANDOM -- JENKINS.pptxAUDIENCE THEORY -- FANDOM -- JENKINS.pptx
AUDIENCE THEORY -- FANDOM -- JENKINS.pptx
 
SOLIDE WASTE in Cameroon,,,,,,,,,,,,,,,,,,,,,,,,,,,.pptx
SOLIDE WASTE in Cameroon,,,,,,,,,,,,,,,,,,,,,,,,,,,.pptxSOLIDE WASTE in Cameroon,,,,,,,,,,,,,,,,,,,,,,,,,,,.pptx
SOLIDE WASTE in Cameroon,,,,,,,,,,,,,,,,,,,,,,,,,,,.pptx
 
How to Send Emails From Odoo 17 Using Code
How to Send Emails From Odoo 17 Using CodeHow to Send Emails From Odoo 17 Using Code
How to Send Emails From Odoo 17 Using Code
 
Unveiling the Intricacies of Leishmania donovani: Structure, Life Cycle, Path...
Unveiling the Intricacies of Leishmania donovani: Structure, Life Cycle, Path...Unveiling the Intricacies of Leishmania donovani: Structure, Life Cycle, Path...
Unveiling the Intricacies of Leishmania donovani: Structure, Life Cycle, Path...
 
Drug Information Services- DIC and Sources.
Drug Information Services- DIC and Sources.Drug Information Services- DIC and Sources.
Drug Information Services- DIC and Sources.
 
3.26.24 Race, the Draft, and the Vietnam War.pptx
3.26.24 Race, the Draft, and the Vietnam War.pptx3.26.24 Race, the Draft, and the Vietnam War.pptx
3.26.24 Race, the Draft, and the Vietnam War.pptx
 
Education and training program in the hospital APR.pptx
Education and training program in the hospital APR.pptxEducation and training program in the hospital APR.pptx
Education and training program in the hospital APR.pptx
 
Patient Counselling. Definition of patient counseling; steps involved in pati...
Patient Counselling. Definition of patient counseling; steps involved in pati...Patient Counselling. Definition of patient counseling; steps involved in pati...
Patient Counselling. Definition of patient counseling; steps involved in pati...
 
Finals of Kant get Marx 2.0 : a general politics quiz
Finals of Kant get Marx 2.0 : a general politics quizFinals of Kant get Marx 2.0 : a general politics quiz
Finals of Kant get Marx 2.0 : a general politics quiz
 
Work Experience for psp3 portfolio sasha
Work Experience for psp3 portfolio sashaWork Experience for psp3 portfolio sasha
Work Experience for psp3 portfolio sasha
 
The Stolen Bacillus by Herbert George Wells
The Stolen Bacillus by Herbert George WellsThe Stolen Bacillus by Herbert George Wells
The Stolen Bacillus by Herbert George Wells
 
Department of Health Compounder Question ‍Solution 2022.pdf
Department of Health Compounder Question ‍Solution 2022.pdfDepartment of Health Compounder Question ‍Solution 2022.pdf
Department of Health Compounder Question ‍Solution 2022.pdf
 
Over the counter (OTC)- Sale, rational use.pptx
Over the counter (OTC)- Sale, rational use.pptxOver the counter (OTC)- Sale, rational use.pptx
Over the counter (OTC)- Sale, rational use.pptx
 
How to Show Error_Warning Messages in Odoo 17
How to Show Error_Warning Messages in Odoo 17How to Show Error_Warning Messages in Odoo 17
How to Show Error_Warning Messages in Odoo 17
 

GEMC - Hepatitis - for Nurses

  • 1. Project: Ghana Emergency Medicine Collaborative Document Title: Hepatitis Author(s): Katherine A. Perry (University of Michigan), RN, BSN 2012 License: Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/ We have reviewed this material in accordance with U.S. Copyright Law and have tried to maximize your ability to use, share, and adapt it. These lectures have been modified in the process of making a publicly shareable version. The citation key on the following slide provides information about how you may share and adapt this material. Copyright holders of content included in this material should contact open.michigan@umich.edu with any questions, corrections, or clarification regarding the use of content. For more information about how to cite these materials visit http://open.umich.edu/privacy-and-terms-use. Any medical information in this material is intended to inform and educate and is not a tool for self-diagnosis or a replacement for medical evaluation, advice, diagnosis or treatment by a healthcare professional. Please speak to your physician if you have questions about your medical condition. Viewer discretion is advised: Some medical content is graphic and may not be suitable for all viewers. 1  
  • 2. Attribution Key for more information see: http://open.umich.edu/wiki/AttributionPolicy Use + Share + Adapt { Content the copyright holder, author, or law permits you to use, share and adapt. } Public Domain – Government: Works that are produced by the U.S. Government. (17 USC § 105) Public Domain – Expired: Works that are no longer protected due to an expired copyright term. Public Domain – Self Dedicated: Works that a copyright holder has dedicated to the public domain. Creative Commons – Zero Waiver Creative Commons – Attribution License Creative Commons – Attribution Share Alike License Creative Commons – Attribution Noncommercial License Creative Commons – Attribution Noncommercial Share Alike License GNU – Free Documentation License Make Your Own Assessment { Content Open.Michigan believes can be used, shared, and adapted because it is ineligible for copyright. } Public Domain – Ineligible: Works that are ineligible for copyright protection in the U.S. (17 USC § 102(b)) *laws in your jurisdiction may differ { Content Open.Michigan has used under a Fair Use determination. } Fair Use: Use of works that is determined to be Fair consistent with the U.S. Copyright Act. (17 USC § 107) *laws in your jurisdiction may differ Our determination DOES NOT mean that all uses of this 3rd-party content are Fair Uses and we DO NOT guarantee that your use of the content is Fair. 2   To use this content you should do your own independent analysis to determine whether or not your use will be Fair.
  • 3. Hepa((s  A  Virus  (HAV)   •  Hepatitis A is an acute infectious disease of the liver •  Usually spread fecal-oral route; transmitted person-to-person by ingestion of contaminated food or water or through direct contact with an infectious person •  Closely associated with poor sanitation and a lack of personal hygiene habits, such as hand-washing •  An estimated 1.4 million cases of hepatitis A occur annually (WHO) 3  
  • 4. Transmission  of  HAV   People almost always get hepatitis A from fecal contamination: •  Food handlers who have the disease did not wash their hands after having a BM •  Drinking water or eat raw shellfish (clams, oysters) that came from unclean water areas •  You were in a place with poor sanitary conditions (dirty) where the hepatitis A virus is common •  There other ways you may get hepatitis A, but these are much less common: –  Day care workers who do not wash their hands after changing a diaper –  Men who have sex with men –  The blood of an infected person getting into your blood –  Users of both injectable and non-injectable street drugs can get it by using dirty or used needles. 4  
  • 5. HAV  Symptoms   Range from mild to severe including •  Fever •  Malaise •  Loss of appetite •  Diarrhea •  Nausea •  Abdominal discomfort •  Dark-colored urine, and light-colored BM’s •  Jaundice (a yellowing of the skin and whites of the eyes) You are most contagious in the two weeks before getting jaundiced and the first week after getting jaundice 5  
  • 6. Treatment  of  HAV   •  There is no specific treatment for hepatitis A •  Recovery from symptoms following infection may be slow and take several weeks or months •  Therapy is aimed at maintaining comfort and adequate nutritional balance, including replacement of fluids that are lost from vomiting and diarrhea 6  
  • 7. Preven(on   •  Improved sanitation and Hepatitis A immunization are the most effective ways to combat the disease •  Adequate supplies of safe-drinking water and proper disposal of sewage within communities, combined with personal hygiene practices, such as regular hand-washing, reduce the spread of HAV •  Several hepatitis A vaccines are available internationally. All are similar in terms of how well they protect people from the virus and their side-effects. No vaccine is licensed for children younger than one year of age. 7  
  • 8. Pa(ent  Educa(on   •  When you have an appetite again, eat healthy foods from all of the 5 food groups: fruits, vegetables, breads, dairy products, meat and fish •  Try to avoid alcohol since it makes your liver work harder •  Drink 6 to 8 glasses of liquid each day. Limit the amount of caffeine you drink such as coffee, tea, and soda •  Your friends and family may need to get a shot to keep them from getting hepatitis A •  Do not share dishes and eating utensils. Wash dishes and utensils in boiling water or a dishwasher. You may want to use disposable (throw-away) dishes •  Do not make food or meals for other people •  Wash your hands well before eating and after using the toilet •  Wash clothing and bedding in the hottest water setting •  Clean toilets with a product that kills germs 8  
  • 9. Pa(ent  Educa(on   CONTACT A CAREGIVER IF: •  You cannot drink liquids or keep food down •  Your skin is itchy, swollen, or has a rash. Your medicine may be causing these symptoms. This may mean you are allergic •  You are bruising easily SEEK CARE IMMEDIATELY IF: •  You feel confused or unusually sleepy. The sleepiness may switch with feeling irritable or jittery •  You have bad abdominal pain •  You have BMs that are red or black and sticky •  Your vomit is red or looks like coffee grounds •  You are too dizzy to stand up 9  
  • 10. Hepa((s  B  Virus  (HBV)   •  Hepatitis B is irritation and swelling (inflammation) of the liver due to infection with the hepatitis B virus (HBV) •  The infection is called acute when a person first becomes infected with HBV •  The infection becomes chronic (long-term) when a person has symptoms, such as liver swelling, for six months or longer •  Acute HBV infections are more common in adults. Infants and young children have a higher risk for chronic HBV 10  
  • 11. Transmission  HBV   •  Contact with infected blood or body fluids, such as saliva and semen •  Once HBV is in your blood, it travels to your liver and injures your liver cells •  HBV can enter your body through a cut or scratch in your skin or through your mucous membranes •  Mucous membranes include your gums and the lining of your rectum or a woman's vagina •  HBV can live on objects and surfaces for seven or more days, with or without visible blood •  HBV can also spread from a mother to her unborn child. 11  
  • 12. Symptoms  of  HBV   •  It can take from 1 to 6 months before symptoms occur •  Some people will have no signs and symptoms and may not know they have been infected. When signs and symptoms do occur, they may last from a few days to months: –  Dark-colored urine or light-colored or gray bowel movements (BMs). –  Fatigue (feeling more tired than usual) and weakness. –  Fever (high body temperature). –  Loss of appetite for food, nausea (upset stomach), and vomiting (throwing up). –  Jaundice (yellowing of the skin or the whites of the eyes). You may also get skin rashes. –  Joint pain and body aches. –  Pain in the right upper side of the abdomen (stomach) 12  
  • 13. Complica(ons  of  HBV   •  Liver cirrhosis: scarring of the liver caused by infection and inflammation. Increased risk for cirrhosis if you drink alcohol or smoke. Increased risk if you have human immunodeficiency virus (HIV), hepatitis C; or hepatitis D •  Liver failure: Liver failure occurs when the liver can no longer function as it should. Risk for liver failure increases if you have cirrhosis. •  Liver cancer: Chronic HBV may lead to liver cancer. The risk for liver cancer increases if you are male and if you have other family members with liver cancer. Your risk also increases if you have liver cirrhosis or if you are also infected with hepatitis C. •  Kidney problems: HBV can lead to inflammation and problems with your kidney function. Your kidneys are organs that remove waste from your body as urine 13  
  • 14. Diagnosis   •  Blood tests: to give information about how the patients body is working •  Abdominal ultrasound: pictures of the liver may be done to check for signs of HBV and to look for other liver problems •  Liver biopsy: a small sample of the liver is removed and sent to a lab to check for swelling, scarring, and other damage. A liver biopsy may help caregivers learn if you need treatment for HBV 14  
  • 15. HBV  preven(on   Getting vaccinated against HBV is the best way to decrease your risk and prevent the disease •  The HBV vaccine is given in three doses over a period of months •  Some people may not respond to the vaccine as well as others •  After being vaccinated, some may need a blood test to check his/her response Photographer's Mate Airman Apprentice Christopher D. Blachly, Wikimedia Commons 15  
  • 16. Treatment  of  HBV   •  The goal of treatment is to prevent the disease from getting worse and leading to more serious liver problems •  Treatment may help improve the function of your liver and decrease your symptoms of liver disease •  HBV may last a short time and go away on its own without treatment •  HBV may become chronic, leading to liver damage and disease 16  
  • 17. Treatment  of  HBV   Medicines: •  Antiviral medicines: Antiviral medicine may be given to help stop the virus from spreading in your body •  Immune globulin: Hepatitis B immune globulin (HBIG) is medicine given if you have been exposed to HBV. Immune globulin helps your body fight the HBV infection. HBIG is also given to newborn babies who were exposed to HBV while in the womb. •  Liver transplant: Some patients may need a liver transplant if they have severe liver disease or liver failure. •  Hepatitis A vaccination: If you are diagnosed with HBV, your caregiver may vaccinate you against hepatitis A. 17  
  • 18. HBV  preven(on   The following people should be vaccinated against HBV: •  Any person not already vaccinated against HBV •  Healthcare workers and workers in other care facilities •  Newborn babies born to women with HBV - All newborn babies should be vaccinated shortly after birth and have additional doses as directed by a caregiver •  People living in care facilities and inmates of correctional facilities 18  
  • 19. HBV  preven(on   •  People who have decreased liver function or who are infected with hepatitis C, hepatitis D, or HIV •  People who inject illegal drugs •  People with kidney failure receiving hemodialysis treatments. More or higher doses of the vaccine may be needed for people with kidney failure •  People with more than one sex partner or men having sex with other men •  People who have had a sexually transmitted disease (STD) before should also be vaccinated 19  
  • 20. HBV  Preven(on   Those who are HBV+: •  •  •  •  •  •  •  Cover any open cuts or scratches. If blood from a wound gets on a surface, clean the surface with bleach right away Dispose of any items with blood or body fluids on them properly Do not donate blood, sperm, or organs to others Do not share items that may have infected blood or body fluids on them (includes toothbrushes, razors, or personal injection items, such as needles) Tell household and sexual contacts that you have HBV. All close contacts should be vaccinated. If contacts have not had the vaccination, they may need to start treatment to help prevent infection. Also tell medical or dental caregivers you have HBV when getting any kind of treatment When having sex, always use a condom, even if you have acute HBV and your infection goes away, you can still spread the virus for up to six months 20  
  • 21. Pa(ent  educa(on   Call your caregiver if: •  The palms of your hands are red •  You have a fever •  You have new or increased swelling in your legs, ankles, or feet •  Your muscles are getting smaller and weaker •  You have questions about your condition, medicines, or care 21  
  • 22. Pa(ent  educa(on   Seek help immediately or call 911 if: •  You have a sudden, severe headache and head pressure •  You have new or increased bruising or red or purple dots on your skin. You may also have bleeding that does not stop easily •  Your abdomen is swollen •  You have severe nausea or cannot stop vomiting •  You see blood in your urine or bowel movements, or you vomit blood •  You have new or increased yellowing of your skin or the whites of your eyes •  You have severe (very bad) pain in your upper abdomen 22  
  • 23. Pa(ent  educa(on   •  Limit or avoid alcohol: Alcohol can increase your liver damage and can damage your brain and heart •  Quit smoking: Smoking harms your lungs, blood, and heart. You are more likely to have a heart attack, lung disease, and cancer if you smoke. You will help yourself and those around you by not smoking •  Pregnant and have viral hepatitis B? –  Avoid close or intimate contact with others as directed by your caregiver –  Avoid injury to your upper abdomen –  Make sure you eat a healthy diet –  You may need to limit your daily activities and rest more –  After your child is born, you should be able to breastfeed your infant 23  
  • 24. GOKLuLe, Wikimedia Commons Pa(ent  educa(on   •  Take your medicine as directed: Call your primary healthcare provider if you think your medicine is not working as expected •  Follow-up visit: tell the patient to ask the caregiver when to return for a follow-up visit. He/she may need to have blood tests to check the function of your liver. Keep all appointments. Write down any questions he/ she may have 24  
  • 25. Hepa((s  C  Virus  (HCV)   •  Hepatitis C is also called non-A or non-B hepatitis •  Inflammation of the liver due to infection caused by a virus •  Similar to Hep A & Hep B, Hepatitis C virus (HCV) attacks and damages your liver •  CDC estimates worldwide there are 3-4 million people infected with HCV each year 25  
  • 26. Symptoms  HCV   The most common symptom of hepatitis C is fatigue (feeling more tired than usual) The patient may present with one or more of the following: •  •  •  •  •  •  •  Dark orange-colored urine or clay-colored stool Fever Itchy skin Jaundice (yellowing of the skin or the whites of the eyes) Joint pain, body aches, or weakness Loss of appetite, nausea or vomiting Pain in the right side of the abdomen 26  
  • 27. Complica(ons  HVC   Hepatitis C may lead to the following problems: •  Liver cirrhosis •  Liver cancer •  Liver failure •  Kidney disease 27  
  • 28. Transmission   Hepatitis C virus is carried in the blood and other body fluids, such as semen or vaginal fluids. Hepatitis C virus may spread by any of the following: •  •  •  •  •  •  •  •  Childbirth: passed from a pregnant woman to her baby during delivery Needle stick injury Long-term dialysis Blood transfusion or an organ transplant before July 1992 Sharing items that may have infected blood on them, such as razors, toothbrushes, or nail clippers Sharing infected needles to use illegal or street drugs Using dirty needles or instruments for tattooing, body piercing, or other procedures Sex: Some people may not know they have hepatitis C and and could pass the virus to their sex partner. 28  
  • 29. Diagnosis   •  Enzyme immunoassay test: EIA checks for hepatitis C antibodies (proteins made by the immune system that attack viruses or bacteria) •  Genotyping: blood test that tests the genotype of the hepatitis C virus that you have •  Hepatitis C profile serological test: checks the activity and number of hepatitis C viruses present in your blood. •  Liver biopsy: small piece of the liver is removed and sent to a lab for tests •  Liver function tests: to check the enzymes and other substances made in the liver 29  
  • 30. Treatment   •  Anti-viral medicines: These medicines work by keeping the virus from spreading. This may prevent or decrease more swelling and damage to the liver. •  Surgery: A liver transplant may be done if your liver stops working. Your diseased liver is removed and replaced with a healthy and donated liver. You may also have a part of your liver removed. 30  
  • 31. Preven(on   There is no available vaccine to prevent hepatitis C. Following are ways to prevent the spread of hepatitis C: •  Caregivers should wear gloves, masks, gowns, or safety goggles when handling blood products and instruments •  Consider the risks of getting hepatitis C before having tattoos or body piercing •  If patients use illegal or street drugs, never reuse or share needles or syringes •  Do not share toothbrushes, razors, or other personal care items •  Mothers infected with hepatitis C should stop breastfeeding if their nipples are cracked or bleeding •  Use latex condoms when having sex 31  
  • 32. Nursing  management   •  Universal Precautions – Gloves are worn when there is to be contact with blood and body fluid •  Goggles/masks are worn when there is a danger of splashing or aerosol of blood-contaminated secretions •  Water repellant gown, if there is a danger of splashing •  Always hand washing before and after contact with blood and body fluid •  Specimens are treated as biohazard. Linen & used material are treated as infectious. •  Establish if the patient is in the acute phase, a carrier, or not 32  
  • 33. Pa(ent  assessment   ACTIVITY/REST May report: •  Fatigue, weakness, general malaise CIRCULATION May exhibit: •  Bradycardia (severe hyperbilirubinemia) •  Jaundiced sclera, skin, mucous membranes ELIMINATION May report: •  Dark urine •  Diarrhea/constipation; clay-colored stools •  Current/recent hemodialysis FOOD/FLUID May report: •  Loss of appetite (anorexia), weight loss or gain (edema) Nausea/vomiting May exhibit: •  Ascites 33  
  • 34. Pa(ent  assesment   NEUROSENSORY May exhibit: •  Irritability, drowsiness, lethargy, asterixi PAIN/DISCOMFORT May report: •  Abdominal cramping, right upper quadrant (RUQ) tenderness •  Myalgias, arthralgias; headache •  Itching (pruritus) May exhibit: •  Muscle guarding, restlessness RESPIRATION May report: •  Distaste for/aversion to cigarettes (smokers) •  Recent flulike URI SEXUALITY May report: •  Lifestyle/behaviors increasing risk of exposure (e.g., sexual promiscuity, sexually active homosexual/ bisexual male) 34  
  • 35. Pa(ent  assessment   SAFETY May report: •  Transfusion of blood/blood products in the past May exhibit: •  Fever •  Urticaria, maculopapular lesions, irregular patches of erythema •  Spider angiomas, palmar erythema, gynecomastia in men (sometimes present in alcoholic hepatitis) •  Splenomegaly, posterior cervical node enlargement TEACHING/LEARNING May report: •  History of known/possible exposure to virus, bacteria, or toxins (contaminated food, water, needles, •  surgical equipment or blood); recent surgical procedure with halothane anesthesia; exposure to toxic chemicals; prescription drug use (e.g., sulfonamides, phenothiazines, isoniazid) •  Travel to/immigration from China, Africa, Southeast Asia, Middle East (hepatitis B [HB] is endemic in these areas) •  Street injection drug or alcohol use •  Concurrent diabetes, HF, malignancy, or renal disease 35  
  • 36. Diagnos(c  studies  for  hepa((s   Liver enzymes: •  Abnormal (4–10 times normal values) AST/ALT: •  Initially elevated. May rise 1–2 wk before jaundice is apparent, then decline. •  Alkaline phosphatase Hepatitis A, B, C, D, E panels (antibody/antigen tests): •  Specify type and stage of disease and determine possible carriers. CBC: •  Red blood cells (RBCs) decreased because of shortened life of RBCs (liver enzyme alterations) or hemorrhage. WBC count and differential: •  Leukopenia, leukocytosis, monocytosis, atypical lymphocytes, and plasma cells may be present. 36  
  • 37. Diagnos(c  studies   Serum albumin: •  Decreased. Blood glucose: •  Transient hyperglycemia/hypoglycemia (altered liver function). Prothrombin time: •  May be prolonged (liver dysfunction). Serum bilirubin: •  Above 2.5 mg/100 mL. (If above 200 mg/100 mL, poor prognosis is probable because of increased cellular •  necrosis.) Liver biopsy: •  Usually not needed, but should be considered if diagnosis is uncertain, of if clinical course is atypical or unduly •  prolonged Urinalysis: •  Elevated bilirubin levels; protein/hematuria may occur 37  
  • 38. Hepa((s  Nursing  management     NURSING PRIORITIES •  1.Reduce demands on liver while promoting physical well-being. •  2.Prevent complications. •  3.Enhance self-concept, acceptance of situation. •  4.Provide information about disease process, prognosis, and treatment needs. DISCHARGE GOALS •  1.Meeting basic self-care needs. •  2.Complications prevented/minimized. •  3.Dealing with reality of current situation. •  4.Disease process, prognosis, and therapeutic regimen understood. •  5.Plan in place to meet needs after discharge 38  
  • 39. Self  care  at  home   The  goals  of  self-­‐care  are  to  relieve  symptoms   and  prevent  worsening  of  the  disease   •  •  •  •  •  •  Drink  plenty  of  fluids  to  prevent  dehydra(on   Avoid  medicines  and  substances  that  can  cause  harm  to  the  liver,  such  as   acetaminophen  (Tylenol)   Avoid  drinking  alcohol  un(l  your  health  care  provider  OKs  it.  If  your  infec(on   becomes  chronic,  you  should  avoid  alcohol  for  the  rest  of  your  life   Avoid  using  drugs,  even  legal  drugs,  without  consul(ng  your  doctor.  Hepa((s  can   change  the  way  drugs  affect  you.  Do  not  start  any  new  medica(on  without  first   talking  to  your  health  care  provider   Try  to  eat  enough  for  adequate  nutri(on.  Try  to  maintain  a  balanced  diet.  Many   people  with  hepa((s  have  the  greatest  urge  to  eat  early  in  the  day   Take  it  easy.  Your  ac(vity  level  should  match  your  energy  level   39  
  • 40. Pa(ent  educa(on   CONTACT A CAREGIVER IF: •  You have a fever. •  You are vomiting (throwing up) and cannot keep food or liquids down •  You have a rash, an itch, or swelling of your abdomen (stomach) or legs •  You are bruising easily •  You have bad abdominal pain •  You have questions or concerns about your disease, medicine, or care SEEK CARE IMMEDIATELY IF: •  You are too dizzy to stand up •  You feel confused or are very sleepy •  Your stools are red, black, or clay-colored •  Your symptoms are getting worse •  Your vomit (throw up) has blood in it or looks like coffee grounds 40  
  • 41. Case  study   45  year  old  female,  who  presented  to  the  ER   41