ST.

MICHAEL’S COLLEGE
College of Nursing
Quezon Ave., Iligan City

“HEPATITIS B”

Submitted by:

Emma Mariz Bernas Garcia

Elma Bercero
Merlinda Valencia
Azizah Ismael
Aslia Marohom
Theresa Avanzado
Beverly Rosco
Michael Altubar
Benjet Eniola
Jaymar Babate

Submitted to:

Ms. Precious Imam, RN

 Table of contents

Introduction

Overview of the disease

Objectives

Diagnosis

Anatomy and Physiology

Pathophysiology

Planning

Nursing Care Plan

Discharge Care Plan

Implementation

Medical / surgical Management

Drug Study

Evaluation

Prognosis
Conclusion

Recommendations

Bibliography
 Overview of the disease

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.

Among these conditions are:

 Polyarteritis nodosa: a disease characterized by inflammation of the small blood vessels

throughout the body. This condition can cause a wide range of symptoms, including muscle
weakness, nerve damage, deep skin ulcers, kidney problems, high blood pressure, unexplained
fevers, and abdominal pain.

 Glomerulonephritis: another rare condition, which is inflammation of the small filtering units of the
kidney.

Objectives
The objectives of this case study are to:

 Define what Cervical Cancer is.

 Trace the Pathophysiology of the disease,

 enumerate its signs and symptoms,

 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

understanding as well as individualized care.

ANATOMY
 PHYSIOLOGY

Functions of liver:

 Storing vitamins, glucose for energy, and making proteins

 Helping build muscles

 Stopping cuts from bleeding (coagulation)

 Killing germs, helping keep the body healthy (immune system)

 Making bile to help digest foods

 Keeping pollutants or toxins from hurting the body

 Filtering medications, chemicals, and toxins from the body

 Removing waste products of food breakdown

Self-Care at Home
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,

you should avoid alcohol for the rest of your life.

 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.

 Avoid prolonged, vigorous exercise until symptoms start to improve.

 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
Acute hepatitis B infection

The most severe effect of acute hepatitis B is dehydration from vomiting and diarrhea.

 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.

Chronic hepatitis B infection

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

transplant would work for you.

 Liver transplant is a major undertaking with an extended recovery period.

 It also depends on the availability of a matching donor liver.

 If liver transplant becomes a possibility for you, your health care provider will discuss the risks

and benefits with you.

Nursing Intervention:

 If there would be liver transplant, assess the suture area

 Perform sterile techniques

 Provide a clean and safe environment to patient to reduce risk for infection

 Assess pain using pain scale

 Assess health status of the patient

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.

The following groups should be vaccinated for hepatitis B:

 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.

Other ways to protect yourself from HBV infection:

 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

weeks and may be fatal.

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%

will clear the infection.

PATIENT’S PROFILE
Name of Patient: R.B.C Health Insurance: Philhealth

Address: Tubod, Iligan City Source of Information: Chart, SO and Patient

Age: 54 Sex: Male Civil Status: Widow Religion: RC Primary Language : BISAYA

Date Admitted: 08/09/10 Time: 4:35 pm Weight: 60 kg Height: Unknown

Arrived via: Wheelchair Stretcher Ambulatory

Blood Reaction: Yes No Dyes/Shellfish: Yes No

Admitting Physician:

Attending Physician: Guitarte, Sanson, MD

NURSING ASSESSMENT

1. Chief Complaint:

Weakness

2. History of Present Illness:

PTA patient experience body weakness for almost a month.

3. Medical History:

Cardiac_____________________ Gastro________________________
Hyper/hypotension Family Arthritis Family
Diabetes____________________ Stroke_______________________
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
Pt. Initials: Chief Complaint:
Body REMARKS
System COLOR ALL ABNORMAL FINDINGS IN PINK AND NORMAL IN GREEN (DIAGNOSTIC,
LABS, ETC)
LOC: Alert Sedated Lethargic Unresponsive
Orientation: Person, Place, purpose, Time (x4) There is
Behavior: appropriate inappropriate (describe) numbness in the
Coordination/equilibrium: Gait Dizziness Vertigo sensation. And
Neuro Ext Strength: Strong Weak Flaccid MAE Equal Unequal (describe) pain in the
Speech: Clear Coherent Slurred Appropriate aphasia abdomen at the
Sensation: Intact Numbness Tingling Pupils: equal reactive rate of 4
Pain: 4 present (0-10) in the abdomen controlled PCA
Glasgow Coma Scale Total 15 Alert-follows simple commands
Apical Pulse: Regular Irreg/irreg Reg/irreg Murmur/rub Hard to hear, unable to Heart sounds are
hear heart sounds heart to hear and
Radial 60 Pedal (absent/diminished/normal/bounding) 58 Equal: Y/N not able to get
CV Rate: Apical not able to count Radial 60 Pulse Deficit? Y/N We can’t say if there’s apical pulse.
pulse deficit here because we’re not able to get the apical pulse Edema on upper
Edema: Y/N Location: Upper Extremities and Lower extremities and lower
Scale: (0-+4) + 2 extremities.
Cap refill: < 3sec in hands >3 sec on feet Skin color: Black and yellowish eyes
Telemetry: Rhythm____________________ BP:
Hydration: Tenting <3 sec >3 sec Fontanels
Rate: 21 Pattern: Regular Irregular Apnea___ sec Not able to get the
Effort: labored unlabored Airway: not obstructed: without congestion lung sound
Accessory muscle use: Y/N because patient
Depth: Normal Shallow Deep has the difficulty to
Breath Sounds: Clear all lobes (not clear) not able to determine because is unable to sit move.
Resp Adventitious: (location) RLL RML RUL LLL LUL
Cough: Y/N Nonproductive Productive- Sputum (color, amount, swallows, odor, consistency):
O2 device: Venti-mask, NC, NRBM, simple mask NONE
O2 flow;____ L/min or ____% SpO2 ______%
Trach present: Y/N Type, size, cuff inflated/deflated NONE
Appearance: intact warm/dry cool/moist lesions (location) Skin is dry, cool,
Pressure sites: Induration,hyperemia, breakdown, blanches with return of color NONE and moist but no
Ulcers: size stage tunneling necrotic tissue exucate epithelialization NONE ulcers are found.
Integu- Wounds: location/condition/drainage NONE Mucous membranes: moist/dry
mentary Suture line: red, swollen, approximated Sutures/staples/steri-strips NONE
Dressing intact/absent. Needs changing Y/N NONE
IV site condition: patent redness swelling pain
IV insertion date 01/13/10 Catheter gauge: 20
IV solution: PNSS Rate: 20 gtts/min
Mobility: 3 , but there’s a “BIG BUT” Strength: WEAK Patient can move
Musculo/ Muscle tone: good Gait: not able to determine however d/t
Skeletal ROM: Full ( passive) Limited (describe) wt. bearing Y/N weakness he does
Equipment: CPM Traction Splint Cast Pins walker NONE not want to move.
Location NONE
Abdo: flat rounded distended soft firm tender non-tender girth__cm Rounded
BS: Active Hyper Hypo Absent Locations: RUQ, RLQ, LUQ, LLQ abdomen with
Hypo – RUQ , LUQ tenderness on the
Flatus NONE Continent/incontinent : defecation is Normal RUQ of the
Nausea/emesis: No Yes: describe NONE abdomen. and a
GI Gag reflex: Y/N Chews/swallows without difficulty hypo BS in both
Stool: color, consistency, amount, heme+/- NOT ABLE TO OBSERVE UQ and active in
NG: verified placement Y/N How:__ Suction:__cm intermittent/continuous LQ.
Enternal feeding: NONE
Ostomy: N/Y (describe type, drainage) NONE
Drainage tubes: (describe type, location, drainage) NONE
Diet:
Bladder distended on palpation: NO Y/N 24 hr intake___ output___Not able to get Urine is dark no
Urine: color : Dark sediment ND odor ND penile lesions.
Foley: Y/N Size:18F Type: indwelling condom; taped Y/N
GU Voiding: frequency burning residual incontinent/continent urgency dysuria
Penile lesions/discharge (describe)
Vaginal lesions/discharge (describe)
Sleep pattern : disturb Support system: family Patient sleeps at
Psycho- Emotional/behavior status: patient’s behavior is appropriate night for 2 hours
social Appearance and general behavior: WEAK Concerns/expectations (Tx, recovery) only due to
Attitude: Calm Marital Status: Widow Religion: RC disturbed sleeping
Cultural/Spiritual Practices: Christian culture pattern
Normal v/s.
VS Temp: 36.2C Pulse: 86 BPM Resp: 20cpm BP: 100/70 mmHg
Nursing Care Plan
Nursing diagnosis:

Fatigue r/t poor physical condition

Goal:

 Patient verbalizes having sufficient energy to complete desired activities.


Action/Interventions:

 Assess characteristics of fatigue:

 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.

 Assess for possible causes of fatigue:

 Recent physical illness

 Emotional stress
 Depression
 Medication side effects
 Anemia
 Sleep disorders
 Imbalanced nutritional intake
 Increased responsibilities and demands at home or work

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

 Evaluate laboratory/diagnostic test results:

 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.

 Give appropriate diet to the patient

Nursing Care Plan

Nursing diagnosis:

Imbalanced Nutrition; Less than Body Requirements r/t insufficient intake to meet metabolic demand

Goal:

 Initiate behaviors, lifestyle changes to regain/ maintain appropriate weight.

 Demonstrate progressive weight gain toward goal with normalization of laboratory values and no
signs of malnutrition.

Action/Interventions:

 Monitor dietary intake/calorie count. Suggest several small feedings and offer “largest” meal @
breakfast. Large meals are difficult to manage when patient is anorexic. Anorexia may also
worsen during the day, making intake of food difficult later in the day.
 Encourage mouth care before meals. Eliminating unpleasant taste may enhance appetite.
 Recommend eating in upright position. Reduces sensation of abdominal fullness and may
enhance intake
 Encourage intake of fruit juices, carbonated beverages, and hard candy through out the day.
These supply extra calories and may be more easily digested/tolerated than other foods

Collaborative:

 Consult dietitian, nutritional support team to provide diet according to patient’s need, with fat and
protein intake as tolerated. Useful in formulating dietary program to meet individual needs.
Fats vary according to bile production and excretion and may necessitate restriction of fat
intake if diarrhea develops. If tolerated, a normal or increased protein intake helps the liver
to regenerate. Protein restriction may be indicated in severe disease because the
accumulation of the end products of protein metabolism can potentiate hepatic
encephalopathy.
 Monitor Serum glucose as indicated. Hyperglycemia/ hypoglycemia may develop,
necessitating dietary changes /insulin administration.
 Administer medications as indicated:
o Antiemetic - Given ½ hr before meals, may reduce nausea and increase food
tolerance.
o Antacids - Counteracts gastric acidity, reducing irritation/ risk of bleeding
o Vitamins – Correct deficiencies and aids in healing process

Nursing Care Plan

Nursing diagnosis:

Risk for fluid volume deficit r/t excessive losses through vomiting and diarrhea

Goal:

 Maintain adequate hydration

Action/Interventions:

 Monitor I and O, compare with periodic weight. Note enteric losses. E.g. vomiting and diarrhea.

Provide information about replacement needs/ effects of therapy.

 Assess vital signs, peripheral pulses, capillary refill, skin turgor, and mucous membranes.

Indicators of circulating volume/ perfusion.

Collaborative:

 Monitor periodic laboratory values, e.g. Hb/Hct, Na, albumin, and clotting times. Reflects

hydration and identifies sodium retention/ protein deficits, which may lead to edema

formation. Deficits in clotting potentiate risk of bleeding/ hemorrhage.

 Administer antidiarrheals agent. Reduces fluid/ electrolyte loss from GI tract,

 Provide IV Fluids, electrolytes. Provides fluid and electrolyte replacement in acute toxic

state.

 Protein hydrolysates. Correction of albumin/ protein deficits can aid in return of fluid from

tissues to the circulatory system

Nursing Care Plan

Nursing diagnosis:

Risk for infection r/t inadequate secondary defenses and immunosuppressed

Goal:

 Verbalize understanding of individual causative/risk factor(s).

 Demonstrate techniques; initiate lifestyle changes to avoid reinfection/transmission to others.

Action/Interventions:

 Establish isolation technique for enteric and respiratory infections according to infection

guidelines. Encourage effective hand washing. Prevents transmission of viral disease to

others. Thorough hand washing is effective in preventing virus transmission.

 Stress need to monitor/ restrict visitors as indicated. Patient’s exposure to infectious process

potentiates risk of secondary complication.

 Explain isolation procedure to the patient. Understanding the reason for safeguarding

themselves and others can be lessening feelings of isolation and stigmatization. Isolation

may last 2-3 wk from onset of illness, depending on types of symptoms.

 Give information regarding availability of gamma globulin, ISG, H-BIG, HB vaccine, through

health department or family physician. Immune globulin may be effective in preventing viral

hepatitis in those who have been exposed, depending on type of hepatitis and period of

incubation.

Collaborative:

 Administer medication as indicated:

o Antiviral drugs – Useful in chronic active hepatitis

o Antibiotics – Use to treat bacterial hepatitis or to prevent / limit secondary

infections.

Nursing Care Plan

Nursing diagnosis:

Risk for impaired skin integrity r/t bile slat accumulation in the tissue

Goal:

 Display intact skin/tissues, free of excoriation.

 Report absence/decrease of pruritus/scratching.

Action/Interventions:

o Encourage use of cool showers and baking soda or starch baths. Avoid use of alkaline soaps.
Apply calamine lotion as indicated. Prevents excessive dryness of skin. Provides relieve from
itching.
o Provide diversional activities. Aids in refocusing attention, reducing tendency to scratch.
o Suggests use of knuckles if desire to scratch is uncontrollable. Keep fingernail cut short, apply
gloves on comatose patient/ during hours of sleep. Recommend loose- fitting clothing. Provide
soft cotton linens. Reduces potential of dermal injury.
o Provide a soothing massage @ bedtime. May be helpful in promoting sleep by reducing skin
irritation.
o Observe skin for the areas of redness, breakdown. Early detection of problem areas allows of
additional intervention to prevent complications/ promote healing.
o Avoid comments according to patient’s appearance. Minimizes psychological stress
associated with skin changes.

Collaborative:

o Administer medication as indicated:

 Antihistamine – relieves itching. Note. Use cautiously in severe hepatic disease.

 Antilipemics - May be use to bind bile acids in the intestine andprevent their

absorption.

Nursing Care Plan

Nursing diagnosis:

Fluid volume excess related to compromised regulatory mechanism.

Goal:

 Patient will demonstrate stabilized fluid volume and decreased edema.

Action/Interventions:

 Measure intake and output, weigh daily, and note weight gain more than 0.5 kg/day. Reflects
circulating volume status, Positive balance/ weight gain often reflects continuing fluid
retention.
 Assess respiratory status, noting increased respiratory rate, and dyspnea. Indicative of
Pulmonary congestion
 Monitor blood pressure. Blood pressure elevation usually associated with fluid volume
excess but may not occur because of fluid shifts out of the vascular space.
 Auscultate lungs, noting diminished/ absent breath sounds and developing adventitious sounds.
Increasing pulmonary congestion may result in consolidation, impaired gas exchange, and
complications.
 Assess degree of peripheral/ dependent edema. Fluid shift into tissues as a result of sodium
and water retention, decreased albumin, and increased anti diuretic hormone (ADH).
 Measure abdominal girth. Reflects accumulation of fluid (ascites) resulting from loss of
plasma proteins or fluid into peritoneal space
 Encourage bed rest when ascites is present. May promote recumbency induced diuresis.

Collaborative:

 Administer medications as indicated. Such as diuretics. To control edema and ascites.

 Monitor electrolytes. To correct further imbalances.

Lab result (8/11/10)

 Result Normal Result Result Normal Result
Urea 2.5- 8.3 mmol/ SGPT (alt) Up to 35
L
Creatinine 210 60- 115 umol/ SGPT (ast) Up to 46
L
Glucose fasting 3.9- 6.1 LDH 200 – 400
Glucose Alkaline 100 – 290
random phosphate
Glucose 1o Acid phosphate 100 – 290
OGTT
Glucose 2o 2HPP8S Lipase
OGTT
Glucose 3o Amylase < 90 ul
OGTT
Uric acid 202- 412 Total protein 6.4 – 8.3
serum
Cholesterol 3.5- 6.5 Albumin serum 3.5 – 5.0
Triglycerides 0 – 1.96 Globulin serum
Sodium 135 – 145 a/g ratio
Chloride Total bilirubin Up to 1.0
Potassium 3.0 3.5 – 5.3 Direct biliburin Up to 0.30
Calcium 8.5 – 10. 5 Indirect
biliburin
Phosphory HBA IC 4.8 – 5.9 %
HDL >13 Total protein
urine
LDL < 4.0 Amylase urine
CPK- Total Total protein 8 – 43
CSF
CPK- MD Glucose CSF 5.9 – 6.0
Troponin hgt

Result Normal Value Remarks

Hgb. 110 120-170g / L
Hematocrit .20 0.37-0.54 x 10 9 Hct.
WBC 40 4.5-10.0 x 1012
Segmenters 0.71 0.50-0.70 Segmenters
Lymphocytes 0.15 0.20-0.40
Monocytes 0.05 0.0-0.07

X – Ray Chest

Impression: Essentially normal lungs. Slight Cardiomegaly; Atherosclerotic aorta.

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

further complications also.

Recommendation
o Patient should follow doctor’s order according to his health status

o Patient should abstain from sex or anything that could transmit the virus to other person

o Patient should stop in drinking alcohol and abusing drugs

o Recommends to have the Hepa B vaccine to protect from this virus

 Bibliography

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