Nursing care plan on hepatitis B

This Nursing care plan is based on the format of Indian nursing council according in which assessment points aren't included. The hepatitis B is a most dangerous diseases condition and it's Incubation period, 2 to 3 months.Prodronal symptoms (insidious onset): fatigue, anorexia,
transient fever, abdominal discomfort, nausea, vomiting,
headache.May also have myalgias, photophobia, arthritis, angioedema,
urticaria, maculopapular rash, vasculitis. Icteric phase occurs 1 week to 2 months after onset of
symptoms.

1. NURSING DIAGNOSISPLANNING/GOAL INTERVENTIONS RATIONAL EVALUATION
Imbalance nutrition
(less than body
required) related to
Insufficient intake to
meet metabolic
demands anorexia,
nausea /vomiting
Aversion to
eating/lack of
interest in food;
alteredtastesen
sation
Monitor dietary
intakeand
caloriccount. 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.
Demonstrate
progressive
weight gain
toward goal with
normalization of
laboratory values
and no signs of
malnutrition
Provide supplemental
feedings andTPNif
needed.
May be necessary to
meet caloric
requirements if
marked deficits are
present and symptoms
are prolonged.
01. NURSING DIAGNOSIS –Imbalance nutrition (less than body required) related to Insufficient intake to meet
metabolic demands anorexia, nausea /vomiting

2. Reduce the
Abdominalpain/cram
ping
•Antiemetics:metoclop
ramide (Reglan),
trimethobenzamide
(Tigan)
Given 1/2 hr before
meals, may reduce
nausea and increase
food tolerance.
Prochlorperazine
(Compazine) is
contraindicated in
hepatic disease.
Initiate behaviors,
lifestyle changes to
regain/maintain
appropriate weight.
Reduce the sign of
Loss of weight;
poormuscletone
•Antacids:Mylanta,
Titralac
Counteracts gastric
acidity, reducing gastric
irritation and risk
ofbleeding.
•Vitamins:B complex,
C, other dietary
supplements as
indicated
Corrects deficiencies
and aids in the healing
process.

3. 2.NURSING DIAGNOSIS –Deficient fluid Volume related to Osmotic diuresis (from hyperglycemiaExcessive gastric
losses:diarrhea.
NURSING DIAGNOSISPLANNING INTERVENTION RATIONAL EVALUATION
Deficient fluid Volume
related to Osmotic
diuresis (from
hyperglycemia)
Excessive gastric
losses:diarrhea.
Maintain body fluid
level and reduce the
intensity of the
symptoms of Disease
Assess patient’s history
related to duration or
intensity of symptoms
such as vomiting,
excessive urination.
Assists in estimation of
total volume depletion.
Symptoms may have
been present for
varying amounts of
time (hours to days).
Fluid level is
maintained and
patient feeling
comfortable
Note orthostatic BP
changes.
Hypovolemiamay be
manifested
byhypotensionand
tachycardia. Estimates
of severity
ofhypovolemiamay be
made when patient’s
systolic BP drops more
than 10 mmHg from a
recumbent to a sitting
then a standing
position.
Demonstrate
adequate hydration as
evidenced by stable
vital signs, palpable
peripheral pulses,
good skin turgor and
capillary refill,
individually
appropriate urinary
output, and
electrolyte levels
within normal range.

4. Evaluate pain relief and
control at regular
intervals. Adjust
medication regimen as
necessary.
Goal is maximum pain
control with minimum
interference with ADLs.
Demonstrate use
of relaxation skills
and diversional
activities as
indicated for
individual
situation.
Inform patient and SO
of the expected
therapeutic effects and
discuss management of
side effects
This information helps
establish realistic
expectations,
confidence in own
ability to handle what
happens.
Discuss use of
additional alternative
or complementary
therapies (acupuncture
and acupressure).
May provide reduction
or relief of pain
without drug-related
side effects.

5. 03. NURSING DIAGNOSIS -
NURSING DIAGNOSISPLA.NNING INTERVENTION RATIONAL EVALUATION
Risk of skin integrity
related to Effects of
radiation and
chemotherapy
Immunologic deficit
Altered nutritional
state, anemia
Reduce the risk of
skin integrity.
Assess skin frequently
for side effects of
cancer therapy; note
breakdown and
delayed wound
healing. Emphasize
importance of
reporting open areas
to caregiver.
A reddening ortanning
effect (radiation
reaction) may develop
within the field of
radiation.
Participate in
techniques to prevent
complications/promot
e healing as
appropriate.
Bathe with lukewarm
water and mild soap.
Maintains cleanliness
without irritating the
skin.
Encourage patient to
avoid vigorous rubbing
and scratching and to
pat skin dry instead of
rubbing.
Helps prevent skin
friction and trauma to
sensitive tissues.
Risk of skin integrity related to Effects of radiation and chemotherapy Immunologic
deficit Altered nutritional state, anemia

6. Protect the patient
from rubbing and
Scratch the skin
Avoid applying heat or
attempting to wash off
marks or tattoos
placed on skin to
identify area of
irradiation;
Helps control
dampness or pruritus.
Maintenance care is
required until skin and
tissues have
regenerated and are
back to normal.
Identify
interventions
appropriate for
specific condition.
Recommend wearing
soft, loose cotton
clothing; have female
patient avoid wearing
bra if it creates
pressure;
Protects skin from
ultraviolet rays and
reduces risk of recall
reactions.
Apply cornstarch,
Aquaphor, Lubriderm,
Eucerin (or other
recommended water-
soluble moisturizing
gel) to area twice daily
as needed;
Reduces risk of tissue
irritation and
extravasation of agent
into tissues.

7. 04. NURSING DIAGNOSIS -Situational low self esteem related to Annoying/debilitating symptoms, confinement /isolation,
length of illness/recovery period
NURSING DIAGNOSISPLANNING INTERVENTION RATIONAL EVALUATION
Situational low self
esteem related to
Annoying/debilitating
symptoms, confinement
/isolation, length of
illness/recovery period
Verbalization of
change in lifestyle;
fear of rejection
/reaction of others,
feelings of
helplessness
Assess effect of illness
on economic factors of
patient and SO.
Financial problems may
exist because of loss of
patient’s role
functioning in the
family and prolonged
recovery.
Verbalize acceptance of self
in situation, including length
of recovery/need for
isolation.
Offer diversional
activities based on
energy level.
Enables patient to use
time and energy in
constructive ways that
enhance self-esteem
minimizeanxietyandd
epression.
Verbalize feelings.
Suggest patient wear
bright reds or blues and
blacks instead of
yellows or greens.
Enhances appearance,
because yellow skin
tones are intensified by
yellow/green colors.
Jaundice usually peaks
within 1–2 wk, then
gradually resolves over
2–4 wk.

8. Depression, lack of
follow-through, self-
destructive behavior
•Avoid making moral
judgments regarding
lifestyle.
Patient may already
feel upset and angry
and condemn self;
judgments from others
will further damage
self-esteem. Can also
startdistrust issues
with care worker.
Identify feelings and
methods for coping
with negative
perception of self.
Make appropriate
referrals for help as
needed: case manager,
discharge planner,
social services, and/or
other community
agencies.
Can facilitate problem
solving and help
involved individuals
cope more effectively
with situation.
Acknowledge self as
worthwhile; be
responsible for self.
Discuss recovery
expectations.
Recovery period may
be prolonged (up to 6
mo), potentiating
family and/or
situationalstressand
necessitating need for
planning, support, and
follow-up.

9. 05. NURSING DIAGNOSIS –Deficiency of knowledge related to Lack of exposure / recall Information misinterpretation
Unfamiliarity with resources
NURSING DIAGNOSISPLANNING INTERVENTION RATIONAL EVALUATION
Deficiency of
knowledge related to
Lack of exposure /
recall
Information
misinterpretation
Unfamiliarity with
resources
Teach the patient for
Requests of
information
Statements of
concern
Assess level of
understanding of the
disease process,
expectations and
prognosis, possible
treatment options.
Identifies areas of lack
of knowledge or
misinformation and
provides opportunity
to give additional
information as
necessary.
Identify relationship
of signs/symptoms to
the disease and
correlate symptoms
with causative factors.
Demostrate the
patient for Inadequate
follow-through of
instructions
Development of
preventable
complications
Provide specific
information regarding
preventionandtransmi
ssion of disease:
contacts may require
gamma-globulin;
personal items should
not be shared; observe
stricthandwashing
while liver enzymes are
elevated. .
Needs and
recommendations vary
with type of hepatitis
(causative agent) and
individual situation.
Verbalize
understanding of
therapeutic needs.

10. Questions or
statements of
misconception;
request for
information
•Discuss restrictions on
donatingblood.
Prevents spread of
infectious disease.
Most state laws
prevent accepting as
donors those who have
a history of any type of
hepatitis.
Verbalize
understanding of
disease process,
prognosis, and
potential
complications.
•Inaccurate follow-
through of
instructions;
development of
preventable
complications
Emphasize importance
of follow-up physical
examination and
laboratory evaluation.
Disease process may
take several months to
resolve. If symptoms
persist longer than 6
mo, liverbiopsymay be
required to verify
presence of chronic
hepatitis.
Initiate necessary
lifestyle changes and
participate in
treatment regimen.
Review necessity of
avoidance of alcohol
for a minimum of 6–12
mo or longer based on
individual tolerance.
Increases hepatic
irritation and may
interfere with recovery.