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CHRONIC HEPATITIS B INFECTION WITH HIGH INFECTIVITY

Nursing Management of a Gastroenterology Ward Patient with Chronic Hepatitis B Infection with High Infectivity

Dela Pea, Eugene Peter A. Galindo, Nia Jessica

Our Lady of Fatima University, Quezon City

Nursing Management 2 Nursing Management of Patient with Chronic Hepatitis B Infection with High Infectivity Mr. E.F.S., a 33 year old male client, ranked as private first class, married, residing at Baranggay Sugurong Pili Camarines Sur, with a surgical history of shrapnel removal on left foot secondary to blast injury last 2004 and an appendectomy last 2006, was admitted to AFPMC (Armed Forces of the Philippines Medical Center) on 19 December, 2011 due to hepatitis virus infection. Patient had undergone hepatitis profile 9 days prior to admission and the results revealed a reactive HBaAg EIA, reactive HBeAg, and a reactive anti-HBcAg. Hence, patient was subsequently admitted to the said institution and diagnosed with chronic hepatitis B infection with high infectivity. Unlike hepatitis A virus (HAV), the hepatitis B virus (HBV) is transmitted primarily through blood wether percutaneous or permucosal routes and it can be found in blood, saliva, semen, and vaginal secretions. Majority of the patients are asymptomatic and diagnosis can be confirmed by means of serology. According to Smeltzer (2010), patients with hepatitis can impair the normal functioning of the liver because of viral infection in which there is a significant necrosis and inflammation of the liver cells (hepatocytes) thus producing characteristic cluster of clinical, biochemical, and cellular changes. The nursing care should focus on improving the liver function of the patient thus preventing potential complications and gradually eradicating his problem. Pathophysiology PFC S.E was diagnosed with chronic hepatitis B infection with highly infectivity. The signs and symptoms of hepatitis are: chills, fever, diarrhea, fatigue, abdominal pain, loss of appetite, nausea, vomiting, jaundice, malaise, rashes, dyspepsia, general aching, weakness, joint pain, dark urine with light stool and upper quadrant pain. According to Navales (2010), the risk factors are direct exchange of contaminated blood and contacts with human secretions and stools. Additional for that, Bare (2010) stated that it can be acquire through intimate contact with carrier or those with acute disease, by sexual oral-

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oral contact and transmission from mother to infant. Ignatavicius (2006) also added that it can be transmitted through blood transfusion, hemodialysis, and accidentally needle pricked. Duncan (2005) cited that it can be acquire through blood products or secretion, exposure to contaminated needle and multiple partners.

History

Patient E.F.S. is a 33 year old male from Baranggay Sugurong Pili Camarines Sur, ranked as a private first class, married, and had a shrapnel removal on left foot secondary to blast injury last 2004. Also, patient had a surgical history of appendectomy and the surgery was done last 2006 in Bicol Medical Center. Patient cannot recall the medications he was taking that time. Mr. E.F.S. does not smoke but drinks alcohol occasionally. Patient has no known history of hypertension, diabetes mellitus and asthma, or having an allergy to any food or medications; but patient has a family history of hypertension. His present condition started 9 days prior to admission when he had undergone hepatitis profile which revealed reactive HBaAg EIA, reactive HBeAg, and a reactive anti-HBcAg. Patient was subsequently admitted to AFPMC (Armed Forces of the Philppines Medical Center) last 19 December, 2011 at exactly 1230H with a chief complaint of hepatitis B infection. Patient was then confined to the said institution specifically in the 5C Gastroenterology Ward cubicle F bed number 8. Nursing Assessment PFC S.E. was alert, conscious, and ambulatory. The patients skin were normal, general uniform, no presence of edema, no presence of lesions, moisture of skin were normal and temperature of the skin were normal also. The patients hair was evenly distributed, thick, textures were silky and oily, no presence of infection, and the hair amount were variable. The nails of the patient were convex curvature, smooth, and the color was pink. The head were rounded, no presence of nodules, no presence of edema,

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and the facial movements were symmetric and the facial features were symmetric also. The eyebrows of the patient were evenly distributed, symmetrically aligned, eyelashes were equally distributed. The eyelids of the patient were intact, the bulbar conjunctiva was pink in color, and pupil is brown in color. The ears of the patient were same as facial skin, symmetrical aligned, normal voice tone, audible, mobile, firm, and tender. The nose were symmetrical in the midline, the air were freely throughout the nares when breathing and the nasal septum were intact in midline. The mouth were pink in color both lower and upper lips. The surfaces of the tongue were pink in color and it moves freely. The left and right arms can flexed and no lesions at all. The abdomen and have scar in left part with 4 inches because of appendectomy last 2006. The left and right lower extremities can flexed no lesion at all, and have a scar in left feet with 1 inch because of the gunshot. The patient weight of the patient is 55 kilograms and the height is 165 centimeters. The patient diet were DAT (diet as tolerated), examples are: meat, fish, pork, chicken, vegetable, fruits, milk, and others. Related Treatments Upon admission the patients orders were following: multivitamins + phospholipids (essential forte), 1 capsule, TID (trice a day), for normalize liver function. Additional medications are: silymarine, 2 capsule, BID (twice a day), for hepatitis protection. And last the entecavir, 0.5miligrams, OD (once a day), for anti invectives. The was diagnostic procedure done to the patient was: CBC (complete blood count) in includes the counts of normal value that blood have according to Polaska (1996). Additional for that Workman (2006) cited that it includes the number of studies of red blood cells counts, white blood cells count, hematocrit, and hemoglobin level of the blood. And he undergone with serology, it marks of viral hepatitis are presents in patient according to Tatro (1996). Burke (2004) said that serology can determine when it increases the liver damage of the patient. And last the AST (aspartate serum transferase) it is the first to elevate and begin to fall as bilirubin starts to increase in liver Smeltzer (2004).

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Nursing Care Plan Mr. E.F.S nursing diagnosis is impaired liver functioning related to destruction of the liver cells secondary to the disease process (Bare, 2010). In chronic persistent hepatitis, there is a subsequent damage in the liver and some may deteriorate rapidly with liver failure (Timby, 2006). Hepatitis B profile of the patient revealed a high viral load of hepatitis B virus in his system and serologic studies revealed reactive antigenic materials and Hinkle (2008) claimed that serologic studies can also detect specific viral antibodies such as anti-HBc and anti-HBs. Also, Roe (2007) stated that presence of hepatitis B surface antigen (HBsAg) and hepatitis B early antigen (HBeAg) is often associated with progression to chronic hepatitis which will contribute to a dysfunctional liver. The short term goal is to focus on improving liver function (Cheever, 2008). Nursing interventions for the patient includes assessing the results of laboratory procedures, proper diet, managing fluid balance, preventing transmission of disease, promote rest, importance of supplemental vitamins and some medication restrictions. Ignatavicius (2006) stated that it is a vital role of the nurse to assess the results of laboratory studies such as liver function tests in order to determine any positive development and to ascertain progression of the disease. Proper diet such as high calorie, low fat and high carbohydrate meals should be implemented because it is more easily digested and more palatable (Black, 2005) and according to Smeltzer (2008), increase intake of high caloric diet and high carbohydrate diet may prevent hypoglycemia due to decrease hepatic glycogen reserves. Carpenito (2000) also added that patient with liver problem should decrease or restrict sodium intake to prevent risks for fluid volume excess and edema formation. Patient should also be educated about fluid balance because according to Bare (2010), patients with impaired liver function usually developed edema caused by hypoalbuminemia. The nurse should also inform the family members and friends who have had intimate contact with the patient about the risks of contracting the disease as claimed by Brunner (2010). Promote

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rest because as what Perry (2009) had said that rest reduces the demands on the liver and increases the livers bloody supply thus reestablishing its functional ability. According to Hawks (2005), supplementation of vitamins such as sylimarin is necessary in maintaining an optimal functioning of the liver and reduces effects of hepatitis and administration of some medications such as acetaminophen is given infrequently because of its hepatotoxic properties. Recommendations The patient should follow up his medical provider regarding what his treatment next. It is also important and helpful to the patient about keeping follow-up appointments and participating in any health promotion activities and recommended health screening as claimed by Smeltzer (2010). Patient should have lifestyle modifications, such as avoiding alcohol contained substances and eating unsanitary prepared foods, with regards to his rehabilitation program. Discuss to the family about how the diseases prevented and make arrangements for them to receive vaccination and immunoglobulin administration as prescribed (Brunner, 2010). According to Untalan (2008), good and meticulous personal hygiene is still fundamental to infection control and prevention of the transmission of disease. Following the doctors instruction of using medication is very essential and patient should avoid self-medicating or using overthe-counter drugs because some drugs has a toxic effect to the liver and may contribute further damage to the liver (Karch, 2008).

Nursing Management 7 References Bare, B., Smeltzer, S. (2004). Medical and Surgical Nursing (12th edition) p. 1139-1142 Burke, K., Lemone, P. (2004). Medical Surgical Nursing Critical thinking Nursing (3rd edition) p. 582 Duncan, L., While, L. (2005). Medical Surgical Nursing (2nd edition). p. 576 Ignatavicius, D., Workman, L. (2006). Medical Surgical Nursing (5th edition) p. 1382-1383 Lipincotte, W. (2008). Nursing Drug Handbook (28th edition) p. 170 Navales, M. (2010). Hadbook of Common Communicable and Infection Disease (3rd edition) p. 103-104 Polaski, A., Tatro, S. (1996). Core Principle and Practice of Medical Surgical Nursing (5th edition) p. 980-984