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Tuesday, April 26, 2011

NCP Nursing Care Plan for Viral hepatitis

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NCP Nursing Care Plan for Viral hepatitis. Hepatitis is a widespread inflammation of the liver that results in degeneration and necrosis of liver cells. Viral hepatitis is a fairly common systemic disease. It's marked by hepatic cell destruction, necrosis, and autolysis, leading to anorexia, jaundice, and hepatomegaly. In most patients, hepatic cells eventually regenerate with little or no residual damage, allowing recovery. However, old age and serious underlying disorders make complications more likely. The prognosis is poor if edema and hepatic encephalopathy develop

Types Of Viral Hepatitis
The most common types are Hepatitis A, Hepatitis B, and Hepatitis C.

  • Type A (infectious or short-incubation hepatitis) is raising among people with immunosuppression. It's usually self-limiting and without a chronic form. About 40% of cases in the United States result from hepatitis A virus. Primarily transmitted by the fecal-oral route, by either person-to-person contact or consumption of contaminated food or water. Although viremia occurs early in infection and can persist for several weeks after onset of symptoms, bloodborne transmission of Hepatitis A virus HAV is uncommon. Hepatitis A virus HAV occasionally might be detected in saliva in experimentally infected animals, but transmission by saliva has not been demonstrated.
  • Type B (serum or long-incubation hepatitis) is also increasing among HIV-positive individuals. Hepatitis B is considered a sexually transmitted disease because of its high incidence and rate of transmission by this route. Hepatitis B is caused by infection with the Hepatitis B virus (HBV). The incubation period from the time of exposure to onset of symptoms is 6 weeks to 6 months. HBV is found in highest concentrations in blood and in lower concentrations in other body fluids (e.g., semen, vaginal secretions, and wound exudates). HBV infection can be self-limited or chronic.
  • Type C accounts for about 20% of all viral hepatitis cases and is primarily transmitted through blood and body fluids or obtained during tattooing. is most efficiently transmitted through large or repeated Percutaneous exposure to infected blood (e.g., through transfusion of blood from unscreened donors or through use of injecting drugs). Although much less frequent, occupational, perinatal, and sexual exposures also can result in transmission of HCV.
  • Type D (delta hepatitis) is responsible for about 50% of all cases of fulminant hepatitis, which has a high mortality. Developing in 1% of patients, fulminant hepatitis causes unremitting liver failure with encephalopathy. It progresses to coma and commonly leads to death within 2 weeks. Hepatitis D virus which is an RNA virus structurally unrelated to the Hepatitis A, B, or C viruses. Hepatitis D, which can be acute or chronic, is uncommon in the United States. Hepatitis D virus HDV is an incomplete virus that requires the helper function of HBV to replicate and only occurs among people who are infected with the Hepatitis B virus. Hepatitis D virus is transmitted through Percutaneous or mucosal contact with infectious blood and can be acquired either as a coinfection with HBV or as superinfection in persons with HBV infection. There is no vaccine for Hepatitis D, but it can be prevented in persons who are not already HBV-infected by Hepatitis B vaccination.
  • Type E (formerly grouped with type C under the name non-A, non-B hepatitis) occurs primarily in people who have recently returned from an endemic area (such as India, Africa, Asia, or Central America); it's more common in young adults and more severe in pregnant females. Hepatitis E is a serious liver disease caused by the Hepatitis E virus (HEV) that usually results in an acute infection. It does not lead to a chronic infection. While rare in the United States, Hepatitis E is common in many parts of the world. Transmission: Ingestion of fecal matter, even in microscopic amounts; outbreaks are usually associated with contaminated water supply in countries with poor sanitation
  • Some older books and websites list additional hepatitis viruses. These are virus-like agents transmitted in blood that were once suspected of causing hepatitis but do not: Hepatitis G. Transfusion transmitted virus (TTV)

Causes for Viral hepatitis
The six major forms of viral hepatitis A, B, C, D, and E

Complications for Viral hepatitis
Life-threatening fulminant hepatitis the most feared complication develops in about 1% of patients, causing unremitting liver failure with encephalopathy
Complications may be specific to the type of hepatitis:

  • Chronic active hepatitis may occur as a late complication of hepatitis B. During the prodromal stage of acute hepatitis B, a syndrome resembling serum sickness, characterized by arthralgia or arthritis, rash, and angioedema, may occur. This syndrome can lead to misdiagnosis of hepatitis B as rheumatoid arthritis or lupus erythematosus. Primary liver cancer may develop after infection with hepatitis B or C.
  • Type D hepatitis can cause a mild or asymptomatic form of type B hepatitis to flare into severe, progressive chronic active hepatitis and cirrhosis.
  • Other complications include a syndrome that resembles serum sickness (muscle and joint pain, rash, angioedema), as well as cirrhosis, pancreatitis, myocarditis, Aplastic anemia, or peripheral neuropathy.

Nursing Assessment NCP Nursing Care Plan for Viral hepatitis
Patient history. Question the patient about potential sources of transmission and risks: a history of blood dyscrasias, multiple blood or blood product transfusions, alcohol or drug abuse (sharing of needles), exposure to hepatotoxic chemicals or medications, and travel to third world countries or areas where the sanitation is poor. Since HAV transmission occurs in association with daycare centers, among male homosexuals, and among household contacts of persons with acute cases, inquire into these areas. Also ask about recent meals, because hepatitis A occasionally occurs from contaminated food or improper sewage treatment. Determine the patient’s occupation; teratogen exposure may cause a nonviral hepatitis.

Diagnostic tests for Viral hepatitis

  • Viral hepatitis serologies
  • Liver function tests
  • Liver scan: May be indicated for differential diagnosis, to identify underlying chronic liver disease, or for evaluating organ function.
  • Liver biopsy: Considered if diagnosis is uncertain or if clinical course is atypical or unduly prolonged.
  • Urinalysis: Checks the urine for bilirubin for the nonjaundiced client with suspected viral hepatitis.

Nursing diagnosis NCP Nursing Care Plan for Viral hepatitis

Nursing Key outcomes NCP Nursing Care Plan for Viral hepatitis

  • The patient will perform activities of daily living within the confines of the disease process, Extent of active management of energy to initate and sustain activity.
  • The patient will identify strategies to reduce anxiety, Personal actions to eliminate or reduce feelings of apprehension and tension from an unidentifiable source.
  • The patient and family will express an understanding of the disease process and treatment regimen Ability to acquire, organize, and use information. Verbalize understanding of condition/disease process and treatment.
  • The patient will discuss fears and concerns, Acknowledge and discuss fears, recognizing healthy versus unhealthy fears.
  • The patient will achieve adequate caloric and nutritional intake, Display normalization of laboratory values and be free of signs of malnutrition.
  • The patient will remain free from signs and symptoms of infection, patient will Identify interventions to prevent/reduce risk of infection.
  • The patient will avoid complications, Demonstrate behaviors, lifestyle changes to reduce risk factors and protect self from injury.

Nursing interventions NCP Nursing Care Plan for Viral hepatitis

  • Activity Therapy: Prescription of and assistance with specific physical, cognitive, social, and spiritual activities to increase the range, frequency, or duration of an individual’s (or group’s) activity. Energy Management: Regulating energy use to treat or prevent fatigue and optimize function. Exercise Promotion: Facilitation of regular physical exercise to maintain or advance to a higher level of fitness and health
  • Anxiety Reduction: Minimizing apprehension, dread, foreboding, or uneasiness related to an unidentified source or anticipated danger. Calming Technique: Reducing anxiety in patient experiencing acute distress
  • Teaching Individual about disease, diagnosis and treatment. Learning Facilitation: Promoting the ability to process and comprehend information. Learning Readiness Enhancement: Improving the ability and willingness to receive information.
  • Anxiety Reduction: Minimizing apprehension, dread, foreboding, or uneasiness related to an unidentified source or anticipated danger. Security Enhancement: Intensifying a patient’s sense of physical and psychological safety. Coping Enhancement: Assisting a patient to adapt to perceived stressors, changes, or threats that interfere with meeting life demands and roles
  • Nutrition Management: Assisting with or providing a balanced dietary intake of foods and fluids. Weight Gain Assistance: Facilitating gain of body weight
  • Infection Protection: Prevention and early detection of infection in a patient at risk. Infection Control: Minimizing the acquisition and transmission of infectious agents. Surveillance: Purposeful and ongoing acquisition, interpretation, and synthesis of patient data for clinical decision making
  • Surveillance: Safety: Purposeful and ongoing collection and analysis of information about the patient and the environment for use in promoting and maintaining patient safety. Analysis of potential risk factors, determination of health risks, and prioritization of risk reduction strategies for an individual or group. Environmental Management Manipulation of the patient’s surroundings for therapeutic benefit


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