Hepatitis A, B, and C its management and treatment
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Jan 14, 2009
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About This Presentation
Hepatitis A,B, and C, its prevention, management, medical treatment and its pathophysiology.
Slide Content
Hepatitis A, B, and CHepatitis A, B, and C
Its prevention, nursing Its prevention, nursing
management, and medical management, and medical
treatmenttreatment
Presented by: Dave Jay S. Presented by: Dave Jay S.
Manriquez RN.Manriquez RN.
Its prevention, nursing Its prevention, nursing
management, and medical management, and medical
treatmenttreatment
Presented by: Dave Jay S. Presented by: Dave Jay S.
Manriquez RN.Manriquez RN.
HEPATITIS AHEPATITIS A
PREVENTION PREVENTION
•If already infected with HAVIf already infected with HAV
1.1.Wash your hands thoroughly every time you use Wash your hands thoroughly every time you use
the bathroom, before touching or preparing food, the bathroom, before touching or preparing food,
and before touching others. Wash carefully with and before touching others. Wash carefully with
soap and warm water and dry thoroughly. soap and warm water and dry thoroughly.
2.2.Contaminated surfaces should be cleaned with Contaminated surfaces should be cleaned with
household bleach to kill the virus. household bleach to kill the virus.
3.3.Heat food or water to 185°F or 85°C to kill the Heat food or water to 185°F or 85°C to kill the
virus. virus.
NOTE: Strict personal hygiene and hand washing help NOTE: Strict personal hygiene and hand washing help
prevent transmission of HAV to others. prevent transmission of HAV to others.
•If already infected with HAVIf already infected with HAV
1.1.Wash your hands thoroughly every time you use Wash your hands thoroughly every time you use
the bathroom, before touching or preparing food, the bathroom, before touching or preparing food,
and before touching others. Wash carefully with and before touching others. Wash carefully with
soap and warm water and dry thoroughly. soap and warm water and dry thoroughly.
2.2.Contaminated surfaces should be cleaned with Contaminated surfaces should be cleaned with
household bleach to kill the virus. household bleach to kill the virus.
3.3.Heat food or water to 185°F or 85°C to kill the Heat food or water to 185°F or 85°C to kill the
virus. virus.
NOTE: Strict personal hygiene and hand washing help NOTE: Strict personal hygiene and hand washing help
prevent transmission of HAV to others. prevent transmission of HAV to others.
PREVENTION…PREVENTION…
•If NOT yet Infected with HAVIf NOT yet Infected with HAV
1.1.Wash your hands carefully with soap and warm Wash your hands carefully with soap and warm
water several times a day, including every time you water several times a day, including every time you
use the bathroom, every time you change a diaper, use the bathroom, every time you change a diaper,
and before preparing food. and before preparing food.
2.2.Do not eat raw or undercooked seafood or shellfish Do not eat raw or undercooked seafood or shellfish
such as oysters from areas of questionable such as oysters from areas of questionable
sanitation (just about everywhere). sanitation (just about everywhere).
3.3.Travelers to developing countries should not drink Travelers to developing countries should not drink
untreated water or beverages with ice in them. untreated water or beverages with ice in them.
Fruits and vegetables should not be eaten unless Fruits and vegetables should not be eaten unless
cooked or peeled. cooked or peeled.
•If NOT yet Infected with HAVIf NOT yet Infected with HAV
1.1.Wash your hands carefully with soap and warm Wash your hands carefully with soap and warm
water several times a day, including every time you water several times a day, including every time you
use the bathroom, every time you change a diaper, use the bathroom, every time you change a diaper,
and before preparing food. and before preparing food.
2.2.Do not eat raw or undercooked seafood or shellfish Do not eat raw or undercooked seafood or shellfish
such as oysters from areas of questionable such as oysters from areas of questionable
sanitation (just about everywhere). sanitation (just about everywhere).
3.3.Travelers to developing countries should not drink Travelers to developing countries should not drink
untreated water or beverages with ice in them. untreated water or beverages with ice in them.
Fruits and vegetables should not be eaten unless Fruits and vegetables should not be eaten unless
cooked or peeled. cooked or peeled.
Vaccines that Work against HAVVaccines that Work against HAV
•HavrixHavrix and and VAQTAVAQTA
–contain no live virus and are very safe contain no live virus and are very safe
–given in a series of 2 shots. The second is given 6-18 given in a series of 2 shots. The second is given 6-18
months after the first. months after the first.
–protection starts about 2-4 weeks after the first shot. protection starts about 2-4 weeks after the first shot.
The second dose is necessary to ensure long-term The second dose is necessary to ensure long-term
protection. protection.
–thought to protect from infection for at least 20 yearsthought to protect from infection for at least 20 years
–must be given before exposure to the virusmust be given before exposure to the virus
•HavrixHavrix and and VAQTAVAQTA
–contain no live virus and are very safe contain no live virus and are very safe
–given in a series of 2 shots. The second is given 6-18 given in a series of 2 shots. The second is given 6-18
months after the first. months after the first.
–protection starts about 2-4 weeks after the first shot. protection starts about 2-4 weeks after the first shot.
The second dose is necessary to ensure long-term The second dose is necessary to ensure long-term
protection. protection.
–thought to protect from infection for at least 20 yearsthought to protect from infection for at least 20 years
–must be given before exposure to the virusmust be given before exposure to the virus
Groups Recommended to have the Groups Recommended to have the
HAV VaccineHAV Vaccine
•All children older than 2 years who live in communities All children older than 2 years who live in communities
where the number of HAV infections is unusually high or where the number of HAV infections is unusually high or
where there are periodic outbreaks of hepatitis A where there are periodic outbreaks of hepatitis A
•People who are likely to be exposed to HAV at workPeople who are likely to be exposed to HAV at work
•. Travelers to developing countries (it must be given at . Travelers to developing countries (it must be given at
least 4 weeks before travel) least 4 weeks before travel)
•Men who have sex with men Men who have sex with men
•People who use illegal drugs People who use illegal drugs
•people with impaired immune systems or chronic people with impaired immune systems or chronic
liver diseaseliver disease
•People with blood-clotting disorders who receive clotting People with blood-clotting disorders who receive clotting
factors factors
HAV VaccineHAV Vaccine
•All children older than 2 years who live in communities All children older than 2 years who live in communities
where the number of HAV infections is unusually high or where the number of HAV infections is unusually high or
where there are periodic outbreaks of hepatitis A where there are periodic outbreaks of hepatitis A
•People who are likely to be exposed to HAV at workPeople who are likely to be exposed to HAV at work
•. Travelers to developing countries (it must be given at . Travelers to developing countries (it must be given at
least 4 weeks before travel) least 4 weeks before travel)
•Men who have sex with men Men who have sex with men
•People who use illegal drugs People who use illegal drugs
•people with impaired immune systems or chronic people with impaired immune systems or chronic
liver diseaseliver disease
•People with blood-clotting disorders who receive clotting People with blood-clotting disorders who receive clotting
factors factors
MEDICAL TREATMENTMEDICAL TREATMENT
•No specific medicines to cure infection No specific medicines to cure infection
with hepatitis Awith hepatitis A
•immune globulinimmune globulin- given to people who are - given to people who are
likely to be exposed to someone who is likely to be exposed to someone who is
infected with HAVinfected with HAV
•No specific medicines to cure infection No specific medicines to cure infection
with hepatitis Awith hepatitis A
•immune globulinimmune globulin- given to people who are - given to people who are
likely to be exposed to someone who is likely to be exposed to someone who is
infected with HAVinfected with HAV
MEDICAL TREATMENTMEDICAL TREATMENT ……
1.1.Bed rest during the acute stage and a diet Bed rest during the acute stage and a diet
that is both acceptable to the patient and that is both acceptable to the patient and
nutritious are part of the treatment and nutritious are part of the treatment and
nursing care.nursing care.
2.2.During the period of anorexia, the patient During the period of anorexia, the patient
should receive frequent small feedings, should receive frequent small feedings,
supplemented, if necessary, by IV fluids with supplemented, if necessary, by IV fluids with
glucose.glucose.
3.3.If dehydration occurs, IV fluids are being If dehydration occurs, IV fluids are being
prescribed to help the patient feel better. prescribed to help the patient feel better.
1.1.Bed rest during the acute stage and a diet Bed rest during the acute stage and a diet
that is both acceptable to the patient and that is both acceptable to the patient and
nutritious are part of the treatment and nutritious are part of the treatment and
nursing care.nursing care.
2.2.During the period of anorexia, the patient During the period of anorexia, the patient
should receive frequent small feedings, should receive frequent small feedings,
supplemented, if necessary, by IV fluids with supplemented, if necessary, by IV fluids with
glucose.glucose.
3.3.If dehydration occurs, IV fluids are being If dehydration occurs, IV fluids are being
prescribed to help the patient feel better. prescribed to help the patient feel better.
MEDICAL TREATMENT…MEDICAL TREATMENT…
1.1.Medicines are being prescribed by the Medicines are being prescribed by the
physician to control nausea and vomiting.physician to control nausea and vomiting.
2.2.People whose symptoms are well-controlled People whose symptoms are well-controlled
can be cared for at home. If dehydration or can be cared for at home. If dehydration or
other symptoms are severe, then the patient other symptoms are severe, then the patient
is managed at the hospital. is managed at the hospital.
3.3.Gradual but progressive ambulation seems Gradual but progressive ambulation seems
to hasten recovery, provided the patient to hasten recovery, provided the patient
rests after activity and does not participate rests after activity and does not participate
in activities to the point of fatigue.in activities to the point of fatigue.
1.1.Medicines are being prescribed by the Medicines are being prescribed by the
physician to control nausea and vomiting.physician to control nausea and vomiting.
2.2.People whose symptoms are well-controlled People whose symptoms are well-controlled
can be cared for at home. If dehydration or can be cared for at home. If dehydration or
other symptoms are severe, then the patient other symptoms are severe, then the patient
is managed at the hospital. is managed at the hospital.
3.3.Gradual but progressive ambulation seems Gradual but progressive ambulation seems
to hasten recovery, provided the patient to hasten recovery, provided the patient
rests after activity and does not participate rests after activity and does not participate
in activities to the point of fatigue.in activities to the point of fatigue.
Dietary ManagementDietary Management
1.1.Recommend small, frequent meals.Recommend small, frequent meals.
2.2.Provide intake of 2,000 to 3,000 kcal/day Provide intake of 2,000 to 3,000 kcal/day
during acute illness.during acute illness.
3.3.Although early studies indicate that a Although early studies indicate that a
high-protein, high-calorie, diet may be high-protein, high-calorie, diet may be
beneficial, advise patient not to force beneficial, advise patient not to force
food and to restrict fat intake.food and to restrict fat intake.
4.4.Carefully monitor fluid balance.Carefully monitor fluid balance.
1.1.Recommend small, frequent meals.Recommend small, frequent meals.
2.2.Provide intake of 2,000 to 3,000 kcal/day Provide intake of 2,000 to 3,000 kcal/day
during acute illness.during acute illness.
3.3.Although early studies indicate that a Although early studies indicate that a
high-protein, high-calorie, diet may be high-protein, high-calorie, diet may be
beneficial, advise patient not to force beneficial, advise patient not to force
food and to restrict fat intake.food and to restrict fat intake.
4.4.Carefully monitor fluid balance.Carefully monitor fluid balance.
Dietary ManagementDietary Management
1.1.If anorexia, nausea and vomiting persist, If anorexia, nausea and vomiting persist,
enteral feedings may be necessary.enteral feedings may be necessary.
2.2.Instruct patient to abstain from alcohol Instruct patient to abstain from alcohol
during the acute illness and for 6 months during the acute illness and for 6 months
after recovery.after recovery.
3.3.Advise patient to avoid substances Advise patient to avoid substances
(medication, herbs, illicit drugs and (medication, herbs, illicit drugs and
toxins) that may affect liver function.toxins) that may affect liver function.
1.1.If anorexia, nausea and vomiting persist, If anorexia, nausea and vomiting persist,
enteral feedings may be necessary.enteral feedings may be necessary.
2.2.Instruct patient to abstain from alcohol Instruct patient to abstain from alcohol
during the acute illness and for 6 months during the acute illness and for 6 months
after recovery.after recovery.
3.3.Advise patient to avoid substances Advise patient to avoid substances
(medication, herbs, illicit drugs and (medication, herbs, illicit drugs and
toxins) that may affect liver function.toxins) that may affect liver function.
NURSING MANAGEMENTNURSING MANAGEMENT
• The patient is usually managed at home The patient is usually managed at home
unless symptoms are severe. unless symptoms are severe.
•The nurse assists the patient and family in The nurse assists the patient and family in
coping with temporary disability and coping with temporary disability and
fatigue that are common in hepatitis and fatigue that are common in hepatitis and
instructs them to seek additional health instructs them to seek additional health
care if the symptoms persist or worsencare if the symptoms persist or worsen
• The patient is usually managed at home The patient is usually managed at home
unless symptoms are severe. unless symptoms are severe.
•The nurse assists the patient and family in The nurse assists the patient and family in
coping with temporary disability and coping with temporary disability and
fatigue that are common in hepatitis and fatigue that are common in hepatitis and
instructs them to seek additional health instructs them to seek additional health
care if the symptoms persist or worsencare if the symptoms persist or worsen
Self-Care at HomeSelf-Care at Home
1.1.Take it easy; curtail your normal activities and Take it easy; curtail your normal activities and
spend time resting at home. spend time resting at home.
2.2.Drink plenty of clear fluids to prevent Drink plenty of clear fluids to prevent
dehydration. dehydration.
3.3.Avoid medicines and substances that can Avoid medicines and substances that can
cause harm to the liver such as cause harm to the liver such as acetaminophenacetaminophen
(Tylenol) and preparations that contain (Tylenol) and preparations that contain
acetaminophen. acetaminophen.
1.1.Take it easy; curtail your normal activities and Take it easy; curtail your normal activities and
spend time resting at home. spend time resting at home.
2.2.Drink plenty of clear fluids to prevent Drink plenty of clear fluids to prevent
dehydration. dehydration.
3.3.Avoid medicines and substances that can Avoid medicines and substances that can
cause harm to the liver such as cause harm to the liver such as acetaminophenacetaminophen
(Tylenol) and preparations that contain (Tylenol) and preparations that contain
acetaminophen. acetaminophen.
Self-Care at Home…Self-Care at Home…
1.1.Avoid alcoholic beverages, as these can Avoid alcoholic beverages, as these can
worsen the effects of HAV on the liver. worsen the effects of HAV on the liver.
2.2.Avoid prolonged, vigorous exercise until Avoid prolonged, vigorous exercise until
symptoms start to improve.symptoms start to improve.
3.3.Call your health care provider if symptoms Call your health care provider if symptoms
worsen or a new symptom appears. worsen or a new symptom appears.
4.4.Be very careful about personal hygiene to Be very careful about personal hygiene to
avoid fecal-oral transmission to other members avoid fecal-oral transmission to other members
of the household.of the household.
1.1.Avoid alcoholic beverages, as these can Avoid alcoholic beverages, as these can
worsen the effects of HAV on the liver. worsen the effects of HAV on the liver.
2.2.Avoid prolonged, vigorous exercise until Avoid prolonged, vigorous exercise until
symptoms start to improve.symptoms start to improve.
3.3.Call your health care provider if symptoms Call your health care provider if symptoms
worsen or a new symptom appears. worsen or a new symptom appears.
4.4.Be very careful about personal hygiene to Be very careful about personal hygiene to
avoid fecal-oral transmission to other members avoid fecal-oral transmission to other members
of the household.of the household.
HEPATITIS BHEPATITIS B
PREVENTIONPREVENTION
•immune globulin (BayHep B, Nabi-HB)immune globulin (BayHep B, Nabi-HB)
–given along with the hepatitis B vaccine to given along with the hepatitis B vaccine to
unvaccinated people who have been exposed to unvaccinated people who have been exposed to
hepatitis B hepatitis B
•EngerixEngerix-B-B, Recombivax HB, Recombivax HB
–safe and works well to prevent the diseasesafe and works well to prevent the disease
–a total of 3 doses of the vaccine are given over a total of 3 doses of the vaccine are given over
several months several months
–recommended for all children younger than 19 yearsrecommended for all children younger than 19 years
•immune globulin (BayHep B, Nabi-HB)immune globulin (BayHep B, Nabi-HB)
–given along with the hepatitis B vaccine to given along with the hepatitis B vaccine to
unvaccinated people who have been exposed to unvaccinated people who have been exposed to
hepatitis B hepatitis B
•EngerixEngerix-B-B, Recombivax HB, Recombivax HB
–safe and works well to prevent the diseasesafe and works well to prevent the disease
–a total of 3 doses of the vaccine are given over a total of 3 doses of the vaccine are given over
several months several months
–recommended for all children younger than 19 yearsrecommended for all children younger than 19 years
Groups Recommended to have the Groups Recommended to have the
HBV VaccineHBV Vaccine
1. All children younger than 18 years, including 1. All children younger than 18 years, including
newborns--especially those born to mothers who newborns--especially those born to mothers who
are infected with HBV.are infected with HBV.
2. All health care and public safety workers who 2. All health care and public safety workers who
may be exposed to blood may be exposed to blood
3. People who have 3. People who have hemophiliahemophilia or other blood or other blood
clotting disorders and receive transfusions of clotting disorders and receive transfusions of
human clotting factors human clotting factors
4. People who require 4. People who require hemodialysishemodialysis for kidney for kidney
disease disease
HBV VaccineHBV Vaccine
1. All children younger than 18 years, including 1. All children younger than 18 years, including
newborns--especially those born to mothers who newborns--especially those born to mothers who
are infected with HBV.are infected with HBV.
2. All health care and public safety workers who 2. All health care and public safety workers who
may be exposed to blood may be exposed to blood
3. People who have 3. People who have hemophiliahemophilia or other blood or other blood
clotting disorders and receive transfusions of clotting disorders and receive transfusions of
human clotting factors human clotting factors
4. People who require 4. People who require hemodialysishemodialysis for kidney for kidney
disease disease
Groups Recommended to have the Groups Recommended to have the
HBV Vaccine…HBV Vaccine…
5. Travelers to countries where HBV infection is 5. Travelers to countries where HBV infection is
common - This includes most areas of Africa, common - This includes most areas of Africa,
Southeast Asia, China and central Asia, Eastern Southeast Asia, China and central Asia, Eastern
Europe, the Middle East, the Pacific Islands, and Europe, the Middle East, the Pacific Islands, and
the Amazon River basin of South America. the Amazon River basin of South America.
6. People who are in prison 6. People who are in prison
7. People who live in residential facilities for 7. People who live in residential facilities for
developmentally disabled persons developmentally disabled persons
HBV Vaccine…HBV Vaccine…
5. Travelers to countries where HBV infection is 5. Travelers to countries where HBV infection is
common - This includes most areas of Africa, common - This includes most areas of Africa,
Southeast Asia, China and central Asia, Eastern Southeast Asia, China and central Asia, Eastern
Europe, the Middle East, the Pacific Islands, and Europe, the Middle East, the Pacific Islands, and
the Amazon River basin of South America. the Amazon River basin of South America.
6. People who are in prison 6. People who are in prison
7. People who live in residential facilities for 7. People who live in residential facilities for
developmentally disabled persons developmentally disabled persons
Groups Recommended to have the Groups Recommended to have the
HBV Vaccine…HBV Vaccine…
8. People who inject illegal drugs 8. People who inject illegal drugs
9. People with chronic liver disease such 9. People with chronic liver disease such
as hepatitis Cas hepatitis C
10. People who have multiple sex partners 10. People who have multiple sex partners
or have ever had a or have ever had a
sexually transmitted diseasesexually transmitted disease
11. Men who have sex with men11. Men who have sex with men
HBV Vaccine…HBV Vaccine…
8. People who inject illegal drugs 8. People who inject illegal drugs
9. People with chronic liver disease such 9. People with chronic liver disease such
as hepatitis Cas hepatitis C
10. People who have multiple sex partners 10. People who have multiple sex partners
or have ever had a or have ever had a
sexually transmitted diseasesexually transmitted disease
11. Men who have sex with men11. Men who have sex with men
Other ways to protect yourself from Other ways to protect yourself from
HBV infectionHBV infection
•Safe SexSafe Sex
•Don't share needles or other sharp Don't share needles or other sharp
equipments such as razorsequipments such as razors
•Health care workers should follow Health care workers should follow
standard precautions and handle needles standard precautions and handle needles
and sharps safely and sharps safely
•Think about the health risks if you are Think about the health risks if you are
planning to get a planning to get a tattootattoo or body or body piercingpiercing
HBV infectionHBV infection
•Safe SexSafe Sex
•Don't share needles or other sharp Don't share needles or other sharp
equipments such as razorsequipments such as razors
•Health care workers should follow Health care workers should follow
standard precautions and handle needles standard precautions and handle needles
and sharps safely and sharps safely
•Think about the health risks if you are Think about the health risks if you are
planning to get a planning to get a tattootattoo or body or body piercingpiercing
MEDICAL TREATMENTMEDICAL TREATMENT
•Acute hepatitis BAcute hepatitis B infectioninfection
•If dehydration occurs, IV fluids are being prescribed to If dehydration occurs, IV fluids are being prescribed to
help the patient feel better.help the patient feel better.
•Medicines are being prescribed by the physician to control Medicines are being prescribed by the physician to control
nausea and vomiting.nausea and vomiting.
•People whose symptoms are well-controlled can be cared People whose symptoms are well-controlled can be cared
for at home. If dehydration or other symptoms are severe, for at home. If dehydration or other symptoms are severe,
then the patient is managed at the hospitalthen the patient is managed at the hospital
NOTE: No treatment can prevent acute HBV infection from NOTE: No treatment can prevent acute HBV infection from
becoming chronic becoming chronic
•Acute hepatitis BAcute hepatitis B infectioninfection
•If dehydration occurs, IV fluids are being prescribed to If dehydration occurs, IV fluids are being prescribed to
help the patient feel better.help the patient feel better.
•Medicines are being prescribed by the physician to control Medicines are being prescribed by the physician to control
nausea and vomiting.nausea and vomiting.
•People whose symptoms are well-controlled can be cared People whose symptoms are well-controlled can be cared
for at home. If dehydration or other symptoms are severe, for at home. If dehydration or other symptoms are severe,
then the patient is managed at the hospitalthen the patient is managed at the hospital
NOTE: No treatment can prevent acute HBV infection from NOTE: No treatment can prevent acute HBV infection from
becoming chronic becoming chronic
MEDICAL TREATMENTMEDICAL TREATMENT ……
•Chronic hepatitis B infectionChronic hepatitis B infection
–Regularly measuring the amount of HBV Regularly measuring the amount of HBV DNADNA
in the blood gives a good idea of how fast the in the blood gives a good idea of how fast the
virus is multiplyingvirus is multiplying
–Treatment: Treatment: antiviralantiviral drugs drugs
•not appropriate for everyone with chronic HBV not appropriate for everyone with chronic HBV
infection. It is reserved for people whose infection infection. It is reserved for people whose infection
is most likely to progress to chronic hepatitis B. is most likely to progress to chronic hepatitis B.
•Chronic hepatitis B infectionChronic hepatitis B infection
–Regularly measuring the amount of HBV Regularly measuring the amount of HBV DNADNA
in the blood gives a good idea of how fast the in the blood gives a good idea of how fast the
virus is multiplyingvirus is multiplying
–Treatment: Treatment: antiviralantiviral drugs drugs
•not appropriate for everyone with chronic HBV not appropriate for everyone with chronic HBV
infection. It is reserved for people whose infection infection. It is reserved for people whose infection
is most likely to progress to chronic hepatitis B. is most likely to progress to chronic hepatitis B.
MedicationsMedications
•InterferonInterferon alfa-2b ( alfa-2b (IntronIntron A) A) - was the standard - was the standard
treatment of chronic hepatitis B for several years treatment of chronic hepatitis B for several years
•Lamivudine (Epivir)Lamivudine (Epivir) - an alternative for people - an alternative for people
who cannot or do not want to take interferon who cannot or do not want to take interferon
•Adefovir dipivoxil (Hepsera)Adefovir dipivoxil (Hepsera) - works well even - works well even
in people whose disease is resistant to in people whose disease is resistant to
lamivudine lamivudine
•Entecavir (Baraclude)Entecavir (Baraclude) - newest medication - newest medication
approved for chronic hepatitis B approved for chronic hepatitis B
•InterferonInterferon alfa-2b ( alfa-2b (IntronIntron A) A) - was the standard - was the standard
treatment of chronic hepatitis B for several years treatment of chronic hepatitis B for several years
•Lamivudine (Epivir)Lamivudine (Epivir) - an alternative for people - an alternative for people
who cannot or do not want to take interferon who cannot or do not want to take interferon
•Adefovir dipivoxil (Hepsera)Adefovir dipivoxil (Hepsera) - works well even - works well even
in people whose disease is resistant to in people whose disease is resistant to
lamivudine lamivudine
•Entecavir (Baraclude)Entecavir (Baraclude) - newest medication - newest medication
approved for chronic hepatitis B approved for chronic hepatitis B
Surgery and Other TherapySurgery and Other Therapy
•No herbs, supplements, or other No herbs, supplements, or other
alternative therapy is known to work as alternative therapy is known to work as
well as antiviral medication in slowing HBV well as antiviral medication in slowing HBV
replication and promoting liver healing in replication and promoting liver healing in
hepatitis B. hepatitis B.
•no surgical therapy for hepatitis B no surgical therapy for hepatitis B
–If liver damage is severe enough, the only If liver damage is severe enough, the only
treatment that will help is treatment that will help is liver transplantliver transplant
•No herbs, supplements, or other No herbs, supplements, or other
alternative therapy is known to work as alternative therapy is known to work as
well as antiviral medication in slowing HBV well as antiviral medication in slowing HBV
replication and promoting liver healing in replication and promoting liver healing in
hepatitis B. hepatitis B.
•no surgical therapy for hepatitis B no surgical therapy for hepatitis B
–If liver damage is severe enough, the only If liver damage is severe enough, the only
treatment that will help is treatment that will help is liver transplantliver transplant
NURSING MANAGEMENTNURSING MANAGEMENT
•nurse identifies psychosocial issues and nurse identifies psychosocial issues and
concerns, particularly the effects of separation concerns, particularly the effects of separation
from family and friends if the patient is from family and friends if the patient is
hospitalized during acute and infective stage. hospitalized during acute and infective stage.
•Follow-up visits by a home care nurse may be Follow-up visits by a home care nurse may be
needed to assess the patient’s progress and needed to assess the patient’s progress and
answer the family members’ questions about answer the family members’ questions about
disease transmission disease transmission
•reinforces previous instructions reinforces previous instructions
•nurse identifies psychosocial issues and nurse identifies psychosocial issues and
concerns, particularly the effects of separation concerns, particularly the effects of separation
from family and friends if the patient is from family and friends if the patient is
hospitalized during acute and infective stage. hospitalized during acute and infective stage.
•Follow-up visits by a home care nurse may be Follow-up visits by a home care nurse may be
needed to assess the patient’s progress and needed to assess the patient’s progress and
answer the family members’ questions about answer the family members’ questions about
disease transmission disease transmission
•reinforces previous instructions reinforces previous instructions
Self-Care at HomeSelf-Care at Home
1.1.Drink plenty of fluids to prevent dehydration. Drink plenty of fluids to prevent dehydration.
Water is fine; broth, sports drinks, Jello, frozen Water is fine; broth, sports drinks, Jello, frozen
ice treats (such as Popsicles), and fruit juices ice treats (such as Popsicles), and fruit juices
are even better because they provide calories. are even better because they provide calories.
2.2.Avoid medicines and substances that can Avoid medicines and substances that can
cause harm to the liver, such as cause harm to the liver, such as
acetaminophenacetaminophen (Tylenol). (Tylenol).
3.3.Avoid drinking alcohol until your health care Avoid drinking alcohol until your health care
provider OKs it. If your infection becomes provider OKs it. If your infection becomes
chronic, you should avoid alcohol for the rest chronic, you should avoid alcohol for the rest
of your life. of your life.
1.1.Drink plenty of fluids to prevent dehydration. Drink plenty of fluids to prevent dehydration.
Water is fine; broth, sports drinks, Jello, frozen Water is fine; broth, sports drinks, Jello, frozen
ice treats (such as Popsicles), and fruit juices ice treats (such as Popsicles), and fruit juices
are even better because they provide calories. are even better because they provide calories.
2.2.Avoid medicines and substances that can Avoid medicines and substances that can
cause harm to the liver, such as cause harm to the liver, such as
acetaminophenacetaminophen (Tylenol). (Tylenol).
3.3.Avoid drinking alcohol until your health care Avoid drinking alcohol until your health care
provider OKs it. If your infection becomes provider OKs it. If your infection becomes
chronic, you should avoid alcohol for the rest chronic, you should avoid alcohol for the rest
of your life. of your life.
Self-Care at Home…Self-Care at Home…
1.1.Avoid using drugs, even legal drugs, without Avoid using drugs, even legal drugs, without
consulting your doctor. Hepatitis can change the way consulting your doctor. Hepatitis can change the way
drugs affect you. If you take prescription medications, drugs affect you. If you take prescription medications,
continue taking them unless your health care provider continue taking them unless your health care provider
has told you to stop. Do not start any new medication has told you to stop. Do not start any new medication
(prescription or nonprescription), herbs, or (prescription or nonprescription), herbs, or
supplements without first talking to your health care supplements without first talking to your health care
provider. provider.
2.2.Try to eat enough for adequate Try to eat enough for adequate nutritionnutrition. Eat foods . Eat foods
that appeal to you, but try to maintain a balanced diet. that appeal to you, but try to maintain a balanced diet.
Many people with hepatitis have the greatest urge to Many people with hepatitis have the greatest urge to
eat early in the day. eat early in the day.
1.1.Avoid using drugs, even legal drugs, without Avoid using drugs, even legal drugs, without
consulting your doctor. Hepatitis can change the way consulting your doctor. Hepatitis can change the way
drugs affect you. If you take prescription medications, drugs affect you. If you take prescription medications,
continue taking them unless your health care provider continue taking them unless your health care provider
has told you to stop. Do not start any new medication has told you to stop. Do not start any new medication
(prescription or nonprescription), herbs, or (prescription or nonprescription), herbs, or
supplements without first talking to your health care supplements without first talking to your health care
provider. provider.
2.2.Try to eat enough for adequate Try to eat enough for adequate nutritionnutrition. Eat foods . Eat foods
that appeal to you, but try to maintain a balanced diet. that appeal to you, but try to maintain a balanced diet.
Many people with hepatitis have the greatest urge to Many people with hepatitis have the greatest urge to
eat early in the day. eat early in the day.
Self-Care at Home…Self-Care at Home…
1.1.Take it easy. Your activity level should match Take it easy. Your activity level should match
your energy level. your energy level.
2.2.Avoid prolonged, vigorous exercise until Avoid prolonged, vigorous exercise until
symptoms start to improve. symptoms start to improve.
3.3.Call your health care provider for advice if your Call your health care provider for advice if your
condition worsens or new symptoms appear.condition worsens or new symptoms appear.
4.4.Avoid any activity that may spread the Avoid any activity that may spread the
infection to other peopleinfection to other people
1.1.Take it easy. Your activity level should match Take it easy. Your activity level should match
your energy level. your energy level.
2.2.Avoid prolonged, vigorous exercise until Avoid prolonged, vigorous exercise until
symptoms start to improve. symptoms start to improve.
3.3.Call your health care provider for advice if your Call your health care provider for advice if your
condition worsens or new symptoms appear.condition worsens or new symptoms appear.
4.4.Avoid any activity that may spread the Avoid any activity that may spread the
infection to other peopleinfection to other people
HEPATITIS CHEPATITIS C
PREVENTIONPREVENTION
•no vaccine for the prevention of HCV no vaccine for the prevention of HCV
transmissiontransmission
•best means of preventing transmission of HCV is best means of preventing transmission of HCV is
to prevent contact with infected blood and to prevent contact with infected blood and
organs and to avoid high-risk sexual behavior organs and to avoid high-risk sexual behavior
such as multiple partners and anal contact. such as multiple partners and anal contact.
•Avoiding alcohol and drugs that can damage the Avoiding alcohol and drugs that can damage the
liver may help slow the rate of progression of liver may help slow the rate of progression of
the disease. the disease.
•no vaccine for the prevention of HCV no vaccine for the prevention of HCV
transmissiontransmission
•best means of preventing transmission of HCV is best means of preventing transmission of HCV is
to prevent contact with infected blood and to prevent contact with infected blood and
organs and to avoid high-risk sexual behavior organs and to avoid high-risk sexual behavior
such as multiple partners and anal contact. such as multiple partners and anal contact.
•Avoiding alcohol and drugs that can damage the Avoiding alcohol and drugs that can damage the
liver may help slow the rate of progression of liver may help slow the rate of progression of
the disease. the disease.
MEDICAL TREATMENTMEDICAL TREATMENT
•pegylated interferon alpha (Pegasys, pegylated interferon alpha (Pegasys,
PEG-Intron)PEG-Intron) - often combined with an - often combined with an
antiviral drug called ribavirin (Virazole)antiviral drug called ribavirin (Virazole)
•pegylated interferon alpha (Pegasys, pegylated interferon alpha (Pegasys,
PEG-Intron)PEG-Intron) - often combined with an - often combined with an
antiviral drug called ribavirin (Virazole)antiviral drug called ribavirin (Virazole)
Certain medical conditions preclude Certain medical conditions preclude
the use of interferonthe use of interferon
•DepressionDepression and certain other mental and neurologic and certain other mental and neurologic
disorders disorders
•Active alcohol or drug abuse Active alcohol or drug abuse
•AutoimmuneAutoimmune diseases such as diseases such as rheumatoid arthritisrheumatoid arthritis, ,
systemic lupus systemic lupus erythematosuserythematosus, or , or psoriasispsoriasis
•Low blood Low blood hemoglobinhemoglobin level ( level (anemiaanemia) or blood cell ) or blood cell
counts counts
•Cirrhosis that is severe enough to cause symptoms Cirrhosis that is severe enough to cause symptoms
such as jaundice, wasting, fluid retention that causes such as jaundice, wasting, fluid retention that causes
swelling, or mental disturbances swelling, or mental disturbances
the use of interferonthe use of interferon
•DepressionDepression and certain other mental and neurologic and certain other mental and neurologic
disorders disorders
•Active alcohol or drug abuse Active alcohol or drug abuse
•AutoimmuneAutoimmune diseases such as diseases such as rheumatoid arthritisrheumatoid arthritis, ,
systemic lupus systemic lupus erythematosuserythematosus, or , or psoriasispsoriasis
•Low blood Low blood hemoglobinhemoglobin level ( level (anemiaanemia) or blood cell ) or blood cell
counts counts
•Cirrhosis that is severe enough to cause symptoms Cirrhosis that is severe enough to cause symptoms
such as jaundice, wasting, fluid retention that causes such as jaundice, wasting, fluid retention that causes
swelling, or mental disturbances swelling, or mental disturbances
MedicationMedication
•Interferon alpha (Intron A) - pegylated Interferon alpha (Intron A) - pegylated
type (Pegasys, PEG-Intron) type (Pegasys, PEG-Intron)
–Interferon is a protein that the body makes naturally Interferon is a protein that the body makes naturally
in response to viral infections in order to fight the in response to viral infections in order to fight the
infection. Pegylation describes a chemical process infection. Pegylation describes a chemical process
that makes the interferon last longer in the body. that makes the interferon last longer in the body.
•RibavirinRibavirin (Virazole) (Virazole)
–has little effect on HCV, but interferon increases its has little effect on HCV, but interferon increases its
potency potency
•Interferon alpha (Intron A) - pegylated Interferon alpha (Intron A) - pegylated
type (Pegasys, PEG-Intron) type (Pegasys, PEG-Intron)
–Interferon is a protein that the body makes naturally Interferon is a protein that the body makes naturally
in response to viral infections in order to fight the in response to viral infections in order to fight the
infection. Pegylation describes a chemical process infection. Pegylation describes a chemical process
that makes the interferon last longer in the body. that makes the interferon last longer in the body.
•RibavirinRibavirin (Virazole) (Virazole)
–has little effect on HCV, but interferon increases its has little effect on HCV, but interferon increases its
potency potency
Surgery and Other TherapySurgery and Other Therapy
•For end-stage liver disease, the only treatment is For end-stage liver disease, the only treatment is
liver transplantationliver transplantation
•Alternative therapies has not been proven to Alternative therapies has not been proven to
work in any scientific study work in any scientific study
–most promising complementary therapy is most promising complementary therapy is milk thistlemilk thistle
–licoricelicorice and and ginsengginseng
–gingerginger (to reduce nausea) and (to reduce nausea) and St. John's St. John's wortwort (to (to
relieve depression) may be taken as complementary relieve depression) may be taken as complementary
therapy to help relieve the side effects of interferon therapy to help relieve the side effects of interferon
•For end-stage liver disease, the only treatment is For end-stage liver disease, the only treatment is
liver transplantationliver transplantation
•Alternative therapies has not been proven to Alternative therapies has not been proven to
work in any scientific study work in any scientific study
–most promising complementary therapy is most promising complementary therapy is milk thistlemilk thistle
–licoricelicorice and and ginsengginseng
–gingerginger (to reduce nausea) and (to reduce nausea) and St. John's St. John's wortwort (to (to
relieve depression) may be taken as complementary relieve depression) may be taken as complementary
therapy to help relieve the side effects of interferon therapy to help relieve the side effects of interferon
NURSING MANAGEMENTNURSING MANAGEMENT
•Same as Hepatitis BSame as Hepatitis B
•Same as Hepatitis BSame as Hepatitis B
Patient InstructionPatient Instruction
•Eat a varied, healthy diet, take part in some physical Eat a varied, healthy diet, take part in some physical
activity daily, and get plenty of rest. activity daily, and get plenty of rest.
•Drink plenty of water and other noncaffeinated fluids Drink plenty of water and other noncaffeinated fluids
to stay well hydrated. to stay well hydrated.
•Avoid alcoholic beverages and medicines such Avoid alcoholic beverages and medicines such
as nonsteroidal anti-inflammatory drugs (like Brufen, as nonsteroidal anti-inflammatory drugs (like Brufen,
AleveAleve, Advil) that can be harmful in people with liver , Advil) that can be harmful in people with liver
disease. disease.
•If you have symptoms, avoid prolonged or vigorous If you have symptoms, avoid prolonged or vigorous
physical exercise until your symptoms improve. physical exercise until your symptoms improve.
•If symptoms worsen at any time, contact your doctor.If symptoms worsen at any time, contact your doctor.
•Eat a varied, healthy diet, take part in some physical Eat a varied, healthy diet, take part in some physical
activity daily, and get plenty of rest. activity daily, and get plenty of rest.
•Drink plenty of water and other noncaffeinated fluids Drink plenty of water and other noncaffeinated fluids
to stay well hydrated. to stay well hydrated.
•Avoid alcoholic beverages and medicines such Avoid alcoholic beverages and medicines such
as nonsteroidal anti-inflammatory drugs (like Brufen, as nonsteroidal anti-inflammatory drugs (like Brufen,
AleveAleve, Advil) that can be harmful in people with liver , Advil) that can be harmful in people with liver
disease. disease.
•If you have symptoms, avoid prolonged or vigorous If you have symptoms, avoid prolonged or vigorous
physical exercise until your symptoms improve. physical exercise until your symptoms improve.
•If symptoms worsen at any time, contact your doctor.If symptoms worsen at any time, contact your doctor.
Self-Care at HomeSelf-Care at Home
1.1.Take it easy; get plenty of rest. Take it easy; get plenty of rest.
2.2.Drink plenty of fluids to prevent dehydration. Drink plenty of fluids to prevent dehydration.
3.3.Do not drink alcohol of any kind, including Do not drink alcohol of any kind, including
beer, wine, and hard liquor. beer, wine, and hard liquor.
4.4.Avoid medicines and substances that can Avoid medicines and substances that can
cause harm to the liver such as cause harm to the liver such as acetaminophenacetaminophen
((TylenolTylenol) and other preparations that contain ) and other preparations that contain
acetaminophen. acetaminophen.
5.5.Avoid prolonged, vigorous exercise until Avoid prolonged, vigorous exercise until
symptoms start to improvesymptoms start to improve
1.1.Take it easy; get plenty of rest. Take it easy; get plenty of rest.
2.2.Drink plenty of fluids to prevent dehydration. Drink plenty of fluids to prevent dehydration.
3.3.Do not drink alcohol of any kind, including Do not drink alcohol of any kind, including
beer, wine, and hard liquor. beer, wine, and hard liquor.
4.4.Avoid medicines and substances that can Avoid medicines and substances that can
cause harm to the liver such as cause harm to the liver such as acetaminophenacetaminophen
((TylenolTylenol) and other preparations that contain ) and other preparations that contain
acetaminophen. acetaminophen.
5.5.Avoid prolonged, vigorous exercise until Avoid prolonged, vigorous exercise until
symptoms start to improvesymptoms start to improve
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