Hepatitis is an infection that attacks the liver (Denniston et al., 2013). The liver carries a lot of significant activities in the body. The liver fights the infections as well as filters the blood impurities. When the liver is damaged, the liver cannot function accordingly. Excessive consumption of alcohol can cause hepatitis. Some people were born with special conditions that can also cause hepatitis. There is a virus that attacks the liver, causing hepatitis. In the United States, there are four types of hepatitis. Examples of hepatitis include the Hepatitis C virus causes hepatitis A, Hepatitis B, and final Hepatitis C. After several months after infection, one develops the Acute Hepatitis C. Those can fight the illness without taking any medication. Twenty-five percent of those infected can create antibodies that will challenge the virus in the first six months after being infected (Razavi et al., 2014).
Prevalence and Incidence of Disease
In the United States, a total of 2,968 Hepatitis C cases were reported in 2016. These statistics were provided by the Center for Disease Control (CDC). Some people were not counted because their body could fight the disease before the symptoms could be seen. Such people do not report because they do not know if they have infected themselves. Research conducted by the CDC indicates that more than 41,000 people live with acute Hepatitis C. in the United States, it is estimated that more than 2.4 million people are suffering from Hepatitis C (Denniston et al., 2013). The chances are that 80% of those infected by Hepatitis C will develop Chronic hepatitis C. 25% of those affected by the infection, can clear it without any form of treatment hence cannot acquire any chronic disease.
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Population Health
Currently, there are those who migrate to the United States. The flow of people from the south and the north bring the infection to America. There are countries where there is no proper treatment for Hepatitis C. The immigrants infect the other Americans with the virus. The research indicated that most of the third world countries do not have the cure for hepatitis C. Hepatitis C is unevenly spread across the states in the United States. Tennessee has recorded the highest number of infection in the United States. The highest number was recorded in 2014 when 17,300,000 people were infected. There are other states such as Alaska and Arizona that there are no cases of Hepatitis C infections (Wiersma et al., 2013).
Culture of the Population
The Hepatitis C infects the elderly at a higher rate than the young. 38% of those who are infected are more than fifty-five years old. The virus can also infect children at a younger age. Out of 600 elderly people infected by Hepatitis C, 1 child of 5 years is also infected. Those who are affected by the Hepatitis virus are living mostly in areas which are now hygienic. Most of these people are immigrants who keep on traveling to different other areas. There are those who are considered to be a drug addict. Too much alcohol consumption can lead to acute Hepatitis C.
Disease/Illness in relation to global health/Healthy People 2020
Hepatitis C has been on the watch by the Global Healthy People 2020. Through the United States Preventive Services Task Force (USPSTF), they have recommended that all adults be screened for Hepatitis C (Metsch et al., 2014). Adults can easily be affected by the virus. The screening will help identify the infected and start their medication. Adults who were born between 1945 to 1965 were all screened for Hepatitis C.
Pathophysiology of the Disease
Hepatitis C is a virus which has infected over 169 million people across the world. The virus becomes chronic at the rate of 50 to 80%. It then causes liver cirrhosis or hepatocellular carcinoma. After the infection has reached the chronic stage, the receptor is implicated. You start feeling weak when CD4+ and CD8+ cells are infected. The T cell fails to control the viral replication of Hepatitis B. After this stage, liver lesions are produced due to the locally driven response from the immune system. Liver cirrhosis is then caused by external factors like too much alcohol consumption (Talbert et al., 2014).
Disease Characteristics
Hepatitis C was discovered in late 1960. The virus was discovered when there was a lot of acute hepatitis. The case could not be related to Hepatitis A, or Hepatitis B. The virus was finally named in 1989 when its genome was cloned (Herrmann et al., 2013). Hepatitis C virus is loosely related to Flaviviruses. The Flaviviridae family has genetic modification similar to that of the Hepatitis C virus. The diversity of HCV is very great and qualifies' it to be grouped alone. The Hepatitis gene is a positive RNA which has more than 9400 nucleotides. HPV genome goes through the posttranslational process. Region (5'UTR) helps the RNA of Hepatitis C to replicate at a higher rate. The heterogeneity of Hepatitis C cannot proofread with the RNA enzymes. Hence they cannot correct copy during the replication process.
T wo Most Common Differentials Diagnoses and Give Rationale for Ruling Out
One differential diagnosis is associated with hepatitis C by an inflamed liver, which is mostly brought about by drug injection use. It is uncommon for transmission of the Hepatitis C virus through sexual means, but it is only increased by the number of sexual partners or other infections like HIV. It has a 70% chance of progressing from acute to chronic. Most forms of viral hepatitis display similar symptoms like general fatigue, nausea, and abdominal pain. This diagnosis can be ruled out under the following rationale: when the test result is non-reactive or negative. The other for hepatitis B also characterized by inflammation of the liver and mostly transmitted sexually and can progress to fulminant hepatitis in about 2% of the times. Hepatitis B patients are always on vaccination, and that can rule out their possibility of infections by the Hepatitis B virus. An Advanced Practice Nurse should understand the conditions of their patients, during and after diagnosis. They should know the exact procedure of developing the differential diagnoses. These nurses have the freedom of developing the treatment procedures to their patients, unlike other nurses, and should take advantage of that freedom and even end up providing the best treatment.
Incorporate Two Evidence-Based Guideline(S) Applicable to Presenting Topic
Testing/Labs, Radiological Procedures, or Procedures Indicated
Any person who feels suspicious about having some infections should always seek medical examination and attention. This is followed by an attempt at testing to get the exact infection contracted by a patient. In the case of Hepatitis C, initial FDA-approved testing for HCV antibody is carried out. An outcome can be reported as either reactive on nonreactive when the OraQuick HCV rapid antibody test was used. In the case that a laboratory test is used, the outcome is given as reactive or nonreactive without specifying signal-to-cutoff ratios. The next stage is HCV RNA testing. If the blood sample is positive for HCV antibody, it is submitted for HCV NAT; two specimens are taken in two different test tubes one for initial HCV antibody and the other for HCV NAT. If the testing is intended for establishing a distinction between true positivity and false positivity for HCV antibody, there is supplemental testing done.
Pharmacological treatment options
A patient confirmed to be HCV-positive should be further evaluated if the condition is chronic as the first stage for treatment. Their liver should be assessed for proper functioning through several liver tests whenever necessary. For the case of acute hepatitis HCV infection, the patients should be monitored and only treated if the HCV RNA persists for a period not less than six months. The treatment option for chronic hepatitis C involved the use of protease inhibitor therapies as from 2011 when they were introduced. The treatment has greatly improved since then. Therapies used today can achieve a sustained virologic response within the first twelve weeks of patients who have completed treatment regardless of the genotype of hepatitis.
Alternative treatment options
There has been great development of the viral infection alternative treatment options. One of the other considerations in treating hepatitis C is a proper diet. A good diet helps the liver work effectively and reduces the chances of developing cirrhosis or scarring that can result in liver failure. Good food also helps in developing a stronger body immune system that can fight infections. The proper diet can include fruits, grains, and vegetables together with lean meat such as chicken and fish. One can also consider getting massages from a qualified massage therapist. Massage can help relieve stress, and general tiredness that can lead into some health complications which may in turn result into hepatitis C. Meditation has been proposed as an alternative procedure that can help patients concentrate and relax their bodies.
Consultations/Referrals if Indicated
There are trained doctors that have studied hepatitis related courses and can deliver proper treatment whenever possible. One can always find these doctors in the hospitals that offer the hepatitis C infection treatment. You can also ask the doctor about the best-trained massage therapists or find one at the American Massage Therapy Association. A patient can meditate either while walking, taking the morning routine jog or even while sitting in a park or some pleasant place without distractions like noise or loud music. You can also meditate while lying down, maybe before sleeping. Proper diet should entail a high consumption of foods with zinc but not exceeding forty milligrams per day. A Japanese study has proven that zinc greatly eases the symptoms of hepatitis C.
Follow Up Plan
For a proper follow-up plan to achieving the best treatment, a hepatitis C patient needs to relax and promptly follow the guidelines provided by their therapists. They should follow a proper dosage routine and always consult the doctors when they missed a dose. They should ensure they regularly visit the massage therapist who they should provide is giving the right treatment as instructed by the doctor. A patient must follow the correct meditation procedures and always avoid distractions when on the practice. They can also prepare workout timetables to help them stay strict to their routine treatment practices. The diet should be well provided and supplements added where necessary to ensure they get the best quantity of the required minerals. In case a patient feels some complications after or during treatment, they should visit the doctor as soon as possible.
Challenges or Barriers Regarding Treatment of Disease
There has been a lot of challenges regarding the treatment of hepatitis C, starting from patient factors like the unawareness by most patients with chronic HCV infections where 65% to 75 % of them are naïve and do not know they are infected. Most patients do fail to seek treatment once the infection diagnoses them. Economic and social pressures present a threat to the treatment of the disease as those infected are less likely to be insured compared to the uninfected population. The National Health and Nutrition Survey have shown that in the United States, 29.6% of HCV-infected patients are uninsured (Talal, et al., 2013) . Some patients say that factors like social rejection force them to deviate from their treatment. Injection drug use, which is the most common mode of HCV contraction, is still prevalent in a more significant section of drug users in the United States with most of them being regular sufferers of psychiatric illnesses.
Current Health Care Policy/National Focus Relevant to the Disease
Hepatitis C virus infects a lot of people and has attracted a lot of attention, including the national level in the United States of America. In 2017, there was a report named Eliminating the Public Health Problem of Hepatitis B and C in the United States, released by the National Academics of Sciences, Engineering, and Medicine. The report was sponsored by other major national institutions like CDC's Division of Viral Hepatitis and Division of Cancer Prevention and Control, HH Office of Minority Health, the American Association for the Study of Liver Diseases, National Viral Hepatitis Roundtable and the Infectious Disease Society of America. Its major focus was on five areas of public health information, essential interventions, service delivery, financing elimination, and research (Mermin, et al., 2015) . This was a report on its second phase, and its bigger goals include reducing the incidences of hepatitis C by 90% and its associated mortality rate by 65% compared to 2015.
Patient education
Patients infected with HCV should abstain from alcohol and any form of drug use since they do accelerate the chances and start of liver cirrhosis. They should be informed about the possibilities of transmission of the virus to sex patients and use protection during sexual intercourse. They should avoid sharing personal items that can easily be stained with blood, like razor blades or toothbrushes (Dore, et al., 2013) . These patients should also avoid involvement in organ donation unless they are recipients and are well informed about the transplant. Patients with hepatitis C virus should consult with qualified medical professionals before they start other forms of treatments like taking a new set of pills or supplements that may seem to trigger unintended complications.
References
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