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Lesson 57. Nursing Implications Associated With Viral Hepatitis
1-57. NURSING IMPLICATIONS ASSOCIATED WITH VIRAL HEPATITIS a. Rest. Patients with viral hepatitis experience fatigue and malaise during all phases of the infection. - (1) Bed rest should be encouraged during the acute phase of the illness.
- (2) During convalescence, the patient should be encouraged to alternate periods of rest with periods of activity.
b. Diet. Nonspecific GI symptoms such as anorexia, nausea, and abdominal pain occurs in-patients with hepatitis. - (1) Diet should be modified to conform to individual symptoms and tolerances.
- (2) The patient should be encouraged to eat the prescribed diet to maintain an optimum balance of nutrients and to promote healing.
- (3) Nursing personnel should note and document what the patient eats. If the patient is unable to tolerate the prescribed diet, the physician may order an alternate form of nutrition therapy.
c. Emotional Support. Viral hepatitis is a prolonged illness, often requiring lengthy hospitalization. The patient may become discouraged with the course of treatment and depressed because of separation from family. - (1) Make an effort to stop and visit with the patient whenever you have a few extra minutes. Allow the patient time to ventilate feelings.
- (2) Arrange with occupational therapy or the facility Red Cross volunteers to provide books, cards, games, and other diversional activities.
- (3) Allow time for visiting with family members.
d. Infection Control. Isolation and infection control procedures should be implemented IAW the local infection control SOP. - (1) Alert the hospital infection control nurse when a patient with hepatitis is admitted.
- (2) Consult the infection control SOP for the procedures to be implemented for that particular type of hepatitis.
e. Referrals. It may be necessary to consult with other activities. - (1) The preventive medicine activity may be required to make a health investigation in certain cases of hepatitis.
- (2) The community health nurse may be required to provide follow-up home visits.
| | Type A Hepatitis Virus
(Infectious Hepatitis) | Type B Hepatitis Virus
(Serum Hepatitis) | Type non-A/non-B
(Hepatitis Virus ) | Mode of Transmission | - Fecal-oral contamination
- Person-to-person
- Water-borne
- Food borne
| - Body secretions of infected persons
- Contaminated needles, syringes
- Mothers to babies
| - Transfusions
- Transfusion products
- Personnel in Renal and Dialysis units
- Institutions with long-term residents
| Incubation Period | 2-6 weeks
Mean: 30 days | 4-24 weeks
Mean: 90 days | 2-15 weeks
Mean: 60 days | Prodromal Phase (Pre-icteric) | - Generally asymptomatic at first with abrupt onset of flu-like symptoms: headache, malaise, fever, lassitude, and nonspecific
- GII symptoms such as anorexia, nausea, upper abdominal disconfort and vomiting
| - Insidious onset of variable symptoms: Includes same symptoms as Type A.
- Arthralgias Uticarial skin rashes
| - Isidious onset of symptoms.
- Similar to type B, but less severe
| Icteric Phase | - Jaundice
- Dark urine
- Pale stools
- Tender and enlarged liver
- Pruritis
When jaundice reaches its peak usually within two weeks, symptoms tend to subside | - Prolonged acute phase with anorexia, malaise and abdominal pain
- Jaundice may or may not occur
| - Similar to Type B, but less severe
- Most cases are without jaundice
| Post-Icteric Phase | | - Prolonged convalescence of 3-6 months
| - Prolonged convalescence
- Probability of a carrier state
| Table 1-1. Types of viral hepatitis. (3) Consult the local SOP or infection control nurse for guidance. f. Blood Donation. Patients who have had viral hepatitis should be instructed that it is unsafe for them to donate blood. They may contaminate a potential recipient. 1-58. NONVIRAL HEPATITIS a. Toxic hepatitis (acute liver cell necrosis) is caused by ingestion, inhalation, or injection of certain chemicals (hepatotoxins) that have a poisonous effect on the liver. Examples include carbon tetrachloride, phosphorus, chloroform, vinyl chloride, and poisonous mushrooms. - (1) Signs and symptoms include anorexia, nausea, vomiting, jaundice, and hepatomegaly.
- (2) Liver damage occurs within 24-48 hours, depending on the dose of the toxin.
- (3) For recovery to occur, the toxin must be identified and removed as soon as possible.
b. Drug induced hepatitis is an idiosyncratic reaction to a drug due to hypersensitivity. Examples include sulfonamides, isoniazid, and halothane. - (1) Symptoms may appear any time during or after exposure to the drug, but usually appear after 2-4 weeks of therapy.
- (2) Onset is generally abrupt, with chills, fever, anorexia, nausea, rash, and pruritis. Jaundice and hepatomegaly may occur later.
- (3) Symptoms subside when the offending drug is removed.
c. Nursing implications. - (1) Care is symptomatic and supportive in nature.
- (2) Patient education should be reinforced regarding proper handling of chemicals, cleaning agents, solvents, and so forth, as applicable.
- (3) Nursing personnel, pharmacists, and physicians should alert patients to medication side effects. If fever, rash, or pruritis result from any medication, it should be stopped at once and the prescribing physician consulted.
- (4) Patients with known liver disease should not receive halothane as an anesthetic.
| | Type A Hepatitis Virus
(Infectious Hepatitis) | Type B Hepatitis Virus
(Serum Hepatitis) | Type non-A/non-B
(Hepatitis Virus ) | Mode of Transmission | - Fecal-oral contamination
- Person-to-person
- Water-borne
- Food borne
| - Body secretions of infected persons
- Contaminated needles, syringes
- Mothers to babies
| - Transfusions
- Transfusion products
- Personnel in Renal and Dialysis units
- Institutions with long-term residents
| Incubation Period | 2-6 weeks
Mean: 30 days | 4-24 weeks
Mean: 90 days | 2-15 weeks
Mean: 60 days | Prodromal Phase (Pre-icteric) | - Generally asymptomatic at first with abrupt onset of flu-like symptoms: headache, malaise, fever, lassitude, and nonspecific
- GII symptoms such as anorexia, nausea, upper abdominal disconfort and vomiting
| - Insidious onset of variable symptoms: Includes same symptoms as Type A.
- Arthralgias Uticarial skin rashes
| - Isidious onset of symptoms.
- Similar to type B, but less severe
| Icteric Phase | - Jaundice
- Dark urine
- Pale stools
- Tender and enlarged liver
- Pruritis
When jaundice reaches its peak usually within two weeks, symptoms tend to subside | - Prolonged acute phase with anorexia, malaise and abdominal pain
- Jaundice may or may not occur
| - Similar to Type B, but less severe
- Most cases are without jaundice
| Post-Icteric Phase | | - Prolonged convalescence of 3-6 months
| - Prolonged convalescence
- Probability of a carrier state
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