OUR LADY OF FATIMA UNIVERSITY

COLLEGE OF NURSING
VALENZUELA CITY CAMPUS

In partial fulfillment of the requirements in

NCM 104 (Communicable Diseases) RLE

HEPATITIS

A case study presented to:

Mr. Gerardo Nicolas, RN, MAN
Clinical Instructor

Presented by:
GROUP 1D
BSN 3Y2-1

Hipple, Lesley S.
Jagna, Ma. Christina Sirikit N.
Lascañas, Miafel B.
Majan, Irica S.
Mallare, Michelle Giselle G.
Quiambao, Razelle F.
Rebadavia, Shaira D.

October 9 2020
2nd Semester
A.Y. 2020 – 2021
 I. LEARNING OBJECTIVES

General Objectives
 This case study aims to broaden the students’ knowledge regarding Hepatitis A, and it is
designed to develop and enhance the skills and attitude in the application of different
nursing processes and management of the patient with hepatitis A.

Specific Objectives
 To be able to acquire knowledge regarding pneumonia, its background and epidemiology
through research.
 To trace the pathophysiology of Hepatitis A.
 To render the necessary nursing care and responsibilities to a client with Hepatitis A.
 To correlate the results of the diagnostic procedures to its normal values.
 To formulate and present drug studies of medications given to the client as a part of
treatment regimen.
 To develop an effective nursing care plan in which the client may benefit.
 To provide health teaching about Hepatitis A.
 II. INTRODUCTION
(Rebadavia, Shaira D.)

DEFINITION:
Hepatitis A is a vaccine-preventable liver infection caused by the hepatitis A virus (HAV). HAV
is found in the stool and blood of people who are infected. Hepatitis A is very contagious. It is
spread when someone unknowingly ingests the virus — even in microscopic amounts — through
close personal contact with an infected person or through eating contaminated food or drink.
Symptoms of hepatitis A can last up to 2 months and include fatigue, nausea, stomach pain, and
jaundice. Most people with hepatitis A do not have long-lasting illness. The best way to prevent
hepatitis A is to get vaccinated.

EPIDEMIOLOGY:
Close to 1.4 million infections are reported worldwide each year, of which approximately half
occur in Asian countries. The Global Burden of Disease project estimates that HAV causes 1 213
718 disability-adjusted life years (DALYs) (95% confidence interval 524 098–2 255 089)
worldwide every year. Acute infection is clinically indistinguishable from other types of
hepatitis, but unlike infections caused by hepatitis B and C viruses, HAV infection does not
cause chronic liver disease. Hepatitis A is rarely fatal and most people recover with life-long
immunity. However, it can take several weeks or months to recover, and severe infections, while
rare, can result in fulminant hepatitis and death.

STATISTICS:
Hepatitis A virus (HAV) infection is endemic to the country. According to University of the
Philippines Manila and Research Institute for Tropical Medicine (RITM) a community-based,
age-specific prevalence study shows that by 5 years of age, more than 90% of the rural and
economically poor population have the antibody to HAV (anti-HAV). Among cases of acute
icteric hepatitis in patients 14 years old and above, 69% were due to HAV. Globally, there are an
estimated 1.4 million cases of hepatitis A every year.
MORTALITY
The hepatitis A case-fatality rate among persons of all ages with reported cases was
approximately 0.3% but may have been higher among older persons (approximately 2% among
persons 40 years of age and older) More recent case-fatality estimates range from 0.3%-0.6% for
all ages and up to 1.8% among adults aged >50 years.

RATIONALE
Our group chose Hepatitis as our case study because it is included in our Communicable Disease
subject. In addition to that we find Hepatitis an interesting topic as it is being recognize as one of
the huge public health concerns in the Philippines. But we most especially want to gain a better
understanding about its concept so that we can apply this knowledge when providing care to our
patient.
 III. PATIENT PROFILE

NAME: J.A.G.
BIRTHDAY: August 23, 1975
AGE: 45 years old
SEX: Male
NATIONALITY: Filipino
RELIGION: Roman Catholic
MARITAL STATUS: Married
ADDRESS: Bulacan
DATE OF ADMISSION: September 25, 2020
TIME OF ADMISSION: 12:45 PM
CHIEF COMPLAINT: Yellowish discoloration of the skin and sclera with fatigability and
loss of appetite
FINAL DIAGNOSIS: Hepatitis A

HISTORY OF PRESENT ILLNESS:

Patient came to the hospital complaining of yellowish discoloration of the skin and sclera
since 5 days before admission. He also complaining of easy fatigability, loss of appetite,
vomiting, body weakness, pain on the lower side of abdomen, and passing dark colored
urine.
On the day he went to the emergency room, no fever showed. There was no past history of
jaundice, blood transfusion or surgical procedures. The client is ambulatory, coherent and v/s
results showed RR of 23 cpm, pulse rate of 94 bpm, BP of 110/70 mmHg, temp of 36.7C.
Anthropometric status as to weight - 70 kilogram and height - 170 cm

PAST MEDICAL HISTORY:

Client has history of pneumonia and was admitted when he was in grade school. He is fond
of taking over the counter medication when he feels ill. Immunizations were completed when
he was one year old. The patient undergone appendectomy when he was in high school. He
has no known allergy to food and medication.
FAMILY HISTORY
(+) Hypertension - father
(+) Diabetes Mellitus - mother
(+) Cancer – auntie (wife side)
(+) PTB – brother

PERSONAL AND SOCIAL HISTORY

Patient is a factory worker in Valenzuela City. He is a type of person that mingles with his
co-employee. He loves to go out with his friends. Patient is non-smoker, but drinks
occasionally and especially if there are birthday celebrations with co-employees, and no
history of taking illicit drugs. He prefers to eat in the canteen inside factory, sometimes in the
canteen outside the factory. He never prefers his food at home because he does not want to be
late at work. He loves eat rice, pork, fish, vegetables, and street foods. He enjoys talking to
his friends while working. His leisure time is watching TV with his family. If the patient has
free time and has day-off from work, he stays at home plays with his family. He is a good
provider to his family and loving husband to his wife and children.

ADMISSION ORDER
Diet: Initially clear liquid diet (if nauseated); low fat (if with diarrhea) then high caloric, high
carbohydrate diet; restrict protein only if with signs of hepatic encephalopathy Vital Signs:
Vital signs every 4 hours and include pain scale and O2 saturation Nursing: Hepatitis
Precaution / Enteric isolation IVF: D5NM 1L x 12 hours, D5 NR 1L X 12 hours – alternately
if there’s no new order to follow Therapeutics: Supportive treatment – no specific treatment,
restricted physical activity, avoid hepatotoxic drugs

Medication: Essentiale 1 cap TID PO

Multivitamins 1 tab OD PO
Ranitidine 150mg TIV OD
Hydroxyzine (Iterax) 10 mg 1 tab TID PO
Paracematol 1 amp TIV for temp of equal or greater than 38.6 and paracetamol
500mg tab PO for temp of 38.5 below
Bedside Care: Vital signs every shift and watch out for any signs of disease progression like
hemorrhage, bed rest, I and O monitoring, provide comfort, morning care done, side rails up
for safety, assess every now and then and relayed any abnormal symptoms and complications
 IV. PHYSICAL ASSESSMENT

BODY PARTS ACTUAL FINDINGS

HEAD Ÿ Normocephalic
Ÿ Black hair and evenly distributed
Ÿ (-) nits, (-) lice
Ÿ (-) alopecia
Ÿ (-) masses, (-) lesions

EYES Ÿ icteric sclera both eyes

Ÿ pale conjunctiva
Ÿ (-) lacrimation
Ÿ pupils 3mm/3mm
Ÿ equally round reacted to light and accommodation

EARS Ÿ Normal shape

Ÿ (-) wound
Ÿ (-) bleeding
Ÿ (-) secretion or cerumen

NOSE Ÿ Normal shape

Ÿ Midline septum
Ÿ (-) secretion
Ÿ (-) lesions, (-) polyps

MOUTH Ÿ Lips: Moist

Ÿ Teeth: (-) dental caries
Ÿ Mucous: Moist
Ÿ Tongue: not dirt
Ÿ Tonsils: not enlarged
Ÿ Uvula: midline

NECK Ÿ (-) Lymph node enlargement

Ÿ (-) scrofuloderma
Ÿ (-) masses

ABDOMEN Ÿ (-) widening of the veins, (-) spider nevi,

Ÿ (+) gurading behavior when touched
Ÿ Pain scale of 6/10
Ÿ Liver palpable slightly enlarged confirm in ULTZ
Ÿ Spleen not palpable
Ÿ (-) Fluid wave, (-) abdominal mass
Ÿ Upon percussion: the entire field of tympanic abdomen,
(-) shifting dullness
Ÿ Upon auscultation: normal bowel sound, (-) bruit
VERTEBRAE Ÿ (-) deformities , (-) masses along the line of the vertebral

EXTREMITIES Ÿ Warm
Ÿ Capilliary refill time < 2 seconds
Ÿ (-) edema
SKIN Ÿ Good turgor
Ÿ Slightly dry
Ÿ Jaundice prominent on the eyes and body
Ÿ Itchiness
 V. ANATOMY AND PHYSIOLOGY
(Hipple, Lesley S. & Jagna, Ma. Christina Sirikit N.)

 Liver: A large, meaty organ that sits on the right side of the belly.
 Weighs about 3 pounds.
 Reddish-brown in color and feels rubbery to the touch.
 Has two large sections called the right and left lobes.
 Protected by the rib cage.

Functions of the Liver:

a) Filters blood from the digestive tract.
b) Detoxifies chemicals and metabolizes drugs.
c) Manufacturers proteins important for blood clotting and other functions.
d) Production of bile, which helps carry away waste and break down fats in the small
intestine during digestion
e) Production of certain proteins for blood plasma
f) Production of cholesterol and special proteins to help carry fats through the body
g) Conversion of excess glucose into glycogen for storage (glycogen can later be
converted back to glucose for energy) and to balance and make glucose as needed 
h) Regulation of blood levels of amino acids, which form the building blocks of
proteins
i) Processing of hemoglobin for use of its iron content (the liver stores iron)
j) Conversion of poisonous ammonia to urea (urea is an end product of protein
metabolism and is excreted in the urine)
k) Clearing the blood of drugs and other poisonous substances
l) Regulating blood clotting
m) Resisting infections by making immune factors and removing bacteria from the
bloodstream
n) Clearance of bilirubin, also from red blood cells. If there is an accumulation of
bilirubin, the skin and eyes turn yellow. 
VI. PATHOPHYSIOLOGY
(Majan, Irica S.)
 VII. LABORATORY
(Mallare, Michelle Gliselle G.)

HEMATOLOGY RESULTS NORMAL VALUE INTERPRETATION

POSSIBLE LIVER
SGOT 253.0 U/L < 30 U/L Above Normal
INJURY
POSSIBLE LIVER
SGPT 635 U/L <35 U/L Above Normal
INJURY

HEMATOLOGY RESULTS NORMAL VALUE INTERPRETATION

Hemoglobin 13.5 g/dL 13-16 g/dL Normal -

Leukocytes 7.500/µL 5,000 – 10,000/µL Normal -

Hematocrits 39 % 40 – 48 % Below Normal ANEMIA

POSSIBLE
Thrombocytes 408.000/ µL 150,000 – 400,000/µL Above Normal
INFLAMMATION
 VIII. DRUG STUDY
(Lascañas, Miafel B.)

MEDICATION/ POSSIBLE SIDE NURSING

MECHANISM OF ACTION RATIONALE CONTRAINDICATION
DRUGS EFFECT CONSIDERATIONS
ESSENTIALE Inhibit steatosis and fibrosis in Nutritional Known hypersensitivity to  Administration of  Assess patient's history
Classification: chronic liver damage. Inhibits support in the soya-bean preparation to essentiale forte may of the interactions with
supplement lipid peroxidation and inhibit management of any of the excipients of provoke gastrointestinal the drug to avoid
collagen synthesis. principal damaged liver essential forte. may disorder such as stomach allergies
Dosage/ Frequency/ actions have been through provoke severe allergic complaints, soft stool  Check if patient is on
Route accelerated membrane reactions and diarrhea. NPO
1 capsule regeneration and stabilization.  On vary rare occasions,
TID allergic reaction may
PO occur

MULTIVITAMINS Opstres is scientifically Dietary  Iron metabolism disorder  Severe allergic reactions  Instruct patient that he
Classification: formulated with vitamin supplement causing increased iron (rash, hives, itching, can take it with or
multivitamins B- complex which produces and storage difficulty breathing, without food.
maintains sufficient energy to  An overload of iron in the tightness in the chest,  Check if patient is on
Dosage/ Frequency/ enable the body to fight stress. blood swelling of the mouth, NPO
Route The B group of vitamins are all  An ulcer from too much face, lips, or tongue)
1 tab water-soluble and are not stomach acid  Decreased coordination
OD adequately stored in the body,  Numbness or tingling of
PO so they need to be replenished the skin
on a daily basis to support many  Severe or persistent
body functions eg, the normal constipation
functioning of the nervous
system and providing energy by
converting carbohydrates to
glucose.
RANITIDINE Competitively inhibit To decrease  Hypersensitivity to  Headache  Obtain history of
Classification: action of histamine at gastric acid ranitidine  Malaise epigastric/abdominal
Anti-ulcer drugs H2- receptor sites of parietal secretion  Do not use if trouble or  Vertigo pain.
cells pain when swallowing  Blurred vision  Administer IV push
Dosage/ Frequency/ food, vomiting with  Jaundice over minimum of 5
Route blood, or bloody or black  Constipation min (prevents
150 mg stool is present arrhythmias,
 Nausea
TIV hypotension)
 Abdominal pain
OD  Transient
burning/pruritus may
occur with IV
administration.

HYDROXYZINE Competes with histamine for Relaxes  Hypersensitivity to  Drowsiness  Watch out for
(iterax) receptor sites in GI tract, blood skeletal muscle Hydroxyzine  Dry mouth, nose and hypesensitivy reaction
vessels, respiratory tract and controls  Porphyria throat such as rashes,
Classification: nausea &  Neonates difficulty of breathing
Antiemetic, treatment vomiting  Pregnancy or feeling tightness in
of anxiety/agitation,  Lactation. the neck.
antipruritic  Instruct regarding
possible side effects.
Dosage/ Frequency/  Assess for dehydration
Route (poor skin turgor, dry
10mg mucous membranes)
1tab
TID
PO

PARACETAMOL Inhibiting prostaglandin To relieve or Hypersensitivity to  Nausea and vomiting  Monitor temperature
Classification: and other substances that reduce fever Paracetamol  Constipation  Watch out for allergic
Analgesics sensitize pain receptors. Drug  Abdominal pain reaction
may relieve fever through  Dyspnea  Give drug without
Dosage/ Frequency/ central action in the  Headache regard for food
Route hypothalamic heat-regulating  Dizziness  Facilitate tepid sponge
1 ampule TIV center. bath
if temp ≥ 38.6
500mg tab PO 38.5
 IX. NURSING CARE PLAN
(Hipple, Lesley S. & Jagna, Ma. Christina Sirikit N.)

NURSING BACKGROUND
CUES PLANNING INTERVENTION RATIONALE EVALUATION
DIAGNOSIS KNOWLEDGE
SUBJECTIVE Acute Exposure to Hepa Short term 1. Established rapport to 1. To easily gain Short term
DATA: abdominal pain A through fecal goal: the patient cooperation from the goal:
related to oral route patient
“Masakit ang After 1 hour of After 1 hr or
inflammation of nursing
tyan ko” as nursing
the liver as intervention 2. Monitored v/s 2. To have baseline data
verbalized by evidenced by intervention the
Blood stream the patient will
the patient. patient reporting 3. Observed and 3. Provides an objective patient used non
use non
pain scale of 8 pharmacologic document location, mean of evaluating the pharmacologic
OBJECTIVE out of 10 al pain relief severity and subjective experience pain relief as
DATA: Virus targets the strategies characteristic of pain of the patient. ( pain evidenced by
T: 36.7 C liver scale) patient doing
BP: 110/70 Long term different
RR: 23 cpm 4. Promoted bed rest 4. To promote healing
goal: technique to
PR: 94 bpm Inflammation of the After 6 hours 5. Controlled 5. To minimize dermal relieve pain
+ facial grimace liver of nursing environment discomfort from cool
+ guarding
position intervention temperature surroundings Long term
towards the the patient will goal:
lower abdomen Abdominal pain report 6. Encouraged patient to 6. To reduce perception After 6 hrs of
(location of the (8 out of 10) verbalized feeling intensity of pain
decreased level nursing
pain) of pain scale intervention the
7. Encouraged patient to 7. To calm and soothes
do deep breathing the patient patient reported
Pain scale of 8
Acute pain exercise pain scale of 3/
out of 1o
10 from 8/10
8. Encouraged 8. To divert attention
diversional activities from pain
such as watching Tv
 NURSING BACKGROUND
CUES PLANNING INTERVENTION RATIONALE EVALUATION
DIAGNOSIS KNOWLEDGE
SUBJECTIVE Fatigue Exposure to Hepa Short term INDEPENDENT: Short term
DATA: secondary to A through goal: 1. Monitored v/s 1. Changes in v/s may goal:
fecal-oral route include signs of
“Wala akong decreased After 1 hour of After 1 hr of
complications.
gana kumain at metabolic nursing nursing
( RR, and subjective
madali rin function as intervention complaints) intervention the
akong evidenced by Blood stream the patient will patient
mapagod” as patient loss of be able to 2. Monitored intake 2. To ensure that the considered
verbalized by appetite regain output patient has proper appetite for food
the patient. Virus targets the considerable intake of fluid and and ate.
liver appetite for other nutrients
Objective: food. Long term
3. Encouraged patient to 3. To enhance intake
VS: eat small but frequent goal:
RR: 23 cpm Inflammation of the Long term food. After 8 hours of
liver goal: Nursing
After 8 hrs of 4. Promoted pleasant, 4. To prevent comfort intervention the
nursing relaxing environment, and relaxation. patient reported
Altered liver intervention improved sense
function 5. Advised to take 8 hrs 5. To gain strength
the patient will of energy.
of sleep at night
report
improved
Loss of appetite sense of 6. Assisted the patient to 6. A plan that balances
energy. develop a schedule periods of activity
for daily activity and with periods of rest
rest. can help the patient
body weakness
complete desired
activities without
adding to levels of
fatigue
Fatigue
7. Assessed patient 7. To identify the extent
ability to perform of deficiency and for
ADL’s better treatment plan
DEPENDENT:
8. Multivitamins 1 tab 8. Dietary supplement
OD PO

9. Essentiale 1 tab PO 9. Liver Vitamin

OD.
 NURSING BACKGROUND
CUES PLANNING INTERVENTION RATIONALE EVALUATION
DIAGNOSIS KNOWLEDGE
SUBJECTIVE Risk for Fluid Exposure to Hepa Short term INDEPENDENT: Short term
DATA: deficit volume A through goal: 1. Monitored v/s 1. Decrease in goal:
related to fecal -oral route circulating fluid
“Nagsusuka ako After 1 hour of After 1 hr or
netong mga excessive nursing volume can cause nursing
nakaraang vomiting as intervention hypotension. intervention the
Blood stream
araw” as evidenced by the patient will patient has
verbalized by patient reporting have 2. Assessed skin turgor 2. To assess signs of knowledge in
the patient of vomiting Virus targets the knowledge on and oral mucous dehydration preventing
liver preventing membrane dehydration as
OBJECTIVE: dehydration as evidenced by
RR: 23 cpm evidenced by 3. Monitored urine 3. To assess urine color patient explain
Body malaise Inflammation of the patient and output measures that
output and color
liver
explains can be taken to
measures that 4. Monitored fluid status 4. To ensure that patient treat and prevent
can be taken to in relation to dietary is getting proper fluid dehydration
Altered liver
treat and intake intake
function
prevent
dehydration Long term
Increase digestive 5. Encouraged patient to 5. To prevent
increased fluid intake dehydration goal:
distress
After 6 hrs of
Long term
nursing
Excessive vomiting goal: 6. Encouraged patient to 6. To prevent vomiting intervention the
After 6 hours avoid caffeine food
patient reported
of nursing
of not
Fluid deficit
intervention 7. Assessed the patient if 7. Dehydrated patients experiencing
the patient will he is unable to eat are experiencing
volume vomiting
without assistance weakness
report of not
experiencing 8. Fluid deficit can
vomiting 8. Emphasized
importance of oral cause a dry sticky
hygiene mouth, to promote
interest in drinking
and reduce discomfort
of dry mucous
membrane
9. Educated client that if 9. To promote stomach
there is an episode of rest.
vomiting not to have
any food/ fluid intake
for 4 hours.

DEPENDENT:
10. Hydroxyzine 10mg 1 10.Anti emetic
tab TID PO

11. D5NM 1L x 12 hrs 11.Parenteral

maintenance of
routine daily fluid and
electrolyte
requirements

12. D5NR 1L x 12 hrs 12. To replace body

fluid volume.
 X. RECOMMENDATIONS
(Quiambao, Razelle F.)

Medications
 Essentiale 1 cap TID PO
 Multivitamins 1 tab OD PO
 Ranitidine 150mg TIV OD
 Hydrooxyzine (Iterax) 10 mg 1 tab TID PO
 Paracetamol 500mg tab PO for temp 38.5 °C

Environment/ Exercise
 Encouraged client to do light to moderate exercise as tolerated but refrain from vigorous
exercises and heavy lifting.
 Encouraged client to do deep breathing exercise.

Treatment:
 Instructed to take medicine as directed.
 Avoidance of unnecessary medication.
 Acetaminophen/ Paracetamol shall be in controlled use.

Health Teaching:
 Mass Media approach.
 Flyers/ pamphlet on how to prevent the spread of Hep A.
 Inform client that Patient with Hep A are most contagious in the 2 weeks before and the
first week after they become jaundiced. Friends, sex partners, and family members may
need to get the hepatitis A vaccine.
 Breaking channel of transmission by constructing sanitation barrier.
 Protection of susceptible by Immunization.
 Food Hygiene
Observation/ Out- Patient
Return to the emergency department if:
 The patient has severe abdominal pain.
 The patient is too dizzy to stand up.
 The patient vomit blood or material that looks like coffee grounds.
 The patient bowel movements are red or black, and sticky.
 The patient feel confused, unusually sleepy, irritable, or jittery.

Call your doctor if:

 The patient cannot drink liquids or keep food down.
 The Patient is bruising easily.
 The patient has questions or concerns about his condition or care.

Diet
 Advised the patient to eat a variety of healthy foods. Healthy foods include fruits,
vegetables, whole-grain breads, low-fat dairy products, and lean meats and fish.
 Recommended that the patient shall limit protein foods such as milk, fish, meat, and fatty
foods. Protein and fat makes the liver work harder. As the client feels better, he can add
other kinds of foods.
 Instructed the patient not drink alcohol. Alcohol can increase liver damage.
 Instructed the patient to drink more liquids. Liquids help liver function properly.

Spiritual
 Advised the patient and her family to pray for fast recovery and guidance.
 Spend quality time with the family