Monday, May 25, 2015

Nursing Diagnoses

5 Key Nursing Diagnoses for People with Hepatitis C
Nursing diagnosis
Plan and outcome
Nursing interventions
1.  Risk for infection r/t immunosuppression and secondary defenses
Reduce transfer of potentially harmful microbes to the patient from outside sources and from the patient to others

Encourage effective hand washing
Implement appropriate isolation precautions according to facility policy
Explain isolation precautions to the patient
Restrict certain visitors, such as young children, to reduce the patient’s exposure to infectious agents
Administer medications as indicated
2. Imbalanced nutrition: less than body requirement r/t altered absorption and metabolism
Initiate lifestyle changes to maintain appropriate weight
Show signs of progressive weight gain
Show no signs of malnutrition
Keep track of calories consumed each day
Suggest eating for frequent small meals
Suggest eating the largest meal for breakfast when appetite is the greatest
Encourage good oral hygiene before and after meals to improve the taste of food
Encourage the patient to sit upright, at a table if possible, for every meal
Tailor the diet to each individual to meet their dietary needs and tolerance to fats and proteins
Monitor blood glucose
3. Deficient fluid volume r/t excessive loss from vomiting/diarrhea
Maintain adequate hydration
Patient shows no signs of deficient fluid volume including delayed capillary refill, abnormal vital signs, dry mucous membranes, poor skin turgor
Monitor patient intake and output
Monitor patient weight daily
Regularly assess blood pressure, heart rate, oxygen saturation, respiratory rate, and temperature
Assess peripheral pulses, capillary refill, and skill turgor for signs of deficient fluid volume
Assess for edema
Provide fluids and electrolytes through oral intake and IV fluids
Administer medications as ordered
4. Fatigue r/t change in metabolism and liver function
Patient is able to complete activities of daily living with little difficulty
Patient reports feeling more energized
Promote rest and relaxation by providing a quiet environment, limiting activity and visitors, and “clustering” care
Provide good skin care to reduce the risk of skin breakdown
Turn and reposition a patient on bedrest with limited mobility every 2 hours to prevent skin breakdown
Encourage rest during and in between activities of daily living
Encourage activity as tolerated including active and passive range of motion exercises in bed
5. Risk for impaired skin integrity r/t bile salt accumulation in the tissue
Patient’s skin is dry, intact, and shows no redness or signs of excoriation
Absence of excessive pruritus
Avoid using harsh soaps to prevent skin irritation
Encourage cool showers and taking a bath with baking soda to prevent dry skin
Provide distraction from itching
Assess skin frequently for signs of skin breakdown
Provide a pressure-redistribution surface for sleeping or bedrest patients
Encourage mobilizing frequently
Initiate turns and repositioning every 2 hours

Reference:
http://nurseslabs.com/7-hepatitis-nursing-care-plans/

Nursing Care for Patients with Hepatitis C

This week I will provide information for nurses regarding care for patients with hepatitis C. I will specifically talk about nursing care related to inadequate nutrition, dehydration, and fatigue. 
Problem
Nursing care
Inadequate nutrition

  • Keep track of calories consumed each day
  • Suggest eating for frequent small meals
  • Suggest eating the largest meal for breakfast when appetite is the greatest
  • Encourage good oral hygiene before and after meals to improve the taste of food
  • Encourage the patient to sit upright, at a table if possible, for every meal
  • Tailor the diet to each individual to meet their dietary needs and tolerance to fats and proteins
  • Monitor blood glucose

Dehydration

  • Monitor patient intake and output
  • Monitor patient weight daily
  • Regularly assess blood pressure, heart rate, oxygen saturation, respiratory rate, and temperature
  • Assess peripheral pulses, capillary refill, and skill turgor for signs of deficient fluid volume
  • Assess for edema
  • Provide fluids and electrolytes through oral intake and IV fluids

Fatigue
  • Promote rest and relaxation by providing a quiet environment, limiting activity and visitors, and “clustering” care
  • Provide good skin care to reduce the risk of skin breakdown
  • Turn and reposition a patient on bedrest with limited mobility every 2 hours to prevent skin breakdown
  • Encourage rest during and in between activities of daily living
  • Encourage activity as tolerated including active and passive range of motion exercises in bed




Check out the following website for more information about nursing care plans for patients with hepatitis C:
http://nurseslabs.com/7-hepatitis-nursing-care-plans/

References: 
http://nurseslabs.com/7-hepatitis-nursing-care-plans/

Treatments

This week I will talk about treatment for hepatitis C, which has come a long way in recent years. A variety of hepatitis C treatments are currently available and advances are being made in terms of new drug research and cost reduction of current medications.
What kinds of treatments are available for hepatitis C?
An acute hepatitis C infection can be treated and sometimes go away on its own. An acute infection will clear up independently in about 25% of people infected. However, treating an acute hepatitis C infection will reduce the risk of developing a chronic infection. 


What treatments are currently available for hepatitis C?


  • Pegylated interferon - This treatment is a protein that is used by the body to fight off infection. This is given as an injection.
  • Ribavirin - This medication is always used in conjunction with another form of treatment 
  • Protease inhibitors - These medications work on the hepatitis C virus directly by inhibiting their ability to reproduce
  • Simeprevir - This medication became available in 2013 and is used in combination with sofosbuvir (Sovaldi) 
  • Sofosbuvir (Sovaldi) - This pill is taken once a day and can be taken without supplemental ribavirin 
  • Ledipasvir/sofosbuvir (Harvoni) - This is a direct-acting antiviral combination pill
  • Ombitasvir/paritaprevir/ritonavir (Viekira Pak) - This is an interferon-free combination pill that can be used for people with a co-infection of HCV/HIV



What can someone with hepatitis C do to help with their own treatment?
  • First, it is important to regularly visit your primary health care provider so they can help you manage symptoms and monitor your health. 
  • Avoid alcohol consumption because it can damage the liver. 
  • Talk to your primary care provider about any over the counter medications or supplements you are taking as certain medications can be harmful to the liver.
This video provides information about some of the latest treatments for hepatitis C

This NY Times articles provides additional information about the availability of the latest medications and the controversy around the price:
http://www.nytimes.com/2015/05/20/business/high-cost-of-hepatitis-c-drug-prompts-a-call-to-void-its-patents.html?_r=0

References:
http://www.cdc.gov/hepatitis/C/cFAQ.htm#cFAQ61
http://www.nytimes.com/2015/05/20/business/high-cost-of-hepatitis-c-drug-prompts-a-call-to-void-its-patents.html?_r=0
http://hepc.liverfoundation.org/treatment/the-basics-about-hepatitis-c-treatment/advances-in-medications/


Tuesday, May 5, 2015

Signs and symptoms

Hepatitis C Virus signs and symptoms
In this blog post I will discuss the possible signs and symptoms resulting from a Hepatitis C Virus (HCV) infection. It is important to be aware that some individuals may be infected with HCV without showing any signs or symptoms. For this reason, it is important to receive appropriate testing, whether or not you have symptoms, if you think you may have been exposed to the virus. 

Symptoms of an acute Hepatitis C include:

  • Nausea and vomiting
  • Itching
  • Anorexia and abdominal pain
  • Fever
  • Jaundice
  • Clay-colored stool
  • Dark-colored urine
  • Fatigue

  • Symptoms can appear anywhere from 2 weeks to 6 months after exposure to the virus
  • The average onset of symptoms occurs at 6-7 weeks after exposure
  • Some individuals do not show any symptoms of the disease





Chronic Hepatitis C infection
  • Individuals with chronic infection still may not show signs and symptoms
  • Liver damage may occur in a chronic infection
  • 60-70% of people infected with HCV develop chronic liver disease
  • Long term health issues resulting from Hepatitis C may include liver failure, liver cancer, and sometimes death

For additional information about Hepatitis C please visit the Centers for Disease Control and Prevention website: http://www.cdc.gov/hepatitis/C/cFAQ.htm#cFAQ41

References:http://www.cdc.gov/hepatitis/C/cFAQ.htm#cFAQ41

https://www.youtube.com/watch?v=te69ip6CEm4




Friday, April 24, 2015

Diagnosis

Diagnosis of Hepatitis C
This week I will be blogging about how Hepatitis C is diagnosed. I will include information from a variety of sources addressing the diagnosis of the disease and the disease process.


Diagnosing Hepatitis C can be difficult because an acute infection is often asymptomatic. In order to diagnose Hepatitis C, the lab will draw samples of blood in order to test for certain blood components specific to an HCV infection.

How is an infection of the Hepatitis C Virus (HCV) detected?
  • Antibodies specific to the HCV may be present in the blood of an infected person
  • Other markers indicating the presence of HCV include specific enzymes and proteins that can also be observed in a blood test
What happens after a test for HCV returns positive?
  • After one of the markers of HCV mentioned above is detected, a more specific test is performed to detect  the presence of RNA specific to the HCV. This will confirm that a person is infected with the virus. 
Here is an example of a tool for providers to follow when diagnosing Hepatitis C:



If you think you have been exposed to the Hepatitis C Provider it is important to talk with a health care provider so they can perform an assessment and if necessary, perform blood tests to determine a diagnosis. If you would like additional information about the different forms of Hepatitis as well as some signs and symptoms of the disease, visit this website: http://www.nakedtruth.idaho.gov/hepatitisb.aspx.

The following website has resources for patients with Hepatitis C: http://www.cdc.gov/hepatitis/C/PatientEduC.htm



















Reference List:
http://www.nakedtruth.idaho.gov/hepatitisb.aspx
http://www.cdc.gov/hepatitis/C/PatientEduC.htm
http://depts.washington.edu/hepstudy/hepC/clindx/virus/discussion.html
http://www.jgld.ro/2006/3/7.pdf

Pathophysiology

The Pathophysiology of Hepatitis C Explained
How does someone get Hepatitis C?
Hepatitis C Virus (HCV) is typically spread when an uninfected person's blood is exposed to the blood of someone infected with Hepatitis C. This can happen as a result of sharing needles, if a health care worker or someone is accidentally stuck with a needly that is contaminated with HCV, a baby born to a mother with Hepatitis C, or, much less commonly, if a person receives a blood transfusion with HCV infected blood. Hepatitis C is rarely transferred person to person via sexual contact or by sharing personal items like a razor or toothbrush. 

In what ways is Hepatitis C not spread from person to person?

  • HCV is not spread through food or water
  • HCV is not spread through breast milk
  • HCV is not spread through hugging, kissing, or holding hands
  • HCV is not spread by coughing or sneezing

How long can Hepatitis C survive outside of a human body?
  • Hepatitis C can survive outside of a body on a surface for 3 weeks. 

What does Hepatitis C Virus look like?
An image of the Hepatitis C Virus viewed under an electron microscope.














What is the pathophysiology of Hepatitis C?

  • Much is still unknown about the Hepatitis C Virus (HCV) and its role in the human body
  • The HCV is sometimes able to evade the body's immune system, leading to a chronic infection
  • Though the body creates an immune response to the HCV, the virus may be able to survive as a result of rapid replication
  • Ultimately, the body continues to try to destroy the HCV and as a result causes damage to the body's own liver cells


For more information about Hepatitis C Virus visit this website:
http://nursing.advanceweb.com/Article/Hepatitis-C-Focus-on-Pathophysiology-amp-Treatment.aspx

Sources:
http://nursing.advanceweb.com/Article/Hepatitis-C-Focus-on-Pathophysiology-amp-Treatment.aspx
http://www.cdc.gov/hepatitis/C/cFAQ.htm
http://www.theguardian.com/science/2013/nov/05/hope-hepatitis-cure-drugs-success-sofosbuvir-ledipasvir

Sunday, April 12, 2015

Epidemiology

How prevalent is the Hepatitis C Virus around the world?
Hepatitis C Virus (HCV) affects people around the globe. About 130-170 million people in the world are infected with HCV. Most individuals who are infected with chronic HCV are unaware of their infection. Here are some global HCV statistics:
  • The World Health Organization estimates over 170 million people are chronic carrier of HCV and that globally about 3% have been infected with HCV
  • Egypt has the highest known prevalence of individuals infected with HCV at over 10% of the population. Egypt also has a high rate of chronic liver disease, liver cancer, and cirrhosis. 
  • In the United States, up to 2-4 million people may be chronically infected with HCV
  • In Europe 5-10 million people may be chronically infected with HCV
  • In India, about 12 million people may be chronically infected with HCV
  • In the U.S. and Western Europe, about 150,000 new cases of HCV occur annually
  • In Japan, about 350,000 new cases occur annually
Of the new cases of HCV diagnosed each year, only about a quarter of them are symptomatic but 60-80% may ultimately develop chronic liver disease. The mortality rate of those diagnosed each year is around 5-7%.

This map shows the prevalence of individuals chronically infected with the Hepatitis C Virus.



This graph depicts the number of acute Hepatitis C Virus infections in the United States between 1992 and 2009.

Watch this video to learn more about who has HCV around the world and how it is primarily spread from person to person:


References:
1. Chapter 3 Infectious Diseases Related To Travel. (n.d.). Retrieved April 12, 2015, from http://wwwnc.cdc.gov/travel/yellowbook/2014/chapter-3-infectious-diseases-related-to-travel/hepatitis-c
2. Clinical Infectious Diseases. (n.d.). Retrieved April 12, 2015, from http://cid.oxfordjournals.org/content/55/suppl_1/S3/F1.expansion.html
3. Hepatitis C. (n.d.). Retrieved April 12, 2015, from http://www.who.int/csr/disease/hepatitis/whocdscsrlyo2003/en/index8.html#94