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HEPATITIS - HEPATITIS Hepatitis is a widespread...

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HEPATITIS Hepatitis is a widespread inflammation of the liver that results in degeneration and necrosis of liver cells. Inflammation of the liver can be due to bacterial invasion, injury by physical or toxic chemical agents (e.g., drugs, alcohol, industrial chemicals), viral infections (hepatitis A, B, C, D, E, G), or autoimmune response. Although most hepatitis is self- limiting, approximately 20% of acute hepatitis B and 50% of hepatitis C cases progress to a chronic state or cirrhosis and can be fatal. CARE SETTING Usually at the community level. In toxic states, brief inpatient acute care on a medical unit may be required. RELATED CONCERNS Alcohol: acute withdrawal Cirrhosis of the liver Psychosocial aspects of care Renal dialysis Substance dependence/abuse rehabilitation Total nutritional support: parenteral/enteral feeding Patient Assessment Database Data depend on the cause and severity of liver involvement/damage. 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 NEUROSENSORY May exhibit: Irritability, drowsiness, lethargy, asterixis 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 SAFETY
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May report: Transfusion of blood/blood products in the past May exhibit: Fever Urticaria, maculopapular lesions, irregular patches of erythema Exacerbation of acne Spider angiomas, palmar erythema, gynecomastia in men (sometimes present in alcoholic hepatitis) Splenomegaly, posterior cervical node enlargement SEXUALITY May report: Lifestyle/behaviors increasing risk of exposure (e.g., sexual promiscuity, sexually active homosexual/bisexual male) TEACHING/LEARNING May report: History of known/possible exposure to virus, bacteria, or toxins (contaminated food, water, needles, surgical equipment or blood); carriers (symptomatic or asymptomatic); recent surgical procedure with halothane anesthesia; exposure to toxic chemicals (e.g., carbon tetrachloride, vinyl chloride); 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 Discharge plan DRG projected mean length of inpatient stay: 6.1 days considerations: May require assistance with homemaker/maintenance tasks Refer to section at end of plan for postdischarge considerations.
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