7 Hepatitis Nursing Care Plans

Imbalanced Nutrition: Less Than Body Requirements

Imbalanced nutrition with less than body requirements is a risk for patients with hepatitis due to the altered absorption and metabolism of digested food, insufficient intake to meet metabolic demands, and increased calorie needs associated with the condition. Patients with hepatitis may experience symptoms such as nausea, vomiting, and anorexia, which can further exacerbate malnutrition and contribute to muscle wasting and weight loss.

Nursing Diagnosis

• Imbalanced Nutrition: Less Than Body Requirements

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

• The client will Initiate behaviors, and lifestyle changes to regain/maintain an appropriate weight.
• The client will demonstrate progressive weight gain toward the goal with normalization of laboratory values and no signs of malnutrition.

Nursing Assessment and Rationales

1. Monitor serum glucose as indicated.
Hyperglycemia or hypoglycemia may develop, necessitating dietary changes and insulin administration. Fingerstick monitoring may be done by the patient on a regular schedule to determine therapy needs.

2. Monitor dietary intake and caloric count. Suggest several small feedings and offer the “largest” meal at breakfast.
Large meals are difficult to manage when the patient is anorexic. Anorexia may also worsen during the day, making intake of food difficult later in the day.

Nursing Interventions and Rationales

1. Encourage mouth care before meals.
Enhances appetite by eliminating unpleasant tastes.

2. Recommend eating in an upright position.
Reduces the sensation of abdominal fullness and may enhance intake.

3. Encourage the 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.

4. Consult with the dietitian, and nutritional support team to provide a diet according to the patient’s needs, with fat and protein intake as tolerated.
Useful in formulating a dietary program to meet individual needs. Fat metabolism varies according to bile production and excretion and may necessitate the 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.

5. Administer medications as indicated:

• 5.1. 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.

• 5.2. Antacids: Mylanta, Titralac
  Counteracts gastric acidity, reducing gastric irritation and risk of bleeding.

• 5.3. Vitamins: B complex, C, and other dietary supplements as indicated
  Corrects deficiencies and aids in the healing process.

• 5.4. Steroid therapy: prednisone (Deltasone), alone or in combination with azathioprine (Imuran)
  Steroids may be contraindicated because they can increase the risk of relapse and development of chronic hepatitis in patients with viral hepatitis; however, the anti-inflammatory effects may be useful in chronic active hepatitis (especially idiopathic) to reduce nausea and vomiting and enable patients 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.

6. Provide supplemental feedings and TPN if needed.

May be necessary to meet caloric requirements if marked deficits are present and symptoms are prolonged.