54 Viral Hepatitis
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solution); infuse 25 mL before paracentesis and 25 mL 6h after.
10. Symptomatic Medications:
-Docusate sodium (Colace) 100 mg PO qhs.
-Lactulose 30 mL PO bid-qid.
11. Extras: KUB, CXR, abdominal ultrasound, liver-spleen scan, GI consult.
12. Labs: Ammonia, CBC, SMA 7&12, LFTs, albumin, amylase, lipase,
INR/PTT. Urine creatinine, Na, K. HBsAg, anti-HBs, hepatitis C virus antibody,
alpha-1-antitrypsin.
Paracentesis Ascitic Fluid
Tube 1: Protein, albumin, specific gravity, glucose, bilirubin, amylase, lipase,
triglyceride, LDH (3-5 mL, red top tube).
Tube 2: Cell count and differential (3-5 mL, purple top tube).
Tube 3: C&S, Gram stain, AFB, fungal (5-20 mL); inject 20 mL into blood
culture bottles at bedside.
Tube 4: Cytology (>20 mL).
Syringe: pH (2 mL).
Viral Hepatitis
1. Admit to:
2. Diagnosis: Hepatitis
3. Condition:
4. Vital signs: qid. Call physician if BP <90/60; T >38.5
C
5. Activity:
6. Nursing: Stool isolation.
7. Diet: Clear liquid (if nausea), low fat (if diarrhea).
8. Special Medications:
-Ranitidine (Zantac) 150 mg PO bid.
-Vitamin K 10 mg SQ qd for 3d.
-Multivitamin PO qd.
9. Symptomatic Medications:
-Meperidine (Demerol) 50-100 mg IM q4-6h prn pain.
-Trimethobenzamide (Tigan) 250 mg PO q6-8h prn pruritus or nausea q6-8h
prn.
-Hydroxyzine (Vistaril) 25 mg IM/PO q4-6h prn pruritus or nausea.
-Diphenhydramine (Benadryl) 25-50 mg PO/IV q4-6h prn pruritus.
10. Extras: Liver/spleen scan, ultrasound, GI consult.
11. Labs: CBC, SMA 7&12, GGT, LDH, amylase, lipase, INR/PTT, IgM anti-
HAV, IgM anti-HBc, HBsAg, anti-HCV; alpha-1-antitrypsin, ANA, ferritin,
ceruloplasmin, urine copper.
