Te Whakahaere Whānau i ngā Take Hepatitis B
Pendahuluan
He mate huaketo te Hepatitis B e pā ana ki te ate, ā, ka taea te whakaputa i ngā mate kino me ngā mate mau tonu. I roto i te mahi whānau tamariki, he nui te pānga o te Hepatitis B nā te mea ka taea te tuku mai i te whaea ki te pēpi (te tuku poutū), inā koa i te wā e whānau ana. He mea nui tēnei tukunga nā te mea he nui te mōrearea o ngā pēpi pangia ki te whakawhanake i te Hepatitis B mau tonu, ka taea ai te horapa ki te cirrhosis, ki te mate pukupuku ate rānei i muri mai i te oranga. Nō reira, me whānui te whakahaere whānau tamariki i ngā mate Hepatitis B, mai i te tiaki i mua i te whānautanga, i roto i te whānautanga, me te tiaki i muri i te whānautanga, me te mahi tahi me ngā mahi hei ārai i te tukunga ki te pēpi me te whānau.
Ngā Ariā Taketake o te Hepatitis B i te Wā e Hapū ana
Ko te huaketo hepatitis B (HBV) te take o te mate Hepatitis B, ā, ka kitea mā roto i ngā whakamātautau serological, inā koa ko te HBsAg. Ka taea e ngā wāhine hapu he HBsAg pai te noho i roto i te wāhanga mate pāwera, mate mau tonu rānei. Ka piki ake te mōrearea o te tuku mai i te whaea ki te tamaiti mēnā he nui ngā taumata huaketo o te whaea (he nui te DNA HBV) me/ranei he HBeAg pai. Ko te nuinga o te tuku ka puta i te wā whānautanga nā te pā o te pēpi ki te toto me ngā wai o te whaea. He iti ake te noa o te tuku i te wā haputanga engari ka taea tonu, inā koa mēnā he toto, he tikanga whakaeke, he raruraru rānei.
I roto i ngā whaea, he maha ngā wā kāore he tohu o te mate hepatitis B, ā, he mea nui te tirotiro i mua i te whānautanga. Ina puta ngā tohu, ka uru atu pea te ngoikore, te whakapairuaki, te mamae o te puku matau o runga, te jaundice, te mimi pouri, me te nui haere o ngā whākōkī ate. Ko te tikanga, kāore te hapūtanga e kino ake te mate hepatitis B i ngā wā katoa, engari ka pāngia pea ētahi wāhine e te mate urutā (te hokinga mai o te kaha o te huaketo), inā koa i te wā i muri i te whānautanga.
Ngā Whāinga o te Whakahaere Whakawhanau
Ko te whāinga o te whakahaere whānautanga mō te mate hepatitis B ko:
1. Kia mau tonu te hauora o ngā wāhine hāpu, ā, kia ārai i ngā raruraru o te mate ate.
2. Ārai i te tuku poutū o te HBV mai i te whaea ki te pēpi.
3. Whakaritea mō te whānautanga haumaru, me te whakaiti i te pānga ki te toto/wai tinana.
4. Kia tika te wā e whiwhi ai te pēpi i te ārai mate (te werohanga me te immunoglobulin mēnā e wātea ana).
5. Whakarato mātauranga me te tohutohu ki ngā whaea me ngā whānau e pā ana ki te tuku, te tiaki, me te whai i te mate.
Te Whakahaere i te Wā Whakawhanau i mua i te Whānau (Haputanga)
1. Te Tirotiro me te Kitenga Moata
Ko te tumanako, me uru te tirotiro HBsAg ki te tiaki i mua i te whānautanga mō ngā wāhine hapu katoa. Mēnā he pai te hua o te HBsAg, ko te mahi e whai ake nei ko te aromatawai i te mōrearea o te tuku me te mahi a te ate. Ko ngā whakamātautau whai muri e taunakitia ana ko te HBeAg, te anti-HBe, ngā taumata DNA HBV (mēnā e wātea ana), me ngā whakamātautau mahi ate (ALT/AST, bilirubin). He mahi tā ngā kaiwhakawhanau ki te whakarite kia mārama te whaea ki te tikanga o ngā hua o te whakamātautau me te hiranga o te whai muri.
2. Te Anamnesis me te Whakamātautau Tinana
Ka arotakehia e te kaiwhakawhanau he āhuatanga hōhonu: he hītori mate ate, he hītori whakawhiti toto, he whakamahinga ngira, he hītori moepuku, he hītori whānau mō te mate hepatitis, me ngā amuamu pēnei i te whakapairuaki nui, te jaundice, te pruritus rānei. Ka arotakehia e te whakamātautau tinana ngā tohu o te anemia, te jaundice, te hepatomegaly (ahakoa he iti noa iho i roto i ngā mahi whānau), te pupuhi, me ētahi atu tohu o ngā raruraru. Ko te aroturuki i te toto toto, te āhua kai, me te āhua hāputanga he mea nui tonu.
3. Te Mahi Ngātahi me ngā Tohutohu
Me mahi tahi ngā kaiwhakawhanau me ngā tākuta (te rongoā whānau me/ranei te rongoā ā-roto/te rongoā ate), inā koa mēnā:
– He tino tiketike te ALT/AST, te jaundice, te whakapae rānei he mate hepatitis whakapeka.
– He nui te HBV DNA, he pai rānei te HBeAg e hiahia ana kia aromatawaihia te rongoā ārai huaketo.
– He tohu kei te puta he mate toto toto tiketike, he raruraru rānei ki te ate.
E kī ana ētahi aratohu me whakaaro pea ki te rongoā ārai huaketo (hei tauira, tenofovir) i te toru o ngā marama o te hapūtanga hei whakaiti i te kawenga huaketo i roto i ngā whaea he nui ngā taumata DNA HBV, ā, ka whakaiti i te tūponotanga o te horapa ki te pēpi. Kei te tākuta tēnei whakatau, engari he wāhi nui tā ngā kaiwhakawhanau ki te tautoko i te piripono me te aroturuki i ngā pānga taha.
4. Mātauranga me te Tohutohu i mua i te whānautanga
Ko te mātauranga te kaupapa matua o te mahi atawhai tamariki. Ko ngā āhuatanga nui hei aro atu ko:
– Ka taea te horapa te Hepatitis B mā te toto me te moepuku; he mea nui kia whakamahia he ure tāwharau mēnā kāore tō hoa i te ārai mate.
– Me whakamātauria ngā mema o te whānau me ngā hoa rangatira mō te HBsAg, ā, me whiwhi hoki i te werohanga hepatitis B mēnā kāore anō kia whai ārai mate rātou.
– Kaua e whakawhitiwhiti i ngā taonga whaiaro ka pāngia pea e te toto (ngā paraihe niho, ngā heu).
– Me karo ngā whaea i te waipiro me ngā raau taero ka kino pea te ate, me te kore kōrero ki a rātou anō.
– Me whakanui tonu ka taea tonu te whānautanga i runga i te āhua noa, ā, ko te mea nui ko te ārai i te pēpi i muri tonu i te whānautanga.
Te Whakahaere i te Wā Whakawhanau i te Wā Whānau (Whānau)
1. Te Whakamahere Whānau
Ko te momo whānautanga (te pokanga tara, te pokanga tākihi rānei) ka whakatauhia i runga i ngā tohu o te whānautanga. Kāore i te tūtohutia te pokanga tākihi mō te mate hepatitis B anake, nā te mea ko te ārai mate pēpi tonu te ārai mate matua. Heoi anō, me whai whakaaro te whiriwhiri i te tikanga ki ngā āhuatanga o te whaea me te tamaiti, tae atu ki ngā kaupapa here haumanu ā-rohe. Ka whakarite ngā kaiwhakawhanau kia whakaritea he mahere whānau me te whakawhitiwhiti kōrero pai i waenga i te tīma.
2. Te Ārai i te Whakatūnga me ngā Mahi Haumaru
Hei whakaiti i te mōrearea o te toto toto:
– Whakamahia ngā mahi ārai paerewa (ngā karapu, te tiaki, me te whakahaere haumaru i ngā mea koi).
– Whakaitihia ngā tikanga whakaeke kore e hiahiatia ana, pērā i te tango i te pēpi i te wā tōmua, te whakamahi i ngā hikohiko o te tumuaki o te kōpū, te tango toto rānei i te kōpū, nā te mea ka piki ake pea te mōrearea o te horapa.
– Whakahaerehia te toto kia tere, kia tika hoki.
– Me whakarite kia whakamahia ngā tikanga ārai mate, ā, kia rite hoki te whakakorenga para hauora ki ngā paerewa.
3. Te Tuhituhi me te Whakawhitiwhiti Kōrero
Me mārama te tuhi i te tūnga o te mate hepatitis B o te whaea, ā, me whakamōhio atu ki te tīma e tiaki ana i te pēpi, kia taea ai te hoatu wawe tonu i te ārai mate i muri i te whānautanga.
Te Whakahaere Whakawhanau i te Wā i Muri i te Whānautanga (Puerperium)
1. Te Manaaki i te Whaea
Mō ngā wāhine whai muri i te whānautanga me te mate hepatitis B, ka aroturukihia e ngā kaiwhakawhanau ngā tohu ora, te nekehanga o te kōpū, te toto, me ngā tohu o te ngoikore o te ate, te mumura rānei o te ate i muri i te whānautanga (hei tauira, te ngenge nui, te jaundice, te mamae o te uma matau o runga). Ko te aromatawai taiwhanga me te aroturukitanga i te nuinga o te wā ka mahia tahi me te tākuta. Me tautoko te piri ki te rongoā mēnā kei te whiwhi te whaea i te rongoā patu huaketo, tae atu ki te mātauranga mō ngā tirotiro kua whakaritea.
2. Te whāngai ū
Ko te whāngai ū i te nuinga o te wā e whakaaetia ana mō ngā whaea e pangia ana e te mate hepatitis B, inā koa mēnā kua whiwhi te pēpi i te werohanga ārai mate hepatitis B i muri tata mai i te whānautanga (me te HBIG, mēnā e wātea ana). He tino iti te mōrearea o te horapa mā te waiū ū ki te whakataurite ki ngā painga o te whāngai ū. Heoi, mēnā he mate toto kei roto i te uma, ka tūtohu pea te kaiwhakawhanau kia tiakina te patunga, ā, whakaarohia te whāngai ū mō te wā poto i te taha e pāngia ana kia ora rā anō te pēpi, e ai ki te taunakitanga a ngā kaimahi hauora.
3. Hauora Hinengaro me te Tautoko Hapori
Ka taea e te tātaritanga o te mate hepatitis B te whakaoho i te manukanuka, te whakama, me te wehi i roto i ngā whaea. Me tautoko ngā kaiwhakawhanau i te hinengaro, me whakatika ngā whakaaro hē, me te whakatenatena i ngā whaea kia haere tonu te maimoatanga me te karo i te whakaaro he he tā rātou. Ka taea e te tohutohu whānau te āwhina i te waihanga i tētahi taiao tautoko.
Te Whakahaere i ngā Pēpi Hou o ngā Whaea HBsAg-Pai
1. Ārai Mate Ārai Tonu
Ko te mahi tino nui hei ārai i te mate hepatitis B i roto i ngā pēpi ko te whakarato i:
– Te werohanga kano ārai mate hepatitis B (HB-0) i te whānautanga i te wā e taea ai, ko te tumanako i roto i ngā haora 12 tuatahi o te oranga.
– HBIG (Hepatitis B Immunoglobulin) mēnā e wātea ana, i roto anō i ngā haora 12 tuatahi, ka hoatu ki tētahi atu wāhi werohanga mai i te kano kano.
He tino whai hua tēnei huinga ki te whakaiti i te tūponotanga ka riro te pēpi hei kaikawe mate mau tonu. He mahi tā ngā kaiwhakawhanau ki te whakarite kia whiwhi te pēpi i tēnei maimoatanga i te wā tika, ki te pupuri i ngā tuhinga, me te whakaako i ngā mātua.
2. Te Rārangi Whakatūpato Whai muri
Me haere tonu ngā pēpi ki te werohanga hepatitis B i runga anō i te kaupapa ā-motu (hei tauira, i te 2, 3, me te 4 marama te pakeke, i ngā wā e tika ana rānei). Me whakarite e ngā kaiwhakawhanau kia mārama ngā whānau ki te hiranga o ngā werohanga katoa, nā te mea kāore e ranea te horopeta whānau anake mō te tiakitanga mō te wā roa.
3. Whakamātautau Whai muri i te Pēpi
E taunaki ana ētahi aratohu kia whakamātauria ngā pēpi o ngā whaea HBsAg-pai i muri i te whakaoti i te raupapa werohanga (hei tauira, i te 9–12 marama te pakeke) kia mōhio ai kua whakawhanakehia ngā paturopi tiaki (anti-HBs) me te whakarite kia kore te pēpi e pangia (HBsAg kino). Ka taea e ngā kaiwhakawhanau te whakamahara i ngā mātua mō tēnei tirotiro me te tuku i a rātou ki ngā whare tiaki tika.
Te Ārai i te Whakawhiti i roto i te Taiao Whānau me ngā Whare Hauora
Haunga te arotahi ki te whaea me te pēpi, kei roto hoki i te whakahaere a te kaiwhakawhanau te aukati i te horapa o te mate i roto i te taiao e karapoti ana. Me tirotirohia, me werohanga hoki ngā whānau e noho ana i te whare kotahi. I roto i ngā whare tiaki hauora, he mea nui te piri ki ngā mahi ārai paerewa, te whakahoromata i ngā taputapu, me te whakahaere tika i ngā ngira me ngā para hauora. Me pupuri hoki e ngā kaiwhakawhanau te muna o ngā kōrero a te tūroro hei whakaiti i te whakama.
Whakamutunga
Ko te whakahaere whānautanga o te mate hepatitis B me whai huarahi whakauru e uru ana ki te tirotiro i mua i te whānautanga, te aroturuki hauora o te whaea, te mahi tahi me ngā tākuta mō te aromatawai me te rongoā whai muri ina hiahiatia, te whakamahere whānau haumaru, me te aukati i te tuku poutū mā te ārai mate pēpi i muri tonu i te whānautanga. Mā te mātauranga tika, te tautoko hinengaro, me te piri ki te kaupapa werohanga me te aroturuki, ka taea te whakaiti i te mōrearea o te tuku mate hepatitis B mai i te whaea ki te tamaiti, me te pupuri tonu i te kounga o te oranga mō te whaea me tōna whānau.
Ki te hiahia koe, ka taea hoki e au te whakarerekē i tēnei tuhinga ki roto i te whakatakotoranga mātauranga (me ngā tohutoro me te rārangi pukapuka), ka taea rānei e au te waihanga i tētahi putanga e ahu mai ana i te "whakahaere kaiwhakawhanau 7-taahiraa a Varney" me te whakatakotoranga SOAP.
