What is Hepatitis?
Hepatitis is characterized by the widespread inflammation of the liver, leading to the degeneration and necrosis of liver cells. This inflammation can stem from various sources, including bacterial infections, physical injuries, toxic chemical agents like drugs, alcohol, and industrial chemicals, viral infections (such as hepatitis A, B, C, D, E, and G), or autoimmune responses. While many cases of hepatitis are self-limiting, it’s important to note that approximately 20% of acute hepatitis B and a significant 50% of hepatitis C cases can progress to chronic conditions or cirrhosis, potentially becoming fatal.
Nursing Care Plans and Management
Nursing care planning and management for patients with hepatitis are crucial for supporting liver function and overall patient well-being. Key aspects include reducing liver workload while promoting physical health, preventing complications associated with hepatitis, enhancing the patient’s self-concept and acceptance of their condition, and providing comprehensive education about the disease process, prognosis, and available treatments.
Nursing Problem Priorities
The primary nursing priorities for patients with hepatitis are:
- Symptom management and supportive care provision.
- Prevention of further liver damage and promotion of liver health.
- Continuous monitoring of liver function and assessment of disease progression.
- Administration of antiviral medications when indicated.
- Patient education on essential lifestyle adjustments to minimize liver stress.
- Prevention of hepatitis transmission to others.
- Management of complications and comorbidities linked to hepatitis.
Nursing Assessment
A thorough nursing assessment is crucial for developing an effective care plan. This involves gathering both subjective and objective data.
Assess for the following subjective and objective data:
Subjective Data:
- Patient reports of fatigue and malaise.
- Complaints of abdominal pain, particularly in the upper right quadrant.
- Nausea and vomiting.
- Loss of appetite or anorexia.
- History of exposure to hepatitis risk factors (e.g., blood transfusions, IV drug use, travel to endemic areas).
- Pruritus (itching).
- Changes in taste or smell.
Objective Data:
- Jaundice (yellowing of the skin and sclera).
- Dark urine and clay-colored stools.
- Elevated liver enzymes (AST, ALT, alkaline phosphatase, bilirubin).
- Hepatomegaly (enlarged liver) and liver tenderness upon palpation.
- Ascites (fluid accumulation in the abdomen) and edema in the extremities.
- Signs of bleeding (ecchymosis, petechiae, bleeding gums).
- Changes in mental status, confusion, or lethargy (signs of hepatic encephalopathy).
- Vital sign abnormalities (tachycardia, fever).
- Dehydration (dry mucous membranes, poor skin turgor).
Nursing Diagnosis
Based on a comprehensive assessment, a nursing diagnosis is formulated to address the specific challenges associated with hepatitis. This diagnosis reflects the nurse’s clinical judgment and understanding of the patient’s individual health status. While nursing diagnoses provide a structured framework for care, their direct application can vary in different clinical settings. The nurse’s expertise and clinical judgment are paramount in tailoring the care plan to meet each patient’s unique needs, prioritizing their health concerns and care objectives. Here are some potential nursing diagnoses relevant to hepatitis:
- Fatigue related to liver inflammation and impaired metabolic function, as evidenced by patient reports of exhaustion and inability to perform usual activities.
- Imbalanced Nutrition: Less than Body Requirements related to anorexia, nausea, and impaired nutrient absorption secondary to liver dysfunction, as evidenced by weight loss and aversion to food.
- Fluid Volume Deficit related to vomiting, diarrhea, and decreased oral intake secondary to hepatitis symptoms, as evidenced by dehydration and electrolyte imbalances.
- Risk for Impaired Skin Integrity related to jaundice and pruritus, as evidenced by scratching and potential skin breakdown.
- Risk for Bleeding related to decreased production of clotting factors by the liver, as evidenced by abnormal clotting studies and potential for hemorrhage.
- Ineffective Health Management related to lack of knowledge about hepatitis, its management, and prevention of transmission, as evidenced by questions about self-care and disease transmission.
- Disturbed Body Image related to jaundice and visible signs of illness, as evidenced by patient expressions of concern about appearance and self-esteem.
- Anxiety related to uncertainty about prognosis, disease severity, and potential complications, as evidenced by expressed concerns and restlessness.
Nursing Goals
The overarching goals and expected outcomes for patients with hepatitis include:
- The patient will maintain adequate hydration, demonstrated by stable vital signs, good skin turgor, capillary refill, strong peripheral pulses, and appropriate urinary output.
- The patient will report a noticeable improvement in their energy levels.
- The patient will be able to perform Activities of Daily Living (ADLs) and engage in desired activities to the best of their ability.
- The patient will verbalize a clear understanding of the hepatitis disease process, prognosis, and potential complications.
- The patient will identify the connection between their signs and symptoms and the causative factors of the disease.
- The patient will articulate an understanding of their therapeutic needs and treatment plan.
- The patient will actively initiate necessary lifestyle modifications and fully participate in their treatment regimen.
Nursing Interventions and Actions
Therapeutic interventions and nursing actions for patients with hepatitis are designed to address the nursing diagnoses and achieve the established goals.
1. Optimizing Nutritional Balance
Encourage meticulous mouth care before meals.
This action is crucial to enhance appetite by eliminating any unpleasant tastes in the mouth, which can be a significant barrier to eating for patients experiencing nausea or taste alterations due to hepatitis.
Recommend positioning the patient in an upright position for meals.
Eating in an upright or high Fowler’s position helps to reduce the sensation of abdominal fullness and pressure. This position can significantly enhance food intake by making the patient more comfortable during and after meals.
Promote the consumption of fruit juices, carbonated beverages, and hard candies throughout the day.
These options provide easily digestible extra calories, which are vital for patients with hepatitis who often struggle with appetite and nutrient absorption. These can be more palatable and easier to tolerate than heavier foods, helping to maintain energy levels and prevent weight loss.
Consult with a dietitian and the nutritional support team to tailor a diet to the patient’s specific needs, adjusting fat and protein intake as tolerated.
A dietitian’s expertise is invaluable in formulating a dietary plan that meets the individual nutritional requirements of a hepatitis patient. Fat metabolism can be compromised due to altered bile production, potentially necessitating fat restriction if diarrhea develops. Conversely, adequate protein intake, if tolerated, is essential for liver regeneration. However, in severe cases like fulminant hepatitis, protein restriction may be necessary to prevent hepatic encephalopathy due to the accumulation of protein metabolism byproducts.
Administer medications as prescribed, such as antiemetics before meals.
Antiemetics can be crucial in controlling nausea and vomiting, common symptoms of hepatitis that significantly reduce appetite and oral intake. Administering these medications before meals can help improve the patient’s comfort and willingness to eat.
Provide supplemental feedings and Total Parenteral Nutrition (TPN) if necessary.
In cases where patients are unable to meet their caloric needs through oral intake, supplemental feedings or TPN may become necessary. This is particularly important for patients with marked nutritional deficits or prolonged symptoms, ensuring they receive adequate nutrition to support recovery.
Alt Text: A nurse administers IV fluids to a hepatitis patient, highlighting fluid balance management in hepatitis care.
2. Promoting Adequate Fluid Balance
Closely monitor intake and output (I&O) and compare with periodic weight measurements. Pay attention to enteric losses such as vomiting and diarrhea.
Accurate I&O monitoring, along with weight tracking, provides essential data on fluid balance and the effectiveness of fluid replacement therapy. Diarrhea in hepatitis patients can arise from the body’s response to viral infection or indicate more serious issues like obstructed portal blood flow and vascular congestion in the GI tract. It can also be a therapeutic effect of medications like lactulose used to reduce serum ammonia levels in hepatic encephalopathy.
Regularly assess vital signs, peripheral pulses, capillary refill, skin turgor, and mucous membranes.
These assessments are critical indicators of the patient’s circulating blood volume and overall perfusion status. They help in detecting early signs of dehydration or fluid overload, guiding timely interventions to maintain fluid balance.
Assess for the presence of ascites or edema formation. Measure abdominal girth as indicated.
Monitoring for ascites and edema, including regular abdominal girth measurements, is important for tracking fluid shifts and retention. These signs are common in hepatitis due to impaired liver function and portal hypertension, and their monitoring helps in managing fluid balance and related complications.
Observe for any signs of bleeding, such as hematuria, melena, ecchymosis, oozing from gums, or puncture sites.
Hepatitis can impair the liver’s production of clotting factors, leading to a prolonged prothrombin time and increased risk of bleeding. Vigilant monitoring for bleeding signs is crucial for early detection and management of coagulation issues.
Monitor periodic laboratory values, including Hb/Hct, sodium, albumin, and clotting times.
Laboratory values provide objective data on hydration status, electrolyte balance, protein levels, and coagulation function. Abnormalities in these values, such as decreased albumin or prolonged clotting times, can indicate fluid retention, edema risk, and bleeding tendencies, guiding appropriate medical and nursing interventions.
Use small-gauge needles for injections and apply pressure for a longer duration than usual after venipuncture.
Due to the increased risk of bleeding in hepatitis patients, using small-gauge needles and applying prolonged pressure after venipuncture minimizes the risk of tissue bleeding and hematoma formation.
Advise the patient to use cotton or sponge swabs and mouthwash instead of a toothbrush, or use a soft-bristled toothbrush.
Gentle oral hygiene is essential to prevent trauma and bleeding of the gums, which can be more prone to bleeding due to impaired coagulation. Soft swabs or a very soft toothbrush minimizes the risk of injury.
Administer intravenous (IV) fluids, typically glucose solutions, and electrolytes as prescribed. Consider protein hydrolysates.
IV fluids are crucial for correcting dehydration and electrolyte imbalances, especially in acute phases of hepatitis. Glucose solutions provide necessary calories, and electrolyte replacement addresses imbalances. Protein hydrolysates may be considered to support nutritional needs, particularly in patients with significant protein deficits.
Administer medications as indicated:
- Diphenoxylate with atropine (Lomotil): This medication can help reduce fluid and electrolyte loss from the gastrointestinal tract by decreasing bowel motility and managing diarrhea.
- Fresh frozen plasma infusion: In cases of severe coagulation defects, fresh frozen plasma may be administered to replace clotting factors and reduce the risk of bleeding and hemorrhage.
3. Promoting Gradual Ambulation and Managing Fatigue
Monitor for recurrence of anorexia, liver tenderness, or enlargement.
These signs can indicate a relapse or exacerbation of hepatitis, signaling the need for increased rest and potential adjustments to the therapeutic regimen. Recognizing these signs early is crucial for preventing further complications and promoting recovery.
Monitor serial liver enzyme levels.
Liver enzyme levels are indicators of liver inflammation and damage. Monitoring these levels helps determine appropriate activity levels for the patient. Prematurely increasing activity can increase the risk of relapse, so enzyme levels guide activity progression.
Institute bed rest or chair rest during the acute toxic state. Ensure a quiet environment and limit visitors as needed.
Rest is paramount during the acute phase of hepatitis to reduce metabolic demands on the liver and promote healing. A quiet environment with limited visitors minimizes stimulation and conserves the patient’s energy, directing it towards recovery. It is believed that upright positions and activity can decrease hepatic blood flow, which is not optimal for liver cell regeneration.
Recommend frequent position changes. Provide and educate caregivers on meticulous skin care.
Frequent position changes are vital to prevent pressure ulcers, especially during prolonged bed rest. Good skin care, including pressure area management, is essential to maintain skin integrity and prevent breakdown.
Consolidate necessary tasks and perform them efficiently at one time as tolerated.
Organizing nursing care to minimize disturbances and allow for extended periods of uninterrupted rest is crucial for managing fatigue. Grouping activities allows the patient to conserve energy and rest more effectively.
Identify and prioritize role responsibilities, alternative care providers, and available community resources.
Hepatitis can significantly impact a patient’s ability to fulfill their usual roles. Identifying alternative care providers and community resources helps problem-solve and address the needs of both the patient and their family, ensuring support during recovery.
Educate on energy-conserving techniques: sitting to shower and brush teeth, planning activities with materials at hand, and scheduling rest periods.
Teaching energy conservation strategies empowers patients to manage fatigue and accomplish daily tasks without overexertion. These techniques help minimize energy expenditure and allow patients to maintain some level of independence and well-being.
Gradually increase activity as tolerated, and encourage passive or active range of motion (ROM) exercises.
Prolonged bed rest can lead to muscle weakness and deconditioning. Gradual activity increases, along with ROM exercises, help maintain muscle strength and prevent complications of immobility. Activity should be balanced with rest to avoid relapse.
Promote stress management techniques: progressive relaxation, visualization, and guided imagery. Discuss appropriate diversional activities like radio, TV, and reading.
Stress management techniques and diversional activities are beneficial for promoting relaxation, conserving energy, and improving coping. They help redirect attention away from discomfort and illness, enhancing mental well-being during recovery.
Administer medications as indicated, such as sedatives and antianxiety agents like diazepam (Valium) and lorazepam (Ativan).
Sedatives and antianxiety agents may be prescribed to aid rest and manage anxiety, especially during periods of discomfort or uncertainty. However, it is crucial to avoid hepatotoxic medications like barbiturates and certain antiemetics (prochlorperazine, chlorpromazine) that can further burden the liver.
Administer antidotes or assist with inpatient procedures (lavage, catharsis, hyperventilation) depending on the cause of toxic hepatitis.
In cases of toxic hepatitis, prompt removal of the causative agent is critical. Depending on the toxin and route of exposure, interventions like gastric lavage, catharsis, or hyperventilation may be necessary to limit liver damage.
4. Preventing Skin Breakdown and Maintaining Skin Integrity
Regularly observe the skin for areas of redness and breakdown.
Early detection of skin issues is essential for timely intervention. Hepatitis-related jaundice and pruritus can increase the risk of skin breakdown due to scratching. Regular skin assessments allow for proactive measures to prevent complications.
Encourage cool showers and baking soda or starch baths. Advise against using alkaline soaps. Apply calamine lotion as needed.
Cool showers and baths with baking soda or starch can soothe irritated skin and reduce itching. Alkaline soaps can exacerbate dryness and itching, so they should be avoided. Calamine lotion provides a topical barrier and further relief from pruritus.
Provide diversional activities to distract from itching.
Engaging in diversional activities helps refocus the patient’s attention away from the discomfort of itching, reducing the urge to scratch and minimizing potential skin damage.
Suggest using knuckles if scratching is uncontrollable. Keep fingernails short and consider gloves for comatose patients or during sleep. Recommend loose-fitting clothing and soft cotton linens.
These measures are aimed at minimizing skin injury from scratching. Using knuckles is less damaging than fingernails. Short nails and gloves reduce the risk of skin damage, especially in patients who are less aware or unable to control scratching. Loose, soft clothing and linens minimize skin irritation.
Provide a soothing massage at bedtime.
A gentle massage, particularly at bedtime, can help relieve skin irritation and promote relaxation, potentially improving sleep quality, which can be disturbed by pruritus.
Avoid making comments about the patient’s appearance.
Jaundice and other skin changes can be distressing for patients. Avoiding judgmental or negative comments about their appearance helps minimize psychological stress and supports their self-esteem during a vulnerable time.
Administer medications as indicated:
- Antihistamines (e.g., diphenhydramine [Benadryl], azatadine [Optimine]): Antihistamines are used to relieve itching by blocking histamine response. Caution is advised in severe hepatic disease due to potential drug metabolism issues.
- Antilipemics (e.g., cholestyramine [Questran]): Cholestyramine can bind bile acids in the intestine, preventing their absorption and reducing pruritus associated with bile acid accumulation. Side effects like nausea and constipation should be monitored.
5. Preventing Transmission and Infection Control
Implement isolation techniques for enteric and respiratory infections according to hospital guidelines. Emphasize and model effective handwashing.
Preventing the spread of hepatitis, especially types A and B, is crucial. Enteric and respiratory isolation precautions help prevent transmission. Hepatitis A and E are transmitted via the fecal-oral route, while types A, B, C, and D can be transmitted through blood, body fluids, and contaminated needles. Strict handwashing is the most effective measure to prevent viral transmission.
Stress the need to monitor and potentially restrict visitors as indicated.
Patients with hepatitis are more susceptible to secondary infections. Limiting exposure to visitors, especially those with infections, reduces the risk of secondary complications, particularly respiratory infections.
Clearly explain isolation procedures to the patient and their significant others (SOs).
Understanding the reasons behind isolation procedures can reduce feelings of isolation and stigmatization. Education helps patients and families cooperate with infection control measures. Isolation duration depends on the type of hepatitis and symptom duration, typically lasting 2-3 weeks from symptom onset.
Provide information about the availability of gamma globulin, ISG, H-BIG, HB vaccine (Recombivax HB, Engerix-B) through the health department or family physician.
Immunoglobulins and vaccines are effective in preventing viral hepatitis in exposed individuals, depending on the type of hepatitis and incubation period. Providing this information allows for timely preventative measures for contacts of hepatitis patients.
Administer medications as indicated:
- Antibiotics appropriate to causative agents (Gram-negative, anaerobic bacteria) or secondary infections: Antibiotics are used to treat bacterial hepatitis or to prevent or manage secondary bacterial infections, which patients with hepatitis are more susceptible to.
6. Providing Emotional Support
Assess the impact of illness on the patient’s and SO’s economic factors.
Hepatitis and its prolonged recovery can lead to financial strain due to lost income and healthcare costs. Assessing the economic impact helps identify needs for social services or financial assistance.
Establish designated time for listening to the patient. Encourage discussion of feelings and concerns.
Creating a trusting nurse-patient relationship is essential. Providing dedicated time for listening and encouraging patients to express their feelings allows them to feel heard and supported. Verbalizing concerns can reduce anxiety and depression and promote positive coping mechanisms. Patients may have anxieties about illness duration, cost, infecting others, and fear of death, especially in severe cases. Concerns about the social stigma of hepatitis may also be present.
Avoid making moral judgments regarding lifestyle choices.
Patients may already be experiencing self-blame or guilt, especially if hepatitis is related to lifestyle factors. Non-judgmental care is crucial to build trust and encourage open communication. Moral judgments can damage self-esteem and hinder the therapeutic relationship.
Discuss realistic recovery expectations.
Recovery from hepatitis can be lengthy, sometimes up to 6 months, causing stress for patients and families. Discussing expected recovery timelines and potential challenges helps in planning, coping, and seeking necessary support and follow-up care.
Offer diversional activities appropriate to the patient’s energy level.
Diversional activities help patients use their time constructively, enhance self-esteem, and minimize anxiety and depression during prolonged convalescence. Activities should be tailored to their energy levels to prevent fatigue.
Suggest wearing bright, uplifting colors like reds, blues, and blacks instead of yellows or greens.
Color choices in clothing can influence how jaundice is perceived. Yellow and green tones can intensify the appearance of jaundice, while brighter, contrasting colors can be more flattering and psychologically uplifting. Jaundice typically peaks within 1-2 weeks and gradually resolves over 2-4 weeks.
Make appropriate referrals for help as needed, such as case managers, discharge planners, social services, and community agencies.
Referrals to support services facilitate problem-solving and help patients and families cope more effectively with the various challenges of hepatitis, including medical, financial, and emotional aspects.
7. Initiating Patient Education and Health Teachings
Assess the patient’s current understanding of the disease process, expectations, prognosis, and treatment options.
This assessment identifies knowledge gaps and misinformation, allowing nurses to provide targeted education. Liver transplantation may be discussed as an option in fulminant liver failure cases.
Provide detailed information regarding disease prevention and transmission:
- Advise contacts may require gamma-globulin.
- Emphasize not sharing personal items.
- Stress strict handwashing and sanitizing of clothes, dishes, and toilet facilities while liver enzymes are elevated.
- Recommend avoiding intimate contact, such as kissing and sexual contact, and exposure to infections, especially URIs.
Specific recommendations vary based on the type of hepatitis and individual circumstances. Clear education on transmission routes and prevention is essential to protect both the patient and others.
Plan for gradual resumption of activity as tolerated, with adequate rest periods. Discuss restrictions on heavy lifting, strenuous exercise, and contact sports.
While complete rest until bilirubin levels normalize is not necessary, strenuous activity should be limited until the liver returns to its normal size. Patients need to understand the importance of continued rest to prevent relapse, which can occur in a significant percentage of adults. Energy levels may take several months to fully recover.
Help the patient identify enjoyable and appropriate diversional activities for convalescence.
Enjoyable activities promote rest, reduce focus on illness, and improve mental well-being during a potentially long recovery period.
Encourage continuation of a balanced diet to support recovery.
A balanced diet promotes overall well-being and provides the nutrients needed for liver healing and tissue regeneration.
Identify strategies to maintain regular bowel function: adequate fluid and fiber intake, moderate activity as tolerated.
Decreased activity, dietary changes, and slowed bowel motility can lead to constipation. Educating patients on maintaining bowel regularity through diet and activity is important.
Discuss the side effects and dangers of over-the-counter (OTC) and prescribed drugs (acetaminophen, aspirin, sulfonamides, some anesthetics) and the importance of informing future healthcare providers about the hepatitis diagnosis.
Many drugs are metabolized by the liver and can be hepatotoxic or cause cumulative toxic effects in liver disease. Patients need to be aware of drugs to avoid and to inform all healthcare providers of their hepatitis history.
Discuss restrictions on blood donation to prevent disease spread.
Individuals with a history of hepatitis are typically restricted from donating blood to prevent transmission through blood products.
Emphasize the importance of follow-up physical examinations and laboratory evaluations.
Long-term follow-up is crucial as the disease process can take months to resolve. Persistent symptoms beyond 6 months may require liver biopsy to assess for chronic hepatitis.
Review the necessity of avoiding alcohol for at least 6-12 months or longer, based on individual tolerance.
Alcohol further irritates the liver and can significantly interfere with recovery. Abstinence from alcohol is critical for liver healing.
Refer to community resources and drug/alcohol treatment programs as indicated.
Patients needing help with substance abuse or requiring additional support should be referred to appropriate community resources and treatment programs to prevent further liver damage and support long-term recovery.
Recommended Resources
Recommended nursing diagnosis and nursing care plan books and resources.
Disclosure: Included below are affiliate links from Amazon at no additional cost from you. We may earn a small commission from your purchase. For more information, check out our privacy policy.
Ackley and Ladwig’s Nursing Diagnosis Handbook: An Evidence-Based Guide to Planning Care We love this book because of its evidence-based approach to nursing interventions. This care plan handbook uses an easy, three-step system to guide you through client assessment, nursing diagnosis, and care planning. Includes step-by-step instructions showing how to implement care and evaluate outcomes, and help you build skills in diagnostic reasoning and critical thinking.
Nursing Care Plans – Nursing Diagnosis & Intervention (10th Edition) Includes over two hundred care plans that reflect the most recent evidence-based guidelines. New to this edition are ICNP diagnoses, care plans on LGBTQ health issues, and on electrolytes and acid-base balance.
Alt Text: Cover of “Nursing Care Plans – Nursing Diagnosis & Intervention 10th Edition” book, a key resource for hepatitis nursing care plans.
Nurse’s Pocket Guide: Diagnoses, Prioritized Interventions, and Rationales Quick-reference tool includes all you need to identify the correct diagnoses for efficient patient care planning. The sixteenth edition includes the most recent nursing diagnoses and interventions and an alphabetized listing of nursing diagnoses covering more than 400 disorders.
Nursing Diagnosis Manual: Planning, Individualizing, and Documenting Client Care Identify interventions to plan, individualize, and document care for more than 800 diseases and disorders. Only in the Nursing Diagnosis Manual will you find for each diagnosis subjectively and objectively – sample clinical applications, prioritized action/interventions with rationales – a documentation section, and much more!
Alt Text: “Nursing Diagnosis Manual” cover, essential for planning and documenting individualized hepatitis patient care.
All-in-One Nursing Care Planning Resource – E-Book: Medical-Surgical, Pediatric, Maternity, and Psychiatric-Mental Health Includes over 100 care plans for medical-surgical, maternity/OB, pediatrics, and psychiatric and mental health. Interprofessional “patient problems” focus familiarizes you with how to speak to patients.
See also
Other recommended site resources for this nursing care plan:
More nursing care plans related to gastrointestinal disorders:
