Viral Hepatitis

1. VIRAL HEPATITIS
EDNA R. JAVIER RN MAN
FACULTY,COLLEGE OFNURSING

2. HEPATITIS
• Inflammatory primary infection of the
liver with at least three distinct clinical
forms, each caused by a different
hepatitis virus

3. TYPES OF HEPATITIS
1. HEPATITIS A (HAV)
2. HEPATITIS B (HBV)
3. TYPE NON-A, NON-B (NANB)
4. DELTA HEPATITIS

4. 3 STAGES OF HEPATITIS
1. PRODROMAL/PRE-ICTERIC STAGE
- lasts 1-3 weeks
- vague GI & general body symptoms
- fatigue, malaise, anorexia, weight loss
- aversion to food & cigarette
- vomiting, diarrhea

5. ICTERIC STAGE
 Fatigue, weight loss, light colored stools,
dark urine
 Continued hepatomegaly with
tenderness,lymphadenopathy,
splenomegaly
 Jaundice, pruritus

6. POST-ICTERIC STAGE
• Fatigue but with an increased sense of
well-being
• Hepatomegaly gradually decreasing

7. OVERVIEW OF VIRAL HEPATITIS
TYPE A TYPE B NANB DELTA
INCUBATION
PERIOD
15-60 days 50-120 days 15-180 days 4-8 weeks
Etiologic agent Hepatitis A
virus
Hepatitis B
virus
NANB virus Hepatitis delta
virus
AGE Children, young
adults
Any age All age groups Only in patients
w/ existing
active HBV
SOURCE OF
INFECTION
Feces, clams,
oysters
Body fluids Blood of
infected
persons,
contaminated
water
Blood/blood
products, IV
drug use

8. OVERVIEW OF HEPATITIS
HAV HBV NANB DELTA
Mode of
transmission
Fecal-oral
route
Blood/body
fluids
Parenteral
Serologic
preparations
Fecal-oral
route
Horizontal
vertical
Immunity Lifelong
immunity post
hepatitis A
Immune post
hepatitis
homologous

9. DIAGNOSTIC TESTS
LABORATORY DATA HEPATITIS A HEPATITIS B
SGPT, SGOT High in prodromal
Rapid drop in icteric phase
elevated
High in prodromal phase
Remains elevated for
months
ALKALINE
PHOSPHATASE
elevated elevated
albumin decreased decreased
bilirubin Elevated in icteric & early
convalescence
Elevated in icteric
Leukocytes, lymphocytes,
neutrophils
Decreased (pre-icteric) decreased

10. DIAGNOSTIC TESTS
Hepatitis A
- HAV present in stool before onset of
disease
- IgG appears after onset of jaundice
- IgM positive in acute infection

11. DIAGNOSTIC TESTS
Hepatitis B
- HBsAg is positive
- anti-HBsAg negative
- anti-HBc is associated with infectivity
- HBeAg is associated with infectivity &
disappears before jaundice
- anti-Hbe is present in carriers

12. NURSING DIAGNOSIS &
INTERVENTION
• Potential fluid volume deficit
- provide frequent high CHO fluids
- administer IVF
• Altered nutrition: LBR
- encourage frequent small feedings
- administer NGT feedings

13. NURSING DIAGNOSIS & INTERVENTION
• Activity Intolerance
- Maintain bed rest
• Knowledge deficit regarding disease transmission
& potential chronicity
- educate pt abt dse & transmission
- emphasize the self-limited nature of most
hepatitis but the need for follow-up of liver function
tests & serum HBsAg
- explain precautions

14. NURSING DIAGNOSIS & INTERVENTION
• Potential for infection
- Collect blood or fecal specimens
- Employ enteric precautions for 7 days after
onset of jaundice for hepatitis A
- Employ blood & body fluid precautions until
patient is HBsAg serum negative for Hepatitis B
- Ensure that all patient contacts are protected
against hepatitis

15. NURSING CARE
1. Promote adequate nutrition
2. Ensure rest/relaxation
3. Monitor/relieve pruritus
4. Administer corticosteroids as ordered
5. Institute isolation procedures
6. In hepatitis A, administer ISG early

16. NURSING CARE
• In Hepatitis B
1. Screen blood donors
2. Use disposable needles & syringes
3. Instruct client to avoid sexual intercourse
4. Administer HBIG as ordered
5. Aminister Hepatitis B vaccine

17. Nursing care
• Provide client teaching & discharge planning
1. Importance of avoiding alcohol
2. Avoidance of persons with known infetions
3. Balance of activity & rest periods
4. Importance of not donating blood
5. Dietary modifications
6. Recognition & reporting of s/s of inadequate
convalescence
7. Techniques/importance of good personal
hygiene

18. PARASITIC WORMS

19. PARASITIC WORMS
• Helminths
• Differ from other agents pathogenic to humans
• 3 groups of helminths
- nematodes
- trematodes
- cestodes
• Portal of entry into the host
- ingestion
- skin penetration
- injection into the blood by an insect

20. OVERVIEW OF INTESTINAL WORM
INFECTION
TAPEWORM HOOKWORM ROUNDWORM PINWORM
OTHER NAME Taeniasis Ancylostomiasis Ascariasis Enterobiasis
OCCURENCE High where
beef & pork
are eaten
raw/underco
oked
Endemic in
tropic &
subtropic areas
worldwide worldwide
ETIOLOGIC
AGENT
Taenia
Saginata
Taenia
Solium
Necator
Americanus
Ancylostoma
duodenale
Ascaris
Lumbricoides
Enterobius
Vernicularis

21. OVERVIEW OF INTESTINAL WORM INFECTION
TAPEWORM HOOKWORM ROUNDWORM PINWORM
RESERVOIR Humans, swine,
cattle
humans humans humans
TRANSMISSION Ingestion of
inadequately
cooked infected
meat
Anal-oral transfer
Contaminated
food or water w/
eggs from feces
Infective larvae in
soil penetrate
skin,
ingestion
Ingestion of infective
eggs from soil
contaminated with
feces
Direct trasmission
of infective eggs
from anus to mouth,
Indirect
transmission
INCUBATION
PERIOD
8-14 weeks Weeks to months Worms reach
maturity 2 months
after ingestion
Life cycle of worm
requires 4-6 weeks

22. OVERVIEW OF INTESTINAL WORM
INFECTION
TAPEWORM HOOKWORM ROUNDWORM PINWORM
PERIOD OF
COMMUNICABILITY
As long as
worm is in the
intestine
Infected
persons can
excrete larvae
for years;
larvae remain
infective in soil
for 3 weeks
As long as
mature,
fertilized female
lives in
intestine;
Embryonic eggs
viable in soil for
years
As long as
gravid females
are depositing
eggs on
perianal skin,
continuous
reinfection
occurs

23. OVERVIEW OF INTESTINAL WORM
INFECTION
TAPEWORM HOOKWORM ROUNDWORM PINWORM
CLINICAL
MANIFESTATIONS
Mild
abdominal
discomfort
Anemia
Weight loss
Weakness
Headache
Impaired
growth
No weight
gain
seizures
Pruritic
dermatitis
Cough
Sorethroat
Bloody sputum
Diarrhea
Flatulence
Abdominal
discomfort
Epigastric pain
Intestinal colic
Atypical
pneumonia
Asthma
Urticaria
n/v
Anorexia
Weight loss
Insomnia
fever
Perianal
pruritus
Insomnia
Restlessness
Worms in the
anus & stools
Enuresis &
bladder
irritability

24. Overview of Intestinal Worm Infection
TAPEWORM HOOKWORM ROUNDWORM PINWORM
LABORATORY
FINDINGS
Fecal
specimen
Leukocytosis
with moderate
eosinophilia
Eosinophilic
leukocytosis
Recovery of
ova in stools &
sputum
Eosinophilia
Recovery of ova
in stools &
sputum
Eosinophilia
Recovery of
ova in
swabbings
from peri-anal
skin

25. Overview of Intestinal Worm Infection
TAPEWORM HOOKWORM ROUNDWORM PINWORM
COMPLICATIONS Macrocytic
anemia
epilepsy
Skin lesions
Allergic
reactions
Severe anemia
Obstruction/per
foration of
intestines
Intussuseption
Larvae may
migrate to
brain, kidney,
skin
pneumonia
Migration to
vagina

26. Overview of Intestinal Worm Infection
TAPEWORM HOOKWORM ROUNDWORM PINWORM
TREATMENT Niclosamide
(Yomesan) 2 g
in 1 dose
(adult)
Parmomycin
(Humatin) 1
gm q4h for 4
doses
Quinacrine
(Atabrine) 800
mg in 1 dose
or 400 mg in 2
doses 30 mins
apart for adults
Mebendazole
100 mg BID for
3 days
Pyrantel
Pamoate
single oral
dose of 11
mg/kg up to
total of 1 g/d
Piperazine
citrate
Daily dose for 2
days
Up to 30 lbs – 1
gm
30-50 lbs – 2
gm
50-100 lbs – 3
gms
Over 100 lbs –
3.5 gms
Vanquin or
Pyrivium
Foamate 5
mg/kg BW
Mebendazole
100 mg PO
one time
Pyrantel
Pamoate
Piperazine
Citrate
* Treatment
repeated after
2 weeks

27. General Management
• Iron therapy
• Nutritional supplements
• Follow-up examination of stools
• Examination & treatment of contacts

28. Nursing Diagnosis & Intervention
1. Altered Nutrition: LBR
- administer iron & nutritional
supplements
- encourage frequent high-protein
feedings
2. Risk for trauma R/T taeniasis
- monitor for signs of CNS involvement
- protect from injury

29. Nursing Diagnosis & Intervention
3. Ineffective breathing pattern
- monitor for signs of pneumonia
- administer oxygen & respiratory
assistance
- aid patients to deep breathe
4. Diarrhea R/T ancylostomiasis, taeniasis
- monitor diarrhea output
- collect stool specimen

30. Nursing Diagnosis & Intervention
5. Pain r/t ascariasis
- assess abdomen
- report s/s of abdominal pain &
distention
- encourage rest
- administer analgesics

31. Patient Education
1. Follow-up examinations of stools after
therapy
2. Nutrition counseling
3. Iron & vitamin supplements
4. Treatment for pinworm should be
repeated in 2 weeks following treatment
5. Daily washing of underwear, clothing
6. Thorough handwashing after defecation

32. Patient Education
7. Family members & close contacts should
be examined & treated
8. Home freezing of meat
9. Employ sewage disposal of contaminated
feces
10. Wear shoes in areas where human or
animal feces may be in soil
11. bury animal feces deep in an area where
children do not play

33. INFECTIOUS
MONONUCLEOSIS

34. INFECTIOUS MONONUCLEOSIS
• Kissing’s disease
• Viral infection that causes hyperplasia of
lymphoid tissue
• Affects adolescents & young adults

35. Infectious mononucleosis
INFECTIOUS
MONONUCLEOSIS
OCCURENCE ETIOLOGIC
AGENT
RESERVOIR
worldwide Epstein-Barr virus humans

36. Infectious mononucleosis
INFECTIOUS
MONONUCLEOSIS
transmission Incubation period Period of
communicability
direct contact
with saliva
4-6 weeks prolonged

37. Clinical Manifestations
1. Prodromal period
- 2-5 days
- malaise, fatigue
- with or without fever
2. Triad
- lymphadenopathy, splenomegaly,
exudative pharyngitis

38. Clinical Manifestations
3. Full blown clinical picture
- fever
- adenopathy
- splenomegaly & hepatomegaly
- tonsilopharyngitis

39. Diagnostic Studies
1. White blood cell count
- lymphocytes & monocytes elevated
2. Leukocyte count
- elevated
3. Throat culture
- positive for group A hemolytic
streptococci

40. Management
1. Surgery
- splenectomy
2. Medications
- corticosteroids
- prednisone
3. General management
- bed rest
- Saline throat gargle
- aspirin or acetaminophen

41. Nursing diagnosis & intervention
1. Activity Intolerance
- encourage bed rest
2. Pain
- administer analgesics
3. Anxiety
- assist patient in developing a realistic
plan for returning to work or school during
convalescence

42. Nursing diagnosis & intervention
4. Risk for ruptured spleen
- monitor for signs of neurologic or
purpuric complications
5. Hyperthermia
- monitor body temperature
- administer antipyretics
- TSB
- encourage adequate fluid intake