Nursing Care Plan (NCP) for Hepatitis

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Outline

Pathophysiology

The inflammation of the liver is called hepatitis and may be the result of lifestyle factors, chronic or autoimmune disorders, or viral agents. Some forms of hepatitis are curable while other forms last a lifetime. Management and treatment of the disease depend on the causative factor.  The widespread inflammation results in degeneration and necrosis of the liver. 70% of hepatitis cases (B and C) progress to a chronic state, cirrhosis or become fatal.

Etiology

About half of all hepatitis cases are attributed to hepatitis viruses A, B, and C. Chronic alcohol use, drugs and excessive use of some medications (acetaminophen, statins) as well as infection such as Epstein-Barr (mononucleosis), can impair the liver’s ability to filter toxins, produce and store metabolic chemicals and store vitamins and minerals.

Desired Outcome

Minimize progressive degeneration and necrosis of the liver, improve healthy lifestyle habits, maintain optimal nutrition and functionality of liver

Hepatitis Nursing Care Plan

Subjective Data:

  • Loss of appetite
  • Fatigue
  • Muscle/joint aches
  • Nausea
  • RUQ abdominal pain
  • Itchy skin

Objective Data:

  • Dark-colored urine
  • Pale colored stools
  • Diarrhea
  • Jaundice
  • Vomiting
  • Fever

Nursing Interventions and Rationales

  • Initiate bleeding precautions per facility protocol
    • No straight razors
    • Use a soft toothbrush and good oral hygiene
    • Use stool softeners to avoid straining with bowel movements
  Coagulation chemicals such as prothrombin and fibrinogen. Damage to the liver may alter the production of these chemicals and increase the risk of bleeding.
  • Monitor fluid and electrolyte balance
    • Monitor I & O
    • Daily weights
    • Assess skin turgor
  Liver impairment may also affect renal function. Ascites and dependent edema may be indicators of hyponatremia. Diarrhea and vomiting may cause fluid imbalances.
  • Provide routine oral care before meals with a soft toothbrush
  Bleeding gums and lack of oral hygiene can lead to infection and poor appetite. Provide oral care before meals to enhance flavor and encourage adequate nutrition.
  • Encourage and assist with positioning
  Recommend patients eat sitting upright to reduce abdominal fullness and encourage dietary intake.
  • Administer medications appropriately and monitor for effectiveness and adverse reactions. Monitor lab values before administration.
  Medications may be given to manage electrolytes, and symptoms of nausea or to assist with alcohol or drug detox. Avoid giving acetaminophen. Antiviral medications may be given to treat certain types of hepatitis.
  • Provide and monitor supplemental feedings and TPN as necessary
  In chronic disease, it may be necessary to provide adequate nutrition and caloric intake
  • Nutrition and Lifestyle education, prevention and protection
    • Avoid alcohol and illicit drugs
    • Avoid exposure to dirty needles
    • Avoid contact with bodily fluids such as semen, blood, stool, and vomit
    • Encourage vaccines for high-risk patients and their families
  High-risk behavior and lifestyle modifications may be necessary. Encourage patients to avoid alcohol and drug use and unprotected sex as viral hepatitis is easily transmitted. Provide nutrition education to promote low fat, low sugar diet. Wheat, gluten, dairy, and artificial sweeteners are difficult for the liver to digest.

Writing a Nursing Care Plan (NCP) for Hepatitis

A Nursing Care Plan (NCP) for Hepatitis starts when at patient admission and documents all activities and changes in the patient’s condition. The goal of an NCP is to create a treatment plan that is specific to the patient. They should be anchored in evidence-based practices and accurately record existing data and identify potential needs or risks.


References

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Transcript

Here, we’re going to work on the hepatitis nursing care plan. So the patho behind hepatitis is, hepatitis is an inflammation of the liver. The hepatitis may be resulted from lifestyle factors, chronic or auto-immune disorders or viral agents. Um, some forms of hepatitis are curable and others are, uh, there for a lifetime. Management and treatment of the disease does depend on the causative factor. The widespread inflammation results in degeneration and necrosis of the liver. About 70% of hepatitis cases, BNC progress to a chronic state cirrhosis, or become fatal.

The nursing considerations that we want to keep in the forefront of our mind, let’s assess and monitor mental status. Uh, these patients can have a quick decline in their mental status. We want to prevent bleeding and at any time we want to assess and manage their pain. The desired outcome for hepatitis is to minimize progressive degeneration and necrosis of the liver, we want to improve quality of life, improve healthy lifestyle habits, and we want to maintain optimal nutrition and functionality of the liver. 

So, a patient, regardless of which type of hepatitis that they have, would typically present the same way because of the liver damage. Uh, they will often complain of a loss of appetite. They will be fatigued, they will complain of muscle or joint aches, they’ll have some nausea, they will have some right upper quadrant abdominal pain, and that’s when the liver is located, and they’ll also have some itchy skin. And a lot of that is attributed to the toxins that have built up from not being processed by the liver. So, their skin would be very itchy. Um, some things that we are going to notice, these are some hallmark signs for anyone with liver damage or hepatitis, is that there will be dark colored urine. The urine is going to be very dark. They’re going to have pale color stools. Um, they’re going to have some diarrhea. Their skin is going to have a yellow tinge. Uh, Jaundice, this is what we call it. So, let’s write that down. Jaundice, they’re also going to have some vomiting and they may also present with a fever. 

So, what are some of the things that you think, uh, we want to, uh, do for these patients? Well, I think that maybe we want to initiate some bleeding precautions. Do we want to put these, these patients are bleeding precautions, so bleeding precautions, and the reason why we want to put them on bleeding precautions is, these patients have an impaired bleeding coagulation, um, because of their liver, their liver controls a lot of the clotting factors producing. So, when your liver is impaired, then you have longer bleeding times. So again, those, um, bleeding precautions include, uh, no straight razors. Uh, we want to make sure that they use a soft toothbrush and we also want to make sure that they use stool softeners to avoid straining with bowel movements. Next up, we want to take a look at those coagulation studies. So we’re going to really, uh, focus on their lab values, but we’re going to look at the PT, the PTT and the INR. Those are just some of the labs that we want to look at. Damage to the  liver is going to alter the production of prothrombin and fibrinogen. So it’s going to increase that risk of bleeding, their bleeding risk is increased. 

Okay, the next thing we want to do is we want to monitor their fluid and electrolyte balance. Liver impairment may also affect renal function. So ascites, which are, uh, pretty much fluid retention, third spacing around the abdomen, and dependent edema are indicators of hypernatremia. Diarrhea, and vomiting may also cause fluid imbalances. We want to keep a close eye on that. Next up, we want to provide routine oral care before meals with a soft toothbrush. The reason for this is we want to provide oral care before meals to enhance flavor and encourage adequate nutrition. A lot of these patients have no appetite. So we want to give them a leg up in any way we can and freshen up their mouth before meals. We’ll also give them the drive to want to eat more. We want to provide a monitor, supplemental feedings and TPN if possible, and this chronic disease, it may be necessary to provide adequate nutrition, uh, supplemental. 

So, sometimes we will give them those, uh, shakes or TPN, which is, it goes through your central line to give them the nutrition. We want to monitor the caloric intake because it’s very important to put them on the road to recovery. We want to encourage and assist with positioning. Uh, it’s very important for the patient when it’s, when it’s time to eat, it is important for them to, to sit upright. And that’s going to reduce abdominal fullness feeling, and encourage dietary intake. Uh, their abdomen is, uh, and their livers are large. So that ascites, that part of the abdomen is full, but also the society’s the fluid that’s kind of there. It’s also giving them a fullness feeling, so we want to encourage, um, the, uh, caloric intake in order to do that. Let’s sit them up. High Fowler’s is preferred. Now let’s look at the key points. 

So pathophysiology, uh, inflammation of the liver is called hepatitis. This is what we’re talking about. It may result from lifestyle factors, chronic or autoimmune diseases or viral agents. Subjective, so what is the patient saying? The patient has a decreased appetite. The patient may also complain of being fatigued, some right, upper quadrant pain and very itchy skin. Uh, some things that we’re going to notice is we’re going to see pale stool. They’re going to be Jaundiced, or show yellowing of the skin or eyes. They’re going to have dark, dark, urine, and they’re going to have a fever. What we want to focus on, is we want to focus on neuro assessment. So, as the toxins build up, there may be changes in their level of consciousness. We’re going to assess for encephalopathy okay, And then finally, we’re going to do lab draws and we’re going to focus on the coagulation studies. What is their liver telling us through their blood. Liver damage alters prothrombin, and fibrinogen production. And it increases the risk of bleeding. I know this was a lot, but as always, we love you guys. Go out and be your best self today and as always, happy nursing.

 

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