Hepatitis A, B, and C its management and treatment


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Hepatitis A,B, and C, its prevention, management, medical treatment and its pathophysiology.

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Hepatitis A, B, and C its management and treatment

  1. 1. Hepatitis A, B, and C Its prevention, nursing management, and medical treatment Presented by: Dave Jay S. Manriquez RN.
  3. 3. PREVENTION <ul><li>If already infected with HAV </li></ul><ul><ul><li>Wash your hands thoroughly every time you use the bathroom, before touching or preparing food, and before touching others. Wash carefully with soap and warm water and dry thoroughly. </li></ul></ul><ul><ul><li>Contaminated surfaces should be cleaned with household bleach to kill the virus. </li></ul></ul><ul><ul><li>Heat food or water to 185°F or 85°C to kill the virus. </li></ul></ul><ul><ul><li>NOTE: Strict personal hygiene and hand washing help prevent transmission of HAV to others. </li></ul></ul>
  4. 4. PREVENTION… <ul><li>If NOT yet Infected with HAV </li></ul><ul><ul><li>Wash your hands carefully with soap and warm water several times a day, including every time you use the bathroom, every time you change a diaper, and before preparing food. </li></ul></ul><ul><ul><li>Do not eat raw or undercooked seafood or shellfish such as oysters from areas of questionable sanitation (just about everywhere). </li></ul></ul><ul><ul><li>Travelers to developing countries should not drink untreated water or beverages with ice in them. Fruits and vegetables should not be eaten unless cooked or peeled. </li></ul></ul>
  5. 5. Vaccines that Work against HAV <ul><li>Havrix and VAQTA </li></ul><ul><ul><li>contain no live virus and are very safe </li></ul></ul><ul><ul><li>given in a series of 2 shots. The second is given 6-18 months after the first. </li></ul></ul><ul><ul><li>protection starts about 2-4 weeks after the first shot. The second dose is necessary to ensure long-term protection. </li></ul></ul><ul><ul><li>thought to protect from infection for at least 20 years </li></ul></ul><ul><ul><li>must be given before exposure to the virus </li></ul></ul>
  6. 6. Groups Recommended to have the HAV Vaccine <ul><li>All children older than 2 years who live in communities where the number of HAV infections is unusually high or where there are periodic outbreaks of hepatitis A </li></ul><ul><li>People who are likely to be exposed to HAV at work </li></ul><ul><li>. Travelers to developing countries (it must be given at least 4 weeks before travel) </li></ul><ul><li>Men who have sex with men </li></ul><ul><li>People who use illegal drugs </li></ul><ul><li>people with impaired immune systems or chronic liver disease </li></ul><ul><li>People with blood-clotting disorders who receive clotting factors </li></ul>
  7. 7. MEDICAL TREATMENT <ul><li>No specific medicines to cure infection with hepatitis A </li></ul><ul><li>immune globulin - given to people who are likely to be exposed to someone who is infected with HAV </li></ul>
  8. 8. MEDICAL TREATMENT … <ul><ul><li>Bed rest during the acute stage and a diet that is both acceptable to the patient and nutritious are part of the treatment and nursing care. </li></ul></ul><ul><ul><li>During the period of anorexia, the patient should receive frequent small feedings, supplemented, if necessary, by IV fluids with glucose. </li></ul></ul><ul><ul><li>If dehydration occurs, IV fluids are being prescribed to help the patient feel better. </li></ul></ul>
  9. 9. MEDICAL TREATMENT… <ul><ul><li>Medicines are being prescribed by the physician to control nausea and vomiting. </li></ul></ul><ul><ul><li>People whose symptoms are well-controlled can be cared for at home. If dehydration or other symptoms are severe, then the patient is managed at the hospital. </li></ul></ul><ul><ul><li>Gradual but progressive ambulation seems to hasten recovery, provided the patient rests after activity and does not participate in activities to the point of fatigue. </li></ul></ul>
  10. 10. Dietary Management <ul><li>Recommend small, frequent meals. </li></ul><ul><li>Provide intake of 2,000 to 3,000 kcal/day during acute illness. </li></ul><ul><li>Although early studies indicate that a high-protein, high-calorie, diet may be beneficial, advise patient not to force food and to restrict fat intake. </li></ul><ul><li>Carefully monitor fluid balance. </li></ul>
  11. 11. Dietary Management <ul><li>If anorexia, nausea and vomiting persist, enteral feedings may be necessary. </li></ul><ul><li>Instruct patient to abstain from alcohol during the acute illness and for 6 months after recovery. </li></ul><ul><li>Advise patient to avoid substances (medication, herbs, illicit drugs and toxins) that may affect liver function. </li></ul>
  12. 12. NURSING MANAGEMENT <ul><li>The patient is usually managed at home unless symptoms are severe. </li></ul><ul><li>The nurse assists the patient and family in coping with temporary disability and fatigue that are common in hepatitis and instructs them to seek additional health care if the symptoms persist or worsen </li></ul>
  13. 13. Self-Care at Home <ul><li>Take it easy; curtail your normal activities and spend time resting at home. </li></ul><ul><li>Drink plenty of clear fluids to prevent dehydration. </li></ul><ul><li>Avoid medicines and substances that can cause harm to the liver such as acetaminophen (Tylenol) and preparations that contain acetaminophen. </li></ul>
  14. 14. Self-Care at Home… <ul><li>Avoid alcoholic beverages, as these can worsen the effects of HAV on the liver. </li></ul><ul><li>Avoid prolonged, vigorous exercise until symptoms start to improve. </li></ul><ul><li>Call your health care provider if symptoms worsen or a new symptom appears. </li></ul><ul><li>Be very careful about personal hygiene to avoid fecal-oral transmission to other members of the household. </li></ul>
  15. 15. HEPATITIS B
  16. 16. PREVENTION <ul><li>immune globulin (BayHep B, Nabi-HB) </li></ul><ul><ul><li>given along with the hepatitis B vaccine to unvaccinated people who have been exposed to hepatitis B </li></ul></ul><ul><li>Engerix -B , Recombivax HB </li></ul><ul><ul><li>safe and works well to prevent the disease </li></ul></ul><ul><ul><li>a total of 3 doses of the vaccine are given over several months </li></ul></ul><ul><ul><li>recommended for all children younger than 19 years </li></ul></ul>
  17. 17. Groups Recommended to have the HBV Vaccine <ul><li>1. All children younger than 18 years, including newborns--especially those born to mothers who are infected with HBV. </li></ul><ul><li>2. All health care and public safety workers who may be exposed to blood </li></ul><ul><li>3. People who have hemophilia or other blood clotting disorders and receive transfusions of human clotting factors </li></ul><ul><li>4. People who require hemodialysis for kidney disease </li></ul>
  18. 18. Groups Recommended to have the HBV Vaccine… <ul><li>5. 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. </li></ul><ul><li>6. People who are in prison </li></ul><ul><li>7. People who live in residential facilities for developmentally disabled persons </li></ul>
  19. 19. Groups Recommended to have the HBV Vaccine… <ul><li>8. People who inject illegal drugs </li></ul><ul><li>9. People with chronic liver disease such as hepatitis C </li></ul><ul><li>10. People who have multiple sex partners or have ever had a sexually transmitted disease </li></ul><ul><li>11. Men who have sex with men </li></ul>
  20. 20. Other ways to protect yourself from HBV infection <ul><li>Safe Sex </li></ul><ul><li>Don't share needles or other sharp equipments such as razors </li></ul><ul><li>Health care workers should follow standard precautions and handle needles and sharps safely </li></ul><ul><li>Think about the health risks if you are planning to get a tattoo or body piercing </li></ul>
  21. 21. MEDICAL TREATMENT <ul><li>Acute hepatitis B infection </li></ul><ul><ul><ul><li>If dehydration occurs, IV fluids are being prescribed to help the patient feel better. </li></ul></ul></ul><ul><ul><ul><li>Medicines are being prescribed by the physician to control nausea and vomiting. </li></ul></ul></ul><ul><ul><ul><li>People whose symptoms are well-controlled can be cared for at home. If dehydration or other symptoms are severe, then the patient is managed at the hospital </li></ul></ul></ul><ul><li>NOTE: No treatment can prevent acute HBV infection from becoming chronic </li></ul>
  22. 22. MEDICAL TREATMENT … <ul><li>Chronic hepatitis B infection </li></ul><ul><ul><li>Regularly measuring the amount of HBV  DNA in the blood gives a good idea of how fast the virus is multiplying </li></ul></ul><ul><ul><li>Treatment: antiviral drugs </li></ul></ul><ul><ul><ul><li>not appropriate for everyone with chronic HBV infection. It is reserved for people whose infection is most likely to progress to chronic hepatitis B.  </li></ul></ul></ul>
  23. 23. Medications <ul><li>Interferon alfa-2b ( Intron A) - was the standard treatment of chronic hepatitis B for several years </li></ul><ul><li>Lamivudine (Epivir) - an alternative for people who cannot or do not want to take interferon </li></ul><ul><li>Adefovir dipivoxil (Hepsera) - works well even in people whose disease is resistant to lamivudine </li></ul><ul><li>Entecavir (Baraclude) - newest medication approved for chronic hepatitis B </li></ul>
  24. 24. Surgery and Other Therapy <ul><li>No herbs, supplements, or other alternative therapy is known to work as well as antiviral medication in slowing HBV replication and promoting liver healing in hepatitis B. </li></ul><ul><li>no surgical therapy for hepatitis B </li></ul><ul><ul><li>If liver damage is severe enough, the only treatment that will help is liver transplant </li></ul></ul>
  25. 25. NURSING MANAGEMENT <ul><li>nurse identifies psychosocial issues and concerns, particularly the effects of separation from family and friends if the patient is hospitalized during acute and infective stage. </li></ul><ul><li>Follow-up visits by a home care nurse may be needed to assess the patient’s progress and answer the family members’ questions about disease transmission </li></ul><ul><li>reinforces previous instructions </li></ul>
  26. 26. Self-Care at Home <ul><li>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. </li></ul><ul><li>Avoid medicines and substances that can cause harm to the liver, such as acetaminophen (Tylenol). </li></ul><ul><li>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. </li></ul>
  27. 27. Self-Care at Home… <ul><li>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. </li></ul><ul><li>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. </li></ul>
  28. 28. Self-Care at Home… <ul><li>Take it easy. Your activity level should match your energy level. </li></ul><ul><li>Avoid prolonged, vigorous exercise until symptoms start to improve. </li></ul><ul><li>Call your health care provider for advice if your condition worsens or new symptoms appear. </li></ul><ul><li>Avoid any activity that may spread the infection to other people </li></ul>
  29. 29. HEPATITIS C
  30. 30. PREVENTION <ul><li>no vaccine for the prevention of HCV transmission </li></ul><ul><li>best means of preventing transmission of HCV is to prevent contact with infected blood and organs and to avoid high-risk sexual behavior such as multiple partners and anal contact. </li></ul><ul><li>Avoiding alcohol and drugs that can damage the liver may help slow the rate of progression of the disease. </li></ul>
  31. 31. MEDICAL TREATMENT <ul><li>pegylated interferon alpha (Pegasys, PEG-Intron) - often combined with an antiviral drug called ribavirin (Virazole) </li></ul>
  32. 32. Certain medical conditions preclude the use of interferon <ul><li>Depression and certain other mental and neurologic disorders </li></ul><ul><li>Active alcohol or drug abuse </li></ul><ul><li>Autoimmune diseases such as rheumatoid arthritis , systemic lupus erythematosus , or psoriasis </li></ul><ul><li>Low blood  hemoglobin level ( anemia ) or blood cell counts </li></ul><ul><li>Cirrhosis that is severe enough to cause symptoms such as jaundice, wasting, fluid retention that causes swelling, or mental disturbances </li></ul>
  33. 33. Medication <ul><li>Interferon alpha (Intron A) - pegylated type (Pegasys, PEG-Intron) </li></ul><ul><ul><li>Interferon is a protein that the body makes naturally in response to viral infections in order to fight the infection. Pegylation describes a chemical process that makes the interferon last longer in the body. </li></ul></ul><ul><li>Ribavirin (Virazole) </li></ul><ul><ul><li>has little effect on HCV, but interferon increases its potency </li></ul></ul>
  34. 34. Surgery and Other Therapy <ul><li>For end-stage liver disease, the only treatment is liver transplantation </li></ul><ul><li>Alternative therapies has not been proven to work in any scientific study </li></ul><ul><ul><li>most promising complementary therapy is milk thistle </li></ul></ul><ul><ul><li>licorice and ginseng </li></ul></ul><ul><ul><li>ginger (to reduce nausea) and St. John's wort (to relieve depression) may be taken as complementary therapy to help relieve the side effects of interferon </li></ul></ul>
  35. 35. NURSING MANAGEMENT <ul><li>Same as Hepatitis B </li></ul>
  36. 36. Patient Instruction <ul><li>Eat a varied, healthy diet, take part in some physical activity daily, and get plenty of rest. </li></ul><ul><li>Drink plenty of water and other noncaffeinated fluids to stay well hydrated. </li></ul><ul><li>Avoid alcoholic beverages and medicines such as nonsteroidal anti-inflammatory drugs (like Brufen, Aleve , Advil) that can be harmful in people with liver disease. </li></ul><ul><li>If you have symptoms, avoid prolonged or vigorous physical exercise until your symptoms improve. </li></ul><ul><li>If symptoms worsen at any time, contact your doctor. </li></ul>
  37. 37. Self-Care at Home <ul><li>Take it easy; get plenty of rest. </li></ul><ul><li>Drink plenty of fluids to prevent dehydration. </li></ul><ul><li>Do not drink alcohol of any kind, including beer, wine, and hard liquor. </li></ul><ul><li>Avoid medicines and substances that can cause harm to the liver such as acetaminophen ( Tylenol ) and other preparations that contain acetaminophen. </li></ul><ul><li>Avoid prolonged, vigorous exercise until symptoms start to improve </li></ul>