Hepatitis and Nursing Care Plan

hepatitis

Hepatitis (Inflammation of liver cells)

• Hepatitis is an infection of the liver caused by a virus

• Hepatitis is an acute inflammation of the liver marked by liver-cell destruction, necrosis.

• In most cases hapatic cells regenerate with little or no damage, however, this depends on timing and available treatment, age, and underlying disorders

Hepatitis A and B

Hepatitis is an infection of the liver which is caused by a virus

Virus A is responsible for hepatitis A

Virus B is responsible for hepatitis B

Virus C is responsible for hepatitis C

HBV is considered more serious than HAV

 

Problems/common reactions

Hepatitis

Inflammation of the liver caused by hepatitis virus

PRE-ICTERIC PHASE

• Fatigue, myalgia, malaise, photophobia, and headache

• Anorexia, dyspepsia, nausea and vomiting

• Altered sense of smell

• Fever, possible hepatomegaly

ICTERIC PHASE

• Mild weight loss

• Dark urine, clay colored stool

• Jaundice and hepatomegaly with tenderness

CONVALESCENT PHASE

• Continued fatigue

• Flatulence, abdominal pain or tenderness and dyspepsia

 

COMPARISON OF CLINICAL AND EPIDEMIOLOGIC CHARACTERISTICS OF VIRAL HEPATITIS

INCUBATION PERIOD:

– Hepatitis A= Range 15 to 48 days

usual 25 to 30 days

– Hepatitis B= range from 28 to 180 days

usual 70 to 75 days

– Hepatitis C (non A and non B)=10 to 180

usual 50 to 60 days

– Hepatitis D= similar to type B

 

ONSET:

  • Hepatitis A= acute
  • Hepatitis B= insidious
  • Hepatitis C= insidious
  • Hepatitis D= present only with HBV

TRANSMITTED BY SALIVA:

  • Hepatitis A = unlikely
  • Hepatitis B = Yes, but by direct transfer
  • Hepatitis C = Similar to B
  • Hepatitis D = Unknown

 

Usual mechanisms of transmission

  • Type A = fecal oral route (contaminated food), dirty hands
  • Type B = Percutaneous, oral-oral, direct contact, Mainly body fluids (blood transfusion) sexual contact, stool
  • Type C = Similar to HBV
  • Type D = Percutaneous (common via blood transfusion), body fluids

 

F e v e r

  • Type A= Common precedes jaundice
  • Type B= Less common
  • Type C =Less common
  • Type D= Less common

J A U N D I C E

  • Type A=Rare in children, more in adult
  • Types B to D=Same as in Type A

 

Abnormal Aspartate aminotransferase (AST) OR Alanine aminotransferase (ALT)

  • Type A= transient (1 to 3weeks)
  • Type B= Prolonged (lasts from 1 to 8 mths)
  • Type C= Prolonged
  • Type D= Prolonged

Age group affected

  • Type A=Usually children and young adults
  • Type B= All age groups
  • Type C= All age groups
  • Type D= All age groups

Virus in feces

• Type A= weeks before jaundice

• Type B= no direct evidence of presence

• Type C= possible

• Type D= unknown

Virus in blood (viremia)

  • Type A = present during late incubation period and early acute phase
  • Type B = present during late incubation period and acute phase
  • may persist for months or years
  • Type C = present during entire clinical course of HBV
  • Type D = unknown

VIRUS IN URINE

  • Type A= very low level
  • Type B= low level
  • Type C= low level
  • Type D= likely low level

 

Immunization/vaccination

Hepatitis B vaccine (active)

•1 st dose

• 2nd dose-1 month after

• 3rd dose -3 months after

Hepatitis B vaccine (passive)

– immunoglobulin

Hepatitis A vaccine (passive)

– immunoglobulin

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Nursing care of a client with viral hepatitis

ISOLATION

• Wear gown and gloves when in contact with client and waste

• Client to remain in room. The rationale for this should be explained to client and his/her family

• Use disposable dishes and utensils

• Double bag all linen

• Keep thermometer in room and discharge when client is discharged

• Discard stool carefully in toilet unless community waste system is not capable of removing pathogen

• Destroy and safely discard all needles or other materials used to puncture skin in a firm box in room

• Observe for depression that might result from elevated bilirubin in the blood stream

• Maintain bed rest; increasing ambulation as the level of jaundice decreases

• Bath skin with warm water, apply lotions and administer medications as ordered to relieve itching caused by increased bilirubin

• Administer oral hygiene twice daily

• Plan care to promote rest and conserve energy

• Assess food dislikes and likes provide client with nourishment between meals

• Reduce light in the room especially if client has photophobia

• Weigh client daily before breakfast

• Instruct client on the effects and transmission of disease

 

Medical treatment

Goals:

• Stop further degeneration of liver

• Reduce trauma to liver cells by hepatotoxins

• Increase body’s defences to heal itself

Manage symptoms

1. No alcohol

2. No hepatotoxic drugs e.g. sedatives, opiates should be avoided

3. Rest-to conserve energy.

 

Health Teaching (prevention of hepatitis A)

• Obtain immune globulin when exposed to the virus; Observe standard precautions

• Perform thorough hand washing

• Avoid eating from public places without adequate hygienic practices

• Use liquid soap and hand driers rather soap and water

• Avoid placing finger and hand held objects in the mouth

• Do not share cigarettes and eating utensil

• Do not eat raw seafood

• Use mask when giving pulmonary resuscitation

• Wash hand properly after using the toilet

• Use hygienic bottled H20 in developing countries

 

Health teaching ( hepatitis B): Prevention

• Receive HBV vaccine especially those at risk

• Give immune globulin B to those exposed to the virus

• Observe standard precautions

• Do not recap needles; If necessary use scoop method

• Dispose needle in sharp puncture resilient container

• Use condom when engaged in sexual intercourse

• Do not share personal items like toothbrush, razor and finger tools

• Use auto blood transfusion for planned surgery

• Use mouth shield when giving mouth to mouth respiration

 

NURSING DIAGNOSES (Liver disorders)

• Altered nutrition less than body requirement: related to loss of appetite

• Fluid volume deficit: related to vomiting

• Activity intolerance: related to inability of the liver to metabolise carbohydrate properly

• Impaired skin integrity: related to jaundice

• Altered comfort : related to pruritus

• Altered urinary elimination pattern: related to oliguria and dark urine

• Risk for altered tissue perfusion: related to reduced packed cell volume (hematemesis, melena)

• Fluid volume excess: related to ascites and oedema

• Risk for altered sensory perception: related to high level of ammonia in the blood stream

• Knowledge deficit: related to infection transmission

 

Nursing care plans for Hepatitis

Altered nutrition less than body requirement: related to loss of appetite

Goal

Client’s appetite will improve and will tolerate at least ¾ of meals within a week of interventions

Interventions

• Assess food likes and dislikes

• Consult dietician

• Serve therapeutic diet

• Serve small, hot, attractive meals frequently

• Give sips of nourishing fluids as tolerated

• Assess food tolerance

• Weigh client daily

Evaluation

Client’s appetite improved and was able to tolerate ¾ of the meals at the end of 3 days intervention

Nursing Care for  Activity intolerance

Goal

Client will be able to cope with ADL at the end of one week of interventions

Interventions

• Assess client’s activity level

• Assist client with ADL

• Encourage client to undertake some activities as condition improves

• Involve relations in the client’s care

• Record activity level daily

 

Nursing Care for Impaired skin integrity

Goal

Client’s intact skin will be maintained and jaundice gradually clear at the end of two weeks of interventions

Nursing Interventions

• Cleanse skin gently using mild soap and apply soothing cream

• Keep finger nails short

• Teach client not to scratch

• Provide soothing bath

• Monitor jaundice

 

Nursing Care for Altered comfort related to pruritus

GOAL

Client’s comfort will be restored evidenced by reduced scratching at the end of 72 hrs of interventions

Nursing INTERVENTIONS

• Give a warm soothing bath

• Apply soothing cream

• Keep bed free of creases and crumbs

• Give anti-histamine as prescribed

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