7 Hepatitis Nursing Care Plans

June 10, 2012

Hepatitis is a widespread inflammation of the liver that results in degeneration and necrosis of liver cells. Inflammation of the liver can be due to bacterial invasion, injury by physical or toxic chemical agents (e.g., drugs, alcohol, industrial chemicals), viral infections (hepatitis A, B, C, D, E, G), or autoimmune response. Although most hepatitis is self-limiting, approximately 20% of acute hepatitis B and 50% of hepatitis C cases progress to a chronic state or cirrhosis and can be fatal.

Nursing Care Plans

Nursing care planning and management for patients with hepatitis includes: reducing the demands of the liver while promoting physical well-being, preventing complications of hepatitis, enhance self-concept, acceptance of situation, and providing information about the disease process, prognosis, and treatment.

This post includes seven (7) nursing care plans and nursing diagnosis for patients with hepatitis:

Imbalanced Nutrition: Less Than Body Requirements

Imbalanced Nutrition: Less Than Body Requirements: Intake of nutrients insufficient to meet metabolic needs.

May be related to

Insufficient intake to meet metabolic demands: anorexia, nausea/vomiting
Altered absorption and metabolism of ingested foods: reduced peristalsis (visceral reflexes), bile stasis
Increased calorie needs/hypermetabolic state

Possibly evidenced by

Aversion to eating/lack of interest in food; altered taste sensation
Abdominal pain/cramping
Loss of weight; poor muscle tone

Desired Outcomes

Initiate behaviors, lifestyle changes to regain/maintain appropriate weight.
Demonstrate progressive weight gain toward goal with normalization of laboratory values and no signs of malnutrition.

Nursing Interventions	Rationale
Monitor dietary intake and caloric count. Suggest several small feedings and offer “largest” meal at breakfast.	Large meals are difficult to manage when patient is anorexic. Anorexia may also worsen during the day, making intake of food difficult later in the day.
Encourage mouth care before meals.	Enhances appetite by eliminating unpleasant taste.
Recommend eating in upright position.	Reduces sensation of abdominal fullness and may enhance intake.
Encourage intake of fruit juices, carbonated beverages, and hard candy throughout the day.	These supply extra calories and may be more easily digested or tolerated than other foods.
Consult with dietitian, nutritional support team to provide diet according to patient’s needs, with fat and protein intake as tolerated.	Useful in formulating dietary program to meet individual needs. Fat metabolism varies according to bile production and excretion and may necessitate restriction of fat intake if diarrhea develops. If tolerated, a normal or increased protein intake helps with liver regeneration. Protein restriction may be indicated in severe disease (fulminant hepatitis) because the accumulation of the end products of protein metabolism can potentiate hepatic encephalopathy.
Monitor serum glucose as indicated.	Hyperglycemia or hypoglycemia may develop, necessitating dietary changes and insulin administration. Fingerstick monitoring may be done by patient on a regular schedule to determine therapy needs.
Administer medications as indicated:
Antiemetics: metoclopramide (Reglan), trimethobenzamide (Tigan)	Given 1/2 hr before meals, may reduce nausea and increase food tolerance. Prochlorperazine (Compazine) is contraindicated in hepatic disease.
Antacids: Mylanta, Titralac	Counteracts gastric acidity, reducing gastric irritation and risk of bleeding.
Vitamins: B complex, C, other dietary supplements as indicated	Corrects deficiencies and aids in the healing process.
Steroid therapy: prednisone (Deltasone), alone or in combination with azathioprine (Imuran)	Steroids may be contraindicated because they can increase risk of relapse and development of chronic hepatitis in patients with viral hepatitis; however, anti-inflammatory effect may be useful in chronic active hepatitis (especially idiopathic) to reduce nausea and vomiting and enable patient to retain food and fluids. Steroids may decrease serum aminotransferase and bilirubin levels, but they do not affect liver necrosis or regeneration. Combination therapy has fewer steroid-related side effects.
Provide supplemental feedings and TPN if needed.	May be necessary to meet caloric requirements if marked deficits are present and symptoms are prolonged.