CARE PLANS – Hepatitis 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 depends 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 Subjective Data Outcome 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 Initiate bleeding precautions per facility protocol No straight razors; Use soft toothbrush and good oral hygiene; Use stool softeners to avoid straining with bowel movements RATIONALE: Coagulation chemicals such as prothrombin and fibrinogen. Damage to the liver may alter the production of these chemicals and increase risk of bleeding. Monitor fluid and electrolyte balance Monitor I & O; Daily weights; Assess skin turgor RATIONALE: 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 soft toothbrush RATIONALE: Bleeding gums and lack of oral hygiene can lead to infection and poor appetite. Provide oral care prior to meals to enhance flavor and encourage adequate nutrition. Encourage and assist with positioning RATIONALE: Recommend patient eat sitting upright to reduce abdominal fullness and encourage dietary intake. Administer medications appropriately and monitor for effectiveness and adverse reactions. Monitor lab values prior to administration. RATIONALE 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 RATIONALE: 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 RATIONALE 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.
