Hepatitis Nursing Diagnosis and Nursing Care Plan

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Hepatitis Nursing Care Plans Diagnosis and Interventions

Hepatitis NCLEX Review and Nursing Care Plans

Hepatitis is the clinical term for inflammation of the liver. It is characterized by the swelling of the liver tissues, consequently damaging it and hindering normal biologic functions.

Hepatitis can arise from an acute (short-term) or chronic (long-term) injury arising from various factors such as infection, medication abuse, etc.

Types of Hepatitis

  1. Acute Hepatitis. This type follows three distinct phases and they are:
    • Prodromal phase – Involves non-specific flu like symptoms such as fatigue, nausea, vomiting, poor appetite, joint pain, fever, etc. In the later of this phase, it would include liver compromise symptoms such as dark colored urine and clay-colored feces.
    • Icteric phase – Characterized as marked yellowing of the skin and sclera due to the spill of bile outside the circulatory system. This phase starts 1-2 weeks after the prodromal phase, lasting for 4 weeks. Prodromal phase symptoms may subside at this point but are replaced by marked liver and spleen enlargement and right upper abdominal discomfort or pain.
    • Convalescence phase – Or recovery phase is characterized by improvement of symptoms but with marked and persistent elevations in liver enzymes and organ size.
  2. Chronic Hepatitis. The hepatitis that developed and persisted for 6 months or more. The clinical manifestations of acute hepatitis persist in this stage. As the condition worsens, the liver would take irreversible damage causing the development of cirrhosis, an extensive damage and scarring of the liver. Cirrhosis can lead to debilitating, even life-threatening conditions such as hepatic encephalopathy, hepatorenal syndrome, and liver cancer.
  3. Fulminant Hepatitis. It is a rare and life-threatening complication of acute hepatitis. It is triggered by either infection with Hepatitis B, D or E, drug-induced causes or auto-immune reactive conditions. This type also has associated coagulation issues and encephalopathy manifestations. Complications arising from fulminant hepatitis include cerebral edema, gastrointestinal bleeding, sepsis and kidney failure, to name a few.

Causes of Hepatitis

There are multiple ways for a patient to have hepatitis and they are listed below:

  1. Infectious Hepatitis. In this subtype, causative organisms could either be bacteria, viruses or parasites. However, the most common is those arising from different virus types namely Hepatitis A, B, C, D, and E. Infection from hepatitis A and E usually spread from person to person through contaminated food and water from an infected patient’s feces. Eating undercooked pork and shellfish may predispose the patient to hepatitis E infection. Hepatitis B, C and D can be transmitted via contact with an infected person’s blood (e.g., blood transfusion, needle prick injury). Hepatitis B and D, in addition, can be contacted through sharing of bodily fluids, such as during unprotected sex and sharing of drug needles for abuse.
  2. Metabolic Hepatitis. This has three major sub-types and they are:
  • Alcohol hepatitis – As the name suggests, it is a type hepatitis arising from chronic and severe alcoholism that results in extensive liver damage.
  • Toxic hepatitis – Toxic hepatitis arises from other harmful substances that can have extensive liver damage and may come from medication abuse, chemicals, supplements and certain poisons.
  • Non-alcoholic hepatitis – A subtype of hepatitis wherein patients have little to no history of alcohol abuse but is due to metabolism compromise such as obesity, diabetes, metabolic syndrome, etc. that is causing the injury to the liver.
  1. Autoimmune hepatitis – A chronic form of liver injury wherein the body’s immune system is triggered and attacks the liver cells, thereby causing damage and injury. The cause is unknown, but it is genetic and environmental links are suggested to its cause.
  2. Ischemic hepatitis – Also known as liver shock wherein there is reduced blood flow to the liver, thereby causing compromise in function and elevated liver enzymes. Causes can be due to shock, heart failure, sepsis, etc. and is reversible once the underlying cause is addressed.

Risk Factors of Hepatitis

Risk factors of hepatitis are as follows:

  1. Environmental risks
    • Unsafe water for drinking and food use
    • Lack of sanitation services
    • Contact with used needles, syringes
  2. Behavioral risk factors
    • Sharing of objects, particularly needles, that might harbor the hepatitis virus
    • Engaging in unsafe sexual practices
    • Exposure and working with harmful chemicals
    • Taking in untreated water or food (not washed)
    • Alcohol abuse
    • Medication usage known to cause liver compromise
  3. Health risk factors
    • Not being vaccinated against preventable hepatitis (e.g., Hepatitis B)
    • Acute or chronic infection with multiple hepatitis viruses
    • Autoimmune disorders (e.g., Autoimmune polyendocrinopathy candidiasis ectodermal dystrophy – APECE)
    • A child being born from an infected mother with hepatitis B.

Signs and Symptoms of Hepatitis

There are various causes of hepatitis but each share common clinical manifestations which are listed below:

  • Fever
  • Fatigue
  • Loss of appetite
  • Nausea and/or vomiting
  • Abdominal pain
  • Dark colored urine
  • Clay-colored stools
  • Joint pain
  • Jaundice – obvious yellowing of the sclera and skin

Hepatitis Nursing Diagnosis

Hepatitis Nursing Care Plan 1

Imbalanced Nutrition: Less than Body Requirements

Nursing Diagnosis: Imbalanced Nutrition: Less than Body Requirements related to compromised absorption and metabolism secondary to hepatitis as evidenced by lack of diet interest, abdominal pain with associated weight loss.

Desired Outcome: The patient will be able to initiate lifestyle changes to regain lost weight and maintenance of laboratory values within normal values.

Hepatitis Nursing InterventionsRationale
Monitor calorie intake and record in a food diary. Suggest to the patient of eating the biggest meal at the beginning of the day.Intake of large meals is difficult for the anorexic patient with hepatitis. For the anorexic, eating becomes more difficult as the day progresses. Enlisting the aid of a food diary ensures that eating patterns and quality and amount of food taken is measured accurately to guide treatment management.
Encourage intake of fluid calories such as fruit juices, hard candy, carbonated beverages, etc.  These type of drinks may be easily tolerated by anorexic patients with hepatitis. They are also ideal in increasing caloric intake otherwise difficult to achieve in other forms of food.
Consult and coordinate with a dietitian and support team in providing the patient adequate diet, including protein and fat as tolerated by the patient. Coordination with a dietitian ensures for better formulation of dietary program for the patient. Inclusion of fat and protein in the diet of the patient will vary on how well it is tolerated. Due to the fat metabolism dependent on the bile production, attaining a balance is warranted in the diet plan. Signs of diarrhea would mean fat intolerance, hence will be restricted. Additions of protein rich food would help in liver regeneration if the patient is able to tolerate. In cases of fulminant hepatitis, protein restriction is warranted due to the risk of developing hepatic encephalopathy brought about by accumulation of ketones from protein metabolism.
Ensure monitoring of serum glucose as warranted.The hepatic patient is prone to hyperglycemia or hypoglycemia episodes. Monitoring blood sugar levels directs therapeutic management for the patient.
Prepare to administer medications as indicated: Antiemetics     Antacids    Helps in addressing food intolerance, particularly when given 30 minutes before meals. This helps control gastric acidity thereby reducing gastric irritation that may lead to bleeding.

Hepatitis Nursing Care Plan 2

Risk for Deficient Fluid Volume

Nursing Diagnosis: Risk for Deficient Fluid Volume related to excessive losses through vomiting and diarrhea secondary to hepatitis.

Desired Outcome: The patient will be able to maintain adequate hydration appropriate to personal health goals as evidenced by normal, stable vital signs, good capillary refill and appropriate urine output. 

Hepatitis Nursing Interventions Rationale
Ensure accurate Intake and output monitoring, including losses via vomiting or diarrhea. Include daily weights if appropriate.Accurate fluid monitoring ensures for directed and guided therapeutic management for the patient. Diarrhea could be a response of the body to the viral load brought by hepatitis but could also mean a more serious implication such as vascular congestion due to obstructed hepatic blood flow or antibiotics used to decrease ammonia levels due to hepatic encephalopathy.
Monitor vital signs regularly, including assessment of skin turgor, capillary refill, and mucus membranes.Monitoring this ensures timely assessment for changes in the overall health of the patient, particularly of the perfusion of tissues and circulation.
Take note of the patient’s laboratory values particularly Hemoglobin, hematocrit, serum sodium, albumin, and clotting times.These laboratory values help in determining hydration status, sodium retention and protein deficiencies that may lead to edema. Clotting times may indicate bleeding risks of the patient and issues with coagulation.    
Anticipate administration of antidiarrheal agents.This reduces fluid and electrolyte losses in the gastrointestinal tract due to diarrhea.
Prepare to administer and maintain IV fluid hydration incorporated with glucose, protein hydrolysates and electrolytes.This provides fluid and electrolyte replacement, especially during the acute phases thus preventing complications from the disease.

Hepatitis Nursing Care Plan 3

Fatigue

Nursing Diagnosis: Fatigue related to episodes of discomfort secondary to hepatitis as evidenced by observed reports of lack in energy levels and intolerance in doing activities of daily living.

Desired Outcome: The patient will be able to report improved energy levels and renewed desire to increase activities of daily living.

Hepatitis Nursing Interventions Rationale
Ensure adequate rest periods especially during episodes of toxic states. Limit visitors and provide a calm environment conducive for resting.Rest and relaxation is necessary for the patient’s healing. Upright position and activity can decrease hepatic blood flow and therefore prevents proper blood flow to the liver.
Recommend frequent position changes as tolerated by the patient. Ensure that good skin care is rendered to the patient.  Frequent position changes help in improving respirations and in alleviating pressure points of the body that may lead to pressure injuries and tissue breakdown.
Coordinate with the patient on clustering related activities and utilizing energy conserving techniques such as sitting while brushing teeth, etc.Utilizing such techniques minimizes patient’s fatigue, thereby preserving energy reserves to do more things that the patient desires.    
Help the patient utilize stress management techniques such as: guided imagery, diversional activities (e.g., watching TV)This promotes relaxation to the patient and thereby conserves energy reserves. This in turn redirects the patient’s attention that will enhance coping to the disease.
Anticipate to administer medications such as sedatives, anti-anxiety drugs, etc.Especially during toxic states, this is helpful in addressing restlessness and discomfort as a direct effect of the disease process.

Hepatitis Nursing Care Plan 4

 Risk for Impaired Skin Integrity

Nursing Diagnosis: Risk for impaired skin integrity related to bile salt accumulation in the tissues secondary to hepatitis.

Desired Outcome: The patient will be able to maintain his skin free from excoriation with reduced reports of pruritus.

Hepatitis Nursing Interventions Rationale
Utilize cold showers and baking soda baths. Apply calamine lotion as tolerated.This type of baths preserves skin moisture and prevents excessive skin dryness. Also, it may provide relief from itching.
Advise the patient about diversional activities such as board games or watching TV.  This aids in refocusing the patient’s attention, therefore reducing the urge to scratch.
Advise the patient on the use of knuckles when scratching. Ensure that the patient’s nails are cut short. Utilize loose fitting clothing for the patient.Utilizing these techniques reduces the risk of skin breakdown and damage to the tissues.  
Provide massage therapy to the patient before sleeping and as tolerated.This promotes patient relaxation, thereby inducing sleep and reducing the patient’s urge to scratch.
Watch out for occurrence of any redness, skin breakdown.Early detection is beneficial for hepatic patients with skin problems so as to prevent complications and ensure patient healing.
Make sure to avoid commenting on the patient’s appearance.This helps in minimizing emotional stress that could be attributed to skin changes.
Anticipate administration of:  antihistamines antilipemics  Directly addresses itching episodes. This is helpful by binding with the bile acids in the intestine, thereby inhibiting absorption. May have side effects of nausea and constipation.

Hepatitis Nursing Care Plan 5

Deficient Knowledge

Nursing Diagnosis: Deficient knowledge related to misinterpretation of information secondary to unfamiliar diagnosis of hepatitis as evidenced by statements of misconceptions and development of preventable complications.

Desired Outcome: The patient will be able to verbalize correct understanding of the disease process and effectively participate in the prescribed therapeutic regimen.

Hepatitis Nursing Interventions Rationale
Assess the patient’s level of knowledge and understanding of the disease process, including prognosis, and treatment options.Discussing with the patient accurate knowledge and information regarding the disease can correct misconceptions the patient may have. Also, its aids the patient in making informed decisions regarding their care (e.g., liver transplant for end stage liver disease.)
Encourage the patient to take a continuously balanced diet.    This promotes healing and tissue regeneration, thereby increasing the patient’s general well-being.
Coordinate with the patient on maintaining optimum bowel function through: proper hydration, roughage in the diet, moderate levels of activity as tolerated.Constipation could be an associated complication if the patient lacks fluid intake, low to no dietary roughage and decreased activity levels.    
Educate the patient of the side effects and adverse effects of medications, especially some over the counter drugs, in relation to liver damage.Because the majority of medications are metabolized in the liver, careful use of drugs is warranted. Some medications are hepatotoxic and may bring cumulative and irreversible liver damage.
Emphasize to the patient the need for continuous follow-up with their doctors, including compliance with laboratory testing.Hepatitis may take several months to resolve. Persistence of symptoms of more than 6 months may indicate chronic hepatitis that would warrant liver biopsy for confirmation.

Nursing References

Ackley, B. J., Ladwig, G. B., Makic, M. B., Martinez-Kratz, M. R., & Zanotti, M. (2020). Nursing diagnoses handbook: An evidence-based guide to planning care. St. Louis, MO: Elsevier.  Buy on Amazon

Gulanick, M., & Myers, J. L. (2022). Nursing care plans: Diagnoses, interventions, & outcomes. St. Louis, MO: Elsevier. Buy on Amazon

Ignatavicius, D. D., Workman, M. L., Rebar, C. R., & Heimgartner, N. M. (2020). Medical-surgical nursing: Concepts for interprofessional collaborative care. St. Louis, MO: Elsevier.  Buy on Amazon

Silvestri, L. A. (2020). Saunders comprehensive review for the NCLEX-RN examination. St. Louis, MO: Elsevier.  Buy on Amazon

Disclaimer:

Please follow your facilities guidelines, policies, and procedures.

The medical information on this site is provided as an information resource only and is not to be used or relied on for any diagnostic or treatment purposes.

This information is intended to be nursing education and should not be used as a substitute for professional diagnosis and treatment.

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