Hepatitis B is a global health problem, it is a liver infection that can cause serious complications and is potentially life threatening arising from the Hepatitis B virus (HBV). This paper will provide an overview of hepatitis B, including demographic information, determinants of health, the epidemiological triangle, the role of the community health nurse and a national organization that addresses the communicable disease.Hepatitis B is an infection of the liver caused by HBV; the infection can be classified as acute or chronic (Daniel, 2014). An individual with acute hepatitis infection may not exhibit symptoms and are unaware they may be carrying the HBV. During this time, individuals infected with the virus may pass the virus on to others, symptoms do not persist longer than two to three weeks, it is considered short term. Normal liver function returns in four to six months. Symptoms include loss of appetite, nausea and vomiting, low-grade fever, tenderness to right upper quadrant, jaundice, fatigue, muscle and joint aches and pain (Daniel, 2014).
Tests performed will be positive for the hepatitis B virus, which are HBsAg+, HBc-IgM and HBe-antigen. The HBV is transmitted when the virus enters the bloodstream through breaks in the skin, the mouth and genitalia areas. Examples include unprotected sex, exposure to needle sticks, skin punctures (skin piercing, tattoos, acupuncture) and sharing personal items that are contaminated (www.cdc.gov). Healthy adults with a strong immune response are likely to rid the virus and recover from an acute infection. Individuals who recover develop positive surface antibodies that protect them against future exposure. Rest, fluids and eating healthy are the primary goals of therapy. Additional follow-up of blood tests are needed to diagnose recovery from an acute infection or the progression to a chronic infection (www.hepb.org). Infants born to infected mothers should receive the hepatitis B vaccine within 12 hours after birth. Most newborn and children who get hepatitis B develop the chronic condition. Chronic hepatitis is long term lasting more than six months, the liver becomes scarred and loses it normal function as liver cells die. As the liver becomes dysfunctional, there is an increase risk of cirrhosis, liver failure and liver cancer. Symptoms include weakness, fatigue, loss of appetite, weight loss, breast enlargement in men, rash on palm and spider like vessels on the skin.
As the disease progresses, additional complications include confusion, encephalopathy, portal hypertension, ascites, anemia and decrease production of clotting factors (www.hepb.org). Individuals with chronic hepatitis are treated with antiviral medications that may decrease or remove the virus from the blood lowering the risk for cirrhosis and liver cancer. Antiviral medications are usually started when liver function tests become worse, symptoms of liver damage are present and there are high levels of hepatitis B virus in the blood. Receiving the hepatitis B vaccine of hepatitis immune globulin (HBIG) injection may help prevent infection if the vaccine is received within 24 hours of contact with the virus (www.nlm.nih.gov). As mentioned, HBV is transmitted through contact of infected blood, body fluids (semen, vaginal discharge, saliva), mucus membranes, skin puncture, needle sharing and individuals on long term dialysis.According to the World Health Organization (WHO), “more than 240 million people have chronic liver infections and more than 780 000 people die every year due to the acute or chronic consequences of hepatitis B”.
Hepatitis B is more prevalent in Asian and Pacific islanders (APIs) who make up less than five percent of the total population in the United States but account for more than fifty percent of Americans living with chronic hepatitis B. Many APIs are unaware of their infection, they are not tested and do not have access to quality medical services. They have the highest incident of hepatitis B related liver cancer. The death rates among APIs are seven times greater than whites.
As a result, APIs are viewed as a serious health disparity in the United States (www.cdc.gov). The determinants of health factors that contribute to the transmission of Hepatitis B include age, socioeconomic status, occupation (health professionals), frequent travel, needle sharing, skin or body piercing, tattooing, sharing personal items, contact and family history and lack of knowledge of transmission and unpracticing of active or passive immunization which prevents and individual from seeking care and may contribute to the diagnosis of disease in the later stages. The epidemiological triangle in relation to the hepatitis B virus consists of an agent, a host and an environment.
In order for the chain of transmission to occur, this process requires a source for the agent, a portal of exit, a mode of transmission and a portal of entry. The agent in this epidemiological triangle is the hepatitis B virus. The host is the individual interacting with the agent by way of unprotected sex, contaminated needles and saliva. Having been exposed to the agent, the host may be a carrier but may not have signs of symptoms or illness and is able to spread to others. Different people have different reactions to the same agent. The environment that influences this interaction is housing, with bloodstream, bodily fluids and semen being the source for the agent and the genitals/anal, mouth and skin are the portal of exit. The best interventions for prevention at this time are antiviral medications and interferon.
An antiviral medication interrupts the viral reproduction process by disabling the DNA formation. Interferon stimulates the immune system to fight infection; aminotransferase (ALT) levels are increase indicating the immune system is attacking the infected liver. The role of the community nurse for individuals with chronic hepatitis B will be discussed; this includes assessment of client and family system, health promotion, disease prevention, treatment and evaluation. The activity level in individuals with chronic hepatitis B experiences fatigue, weakness and decrease energy. Advising the individual to schedule rest periods, positioning frequently to prevent skin breakdown will improve energy level and performance and allows individuals to perform activities of daily living. Administering antiemetics and antacids will prevent malnutrition from inadequate intake due to potential nausea and vomiting. Assessing the individual for adequate hydration includes observing for good skin turgor, monitoring intake and urine output and monitoring individual’s weight.
A dietitian consult may be needed to support the patient’s nutritional needs if needs are not met. Sexuality/lifestyle is priority and must be assessed to evaluate understanding of reinfection and transmission to others. Protection must be used during sexual contact, no sharing of needles and personal items. Skin assessment includes assessing for ascites and measuring abdominal girth, observing for signs of bleeding (hematuria, melena, ecchymosis), excoriation, pruritus and skin breakdown as there is an increase chance for bleeding. Advising the individual to apply calamine lotion may prevent dryness and scratching. Prothrombin time may be prolonged due to liver dysfunction, which causes individuals to bleed easily. The importance of reducing the demand on the liver must be stressed, these restrictions include avoidance of alcohol, no heavy lifting or strenuous activity until the liver returns to normal size, side effects and dangers of taking over the counter or prescribed medications (Acetaminophen, Aspirin, Sulfonamides, Ibuprofen) that are toxic to the liver or metabolized by the liver should be avoided as they cause cumulative toxic effects.
Emphasizing the importance of physical examination, laboratory tests, which include liver function panel, Prothrombin levels and albumin, are critical to monitor disease progression. In addition to these nursing priorities, the health professional must also assess effect of illness on economic factor of the individual because of their loss of role function in the family. Utilizing community resources to assist the individual with activities of daily living include Meal on Wheels and housekeeping services. Hepatitis Foundation International is a national organization that addresses hepatitis B.
The organization educates individuals to make healthy choices; it provides the latest and most reliable information for individuals to make well-informed decisions. They have a large resource of information to help those living with hepatitis. The organization offers many helpful resources, Webinars, online store, DVDs and research information. Information concerning medications, testing and treatment are also available to engage individuals to be responsible for their own health. With hepatitis B being a global health concern, there is a need to create awareness about transmission in the community. Active and passive immunization should be available for high-risk individuals; efforts are needed to achieve better immunity