blood from the portal venous system into the system circulation Build up of

Blood from the portal venous system into the system

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blood from the portal venous system into the system circulation Build-up of ammonia: alterations in consciousness, intellectual function, behavior, personality ↓ LOC (marked confusion, stuporous), neuromuscular disturbances (asterixis, hyperreflexia), and impaired thinking, fetor hepaticus (sweet odor to breath, constructional apraxia Watch ammonia levels closely EEG: generalized slowing, increase in the amplitude of brain waves, and characteristic triphasic waves Meds : Lactulose and broad spectrum antibiotics (Neomycin and Flagyl) IV admin. of glucose to minimize protein breakdown, admin. Of vitamins to correct deficiencies, and correction of electrolyte imbalances (K+) Liver transplantation Diet: low protein Monitor: neurological status, mental status (daily record of handwriting), fluid IO daily, VS q4hrs, potential sites of infection, serum ammonia level, electrolyte status, d/c sedatives, tranquilizers, and analgesics
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Disorder/Causes Definition Clinical Manifestations Assessment & Dx. Testing Treatment & Management Nursing Considerations Hepatitis Diffuse inflammatory disease of the liver 3 phases: Preicteric: flu symptoms (joint pain, some fatigue, loss of appetite, nausea, cough) Icteric: pruritus, jaundice Posticteric: fatigue, recovery Preicteric: ↑AST, ALT, bilirubin May have ↑ PT Be cautious with medications metabolized in the liver (use analgesics sparingly) Promote adequate hydration and nutrition, provide rest, help control itching Diet: ↑ calorie, small frequent meals, avoid alcohol, restrict protein and sodium Hepatitis A Transmitted: fecal-oral route (ingestion of food or liquids) Diffuse inflammation to the liver and it becomes swollen Necrosis and inflammation of liver cells produce a characteristic cluster of clinical, biochemical, and cellular changes Anicteric (without jaundice); mild, flu-like symptoms; upper respiratory tract symptoms with low grade fever; severe anorexia; jaundice; dark urine; dyspepsia; indigestion; strong aversion to the taste of cigarettes Liver and spleen are moderately enlarged Wil not become chronic Liver and spleen are often moderately enlarged for a few days after onset Prevention: vaccine (Havrix and Vaqta), immune globulin (w/in 2 weeks of exposure – 6-8 weeks of passive imm.) Prevention: scrupulous hand washing, proper disposal of sewage, safe water supply, preventable vaccines for travelers and high risk groups Immune globulin recommended for household members and sexual contacts of people with hepatitis A May last about 4-8 weeks Symptoms about 2 months Can be in stool for 7-10 days before and 2-3 weeks after symptoms appear Bed rest during the acute stage, gradual but progressive ambulation Diet: frequent small feedings (anorexia), supplemented if necessary by IV fluids with glucose, avoid alcohol Hepatitis E Transmitted: fecal-oral route SAME AS HEP A (few differences) Jaundice is almost always present No vaccine or prophylactic treatment Prevention: avoid contact with virus through good hygiene Incubation period: 15-65 days Hepatitis B Transmitted: blood (hemodialysis)
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