TABLE 44-8 NURSING ASSESSMENT

Hepatitis

Subjective Data

Important Health Information

Past healty history hemophilia;exposure to infected persons.

Ingestion of contaminated food or water ;exposure to benzene,carbon tetrachloride, or other

hepatotoxic agents: crowded,unsanitary living conditions ; exposure to contaminated needles,
recent travel ;organ transplant recipient;exposure to new drug regimens,hemodialysis,
transfusion of blood or blood products before 1992,human immunodeficiency virus status (if
know)

Medications : use and misuse of acetaminophen,phenytoin,halothane,methyldopa

Functional Healty Patterns

Healty perception- health management :intravenous drug and alcohol

Abuse,malaise,distaste for cigarettes (in smokers), high- risk sexual behaviors.

Nutrition – metabolic : weight loss, anorexia,nausea,vomiting: feeling of fullness in right upper quadrant

Elimination : dark urine ; light – colored stools,constipation or diarrhea,skin rashes,hives

Activity – exercise : fatigue, arthralgias, myalgias

Cognitive- perceptual : right upper quadrant pain and liver tenderness,headache ; pruritus

Role – relationship : exposure as health care worker, long-term care institution resident, incarceration

Objective Data

General

Low grade fever,lethargy , iymphadenopathy

integumentary

Rash or other skin changes, jaundice, icteric sclera,injection sites

Gastrointestinal

Hepatomegaly, splenomegaly

Possible Diagnostic Findings

elevated liver enzyme levels ; serum total bilirubin, hypoalbuminemia, anemia,bilirubin in urine and
increased urobilinogen, prolonged prothrombin time, positive tests for hepatitis including anti-HAV
igM,anti – HAV igG, HBsAg,HBeAg, HBcAg, anti – HBc IgM, HBV DNA, anti – HCV, HCV RNA, anti – HDV ;
abnormal liver scan ;abnormal results on liver biopsy.

DNA,deoxyribonucleic acid ; HAV, hepatitis A virus ; HBcAg, hepatitis B core antigen ;HBeAg, hepatitis B
e antigen;HBsAg, hepatitis B surface antigen;HBV, hepatitis B virus ; HCV, hepatitis C virus ; HDV,
hepatitis D virus ; RNA, Ribonucleic acid

TABLE 44-9 PREVENTIVE MEASURES FOR VIRAL HEPATITIS

HEPATITIS A

General Measures

 Hand washing
 Proper personal hygiene
 Environmental sanitation
 Control and screening (signs , symptoms) of food handlers
 Serologic screening while carrying virus
 Active immunization HAV vaccine

Use of Immune Globulin

 Early administration (1-2 wk after exposure) to those exposed

 Prophylaxis for travelers to areas where hepatitis A is common if not vaccinated with HAV
vaccine

Special considerations for healty care personnel

 Wash hands after contact with patient or removal of gloves

 Use infection control precautions

HEPATITIS B DAN C

Percutaneous Transmissions

Screening ofdonated blood

B – HbsAg

C- anti HCV

Use of disposable needles and syringes

Sexual transmission

 Acure exposure : HBIG administration to sexual partner of HBsAg-positive person

 Administer HBV vaccine series to uninfected sexual partners
 Use condoms for sexual intercourse
General Measures

 Hand washing
 Avoid sharing toothbrushes and rozors
 HBIG administrationfor one – time exposure (needle stick,contact of mucous membranes with
infectious material
 Active immunization : HBV vaccine

Special Considerations for healty care personnel

 Use infection control precautions

 Reduse contact with blood or blood – containing secretions
 Handle the blood of patients as potentially infective
 Dispose of needles IV access devices when available

HAV, hepatitis A virus; HBIG,hepatitis B immune globulin;HBsAg, hepatitis B surface antigen ; HBV,
hepatitis B virus ; HCV, hepatitis C virus

A suggested guideline for general practice to prevent you from contracting viral hepatitis from
diagnosed and undiagnosed patients and carriers is for you to wear disposable gloves,goggles and
gowns (sometimes) when fecal or blood contamination is likely in hadling (1) soiled bedpans, urinals,
and catheters and (2) when the patient’s bed liners are solied by body excreta or secretions.

Hepatitis A. outbreaks of viral hepatitis are usually due to HAV. In the united states there is usually one
major outbreak per Decade. Preventive measure include personal and environmental hygiene and
health education to promote good sanitation ( table 44-9). Hand washing is essential and is probably the
most important precaution. Teach about careful hand washing after bowel movements and before
eating.

Vaccination is the best protection against HAV. All children over the age of 1 year should receive
the vaccine. Adults at risk should also receive the vaccine. These incude at-risk people who travel to
areas with increased rates of hepatitis A, men who have sex with men . injecting and noninjecting drug
users,persons with clotting factor disorders (e.g., hemophilia), persons with chronic liver disease, and
children living in regions of the united states with consistently increased rates of hepatitis A.

There are currently several forms of the HAV vaccine, including havrix,vaqta,and avaxim. HAV
vaccine is inactivated hepatitis A virus. Primary immunizarion consists of a single dose administered
intramusculary (IM) in the deltoid muscle. A booster is recommended any time between 6 and 12
months body titers and long- term protection. The primary immunization provides immunity within 30
days after a single dose in more than 95 % of those vaccinated.

Twinrix, a combined HAV and HBV vaccine, is available for persons over 18 years of age.
Immunization, consists of three doses, given on a 0-,1- and 6 month schedule, the same schedule as that
used for the single HBV vaccine. Twinrix may be given to high – risk individuals, including patients with
chronic liver disease.users of illicit IV drugs,patiens on hemodialysis, men who have sex with men, and
persons with clotting factor disorders who receive therapeutic blood products. The side effects of the
vaccine are mild and are usually limited to soreness and redness at the injection site.

Nursing Care Plan 44-1

Patient with acute viral hepatitis

Nursing diagnosis

imbalanced nutrition les than body requirements related to anorexia,nausea and reduced metabolism of
nutrients by liver as evidenced by inadequate food intake, aversion to eating and body weight 20 % or
more under ideal

Patient goals

1. Montains weight appropriate for height

2. Food and fluid intake adequate to meet nutrition needs

Outcomes (NOC)

Nutritional status

 Nutrient intake ___

 Food intake ___
 Fluid intake ___

 Weight / height ratio ___

 Energy ___

Measurement scale

1 = severe deviation from normal range

2 = substantial deviation from normal range •

3 = moderate deviation from normal range

4 = mild deviation from normal range

5 = no deviation from normal range

Interventions ( NIC) and rationales

Nutrition Therapy

 complete a nutritional assessment to determine baseline nutritional state.

 Monitor food/fluid ingested and calculate daily caloric intake So appropriate interventions can be
planned
 Determine in collaboration with the dietitian, the number of Calories and type of nutrients needed
to meet nutrition Requirements so the proper nutritional requirements can be Provided
 present food in an attractive, pleasing manner,giving Consideration to color, texture and vanety to
stimulate patient’s appetite
 provide oral care before meals to stimulate appetite.

Nausea Management
 Teach the use of nondrug techniques (e.g., Biofeedback,hypnosis,relaxation,guided imagery music
therapy,distraction,acupressure) to manage nausea Without use of drugs requiring hapatic
metabolism.
 Encourage eating small (amounts of food that are appealing to the nauseated person to increase
nutrition intake
 weigh regularly to monitor weight loss secondary to poor appetite.

Nursing diagnosis activity intolerance related to fatique and weakness as evidenced by verbal report of
fatigue or weakness, altered response to activity

Patient Goals 1. Demonstrates gradual increase in activity tolerance

2. Reports ability to perform daily activities with scheduled rest periods

Outcomes (NOC)

Energy Conservation

 Recognizes energy limitations ___

 Reports adequate endurance of activity ___
 Balances activity and rest ___
 Uses energy conservation techniques ___
 Organizes activities to conserve energy ___

Measurement Scale

1 = Never demonstrated

2 = Rarely demonstrated

3 = Sometimes demonstrated

4 = Often demonstrated

5 = Consistently demonstrated

Interventions (NIC) and Rationales

Energy Management

 determine patient’s physical limitations for baseline comparison

 Assist patient to schedule rest periods to prevent stress on liver function
  encourage patient to choose activities that gradually build endurance so previous activity
Pattern can be resumed
 limit environmental stimuli (e.g., light and noise) to facilitate relaxation
 instruct patient / caregiver to recognize signs and symptoms of fatigue that require reduction
in activity to promote self –management.
 teach activity organization and time management techniques to prevent fatigue
 monitor patient for evidence of excess physical and emotional fatigue to prevent setback of
activity progression

Nursing Diagnosis risk for impaired liver function related to viral infection

Patient goal maintains adequate liver function throughout infections process to meet physiologic needs

Risk control

 Acknowledges risk factors ___

 Recognizes changes in health status ___
 Monitors health status changes ___
 Follows selected risk control strategies ___

Measurement Scale

1= Never demonstrated

2= Rarely demonstrated

3 = sometimes demonstrated

4 = often demonstrated

5 = consistently demonstrated

Knowledge : disease process

 Effects of disease ___

 Potential complications of disease ___
 Signs and symptoms of complications ___
 Precautions to prevent complications of disease ___

Measurement scale

1= No knowledge

2= limited knowledge

3=moderate knowledge

4=substantial knowledge

5= extensive knowledge
Interventions (NIC) and rationales

Teaching : disease process

 Explain pathophysiology of the disease and how it relates to anatomy and physiology
 Describe rationale behind management /therapy/treatment recommendations so that
appropriate follow – up care will be planned and carried out.
 Describe possible chronic complications to identify the risk for liver impairment
 Discuss lifestyle changes that may be required to prevent further complications and/ or control
the disease (e.g., avoidance of alcohol,infection control measures)
 Explore possible resources / support for long-term disease management
 Instruct patient on which signs and symptoms (e.g., bleeding gums ,blood in stools) to report to
healty care provider to enable prompt intervention
 Instruct patient on measures to control / minimize symptoms to enable liver to repair itself and
prevent relapse