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  1. 1. HEPATITIS C Teresa Pate, RN Chamberlain College of Nursing NR 305 Health Assessment Trish Whitman, MSN, RN October 17 th , 2010
  2. 2. Introduction <ul><li>This author will identify, define, and describe Hepatitis C and the devastating effect and prevalence of this disease. Signs and symptoms will be investigated, along with the possible and known associated risk factors. Disease management and nursing interventions will be explored. Strategies for a focused health assessment will be suggested, considering normal and abnormal findings, and the use of specific assessment techniques toward the Hepatitis C patient. Guidelines for screening and strategies for prevention will be identified. The importance of incorporating these guidelines and strategies into the practice of professional nursing will be stressed, toward the public, and to the client. </li></ul>
  3. 3. Hepatitis C (HCV) <ul><li>Definition </li></ul><ul><li>Previously known as non-A, non-B (Dartmouth, 2010). </li></ul><ul><li>Type of viral infection of the liver (Centers, 2010). </li></ul><ul><li>Description </li></ul><ul><li>Virus spread by blood (Centers, 2010). </li></ul><ul><li>Infected by an interruption in skin or membranes (Centers, 2010). </li></ul><ul><li>Carriers can infect others (Centers, 2010). </li></ul><ul><li>Acute or chronic (Centers, 2010). </li></ul>
  4. 4. Hepatitis C <ul><li>Incidence </li></ul><ul><li>*U.S. </li></ul><ul><li>“ Most common chronic bloodborne infection” (Centers, 2010, para. 1) </li></ul><ul><li>Approximately 17,000 are newly infected every year (Centers, 2010). </li></ul><ul><li>3.2 million are infected chronically (Centers, 2010). </li></ul><ul><li>*World </li></ul><ul><li>Approximately 200 million are infected (Dartmouth, 2010). </li></ul><ul><li>100 million are chronic status (World, 2010). </li></ul>
  5. 5. Hepatitis C <ul><li>Prevalence </li></ul><ul><li>U.S. </li></ul><ul><li>More prevalent among “African Americans (3.2%), then Hispanics </li></ul><ul><li>(2.1%), and least common among Non-Hispanic Whites (1.5%)” </li></ul><ul><li>(University, 2010, para. 1). </li></ul><ul><li>Worldwide </li></ul><ul><li>Variable (Dartmouth, 2010). </li></ul><ul><li>“ Higher among less developed nations” (Dartmouth, 2010, para. 3). </li></ul><ul><li>Decreased in Northern Europe (Dartmouth, 2010). </li></ul><ul><li>Increased in Egypt and Africa (Dartmouth, 2010). </li></ul>
  6. 6. Hepatitis C <ul><li>Identification </li></ul><ul><li>First named in 1989 (Centers, 2010). </li></ul><ul><li>6 main genotypes (Dartmouth, 2010). </li></ul><ul><li>15 known subtypes (Dartmouth, 2010 ). </li></ul>
  7. 7. HCV Summary of Relevant Evidence <ul><li>Signs and Symptoms </li></ul><ul><li>Established/Suspected Risk Factors </li></ul><ul><li>Current Viewpoints-Disease Management </li></ul><ul><li>Current Literature-Nursing Interventions </li></ul>
  8. 8. Acute HCV Signs and Symptoms <ul><li>Symptoms less than 6 months </li></ul><ul><li>15-25% the immune system is able to clear virus (Centers, 2010). </li></ul><ul><li>May have no symptoms at all (Centers, 2010). </li></ul><ul><li>Symptoms may be mild (Centers, 2010). </li></ul><ul><li>May include decreased appetite, nausea/vomiting, </li></ul><ul><li>pain in the abdomen, light colored stools, </li></ul><ul><li>increased temperature, feeling of exhaustion, </li></ul><ul><li>pain in the joints, and yellowing of skin/eyes, </li></ul><ul><li>itching of skin, trouble sleeping (Centers, 2010). </li></ul><ul><li>Urine that is dark in color (Maricopa, 2010). </li></ul>
  9. 9. Chronic HCV Signs and Symptoms <ul><li>Symptoms longer than 6 months </li></ul><ul><li>75-85% the immune system is not able to clear virus (Centers, 2010). </li></ul><ul><li>Any of the acute infection symptoms (Centers, 2010). </li></ul><ul><li>Swelling of abdomen, possible ascites (Maricopa, 2010)/ </li></ul><ul><li>Possible psychiatric difficulties (Centers, 2010). </li></ul><ul><li>60-70% will eventually develop liver disease (Centers, 2010). </li></ul><ul><li>5-20% will go on to develop cirrhosis of the liver, may take 20-30 years (Centers, 2010). </li></ul><ul><li>1-5% mortality rate from liver cancer and cirrhosis (Centers, 2010). </li></ul>
  10. 10. Established HVC Risk Factors/Transmission <ul><li>Drug users injecting with contaminated needles (Centers, 2010). </li></ul><ul><li>Drug users not injecting (Maricopa, 2010). </li></ul><ul><li>Unprotected sex with partner with HVC (Centers, 2010). </li></ul><ul><li>Begin born to a mother positive for HVC (Centers, 2010). </li></ul><ul><li>Healthcare workers stuck with HVC dirty needles (Centers, 2010). </li></ul><ul><li>Kidney dialysis patients (Centers, 2010). </li></ul><ul><li>Receiving tatoos/piercing body parts (CDC, 2010). </li></ul><ul><li>Contact with blood/blood containing fluids from HVC infected </li></ul><ul><li>person by break in skin or mucous membranes (Centers, 2010). </li></ul><ul><li>Receiving clot factors before 1987 (Centers, 2010). </li></ul><ul><li>Transplanted organs or blood before 1992 (Centers, 2010). </li></ul><ul><li>Liver problems undiagnosed (Maricopa, 2010). </li></ul><ul><li>Those that work in public safety positions (Maricopa, 2010). </li></ul><ul><li>Those that are incarcerated (Maricopa, 2010). </li></ul><ul><li>War veterans. </li></ul>
  11. 11. HCV Disease Management <ul><li>No illegal drugs (Maricopa, 2010). </li></ul><ul><li>No use of alcohol (Maricopa, 2010). </li></ul><ul><li>No ASA/Acetaminophen (Maricopa, 2010). </li></ul><ul><li>Monitor treatment adherence (Raymond, 2010). </li></ul><ul><li>Drug testing as appropriate (Raymond, 2010). </li></ul><ul><li>Monitor liver enzymes, HCV antibodies/RNA (Raymond, 2010). </li></ul><ul><li>Incorporate multidisciplinary team input (Raymond, 2010). </li></ul><ul><li>Referral to GI Specialist if indicated. </li></ul><ul><li>Biopsy of liver/chemotherapy if appropriate (Raymond, 2010). </li></ul><ul><li>Referral to Psychiatric Services as needed (Maricopa, 2010). </li></ul><ul><li>Vaccinate against hepatitis A and B if not done (Maricopa, 2010). </li></ul><ul><li>Active involvement in public education/prevention of hepatitis C. </li></ul><ul><li>Assist in identification/proactive screening those who are high risk. </li></ul><ul><li>Prevention of transmission education for high risk population. </li></ul>
  12. 12. HCV Nursing Interventions <ul><li>Encourage/educate/involve patient in treatment plan </li></ul><ul><li>Discourage/monitor for use of drugs/alcohol (Maricopa, 2010). </li></ul><ul><li>Advocate rest (Maricopa, 2010). </li></ul><ul><li>Explore immunization status of hepatitis A and B (Maricopa, 2010). </li></ul><ul><li>Encourage attendance to AA/NA meetings/rehab/outpatient services </li></ul><ul><li>Encourage/promote use of community support groups (Maricopa, 2010). </li></ul><ul><li>Monitor for signs of depression or other psychiatric sx (Maricopa, 2010). </li></ul><ul><li>Encourage/educate/include family support (Maricopa, 2010). </li></ul><ul><li>Educate regarding Hepatitis C/ preventing transmission </li></ul><ul><li>Encourage adequate and appropriate intake of food/liquids, decreased protein diet, no adding salt, frequent/small portions (Maricopa, 2010). </li></ul><ul><li>Monitor for signs of infection/dehydration/decreased nutritional status </li></ul><ul><li>Administer chemotherapy injections, rotating sites </li></ul><ul><li>Teach family member/patient how to administer chemotherapy injections/how to prevent infection/how to watch for signs of infection/how to rotate sites of injections as indicated. </li></ul><ul><li>Use Universal Precautions (CDC, 2010). </li></ul>
  13. 13. HCV Health Assessment Strategies <ul><li>Normal Findings </li></ul><ul><li>Abnormal Findings </li></ul><ul><li>Description of Assessment Techniques </li></ul>
  14. 14. HCV Health Assessment Strategies <ul><li>Normal Findings </li></ul><ul><li>No signs or symptoms of acute/chronic liver infection. </li></ul><ul><li>Normal system review. </li></ul><ul><li>Normal range liver enzymes. </li></ul><ul><li>Negative anti-HCV, HCV RNA (CDC, 2010). </li></ul><ul><li>Abnormal Findings </li></ul><ul><li>Signs or symptoms of acute/chronic liver infection. </li></ul><ul><li>Elevated range of liver enzymes (CDC, 2010). </li></ul><ul><li>Positive anti-HCV, HCV RNA (CDC, 2010). </li></ul>
  15. 15. HCV Health Assessment Strategies Description of Assessment Techniques <ul><li>Inspection </li></ul><ul><li>Auscultation </li></ul><ul><li>Palpation </li></ul><ul><li>Percussion </li></ul><ul><li>Focused Question Assessment </li></ul>
  16. 16. HCV Health Assessment Strategies Description of Assessment Techniques <ul><li>Inspection - Observe abdomen size, skin/eye color, pupil size, alertness, appropriateness, facial expressions during exam, skin turgor, skin condition, paleness of lower/inner eyelids and skin, indications of infection, redness of palms, body posturing, indications of discomfort, mannerisms, mood, memory, orientation, signs of psychological problems (such as depression), grooming, development, nutritional state, veining of abdomen or chest, edema of extremities. </li></ul><ul><li>Auscultation - Listen to lung fields/abdominal quadrants/heart sounds </li></ul><ul><li>Palpation - Palpate chest and abdomen, mild and deep, for tenderness, pain, noting symmetry/asymmetry/masses/enlarged liver or other organs . </li></ul><ul><li>Percussion - Lower chest, upper/mid abdomen, noting tympanic and dullness sounds. Measure in centimeters the height and width of the dull sounds for approximate liver enlargement. </li></ul>
  17. 17. HCV Health Assessment Strategies Description of Assessment Techniques <ul><li>Focused Question Assessment </li></ul><ul><li>Are you using latex condoms every time you are having sex? Do you have multiple partners? Are you pregnant? Do you feel depressed? </li></ul><ul><li>Are you sharing personal care items, such as a razor, or a toothbrush? Have you ever received a blood transfusion, or any other blood products/clotting factors? If so, what year? Does anyone you know have hepatitis, such as a friend, or a family member? Do you have a family member or a friend that can be your support system? </li></ul><ul><li>When was the first time you have injected? When was the last time you have injected? Are you still using drugs? What about alcohol? </li></ul><ul><li>Have you obtained treatment for drug/alcohol use? When did your symptoms start? Does anything make the symptoms better, or worse? Are you having pain? Point to where the pain is occurring.  Rate your pain from 1-10, 1 being the least amount of pain, and 10 being the worst pain you have had in your life. </li></ul><ul><li>Have you received a vaccination for Hepatitis A and B? </li></ul><ul><li>What facility gave you the vaccination? </li></ul>
  18. 18. HCV Screening Guidelines <ul><li>Current Guidelines to Screen Populations/Individuals </li></ul><ul><li>Screen all patients for at risk behaviors/exposure </li></ul><ul><li>There is no screening test for acute hepatitis C. </li></ul><ul><li>Liver enzyme test for all patients exhibiting </li></ul><ul><li>liver illness. </li></ul><ul><li>Over 6 months signs and symptoms, obtain </li></ul><ul><li>anti-HCV, HCV RNA (CDC, 2010). </li></ul><ul><li>Implementation of Guidelines into Nursing Practice </li></ul><ul><li>Monitor, educate, open communication without judgment </li></ul><ul><li>regarding risk of exposure/behaviors/responsibility/ </li></ul><ul><li>obtaining hepatitis A and B vaccinations/ informing </li></ul><ul><li>of no vaccination for the prevention of hepatitis C/ </li></ul><ul><li>possible complications, mortality risks (CDC, 2010). </li></ul>
  19. 19. Primary and Tertiary Non-pharmacological Prevention Strategies <ul><li>Primary prevention strategies include decreasing HCV infection rates by educating those who are at risk. This would include referring to drug/alcohol programs, finding clean needle access programs for those who refuse to stop injecting, targeting “STD clinics, HIV/AIDS and substance abuse programs, and correctional settings” (New, 2010, para. 9). </li></ul><ul><li>Tertiary prevention strategies include attempting to identify those who are infected, giving them education, pamphlets, treatment options, encouraging the use of condoms, referral to services. </li></ul><ul><li>(New, 2010). </li></ul>
  20. 20. Conclusion <ul><li>Hepatitis C is a disease which is costly, both in finances, toward society, patient, and family, but in the lives that would have been productive, living life to its fullest potential. It is a devastating disease that kills with no discrimination. There is no vaccination to prevent hepatitis C. There is much need for evidence in health management, education compliance, and personal prevention. Nursing professionals are being challenged every day, in screening, identifying at risk patients, and caring for those who are infected. </li></ul><ul><li>Dedicated to Jessica and Kaylee. </li></ul>
  21. 21. Reference <ul><li>CDC. Centers for Disease Control and Prevention. (2010). Hepatitis C information </li></ul><ul><li>for health professionals. Retrieved from </li></ul><ul><li>http://www.cdc.gov/hepatitis/HCV/index.htm </li></ul><ul><li>Dartmouth Medical School. (2010). Hepatitis C: an epidemic for anyone, para.2-4. </li></ul><ul><li>Retrieved from </li></ul><ul><li>http://www.epidemic.org/theFacts/theEpidemic/worldPrevalence/ </li></ul>
  22. 22. Reference <ul><li>Maricopa County Department of Public Health. (2010). Living with hepatitis C: </li></ul><ul><li>staying healthy. Retrieved from </li></ul><ul><li>http://www.maricopa.gov/Public_Health/ControlPrevention/HepC/ StayHealt </li></ul><ul><li> h y.aspx </li></ul><ul><li>New York State Department of Health. (2010). Strategic plan: Implementation and </li></ul><ul><li>recommendations, para. 9. Retrieved from </li></ul><ul><li>http://www.health.state.ny.us/diseases/communicable/hepatitis/strategic/preventi </li></ul><ul><li>on.htm </li></ul>
  23. 23. Reference <ul><li>Raymond, S. (2010). Disease management programs for hepatitis C: a team </li></ul><ul><li>approach to setting goals. Disease Management and Health Outcomes , 9(8). </li></ul><ul><li>Retrieved from http://ideas.repec.org/a/wkh/dmhout/v9y2001i8p431-439.html </li></ul><ul><li>University of Pittsburg: Epideminology Data Center. (2010). Hepatitis C and race </li></ul><ul><li>para 1. Retrieved from </li></ul><ul><li>http://www. edc . pitt . edu / virahepc /race.html </li></ul>
  24. 24. Reference <ul><li>World Health Organization. (2010). Prevalence of hepatitis C in healthy </li></ul><ul><li>population. Retrieved from </li></ul><ul><li>http://www. searo .who. int /en/Section1243/Section1310/Section1343/Section13 </li></ul><ul><li>44/Section1355_5302.htm </li></ul>