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AN

ASSIGNMENT

ON

NURSING ASSESSMENT OF HEPATITIS AND

CARE PLAN FOR THE DIFFERENT TYPES OF HEPATITIS

WRITTEN BY:

AMANG, AMANG OTEI

16/02245012

DEPARTMENT OF NURSING SCIENCE

FACULTY OF ALLIED MEDICAL SCIENCES

UNIVERSITY OF CALABAR, CALABAR

SUBMITTED TO:

MR. NDUKA (COURSE LECTURER)

DEPARTMENT OF NURSING SCIENCE

FACULTY OF ALLIED MEDICAL SCIENCES

UNIVERSITY OF CALABAR, CALABAR

IN PARTIAL FULFILLMENT OF THE COURSE REQUIREMENT:

MEDICAL SURGICAL NURSING 4 (NSC 332)

SEPTEMBER 2019
NURSING ASSESSMENT OF HEPATITIS

The nurse's role in the care of clients with acute viral hepatitis is based upon a nursing assessment of the
client and his family system, diagnosis and planning for the individual needs of the client, and
anticipatory guidance related to the client's return to the family and community.

Assessment

All patients with CHB should have a thorough initial assessment. A clinical history should be taken that
includes ethnicity, place of birth, risk factors for acquiring the hepatitis B virus (HBV), family history of
CHB or hepatocellular carcinoma (HCC), any previous HBV medication and any factors that could
influence disease progression (Lee et al, 2010).

A physical examination should be carried out to look for signs and symptoms of liver disease and all
patients should have a baseline liver ultrasound. Laboratory investigations to check for other forms of
liver disease or bloodborne viruses should be part of the initial assessment and include HBV serology
(including genotype), assessment of liver enzymes and hepatic function, metabolic liver disease screen,
renal and bone profile, full blood count and INR (international normalised ratio), alpha-fetoprotein and
co-infections with HIV, hepatitis C virus or hepatitis D virus (delta virus) (B Positive, 2008).

NURSING CARE PLAN FOR THE DIFFERENT TYPES OF HEPATITIS

S/N NURSING NURSING NURSING SCIENTIFIC EVALUATION


DIAGNOSIS OBJECTIVES INTERVENTIONS RATIONALE

1 Nutrition; -Initiate - Monitor dietary - Large meals


imbalanced less behaviours, intake calorie count, are difficult to
than body lifestyle suggest several small manage when
requirements changes to feeding and offer patient is
related to regain/maintai "largest" meal at anorexic.
insufficient n appropriate breakfast Anorexia may
intake to meet weight. also worsen
metabolic - Encourage mouth during the day,
-Demonstrate care before meals.
demands making intake
(anorexia, progressive Recommend eating of food difficult
weight gain in upright position
nausea and later in the day
vomitting). toward goal
with - Encourage intake of -Eliminating
Altered fruit juices, carnated
absorption and normalisation unpleasant
beverages, and hard
metabolism and of laboratory candy throughout taste may
of ingested values and no the day enhance
foods signs of appetite .
malnutrition
Evidence by - Reduce
aversion sensation of
aversion to abdominal
eating / lack of fullness and
interest in food; may enhance
altered taste intake
sensation,
abdominal -These supply
extra calories
pain/cramping,
loss of weight; and may be
more easily
poor muscle
tone digested/
tolerate than
other foods

2 Infection, risk -Verbalize -Establish isolation -Prevent


for inadequate understand of techniques for transmission of
secondary individual enteric and viral disease to
defenses e.g causative/risk respiratory infection others.
leukopenia and factors according to Thorough hand
immunosuppres infection guidelines/ washing is
sion -Demonstrate policy effective in
techniques;
malnutrition preventing
initiate - Encourage/ model virus
- Insufficient lifestyle effective hand transmission.
knowledge to changes to washing Type A and E
avoid exposure avoid are transmitted
to pathogens reinfection/ by oral-fecal
transmission
Evidence by route.
to others Contaminated
presence of and
symptom water, milk and
establish an food (especially
actual diagnosis inadequately
cooked
shellfish). Type
A,B,C and D are
transmitted by
contaminated
blood, blood
products
needle,
punches,open
wounds and
contact with
saliva, urine
stool and
semen.
Incidence of
both hepatitis B
virus (HBV) and
hepatitis C virus
(HCV) has
increased
among health
care providers
and high-risk
patients.

3 Risk for fluid Maintain - Monitor intake and - Provides


volume related adequate output chart, information
to excessive hydration,as compare with about
loses through evidence by periodic weight. replacement
vomitting and stable vital Example; enteric needs effect of
diarrhoea, Third signs, good losses (vomitting and therapy.
space shift, skin turgor, diarrhoea). Diarrhoea may
altered clothing capillary refill, be due to
process. strong transient flulike
Evidenced by peripheral response to
presence of pulses, and viral Infection
signs and individual or may
symptoms appropriate represent a
establishes an urinary more serious
actual diagnosis output. problem of
obstructed
portal blood
flow with
vascular
congestion in
the GI tract.
References

1. World Health 0rganization. What is hepatitis? who.int/features/qa/76/en/ (accessed 6 April 2016).

2 British Liver Trust. Hepatitis B. britishlivertrust.org.uk (accessed 10 April 2016).

3. The Lancet Commission. Addressing liver disease in the UK: a blueprint for attaining excellence in
health care are reducing premature mortality from lifestyle issues of excess consumption of alcohol,
obesity and viral hepatitis. The Lancet 2014;27:1-45.

4. Public Health England. Hepatitis B: guidance, data and analysis, 2014.


gov.uk/government/collections/hepatitis-b-guidance-data-and-analysis#diagnosis-and-management.
(accessed 8 April 2016).

5. Health and Safety Executive. Hepatitis B virus, 2015. hse.gov.uk/biosafety/blood-borne-


viruses/hepatitis-b.htm. (accessed 15 April 2016).

6. Hawley C. Understanding viral hepatitis: as easy as A,B C. British Journal of Primary Care Nursing
2012;9:1.

7. NHS Choice. Hepatitis B. nhs.uk/conditions/Hepatitis-B/Pages/Introduction.aspx (accessed 6 April


2016).

8. Perillo R. Benefits and risks of interferon therapy for hepatitis B. Hepatology 2009;49:103-11.

9. Pol S, Lampertico P. First-line treatment of chronic hepatitis B with Entecavir or Tenofovir in


'reallife' settings: from clinical trials to clinical practice. Journal of Viral Hepatitis 2012;19 (6):377-386.
10. NHS England (B07/P/a). Clinical Commissioning Policy Statement: Treatment of chronic hepatitis C
in patients with cirrhosis, 2015. england.nhs.uk/commissioning/wp
content/uploads/sites/12/2015/06/hep-c-cirrhosis-polcy-statmnt-0615.pdf (accessed 6 April 2016).

11. Public Health England. Hepatitis C in the UK 2015 Report, July 2015. PHE publications number:
2015208

12. NICE. Hep B and Hep C testing: people at risk of infection, 2012.
nice.org.uk/guidance/ph43/chapter/1-recommendations#/recommendation-5-testing-for-hepatitis-b-
and-c-in-prisons-and-immigration-removal-centres (accessed 5 May 2016).

13. British Liver Trust. Hepatitis C, 2016. britishlivertrust.org.uk.

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