Physiological Adaptation Q 125

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Which of the following symptoms during the icteric phase of viral hepatitis should the nurse expect the client to inhibit?

  

     A. Watery stool

     B. Yellow sclera

     C. Tarry stool

     D. Shortness of breath

    

    

Correct Answer: B. Yellow sclera

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Liver inflammation and obstruction block the normal flow of bile. Excess bilirubin turns the skin and sclera yellow and the urine dark and frothy. After 3 to 10 days, the urine darkens, followed by jaundice. Systemic symptoms often regress, and patients feel better despite worsening jaundice. The liver is usually enlarged and tender, but the edge of the liver remains soft and smooth. Mild splenomegaly occurs in 15 to 20% of patients. Jaundice usually peaks within 1 to 2 weeks.

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Option A: Watery stools or gastroenteritis occurs during the prodromal phase of the disease. Nonspecific symptoms occur; they include profound anorexia, malaise, nausea and vomiting, a newly developed distaste for cigarettes (in smokers), and often fever or right upper quadrant abdominal pain. Urticaria and arthralgias occasionally occur, especially in HBV infection.

Option C: Patients develop pale-colored stools during the icteric phase, not tarry stools. Manifestations of cholestasis may develop during the icteric phase (called cholestatic hepatitis) but usually resolve. When they persist, they cause prolonged jaundice, elevated alkaline phosphatase, and pruritus, despite general regression of inflammation.

Option D: Some may develop an aversion to cigarette smoke during the prodromal phase of the disease, but shortness of breath rarely occurs in this case. Patients experience anorexia, nausea, vomiting, alterations in taste, arthralgias, malaise, fatigue, urticaria, and pruritus, and some develop an aversion to cigarette smoke.

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