1. The client/caregiver will be able to define hepatitis and the types of hepatitis.
    1. Hepatitis is an inflammation of the liver that can result in malfunction and liver damage. It can be acute or chronic.
    2. The most common cause of hepatitis is a viral infection. Forms of viral hepatitis are
      • Hepatitis A (infectious hepatitis or HAV)
      • Hepatitis B (serum hepatitis or HBV)
      • Hepatitis C (HCV)
      • Hepatitis D (HDV)
      • Hepatitis E (HEV)
    3. Forms of non viral hepatitis are
      • Toxic hepatitis—develops after exposure to chemicals toxic to the liver.
      • Drug induced hepatitis—develops as a result of drug reaction.
  2. The client/caregiver can describe mode of transmission for each form of hepatitis.
    1. Hepatitis A (incubation period of 3 to 5 weeks) is transmitted by
      1. Oral route from feces (stool) and saliva of infected person
      2. Contaminated water, food, and equipment
    2. Hepatitis B (incubation period of 2 to 5 months) is transmitted by
      1. Infected blood products, needles, and dental and surgical equipment
      2. Sexually through vagina secretions and semen of carriers or with active infection
    3. Hepatitis C (incubation period of 2 to 20 weeks) is transmitted by
      1. Infected blood or blood products
      2. Sexual contact
    4. Hepatitis D (incubation period of 2 to 5 months) is transmitted by
      1. The same way as hepatitis B and occurs as dual infection but not alone
    5. Hepatitis E (incubation period is 2–9 weeks) is transmitted by
      1. Fecal (stool) to oral method. There is a low risk of person-to-person contact but can be severe in pregnant women.
  3. The client/caregiver can recognize signs and symptoms of hepatitis.
    1. Signs and symptoms are divided into three phases of hepatitis: preicteric, icteric, and posticteric.
    2. The preicteric phase has the following symptoms:
      • Nausea and vomiting
      • A loss of appetite and weight loss
      • Fever
      • Complaints of tiredness
      • Headaches and joint pain
      • Discomfort in the right upper quadrant of abdomen
      • Enlargement of the spleen, liver, and lymph nodes
      • Rash and urticaria (itching of skin)
    3. The icteric phase has the additional symptoms:
      • Jaundice (yellowing tint to skin and eyes)
      • Pruritus
      • Clay- or light-colored stools
      • Dark urine
    4. The posticteric phase has the following symptoms:
      • Ending of previous symptoms
      • Liver enlargement
      • Continued fatigue
  4. The client/caregiver can list measures to prevent hepatitis infections.
    1. Receive vaccinations against hepatitis A, B, and E.
    2. Perform thorough handwashing techniques, especially after using toilet.
    3. Perform good personal and environmental hygiene.
    4. Obtain adequate rest and eat well-balanced diet.
    5. Use safe sex practices.
    6. Report any known exposure. You may receive immune globulin.
    7. Use standard precautions:
      1. Wear gloves if hands come in contact with body fluids.
      2. Wear gown and face shield if body fluids may be splashed.
      3. Increase fluids to two liters per day unless contraindicated.
      4. Weigh daily, weekly, or as ordered.
      5. Avoid alcohol.
    8. Do not share razors, toothbrushes, or needles.
    9. Use household bleach solution (10 parts water to one part bleach) to clean any surface contaminated with blood or feces (stool).
    10. Avoid drinking or using any potentially contaminated water.
    11. Screen food handlers. Screen public salad bars for presence of sneeze guards and hygienic devices and practices to prevent contamination.
    12. Require child care providers to wear gloves during diaper changes and to use routine hand washing.
    13. Do not share cigarettes, eating utensils, or beverage containers.
    14. Use liquid soap dispensers and electric hand dryers in public restrooms.
    15. Avoid placing fingers or hand held objects in mouth.
    16. Avoid eating raw seafood.
  5. The client/caregiver is aware of measures to manage hepatitis.
    1. Assess and report any signs of bleeding, confusion, edema, lethargy, and weight changes.
    2. Decrease itching.
      1. Take medications or apply lotions as prescribed.
      2. Take cool showers and avoid high temperatures.
      3. Keep fingernails short to prevent skin irritation if scratching.
      4. Wear cotton, loose-fitting clothing.
    3. Provide general comfort measures.
      1. Quiet environment
      2. Good mouth care
      3. Good hygiene
    4. Provide adequate nutrition.
      1. Offer small, frequent meals. Because of lack of appetite, try to offer foods that appeal to client and use some fat (in moderation) to make food appealing to the taste.
      2. Offer high-calorie, high-protein nutritious foods. Check with physician regarding protein content. High levels of ammonia can indicate a need to restrict protein intake.
    5. Rest as ordered. Avoid heavy lifting.
    6. Use an electric razor and soft-bristled toothbrush to prevent bleeding.
    7. Avoid alcohol and drugs that may cause further damage to liver.
    8. Avoid over-the-counter medications unless recommended by physician, especially aspirin and aspirin products.
    9. Keep follow-up appointments with physician and laboratory.
  6. The client/caregiver is aware of possible complications.
    1. Need for liver transplant
    2. Liver cirrhosis
    3. Hepatitis coma and death

Resources

Centers for Disease Control and Prevention
www.cdc.gov/ncidod/diseases/hepatitis/index.htm

Dietician
Community support groups

References

Ackley, B. J., & Ladwig, G. B. (2006). Nursing diagnosis handbook: A guide to planning care. Philadelphia: Mosby Inc.
Cohen, B. J., & Taylor, J. J. (2005). Memmler’s The Human Body in Health and Disease (10th ed.). Philadelphia: Lippincott Williams & Wilkins.
Lutz, C., & Przytulski, K. (2001). Nutrition and diet therapy. Philadelphia: F. A. Davis Company.
Nutrition made incredibly easy. (2003). Philadelphia: Lippincott Williams & Wilkins.
Perry, A., & Potter, P. (2006). Clinical nursing skills & technique. St. Louis: Mosby Inc.
Portable RN: The all-in-one nursing reference. (2002). Springhouse: Lippincott, Williams & Wilkins.
Taylor, C., Lillis, C., & LeMone, P. (2005). Fundamentals of nursing. Philadelphia: Lippincott, Williams & Wilkins.
Timby, B. K., & Smith, N. C. (2003). Introductory medical-surgical nursing (8th ed.). Philadelphia: J. B. Lippincott Williams & Wilkins.

Credits

Client Teaching Guides for Home Health Care, 2nd ed.
© 2008 Jones and Bartlett Publishers, Inc.
www.jbpub.com

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