HEPATITIS

Outline1-patient demographic data 2- history: a. history of present illnesses b-past medical & surgical history 3-physical assessment4- diagnostic test 5- medication . 6-nursing process 7- comparing case with text book 8- reference .

ObjectiveAt end of this lecture the student

will be able to :

1- Definition of hepatitis . 2- recognize Clinical Manifestations 3-know the type of hepatitis B. 4- know Functions of the Liver5- know the Treatment of Hepatitis B

Pathophysiology

,What is Hepatitis B?HEPATITIS is

inflammation of the liver. It may be caused by

1.) Excessive Alcohol intake

2.) Various drugs and chemicals,

3.) Certain Medical conditions

and4.) MOST commonly by

various viruses that infect the liver, leading to Viral hepatitis.

What is Hepatitis B?Hepatitis B can cause

short-term(ACUTE) infection that may/may not cause any symptoms and the person gets better on his own in most people. However a few progress to persistent (CHRONIC) infection and may remain well but pass the infection to others.

Functions of the Liver -Glycogen storage (Body

Fuel) -Helps process fats and

proteins from digested food. -Makes proteins essential for

blood clot (clotting factors) -Process medicines that

people ingest -Help remove or process

alcohol, poisons and toxins from the body.

-Produces bile that breaks down fats in food so that they can be absorbed from the intestine.

Transmission of Hepatitis BVertical Transmission

(From Mother to child)Horizontal Transmission

(Person to Person)Having unprotected sex

with an infected personFrom infected blood.NOTE: The virus is not

passed on during normal social contact such as holding hands, hugging or sharing cups or crockery.

Symptoms of Hepatitis BMuscular achesTiredness and

feeling unwell (Malaise)

Alcohol IntolerancePoor AppetitePain over liver (Right

upper quadrant)JaundiceIn severe case

(Cirrhosis, Cancer)

Treatment of Hepatitis BNo curative

treatment , but tries to delay

INTERFERON ANTIVIRAL DRUGSNOTE: Resistance to

drugs may also develop.

LIVER TRANSPLANTDIET AND ALCOHOL

Patient demographic data Client name :N.SMarital status: marriedAdmission date : 23/11/2014Physical limitation: no limitation ,but

some pain in abdData of surgery :no surgery orderEducational level: high schoolReligion : MuslimData & place of birth: sihat 2/8/1977Allergy : no specific allergyBlood group :B+

History Taking Smoking : Doesn’t smoke . Alcohol: Doesn’t drink . Diet : high ca . Chief complain: He Complain from abdomen pain , frequent

score 9/10 , pain like shooting and feel tired , with dark urine and pain when micturate.

History of present illness : pt 37 year old , male , mediclly free , was come to hospital because compline of abdomen pain before 5 days

Current complain : patient have hepatits b , some pain when walk , Past health history : A- past health problem :No childhood illness, no accident, he taken all immunization B- Hospitalization :He doesn't admissions to hospital before .

Physical assessment:General survey : mr. n.s is 37 year old , male office work, nourshed well devloped , and appers stated age, alert, oriented, cooperative , ht 180cm , wt 85kg , normal v.s , but need some help to do daily activity Integumentary system :Pink y nail color , he don’t has

jaundice , no edema , capillary refill with 2 sec .

Physical assessment:Head and neck :Head : size of head is medium, no deformity ,no tenderness, temporal pulse present, hair loss, equal muscle strength . Neck : Normal Lymph Node ,Normal Thyroid Gland ,Centralized Trachea ,Carotid Pulse Present . Respiratory system :Some cough ,symmetrical shape and contour, Dosen’t have SOB ,normal respiratory rate – no mass, lung percussion is resonant, .

Physical assessment:Cardiovascular system : No chest pain, fatigue, no orthopnea,no sign of cynosis, Normal Pulse,equal pulse,no cardiomegaly s1+s2 no murmurs ,jugular vein is flat .

Abdomen:Pt can’t tolerant the food , so he

dosen’t like to eat , and vomite twice time in same day , the vein is not seen , hepatomegaly is appear and it clearly seen

Physical assessment:Urinary system: dark yellowsh color urine no

nocturia , no incontinence , some sweling Musculoskeletal system :No pain , no stiffness, sing of weakness, no deformity , symmertic of structure and function as well as normal, no hammar toes, can ao instruction for flexion and extension . Neurological system: PT oriented GCS 15/15, respond to external stimuli and pain Peripheral vascular system: Normal pulse for all site – normal Allen's test – normal capillary refill

Intake & Output Total output Total intake 1800ml 1700ml

Balance = 100- Nursing care = increase fluid intake

Diagnostic test : Intervention Result Normal value Name test

1 -repeat the test 2-inform the physician

604.1 30-65u/l

sGPT

-repeat the test 2-inform the physician

961.6 15-37u/l

SGOT

7.7 6-8.3 TOTAL PROTEN

-repeat the test 2-inform the physician

40 60-180 AMYLASE

-repeat the test 2-inform the physician

2.29 3.5-4.8g/dl

ALBUMIN

-repeat the test 2-inform the physician

458 0-160 LIPASE

-repeat the test 2-inform the physician

155 30-120 ALKALINE PHOSPHAT

-repeat the test 2-inform the physician

250 0-51 GGT

MedicationIntervention

Side effect

Indication

Classification Dose, route

Name

1 -monitor pt hypertension , edema, heart failure

2 -give with food

1 -back pain 2 -

hypotension Peripheral edema 4 -

abdomen pain

1-osteoarthritis

2 -acute pain

3 -primary dysmenorrheal

Cyclooxygenase -2 inhibitor

200mg, cap bid celecoxib

1-protect injectate from light & heat

2-teach pt about food contain folic acid

1-fell flushed if iv

2 -allergic hypersensiftiy

3-malaise

1-megaloblastic anemia

2-hepatic disease

Folic acid derivative 15g oint skin once a day

Fluidic acid

1-stopped gradually

2-first dose in bed time

3 -warn pt avoid driving

1-leukopenia

2-fractures3-myalgia4-diplopia

5-amblyopia

1-seizures2-

postherpetic neuralgia

Gamma-aminobutyric acid

(GABA)

300mg ,cap bid Gatapntin

Medication

1-give before 15m to meal 2-give subcutaneously 3-avoid over use of one area

Dry mouth 2-hypoglycemia 3- rash

Diabetes 1&2

Pancreatic hormone

Sc, 25%, 75%

Humalog

1- 1h before meal 2- tell pt swallow the tab whole and don’t open or chew it

1- asthenia2- constipation3- rash

1-duodenl ulcer2-gastric ulcer3- erosive esophagitis

Proton pump inhibitor

20mg cap bid omeprazole

1- monitor renal function 2- give slowly if route i.v or i.m

1-vomiting 2-phlebitis 3- nausea 4-cardic arrest

To prevent or treat hypokalemia

Potassium salt 100ml topical bid

Potassium permanganate

Nursing process Nursing diagnosis: activity intolerant related to fatigue

Goal : pt reports decrease in fatigue and increase ability to participate in activity

Intervention : 1- assess level of activity tolerance and degree of fatigue 2-provide diet high in carbohydrates with protein intake consistent with

liver function 3- encourage rest when fatigued or when abdominal pain or discomfort

occurs

rational : 1-provides baseline for further assessment and criteria for assessment of effectiveness of interventions

2-provides calories for energy and protein for healing 3- conserves energy and protects the liver

Evaluation : 1- exhibits increased interest in activities 2-reports increase strength and well-being 3-reports absence of abdominal pain and discomfort

Nursing process Nursing diagnosis: imbalanced nutrition , less than body requirement related

to abdominal distention and discomfort and anorexia

Goal positive nitrogen balance , no further loss of muscle mass, meet nutritional requirements

Intervention: assess dietary intake and nutritional status through diet history and diary data daily weight, lab

2-offer smaller, more frequent meal (6/day) . 3-assist patient in identifying low-sodium food

Rational : 1-identifies defect in nutritional intake and adequacy nutritional state

2-decrease feeling of fullness, bloating 3-reduces edema, and ascites formation

Evaluation: 1-exhibits improved nutritional status by increase weight and improve laboratory data

2-report increased appetite and well-being 3-gains weight without increase edema or ascites formation

Nursing process Nursing diagnosis: fluid volume excess related to ascites and edema formation

Goal : restoration of normal fluid volume

Intervention:1-restrct sodium and fluid intake if prescribed 2-administer diuretic agent, potassium, and protein supplements as prescribed 3- record intake and output every 1 to 8 h depending on response to

interventions and on patient acuity

Rational : 1- minimizes formation of ascites and edema . 2- promotes excretion of fluid through the kidneys and maintenance normal

fluid 3- indicate effectiveness of treatment and adequacy of fluid intake .

Evaluation: 1-consumes diet low in sodium and within prescribed fluid restriction .

2- take diuretic agents, potassium as indicated without experiencing side effects 3- exhibits increase urine output .

RECARCH Abstract Oakes K (2014) Chronic hepatitis B, part 1: hepatitis B:

prevalence and pathophysiology. Nursing Times; 110: 7, 12-16.

Chronic hepatitis B is a growing worldwide public health issue. Its prevalence and the mode of transmission of the virus varies greatly between parts of the world. Prevalence is rising in the UK due to an increase in migration from areas with a high prevalence of chronic hepatitis B.

This article, the first of a two-part series, discusses the prevalence and pathophysiology of chronic hepatitis B, as well as recommendations for screening high-risk groups and immunization against the disease. Part two discusses the management of the virus.

RECARCH Long-term safety of lamivudine treatment in patients with chronic hepatitis B Abstract Data on thelong-term safety of lamivudine are limited. The aim of this analysis was to

determine the incidence of hepatitis flares, hepatic decompensation, and liver-disease-related (LDR) serious adverse events (SAE) during long-term lamivudine treatment. We reviewed data on 998 patients with HBeAg-positive compensated chronic hepatitis B who received lamivudine for up to 6 years (median, 4 years) and 200 patients who received placebo for 1 year. Hepatitis flares occurred in 10% of thelamivudine-treated patients in year 1 and in 18%–21% in years 2–5. A temporal association between hepatitis flares and lamivudine-resistant mutations increased from 43% in year 1 to >80% in year 3. Ten hepatic decompensation events occurred in 8 (<1%) lamivudine-treated patients. Fifty-three (5%) lamivudine-treated patients experienced a total of 60 LDR SAEs. Four patients died, 2 from liver-related causes. The proportion of patients with a documented lamivudine-resistant mutation increased from 23% in year 1 to 65% in year 5. During each year of the study, patients with lamivudine-resistant mutations experienced significantly more hepatitis flares than patients without lamivudine-resistant mutations (P < 0.005). The occurrence of hepatic decompensation (0%–2%) and LDR SAEs (1%–10%) among patients with lamivudine resistance remained stable during the first 4 years with mutations and increased afterward to 6% (P = 0.03) and 20% (P = 0.009), respectively. This study demonstrated that lamivudine treatment for up to 6 years has an excellent safety profile in patients with HBeAg-positive compensated liver disease, but patients with long-standing lamivudine-resistant mutations may experience worsening liver disease.

Reference Book

Drug to know for the nclex-rn Pharmacology for nurses for

adams, holland,urbanAssessment an incredibly visualMedical

Webhttp://www.mayoclinic.org/http://emedicine.medscape.com/

STUDENT NAME : EISSA HUSSAIN

CLINICAL INSTRUCTOR: DR.SHADI ALSHADFAN,

DR.FIRAS ABU SNEINEH