Beruflich Dokumente
Kultur Dokumente
Hepatitis is a general term that means inflammation of the liver. The liver can become inflamed as a result
of infection, a disorder of the immune system, or exposure to alcohol, certain medications, toxins, or
poisons.
Hepatitis B is caused by infection with the hepatitis B virus (HBV). This infection has 2 phases:
acute and chronic.
Acute (new, short-term) hepatitis B occurs shortly after exposure to the virus. A small number
of people develop a very severe, life-threatening form of acute hepatitis called fulminant hepatitis.
Chronic (ongoing, long-term) hepatitis B is an infection with HBV that lasts longer than 6
months. Once the infection becomes chronic, it may never go away completely.
The hepatitis B virus is known as a blood-borne virus because it is transmitted from one person to
another via blood. Semen and saliva, which contain small amounts of blood, also carry the virus. The
virus can be transmitted whenever any of these bodily fluids come in contact with the broken skin or a
mucous membrane (in the mouth, genital organs, or rectum) of an uninfected person.
Symptoms develop within 30-180 days of exposure to the virus. The symptoms are often compared to
flu. Most people think they have flu and never think about having HBV infection.
Appetite loss
Feeling tired (fatigue)
Nausea and vomiting
Itching all over the body
Pain over the liver (on the right side of the abdomen, under the lower rib cage)
Jaundice - A condition in which the skin and the whites of the eyes turn yellow in color
Urine becomes dark in color (like cola or tea).
Stools are pale in color (grayish or clay colored).
Patients with chronic hepatitis B are at risk of developing liver cancer. The way in which the cancer
develops is not fully understood. Symptoms of liver cancer are nonspecific. Patients may have no
symptoms, or they may experience abdominal pain and swelling, an enlarged liver, weight loss, and
fever. The most useful diagnostic screening tests for liver cancer are a blood test for a protein produced
by the cancer called alpha-fetoprotein and an ultrasound imaging study of the liver. These two tests are
used to screen patients with chronic hepatitis B, especially if they have cirrhosis or a family history of liver
cancer.
Rarely, chronic hepatitis B infection can lead to disorders that affect organs other than the liver. These
conditions are caused when the normal immune response to hepatitis B mistakenly attacks uninfected
organs.
Glomerulonephritis: another rare condition, which is inflammation of the small filtering units of the
kidney.
Objectives
identify and understand types of medical treatment necessary for the treatment of
Cervical Cancer
formulate and apply nursing care plan utilizing the nursing process, and
lastly to develop our sense of unselfish love and empathy in rendering nursing care to
our patient so that we may be able to serve future clients with higher level of holistic
PHYSIOLOGY
Functions of liver:
The goals of self-care are to relieve symptoms and prevent worsening of the disease.
Drink plenty of fluids to prevent dehydration. Water is fine; broth, sports drinks, Jello, frozen ice
treats (such as Popsicles), and fruit juices are even better because they provide calories.
Avoid medicines and substances that can cause harm to the liver, such as acetaminophen
(Tylenol).
Avoid drinking alcohol until your health care provider OKs it. If your infection becomes chronic,
Avoid using drugs, even legal drugs, without consulting your doctor. Hepatitis can change the
way drugs affect you. If you take prescription medications, continue taking them unless your
health care provider has told you to stop. Do not start any new medication (prescription or
nonprescription), herbs, or supplements without first talking to your health care provider.
Try to eat enough for adequate nutrition. Eat foods that appeal to you, but try to maintain a
balanced diet. Many people with hepatitis have the greatest urge to eat early in the day.
Take it easy. Your activity level should match your energy level.
Call your health care provider for advice if your condition worsens or new symptoms appear.
Avoid any activity that may spread the infection to other people.
MEDICAL MANAGEMENT
If you are dehydrated, your doctor may prescribe IV fluid to help you feel better.
If you are experiencing significant nausea and vomiting, you will receive medicines to control
these symptoms.
People whose symptoms are well controlled can be cared for at home.
If dehydration or other symptoms are severe or if you are extremely confused or difficult to
arouse, you may need to stay in the hospital.
There is no treatment that can prevent acute HBV infection from becoming chronic.
The degree of liver damage is related to the amount of active, replicating (multiplying) virus in the blood
and liver. Regularly measuring the amount of HBV DNA in the blood gives a good idea of how fast the
virus is multiplying. The treatments now in use are antiviral drugs, which stop the virus from multiplying.
Antiviral agents, while the best therapy known for chronic hepatitis B, do not work in all individuals
with the disease.
Although there are several antiviral agents for chronic hepatitis B approved by the U.S. Food and
Drug Administration (FDA), research is ongoing. This means that dosages and treatment
recommendations are subject to change.
Research is ongoing to find medications that work better with fewer side effects.
Antiviral therapy is not appropriate for everyone with chronic HBV infection. It is reserved for people
whose infection is most likely to progress to chronic hepatitis B.
Decisions to start medications for treatment of hepatitis B are made by you and your health care
provider, often in consultation with a specialist in diseases of the digestive system
(gastroenterologist) or liver (hepatologist).
The decision is based on results of liver function tests, HBV DNA tests, and, frequently, liver
biopsies after a complete history and physical examination.
Depending on the results of these tests, you may decide to start therapy or to delay it until later.
Treatment is usually started when blood tests indicate that liver functions are deteriorating and the
amount of replicating HBV is rising. The interval between diagnosis and starting treatment can be a year
or two or several years. Many people may never require medication.
If you have chronic hepatitis B infection and think you might be pregnant, let your health care provider
know right away. If you are pregnant and think you have been exposed to hepatitis B, let your health care
provider know right away.
SURGICAL MANAGEMENT
There is no surgical therapy for hepatitis B.
If liver damage is severe enough that the liver starts to fail, the only treatment that will help is liver
transplant.
If this should happen to you, your health care provider will talk to you about whether liver
If liver transplant becomes a possibility for you, your health care provider will discuss the risks
Nursing Intervention:
Provide a clean and safe environment to patient to reduce risk for infection
Hepatitis B Prevention
There is a vaccine against the hepatitis B virus (Engerix-B, Recombivax HB ). It is safe and works well to
prevent the disease. A total of 3 doses of the vaccine are given over several months.
This vaccine has successfully prevented infection in people exposed to the virus.
The vaccine is recommended for all children younger than 19 years. It can be given as part of
their normal vaccination series.
All children younger than 18 years, including newborns--especially those born to mothers who are
infected with HBV
All health care and public safety workers who may be exposed to blood
People who have hemophilia or other blood clotting disorders and receive transfusions of human
clotting factors
People who require hemodialysis for kidney disease
Travelers to countries where HBV infection is common - This includes most areas of Africa,
Southeast Asia, China and central Asia, Eastern Europe, the Middle East, the Pacific Islands, and
the Amazon River basin of South America.
People who are in prison
People who live in residential facilities for developmentally disabled persons
People who inject illegal drugs
People with chronic liver disease such as hepatitis C
People who have multiple sex partners or have ever had a sexually transmitted disease
Men who have sex with men
Hepatitis B immune globulin (BayHep B, Nabi-HB) is given along with the hepatitis B vaccine to
unvaccinated people who have been exposed to hepatitis B.
These include close contacts of people with HBV infection, health care workers who are exposed
to HBV-contaminated blood, and infants born to mothers infected with HBV.
It also includes people who have finished only part of the 3-shot vaccination series.
Giving the immune globulin and the vaccine together in these situations prevents transmission of
the disease in 80-90 percent of cases.
If you are sexually active, practice safe sex. Correct use of latex condoms can help prevent
transmission of HBV, but even when used correctly, condoms are not 100% effective at
preventing transmission. Men who have sex with men should be vaccinated against both hepatitis
A and hepatitis B.
If you inject drugs, don't share needles or other equipment.
Don't share anything that might have blood on it, such as a razor or toothbrush.
Think about the health risks if you are planning to get a tattoo or body piercing. You can become
infected if the artist or piercer does not sterilize needles and equipment, use disposable gloves, or
wash hands properly.
Health care workers should follow standard precautions and handle needles and sharps safely.
If you are pregnant or think you might be pregnant, tell your health care provider if you have any
of the risk factors for HBV infection.
Hepatitis B Prognosis
Some people rapidly improve after acute hepatitis B. Others have a more prolonged disease
course with very slow improvement, or with periods of improvement followed by worsening of symptoms.
A small group of people (about 1% of people infected) suffer rapid progression of their illness
during the acute stage and develop severe liver damage (liver failure). This may occur over days to
Other complications of HBV include development of a chronic HBV infection. People with chronic
HBV infection are at further risk for liver damage (cirrhosis), liver cancer, liver failure, and death.
Children are less likely than adults to clear the infection. More than 95% of people who become
infected as adults or older children will stage a full recovery and develop protective immunity to the
virus. However, this drops to 30% for younger children, and only 5% of newborns that acquire the
infection from their mother at birth will clear the infection. This population has a 40% lifetime risk of
death from cirrhosis or hepatocellular carcinoma. Of those infected between the age of one to six, 70%
PATIENT’S PROFILE
NURSING ASSESSMENT
1. Chief Complaint:
Weakness
3. Medical History:
C Cardiac_____________________ Gastro_______________________
Hyper/hypotension Family Arthritis Family
Diabetes____________________ Stroke_______________________
C Cancer_____________________ Glaucoma______________________
Respiratory________________ Asthma_______________________
Mental Disorder______________ Others (Pls specify)_____________
Drug allergies___________________________________________________
4. Surgeries/ Procedures
Laboratory procedures
CBC
CXR
Hepa B test
U/A
PHYSICAL ASSESSMENT
Nursing diagnosis:
Goal:
Severity
Changes in severity over time
Aggregating factors
Alleviating factors
Using a quantitative rating scale such as 1 to 10 can help the patient describe the amount of
fatigue experienced. Other rating scales can be developed using pictures or descriptive words.
This method allows the nurse to compare changes in the patient’s fatigue level over time. It is
important to determine if the patient’s level of fatigue is constant or if it varies over time.
Identifying the related factors with fatigue can aid in determining possible causes and
establishing a collaborative plan of care.
Assess the patient’s ability to perform activities of daily living (ADLs), instrumental activities of
daily living (IADLs), and demands of daily living (DDLs). Fatigue can limit the person’s ability
to participate in self-care and perform his or her role responsibilities in the family and
society.
Assess the patient’s emotional response to fatigue. Anxiety and depression are the more
common emotional responses associated with fatigue. These emotional states can add to
the person’s fatigue level and create a vicious cycle.
Evaluate the patient’s routine prescription and over-the-counter medications. Fatigue may be a
medication side effect or an indication of a drug interaction. The nurse should give
particular attention to the patient’s use of -blockers, calcium channel blockers,
tranquilizers, alcohol, muscle relaxants, and sedatives.
Assess the patient’s emotional response to fatigue. Anxiety and depression are the more
common emotional responses associated with fatigue. These emotional states can add to
the person’s fatigue level and create a vicious cycle.
Assess the patient’s nutritional intake of calories, protein, minerals, and vitamins. Fatigue may
be a symptom of protein-calorie malnutrition, vitamin deficiencies, or iron deficiencies.
Evaluate the patient’s sleep patterns for quality, quantity, time taken to fall asleep, and feeling
upon awakening. Changes in the person’s sleep pattern may be a contributing factor in the
development of fatigue.
Assess the patient’s usual level of exercise and physical activity. Both increased physical
exertion and limited levels of exercise can contribute to fatigue.
Assess the patient’s expectations for fatigue relief, willingness to participate in strategies to
reduce fatigue, and level of family and social support. The patient will need to be an active
participant in planning, implementing, and evaluating therapeutic interventions to relieve
fatigue. Social support will be necessary to help the patient implement changes to reduce
fatigue.
Encourage the patient to keep a 24-hour fatigue/activity log for at least 1 week. Recognizing
relationships between specific activities and levels of fatigue can help the patient identify
excessive energy expenditure. The log may indicate times of day when the person feels
the least fatigued. This information can help the patient make decisions about arranging
his or her activities to take advantage of periods of high energy levels.
Assist the patient to develop a schedule for daily activity and rest. A plan that balances periods
of activity with periods of rest can help the patient complete desired activities without
adding to levels of fatigue.
Monitor the patient’s nutritional intake for adequate energy sources and metabolic requirements.
The patient will need adequate intake of carbohydrates, protein, vitamins, and minerals to
provide energy resources.
Minimize environmental stimuli, especially during planned times for rest and sleep. Bright
lighting, noise, visitors, frequent distractions, and clutter in the patient’s physical
environment can inhibit relaxation, interrupts rest/sleep, and contribute to fatigue.
Collaborative
Blood glucose
Hemoglobin/hematocrit
BUN
Oxygen saturation, resting and with activity
Changes in these physiological measures can be compared with other assessment data to
understand possible causes of the patient’s fatigue.
X – Ray Chest
Conclusion
Therefore I conclude that Hepatitis B cannot be cured but it can be treated to prevent further
complications. And sometimes Hepatitis B is asymptomatic that an infected person will not feel any
symptoms. It is a dangerous health problem because it can lead to liver cirrhosis or liver cancer. That
mostly could lead to death. If a person has an hepatitis B it’s the symptoms that being treated to prevent
Recommendation
o Patient should abstain from sex or anything that could transmit the virus to other person
http://www.medicinenet.com/hepatitis_b/article.htm
http://en.wikipedia.org/wiki/Hepatitis_B
http://www.who.int/mediacentre/factsheets/fs204/en/
http://www.scribd.com/doc/17471585/Nursing-Care-Plan-for-Hepatitis
http://nursingcrib.com/communicable-diseases/hepatitis-b-serum-hepatitis/
http://nursingcrib.com/nursing-care-plan/nursing-care-plan-%E2%80%93-liver-cirrhosis/
http://www.hepfi.org/nnac/pdf/Nursing_Care_Plan_Risk_For_Impaired_Liver_Function.pdf