Hepatitis | Full Med Surg Nursing School Lecture

Hey there, friends. In this video, we are diving into viral hepatitis. We will go through step by step, the pathophysiology you have to know for nursing school so you can fully understand it and be ready to critically think about it on your nursing school exams. We will also be talking, of course, about the signs and symptoms for viral hepatitis, as well as the nursing assessments and nursing interventions that you will be doing as a nurse. Now, this is one disorder that you will absolutely be tested on a ton in nursing school. So we are going to break it down really easy, super simple for you, so that you can fully understand it and of course, critically think about it and be more prepared for your nursing school exams. Let's dive in. Welcome to the nursing school show, my friend. My name is Christina Rafano and I am here to help you pass nursing school step by step. So hit that subscribe button and click the notification bell. Let's do this. So when you think of hepatitis, the first thing that needs to come to your mind is do, do, do inflammation of the liver. That's exactly what is going on here. There is a virus in the liver cells, cells in the liver, and the inflammatory response is being triggered. The liver becomes inflamed, it gets damaged, and it isn't able to do its job properly. Now, viral hepatitis can start out as acute inflammation and if it's not resolved and if it lasts more than six months, it can then lead to chronic inflammation and then chronic hepatitis. There are many possible causes of viral hepatitis, namely hepatitis A, B, C, D and E. And each one of them is transmitted in a different way. So, so let's walk through the pathophysiology of viral hepatitis step by step. So of course, when you get to your nursing school exam, question about hepatitis that you will be able to work through it using your awesome critical thinking skills. The first step in this process is that there is a virus that makes its way into the liver cells. These are called hepatocytes, the liver cells. Now, our cells don't like to have viruses inside of them, right? It's foreign. So they send out a warning signal out to the immune system that they have been infected. And then viral hepatitis is caused by hepatitis A virus, B virus, C virus, D virus or E virus. Now, the second step of this process is that the immune system in the body comes to the rescue and it tries to kill the virus. Now, unfortunately, this process also leads to the death of liver cells as well. So as more and more cell the liver are infected with the virus, the immune system is triggered and it wants to kill the virus off. Then at the same time, there are more and more liver cells, those hepatocytes that are dying. Now, when these cells die and the immune response is just continually being triggered by this virus, then inflammation will develop in the liver and it can get worse and worse. Then this leads us to step number three, which is possible complications. Then, when the inflammatory response is triggered in the body, it can cause a whole lot of issues, things like fever, enlargement of the liver, and this is called hepatomegaly. And then jaundice. Now, if the hepatitis infection continues for longer than six months, it's considered to be a chronic infection infection. And then this can eventually lead to liver cirrhosis, where the liver is really severely damaged. So remember, when you think of viral hepatitis, think liver inflammation. The cells inside the liver, those hepatocytes, are dying and the liver isn't able to function properly. Now, I know the pathophysiology can be a lot to learn, but do not worry, friend, you know me. I have a free cheat sheet that walks you through some amazing nursing school study tips to help you learn things f in nursing school. So it's called the nursing school study checklist. I'm going to put the link down below this video in the description box for you to check it out. Highly recommend it. So be sure to snag it after you watch this video. Now, the symptoms of viral hepatitis are broken up into three main categories. Okay, you're ready. The pre ictoric stage, the ictoric stage, and then the post ictoric stage. I know kind of funny names. Now, these stages progress as the hepatitis infection gets worse. So let's walk through the signs and the symptoms of each one and exactly why they happen so that you can really, finally understand it. And then you will be ready for your nursing school exams and be able to really critically think about hepatitis on your exams. So the pre ictoric stage. Now, this is the first stage of viral hepatitis where the symptoms are pretty general and they're not really specific to liver damage. Now, since viral hepatitis is inflammation of the liver, you'll see the typical signs of inflammation, things like a fever, fatigue, muscle aches, diarrhea, and nausea and vomiting. So it will appear similar to maybe the flu. The body is trying to kill off the virus, so it's increasing body temperature to try to kill it. Right. The immune system will send out those white blood cells to try to get rid of the virus. And that inflammation causes that fatigue and the muscle aches and then nausea and vomiting. And diarrhea, those are all common as, as well because the body is just trying to expel the virus out. Right. So all of these symptoms in the preictoric stage, they're pretty non special specific, they're pretty general. And it really isn't that clear that it's the liver causing the issues. The only markers they may have during this phase that show that it's a liver problem might just be an increase in the liver labs, things like their alanine transaminase or their ALT or their aspartate transaminase or their ast. Now these are enzymes in the liver that help the liver break down proteins. So, so when the liver is damaged, that ALT and the ast, those levels, they're probably going to be increased. Now the next phase is where jaundice might occur. Now the patient will have jaundice, which means a yellowing of the skin and the sclera of the eyes. And then dark urine, clay colored stools and itchy skin might happen too. So let's break down why jaundice occurs. It all starts with bilirubin. And bilirubin is usually processed by the liver. If the liver is damaged, it will build up in the blood leading to that yellow tinted skin in the eyes. The clay colored stools are caused by a lack of bilirubin in the GI tract. Stain in the blood just builds up and builds up in the blood and doesn't get expelled out. So normally bilirubin is what creates that brown color of stool and then the dark urine, it might be dark as the kidneys try to compensate for the high bilirubin levels in the blood. So the kidneys are going to try to get rid of that excess, so leading to that dark urine. Now in addition to bilirubin building up in the blood and the skin, bile, bile salts also build up on the skin and can cause that really itchy skin. So both bile salts and that bilirubin are found in bile. And so when bile builds up in the blood, you'll see that yellow tint along with itchy skin. Now the key thing to remember here is that the liver normally processes this bile in the bilirubin, but if it's damaged, it will build up in the blood and then that will then lead to those symptoms. The liver may also be enlarged and cause pain. Then all that inflammation in the liver causes swelling of the cells and fluid buildup around the liver. So the liver may become enlarged and can be pretty, pretty painful. And as the body's inflammatory response starts to wind down. The patient won' have those general flu like symptoms as much during this phase. So remember, this is where those nursing school exams, they might be a little bit tricky for you. As the jaundice starts to occur, the patient will start to feel better, even though their liver is still damaged. Now, the third phase of viral hepatitis is the post ictric phase where the patient starts to recover. Then as the liver starts to heal, the jaundice will then start to go down, will start to go away and the urine will get lighter in color again. And then the stool will become more brown in color, darker in color, and the liver will also become less and less painful as really all that swelling really decreases. And then their liver labs, right, like we talked about the AST and the altar, those will start to return back to normal values. So remember, when you think of viral hepatitis, think liver inflammation. The cells inside the liver are dying and the liver isn't able to function properly. Of course, if you're a nursing member, just a reminder for you, be sure to log into your dashboard and then download the study guide that we have for you on hepatitis. It's super helpful for you. That way you can remember all of these phases as you study. Just a really nice guide for you to going to be really helpful for you as you study to help you remember all of this. And if you're not a nursing SOS member yet, don't worry. Be sure to join the wait list so that you can join the next time that enrollment opens. I'm going to put the link down below in the description for you to check out all of the details. So now that we've broken down hepatitis, that it's the virus attacking liver cells, right? And it's causing inflammation in the liver. And then as the liver becomes inflamed, so cells start to get damaged and they start to die and the liver isn't able to function properly. So that's, that's what you need to think of when you think of hepatitis, right? Inflammation. And the first thing that should come to your mind, right, inflammation of the liver. So now let's go through the three main things that you will need to assess for in a patient with viral hepatitis or if it's suspected. And those are doing a patient history. You're going to be assessing inflammation and assessment, assessing the extent of their liver damage. So getting a patient history is super important because the different types of hepatitis viruses are transmitted, transmitted in different ways. So assess if the patient has been exposed to anyone infected with Hepatitis. Have they traveled to an area where hepatitis is prevalent? Or have they ingested food or water that may have been contained, contaminated? Then the next thing you'll need to assess for are the general signs and symptoms of that inflammatory response. When the inflammatory response is triggered because of that hepatitis virus, it can cause some general flu like symptoms that we talked about, right? And so you'll need to assess for those things like fever, fatigue, muscle aches, diarrhea and nausea or vomiting. So make sure to check their, check their temperature, their other vital signs, right? Ask them if they have any muscle aches, have they experienced any fatigue or any nausea, or there's GI symptoms. So these symptoms are caused by, like we said, that inflammatory response. When the immune system sends those white blood cells to try to get rid of the virus and then that inflammation all appears occurs, right? It causes that fatigue, the muscle aches, and then the nausea, the vomiting and the diarrhea. Those are common because then the body is trying to expel, it's trying to get rid of the virus, it's trying to get it out of the body. So the whole body is responding against this virus, trying to kick it out. It does not want it inside the body. So of course you're going to need to assess for those things. Now, the second part of then your nursing assessment will be related to the liver damage itself, itself. You will check for things like jaundice, right? Check for abdominal pain, clay colored stools and dark urine. Then, like we talked about earlier, you will also want to look at their liver labs, their AST and their alt, right? These are those enzymes in the liver that help to break down proteins. So when the liver is damaged, the ALT and the AST levels, they might be increased because it can't do its job right there. Bilirubin levels will also be elevated. Since the liver can't process all that bilirubin, it will just build up and build up in the blood, then causing those elevated bilirubin levels. So remember those three main nursing assessments that you need to do. Patient education, inflammation and liver damage. And then you will be golden for your nursing school exam on hepatitis to be able to critically think through all those. Now, as the nurse, there are a few key nursing interventions, interventions that you need to do to help your patient recover from viral hepatitis. So let's walk through the nursing interventions. So although sometimes their condition will be chronic and last a lifetime, there's still things we can do to help them out. So the two main goals are to help the liver to heal and then prevent complications. Since many types of viral hepatitis can be spread through contact, it's super important to educate your patient on the proper hand washing technique and hygiene. Of course, they should not share any personal hygiene products, things like toothbrushes, razors, toothpaste, drinking cups, towels. Or they should not be sharing eating utensils with other people. And if possible, they should use a private bathroom that isn't shared by anyone else. Or they should clean the bathroom after each use. Then, to help prevent the transmission of the virus to other people, you will also need to educate them on safe sexual practices to help prevent the transmission of the virus to someone else. So some viruses like hepatitis B are found in saliva and have a higher rate of transmission than others. And make sure that when you give an injection, a blood transfusion, or start an IV or another procedure that involves piercing the patient's skin or going into their bloodstream, make sure that you follow proper aseptic technique. You want to both reduce transmission of hepatitis to your patients as well as prevention. Prevent yourself from contracting it as well. The patient should also avoid alcohol. Since alcohol is metabolized primarily by the liver, it will put a lot of strain on it. So we want to avoid really anything that will put too much stress on the liver so we can allow it to heal as much as possible. Your patients should also avoid medications that are metabolized from primarily by the liver. Right? And you'll need to watch for drug toxicity, especially with medications that are mainly absorbed and processed in the liver. If they have to take those medications, things like acetaminophen, some antibiotics and some anti seizure medications. Now, two types of hepatitis have vaccines currently, and those are hepatitis A and hepatitis B. Now they are given to infants and young children, usually given at birth and then around age 1 year old. Or it may also be given before traveling to a country where it's prevalent. So make sure that your patients are up to date with their current vaccines. So remember friend, like we said, when you think of hepatitis, think liver inflammation. The cells inside the liver are dying. The liver is not able to flow function properly. Now, of course, there's three ways that I can help you more through nursing school, okay? Number one, be sure to download this do do do nursing school study checklist that I have for you that walks you through how to study in nursing school step by step. You know me, you know I love step by step processes and teaching you things step by step. So that's what that does. And be sure to check out our nursing school boxes that we have for you. You are going to link Love them. They are packed with resources to help you succeed in nursing school and pass your exams. And of course, if you want me to come alongside you all through nursing school and hold your hand throughout your nursing school journey, don't miss out on joining the Nursing SOS Membership community. It is filled with step by step nursing lectures to help you understand everything faster. For med surge, for Fundamentals, for all the classes that you're going to be taking so you can be more prepared for your exams. The links to all of those things are down below in the description for you to check it out. And if you like this video, make sure to hit that like button. Leave a comment below of course, to let me know that you loved it. I love hearing from you. Share it with one of your nursing school friends. And of course hit that subscribe button and click the notification bell so you never miss a video. And click on one of these videos right over here so you can keep rocking nursing school. And as always my friend, go become the nurse that God created only you to be. And I'll catch you next time on the Nursing School show. Take care. Bye bye.