P.M., a 24-year-old house painter, has been too ill to work for the last 3 days. When he arrives at your outpatient clinic,

P.M., a 24-year-old house painter, has been too ill to work for the last 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 N/V, especially after eating any fatty food. P.M. describes vague abdominal pain that started about the same time as the other problems. PMH: no health problems, nonsmoker, drinks a “few” beers each evening to relax. Assessment: VS are 128/84, 88, 26, 38.1° C; AAO x 3, MAEW except for aching pain in his muscles; very slight scleral jaundice present; heart tones clear and without adventitious sounds; breath sounds clear throughout A&P; abdomen soft and palpable without distinct masses. You note moderate hepatomegaly; liver edge is easily palpated and tender to palpation. P.M. mentions that his urine has been getting darker over the last 2 days. P.M. is presenting with the key signs of hepatitis. Lab work is sent for identification of his precise problem. Results: 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 cmm, direct bilirubin 1.6 mg/dL, total bilirubin 2.3 mg/dL, albumin 3.8 g/dL, total protein 6.2 g/dL, ALT (SGPT) 66 U/L, AST (SGOT) 52 U/L, LDH 205 U/L, ALP 176 U/L, PT = 12 s/INR = 1.06, PTT 32 s, urine urobilinogen 1.6 E U/L, albuminuria 160 mg/dl, + bilirubinuria, + for anti-HAV IgM. 1. Which key diagnostic tests will determine exactly what type of hepatitis is present? 2. An acute care battery was drawn. Which of the labs listed above specifically? indicates liver disease? 3. List medications, chemicals or other systems problems that can alter liver enzymes 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 (any/all types). 7. In P.M.’s case, the IgM-class anti-HAV antibody is positive. This 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 for P.M.? 9. How would you explain to P.M. the likely progression of his disease? (requires not only knowledge of disease and progression but figuring out his thought processes) 10. P.M. is living at home with his parents and 8 younger siblings. The youngest is a 4-year-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? [an] 11. Given P.M.’s lifestyle, what specific patient teaching points must you emphasize? 12. List four critical issues relevant to P.M.’s nursing care.