HESI - Mr. Estefan

Which of the following instructions should you include in your discharge instructions for Mr. Estefan? Select all that apply (there are 5 correct answers). - Stay home from work - Restrict usual activity, allowing for rest - Drink large amounts of fluid - Drink a glass of wine at bedtime to facilitate sleep - Use over-the-counter cold remedies to treat symptoms such as fever, cough, and lack of appetite - Eat small frequent meals - Instruct the person who cleans toilets in his home to wear disposable gloves

- Stay home from work - Restrict usual activity, allowing for rest - Drink large amounts of fluid - Eat small frequent meals - Instruct the person who cleans toilets in his home to wear disposable gloves

Before providing written instructions for Mr. Estefan, you talk with him about hepatitis. Which of the following statements are appropriate? "Hepatitis A often results in cirrhosis of the liver." "Once you have had hepatitis A, you will have immunity." "Once you have had hepatitis A, you can't get any form of hepatitis in the future." "Hepatitis A often results in a chronic form of hepatitis."

"Once you have had hepatitis A, you will have immunity." The presence of the hepatitis A virus stimulates the production of antibodies against the virus, resulting in lifelong immunity against the disease.

The incubation period for hepatitis B averages: - 4-10 days - 20-40 days - 2-3 months - 6-9 months

- 2-3 months The incubation period for hepatitis B averages 2-3 months, but can be anywhere from 1-6 months.

If Mr. Estefan has hepatitis A, it is likely that he was exposed to the virus: - 1-2 weeks ago - 2-6 weeks ago - 6 months ago - 1 year ago

- 2-6 weeks ago The incubation period (before symptoms appear) for hepatitis A can be anywhere from 15-45 days (2-6 weeks), with a mean of 30 days. Symptoms begin with a flu-like prodromal phase that often persists for 1-2 weeks before jaundice appears. Mr. Estefan returned from his vacation three weeks ago and has been feeling badly for about a week now.

Mr. Estefan asks you how long it will take to fully recover from hepatitis B. Your best answer is: - 3-4 days - 3-4 weeks - 3-4 months - 3-4 years

- 3-4 months It takes approximately 3-4 months for liver function tests to return to normal after hepatitis B infection. Full recovery may take up to six months. If hepatitis B antigens remain after six months, the hepatitis may be chronic. Persons with chronic hepatitis B infection remain contagious, and may have persistent symptoms varying in severity. Chronic hepatitis B infection may lead to liver cancer, liver failure, and the need for liver transplant. Only a small percentage of persons with acute hepatitis B infection develop chronic infection.

Until a type of hepatitis is diagnosed, you need to provide Mr. Estefan with instructions to prevent transmission of all forms of hepatitis. In addition to the instructions already provided, which of the following are indicated to prevent transmission of the hepatitis virus? Select all that apply (there are 2 correct answers). - Avoid all sexual activity - Do not donate blood - Sleep in a separate room - Take an antibiotic that will be prescribed

- Avoid all sexual activity Hepatitis (A,B,C,D,E) is potentially transmissible through sexual contact, although transmission of hepatitis A and hepatitis E through this route is less likely. Total abstinence from sexual activity is the only absolute way to prevent virus transmission by the sexual route. Use of condoms is considered "safer," if non-animal condoms are used properly, withdrawal occurs before the penis has lost the erection, and the condom remains intact. Transmission aspects of hepatitis G are still not fully known. - Do not donate blood Hepatitis B, C, D, and G are all transmissible through blood. Blood donation should be restricted at this time.

Which of the following nursing diagnoses apply for Mr. Estefan? Select all that apply (there are 2 correct answers). - Ineffective Airway Clearance - Hypothermia - Deficient Fluid Volume - Risk for Infection Transmission - Disturbed Thought Processes

- Deficient Fluid Volume Mr. Estefan has been anorexic, nauseated, and vomiting. His fluid volume deficit will continue if it is not addressed. This is an appropriate nursing diagnosis for Mr. Estefan. - Risk for Infection Transmission All forms of viral hepatitis are transmissible. Risk for Infection Transmission is an appropriate nursing diagnosis. Nursing interventions are needed to prevent virus transmission.

You know that hepatitis A is most commonly transmitted by which of the following routes? - Fecal-oral - Blood - Sexual contact - Droplet spread

- Fecal-oral The hepatitis A virus is most commonly found in the gastrointestinal tract. It is transmitted by the fecal-oral route.

Which of the following places Mr. Estefan at increased risk for hepatitis A? - Smoking one pack of cigarettes a day - Working as a cook in a steakhouse - His single lifestyle - His recent vacation to an underdeveloped country

- His recent vacation to an underdeveloped country Travel to underdeveloped countries with poor sanitation systems is one of the greatest risk factors for contracting the hepatitis A virus. Shellfish and other food sources that are harvested from waters contaminated by raw sewage are likely sources of infection. Also, food that is prepared by a person who does not utilize proper hand hygiene after defecation is a potential source of infection.

Which of the following are indicated when obtaining blood and other specimens? Select all that apply (there are 6 correct answers). - Wearing a face mask when obtaining specimens - Using gloves for blood-drawing - Hand hygiene after blood-drawing - Using gloves when handling the urine specimen - Hand hygiene after handling the urine specimen - Using gloves when handling the stool specimen - Hand hygiene after handling the stool specimen

- Using gloves for blood-drawing - Hand hygiene after blood-drawing - Using gloves when handling the urine specimen - Hand hygiene after handling the urine specimen - Using gloves when handling the stool specimen - Hand hygiene after handling the stool specimen

Mr. Estefan asks if his family and friends will be able to visit him in the hospital. You encourage him to have visitors when hospitalized. Visitors are encouraged for Mr. Estefan because they: - provide further assessment data - alleviate social isolation - encourage increased activity - encourage respiratory effort through conversation

- alleviate social isolation Separation from friends and family may cause a hospitalized person to feel isolated, especially when the person has an infectious process. Visitors can help prevent or alleviate the social isolation the person may feel.

Mr. Estefan asks if there are any other things that can be done to protect his family and friends. There are protective measures for those not yet exposed and those potentially exposed to the hepatitis A virus. You tell Mr. Estefan these measures include: Select all that apply (there are 2 correct answers). - getting the hepatitis A vaccine - avoiding direct contact with Mr. Estefan until he is no longer contagious - receiving an immune globulin injection - taking interferon by mouth

- getting the hepatitis A vaccine For persons age 1-40 years of age who have not previously received the hepatitis A vaccine, hepatitis A vaccine can protect against infection with the current exposure and also protect against infection with future exposures. It is not recommended for persons who are immunocompromised or have chronic liver disease. Ideally, Mr. Estefan should have had this vaccine before traveling to an underdeveloped country. - receiving an immune globulin injection For persons less than one year of age or older than 40 years of age who have not previously received the hepatitis A vaccine, immune globulin injection can provide short term protection if given within two weeks of exposure to the hepatitis A virus. It can also be given to individuals who cannot receive the hepatitis A vaccine. It is not the preferred method for healthy persons 1-40 years of age because it does not provide long term immunity against future exposure.

For hepatitis B, postexposure prophylaxis involves: Select all that apply (there are 2 correct answers). - passive immunization with standard immune globulin - passive immunization with hepatitis B immune globulin - active immunization with hepatitis B vaccine

- passive immunization with hepatitis B immune globulin For hepatitis B, postexposure prophylaxis includes immunization with hepatitis B immune globulin (HBIG), which provides antibodies against hepatitis B. This is passive immunization. - active immunization with hepatitis B vaccine For hepatitis B, postexposure prophylaxis includes immunization with the hepatitis B vaccine (HBV), which will stimulate production of antibodies against hepatitis B. This involves a series of three injections over a six-month period (unless the person has been previously immunized, in which case one booster dose is given). This is active immunization.

Mr. Estefan has signs and symptoms consistent with dehydration and hypovolemia. These include: Select all that apply (there are 5 correct answers). - poor skin turgor - thirst - weakness - diuresis - oliguria - ascites - tachycardia

- poor skin turgor - thirst - weakness - oliguria - tachycardia

You know that a major objective of nursing care when Mr. Estefan is hospitalized will be to: - prevent respiratory impairment - increase activity tolerance - provide adequate rest - restore adequate gas exchange

- provide adequate rest It will be important to provide for rest, so that Mr. Estefan can conserve energy for healing.

Given this new information, you know that Mr. Estefan is also at risk for hepatitis B and hepatitis C. Hepatitis G may co-infect with hepatitis C. It is an uncommon form of hepatitis, and is not fully understood. An accurate diagnosis of any type of hepatitis is determined by: - a patient's history - a patient's signs and symptoms - serologic testing - x-ray of the abdomen

- serologic testing Specific serologic testing is the only accurate way to diagnose hepatitis and distinguish between the various types of viral hepatitis.

The type of hepatitis that Mr. Estefan has can be determined only through serologic testing. Mr. Estefan's intravenous (IV) drug use places him at high risk for hepatitis B and hepatitis C.In addition, IV drug use places him at risk for human immunodeficiency virus (HIV) infection.

After counseling, Mr. Estefan agrees to be tested for the presence of HIV antibodies. He has signed a consent form.You ask Mr. Estefan to return to the clinic tomorrow.

As a health care worker, you have been immunized with the hepatitis B vaccine.

All healthcare workers should receive this vaccine, because of the possibility of blood exposure. Besides adults in high-risk groups, the hepatitis B vaccine is recommended for all newborns and all adolescents.

Mr. Estefan is severely dehydrated, and will be admitted to the hospital for rehydration.

As Mr. Estefan waits for arrangements to be made for his hospital admission, you explain to him that anyone he has shared a needle with or had sex with in the past few months will need to come to the clinic to be evaluated for possible immunization (postexposure prophylaxis).

Since the fecal-oral route is the most common mode of transmission for hepatitis A, child-care providers working in day-care centers are at risk, because of exposure to soiled diapers.

Children attending day-care facilities may also be at risk for the same reason. Regular, careful hand hygiene in these facilities is very important!

Concerned about Mr. Estefan's fluid status, you assess him for dehydration.In dehydration, body fluids are more concentrated than normal.

Dehydrated patients are also often hypovolemic.

You stress the importance of handwashing in preventing the spread of hepatitis.

Handwashing after using the bathroom is extremely important in preventing spread of the virus.

Since Mr. Estefan is jaundiced and hepatitis is prevalent in the community, you suspect he may have one of the six identified types of hepatitis (A,B,C,D,E,G).

Hepatitis A, B, and C are most prevalent.In particular, Mr. Estefan is at increased risk for hepatitis A.

Mr. Estefan's serum liver function tests for aspartate aminotransferase (AST) and alanine aminotransferase (ALT) are elevated, a result of enzyme release from damaged liver cells.Serum bilirubin is also elevated, secondary to the diseased liver's inability to conjugate bilirubin. Hyperbilirubinemia is responsible for Mr. Estefan's jaundice.

In addition, Mr. Estefan is mildly hypoglycemic, probably a result of his limited food intake.Prothrombin time (PT) is slightly prolonged, reflecting decreased production of prothrombin due to liver disease.Mr. Estefan also has a low white blood cell count. This is common in viral infections.

The next day, Mr. Estefan is seen in the clinic again. He has been vomiting almost continuously for the past 24 hours.Most of his lab results are available. Serologic tests confirm that Mr. Estefan has active hepatitis B infection. Hepatitis B surface antigen (HBsAg) and antibody (IgM anti-HBc) to hepatitis B core antigen (HBcAg) are present in his blood.Testing also reveals that Mr. Estefan has immunity against hepatitis A. Antibodies against hepatitis A are present in his blood (IgM anti-HAV). Many adults in urban areas have anti-HAV in their blood, unaware that they have had an asymptomatic or mildly symptomatic form of hepatitis A in the past.

Mr. Estefan has no evidence of hepatitis C, hepatitis G, or hepatitis D. Hepatitis D can co-infect with hepatitis B.Results of testing for human immunodeficiency virus (HIV) are not yet available.

Mr. Estefan is admitted to the hospital. He is rehydrated. His vomiting subsides and his appetite improves slightly. After two days, he is discharged home. You see Mr. Estefan weekly in the clinic. His hepatitis symptoms gradually subside over the next few months. You provide counseling regarding intravenous drug use. After much encouragement from you, Mr. Estefan starts attending meetings for treatment of his substance abuse problem.

Mr. Estefan tested human immunodeficiency virus (HIV) negative. You impress upon him the importance of "safe" sex.

A chronic form of hepatitis sometimes follows acute hepatitis B or hepatitis C infection. It does not occur after acute hepatitis A infection. Chronic hepatitis infection is much more common after hepatitis C infection. More than 50% of these patients develop chronic infection. Chronic hepatitis C infection can lead to liver cancer, cirrhosis of the liver, and need for liver transplant.

Persons with chronic hepatitis infection remain contagious, and may or may not have symptoms. Screening of high-risk groups (IV drug use, male homosexuality, HIV positive, blood transfusion before 1990, piercings/tattoos) is useful in identifying persons with chronic hepatitis infection. Treatment to prevent progressive liver disease is possible.

You know that hepatitis E has characteristics similar to hepatitis A, and is even less common than hepatitis A.

The clinic physician is in a hurry.He quickly examines Mr. Estefan, orders diagnostic lab work (blood, urine, and stool specimens), and tells you to send Mr. Estefan home with specific instructions for the patient with hepatitis A.

You also advise Mr. Estefan that he should not prepare meals for anyone until he is told he is no longer contagious. Even though infectivity is generally diminished with the appearance of jaundice, this approach would be safe.Eating utensils and dishes should be thoroughly washed with soap and water.

While talking with Mr. Estefan, he admits to being a "recreational" intravenous drug user. You explain to Mr. Estefan that this new information is very important, and you promptly report it to the physician.

Mr. Estefan is a 30-year-old cook who has come to the Outpatient Clinic where you work. The clinic is part of a large metropolitan hospital.Mr. Estefan's chief complaint is that he "aches all over."

You obtain information about Mr. Estefan's complaint, and collect other assessment data.You observe that Mr. Estefan is jaundiced. His skin and sclera are yellow.