o
The CDC does not recommend IG or antiviral agents such as interferon for
postexposure.
Acute Intervention Viral Hepatitis (All types)
In patients with hepatitis,
assess for the presence and degree of jaundice
. The
urine may have a dark brown or brownish red color
because of bilirubin. Comfort
measures to relieve pruritus (if present), headache, and arthralgias are helpful.
Ensure that the patient receives adequate nutrition.
The anorexia and distaste for
food cause nutritional problems. Assess the patient's tolerance of specific foods
and eating pattern. Small, frequent meals may be preferable to three large ones
and may also help prevent nausea. Often a patient with hepatitis finds that
anorexia is not as severe in the morning, so it is easier to eat a good breakfast
than a large dinner.
Measures to stimulate the appetite, such as mouth care,
antiemetics, and attractively served meals in pleasant surroundings, should be
included in your nursing care plan. Drinking carbonated beverages and avoiding
very hot or very cold foods may help alleviate anorexia
. Adequate fluid intake
(2500 to 3000 mL/day) is important.
Assess the patient's response to the rest and activity plan, and modify it
accordingly. Liver function tests and symptoms are used as a guide to activity.
Psychologic and emotional rest is as essential as physical rest.
Limited activity may
produce anxiety and extreme restlessness in some patients.
Diversional activities,
such as reading and hobbies, may help.
Ambulatory and Home Care Hepatitis
Most patients with viral hepatitis are cared for at home.
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Assess the patient's knowledge of nutrition and provide the necessary dietary
teaching. Caution the patient about overexertion and the need to follow the
health care
provider's advice about when to return to work.
Teach the patient and
the caregiver how to prevent transmission to other family members. Also teach what
symptoms should be reported to the health care provider.
Assess the patient for manifestations of complications. Bleeding tendencies with
increasing prothrombin time values, symptoms of encephalopathy, or elevated
liver function tests indicate problems.
Instruct the patient to have
regular follow-up for at least 1 year
after the diagnosis
of hepatitis.
All patients with chronic HBV or HCV should avoid alcohol, since it
can accelerate disease progression.
The patient who is receiving interferon for the treatment of HBV or HCV requires
education regarding this drug.
Because interferon is administered
subcutaneously, the patient or the caregiver needs to be taught how to
administer the drug. The numerous side effects with the therapy, including flu-
like symptoms (e.g., fever, malaise, fatigue), depression, make adherence to
therapy challenging for some patients.
Patients who are positive for HBsAg (chronic carrier status) or HCV antibody
should
not be blood donors.
Resources: Lewis, Sharon L. Medical-surgical nursing
Assessment and management of clinical problems
9th ed.
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