cp of viral hepatits ( prelim )
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LICEO DE CAGAYAN UNIVERSITY
COLLEGE OF NURSING
NCM104
In Partial Requirements of the course NCM104
Medical - Surgical Ward
Related Learning !"erience
A CASE STUDY ON
“Viral Hepatitis”
Su#mitted $o%
Mrs. Arlyn B. Celestil RN.MNClinical Instructor
Su#mitted #&%
R!se My O. C! "ler
'SN-NCM104
De#e$%er &' (01(
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TABLE OF CONTENTS
PAGES
I. INTRODUCTION
A. OVERVIEW OF THE STUDY 1
B. SCOPE AND LIMITATIONS OF THE STUDY 2
C. OBJECTIVE OF THE STUDY
II. PROFILE OF THE PATIENT 3
III.DEVELOPMENTAL THEORY 4
IV. HEALTH HISTORY
a.Pers!a" Hea"#$ H%s#r& '
(.H%s#r& ) Prese!# I""!ess *
V. MEDICAL MANAGEMENT
a. Me+%,a" Or+ers -%#$
(. La(ra#r& Res/"#s 0
,. Dr/ S#/+&
VI. ANATOMY AND PHYSIOLOGY 13
VII. PATHOPHYSIOLOGY 14
VIII. NURSING ASSESSMENT
a. N/rs%! S&s#e Re%e- C$ar# 1'
IX. NURSING MANAGEMENT
(. I+ea" N/rs%! Ma!aee!# 25
,. A,#/a" N/rs%! Ma!aee!# 23
X. EVALUATION AND IMPLICATION 2*
XI. REFERRALS AND RECOMMENDATION(HEALTH TEACHINGS) 230
XII. PROGNOSIS 20
XIII.BIBLIOGRAPHY 2
(
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I. INTRODUCTION
a. Overview ! "#e S"$%&
He6a#%#%s %s a ser%/s %!)"aa#%! ) #$e "%er7 /s/a""& +/e # a %r/s. I# ,a! a"s (e,a/se+ (& a! era,#%e %/!e s&s#e7 a!+ )r +r/s7 a",$"%s7 ,$e%,a"s7 a!+e!%r!e!#a" #8%!s. I! #$e U!%#e+ S#a#es7 %ra" $e6a#%#%s /s/a""& a66ears as #&6e A7 B7r C. T- #$er #&6es 99 D a!+ E 99 are rare %! #$e U.S.
T&6e A %s #$e s# ,! )r ) %ra" $e6a#%#%s. I# )#e! a))e,#s s,$" ae+ ,$%"+re!.T$e +%sease %s /s/a""& #ra!s%##e+ -$e! se!e %!es#s )e,a" a##er #$r/$,!#a%!a#e+ )+ r -a#er. Y/ ,a! a"s e# $e6a#%#%s A (& $a%! se8 -%#$ se!e-$ $as #$e %r/s. A 6ers! -$ $as $e6a#%#%s A ,a! (e ,!#a%/s (e)re #$e& ee!:!- #$e& $ae #$e +%sease. U!"%:e #$er )rs ) %ra" $e6a#%#%s7 #$e %r/s +es!; # s#a&
%! &/r (+& !,e &/ re,er. T$e (es# -a& # 6ree!# $e6a#%#%s A %s -%#$ a a,,%!e a!++ $&%e!e.
He6a#%#%s #&6es B a!+ C a))e,# 6e6"e ) a"" aes. Ms# 6e6"e -$ (e,e %!)e,#e+-%#$ $e6a#%#%s B e# r%+ ) #$e %r/s -%#$%! * !#$s. T$%s #&6e ) s$r# %!)e,#%! %s :!-!as a! s,arr%! ) #$e "%er? a!+ "%er ,a!,er. T$ere %s a a,,%!e # 6ree!# $e6a#%#%s B.
A!&!e -$ $as ,$r!%, $e6a#%#%s B %s a"s s/s,e6#%("e # %!)e,#%! -%#$ a!#$er s#ra%! ) %ra" $e6a#%#%s :!-! as $e6a#%#%s D >)rer"& ,a""e+ +e"#a %r/s?. He6a#%#%s D %r/s ,a!!"& %!)e,# ,e""s %) #$e $e6a#%#%s B %r/s >HBV? %s 6rese!#. Pe6"e -$ /se IV +r/s are a#rea#es# r%s:. Be%! %!)e,#e+ -%#$ (#$ $e6a#%#%s B a!+ D ra%ses #$e r%s: ) +ee"6%!,%rr$s%s r "%er ,a!,er.
He6a#%#%s C %s /s/a""& s6rea+ #$r/$ ,!#a,# -%#$ %!)e,#e+ ("+7 as -$e! IV +r/ /serss$are !ee+"es. I# ,a! (e e%#$er a,/#e >a s$r# #er %!)e,#%!? r (e,e ,$r!%, a!+ee! "%)e #$rea#e!%!. T$ere %s ! a,,%!e )r $e6a#%#%s C.
He6a#%#%s E %s rare %! #$e U!%#e+ S#a#es. I# %s s6rea+ #$r/$ %!es#%! )+ r -a#er,!#a%!a#e+ -%#$ )e,es. T$ere %s ! a,,%!e )r $e6a#%#%s E. T$e !"& -a& # 6ree!##$e +%sease %s # re+/,e #$e r%s: ) e86s/re # #$e %r/s.
)
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'. Se a*% Li+i"a"i* ! "#e S"$%&
T$%s s#/+& %!,"/+es #$e ,""e,#%! ) %!)ra#%! s6e,%)%,a""& # #$e 6a#%e!#@s $ea"#$
,!+%#%! 6r%ar%"& # V%ra" He6a#%#%s. T$e s#/+& a"s %!,"/+es #$e assesse!# ) #$e
6$&s%"%,a"9e#%!a" s#a#/s7 a+e/a,& ) s/66r# s&s#es7 a!+ ,are %e! (& #$e)a%"& as -e"" as #$er $ea"#$ ,are 6r%+ers.
T$e s,6e ) #$%s s#/+& %!,"/+es
•Da#a ,""e,#e+ %a assesse!#7 %!#er%e-s -%#$ #$e 6a#%e!# a!+ )a%"& e(ers
a!+ ,"%!%,a" re,r+s.
• A,#/a" a!+ I+ea" 6r("es a!+ %#s a66r6r%a#e !/rs%! %!#ere!#%!s #$a# -/"+ (e
a66"%e+ #$r/$/# $%s s#a& %! #$e $s6%#a".
•Dee"6%! a 6"a! ) ,are #$a# -%"" re+/,e %+e!#%)%e+ 6re+%,ae!#s a!+
,6"%,a#%!s
•Cr+%!a#%! a!+ +e"ea#%! %!#ere!#%!s -%#$%! #$e 6"a! ) ,are # ass%s# 6a#%e!#
Mr.RTN # rea,$ a8%/ )/!,#%!a" $ea"#$.
•F/r#$er ea"/a#%! #$e e))e,#%e!ess ) !/rs%! %!#ere!#%!s #$a# $ae (ee!
a66"%e+ # 6a#%e!# Mr. RTN e!#%re ,/rse ) #$era6&.
T$e s#/+& %s "%%#e+ (& #$e )""-%! )a,#rs
T$e !/rs%! %!#ere!#%!s +!e # 6a#%e!# Mr.RTN are !"& "%%#e+ # /r
assesse!# )r 3 ,!se,/#%e +a#es Ne(er 217 2512 1535a. >assesse!# 1 s#
%s%#?7 Ne(er 227 2512 >2!+ %s%#?7 Ne(er 237 2512 >3 r+ %s%#?. I!)ra#%! a#$ere+
-as "%%#e+ !"& # #$e ,"%e!# a!+ #$e +a#a re)"e,#e+ ! #$e 6a#%e!#@s ,$ar# a!+ )r /r
6$&s%,a" assesse!#. T$ere -ere a"s "%%#a#%!s ! #$e %!#ere!#%!s -e -ere !"&
6er%##e+ # 6er)r7 #$e #%e a!+ +%s#a!,e a""##e+ )r /r %s%# !"&. N %!#er%e-s -ere
a+e -%#$ #$e 6re%/s 6$&s%,%a!s a##e!+%! # /r 6a#%e!#.
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. O',e"ive ! "#e -"$%&
A# #$e e!+ 3 +a&9,are # #$e 6a#%e!#7 -e -%"" (e a("e # + #$e )""-%!
1. Assess a!+ !%#r #$e $ea"#$ s#a#/s a!+ %#a" s%!s ) & 6a#%e!#s.
2. I+e!#%)& a,#/a" a!+ 6#e!#%a" $ea"#$ 6r("es ) #$e 6a#%e!#.
3. P"a! )r #$e 6a#%e!#@s ,are
4. Per)r !/rs%! %!#ere!#%!s >e+%,a#%!s %!,"/+e+? e))e,#%e"& a!+
e))%,%e!#"&
'. Ea"/a#e 6a#%e!#@s res6!se a!+ rea,#%! a!+
*. I6ar# $ea"#$ #ea,$%!s # /r 6a#%e!#
*
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II. PATIENTS PROFILE
Nae RTN
e!+er Ma"e
Ae 23 &ears "+
B%r#$+a#e Se6#e(er 357 15
P"a,e ) B%r#$ B/:%+!!
A++ress L/(a&a- Va"e!,%a B/:%+!!
S#a#/s S%!"e
Re"%%! Ra! Ca#$"%,
Na#%!a"%#& F%"%6%!
He%$# 'F#. '%!,$es Ta""
We%$# >6rese!#? '0 :
E+/,a#%!a" A##a%!e!# H%$ S,$" ra+/a#e
O,,/6a#%! CAFU
I!,e 27556$6$G!#$
C$%e) C6"a%!#s Ye""-%s$ S,"era
A+%##%! D%a!s%s V%ra" He6a#%#%s
A+%ss%! Da#e O,#(er 27 2512
A+%ss%! T%e 2556..
A##e!+%! P$&s%,%a! Dr. C&!#$%a M. W
Hs6%#a" Ca6 Ea!e"%s#a S#a#%! Hs6%#a"
1
+
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III.DEVELOPMENTAL THEORY
2Eri/ Eri/-* P-&#-ia0 T#er&
• P-&#-ia0 C*!0i"1 I!#%a,& Vers/s Is"a#%! > 2592' &ears "+?
• Ma,r 2$e-"i*1 es#a("%s$e+ +/r%! #$e %+e!#%#&ers/s ,!)/s%! s#ae? %s esse!#%a" # (e%! a("e # )r %!#%a#e re"a#%!s$%6s. S#/+%es$ae +e!s#ra#e+ #$a# #$se -%#$ a 6r se!se ) se") #e!+ # $ae "ess ,%##e+re"a#%!s$%6s a!+ are re "%:e"& # s/))er e#%!a" %s"a#%!7 "!e"%!ess7 a!++e6ress%!.
Er%:s! (e"%ee+ %# -as %#a" #$a# 6e6"e +ee"6 ,"se7 ,%##e+ re"a#%!s$%6s -%#$#$er 6e6"e. S/,,ess "ea+s # s#r! re"a#%!s$%6s7 -$%"e )a%"/re res/"#s %! "!e"%!ess
a!+ %s"a#%!.
,
http://psychology.about.com/od/profilesofmajorthinkers/p/bio_erikson.htmhttp://psychology.about.com/od/theoriesofpersonality/a/psychosocial.htmhttp://psychology.about.com/od/theoriesofpersonality/a/psychosocial.htmhttp://psychology.about.com/od/theoriesofpersonality/a/psychosocial.htmhttp://psychology.about.com/od/theoriesofpersonality/a/psychosocial.htmhttp://psychology.about.com/od/profilesofmajorthinkers/p/bio_erikson.htm
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IV. HEALTH HISTORY
a. H%s#r& ) Prese!# I""!ess
A ,ase ) a 23 &ear "+7 a"e7 Ra! Ca#$"%, )r L/(a&a- Va"e!,%a
B/:%+!! -as a+%##e+ # Ca6 Ea!e"%s#a S#a#%! Hs6%#a". Pr%r # a+%ss%! ,/$
-as !#e+ -%#$ ! a!+ )) )eer )""-e+ (& &e""-%s$ +%s,"ra#%! ) s,"era.
Pa#%e!# $a+ ! 6re%/s $s6%#a"%a#%! a!+ -as !# :!-! )r +%a(e#es7
$&6er#e!s%!7 as#$a7 a!+ $as ! :!-! )+ a!+ +r/ a""er&.
(. Pas# Me+%,a" H%s#r&
C"%e!# $as ! :!-! e+%,a" $%s#r& a!+ #$%s %s #$e )%rs# #%e #$a# $e -as (e%!
$s6%#a"%e+. He $as 6re%/s %""!esses s/,$ as )eer7 ,/$ a!+ ,"+s (/# !"&
a!ae+ a# $e a!+ ! ,!s/"#a#%! -as +!e a!+ ! e+%,a#%! -ere#a:e!.
V. MEDICAL MANAGEMENT
a. Me+%,a" Or+ers
Da#e a!+ #%e D,#r@s r+er O,#(er 272512
1'25H
Per a+%# # %s"a#%!
TPR eer& s$%)# A##a,$ CBC7 Ur%!a"&s%s7 )e,a"&s%s7 a!+ HBs
AEsse!#%a"e #a( TIDP"ease re)er a,,r+%!"&
Ne(er 147 2512
15'5H
Fr a!#% HAV 1
UTK ) HBTNe(er 1*7 2512
51*H
Fr re)erre+ # +e!#a" +e6ar#e!#
535H Fr a!#% HAV 1 !,e -%#$ !e&Fr s,$e+/"%! ) UTK ) HBT !,e -%#$
!e&
(. La(ra#r& Res/"#s
COMPLETE BLOOD COUNT
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O"'er 3453673
Te-" Re-$0"- Re!ere*e
WBC 7555 >'75559157555?3
He"(%! 13.' >14910?
Hea#,r%# 4'.0 >459'4?
Ne/#r6$%" 44 >'595?
L&6$,e 4' >2595?
Es%!6$%" 50 >5295*?
HB-A8
O"'er 345 3673
HBsA N!9rea,#%e
S&6$%"%s!!e
URINALYSIS
O"'er 345 3673
C"r Dar: Ye""-
Tra!s6are!,& ,"ear
S/ar !!e
A"(/%! !!e
s6e,%)%, ra%#& 1.52'
WBC 5.2 G$6)
FECALYSIS
O"'er 345 3673
C0r1 Brw* RBC1 NONE
C#ara"er1 S!" 9BC1 NONE
Para-i"e-1 *
,. Dr/ S#/+&
7.
Na+e ! Dr$81 A8%,%""%!
.
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Da"e r%ere% Ne(er 1*7 2512
C0a--i!ia"i* A!#%9%!)e,#%e +r/
D-e:!re;$e*& '55 ,a6 TID )r 3+a&s
Me#a*i-+ ! A"i* A! a%!6e!%,%""%! #$a# 6ree!#s (a,#er%a" ,e""9-a"" s&!#$es%s
+/r%! re6"%,a#%! ,"a/a"a!%, a,%+ %!,reases a8%,%""%! e))e,#%e!ess (&
Sei!i I*%ia"i* Fr re,/rre!# r 6ers%s#e!# a,/#e #%#%s e+%a7 "-er res6%ra#r&
%!)e,#%!7 s%!/s%#%s7 s:%! a!+ s:%! s#r/,#/re a!+ /r%!ar& #ra,# %!)e,#%!
C*"rai*%ia"i* C!#ra%!+%,a#e+ %! 6a#%e!#s $&6erse!s%#%%#& # +r/ r #$er 6e!%,%""%!
a!+ %! #$se -%#$ $%s#r& ) a8%,%""%! re"a#e+ ,$"es#a#%, a/!+%,e r $e6a#%,
+&s)/!,#%!
Si%e E!!e"- CNS A%#a#%!7 a!8%e#& 7 %!s!%a
I Na/sea a!+ %#%! 7 as#r%#%s
N$r-i*8 Ma*a8e+e*"1
Use ,a/#%/s"& %! 6a#%e!# s -%#$ #$er +r/ a""er%es (e,a/se ) 6ss%("e ,rss9
se!s%#%%#& O(#a%! s6e,%e! )r ,/"#/re a!+ se!s%#%%#& #es# (e)re %%! )%rs# +se
%e +r/ a#"eas# 1$r (e)re (a,#er%a" s#a#%, a!#%(%#%,
S$/"+ (e #a:e! -%#$ ea"s
3.
Na+e ! Dr$8 Esse!#%a"e )r#e
Da"e r%ere% O,#(er 27 2512
C0a--i!ia"i* He6a#%, 6r#e,#r
D-e:!re;$e*& 1 #a( TID
Me#a*i-+ ! A"i* N/r%s$ #$e "%er
Sei!i I*%ia"i* T #rea# #8%, a!+ e#a("%, "%er +%sease
C*"rai*%ia"i* C!#ra%!+%,a#e+ # 6a#%e!#s $&6erse!s%#%%#& # #$%s +r/
Si%e e!!e"- Hea+a,$e7 !a/sea 7 %#%!7 ,!s#%6a#%!
N$r-i*8 Ma*a8e+e*"
S$/"+ (e #a:e! -%#$ ea"s
F""- #$e 12 r%$#s ) 6a#%e!#
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Me#a*i-+ ! a"i* A!#ra!%"%, a,%+ +er%a#%e %!$%(%#s 6rs#a"a!+%! s&!#$es%s a!+
a))e,#s 6"a#e"e# )/!,#%!
Sei!i i*%ia"i* Re"%e) 6a%! %!,"/+%! /s,/"ar7 r$e/a#%,7 $ea+a,$e a!+ %ra%!e
C*"rai*%ia"i* C!#ra%!+%,a#e+ # 6a#%e!#s $&6erse!s%#%%#& # +r/ I
%!)"aa#%! r /",era#%!
Si%e e!!e"- CNS +r-s%!ess7 %!s!%a 7 +%%!ess
I seere +%arr$ea7 /",era#%! 7 ("ee+%!
S:%! /r#%,ar%a 7 ras$
CV 6a"6%#a#%!
N$r-i*8 i*"erve*"i*
D%s,!#%!/e +r/ 6r6#"& %) +%arr$ea7 +ar: s#"s7 e6%s#a8%s7 ras$ ,,/r a!+ +
!# /se aa%! N#%)& 6$&s%,%a! %) 6ers%s#e!# I +%s,)r#7 sre #$ra# ,,/r
VI. ANATOMY AND PHYSIOLOGY
11
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H$+a* A*a"+&
T$e 0iver 7 hepar 7 %s a %#a" ra! 6rese!# %! er#e(ra#es a!+ se #$er a!%a"s. I# $as a
-%+e ra!e ) )/!,#%!s7 %!,"/+%!+e#8%)%,a#%!7 6r#e%! s&!#$es%s7 a!+ 6r+/,#%! )(%,$e%,a"s !e,essar& )r +%es#%!. T$e "%er %s !e,essar& )r s/r%a" #$ere %s
,/rre!#"& ! -a& # ,6e!sa#e )r #$e a(se!,e ) "%er )/!,#%! %! #$e "! #er7a"#$/$ !e- "%er +%a"&s%s #e,$!%/es ,a! (e /se+ %! #$e s$r# #er.
T$%s ra! 6"a&s a ar r"e %! e#a("%s a!+ $as a !/(er ) )/!,#%!s %! #$e (+&7%!,"/+%! "&,e! s#rae7 +e,6s%#%! ) re+ ("+ ,e""s7 6"asa
6r#e%! s&!#$es%s7 $r!e 6r+/,#%!7 a!+ +e#8%)%,a#%!. I# "%es (e"- #$e +%a6$ra %!#$e a(+%!a"96e"%, re%! ) #$e a(+e!. I# 6r+/,es (%"e7 a! a":a"%!e ,6/!+
-$%,$ a%+s %! +%es#%! %a #$e e/"s%)%,a#%! ) "%6%+s. T$e "%er;s $%$"&s6e,%a"%e+ #%ss/es re/"a#e a -%+e ar%e#& ) $%$9"/e (%,$e%,a" rea,#%!s7
%!,"/+%! #$e s&!#$es%s a!+ (rea:+-! ) sa"" a!+ ,6"e8 "e,/"es7 a!& ) -$%,$are !e,essar& )r !ra" %#a" )/!,#%!s. 2
T$e "%er %s a "are7 ea#& ra! #$a# s%#s ! #$e r%$# s%+e ) #$e (e""&. We%$%! a(/# 3
6/!+s7 #$e "%er %s re++%s$9(r-! %! ,"r a!+ )ee"s r/((er& # #$e #/,$. Nra""& &/
,a!;# )ee" #$e "%er7 (e,a/se %#;s 6r#e,#e+ (& #$e r%( ,ae.
T$e "%er $as #- "are se,#%!s7 ,a""e+ #$e r%$# a!+ #$e "e)# "(es. T$e a""("a++er s%#s
/!+er #$e "%er7 a"! -%#$ 6ar#s ) #$e 6a!,reas a!+ %!#es#%!es. T$e "%er a!+ #$ese
ra!s -r: #e#$er # +%es#7 a(sr(7 a!+ 6r,ess )+.
T$e "%er;s a%! ( %s # )%"#er #$e ("+ ,%! )r #$e +%es#%e #ra,#7 (e)re 6ass%!
%# # #$e res# ) #$e (+&. T$e "%er a"s +e#8%)%es ,$e%,a"s a!+ e#a("%es +r/s. As %#
+es s7 #$e "%er se,re#es (%"e #$a# e!+s /6 (a,: %! #$e %!#es#%!es. T$e "%er a"s a:es
6r#e%!s %6r#a!# )r ("+ ,"##%! a!+ #$er )/!,#%!s.
Liver Conditions
• He6a#%#%s I!)"aa#%! ) #$e "%er7 /s/a""& ,a/se+ (& %r/ses "%:e $e6a#%#%s A7 B7a!+ C. He6a#%#%s ,a! $ae !!9%!)e,#%/s ,a/ses #7 %!,"/+%! $ea& +r%!:%!7+r/s7 a""er%, rea,#%!s7 r (es%#&.
1(
http://en.wikipedia.org/wiki/Vital_organhttp://en.wikipedia.org/wiki/Vertebratehttp://en.wikipedia.org/wiki/Detoxificationhttp://en.wikipedia.org/wiki/Protein_synthesishttp://en.wikipedia.org/wiki/Digestionhttp://en.wikipedia.org/wiki/Liver_dialysishttp://en.wikipedia.org/wiki/Organ_(anatomy)http://en.wikipedia.org/wiki/Metabolismhttp://en.wikipedia.org/wiki/Metabolismhttp://en.wikipedia.org/wiki/Glycogenhttp://en.wikipedia.org/wiki/Plasma_proteinhttp://en.wikipedia.org/wiki/Plasma_proteinhttp://en.wikipedia.org/wiki/Hormonehttp://en.wikipedia.org/wiki/Hormonehttp://en.wikipedia.org/wiki/Bilehttp://en.wikipedia.org/wiki/Digestionhttp://en.wikipedia.org/wiki/Emulsificationhttp://en.wikipedia.org/wiki/Lipidshttp://en.wikipedia.org/wiki/Biological_tissuehttp://en.wikipedia.org/wiki/Liver#cite_note-2http://www.webmd.com/hepatitis/default.htmhttp://en.wikipedia.org/wiki/Vital_organhttp://en.wikipedia.org/wiki/Vertebratehttp://en.wikipedia.org/wiki/Detoxificationhttp://en.wikipedia.org/wiki/Protein_synthesishttp://en.wikipedia.org/wiki/Digestionhttp://en.wikipedia.org/wiki/Liver_dialysishttp://en.wikipedia.org/wiki/Organ_(anatomy)http://en.wikipedia.org/wiki/Metabolismhttp://en.wikipedia.org/wiki/Glycogenhttp://en.wikipedia.org/wiki/Plasma_proteinhttp://en.wikipedia.org/wiki/Plasma_proteinhttp://en.wikipedia.org/wiki/Hormonehttp://en.wikipedia.org/wiki/Bilehttp://en.wikipedia.org/wiki/Digestionhttp://en.wikipedia.org/wiki/Emulsificationhttp://en.wikipedia.org/wiki/Lipidshttp://en.wikipedia.org/wiki/Biological_tissuehttp://en.wikipedia.org/wiki/Liver#cite_note-2http://www.webmd.com/hepatitis/default.htm
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• C%rr$s%s L!9#er +aae # #$e "%er )r a!& ,a/se ,a! "ea+ # 6era!e!#s,arr%!7 ,a""e+ ,%rr$s%s. T$e "%er #$e! (e,es /!a("e # )/!,#%! -e"".
• L%er ,a!,er T$e s# ,! #&6e ) "%er ,a!,er7 $e6a#,e""/"ar ,ar,%!a7a"s# a"-a&s ,,/rs a)#er ,%rr$s%s %s 6rese!#.
• L%er )a%"/re L%er )a%"/re $as a!& ,a/ses %!,"/+%! %!)e,#%!7 e!e#%, +%seases7a!+ e8,ess%e a",$".
• As,%#es As ,%rr$s%s res/"#s7 #$e "%er "ea:s )"/%+ >as,%#es? %!# #$e (e""&7 -$%,$(e,es +%s#e!+e+ a!+ $ea&.
• a""s#!es I) a a""s#!e (e,es s#/,: %! #$e (%"e +/,# +ra%!%! #$e "%er7$e6a#%#%s a!+ (%"e +/,# %!)e,#%! >,$"a!%#%s? ,a! res/"#.
• He,$ra#s%s He,$ra#s%s a""-s %r! # +e6s%# %! #$e "%er7
+aa%! %#. T$e %r! a"s +e6s%#s #$r/$/# #$e (+&7 ,a/s%! /"#%6"e #$er$ea"#$ 6r("es.
• Pr%ar& s,"ers%! ,$"a!%#%s A rare +%sease -%#$ /!:!-! ,a/ses7 6r%ar&s,"ers%! ,$"a!%#%s ,a/ses %!)"aa#%! a!+ s,arr%! %! #$e (%"e +/,#s %! #$e"%er.
• Pr%ar& (%"%ar& ,%rr$s%s I! #$%s rare +%sr+er7 a! /!,"ear 6r,ess s"-"& +es#r&s#$e (%"e +/,#s %! #$e "%er. Pera!e!# "%er s,arr%! >,%rr$s%s? ee!#/a""&+ee"6s.
A!a#&
T$e "%er %s a re++%s$ (r-! ra! -%#$ )/r "(es ) /!e/a" s%e a!+ s$a6e. A $/a!
"%er !ra""& -e%$s 1.441.** : >3.23. "(?7 a!+ %s a s)#7 6%!:%s$9(r-!7 #r%a!/"arra!. I# %s (#$ #$e "ares# %!#er!a" ra! >#$e s:%! (e%! #$e "ares# ra! era""? a!+
#$e "ares# "a!+ %! #$e $/a! (+&. I# %s ",a#e+ %! #$e r%$# /66er /a+ra!# )#$e a(+%!a" ,a%#&7 res#%! /s# (e"- #$e +%a6$ra. T$e "%er "%es # #$e r%$# ) #$e
s#a,$ a!+ er"%es #$e a""("a++er . I# %s ,!!e,#e+ # #- "are ("+ esse"s7 !e,a""e+ #$e $e6a#%, ar#er& a!+ !e ,a""e+ #$e 6r#a" e%!. T$e $e6a#%, ar#er& ,arr%es ("+
)r #$e ar#a7 -$ereas #$e 6r#a" e%! ,arr%es ("+ ,!#a%!%! +%es#e+ !/#r%e!#s )r#$e e!#%re as#r%!#es#%!a" #ra,#a!+ a"s )r #$e s6"ee! a!+ 6a!,reas. T$ese ("+esse"s s/(+%%+e %!# ,a6%""ar%es7 -$%,$ #$e! "ea+ # a "(/"e. Ea,$ "(/"e %s a+e /6 ) %""%!s ) $e6a#%, ,e""s -$%,$ are #$e (as%, e#a("%, ,e""s. L(/"es are #$e )/!,#%!a"
/!%#s ) #$e "%er.
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T- ar #&6es ) ,e""s 66/"a#e #$e "%er "(es :ara# 6are!,$&a" a!+ !!9
6are!,$&a" ,e""s. 05= ) #$e "%er "/e %s ,,/6%e+ (& 6are!,$&a" ,e""s ,!"&re)erre+ # as$e6a#,es. N!96are!,$&a" ,e""s ,!s#%#/#e 45= ) #$e ##a" !/(er )
"%er ,e""s (/# !"& *.'= ) %#s "/e. S%!/s%+a" e!+#$e"%a" ,e""s7 /6))er ,e""s a!+$e6a#%, s#e""a#e ,e""s are se ) #$e !!96are!,$&a" ,e""s #$a# "%!e #$e $e6a#%,s%!/s%+.
1)
http://www.webmd.com/digestive-disorders/cirrhosis-liverhttp://www.webmd.com/cancer/understanding-liver-cancer-basic-informationhttp://www.webmd.com/digestive-disorders/digestive-diseases-liver-failurehttp://www.webmd.com/digestive-disorders/ascites-medrefhttp://www.webmd.com/digestive-disorders/gallstoneshttp://www.webmd.com/digestive-disorders/inherited-liver-diseaseshttp://www.webmd.com/digestive-disorders/cholangitis-primary-sclerosinghttp://www.webmd.com/digestive-disorders/tc/primary-biliary-cirrhosis-pbc-topic-overviewhttp://en.wikipedia.org/wiki/Lobe_(anatomy)http://en.wikipedia.org/wiki/Skinhttp://en.wikipedia.org/wiki/Glandhttp://en.wikipedia.org/wiki/Right_upper_quadranthttp://en.wikipedia.org/wiki/Abdominal_cavityhttp://en.wikipedia.org/wiki/Thoracic_diaphragmhttp://en.wikipedia.org/wiki/Gallbladderhttp://en.wikipedia.org/wiki/Blood_vesselhttp://en.wikipedia.org/wiki/Portal_veinhttp://en.wikipedia.org/wiki/Hepatic_arteryhttp://en.wikipedia.org/wiki/Gastrointestinal_tracthttp://en.wikipedia.org/wiki/Spleenhttp://en.wikipedia.org/wiki/Pancreashttp://en.wikipedia.org/wiki/Lobules_of_liverhttp://en.wikipedia.org/wiki/Hepatocyteshttp://en.wikipedia.org/wiki/Kupffer_cellshttp://www.webmd.com/digestive-disorders/cirrhosis-liverhttp://www.webmd.com/cancer/understanding-liver-cancer-basic-informationhttp://www.webmd.com/digestive-disorders/digestive-diseases-liver-failurehttp://www.webmd.com/digestive-disorders/ascites-medrefhttp://www.webmd.com/digestive-disorders/gallstoneshttp://www.webmd.com/digestive-disorders/inherited-liver-diseaseshttp://www.webmd.com/digestive-disorders/cholangitis-primary-sclerosinghttp://www.webmd.com/digestive-disorders/tc/primary-biliary-cirrhosis-pbc-topic-overviewhttp://en.wikipedia.org/wiki/Lobe_(anatomy)http://en.wikipedia.org/wiki/Skinhttp://en.wikipedia.org/wiki/Glandhttp://en.wikipedia.org/wiki/Right_upper_quadranthttp://en.wikipedia.org/wiki/Abdominal_cavityhttp://en.wikipedia.org/wiki/Thoracic_diaphragmhttp://en.wikipedia.org/wiki/Gallbladderhttp://en.wikipedia.org/wiki/Blood_vesselhttp://en.wikipedia.org/wiki/Portal_veinhttp://en.wikipedia.org/wiki/Hepatic_arteryhttp://en.wikipedia.org/wiki/Gastrointestinal_tracthttp://en.wikipedia.org/wiki/Spleenhttp://en.wikipedia.org/wiki/Pancreashttp://en.wikipedia.org/wiki/Lobules_of_liverhttp://en.wikipedia.org/wiki/Hepatocyteshttp://en.wikipedia.org/wiki/Kupffer_cells
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B0% !0w
T$e "%er e#s a +/a" ("+ s/66"& )r #$e $e6a#%, 6r#a" e%! a!+ $e6a#%, ar#er%es.S/66"&%! a66r8%a#e"& '= ) #$e "%er;s ("+ s/66"&7 #$e $e6a#%, 6r#a" e%!,arr%es e!/s ("+ +ra%!e+ )r #$e s6"ee!7 as#r%!#es#%!a" #ra,#7 a!+ %#s ass,%a#e+
ra!s. T$e $e6a#%, ar#er%es s/66"& ar#er%a" ("+ # #$e "%er7 a,,/!#%! )r #$erea%!+er ) %#s ("+ )"-. O8&e! %s 6r%+e+ )r (#$ s/r,es a66r8%a#e"& $a") ) #$e "%er;s 8&e! +ea!+ %s e# (& #$e $e6a#%, 6r#a" e%!7 a!+ $a") %s e# (& #$e
$e6a#%, ar#er%esB"+ )"-s #$r/$ #$e "%er s%!/s%+s a!+ e6#%es %!# #$e ,e!#ra" e%! ) ea,$ "(/"e.
T$e ,e!#ra" e%!s ,a"es,e %!# $e6a#%, e%!s7 -$%,$ "eae #$e "%er.
T$e #er biliary tree %s +er%e+ )r #$e ar(rea" (ra!,$es ) #$e (%"e +/,#s.
T$e (%"e 6r+/,e+ %! #$e "%er %s ,""e,#e+ %! (%"e ,a!a"%,/"%7 -$%,$ ere # )r (%"e+/,#s. W%#$%! #$e "%er7 #$ese +/,#s are ,a""e+ intrahepatic >-%#$%! #$e "%er? (%"e +/,#s7
a!+ !,e #$e& e8%# #$e "%er #$e& are ,!s%+ere+ extrahepatic >/#s%+e #$e "%er?. T$e%!#ra$e6a#%, +/,#s ee!#/a""& +ra%! %!# #$e r%$# a!+ "e)# $e6a#%, +/,#s7 -$%,$ ere #
)r #$e ,! $e6a#%, +/,#. T$e ,&s#%, +/,# )r #$e a""("a++er %!s -%#$#$e ,! $e6a#%, +/,# # )r #$e ,! (%"e +/,#.
B%"e e%#$er +ra%!s +%re,#"& %!# #$e +/+e!/ %a #$e ,! (%"e +/,#7 r (e #e6rar%"&s#re+ %! #$e a""("a++er %a #$e ,&s#%, +/,#. T$e ,! (%"e +/,# a!+ #$e 6a!,rea#%,
+/,# e!#er #$e se,!+ 6ar# ) #$e +/+e!/ #e#$er a# #$e a6/""a ) Va#er .
S$r!ae a*a"+&
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A6ar# )r a 6a#,$ -$ere %# ,!!e,#s # #$e +%a6$ra >#$e s9,a""e+
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Ea,$ ) #$e "(es %s a+e /6 ) "(/"es a e%! es )r #$e ,e!#re7 -$%,$ #$e! %!s ##$e $e6a#%, e%! # ,arr& ("+ /# )r #$e "%er.
O! #$e s/r)a,e ) #$e "(/"es7 #$ere are +/,#s7 e%!s a!+ ar#er%es #$a# ,arr& )"/%+s # a!+)r #$e.
F$*"i*a0 a*a"+&
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VII. PATHOPHYSIOLOGYDia8*-i-1 V%ra" He6a#%#%s
De!i*i"i* %s a %ra" %!)e,#%! ) #$e "%er ass,%a#e+ -%#$ (ra+ s6e,#r/ ) ,"%!%,a"
a!%)es#a#%!s )r as&6#a#%, %!)e,#%! #$r/$ %,#er%, $e6a#%#%s # $e6a#%, !e,rs%s
Pre+%s6s%! )a,#rs Pre,%6%#a#%! )a,#rs
E!%r!e!# Ae>42 &ears "+?
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NURSING SYSTEM REVIE9 CHART
Na+e1 RTN Da"e1Ne(er 217 2512
Vi"a0 Si8*-1
Te+1.
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VI. NURSING SYSTEM REVIE9 CHART
Nae RTN Da#e Ne(er 217 2512
V%#a" s%!s
P/"se 0*(6 Te6 3*.3QC We%$# '0:
INSTRUCTIONS1 P"a,e a! >8? %! #$e area ) a(!ra"%#&. Wr%#e ,e!# ! #$e s6a,e.I!+%,a#e+ #$e ",a#%! ) #$e 6r("e %! #$e )%/re /s%! >8?.
EENT1 %6a%re+ %s%! ("%!+ 6a%! re++e!e+ +ra%!ae /s 8 $ar+ ) $ear%! +ea) #$ra# )r a(!ra"%#& ! 6r("e
RESPIRATION1 as&e#r%, #a,$&6!ea (arre" ,$es# a6!ea ra"es ,/$ (ra+&6!ea s$a""- r$!,$ s6/#/ +%%!%s$e+ +&s6!ea r#$6!ea "a(re+ -$ee%! 6a%! ,&a!#%, assess res6. ra#e7 r$$7 +e6#$7 6a##er!8 (rea#$ s/!+7 ,)r# r ! 6r("e
GASTROINTESTINAL TRACT
(ese 8 +%s#e!#%! ass +&s6$a%a r%%+"& 6a%! assess a(+e!7 (-e" $a(%#s7 s-a""-%!8 (-e" s/!+s7 ,)r# ! 6r("e
GENITO@URINARY AND GYNE 6a%! /r%!e ,"r a%!a" ("ee+%! $ea#/r%a +%s,$are !,#/r%a
1
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assess /r%!e )re.7 ,"r7 +r7 ,)r# &!9("ee+%! +%s,$are ! 6r("e
NEURO 6ara"&s%s s#/6r/s /!s#ea+& se%/res
"e#$ar#%, ,a#se er#% #rers ,!)/se+ %s%! r%6 assess #r )/!,#%!7 se!sa#%!7 LOC7 s#re!#$7 r%67 a"#7 ,r+%!a#%!7 s6ee,$7 ! 6r("e
MUSCULOSELETAL a66"%a!,e s#%))!ess %#,$%! 6e#e,$%ae $# +ra%!ae 6rs#$es%s s-e""%! "es%! 8 6r #/rr 8 ," +e)r%#&
NURSING ASSESSMENT II
SUBECTIVE OBECTIVECOMMUNICATION18 Hear%! "ss
V%s/a" ,$a!es De!%e+
"asses "a!/ae
,!#ra,# "e!ses $ear%! a%+e R LP/6%" s%e 394 s6ee,$+%))%,/"#%esRea,#%! 6/6%"s e/a""& r/!+e+ rea,#%! #"%
$#s a,,+a#%!.
OXYGENATION +&s6!ea8 s:%! $%s#r&
A6r%" 2511
,/$ s6/#/ +e!%e+
Res6. 8 re/"ar %rre/"ar Des,r%(e res6%ra#r& ra#e %s -%#$ %! !ra"ra!e a!+ "%%#.
R r%$# "/! s&e#r%, # #$e "e)# "/!L "e)# "/! s&e#r%, # #$e r%$# "/!
CIRCULATION1
8 ,$es# 6a%! "e 6a%!8 !/(!ess )
E8#ree#%es +e!%e+
Hear# r$$ 8 re/"ar %re/"ar A!:"e e+ea !!eCar#%+ ra+%a" +rsa" 6e+%s )era"R 0* L 0* Ce!#s a"" 6/"se are 6a"6a("e.
NUTRIRION1D%e# D%e# as T"era#e+8 N VC$ara,#er%s#%, re,e!# ,$a!e %!
We%$#7 a66e#%#e
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s-a""-%! D%))%,/"#&8 +e!%e+
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ELIMINATION1
Us/a" (-e" 6a##er! /r%!e)re/e!,& #%es a +a& ,!s#%6a#%! /re!,& Ree+%esPa6a&a7 (a!a!a +&s/r%aNe(er 217 2512 $ea#/r%a Da#e ) "as# BM %!,!#%!e!,e 6"&/r%a +%arr$ea )"& %! 6"a,e C$ara,#er +e!%e+
Ce!#s B-e" s/!+s
Nra,#%e A(+%!a"D%s#e!#%! Prese!# &es 8! Ur%!e > ,"r7,!s%s#e!,& O+r?+ar: &e""- 7)/" .+r %) )"e& (a
,a#$e#er %s I! 6"a,e
MGT. OF HEALTH ILLNESS18 A",$" +e!%e+> a/!#7 )re/e!,&? '559*55" 3#%es a +a& SBE "as# Pa6 Sear !# a66"%,a("eLMP !# a66"%,a("e TE !!e
Br%e)"& +es,r%(e #$e 6a#%e!#@s a(%"%#& # )""-#rea#e!#s > +%e#7 e+s7 e#,.? )r ,$r!%,$ea"#$ 6r("es.> %) 6rese!#?
T$e 6a#%e!# %s a("e # )""- #$e e+%,a#%!s6res,r%(e+ (& #$e 6$&s%,%a!.
SIN INTEGRITY1
8 +r& ,e!#s-a"a 7a!6+ : %#,$%! a6a!a#" sa : 6a!%# #$er er(a"%e+ (& #$e 6#. +e!%e+
8 +r& ,"+ 6a"e )"/s$e+ 8 -ar %s# ,&a!#%,ras$es7 /",ers7 +e,/(%#%s> +es,r%(e s%e7",ar#%!7 +ra%!ae? T$ere %s !ras$es7ras$es7 +e,/(%#%s #$a# are (sere7
ACTIVITY: SAFETY1 ,!/"s%! +%%!ess "%%#e+ #%!
O) %!s a(/"a#e (a#$e se") #$er 8 +e!%e+
LOC a!+ r%e!#a#%! 6a#%e!# %s ,!s,%/s# #%e 7 6ers! a!+ 6"a,e a%# -a":er ,are #$er s#ea+& /!s#ea+&
Se!sr& a!+ #r "sses %! )a,e re8#re%#%esN se!sr& a!+ #r "sses %! )a,e a!+e8#ree#%es ROM "%%#a#%!s $e $as !6r("erear+%! ROM.
COMFORT: SLEEP: A9AE18 6a%!> ",a#%!? )re/e!,&Ree+%es
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COPING1O,,/6a#%! CAFUMe(ers ) $/se$"+s Ms# s/66r#%e 6ers! $%s (r#$er
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IX. IDEAL NURSING MANAGEMENT1.
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A"$a0 N$r-i*8 Ma*a8e+e*"
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I 2. A%+ /se ) a":a"%!e sa6.3. ee6 )%!er!a%"s ,/# s$r#. Pr%+e s)# ,##!
"%!e!s.4. Pr%+e +%ers%!a" a,#%%#%es.'. A+%!%s#er e+%,a#%!s as %!+%,a#e+ a!#%$%s#a%!e7
+%6$e!$&+ra%!e >Be!a+r&"?7 aa#a+%!e >6#%%!e?E L! #er a# #$e e!+ ) 0 $rs !/rs%! %!#ere!#%!s
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X. EVALUATION AND IMPLICATION
W%#$%! #$e s6a! ) 2 +a&s ) re!+er%! ,are # RTN7 I -as a("e # %+e!#%)&
6#e!#%a" 6r("es a!+ s6e,%)%, !/rs%! %!#ere!#%!s -ere 6r%+e+. W%#$ #$e $e"6 )
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re,!%e s%!s a!+ s&6#s a!+ #$er r%s: )a,#rs ) $%s ,!+%#%!. M& 6a#%e!# -as
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XI. REFERRALS a*% RECOMMENDATION
O/r )/r#$er I!6a#%e!# ,are %!,"/+es !%#r%! ) ,$a!es %! %#a" s%!s7 assesse!# )
e))e,#%e!ess ) #rea#e!# re%e!7 re%!)r,ee!# ) +%e#ar& a+%,e7 a!+ #$e a+%,e
rear+%! #$e %6r#a!,e ) a+e/a#e (e+ res#.
O/r )/r#$er /#6a#%e!# ,are %!,"/+es %!s#r/,#%!s ) Mr. RTN $%s +%e#ar&
+%)%,a#%!7 ,6"%a!,e -%#$ #rea#e!# re%e! a!+ $%s 6ar#%,%6a#%! #$r/$ re6r#%!) a+erse e))e,#s ) e+%,a#%!s # $%s 6$&s%,%a!7 Dr.C&!#$%a W. T$e 6a#%e!# -as a"s
%!s#r/,#e+ # $ae a re/"ar ,$e,:9/6 a# Ca6 Ea!e"%s#a S#a#%! $s6%#a" %! r+er #
!%#r $%s ,/rre!# ,!+%#%!.
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HEALTH TEACHINGS
Nae ) 6a#%e!# RTN
Me+%,a#%!s
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#$a# #$e +,#r r+ere+ s #$a# -%#$/# $es%#a#%! #$e& -%"" rea""& ,6"& a"" #$e
e+%,a#%!s %e! -%#$ #$e. A+$ere!,e # #$e e+%,a#%! 6r#es %6ree!# ) ,!+%#%!.
E8er,%se
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(e+ %) $%s (+& ,a! #"era#e a!+ (& #/r!%! # s%+es # 6ree!# 6!e/!%a a!+
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+%s,$are+. E!,/rae+ 6a#%e!# # + +ee6 (rea#$%! e8er,%sesG Re"a8a#%! Te,$!%/e
Trea#e!#
A+%se+GE6$as%e+ #$e %6r#a!,e # a+$ere # #rea#e!# re%e!. T$a# %s #
)a,%"%#a#e )as#er %6ree!# ) 6rese!# ,!+%#%! a!+ 6ree!# ,6"%,a#%!. Be+ res# %s %6r#a!# # 6ree!# er )a#%a(%"%#& #$e! a(/"a#e -%#$ %! #"era("e
"%%#s A+%se+ # # #$e%r $ea"#$ ,e!#er )r ,$e,: /6 !%#r%!. T$%s s$/"+ (e +!e
!,e %! #$e -ee:. I!,rease+ )"/%+ %!#a:e /6 # *90 "asses a +a&
O/#6a#%e!# >CHEC9UP?
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a!+ ea"/a#%! ) #$e ,"%e!#@s $ea"#$ ,!+%#%!. T$%s %s er& %6r#a!# s #$a# #$e
$ea"#$ ,!+%#%! ) #$e ,"%e!# -%"" (e ea"/a#e+ %) #$ere %s (e##er %6ree!#. T$e
6$&s%,%a! s$/"+ see a!+ e8a%!e #$e 6$&s%,a" a66eara!,e ) #$e ,"%e!#.
D%e#
I!,rease+ %!#a:e ) 6r#e%! (e,a/se #$%s %s %6r#a!# )r s:%! %!#er%#&.
I!,rease+ %!#a:e ) )r/%#s a!+ ee#a("es (e,a/se #$%s ,a! 6r%+e %#a%!s a!+
%!era"s )r !/#r%#%!.
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E!,/rae # ea# )+s r%,$ %! %!, s/,$ as es7 (ee)7 !/#s7 sar+%!es7 a!+ )+s
#$a# are r%,$ %! V%# (* s/,$ as (a!a!as a!+ a,a+s
T$e 6a#%e!# #$ers %s a+%se+ # ,e(a,: ! #$e s,$e+/"e+ +a#e ) %s%# -%#$ #$e
6$&s%,%a! #e#$er -%#$ #$e re)erra" )r %e! +/r%! #%e ) +%s,$are+ ! #$e e8a,##%eG+a#e a!+ 6"a,e s6e,%)%e+ )r !%#r%!Gre,$e,:%! ) $%s ,!+%#%!. E!,/rae
6a#%e!# # ea# re )r/%#s a!+ ee#a("es as -e"" # $ae r%,$ %! )%(er # 6ree!#
,!s#%6a#%!. A!+ "as#"& e!,/rae+ #$e 6a#%e!## $ae re/"ar %s%# # #$e $ea"#$ ,e!#er
r ,"%!%, a!+ a%+ se")9e+%,a#%! r #a:%! e+%,a#%!s /# ) -$a# %s (e%! 6res,r%(e+.
XII. PROGNOSIS
T$e a##e!+%! 6$&s%,%a!7 as -e"" as #$se -$ ae ,are a!+ s#/+%e+ #$e ,ase )
Mr.RTN ,ae /6 -%#$ + 6r!s%s (as%! )r #$e a)ree!#%!e+ %!+%,a#rs7 a!+
/s#%)%e+ as )""-s
A. !-"e+e ) #$e +%sease ,!+%#%!
T$e +%a!s%s )r #$%s ,r%#er%! %s 6r (e,a/se $e@s + !# )/""& /!+ers#a!+ #$e
%6r#a!,e ) ,6"%a!,eGa+$er%! # #rea#e!# re%e! a"#$/$ $e $as a 6s%#%e
a##%#/+e (/# s#%"" "a,: ) )%!a!,%a" as6e,# -as rea""& a! %6a,# ! $%
B. Aa%"a(%"%#& ) e+%,a#%!s a!+ ,6"%a!,e
N# +7 (e,a/se se#%e $e ,a! #a:e #$se e+%,a#%! !ee+e+ (/# as /,$
as #$e& -a!#e+ # s#%"" #$ere -/"+ (e a #%es #$a# #$e& +!@# $ae s/))%,%e!# )/!+s )r
#rea#e!# re%e! ,6"%a!,e.
C. A##%#/+e a!+ -%""%!!ess # #a:e #$e e+%,a#%!s a!+ )""- #rea#e!# re%e!
+ 6r!s%s (e,a/se $e -as a("e # #a:e $%s e+%,a#%!s ! #%e a!+
)""-e+ #$e #rea#e!# re%e! )r a!aee!# ) $%s ,!+%#%! -%#$ a 6s%#%e a##%#/+e
)r ,6"%a!,e a!+ ,6era#%! a"#$/$ #$ere -/"+ (e a #%e #$a# $e ,a!@# +e!& #$a#
$e %sse+ se +sae +/e # )%!a!,%a" as6e,#
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D/es7 M.E.e#.a".7 >2552?.. Nurse’s pocket guide: diagnosis, interventions &
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D/es7 M.E.e#.a".7 >2552?.. Nursing care plan: guidelines for individualizing
patient care >*#$ E+%#%!? P$%"a+e"6$%a
F..A. Da%s C6a!&./"a!+%,:7 M. e#.a".7Nursing care plan. (3rd dition!
I!a#a%,%/s7 D.D. Wr:a!7 M.L. >255*?. "edical#surgical nursing: critical
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%er7 B. e#.a".7 >2554?. $unda%entals of nursing: concepts, process & practice.
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Early Hepatitis B Screening and Treatment Saves Lives and Health Care Dollars
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