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Hepatitis B (HBV), Robyn Harris, References, VanMeter, K.C. & Hubert,…
Hepatitis B (HBV)
About Hepatitis B
Pathophysiology
inflammation of the liver, is a type of viral hepititis
damages liver cells via cell-mediated immune responses to the virus
results in inflammation and necrosis in the liver (chronic in hepatitis B, persisting for more than 6 months)
eventually causes permanent liver cirrhosis, increased rates of hepatocellular cancer associated with the disease as well
may exist in a 'carrier state': can be infectious while being asymptomatic
Etiology
more than half of those who test HIV-positive also test positive for hepatitis B
estimated that 2 billion people have hepatitis B
50% of cases are asymptomatic
double-stranded DNA virus called the hepatitis B virus (HBV)
3 atnigens - two core and one surface
helpful for diagnosing and monitoring the course of development for the disease
incubation period of ~2 months, making it hard to track sources of infection
transmitted primarily via infected blood; also found in many body secretions
risk factors
being an IV drug user
being on hemodialysis
exposure to bodily fluids or blood, such as in health care
pregnancy can pass the disease to the fetus
tattooing or body piercing
Signs and Symptoms
can be asymptomatic
preicteric stage: fatigue, nausea, anorexia, muscle aches, fever, mild URQ discomfort, elevated AST and ALT levels
icteric stage: jaundice, light coloured stools, dark urine, pruritic skin, hepatomegaly, prolonged blood clotting
posticteric stage: marked reduction of signs, prolonged over ~16 weeks
Treatment
HBV vaccine gives long term protection for high-risk groups
health professionals
routinely administered to children
hepatitis B virus immune globulin (temporary measure)
gamma globulin may help if given early on in the course of the disease
supportive measures most helpful: rest, high protein/carb/vitamin diet
interferon alpha or lamivudine to decrease viral replication (only effective in 30-40% of individuals)
Nursing Implications
Assessment
serum levels of liver enzymes
health history (including travel history, medication history, any drug use in the past, etc)
symptoms such as weight loss, rashes or hives, RUQ pain, jaundice, dark urine, light colored stools, or fatigue
fever, lethargy, rash or other skin changes
hepatomegaly or splenomegaly
positive tests for hepatitis B
Nursing Diagnoses
imbalanced nutrition: less than body requirements related to insufficient dietary intake
activity intolerance related to weakness and fatigue
risk for impaired liver function as evidenced by viral infection
knowledge deficiency related to condition, prognosis, prevention, or treatment
Nursing Interventions
manage fatigue with actions such as encouraging rest, stress-management techniques, frequent position changes to maintain skin integrity
monitor nutritional contents such as input and output, weight changes, encourage fluids, provide calorie-dense snacks between meals
minimize infection spread by ensuring proper hand hygiene, employ isolation techniques for those most at-risk for contracting infection
encourage and educate client on preventative measures such as vaccination and aseptic needle techniques, provide education to client and family around hepatitis B, including risk factors, prognosis, etc.
Robyn Harris
References
VanMeter, K.C. & Hubert, R.J. (2018). Gould's Pathophysiology for the Health Professions (6th ed.). Saunders.
Lewis, S. L., Bucher, L., Heitkemper, M. M., Harding, M. M., Barry, M. A., Lok, J., & Goldsworthy, S. (2017). Medical-Surgical Nursing in Canada: Assessment and Management of Clinical Problems (4 edition). Elsevier.
Doenges, M. E., Moorhouse, M. F., & Murr, A. C. (2014). Nursing Care Plans: Guidelines for Individualizing Client Care Across the Lifespan