Week 8: Nursing Diagnoses

1. Imbalanced nutrition less than body requirements related to loss of appetite, nausea, and vomiting.

2. Acute pain related to swelling of the liver is inflamed liver and portal vein dam.

3. Fatigue related to chronic inflammatory process secondary to hepatitis.

4. Risk for impaired tissue integrity related to pruritus secondary to accumulation of bilirubin pigments in bile salts.

5. Risk for infection related to the nature of the infectious viral agent (Rita, 2011).

1.		(Rita, 2011)
Actual/Potential	Imbalanced nutrition less than body requirements
Related to	Loss of appetite, nausea, vomiting
	Plan	Outcome
Plan/Outcome	Rest before meals Eat several small meals each day	Pt will report reduced fatigue at mealtime. Pt will eat without experiencing any nausea or vomiting.
	Intervention	Rational
Nursing intervention	Teach importance of sitting in upright position when eating. Educate patient about the importance of resting prior to eating	Lowering the feeling of fullness and abdominal discomfort at mealtime. Reducing fatigue prior to mealtime will allow patient to eat without getting tired.

 

References

Rita. (2011). Nursing Care Plan for Hepatitis: Assessment, Diagnosis and Interventions. Retrieved May 31, 2015, from http://nursing-care-plan.blogspot.com/2011/11/nursing-care-plan-for-hepatitis.html

Week 7: Nursing Care for Hepatitis B

In caring for the person with Hepatitis B virus there are many aspects of the health maintenance process that must be addressed.

Nursing Intervention	Resaoning
Monitor hydration through intake and output and encourage fluids as tolerated	When experiencing nausea, vomiting, and diarrhea it is easy to become dehydrated.
Monitor prothrombin time and for signs of bleeding.	This is a measure of how well the blood is clotting and tells the doctor if there is a need for Vitamin K to decrease clotting time
Encourage the patient to eat meals in a sitting position to reduce pressure on the liver.	Eating meals in a sitting position reduces pressure in the abdomen from the stomach and intestinal tract processing food.
Encourage pleasing meals in an environment with minimal noxious stimuli (odors, noise, and interruptions).	This allows for relaxation at mealtime, with decreased stress on the body.
Teach self-administration of antiemetics as prescribed.	Antiemetics are used to decrease/eliminate nausea and therefore reduce vomiting and decrease dehydration.
Encourage rest during symptomatic phase, according to level of fatigue.	Resting when symptoms are more noticeable will help to reduce fatigue and discomfort.
Encourage diversional activities when recovery and convalescence are prolonged.	Finding a variety of things to do while recovering from the illness will help time to pass more quickly.
Encourage gradual resumption of activities and mild exercise during convalescent period.	Gradual increases in activity will help to build up stamina and allow return to normal without causing undo stress on the body.
Stress importance of proper public and home sanitation and proper preparation and dispensation of foods.	Good hand hygiene and proper food handling will reduce risk of transmitting the virus to others.
Encourage specific protection for close contacts.	This is to help keep from spreading the virus to those around the infected person while the virus is still in the system.
Explain precautions about transmission and prevention of transmission to others to the patient and family.	This educates the person with the virus about how to keep those around them safe from transmission of the virus (example: don’t share toothbrushes, razors, needles, eating utensils, no sexual contact)
Warn the patient to avoid trauma that may cause bruising.	Avoiding trauma will reduce risk of injuries that can cause bruising and bleeding.
Stress the need to follow precautions with blood and secretions until the patient is deemed free of HBsAg.	It is important to decrease any possibility of transmitting the virus to others and following all preventative actions until the virus is no longer present in the blood.
Emphasize that most hepatitis is self-limiting, but follow up is needed for liver function tests. (Towers, 2015)	This is important to understand in order to keep the best possible outlook while going through the recovery process. Emphasis on following up with liver tests is important to ensure that the virus is resolved.

References

Towers, C.V., Hastings, P.D. (2015). Hepatitis nursing management. Retrieved May 31, 2015, from http://intranet.tdmu.edu.ua/data/kafedra/internal/magistr/classes_stud/English/Second%20year/Clinical%20Nursing/3%20term/10.%20Implementation%20of%20nursing%20process%20in%20chronic%20hepatitis..htm

Week 6: Treatments and Drugs

Treatments:

Acute and Chronic

• Well-balanced diet

• Vitamin supplements

• Rest (degree of strictness varies)

• Avoidance of alcohol intake and drugs detoxified by the liver (Lewis, et al., 2014)

Drugs:

Chronic HBV

Treatment	Medication	Side effects
Antiviral Analogs:	Lamivudine (Epivir)	Headache, severe insomnia, myalgias
Nucleoside, Nucleotide	Adefovir (Hepsera)	Headache, nausea, vomiting, hepatomegaly
	Telbivudine (Tyzeka)	Fatigue, headache, nausea, myalgia
	Entecavir (Baraclude)	Fatigue, headache, nausea, hepatomegaly
Interferon alfa-2b	Intron A	Depression, difficulty breathing, chest tightness
Pegylated Interferon	PegIntron, Pegasys	Depression, fatigue, insomnia, headache, myalgia

Table constructed from information found in Medical-Surgical Nursing

(Lewis, et al., 2014)

Treatment for acute hepatitis B infection

If your doctor determines your hepatitis B infection is acute — meaning it is short-lived and will go away on its own — you may not need treatment. Instead, your doctor might recommend rest and adequate nutrition and fluids while your body fights the infection (Mayo Clinic Staff, 2014).

 

Treatment for chronic hepatitis B infection

If you've been diagnosed with chronic hepatitis B infection, you may have treatment to reduce the risk of liver disease and prevent you from passing the infection to others. Treatments include:

• Antiviral medications. Several antiviral medications — including lamivudine (Epivir), adefovir (Hepsera), telbivudine (Tyzeka) and entecavir (Baraclude) — can help fight the virus and slow its ability to damage your liver. Talk to your doctor about which medication might be right for you.
• Interferon alfa-2b (Intron A). This synthetic version of a substance produced by the body to fight infection is used mainly for young people with hepatitis B who don't want to undergo long-term treatment or who might want to get pregnant within a few years. It's given by injection. Side effects may include depression, difficulty breathing and chest tightness.
• Liver transplant. If your liver has been severely damaged, a liver transplant may be an option. During a liver transplant, the surgeon removes your damaged liver and replaces it with a healthy liver. Most transplanted livers come from deceased donors, though a small number come from living donors who donate a portion of their livers.

Other drugs to treat hepatitis B are being developed (Mayo Clinic Staff, 2014).

References

Lewis, S. L., Dirksen, S. R., Heitkemper, M. M., Bucher, L. (2014). Medical-surgical nursing, assessment and management of clinical problems, 9 ed., (p. 1006-1015). Elsevier Mosby, St Louis, Missouri. ISBN: 978-0-323-08678-3

Mayo Clinic Staff. (2014). Diseases and conditions: hepatitis b – treatments and drugs. Retrieved May 31, 2015, from http://www.mayoclinic.org/diseases-conditions/hepatitis-b/basics/treatment/con-20022210

Week 5: Signs and Symptoms of Hepatitis B

Symptoms of HBV may not be apparent for months or years. However, common symptoms include:

• dark urine
• joint pain
• loss of appetite
• fever
• abdominal discomfort
• weakness
• yellow eyes and skin (jaundice)

Any symptoms of HBV should be treated right away. In addition, you should let your doctor know immediately if you have been exposed to hepatitis B. You may be able to prevent infection (Kahn, A., 2012).

How soon after exposure to Hepatitis B will symptoms appear?

On average, symptoms appear 90 days (or 3 months) after exposure, but they can appear any time between 6 weeks and 6 months after exposure (CDC, 2015).

 

How long do acute Hepatitis B symptoms last?

Symptoms usually last a few weeks, but some people can be ill for as long as 6 months (CDC, 2015).

 

Can a person spread Hepatitis B without having symptoms?

Yes. Many people with Hepatitis B have no symptoms, but these people can still spread the virus (CDC, 2015).

 

What are the symptoms of chronic Hepatitis B?

Some people have ongoing symptoms similar to acute Hepatitis B, but most individuals with chronic Hepatitis B remain symptom free for as long as 20 or 30 years. About 15%–25% of people with chronic Hepatitis B develop serious liver conditions, such as cirrhosis (scarring of the liver) or liver cancer. Even as the liver becomes diseased, some people still do not have symptoms, although certain blood tests for liver function might begin to show some abnormalities (CDC, 2015).

References

Kahn, April. (2012). Hepatitis B Overview. Retrieved May 27, 2015, from http://www.healthline.com/health/hepatitis-b#Overview1

Centers for Disease Control and Prevention. Hepatitis B Virus. March 6, 2015, Retrieved May 30,2015, from http://www.cdc.gov/hepatitis/B/bFAQ.htm#statistics

Week 4: Diagnosis of Hepatitis B

Hepatitis B is usually diagnosed through routine or requested screening tests. People are often screened for HBV when they:

• Have come in contact with someone with HBV
• Have traveled to a country where HBV is common
• Have been in jail
• Use drugs
• Receive kidney dialysis
• Are pregnant
• Are men who have sex with men
• Have HIV (Kahn, A., 2012)

To screen for HBV, your doctor will perform a series of blood tests.

Three tests are used to determine the state of your infection:

Hepatitis B Surface Antigen Test 

A hepatitis B surface antigen (HBsAg) test shows if you are contagious. A positive result means you are infected and can spread the virus. A negative result means you don’t have HBV. This test does not distinguish between chronic and acute infection (Kahn, 2012).

Hepatitis B Core Antigen Test 

The hepatitis B core antigen (HBcAg) test shows whether you are currently infected with HBV. Positive results usually mean you have chronic HBV. It may also mean you are recovering from acute HBV (Kahn, 2012).

Antibody Hepatitis B Surface Antigen Test

An antibody hepatitis B surface antigen (anti-HBs) test shows whether you are immune to HBV. A positive test means you cannot contract HBV. There are two possible reasons for a positive test. You may have been vaccinated. You may also have recovered from an acute infection with HBV (Kahn, 2012).

Liver Function Tests

HBV symptoms can mimic the symptoms of other conditions, including liver diseases.

Liver function (ALT) tests check your blood for heightened enzymes from your liver. The results of this test can reveal whether your liver is being stressed. It can also identify signs of disease.

If these tests are positive, you might be tested for HBV. Hepatitis viruses are a major cause of liver damage (Kahn, 2012).  

References

Kahn, April. (2012). Hepatitis B Overview. Retrieved May 27, 2015, from http://www.healthline.com/health/hepatitis-b#Overview1