Hepatitis

A. Description
1. Inflammation of the liver caused by a virus, bacteria, or exposure to medications or
hepatotoxins.
2. The goals of treatment include resting the inflamed liver to reduce metabolic demands
and increasing the blood supply, thus promoting cellular regeneration and preventing
complications.
B. Types of hepatitis include hepatitis A virus (HAV), hepatitis B virus (HBV), hepatitis C virus
(HCV), hepatitis D virus (HDV), and hepatitis E virus (HEV).
C. Assessment and stages of viral hepatitis
1. Pre-icteric Stage
The first stage of hepatitis, preceding the appearance of jaundice; includes flulike
symptoms—malaise, fatigue; anorexia, nausea, vomiting, diarrhea; pain—headache,
muscle aches, polyarthritis; and elevated serum bilirubin and enzyme levels.
2. Icteric Stage
The second stage of hepatitis; includes the appearance of jaundice and associated
symptoms such as elevated bilirubin levels, dark or tea-colored urine, and clay-colored
stools; pruritus; and a decrease in preicteric-phase symptoms.
3. Posticteric Stage
The convalescent stage of hepatitis, in which the jaundice decreases and the color of the
urine and stool returns to normal; energy increases, pain subsides, there is minimal to
absent gastrointestinal symptoms, and bilirubin and enzyme levels return to normal.

Hepatitis A
A. Description: Formerly known as infectious hepatitis
B. Individuals at increased risk
1. Crowded conditions (e.g., day care, nursing home)
2. Exposure to poor sanitation
C. Transmission
1. Fecal-oral route
 2. Person-to-person contact
3. Parenteral
4. Contaminated fruits or vegetables, or uncooked shellfish
5. Contaminated water or milk
6. Poorly washed utensils
D. Incubation and infectious period
1. Incubation period is 2 to 6 weeks.
2. Infectious period is 2 to 3 weeks before and 1 week after development of jaundice.
E. Testing
1. Infection is established by the presence of HAV antibodies (anti-HAV) in the blood.
2. ImmunoglobulinM (IgM) and immunoglobulin G (IgG) are normally present in the
blood,
and increased levels indicate infection and inflammation.
3. Ongoing inflammation of the liver is evidenced by the presence of elevated levels of
IgM antibodies, which persist in the blood for 4 to 6 weeks.
4. Previous infection is indicated by the presence of elevated levels of IgG antibodies.
F. Complication: Fulminant (severe acute and often fatal) hepatitis
G. Prevention
1. Strict hand washing
2. Stool and needle precautions
3. Treatment of municipal water supplies
4. Serological screening of food handlers
5. Hepatitis A vaccine: Two doses are needed at least 6 months apart for lasting
protection. For additional information, refer to http://www.cdc.gov/vaccines/hcp/vis/vis-
statements/hep-a.html
6. Immunoglobulin: For individuals exposed to HAV who have never received the
hepatitis A vaccine;
administer immune globulin during the period of incubation and within 2 weeks of
exposure.
7. Immune globulin and hepatitis A vaccine are recommended for household members
and sexual contacts of individuals with hepatitis A.
 8. Preexposure prophylaxis with immune globulin is recommended to individuals
traveling to countries with poor or uncertain sanitation conditions.

Hepatitis B
A. Description
1. Hepatitis B is nonseasonal.
2. All age groups can be affected.
B. Individuals at increased risk
1. IV drug users
2. Clients undergoing long-term hemodialysis
3. Health care personnel
C. Transmission
1. Blood or body fluid contact
2. Infected blood products
3. Infected saliva or semen
4. Contaminated needles
5. Sexual contact
6. Parenteral
7. Perinatal period
8. Blood or body fluid contact at birth
D. Incubation period: 6 to 24 weeks
E. Testing
1. Infection is established by the presence of hepatitis B antigen–antibody systems in the
blood.
2. The presence of hepatitis B surface antigen (HBsAg) is the serological marker
establishing the diagnosis of hepatitis B.
3. The client is considered infectious if these antigens are present in the blood.
4. If the serological marker (HBsAg) is present after 6 months, it indicates a carrier state
or chronic hepatitis.
 5. Normally, the serological marker (HBsAg) level declines and disappears after the acute
hepatitis B episode.
6. The presence of antibodies to HBsAg (anti-HBs) indicates recovery and immunity to
hepatitis B.
7. Hepatitis B early antigen (HBeAg) is detected in the blood about 1 week after the
appearance of HBsAg, and its presence determines the infective state of the client.
F. Complications
1. Fulminant hepatitis
2. Chronic liver disease
3. Cirrhosis
4. Primary hepatocellular carcinoma
G. Prevention
1. Strict hand washing
2. Screening blood donors
3. Testing of all pregnant women
4. Needle precautions
5. Avoiding intimate sexual contact and contact
with body fluids if test for HBsAg is positive.
6. Hepatitis B vaccine: Adult and pediatric forms; there is also an adult vaccine that
protects against hepatitis A and B.
7. Hepatitis B immune globulin is for individuals exposed to HBV through sexual contact
or through the percutaneous or transmucosal routes who have never had hepatitis B and
have never received hepatitis B vaccine.

Hepatitis C
A. Description
1. HCV infection occurs year-round.
2. Infection can occur in any age group.
3. Infection with HCV is common among IV drug users and is the major cause of
posttransfusion
hepatitis.
 4. Risk factors are similar to those for HBV because hepatitis C is also transmitted
parenterally.
B. Individuals at increased risk
1. Parenteral drug users
2. Clients receiving frequent transfusions
3. Health care personnel
C. Transmission: Same as for HBV, primarily through blood
D. Incubation period: 5 to 10 weeks
E. Testing: Anti-HCV is the antibody to HCV and is measured to detect chronic states of
hepatitis C.
F. Complications
1. Chronic liver disease
2. Cirrhosis
3. Primary hepatocellular carcinoma
G. Prevention
1. Strict hand washing
2. Needle precautions
3. Screening of blood donors

Hepatitis D
A. Description
1. Hepatitis D is common in the Mediterranean and Middle Eastern areas.
2. Hepatitis D occurs with hepatitis B and causes infection only in the presence of active
HBV infection.
3. Coinfection with the delta agent (HDV) intensifies the acute symptoms of hepatitis B.
4. Transmission and risk of infection are the same as for HBV, via contact with blood and
blood
products.
5. Prevention of HBV infection with vaccine also prevents HDV infection, because HDV
depends on HBV for replication.
 B. High-risk individuals
1. Drug users
2. Clients receiving hemodialysis
3. Clients receiving frequent blood transfusions
C. Transmission: Same as for HBV
D. Incubation period: 7 to 8 weeks
E. Testing: Serological HDV determination is made by detection of the hepatitis D antigen
(HDAg) early in the course of the infection and by detection of anti-HDV antibody in the
later disease stages.
F. Complications
1. Chronic liver disease
2. Fulminant hepatitis
G. Prevention: Because hepatitis D must coexist with hepatitis B, the precautions that help
to prevent hepatitis B are also useful in preventing delta hepatitis.

Hepatitis E
A. Description
1. Hepatitis E is a waterborne virus.
2. Hepatitis E is prevalent in areas where sewage disposal is inadequate or where
communal bathing in contaminated rivers is practiced.
3. Risk of infection is the same as for HAV.
4. Infection with HEV presents as a mild disease except in infected women in the third
trimester of pregnancy, who have a high mortality rate.
B. Individuals with increased risk
1. Travelers to countries that have a high incidence of hepatitis E, such as India, Burma
(Myanmar), Afghanistan, Algeria, and Mexico.
2. Eating or drinking of food or water contaminated with the virus
C. Transmission: Same as for HAV
D. Incubation period: 2 to 9 weeks
E. Testing:
Specific serological tests for HEV include detection of IgM and IgG antibodies to hepatitis E
(anti-HEV).
F. Complications
1. High mortality rate in pregnant women
2. Fetal demise
G. Prevention
1. Strict hand washing
2. Treatment of water supplies and sanitation measures.

Client and Family Home Care Instructions for Hepatitis

 Hand washing must be strict and frequent.
 Do not share bathrooms unless the client strictly adheres to personal hygiene
measures.
 Individual washcloths, towels, drinking and eating utensils, and toothbrushes and
razors must be labeled and used only by the client.
 The client must not prepare food for other family members.
 The client should avoid alcohol and over-the-counter medications, particularly
acetaminophen and sedatives, because these medications are hepatotoxic.
 The client should increase activity gradually to prevent fatigue.
 The client should consume small, frequent meals consisting of high-carbohydrate,
low-fat foods.
 The client is not to donate blood.
 The client may maintain normal contact with persons as long as proper personal
hygiene is maintained.
 Close personal contact such as kissing and sexual activity should be discouraged with
hepatitis B until surface antigen test results are negative.
 The client needs to carry a MedicAlert card noting the date of hepatitis onset.
 The client needs to inform other health professionals, such as medical or dental
personnel, of the onset of hepatitis.
 The client needs to keep follow-appointments with the health care provider.
Name: Middle East Respiratory Syndrome – Coronavirus (MERS-CoV)
Other Names:
 Camel Flu
 SARS of Middle East
Signs and Symptoms:
1. SARS with symptoms of:
1. fever
2. cough
3. shortness of breath
2. Gastrointestinal (GI) Symptoms:
 diarrhea
 nausea and vomiting
Vector:
1. Dromedary/Arabian Camel
2. Tomb Bats
Causative Agent: Beta Coronavirus
Mode of Transmission: (precise way is NOT fully understood):
1. Airborne – like other coronaviruses, spreads from an infected person’s respiratory
secretions such as through coughing
2. Close contact – providing unprotected care to an infected person (e.g. in healthcare
settings, such as hospitals)
Medical Management:
- No vaccine or specific treatment is currently available
- Treatment is supportive and based on the patient’s clinical condition (medical care
focuses on relief of symptoms)
Nursing Management:
- Provide patients with strategies to help them protect themselves from respiratory illnesses
such as:
1. Wash your hands often with soap and water for 20 seconds, and help young children do
the same. If soap and water are not available, use an alcohol-based hand sanitizer.
2. Cover your nose and mouth with a tissue when you cough or sneeze, then throw the
tissue in the trash.
3. Avoid touching your eyes, nose and mouth with unwashed hands.
4. Avoid personal contact, such as kissing, or sharing cups or eating utensils, with sick
people.
5. Clean and disinfect frequently touched surfaces and objects, such as doorknobs.
Name of Disease: Crimean Congo Hemorrhagic Fever
Other names:
 Crimean hemorrhagic fever
 Congo Fever
 Central Asian Hemorrhagic Fever

Signs and Symptoms:

Early signs: headache, high fever, back pain, joint pain, stomach pain, and vomiting. Red eyes, a
flushed face, a red throat, and petechiae (red spots) on the palate are common. Symptoms may
also include jaundice, and in severe cases, changes in mood and sensory perception.
Late signs: Large areas of severe bruising, severe nosebleeds, and uncontrolled bleeding at
injection sites can be seen (begins at 4th day of illness and lasts for about 2 weeks).
Vector/Mode of Transsmission:
Ixodid (hard) ticks are both a reservoir and a vector for the CCHF virus. Numerous wild and
domestic animals, such as cattle, goats, sheep and hares, serve as amplifying hosts for the virus.
Transmission to humans occurs through contact with infected ticks or animal blood. CCHF can
be transmitted from one infected human to another by contact with infectious blood or body
fluids.
Medical Management:
 Treatment for CCHF is primarily supportive.
 Care should include:
 Attention to fluid balance and correction of electrolyte abnormalities
 Oxygenation and hemodynamic support
 Appropriate treatment of secondary infections.
 The virus is sensitive in vitro to the antiviral drug ribavirin.

Nursing Management:
 The use insect repellent on exposed skin and clothing should be advised to agricultural
workers and others working with animals.
 Insect repellants containing DEET (N, N-diethyl-m-toluamide) are the most effective in
warding off ticks.
 Wearing gloves and other protective clothing is recommended.
 Individuals should also avoid contact with the blood and body fluids of livestock or
humans who show symptoms of infection.
 Use proper infection control precautions to prevent occupational exposure.
Name: Leptospirosis
Other Names: Weir's disease, Canicola fever, Hemorrhagic jaundice, Mud fever, Swineherd
disease
Signs and symptoms:
 Fever
 Non-specific symptoms of muscle pain, headache
 Calf-muscle pain and reddish eyes from some cases
 Severe cases result tot liver involvement, kidney failure or brain involvement. Thus
some cases may have yellowish body discoloration, dark-colored urine and light stools,
low urine output, severe headache.

* The time between a person’s exposure to a contaminated source and becoming sick is 2
days to 4 weeks.
*The illness lasts from a few days to 3 weeks or longer. Without treatment, recovery may
take several months.

Mode of Transmission:

 Entry of the leptospira bacteria through wounds when in contact with flood waters,
vegetation, moist soil contaminated with the urine of infected animals, especially rats.

Medical Manangement:
▪ Medication:
Antibiotics (should be given early in the course of the disease)
-doxycycline
-penicillin

▪ Intravenous antibiotics may be required for persons with more severe symptoms

▪ Depending on which organs leptospirosis affects, the individual may need a ventilator to help
them breathe. If it affects the kidneys, dialysis may be necessary.

▪ Intravenous fluids can provide hydration and essential nutrients.

▪ During pregnancy, leptospirosis can affect the fetus. Anyone who has the infection during
pregnancy will need to spend time in the hospital for monitoring.
Nursing Management

Health teaching

 Provide education to clients telling them to avoid swimming or wading in potentially

contaminated water or flood water.
 Use of proper protection like boots and gloves when work requires exposure to
contaminated water.
 Drain potentially contaminated water when possible.
 Existing cuts or abrasions should be covered with waterproof dressings before
possible exposure.
 Control rats in the household by using rat traps or rat poison, maintaining cleanliness
in the house.

Management

 Isolate the patient and concurrent disinfection of soiled articles.

 Stringent community-wide rat eradication program. Remove rubbish from work and
domestic environment to reduce rodent population.
 Report all cases of leptospirosis.
 Investigation of contacts and source of infection
 Chemoprophylaxis can be done in a group of high risk infected hosts.
Name of Disease: BOTULISM
Other names:
S/Sx:

 double vision
 blurred vision
 drooping eyelids
 slurred speech
 difficulty swallowing
 difficulty breathing
 a thick-feeling tongue
 dry mouth
 muscle weakness
Infants with botulism may:

 appear lethargic
 feed poorly
 be constipated
 have a weak cry
 have poor muscle tone (appear “floppy”)

Vector/Mode of Transmission: clostridium botulinum

 Food-borne botulism
o the ingestion of preformed toxin in contminated food, often home-canned
foods
 Wound botulism
o When C. botulinum bacteria get into a wound — possibly caused by an injury
you might not notice — they can multiply and produce toxin
o This type of botulism is more common in people who inject black tar heroin
 Infant botulism
o Babies get infant botulism after consuming spores of the bacteria, which then
grow and multiply in their intestinal tracts and make toxins

Medical management:
 Medication:
o Antitoxin: reduces risk of complications\
 Immune globulin is used to treat infants
o Antibiotics
 Mechanical ventilator for severe cases (d/t respiratory failure)
 Rehabilitation

Nursing Management:
 Health teaching:
o Good practice on food preparation particularly during heating/sterilization
o Hygiene
o WHO 5 Keys to Safer Food:
 Keep clean
 Separate raw and cooked
 Cook thoroughly
 Keep food at safe temperatures
 Use safe water and raw materials

 Before giving anti-toxin, obtain an accurate patient history of allergies.

 If the patient has difficulty in swallowing, initiate nasogastric tube feedings or TPN as
ordered.
 Suction the patient as needed.
 Administer I.V. fluids as ordered.
 Turn the patient often and encourage deep breathing exercises.
 Position the patient in proper alignment and assist with range-of-motion exercises.
 Observe the patient carefully for abnormal neurologic signs.
 Monitor intake and output.
 If the patient has difficulty speaking, try to anticipate his needs. Assure him that this
symptom will pass and establish an alternative method of communication.