Acute Hepatitis B

Acute Hepatitis B

1. Sign & symptom

   • Diagnosis
     • Physical Examination
       • Enlarged and tender liver
       • Yellowing of the skin
     • Lab test
   • Nursing Problem
     • Fatigue
       • Nursing Intervention
         • Encourage planned rest period throughout the day
         • Assist to identify essential activity and those that can be deferred or delegated to others
         • Suggest using level of fatigue to determine activity level, with gradual resumption of activity as fatigue and sense of well-being improves
     • Abdominal pain, Muscle and body aches
       • Nursing Intervention
         • Observe or monitor signs and symptoms associated with pain, such as BP, heart rate, temperature, color and moisture of skin, restlessness, and ability to focus
         • Assess for probable cause of pain
         • Assess patient's knowledge of or preference for the array of pain-relief strategies available
         • Evaluate patient's response to pain and medications or therapeutics aimed at abolishing or relieving pain
         • Assess to what degree cultural, environmental, intrapersonal, and intrapsychic factors may contribute to pain or pain relief
         • Evaluate what the pain means to the individual
         • Assess patient's expectations for pain relief
         • Assess patient's willingness or ability to explore a range of techniques aimed at controlling pain
         • Assess appropriateness of patient as a patient-controlled analgesia (PCA) candidate: no history of substance abuse; no allergy to narcotic analgesics; clear sensorium; cooperative and motivated about use; no history of renal, hepatic, or respiratory disease; manual dexterity; and no history of major psychiatric disorder.
         • Monitor for changes in general condition that may herald need for change in pain relief method
         • Assess for effects of chronic pain such as depression; guilt; hopelessness; sleep, sexual, and nutritional disturbances; and alterations in interpersonal relationships
     • Chills and fever
       • Nursing Intervention
         • Assess and monitor client’s temperature and note for presence of chills/ profuse diaphoresis; also note for degree and pattern of occurrence
         • Adjust and monitor environmental factors like room temperature and bed linens as indicated
         • Apply tepid sponge bath
         • Administer antipyretics as prescribed by the physician, utilizing the 10 Rs in giving medication
         • Provide cooling blanket as indicated
         • Encourage client to increase fluid intake
         • Raise the side rails at all times
         • Start intravenous normal saline solutions or as indicated
         • Provide high caloric diet or as indicated by the physician
         • Educate client of signs and symptoms of hyperthermia and help him identify factors related to occurrence of fever; discuss importance of increased fluid intake to avoid dehydration
     • Nausea, Vomiting and Anorexia
       • Nursing intervention
         • Weight daily.Instruct to weigh at least weekly at home
         • Help plan a diet of appealing foods that provides a high-kilocalorie intake of approximately 16 carbohydrate kilocalories per kilogram of ideal body weight
         • Encourage planning food intake according to symptoms of the disease. Discuss eating smaller meals and using between meals snacks to maintain nutrient and calorie intake
         • Instruct to avoid alcohol intake and diet drinks
         • Encourage use of nutritional supplements such as Ensure or instant breakfast drinks to maintain calorie and nutrient intake
     • General malaise
       • Nursing Intervention
         • Assessed patient’s ability to perform tasks/noting reports of weakness, fatigue and difficulty accomplishing task
         • Recommended quiet atmosphere; bed rest if indicated stress-need to monitor and limit visitors, phone calls and repeated unplanned interruptions
         • Elevated head of bed as tolerated
         • Provided/recommended assistance with activities / ambulation as necessary, allowing doing as much as possible
         • Assisted Physiotherapist to prioritize ADLs/desired activities
     • Jaundiced
       • Nursing Intervention
         • Use warm water rather than hot water when bating
         • Use measures to prevent dry skin: Apply an emollient or lubricant as needed to keep skin moist, avoid soap or preparations with alcohol and do not rub the skin
         • If indicated, apply mittens to the hands to prevent scratching
         • Administer prescribed antihistamine to relieve pruritus cautiously
         • Institute measures to prevent skin and tissue breakdown: Turn at least every 2 hours, use an alternating pressure mattress, and frequently assess skin condition.
     • Diarrhea and constipation
       • Nursing Intervention
         • Assess for abdominal pain, cramping, frequency, urgency, loose or liquid stools, and hyperactive bowel sensations
         • Tolerance to milk and other dairy products
         • Medications patient is or has been taking
         • Idiosyncratic food intolerances
         • Method of food preparation
         • Osmolality of tube feedings
         • Change in eating schedule
         • Level of activity
         • Adequate privacy for elimination
         • Current stressors
         • Previous gastrointestinal (GI) surgery
         • History of GI diseases
         • History of Abdominal radiation
         • Assess impact of therapeutic or diagnostic regimens on diarrhea
         • Assess hydration status
         • Assess condition of perianal skin
         • Explore emotional impact of illness, hospitalization, and/or soiling accidents by providing privacy and opportunity for verbalization
     • Treatment
       • Adequate Rest
       • Balanced diet
       • Avoid Alcohol Intake
       • encouraged to practicse safe sex and avoid shsyringesaring of
       • Complication
         • Fulminant hepatitis
         • Liver failure
         • Death

2. 90-95% Patient

   • Recovered

3. Mode of transmission

   • Risk Factor
     • Have sex with an infected person
     • Inject drugs or share needles, syringes, or other drug equipment
     • Are men who have sexual contact with other men
     • Live with a person who has chronic Hepatitis B
     • Are infants born to infected mothers?
     • Have a sexually transmitted disease
     • Are exposed to blood on the job
     • Have multiple sex partners
     • Are hemodialysis patients
   • Sexual contact
   • Blood-borne virus transmission

4. Precaution

   • Standard Precautions
     • Personal protective equipment: Gloves, (+-)Mask,eyeprotection,faceshield (+-)Gown
     • Single-use items should be discarded properly
     • Contaminated reusable items should be cleaned
     • The Use of Household Bleach (5.25%) 1 in 4 Mixing 10ml of household bleach (5.25%) with 40ml of water
     • Disinfect surfaces or articles contaminated with blood-stained
     • Cover all wounds before work to prevent non-intact skin exposure.
     • Use devices with safety features provided
     • Avoid recapping needles
     • Discard used needles or sharps promptly in appropriate sharps disposal containers
   • Infection Control

5. Incubation

   • 45-160 days

6. Cause

   • Hepatitis B Virus (HBV)
   • HIV infection
   • alcohol or aflotoxins