LEARNING GUIDE - HEPATITIS AND CIRRHOSIS

1.

Match the following descriptions with the appropriate type of hepatitis: _____ Transmitted by fecal contamination of water a. Hepatitis A in developing areas _____ Primary worldwide cause of chronic hepatitis b. Hepatitis B _____ Rare in the United States, transmitted via water c. Hepatitis C _____ Only infects people with hepatitis B d. Hepati tis D _____ Transmitted by fecal-oral route _____ Poses a threat to healthcare workers through needle sticks _____ Typically benign and self-limiting _____ Known as non-A, non-B hepatitis _____ Coexists with HBV, HCV and HIV e. Hepatitis E f. Hepatitis G

2.

Describe the progression and clinical manifestations of hepatitis in the following phases: a. Acute phase

b. Convalescent phase c. Chronic phase

3.

Thirty percent of individuals with acute HBV and 80% of those with HCV are asymptomatic. Explain the problems that this can cause.

4.

Which types of hepatitis virus can lead to chronic hepatitis?

5.

Fulminant hepatitis is a rapidly progressing disease that can result in ___________________. What can cause toxic hepatitis?

6.

7.

Explain the reason for each of the following alterations in diagnostic findings for a client with acute hepatitis: a. Elevated AST and ALT b. Elevated alkaline phospatase c. Decreased albumin d. Prolonged prothrombin time Describe the nursing interventions related to preparing a client for a liver biopsy.

8.

9. 10.

Vaccines are available for which types of hepatitis? Describe the post exposure prophylaxis for the following: a. Hepatitis A b. Hepatitis B c. Hepatitis C

11.

What are the goals of treatment for: a. Hepatitis A b. Hepatitis B c. Hepatitis C

12.

Explain the use of the following medications for the treatment of hepatitis. Include an explanation about the action and side effects. a. Interferon alpha b. lamivudine c. ribavirin

13.

Describe methods of prevention and protection for: a. Hepatitis A

b. Hepatitis B c. Hepatitis C

14.

The nurse is providing discharge instructions for a client with Hepatitis A. What recommendations should she make relative to: a. Fatigue

b. Nutrition: less than body requirements

c. Alteration in comfort: a) pruritus b) malaise

15.

Describe the pathophysiology of alcoholic cirrhosis. At what stage will discontinuing drinking allow the liver to heal?

16.

Describe the pathophysiology for each of the following complications of cirrhosis: a. b. c. Portal hypertension Esophageal varices Edema and ascites

d.

Hepatic encephalopathy

e.

Splenomegaly

17.

Place a letter beside each of the following manifestations of cirrhosis indicating whether it is an early (E) or late (L) manifestation: _____ _____ _____ _____ _____ _____ _____ _____ _____ constipation hypertension weight loss gynecomastia anorexia weakness anemia bleeding ascites

18.

What alterations in CBC would you expect to find in a client with late stage cirrhosis? Explain your answer.

19.

Describe the treatment for ascites with respect to the following: a. Diet b. Medications c. Paracentesis d. Peritovenous shunt

20.

Explain the following procedures used to treat esophageal and gastric varices: a. Beta-blockers b. Vasopressin and nitroglycerin combination c. Endoscopic sclerotherapy d. Balloon tamponade e. Transjugular intrahepatic portosystemic shunts (TIPS)

21.

Why are Lactulose and Neomycin used to treat clients with cirrhosis?

22.

What instructions would you give to a client with cirrhosis regarding his dietary intake?

23.

Describe the nursing responsibilities associated with paracentesis.

24.

For each of the following nursing diagnoses commonly associated with cirrhosis, designate expected outcomes and appropriate nursing interventions: a. Excess fluid volume related to portal hypertension and hyperaldoseteronism b. Impaired skin integrity related to edema, ascites, and pruritis c. Risk for injury: hemorrhage, risk factors include: altered clotting factors and compromised vascular integrity d. Altered thought processes related to increased serum levels of ammonia

25. 26. 27.

What are the most common causes of liver cancer? Describe the manifestations of liver cancer. Describe the following treatments for liver cancer: a. Lobectomy b. Radiofrequency ablation c. Cryoablation d. Percutaneous ethanol or acetic acid injection e. Chemotherapy

28. 29. 30.

Describe the signs and symptoms that would indicate rejection of a liver transplant. Explain the post operative nursing care for a client with a liver transplant. Liver transplantation is a practical therapeutic option for many people with end stage liver disease. However, there is a scarcity of available livers. Discuss practical solutions and ethical dilemmas related to the lack of resources.

25.

What is the prognosis for most clients with liver cancer?