So good day everyone.

Here is the symptomatology of our case presentation consisting

symptoms of hepatits b and their rationale.

First is appetite loss. Because your liver plays a role in digestion, you may
experience a loss of appetite as it is inflamed. Liver disease can affect the
absorption of food and the production of proteins and vitamins. Therefore, your
diet may influence your weight, appetite, and the amounts of vitamins in your
body. So appetite loss is the result of poor digestion that comes with an inflamed liver.
Pag poor ang digestion mo malaki chance na magka stomach ache ka or any stomach
problem and automatically mag lead yun sa pagkawala mo ng gana kumain.

Second symptom is feeling tired or fatigue. Fatigue is a common symptom of liver

disease but not well-characterized in patients with chronic hepatitis B virus
(HBV). Some studies suggest that when your body is fighting an infection that
won't go away, it triggers fatigue. So your body is using your internal energy to fight
back an infection because that’s how our body tries to clear our system from any
damage, kaya yung pag use up ng energy ng katawan natin is naga lead sa fatigue or
tiredness.

Third symptom is nausea or vomiting. Nausea and an upset stomach are common
early symptoms of liver disease, but as your liver's ability to eliminate toxins
decreases, your digestive distress will likely increase. Ongoing nausea is a
reaction to excess waste products in the body, and unexplained vomiting is often
linked to liver problems. This means nausea or vomiting is your liver’s way of showing
that it is pushing toxins out of your body as it accumulates different types of toxicity
because of the liver problem so gina try toh I remove ng katawan natin through
vomiting.

Fourth symptom is itching all over the body. The toxins that build up in your blood
and cause jaundice or yellowing of eyes and skin can also make you itch. You
may feel it in just your hands and feet or all over your body. Most people living
with HBV have episodes with rashes that itch, or with an itch without the rash.
Rashes can be caused by all kinds of things, but the skin truly does let us know
when there is something going on with our body. So some of the ways that an
inflamed liver exposes its toxins in our body is through jaundice aka yellowing of the
eyes or through rashes. When either of these signs show up given na din na kasama
yung itching sensation na ma feel mo sa different parts ng katawan mo.

Fifth symptom is pain over the liver specifically on the right side of the abdomen and
under the lower rib cage. Pain or discomfort from an enlarged liver usually occurs
in the upper right quadrant of the stomach. It may also be felt in the right upper
back and shoulder blade area. So because abnormal na yung liver mo both function
and size. Pain is going to be unavoidable on any of its parts because that’s the body’s
natural reaction to most of diseases.

Sixth symptom is jaundice. A condition in which the skin and the whites of the eyes
turn yellow in color. If patients with chronic hepatitis B progress to cirrhosis
(when the liver becomes severely scarred) they will develop signs and symptoms
of liver failure, including: Jaundice. So when your inflamed liver reaches to a point of
cirrhosis in which it starts to become even more severely scarred, that’s when
discoloration all over your body starts, as mentioned earlier this is the body’s way of
showing built-up toxins inside your body.

Seventh symptom is when urine becomes dark in color similar to cola or tea. Brown
urine is one of the first and most common signs of hepatitis, which is another
name for liver inflammation. There's more than one type of this disease, including
hepatitis A, B, and C. When you have it, your liver can't clean your blood properly.
This can lead to a buildup of an orange-yellow substance called bilirubin in your
blood and urine, and can turn urine brown. So our liver is one of the organs that
keeps our blood clean, and hepatitis b prevents it from doing its job. When this happens
mag build up na rin yung bilirubin which is an orange-yellow substance, and magsama
na rin yun sa urine mo that’s why it decolorizes or turns into brown as well.

The eight and last symptom we have is when stools are pale in color or it turns grayish
or clay colored. The liver releases bile salts into the stool, giving it a normal brown
color. You may have clay-colored stools if you have a liver infection that reduces
bile production, or if the flow of bile out of the liver is blocked. So one of the things
that come with a liver infection is the decrease of bile and its production. Bile is the
factor na nagabigay sa stool ng normal brown color but since your body lacks it when
you have a liver problem your stool turns grayish or whitish.

So there are many more symptoms of hepa b symptoms but those are just few we have
for now. That’s all po for the symptomatology thank u.

- BOUNDARY –
So good day and now I’m going to present the nursing care plan of our case
presentation on hepatitis b.

First off, our patient is patient S.L., she’s a 34 year old woman and her chief complaints
are itchy throat, non-productive cough also known as dry cough, and headache. She’s
diagnosed with hepatitis B. she’s located in room 4 bed 1 and attended by physician dr.
tuason.

The intervention was set on april 25, 2022 at 8am.

So for the only subjective cue, Patient is experiencing fatigue as verbalized, “Kapoy
akong lawas.” She expressed that her body feels tired and restless.

Then the objective cues include Temperature of 37.8°C, Itchy throat, Nonproductive
cough, Yellowish discoloration of skin and sclera, HBsAg or Hepatitis B surface
antigen which is the standard blood test for hepa b is reactive or positive
meaning that she is currently infected with hepa b and is able to pass the
infection on to others, HPV DNA, a A laboratory test in which cells are scraped
from the cervix to look for DNA of human papillomaviruses is at 220,000
International Units Per Millilitre, and Tenofovir Disoproxil  for the treatment of HIV
infection in adults and children 2 years of age and older is taken at 300 milligram
everyday.

The priority need for the patient is her health perception or health management as the
cues focuses on the medication regimen and health promotion tests of the patient.

The nursing diagnosis of the patient resulted to Ineffective protection related to viral
infection as evidenced by yellowish discoloration of the skin and sclera, above
normal temperature, fatigue, nonproductive cough, and itchy throat. So the
intervention examined that the patient’s body failed to be protected from viral infections
which led to having to find a better solution for her hepa b diagnosis, as mentioned
earlier she expressed her tiredness and fatigue which is one of the confirmation for the
diagnosis.

The rationale states that The patient's immune system plays a vital role in an
individual’s health as it is the one responsible to protect the body by fighting off
internal and external threats such as the hepatitis B virus. If the patient has
ineffective protection, the virus can easily proliferate, leading to serious
conditions such as liver disease, wherein fatigue, fever, and yellowish
discoloration of the skin and sclera are one of its signs and symptoms.
Furthermore, medications intended for HBV like tenofovir disoproxil may cause
side effects such as nonproductive cough and itchy throat. So it is evident that the
patient has a weak immune system which is the reason why she caught the virus in the
first place as her system wasn’t able to fight off the lingering threat inside due to its lack
of power. The consequences of this can start off with minor problems like fatigue,
fever,and discoloration but can eventually lead to a serious liver problem if not treated
that’s why medications such as tenofovir disoproxil must be taken as early as the
primary symptoms hit your body to avoid any major complications.

The patient or goal is that Within 6 hours of nursing intervention, the patient will be
able to demonstrate improvements in health status as evidenced by absence of
fever with a temperature within 35.5 – 37.5 °C (axillary), fatigue, itchy throat, and
nonproductive cough. So in 6 hours the physician will know if the medications given
and the tests conducted are effective if any signs of high fever, tiredness, itchy throat
and dry cough are completely gone.

So now let’s proceed to the nursing intervention

First, Establish isolation techniques for respiratory infections according to

infection guidelines and policy. This Prevents transmission of viral disease to
others. Thorough hand washing is effective in preventing virus transmission. So it
is important to be clean as possible to avoid furthering the infection and to avoid
spreading it to other people.

Second is, Assess immunization status and history because People with
incomplete immunizations may not have sufficient acquired active immunity. Ask
the patient during history taking when they were last immunized. This is very
important considering a weak immune system is the main cause of her acquiring the
virus so it is important to take not if the patient is immunized or needs to be immunized
which will not only solve viral infection problems but also help the patient avoid being
infected in the future.

Third, Assess the intactness of amniotic membranes because Prolonged rupture

of amniotic membranes before delivery puts the mother and neonate at increased
risk for infection. So Amniotic membrane, or amnion, is the innermost layer of the
placenta and consists of a thick basement membrane. The amniotic membrane
surrounds and protects the developing fetus in utero and separates mother and fetus.
Therefore the physician have to make sure it is intact to prevent not only the mother but
also her baby from catching any infection.

Fourth, Encourage increased fluid intake unless contraindicated (e.g., heart

failure, kidney failure) because Fluids help promote diluted urine, frequent
emptying of the bladder, and reducing the stasis of urine. This ultimately reduces
the risk of bladder infection or urinary tract infection. Increased fluid intake also
helps replace fluid lost during fever and helps thin secretions. So bladder infection
oftentimes come from stagnation of urine inside so it is advised to up your fluid intake
unless you have heart failure or kidney failure, so that your urine doesn’t stagnate and
help you release more often but without pain or any complication

Fifth, Administer antibiotics appropriate to causative agents (such as Gram-

negative and anaerobic bacteria), or secondary process because Antibiotics are
used to treat bacterial hepatitis or to prevent/limit secondary infections. So
causative agents in infection are pathogens. Pathogens are micro-organisms that are
capable of causing diseases or infections. Our body can fight this microorganisms using
antibiotics and eventually preventing any form of primary infections like hepatitis b or
secondary infections.

Sixth, Educate the patient on the side effects and adverse effects of medications,
especially some over the counter drugs, in relation to liver damage. Because the
majority of medications are metabolized in the liver, careful use of drugs is
warranted. Some medications are hepatotoxic and may bring cumulative and
irreversible liver damage. It is important for the patient to know these effects because
some medication may cause more harm than good, most medications reside in the liver
so if a medicine triggers an unhealthy response from the organ then it can be very
dangerous. Make sure that your drug intake is safe for your liver and any internal
organs.

Seventh, Monitor serial liver enzyme levels because this Aids in determining
appropriate levels of activity as premature increase in activity potentiates risk of
relapse. Elevated liver enzymes often indicate inflammation or damage to cells in the
liver. Inflamed or injured liver cells leak higher than normal amounts of certain
chemicals, including liver enzymes, into the bloodstream, elevating liver enzymes on
blood tests. So make sure to match the patient’s energy to her liver enzyme levels and
measure the intensity of any sort of activity that may be conducted to avoid the
occurrence of relapse

Eighth, Encourage intake of protein-rich and calorie-rich foods and encourage a

balanced diet because Proper nutrition and a balanced diet support the immune
systems’ responsiveness and enhance the health of all the tissues of the body.
Adequate nutrition enables the body to maintain and rebuild tissues and helps
keep the immune system functioning well. So The protein you eat helps repair tissue
and fight off viral or bacterial infection. Proteins make up the framework of your cells,
including the cells of the immune system and just about every other system in the body.

Ninth, Encourage sleep and rest because Adequate sleep is an essential

modulator of immune responses. A lack of sleep can weaken immunity and
increase susceptibility to infection. For instance, shorter sleep durations are
associated with a rise in suffering from the common cold. So Sleep provides
essential support to the immune system. Getting sufficient hours of high-quality sleep
enables a well-balanced immune defense that features strong innate and adaptive
immunity, efficient response to vaccines, and less severe allergic reactions.

And lastly, Emphasize to the patient the importance of follow-up physical

examination and laboratory evaluation. Disease process may take several months
to resolve. If symptoms persist longer than 6 months, liver biopsy may be
required to verify presence of chronic hepatitis. So Liver function tests are used to
measure specific enzymes and proteins in your blood. Having atypical results on any of
these liver tests usually requires a follow-up to determine the cause of the atypical
characteristics. Even mildly elevated results can be associated with liver disease.
Therefore always take advantage of follow up check ups not only to prevent but more
importantly to be ahead just incase your disease developed into something more
harmful.

So that’s all for the intervention lastly is the evaluation.

So on April 25, 2022 at 2PM, the goal is partially met.

At the end of the 6 hours of nursing intervention, the patient is showing signs of
improvements as evidenced by the absence of signs and symptoms of infection
such as fever with a temperature of 36.9°C and fatigue as verbalized by the
patient, “Wala naman ko gibatig kakapoy abtik na gani akong paminaw” however,
itchy throat and nonproductive cough have not yet subsided.

So partially met lang siya kase out of the three goals which are absence of fever, itchy
throat, and unproductive cough, absence of fever lang yung na achieve, but at the same
time on a positive note, na express din ng patient na hindi na siya pagod and alert na
siya so the goal is partially met.

And that’s all for our case presentation’s nursing care plan thank you.