Case study: Hepatitis A Scenario P., a 24-year-old house painter, has been too ill to work for the past 3 days. When he arrives at your outpatient…

Question Answered step-by-step Case study: Hepatitis A  ScenarioP.M., a 24-year-old house painter, has been too ill to work for the past 3 days. When he arrives at your outpatient clinic, he seems an alert but acutely ill young man of average build, with a deep tan over exposed areas of skin. He reports headaches, severe myalgia, a low-grade fever, cough, anorexia, and nausea and vomiting (N/V), especially after eating any fatty food. P.M. describes vague abdominal pain that started about the same time as the other problems. His past medical history (PMH) reveals he has no health problems, is a nonsmoker, and drinks a “few” beers each evening to relax. Vital signs (VS) are 128/84, 88, 26, 100.6° F; awake, alert, and oriented (AAO) X 3; moves all extremities well (MAEW) except for aching pain in his muscles; very slight scleral jaundice present; heart tones clear and without adventitious sounds; bowel sounds clear throughout abdomen and pelvis; abdomen soft and palpable without distinct masses.You note moderate hepatomegaly measured at the midclavicular line; liver edge is easily palpated and tender to palpation. P.M. mentions that his urine has been getting darker over the past 2 days. P.M. is manifesting the key signs of hepatitis. Lab work is sent for identification of his precise problem. Results are Na 140 mmol/L, K 3.9 mmol/L, Cl 102 mmol/L, CO2 26 mmol/L, BUN 10 mg/dl, creatinine 1.0 mg/dl, platelets 86 thou/mm3, direct bilirubin 1.6 mg/dl, total bilirubin 2.3 mg/dl, albumin 3.8 g/dl, total protein 6.2 g/dl, alanine aminotransferase (ALT) 66 units/L, aspartate aminotransferase (AST) 52 units/L, lactate dehydrogenase (LDH) 205 units/L, alkaline phosphatase 176 units/L, PT 12 sec, INR 1.06, PTT 32 sec. Urine urobilinogen is 1.6 IU/L, albuminuria 160 mg/dl, positive for bilirubinuria, positive for anti-HAV (hepatitis A virus) IgM.  1. Which key diagnostic tests will determine exactly what type of hepatitis is present? international units per milliliter that can be detected within 2 weeks of exposure).  2. A CBC, BMP, LFT, and PT/PTT were drawn. Which of the lab values listed above specifically indicates liver disease?   3. List three drugs that can cause increased ALT levels.   4. Considering that the basic pathology of hepatitis involves inflammation, degeneration, and regeneration of the hepatocyte, what type of diet will you strongly encourage P.M. to follow?    5. Differentiate between hepatitis A, B, and C on the basis of the mode of transmission and prevention.    6. Name three major activities that can be done in a community to prevent the spread of hepatitis (all types).     7. In P.M.’s case, the IgM class anti-HAV antibody is positive. This result indicates that P.M. is infected with hepatitis A and is in the acute or early convalescent period of the disease.Is this disease contagious? What precaution would you take?     8. Pruritus is usually associated with jaundice. What will you do to ease this problem forP.M.?   9. How would you explain to P.M. the likely progression of his disease? (This approach requires not only knowledge of disease and its progression but an ability to figure out P.M.’s thought processes.)    10. P.M. is living at home with his parents and 4 younger siblings. The youngest is 4 years old. His parents ask how to prevent the rest of the family from getting hepatitis. What specific instructions will you give? How will you know that these instructions are understood?    11. Given P.M.’s lifestyle, what specific patient teaching points must you emphasize?  Health Science Science Nursing NURS 450 Share QuestionEmailCopy link Comments (0)