NCMB 312 Communicable Disease Nursing - Diseases Caused by Bacteria PDF

BACHELOR OF SCIENCE IN NURSING NCMB 312 - COMMUNICABLE DISEASE NURSING COURSE MODULE COURSE UNIT WEEK 2 17 11 DISEASES CAUSE BY BACTERIA ü Re...

BACHELOR OF SCIENCE IN NURSING NCMB 312 - COMMUNICABLE DISEASE NURSING COURSE MODULE COURSE UNIT WEEK 2 17 11 DISEASES CAUSE BY BACTERIA ü Read course and unit objectives ü Read study guide prior to class attendance ü Read required learning resources and refer to unit terminologies for jargons ü Proactively participates in chat room discussions ü Participate in weekly discussion ü Answer and submit course unit tasks ü Module, Reference Books, Laptop, Internet, Headset At the end of the course unit, learners will be able to: Cognitive: 1. Enumerate the definition, signs and symptoms, mode of transmission, period of communicability, nursing and medical management of cholera, dysentery, typhoid fever and hepatitis.  2. Identify their differences in terms of pathophysiology. 3. Integrate the application of concepts of cholera, dysentery, typhoid fever and hepatitis in the practice of nursing profession holistically and competently.. Affective: 1. Listen attentively during class discussions 2. Demonstrate tact and respect when challenging other people’s opinions and ideas 3. Accept comments and reactions of classmates on one’s opinions openly and graciously. 4. Develop heightened interest in studying Communicable Disease Nursing Psychomotor: 1. Participate actively during class discussions and group activities 2. Express opinion and thoughts during class Cholera – is an infectious disease that causes severe watery diarrhea, which can lead to dehydration and even death if untreated. It is caused by eating food or drinking water contaminated with a bacterium called Vibrio cholerae. Dysentery – is an intestinal inflammation, primarily of the colon. It can lead to mild or severe stomach cramps and severe diarrhea with mucus or blood in the feces. Without adequate hydration, it can be fatal. Infection with the Shigella bacillus, or Entamoeba hystolica are the most common cause. Typhoid Fever – is a systemic infection caused by Salmonella Typhi, usually through ingestion of contaminated food or water. The acute illness is characterized by prolonged fever, headache, nausea, loss of appetite, and constipation or sometimes diarrhea. Symptoms are often non- specific and clinically non-distinguishable from other febrile illnesses. Hepatitis – is an inflammation of the liver that can cause a range of health problems and can be fatal. There are five main strains of the hepatitis virus, referred to as types A, B, C, D and E. CHOLERA Cholera is an acute, diarrheal illness caused by infection of the intestine with the toxigenic bacterium and etiologic agent Vibri coma or Vibrio cholerae serogroup. An estimated 2.9 million cases and 95,000 deaths occur each year around the world. The infection is often mild or without symptoms, but can sometimes be severe. Approximately one in 10 (10%) infected persons will have severe disease characterized by profuse watery diarrhea, vomiting, and leg cramps. In these people, rapid loss of body fluids leads to dehydration and shock. Without treatment, death can occur within hours. Waldemar Haffkine was a Russian-Jewish bacteriologist developed the first cholera vaccine in July 1892. Filippo Pacini (1854) - V. cholerae was first isolated as the cause of cholera by Italian anatomist. John Snow is widely considered to be the father of modern epidemiology. But it was not until 1854 that the physician John Snow (1813-1858) made a major contribution to fighting cholera when he was able to demonstrate a link between cholera and the contaminated drinking water through his pioneering studies. For his persistent efforts to determine how cholera was spread and for the statistical mapping methods he initiated. Cholera is a bacterial disease usually spread through seven Fs – foods, fluids, fingers, feces, fomites, fields, flies. Cholera is spread the way many diarrheal diseases are spread, through the (1) Fluid/Water: By drinking water that has been contaminated by feces and has not been treated (disinfected). (2) Fingers: By getting hands in one’s mouth, when hands are not washed after using the toilet or after contact with feces on the ground (which is especially common for young children who are crawling). (3) Flies: Because flies sit on feces and then land on food. (4) Food: By eating food that has been contaminated (made dirty) by fingers, flies, or water that have come in contact with feces. (5) Fields/Floors: The soil where food is grown can contain feces when cholera-infected people or animals feces on the ground or near water sources instead of using latrines or burying the feces. Hands that have been working in the soil can pass microbes like cholera on when hand washing is not done afterwards. Floors that get contaminated with animal or human feces can also end up contaminating fingers that end up in mouths. (6) Fomites: inanimate objects that can become contaminated with infectious agents and serve as a mechanism for transfer between hosts. The classic example of a fomite is a park water fountain from which many people drink. Infectious agents deposited by one person can potentially be transmitted to a subsequent drinker. (7) Feces: The cholera bacterium is usually found in water or food sources that have been contaminated by feces (poop) from a person infected with cholera. Cholera is most likely to be found and spread in places with inadequate water treatment, poor sanitation, and inadequate hygiene. Cholera is also known as El Tor and Violent Dysentery. The incubation period is from a few hours to 5 days (average of 3 days). It can take anywhere from a few hours to 5 days for symptoms to appear after infection. Symptoms typically appear in 2-3 days. The period of communicability is as long as microorganisms are present in the bowel excreta. Cholera infection is often mild or without symptoms, but can sometimes be severe. Approximately one in ten (10%) infected persons will have severe disease characterized by profuse watery diarrhea, vomiting, and leg cramps. The clinical manifestations are: milddiarrhea that becomes voluminous; rice-watery stool (pathognomonic sign); washer woman’s hands; effortless vomiting; cramping of the extremities (hypokalemia) and signs of severe dehydration. In these people, rapid loss of body fluids leads to dehydration and shock. Without treatment, death can occur within hours. The three (3) deficits during Cholera: (1) Severe dehydration and ECF volume deficit; (2) Hypokalemia; and (3) Metabolic acidosis. The diagnostic tests are: stool or vomitus culture; serum electrolytes; and dark field or phase microscopy. To test for cholera, doctors must take a stool sample or a rectal swab and send it to a laboratory to look for the cholera bacterium. Cholera can be simply and successfully treated by immediate replacement of the fluid and salts lost through diarrhea. Patients can be treated with oral rehydration solution (ORS), a prepackaged mixture of sugar and salts to be mixed with 1 liter of water and drunk in large amounts. This solution is used throughout the world to treat diarrhea. Severe cases also require intravenous fluid replacement. With prompt appropriate rehydration, fewer than 1% of cholera patients die. Antibiotics shorten the course and diminish the severity of the illness, but they are not as important as receiving rehydration. Persons who develop severe diarrhea and vomiting in countries where cholera occurs should seek medical attention promptly. The medical management are to correct of dehydration and fluid imbalance and antibiotics of tetracycline as drug of choice. The nursing management are: (1) assess patient for signs of dehydration and complications; (2) observe enteric precautions (feces); and (3) increase oral fluid intake. The disease is not likely to spread directly from one person to another; therefore, casual contact with an infected person is not a risk for becoming ill. The risk for cholera is very low for people visiting areas with epidemic cholera. When simple precautions are observed, contracting the disease is unlikely. All people (visitors or residents) in areas where cholera is occurring or has occurred should observe the following recommendations: (1) Drink only bottled, boiled, or chemically treated water and bottled or canned carbonated beverages. (2) When using bottled drinks, make sure that the seal has not been broken. (3) To disinfect the water to drink: boil for 1 minute or filter the water and add 2 drops of household bleach or ½ an iodine tablet per liter of water. (4) Avoid tap water, fountain drinks, and ice cubes. (5) Wash the hands often with soap and clean water. (6) If no water and soap are available, use an alcoholbased hand cleaner (with at least 60% alcohol). (7) Clean the hands especially before eating or preparing food and after using the bathroom. (8) Eat foods that are packaged or that are freshly cooked and served hot. (9) Do not eat raw or undercooked meats and seafood, or raw or undercooked fruits and vegetables unless they are peeled. (10) Dispose of feces in a sanitary manner to prevent contamination of water and food sources The FDA recently approved a single-dose live oral cholera vaccine called Vaxchora® (lyophilized CVD 103-HgR) for adults 18 – 64 years old who are traveling to an area of active cholera transmission with toxigenic Vibrio cholerae (the bacteria strain that most commonly causes cholera). The vaccine is not routinely recommended for most travelers from the United States, as most people do not visit areas of active cholera transmission. No cholera vaccine is 100% protective and vaccination against cholera is not a substitute for standard prevention and control measures, including precautions for food and water. DYSENTERY Amoebic Dysentery Amoebic dysentery, also known as Amoebiais is caused by the protozoan parasite Entamoeba histolytica. It is transmitted in areas where poor sanitation allows contamination of drinking water and food with feces. In these areas, up to 40% of people with diarrhea may have amoebic dysentery. E. histolytica infection can occur when a person: (1) Puts anything into their mouth that has touched the feces (poop) of a person who is infected with E. histolytica. (2) Swallows something, such as water or food, that is contaminated with E. histolytica. (3) Swallows E. histolytica cysts (eggs) picked up from contaminated surfaces or fingers. Only about 10% to 20% of people who are infected with E. histolytica become sick from the infection. Those people who do become sick usually develop symptoms within 2 to 4 weeks, though it can sometimes take longer. The causal agent, Entamoeba histolytica, was discovered in Russia in 1873 by Friedrich Losch. His early observations came from the case of a young farmer who had been suffering from chronic dysentery. The symptoms are often quite mild and can include +/- fever, +/- vomiting, abdominal pain, diarrhea with tenesmus and muco-purulent blood streaked loose stool (poop), and stomach cramping. Rarely, E. histolytica invades the liver and forms an abscess (a collection of pus). In a small number of instances, it has been shown to spread to other parts of the body, such as the lungs or brain, but this is very uncommon. Although anyone can have this disease, it is more common in people who live in tropical areas with poor sanitary conditions. In the United States, amebiasis is most common in: (1) People who have traveled to tropical places that have poor sanitary conditions, (2) Immigrants from tropical countries that have poor sanitary conditions. (3) People who live in institutions that have poor sanitary conditions. (4). Men who have sex with men. But in the Philippines, most common is unsanitary conditions and poor hygiene in preparation of foods. Diagnosis of amebiasis can be very difficult. One problem is that other parasites and cells can look very similar to E. histolytica when seen under a microscope. Therefore, sometimes people are told that they are infected with E. histolytica even though they are not. Entamoeba histolytica and another ameba, Entamoeba dispar, which is about 10 times more common, look the same when seen under a microscope. Unlike infection with E. histolytica, which sometimes makes people sick, infection with E. dispar does not make people sick and therefore does not need to be treated. If the patient have been told that he is infected with E. histolytica but are feeling fine, the patient might be infected with E. dispar instead. Unfortunately, most laboratories do not yet have the tests that can tell whether a person is infected with E. histolytica or with E. dispar. Until these tests become more widely available, it usually is best to assume that the parasite is E. histolytica. The healthcare provider will ask the patient to submit fecal samples. Because E. histolytica is not always found in every stool sample, the patient may be asked to submit several stool samples from several different days. A blood test is also available but is only recommended when the healthcare provider thinks that the infection may have spread beyond the intestine (gut) to some other organ of the body, such as the liver. However, this blood test may not be helpful in diagnosing the current illness because the test can be positive if you had amebiasis in the past, even if the patients are not infected now. But the risk of spreading infection is low if the infected person is treated with antibiotics of metronidazole as drug of choice and practices good personal hygiene. This includes thorough handwashing with soap and water after using the toilet, after changing diapers, and before handling or preparing food. Bacillary Dysentery Bacillary Dysentery also known as Shigella infection (shigellosis) or Bloody Flux is an intestinal disease caused by a family of bacteria known as shigella. The main sign of shigella infection is diarrhea, which often is bloody. Kiyoshi Shiga (1897) - a Japanese Scientist discovered Shigella bacteria causing dysentery. Diarrhea and bloody diarrhea can result from a number of diseases. Confirming shigellosis involves taking a sample of your stool to be tested in a laboratory for the presence of shigella bacteria or their toxins. Shigella can be passed through direct contact with the bacteria in the stool. For example, this can happen in a child care setting when staff members don't wash their hands well enough after changing diapers or helping toddlers with toilet training. Shigella bacteria also can be passed in contaminated food or by drinking or swimming in contaminated water. Children under age 5 are most likely to get shigella infection, but it can occur at any age. A mild case usually clears up on its own within a week. When treatment is needed, doctors generally prescribe antibiotics of cotrimoxazole as drug of choice. Signs and symptoms of shigella infection usually begin a day or two after contact with shigella, but may take up to a week to develop. Signs and symptoms may include: Diarrhea (often containing blood or mucus), Abdominal pain or cramps, with or without fever, with or without vomiting. Although some people have no symptoms after they've been infected with shigella, their feces may still be contagious up to a few weeks. The incubation period is 1 to 4 days. The mode of transmission is same as cholera with 7 Fs. Infection occurs when the patient accidentally swallow shigella bacteria (Shigella dysenteriae) that comes in three (3) strains Shigella flexneri, Shigella boydii, and Shigella sonnei. Shigella infection usually runs its course in five to seven days. Replacing lost fluids from diarrhea may be all the treatment you need, particularly if your general health is good and your shigella infection is mild. Avoid drugs intended to treat diarrhea, such as loperamide (Imodium) or atropine (Lomotil), because they can make your condition worse. For severe shigella infection, antibiotics may shorten the duration of the illness. However, some shigella bacteria have become drug resistant. So it's better not to take antibiotics unless shigella infection is severe. Antibiotics may also be necessary for infants, older adults and people who have HIV infection, as well as in situations where there's a high risk of spreading the disease replacement. For generally healthy adults, drinking water may be enough to counteract the dehydrating effects of diarrhea. Children may benefit from an oral rehydration solution, such as Pedialyte, available in drugstores. Many pharmacies carry their own brands. Children and adults who are severely dehydrated need treatment in a hospital emergency room, where they can receive salts and fluids through a vein (intravenously), rather than by mouth. Intravenous hydration provides the body with water and essential nutrients much more quickly than oral solutions do. Risk factors are: (1) Age. Children under age 5 are most likely to get shigella infection, but it can occur at any age. (2) Living arrangements and activities. Close contact with other people spreads the bacteria from person to person. Shigella outbreaks are more common in child care centers, community wading pools, nursing homes, jails and military barracks. (3) Time spent in areas that lack sanitation. People who live or travel in developing countries are more likely to contract shigella infection. (4) Men who have sex with men. Men who have sex with men are at higher risk because of direct or indirect oral-anal contact. Shigella infection usually clears up without complications, although it may take weeks or months before your bowel habits return to normal. The complications may include: (1) Dehydration. Persistent diarrhea can cause dehydration. Symptoms include lightheadedness, dizziness, lack of tears in children, sunken eyes and dry diapers. Severe dehydration can lead to shock and death. (2) Seizures. Some children who run high fevers with a shigella infection have seizures. It's not known whether the convulsions are a result of the fever or the shigella infection itself. If the child has a seizure, contact the doctor immediately. (3) Rectal prolapse. In this condition, straining during bowel movements may cause the mucous membrane or lining of the rectum to move out through the anus. (4) Hemolytic uremic syndrome. This rare complication of shigella, more commonly caused by bacteria called E. coli, can lead to a low red blood cell count (hemolytic anemia), low platelet count (thrombocytopenia) and acute kidney failure. (5) Toxic megacolon. This rare complication occurs when the colon becomes paralyzed, preventing from having a bowel movement or passing gas. Signs and symptoms include abdominal pain and swelling, fever, and weakness. If don't receive treatment for toxic megacolon, the colon may break open (rupture), causing peritonitis, a life-threatening infection requiring emergency surgery. (6) Reactive arthritis. Reactive arthritis develops in response to an infection. Signs and symptoms include joint pain and inflammation, usually in the ankles, knees, feet and hips; redness, itching and discharge in one or both eyes (conjunctivitis); and painful urination (urethritis). Although researchers continue their work to develop a shigella vaccine, nothing is available yet. To prevent the spread of shigella: (1) Wash hands frequently and thoroughly. (2) Supervise small children when they wash their hands. (3) Dispose of soiled diapers properly. (3) Disinfect diaper- changing areas after use. (4) Don't prepare food for others if you have diarrhea. (5) Keep children with diarrhea home from child care, play groups or school. (6) Avoid swallowing water from ponds, lakes or untreated pools. (7) Avoid sexual activity with anyone who has diarrhea or who recently recovered from diarrhea. TYPHOID FEVER Typhoid fever, also known as enteric fever, is a potentially fatal multisystemic illness caused primarily by Salmonella enterica serotype typhi and, to a lesser extent, S enterica serotypes paratyphi A, B, and C. The terms typhoid and enteric fever are commonly used to describe both major serotypes. Karl Joseph Eberth was the first to describe the bacillus that was suspected to cause typhoid in 1880. Four years later, Georg Gaffky was a pathologist that confirmed this link, naming the bacillus Eberthella typhi, which is known today as Salmonella enterica. British bacteriologist Almroth Edward Wright first developed an effective typhoid vaccine at the Army Medical School in Netley, Hampshire. It was introduced in 1896 and used successfully by the British during the Boer War in South Africa. The simple etiologic agent is Salmonella typhi. The incubation period varies, usually 1 – 3 weeks, average of 2weeks. The period of communicability is as long as the bacilli appears in the excreta. The mode of transmission is fecal – oral route with iIngestion of contaminated food and water through 7 F’s – fingers, feces, flies, food, fomites, fluids and fields. The clinical manifestations are: Gradual onset of A-norexia and abdominal pain, B-radycardia, Constipation D-iarrhea, D- evelop skin eruptions on the abdomen, back and chest (ROSE SPOTS) which is the pathognomic sign, E-nlarged spleen, F-ever and chills, G-eneralized body weakness, and H- eadache. The three (3) cardinal signs of Pyrexial stage of Typhoid Fever are: Rose Spots, Enlargement of the Spleen (Splemomegaly and Fever (REF). A diagnosis of typhoid fever can usually be confirmed by analyzing samples of blood, stools or urine for culture. These will be examined under a microscope for the Salmonella typhi bacteria that cause the condition. The bacteria aren't always detected the first time, so the patient may need to have a series of tests. A complete blood count (CBC) will show a high number of white blood cells. A blood culture during the first week of the fever can show S typhi bacteria. Other tests that can help diagnose this condition include Fluorescent antibody study to look for substances that are specific to S typhi bacteria. If the Widal test range is more than or equal to 1:160 titre for antigen O and antigen H, then it indicates typhoid infection. For the diagnosis of a Widal blood test, 1:20, 1:40, 1:60, 1:80, 1:160, and 1:200 titres need to be included in the diagnosis to obtain the typhoid test report. The Widal test is positive if TO antigen titer is more than 1:160 in an active infection, or if TH antigen titer is more than 1:160 in past infection or in immunized persons. A single Widal test is of little clinical relevance due to the high number of cross-reacting infections, including malaria. The medical management are: (1) Antibiotics: chloramphenicol – drug of choice. (2) IVF to correct dehydration or fluid imbalance. (3) Paracetamol for the fever. (4) Oral therapy rehydration (oresol, hydrites). Antibiotic therapy is the only effective treatment for typhoid fever. Commonly prescribed antibiotics include: (1) Ciprofloxacin (Cipro). In the United States, doctors often prescribe this for non-pregnant adults. Another similar drug called ofloxacin also may be used. Unfortunately, many Salmonella typhi bacteria are no longer susceptible to antibiotics of this type, particularly strains acquired in Southeast Asia. (2) Azithromycin (Zithromax). This may be used if a person is unable to take ciprofloxacin or the bacteria is resistant to ciprofloxacin. (3) Ceftriaxone. This injectable antibiotic is an alternative in morecomplicated or serious infections and for people who may not be candidates for ciprofloxacin, such as children. These drugs can cause side effects, and long-term use can lead to the development of antibiotic-resistant strains of bacteria. Three typhoid vaccines are currently recommended by WHO for control of endemic and epidemic typhoid fever: (1) an injectable typhoid conjugate vaccine (TCV), consisting of Vi polysaccharide antigen linked to tetanus toxoid protein licensed for children from 6 months of age and adults up to 45 years of age; (2) an injectable unconjugated polysaccharide vaccine based on the purified Vi antigen (known as Vi-PS vaccine) for persons aged two years and above; and (3) an oral live attenuated Ty21a vaccine in capsule formulation for those over six years of age. The nursing management are: (1) Enteric isolation, (2) Vital signs must be recorded accurately. (3) Intake and output must be accurately measured. (3) Concurrent disinfection. (4) Increase oral fluid intake HEPATITIS Hepatitis refers to an inflammatory condition of the liver. It’s commonly caused by a viral infection, but there are other possible causes of hepatitis. These include autoimmune hepatitis and hepatitis that occurs as a secondary result of medications, drugs, toxins, and alcohol. Autoimmune hepatitis is a disease that occurs when the body makes antibodies against the liver tissue. Other name for Hepatitis A are Infectious hepatitis and Catarrhal-jaundice hepatitis, Hepatitis B is Serum Hepatitis and Hepatitis C is Post-transfusion hepatitis. The liver is located in the right upper area of the abdomen. It performs many critical functions that affect metabolism throughout the body, including: (1) bile production, which is essential to digestion; (2) filtering of toxins from the body; (3) excretion of bilirubin (a product of brokendown red blood cells), cholesterol, hormones, and drugs; (4) breakdown of carbohydrates, fats, and proteins; (5) activation of enzymes, which are specialized proteins essential to body functions; (6) storage of glycogen (a form of sugar), minerals, and vitamins (A, D, E, and K) synthesis of blood proteins, such as albumin; and (7) synthesis of clotting factors. The hepatitis B virus was discovered in 1965 by Dr. Baruch Blumberg who won the Nobel Prize for his discovery. Originally, the virus was called the "Australia Antigen" because it was named for an Australian aborigine's blood sample that reacted with an antibody in the serum of an American hemophilia patient. According to the Centers for Disease Control and Prevention (CDC), approximately 4.4 million Americans are currently living with chronic hepatitis B and C. Many more people don’t even know that they have hepatitis. Treatment options vary depending on which type of hepatitis the patient have. A patient can prevent some forms of hepatitis through immunizations and lifestyle precautions. The five (5) types of viral hepatitis are classified as hepatitis A, B, C, D, and E. A different virus is responsible for each type of virally transmitted hepatitis. Hepatitis A is always acute, short-term disease caused by an infection with the hepatitis A virus (HAV). The virus is one of several types of hepatitis viruses that cause inflammation and affect the liver's ability to function. This type of hepatitis is most commonly transmitted by consuming food or water contaminated by feces from a person infected with hepatitis A or from close contact with a person or object that's infected. It can be fecal-oral or oral-anal route of transmission. Mild cases of hepatitis A don't require treatment. Most people who are infected recover completely with no permanent liver damage. Hepatitis B is most likely to become ongoing and chronic and transmitted through contact with infectious body fluids, such as blood, vaginal secretions, or semen, containing the hepatitis B virus (HBV). Injection drug use, having sex with an infected partner, or sharing razors with an infected person increase the risk of getting hepatitis B. It’s estimated by the CDC that 1.2 million people in the United States and 350 million people worldwide live with this chronic disease. Hepatitis C comes from the hepatitis C virus (HCV). Hepatitis C is transmitted through direct contact with infected body fluids, typically through injection drug use and sexual contact. HCV is among the most common blood borne viral infections in the United States. Approximately 2.7 to 3.9 million Americans are currently living with a chronic form of this infection. Hepatitis D is also called delta hepatitis, hepatitis D is a serious liver disease caused by the hepatitis D virus (HDV). HDV is contracted through direct contact with infected blood. Hepatitis D is a rare form of hepatitis that only occurs in conjunction with hepatitis B infection. The hepatitis D virus can’t multiply without the presence of hepatitis B. It’s very uncommon in the United States. Hepatitis E is a waterborne disease caused by the hepatitis E virus (HEV). Hepatitis E is mainly found in areas with poor sanitation and typically results from ingesting fecal matter that contaminates the water supply. This disease is uncommon in the United States. However, cases of hepatitis E have been reported in the Middle East, Asia, Central America, and Africa, according to the CDC. Causes of noninfectious hepatitis are excessive alcohol consumption can cause liver damage and inflammation. This is sometimes referred to as alcoholic hepatitis. The alcohol directly injures the cells of the liver. Over time, it can cause permanent damage and lead to liver failure and cirrhosis, a thickening and scarring of the liver. Other toxic causes of hepatitis include overuse or overdose of medications and exposure to poisons. As in the case of autoimmune system response, in some cases, the immune system mistakes the liver as a harmful object and begins to attack it. It causes ongoing inflammation that can range from mild to severe, often hindering liver function. It’s three times more common in women than in men. Hepatitis signs and symptoms typically don't appear until the patient had the virus for a few weeks. Hepatitis signs and symptoms can include: fatigue (up 2-4 months), sudden nausea and vomiting, abdominal pain or discomfort, especially on the upper right side beneath the lower ribs (hepatomegaly), clay-colored bowel movements (excretion of conjugated bilirubin into the intestines is decreased), loss of appetite (encourage high calorie and low fat diet), lowgrade fever, dark urine (increase bilirubin), joint pain, yellowing of the skin (jaundice) and the whites of the eyes (icteric sclera) and intense itching and It is believed that pruritus in hepatitis is caused by an accumulation of toxins that the liver cannot eliminate. Instead of the toxins being removed by the liver, they accumulate in the bloodstream and cause jaundice and severe itching. Bilirubin is one of those toxins that cause pruritus. These symptoms may be relatively mild and go away in a few weeks. Sometimes, however, hepatitis A infection results in a severe illness that lasts several months. If the patient has infectious forms of hepatitis that are chronic, like hepatitis B and C, patient may not have symptoms in the beginning. Symptoms may not occur until the damage affects liver function. Chronic hepatitis develops slowly, so these signs and symptoms may be too subtle to notice. The nurse may assist in taking history and physical examination, to diagnose hepatitis, first the doctor will take the history to determine any risk factors that the patient may have for infectious or noninfectious hepatitis. During a physical examination, the doctor may press down gently on the abdomen to see if there’s pain or tenderness. The doctor may also feel to see if the liver is enlarged. If the skin or eyes are yellow, the doctor will note this during the exam. Liver function tests (SGOT/SGPT – serum transaminase) use blood samples to determine how efficiently the liver works. Abnormal results of these tests may be the first indication that there is a problem, especially if the patient doesn’t show any signs on a physical exam of liver disease. High liver enzyme levels may indicate that the liver is stressed, damaged, or not functioning properly. If the liver function tests are abnormal, the doctor will likely order other blood tests to detect the source of the problem. These tests can check for the viruses that cause hepatitis. They can also be used to check for antibodies that are common in conditions like autoimmune hepatitis. An abdominal ultrasound uses ultrasound waves to create an image of the organs within the abdomen. This test allows the doctor to take a close at the liver and nearby organs. It can reveal: fluid in the abdomen, liver damage or enlargement, liver tumors, abnormalities of the gallbladder; and sometimes the pancreas shows up on ultrasound images as well. This can be a useful test in determining the cause of the abnormal liver function. A liver biopsy is an invasive procedure that involves the doctor taking a sample of tissue from the liver. It can be done through the skin with a needle and doesn’t require surgery. Typically, an ultrasound is used to guide the doctor when taking the biopsy sample. Hemorrhage is a common complication od liver biopsy and need to check if there is a prolonged prothrombin time. This test allows the doctor to determine how infection or inflammation has affected your liver. It can also be used to sample any areas in the liver that appear abnormal. The Nursing Interventions: (1) Practicing good hygiene including washing hands is one of the best way to protect against hepatitis A; (2) Bed rest; (3) small frequent feeding, high in carbohydrates, in severe cases spare protein; (4) Avoid alcohol and OTC drugs; (5) Implement Standard precaution; and (6) prevention is vaccination. Hepatitis B vaccination @ 0, 6, 14 weeks 0.5 cc IM. Vaccines are available for people most at risk. Getting a hepatitis A vaccine or an injection of immunoglobulin (an antibody) within two weeks of exposure to hepatitis A may protect the patient from infection. Hepatitis A usually doesn’t require treatment because it’s a short-term illness. Bed rest may be recommended if symptoms cause a great deal of discomfort. If the patient experience vomiting or diarrhea, the nurse may encourage the patient to follow the doctor’s orders for hydration and nutrition. Acute hepatitis B doesn’t require specific treatment. Chronic hepatitis B is treated with antiviral medications. This form of treatment can be costly because it must be continued for several months or years. Treatment for chronic hepatitis B also requires regular medical evaluations and monitoring to determine if the virus is responding to treatment. Hepatitis B can be prevented with vaccination. The CDC recommends hepatitis B vaccinations for all newborns. The series of three vaccines is typically completed over the first six months of childhood. The vaccine is also recommended for all healthcare and medical personnel. Antiviral medications are used to treat both acute and chronic forms of hepatitis C. People who develop chronic hepatitis C are typically treated with a combination of antiviral drug therapies. They may also need further testing to determine the best form of treatment. People who develop cirrhosis (scarring of the liver) or liver disease as a result of chronic hepatitis C may be candidates for a liver transplant. Currently, there is no vaccination for hepatitis C. No antiviral medications exist for the treatment of hepatitis D at this time. According to a 2013 study, a drug called alpha interferon (medication for chronic hepatitis) can be used to treat hepatitis D, but it only shows improvement in about 25 to 30 percent of people. Hepatitis D can be prevented by getting the vaccination for hepatitis B, as infection with hepatitis B is necessary for hepatitis D to develop. Currently, no specific medical therapies are available to treat hepatitis E. Because the infection is often acute, it typically resolves on its own. People with this type of infection are often advised to get adequate rest, drink plenty of fluids, get enough nutrients, and avoid alcohol. However, pregnant women who develop this infection require close monitoring and care. Tips to prevent hepatitis such as: (1) Hygiene; (2) Practicing good hygiene is one key way to avoid contracting hepatitis A and E. If the patient is traveling to a developing country, patient should avoid: local water, ice, raw or undercooked shellfish and oysters, raw fruit and vegetables. Hepatitis B, C, and D contracted through contaminated blood can be prevented by: not sharing drug needles, not sharing razors, not using someone else’s toothbrush, and not touching spilled blood. Hepatitis B and C can also be contracted through sexual intercourse and intimate sexual contact. Practicing safe sex by using condoms and dental dams can help decrease the risk of infection. The use of vaccines is an important key to preventing hepatitis. Vaccinations are available to prevent the development of hepatitis A and B. Experts are currently developing vaccines against hepatitis C. A vaccination for hepatitis E exists in China, but it isn’t available in the United States. People with chronic hepatitis B and C are encouraged to avoid alcohol because it can accelerate liver disease and failure. Certain supplements and medications can also affect liver function. If patient have chronic hepatitis B or C, check with the doctor before taking any new medications. Complications of hepatitis are chronic liver disease, cirrhosis, and liver cancer. When the liver stops functioning normally, liver failure can occur. Complications of liver failure include: bleeding disorders, a buildup of fluid in the abdomen, known as ascites, increased blood pressure in portal veins that enter the liver, known as portal hypertension, kidney failure, hepatic encephalopathy, which can involve fatigue, memory loss, and diminished mental abilities due to the buildup of toxins, like ammonia, that affect brain function, hepatocellular carcinoma, which is a form of liver cancer and even death. Navales, Dionesia M. (2010). Handbook of Common Communicable and Infectious Disease, C and E Publishing, Inc. QC. Hinkle, Janice L. (2014) Brunner & Suddarth's textbook of medical-surgical nursing,13th. Philadelphia: Lippincott Williams & Wilkins.617.0231 H59 2014, c5 Borromeo, Annabelle R. et.al. (2014). Lewis's Medical-Surgical Nursing: Singapore: Elsevier Mosby. 617.0231 L58 2014, c3 Links: www.cdc.gov www.ecdc.europa.eu www.doh.gov.ph http://caro.doh.gov.ph/infectious-diseases/ www.who.org www.health.com www.mayoclinic.org Can access to YouTube, Google and other electronic communicable disease nursing books available Study Questions Download a research article on the topic about cholera, dysentery, typhoid fever and hepatitis from any site and relate it to the Philippine setting. If the article is Philippine setting, what are your recommendations to end up the problem with these four (4) infectious diseases (choose one to react). Submit a 200-300 word essay reflection.