1 page/≈275 words
Health, Medicine, Nursing
Diagnosis Hepatitis: Same treatment all around? Discussion post (Case Study Sample)
I am submitting three postings and I need you to respond to them individually. Please provide constructive and insightful comments that go beyond that of agree or disagree. 1)This post is from Claire: Hepatitis B and C are similiar in that they are both transmitted though blood/body fluids, but they also share other similiarities such as their risk factors; sharing needles (IV/injection drug users), recipients of blood products, healthcare workers exposed to splashes of body fluids to mucous membranes, unprotected sexual contact, and accidental needle sticks. They both can progress to a carrier state, also they can cause cirrhosis and liver cancer (hepatocellular carcinoma). Their clinical manifestations are similiar to some extent such as; jaundice and increased liver enzymes, otherwise hep B has more objective and subjective signs and symptoms. Unlike Hep C which can be asymptomatic for a long period, and is usually diagnosed after blood results show Anti-HCV serum. The treatments for hep B and C are different. Hep B consists of; immunizations and medications - The active vaccine Recombivax HB is recommended for people who are at risk such as healthcare workers, and it is also recommended for people with Hep C. Both active and passive immunizations are recommended for people who have been exposed to Hep B through sexual contact or through the percutaneous or transmucosal routes (Smeltzer et al., 2010). Alpha-interferon is an injection administered to treatment of Hep B, however, the patient should be warned of the early side effects, as well as the delayed side effects such as; bone marrow suppression and bacterial infections at which time the medication should be discontinued. There are also oral medications lamivudine and adefovir for the treatment of chronic Hep B. The treatment for Hep C are a combination of oral medications interferon and ribavarin, according to (Smeltzer et al., 2010) Ribavarin should be used with catuion in women of child bearing age, and Hemolytic anemia is the most common side effect which can warrant discontinuation. The nurse should teach the importance of stringent handwashing, well water should be boiled before use, not to share needles, and use protection during sexual intercourse. An assessment should be made of the hospitalized patient psychologically and psychosocially, the nurse should also promote good nutrition, and teach the patient to abstain from alcohol and raw shellfish. Realtives and friends of the patient should be taught about the risks of contracting the disease, preventative methods - series of Hep B vaccinations, and to recognize the signs and symptoms of the disease and report such to their physcian immediately. Hep B (HBV) is a double stranded DNA virus and Hep C (HCV) is a single stranded RNA virus, therefore their treatments of injections and medications cannot be the same because they are treating two different types of viruses. 2)This post is from Cynthia: HVB is contagious through sexual contact. HCV is contagious through high risk sexual contact. High risk would include individuals with multiple partners, and men who have sex with other men. The incubation period for HBV is 45-180 days with the average being 56-59 days. With HCV, incubation period is 14-180 days, with the average being 56 days. HBV is contagious before and after symptoms appear and is infectious for 4- 6 months. In people who are carriers, it continues for the lifetime of the person. HCV is contagious 1-2 weeks before symptoms appear and continues during the clinical course 75-85% of individuals go on to develop chronic HCV. HBV can live on a dry surface for at least 7 days. 30% of patients with acute HBV will be asymptomatic. 80% of patients with acute HCV will be asymptomatic. The onset of HBV is usually insidious, and symptoms are severe. The majority of HCV cases are asymptomatic or mild. HCV has a high rate of persistence. Those with HCV infection are at a greater risk to become chronic compared with HBV There is currently no vaccine for HCV. For HBV there is a vaccine which consists of a series of 3 shots. The second shot is given 1 month after the first shot, and the third shot is given 6 months after the first shot. The treatment for chronic HBV is focused on decreasing the viral load, liver enzyme levels, and the rate of disease progression. First line therapies include pegylated interferon, entecavir, and tenofovir. The treatment of chronic HCV is directed at eradicating the virus, reducing the viral load, and decreasing progression of the disease. Medications include pegylated interferon with ribavirin treatment is individualized based on severity of liver disease. Nursing care for patients with viral hepatitis include assess the patient's knowledge and teaching about dietary nutrition. Rest and adequate nutrition. Teach how to prevent transmission to others and what symptoms to watch for. Teach patient about how interferon is administered and the numerous side effects with the therapy. I believe the same type of nursing interventions can be applied to both HBV and HCV because collaborative therapy for acute and chronic hepatitis is a well-balanced diet, vitamin supplements, and rest, varies with degree of illness, and avoiding alcohol and intake of drugs 3)This post is from Joseph: Hepatitis B virus (HBV) which is a DNA virus and Hepatitis C virus (HCV) an RNA virus, share some basic similarity in their mode of transmission. Such process of transmission might be through: (1) the skin and mucous membrane route by infectious or contaminated blood, blood products, or other body fluids and secretions; (2) Multiple sexual partners/unprotected sex; (3) History of sexually transmitted disease; (4) Past or current illicit IV/injection drug use; (5) Hemodialysis; (6) Mother-fetal route especially at childbirth; and (7) Accidental needle-sticks or injuries from sharp instruments (which may happen in healthcare settings). However, hepatitis B infection is frequently ascribed to indiscriminate sexual activities, while hepatitis C infection is more visible among people who share contaminated needles through IV/injection drug use. Before 1992 when widespread screening of blood supply began in the U.S, organ transplants and the transfusion of unscreened blood could also lead to infection with the hepatitis C virus. Chronic cases of hepatitis B infection could lead to the development of hepatocellular carcinoma and remains a major cause of cirrhosis worldwide, while chronic hepatitis C which also accounts for cases of hepatocellular carcinoma and cirrhosis is regarded as the most common reason for liver transplantation. The incubation period for hepatitis B virus is between 1-6 months with signs and symptoms usually insidious and patients may be asymptomatic. A high percentage of people infected with the HBV virus could potentially develop antibodies that might aid in spontaneous recovery within 6 months. For hepatitis C, the incubation period may range from 15-160 days with most patients asymptomatic following the initial infection. However, patients infected with hepatitis C virus may eventually proceed to a carrier state with an increased risk of developing chronic liver disease. For patients with hepatitis B or C who becomes symptomatic, clinical presentation may include fatigue, anorexia, nausea and vomiting, abdominal discomfort, headache, malaise, generalized aching, arthritis, myalgias, angioedema, urticaria, skin rashes, and vasculitis. Enlargement of the liver and spleen is possible, while jaundice may be evident or not. Since hepatitis B is more of a sexually transmitted disease, hepatitis B vaccination is recommended for all unvaccinated people with the history of sexually transmitted disease (STD), or for those who are being evaluated for STD, for people with multiple sex partners, and all sexually active individuals with different sexual orientations. Hepatitis B Immune Globulin is another vaccination option that could provide passive immunity for people exposed to HBV, or who have never had hepatitis B or hepatitis B vaccination. Also, universal childhood vaccination for hepatitis B prevention which is inclusive of newborns and unvaccinated children up to age 19 has been instituted in the United States. There is no vaccination for hepatitis C and the infection might not always require specialized treatment. However, both viral infections can be managed through drug therapies, although with some degree of variations. With chronic hepatitis B, alpha-interferon is a drug of promise that could be administered via daily injection for up to 4 to 6 months with the potential for disease remission. However, the drug may induce significant side effects in some patient that may include bone marrow suppression, thyroid dysfunction, alopecia, and bacterial infections, which may warrant dosage reduction or discontinuation. For hepatitis C on the other hand, the combination of interferon (Intron-A) and ribavirin (Rebetol) are considered effective for the management of the disease which may lead to complete remission. The most significant side effect of such drug therapy is hemolytic anemia which may necessitate dosage reduction or discontinuation, and its use in women of child bearing age should be carefully monitored. While daily administration of alpha-interferon via injection for the management of hepatitis B is necessary, the dosage interval for interferon (Intron-A) in the management of hepatitis C could be reduced to once a week. Such effective and less cumbersome treatment regimen could be achieved by adding the molecule polyethylene glycol moiety (PEG) to interferon (Intron-A), in order to keep the medication longer in the body without compromising its efficacy. Nursing care for hepatitis patients could include promoting emotional, physical, and psychological rest; minimizing social isolation; providing diet therapy to include eating small frequent meals, high in carbohydrates and calories with moderate amounts of fat and protein; encouraging compliance and adherence to treatment and medication therapy; providing health teaching on modes of transmission of hepatitis and the observation of precautionary measures to prevent infection transmission or reinfection; providing education on the risk of piercing and tattooing in transmission of HCV; encouraging patients on the avoidance of alcohol and checking with healthcare provider before taking vitamin supplements, herbal preparations, and over-the-counter medications, which may lead to adverse drug interactions and further complicate liver functions; also, patients should be encouraged to avoid sexual activity until further testing for the infection becomes negative. source..
Response to Claire:
The risk factors of Hepatitis B and Hepatitis C could be the same in that the risk factors are the same, as noted here, sharing of needles for example during injection, and recipients of blood products. What however that is not highlighted or clarified in this case is the fact that the exchange of fluids amongst people must involve one partner infected who in turn infects the non-infected (Javier et al, 2011). After all, it is not a guarantee that hepatitis can be contracted by sheer sharing of needles or exchange of fluids. What if both are free of the Hepatitis virus? That means that they cannot infect each other.
Response to Cynthia:
In addition to teaching the patients about the best way to keep themselves away from infection it is important to let them know that the treatment is not very affordable and the cost is quite a toll order ...
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