Name: Ma Rupina B.

Ponce

Course: Bachelor Of Science Major In Nursing

Section: C

Hepatitis

Definition:

Hepatitis means inflammation of the liver. The liver is a vital organ that processes nutrients,
filters the blood, and fights infections. When the liver is inflamed or damaged, its function can
be affected.

ETIOLOGY & EPIDEMIOLOGY:

Viral Hepatitis

Most of the time, hepatitis results from hepatitis viruses A, B, C, D, and E. It is unclear whether the
Hepatitis G virus is pathogenic in humans or not. Hepatitis A, B, C, and D are endemic to the United
States with hepatitis A, B, and C viruses causing 90% of acute viral hepatitis in the United States and
Hepatitis C being the most common cause of chronic hepatitis.

Hepatitis A is an RNA virus from the Picornaviridae family. It is usually present in the highest
concentration in the stool of infected individuals with the greatest viral load shedding occurring
during the end of the incubation period. The most common mode of transmission of hepatitis A is via
the fecal-oral route from contact with food, water, or objects contaminated by fecal matter from an
infected individual. It is more commonly encountered in developing countries where due to poverty
and lack of sanitation, there is a higher chance of fecal-oral spread. International travel is the most
significant risk factor identified from the cases reported in the United States. People who come in
contact with infected individuals are also at risk, and the secondary infection rate for household
contacts is about 20%, which may also play a more prominent role in the maintenance of hepatitis A
virus outbreaks

Viral Hepatitis is considered a major public health issue. Viral hepatitis infects millions of people
annually causing significant morbidity and mortality. Chronic Hepatitis B and C infection can cause
liver damage that includes liver fibrosis, cirrhosis, hepatocellular carcinoma, and features of portal
hypertension. The World Health Organization (WHO) estimated that 1.3 million people have died
due to hepatitis in 2015, and 1 in 3 people in the world have had infections with either hepatitis B or
hepatitis C virus. Reportedly, infection rates show that 2 billion people infected with the hepatitis B
virus, 185 million with the hepatitis C virus, and 20 million with the hepatitis E virus. Hepatitis A virus
affects 90% of children in high endemic regions. Viral hepatitis ends up causing 1.4 million deaths
annually, and hepatitis B and C viruses are responsible for about 90% of those deaths.

Incidence

About 2.3 billion people of the world are infected with one or more of the hepatitis viruses. Viral
hepatitis results in around 1.4 million deaths each year, HBV and HCV are responsible for about 90%
of these fatalities, whilst the remaining 10% of fatalities are caused by other hepatitis viruses
PATHOPHYSIOLOGY OF THE LIVER AND VIRAL HEPATITIS

Viral hepatitis is a disease which initially affects the liver. Hepatitis has several different routes of
transmission and comes in several different forms such as Hepatitis A, B, C, D and E. It is triggered by
many microorganisms such as cytomegalovirus (CMV), Epstein-Barr virus (EBV) and Herpes Simplex
virus (HSV) (McCance & Huether, 2019). Below are more details on the pathophysiology of disease.

Viruses enter the blood stream and spread to the liver. They infect the hepatocytes and multiply.
They change the antigen structure on the virus site. The body begins to use self-mediated immune
response attempting to damage the hepatocytes. In Hep B and C, they can continue this process over
and over for years.

STAGES OF VIRAL HEPATITIS

There are three stage of symptoms: prodromal, icteric and convalescent. Based on which phase the
patient is in, the symptoms will vary. In the prodromal stage, the virus is in the blood and will release
chemicals. These chemicals will create symptoms such as fever, headache, fatigue, nausea, vomiting,
skin rashes and joint pains. In the icteric stage, conjugated bilirubin and transaminases spills into the
blood because of damage of bile ducts and hepatocytes. The conjugated and unconjugated bilirubin
make the patient appear yellow and present with dark urine. The liver may become enlarged in this
state as well which is termed hepatomegaly. In the convalescent stage, the symptoms become
better or the patient returns to normal (McCance & Huether, 2019).

HEPATITIS A

Hepatitis A is a RNA virus of the family Picornaviridae. It has a 30 to 50 day incubation period. The
virus is secreted for 2 weeks prior to the appearance of symptoms and up until 3 months later. It is
spread via fecal/oral route, transfusion of blood or men having sex with men. It is highly contagious
and is prevalent in crowded areas, unsanitary areas and areas with contaminated food and water.
The symptoms appear like food poisoning symptoms. The severity is mild and the disease is not
chronic. Vaccination is available and typical given with Hepatitis B vaccine to improve outcomes. The
best prevention is washing hands, wearing gloves and keeping meticulous hygiene (McCance &
Huether, 2019).

HEPATITIS B

Hepatitis B a DNA virus with 8 different genotypes. It has a 3 to 8 week incubation period. It is
transmitted parenterally, sexually or through mother to baby. Mother to baby occurs only if the
mother was exposed to the virus during the third trimester of pregnancy. The disease can cause liver
injury low grade fever, inflammation, risk for Hepatitis C, risk for cirrhosis, risk for liver failure and
risk for hepatocellular carcinoma. The disease could be severe and chronic. Treatment is with
nucleotide analogs and interferons and a preventative vaccination is available (McCance & Huether,
2019).

HEPATITIS C

Hep C is a RNA virus with 10 different genotypes. It has a 40 day incubation period. It is spread via
parenteral route. Sometimes there may not be any symptoms to aid in diagnosis but liver enzymes
will be elevated. It can increase the risk for chronic liver disease, cirrhosis, hepatocellular carcinoma,
esophageal varices and potential need for liver transplant. Severity is mostly mild. Treatment is with
antivirals drugs and sometimes drug resistance can develop when disease becomes more severe.
There is no vaccination. The CDC says that people who are born from 1945 to 1965 should be
screened for the virus (McCance & Huether, 2019).

HEPATITIS D

Hepatitis D is a defective single stranded RNA virus and usually occurs with Hepatitis B. It is spread
parenterally. Drug users are most at risk. It could be mild or severe and lead to liver failure.
Treatment is with pegylated interferon alpha and treatment has a high failure rate (McCance &
Huether, 2019).

HEPATITIS E

Hepatitis E is a RNA virus in the family Hepeviridae. It has a 50 day incubation period. It is spread via
fecal oral route, through contaminated water or uncooked meat. It is most common in Asia and
Africa. The severity is mild and disease is usually not chronic but if severe enough can lead to acute
liver failure of chronic hepatitis. It resembles Hepatitis A but could be asymptomatic. It can produce
neurological symptoms and impair kidney function. Treatment is with ribavirin and pegylated
interferons (McCance & Huether, 2019).
 Treatment / Management

The basic treatment of acute viral hepatitis is supportive. Patients who are experiencing significant
nausea or vomiting and those who are elderly and immunocompromised should be admitted and
started on intravenous fluids to rehydrate them. Patients who have complications like liver abscess,
variceal bleed, or hepatic encephalopathy require admission and appropriate treatment. However,
most of the patients can be safely monitored as an outpatient. Patients should avoid medications
like acetaminophen or substances like alcohol that can be hepatotoxic. Patients with acute viral
hepatitis infection take proper rest and avoid vigorous physical activities until the symptoms
improve. If required, patients should obtain a referral to specialty services like gastroenterology or
hepatology. No specific treatment exists for hepatitis

Management

Bed rest, refraining from alcohol, and taking medication to relieve symptoms.

Most people who have hepatitis A and E get well on their own after a few weeks.

Hepatitis B is treated with drugs, such as lamivudine and adefovir dipivoxil. Administer hepatitis B
vaccine.

Hepatitis C is treated with a combination of peginterferon and ribovarin.

Drug Study 01

Drug name Action Dosage/route Indication/ Contraindic Adverse Nursing

uses ation reaction management/Patients
Teaching

Generic Name After Adult dosage HIV increased Noted for Be alert for new
Lamivudine intracellular (ages 18 years infection blood combinatio seizures or increased
conversion to and older) (with other acidity due n of seizure activity,
Brand name: its active form antiretrovir to high lamivudine especially at the onset
Epivir and (lamivudine-5- Typical dosage: als). levels of plus of drug treatment.
Epivir-HBV triphosphate), 300 mg each Chronic lactic acid. zidovudine Document the
inhibits viral day. This hepatitis B acute number, duration, and
DNA synthesis amount can be infection. inflammatio CNS: severity of seizures,
by inhibiting given as 150 mg Unlabeled n of the SEIZURES, and report these
the enzyme twice a day, or Use: Part pancreas. fatigue, findings immediately
reverse 300 mg once a of HIV- chronic headache, to the physician.
transcriptase. day. postexposu inflammatio insomnia,
Therapeutic re n of the malaise, Be alert for signs of
Effects: Slows Child dosage prophylaxis pancreas. a depression, enlarged, fatty liver
the progression (ages 3 months with mother who dizziness. (hepatomegaly with
of HIV infection to 17 years) zidovudine is producing Resp: steatosis) that can
and decreases and milk and cough. GI: progress to liver
the occurrence Dosage is based indinavir. breastfeedin HEPATOME dysfunction and liver
of its sequelae. on your child’s g. GALY WITH failure. Signs of liver
Increases CD4 weight. STEATOSIS, disease include
cell counts and PANCREATI anorexia, abdominal
decreases viral Typical dosage: TIS (↑ IN pain, abdominal
load. 4 mg/kg, twice PEDIATRIC swelling (ascites),
Protection per day, or 8 PATIENTS), severe nausea and
from liver mg/kg once anorexia, vomiting, yellow skin
damage caused daily. diarrhea, or eyes, fever, sore
by chronic For children nausea, throat, malaise,
hepatitis B who weigh 14 vomiting, weakness, facial
infection; kg (31 lbs) to abdominal edema, lethargy, and
decreases viral <20 kg (44 lbs): discomfort, unusual bleeding or
load. 150 mg once abnormal bruising. Notify
daily, or 75 mg liver physician of these
twice daily. function signs immediately.
For children studies,
who weigh ≥20 dyspepsia. Monitor signs of
(44 lbs) to ≤25 Derm: pancreatitis, including
kg (55 lbs): 225 alopecia, upper abdominal pain
mg once daily, erythema (especially after
or 75 mg in the multiforme eating), indigestion,
morning and , rashes, weight loss, and oily
150 mg in the urticaria. stools. Report these
evening. Endo: signs to the physician
For children hyperglyce immediately.
who weigh ≥25 mia. F and
kg (55 lbs): 300 E: lactic Monitor signs of
mg once daily, acidosis. hypersensitivity
or 150 mg twice Hemat: reactions and
daily. anemia, anaphylaxis, including
Child dosage neutropeni pulmonary symptoms
(ages 0–2 a, pure red (tightness in the
months) cell aplasia. throat and chest,
MS: wheezing, cough,
Dosage for musculosk dyspnea) or skin
children eletal pain, reactions that could
younger than 3 arthralgia, indicate Stevens-
months has not muscle Johnson syndrome
been weakness, (rash, pruritus,
established. myalgia, urticaria, dermatitis,
rhabdomyo exfoliation). Notify
lysis. physician or nursing
Neuro: staff immediately if
neuropathy these reactions occur.
. Misc:
HYPERSENS Monitor signs of lactic
ITIVITY acidosis, including
REACTIONS confusion, lethargy,
, stupor, shallow rapid
INCLUDING breathing,
ANAPHYLA tachycardia,
XIS AND hypotension, nausea,
STEVENS- and vomiting. Notify
JOHNSON physician immediately
SYNDROM if these signs occur.
E.
Assess any
musculoskeletal pain,
muscle tenderness, or
weakness, especially if
accompanied by fever,
malaise, and dark-
colored urine. These
symptoms may
represent drug-
induced myopathy,
and that myopathy
can progress to severe
muscle damage
(rhabdomyolysis).
Report any
unexplained
musculoskeletal
symptoms to the
physician
immediately.

Be alert for signs of

peripheral neuropathy
(numbness, tingling,
decreased muscle
strength). Establish
baseline
electroneuromyograp
hic values using EMG
and nerve conduction
at the beginning of
drug treatment
whenever possible,
and reexamine these
values periodically to
assess drug-induced
changes ...
 Drug study 02

Drug name Action Dosage/route Indication/ Contraindic Adverse Nursing

uses ation reaction management/Patients
Teaching

Generic name: Provide active Adult and Prevention Hypersensiti INTEG: Assess: for skin
Hepatitis B immunity to child>10 yr: IM of hepatitis vity soreness at reactions: rash,
vaccine hepatitis B 1 ml, then 1 ml B virus injection induration, urticaria
after 1 mo, then site,
Brand name: 1 ml 6 mo after urticaria, Administer: after
Heptavax- B initial dose erythema, rotating vial, do not
Child 3 mo-10 swelling shake
Func. Class.: yr: IM 0.5 ml, SYST: Only with epinephrine
Vaccine then 0.5 ml Induration 1: 100 on unit to treat
after 1 mo, then CNS: laryngospasm
0.5 ml 6 mo headache, In deltoid for better
after initial dose dizziness, protection give 2 ml
fever dose in two different
Patients with GI: Nausea, sites
decreased vomitting
immunity: IM 2 Perform/provide:
ml then 2 ml Written record of
after 1 mo then immunization
2 ml 6 mo after Comfort measures
initial dose
Evaluate:
Available form For history of
include: Iin IM allergies, skin
10 mg/0.5 ml, conditions ( eczema,
20 g/ml psoriasis, dermatitis)
reactions to
vaccinations
For anaphylaxis:
inability to breathe,
bronchospasm.

Nursing care plan 01

Assessment Diagnosis Planning Intervention Rationale Evaluation

Subjective Data: Fatigue related Patient will 1.Institute bed 1.Promotes rest Report an increased
patient’s feelings, to Decreased lessen liver red or chair rest and relaxation. feeling of energy.
perceptions, and metabolic demands during toxic Available energy At the level of ability,
concerns. energy while state. Provide is used for do ADLs and engage
(Symptoms) production, boosting quiet healing. Activity in preferred
States of physical well- environment; and an upright activities.
Patient Verbalize discomfort, being, limit visitors as position are
of not being able Altered body preventing needed. believed to
to keep up with chemistry (e.g., hepatitis decrease hepatic
responsibilities changes in liver complications, 2. Recommend blood flow,
function, effect improving changing which prevents
Patient verbalized on target self-concept, position optimal
of feeling of organs) as accepting the frequently. circulation to the
having no energy evidence of situation, and Provide and liver cells.
Reports of Reports of lack giving instruct
increases physical of knowledge caregiver in good 2. Promotes
aces energy/inability about the skin care. optimal
to maintain illness respiratory
Patient verbalized usual routines. process, 3. Do necessary function and
of difficulty Decreased prognosis, tasks quickly and minimizes
concentrating performance and therapy. at one time as pressure areas
Increase in tolerated. to reduce risk of
physical tissue
complaints 4. Determine breakdown.
and prioritize
role 3. Allows for
responsibilities extended
and alternative periods of
providers and uninterrupted
possible rest.
community
resources 4. Promotes
available problem solving
of most pressing
5. Identify needs of
energy- individual and
conserving family.
techniques:
sitting to shower 5. Helps
and brush teeth, minimize
planning steps of fatigue, allowing
activity so that patient to
all needed accomplish more
materials are at and feel better
hand, scheduling about self.
rest periods.
6. Prolonged
6. Increase bedrest can be
activity as debilitating. This
tolerated, can be offset by
demonstrate limited activity
passive or active alternating with
ROM exercises. rest periods.

7. Encourage use 7. Promotes

of stress relaxation and
management conserves
techniques: energy, redirects
progressive attention, and
relaxation, may enhance
visualization, coping.
guided imagery.
Discuss 8. Indicates lack
appropriate of resolution and
diversional exacerbation of
activities: radio, the disease,
TV, reading requiring further
rest, change in
8. Monitor for therapeutic
recurrence of regimen.
anorexia and
liver tenderness 9. Assists in
or enlargement. managing
required rest.
9. Administer Use of
medications as barbiturates and
indicated: antianxiety
sedatives, agents, such as
antianxiety prochlorperazine
agents: (Compazine) and
diazepam chlorpromazine
(Valium), (Thorazine), is
lorazepam contraindicated
(Ativan). because of
hepatotoxic
10. Monitor effects.
serial liver
enzyme levels. 10. Aids in
determining
11. Administer appropriate
antidote or assist levels of activity
with inpatient because
procedures as premature
indicated increase in
(lavage, activity
catharsis, potentiates risk
hyperventilation) of relapse.
depending on
route of 11. Removal of
exposure. causative agent
in toxic hepatitis
may limit degree
of tissue
involvement and
damage.
 NURSING CARE PLAN 02

Assessment Diagnosis Planning Intervention Rationale Evaluation

Subjective Situational Low Self- Patient will be 1.Contract with 1.Establishing The patient
data: Esteem related to able to patient regarding time will be able to
Patient Annoying/debilitating Verbalize time for listening. enhances express his or
verbalized symptoms, feelings. Encourage trusting her emotions
“Gagaling pa confinement/isolation, discussion of relationship. verbally.
kaya ako sa length of Patient will be feelings/concerns. Providing
sakit ko ang illness/recovery able to 2. Avoid making opportunity The patient
sakit sa period evidenced by Identify moral judgments to express will be able
pakiramdam Verbalization of fear feelings and regarding feelings Recognize
ng ganito, of life/ feelings of methods for lifestyle. allows sentiments
napakahirap” helplessness coping with patient to and ways for
Depression, lack of negative 3. Discuss feel more in dealing with a
follow-through, self- perception of recovery control of the poor self-
destructive behavior self. expectations. situation. perception.
Verbalization
Patient will be 4. Assess effect of can decrease The patient
able to illness on anxiety and will be able to
Verbalize economic factors depression verbally
acceptance of of patient and SO. and facilitate accept himself
self in positive in the
situation, 5. Offer coping condition,
including diversional behaviors. including the
length of activities based Patient may time of
recovery/need on energy level. need to recuperation
for isolation. express and the
Acknowledge 6. Suggest patient feelings requirement
self as wear bright reds about being for isolation.
worthwhile; be or blues and ill, length and Recognize
responsible for blacks instead of cost of yourself as
self. yellows or greens. illness, valuable;
possibility of accept
7. Make infecting responsibility
appropriate others, and for yourself.
referrals for help (in severe
as needed: case illness) fear
manager, of death.
discharge May have
planner, social concerns
services, and/or regarding the
other community stigma of the
agencies. disease.
2. Patient
may already
feel upset
and angry
and condemn
self;
judgments
from others
will further
damage self-
esteem. Can
also start
distrust
issues with
care worker.

3. Recovery
period may
be prolonged
(up to 6 mo),
potentiating
family and/or
situational
stress and
necessitating
need for
planning,
support, and
follow-up.

4. Financial
problems
may exist
because of
loss of
patient’s role
functioning
in the family
and
prolonged
recovery.

5. Enables
patient to
use time and
energy in
constructive
ways that
enhance self-
esteem and
minimize
anxiety and
depression.

6. Enhances
appearance,
because
yellow skin
tones are
intensified by
yellow/green
colors.
Jaundice
usually peaks
within 1–2
wk, then
gradually
resolves over
2–4 wk.

7. Can
facilitate
problem
solving and
help involved
individuals
cope more
effectively
with
situation.