{ "name": "Hepatitis", "slug": "hepatitis", "url": "https://nursingplex.com/care-plans/hepatitis", "category": "Gastrointestinal", "summary": "Liver inflammation; rest, nutrition, transmission precautions and hepatotoxin avoidance.", "nursing_diagnoses": [ "Fatigue", "Imbalanced nutrition", "Risk for infection transmission" ], "overview": [ "Hepatitis is inflammation of the liver that causes hepatocyte swelling, necrosis and impaired bile flow. Viral hepatitis is the most common form, though alcohol, drugs including acetaminophen overdose, toxins and autoimmune disease produce a similar clinical picture. The route of transmission determines both prevention and prognosis, which is why nurses must be able to separate the types quickly.", "Hepatitis A and E spread by the fecal-oral route through contaminated food and water; they cause acute illness only, do not become chronic, and are prevented with hygiene and, for hepatitis A, vaccination. Hepatitis B spreads by blood, sexual contact and perinatal transmission; it can become chronic and lead to cirrhosis and hepatocellular carcinoma, and it is vaccine-preventable. Hepatitis C spreads primarily through blood, especially shared injection equipment, becomes chronic in most infected people, and now has highly effective direct-acting antiviral cures. Hepatitis D occurs only alongside hepatitis B.", "Clinically, illness moves through phases. The prodromal phase brings fatigue, anorexia, nausea, low-grade fever, right upper quadrant discomfort and often a distaste for cigarettes. The icteric phase brings jaundice, dark urine, clay-colored stools and pruritus as bilirubin accumulates. The convalescent phase brings gradual return of energy over weeks to months. Fulminant hepatic failure is rare but life-threatening, signaled by encephalopathy, a rising INR and worsening jaundice." ], "key_facts": [ { "label": "Transmission shorthand", "text": "A and E are fecal-oral (food and water); B, C and D are bloodborne and sexually or perinatally transmitted for B." }, { "label": "Chronicity", "text": "A and E do not become chronic. B becomes chronic in a minority of adults but most infected infants. C becomes chronic in most adults and is the leading cause of transplant-related liver disease." }, { "label": "Vaccines", "text": "Available for hepatitis A and B. The hepatitis B vaccine also protects against D. There is no vaccine for hepatitis C." }, { "label": "Post-exposure", "text": "After a needlestick from a hepatitis B source, hepatitis B immune globulin plus vaccine is given as soon as possible; for hepatitis C there is no prophylaxis, so testing and early antiviral treatment are the plan." }, { "label": "Avoid hepatotoxins", "text": "No alcohol during illness and recovery; strictly limit acetaminophen and review all prescriptions, over-the-counter drugs and herbal products with the provider." } ], "nursing_priorities": [ "Prevent transmission to household contacts, partners and health care workers.", "Support liver rest and recovery with nutrition and activity balance.", "Manage fatigue, nausea, anorexia and pruritus.", "Remove hepatotoxic exposures, especially alcohol and acetaminophen.", "Monitor for progression to fulminant failure or chronic disease.", "Support adherence to antiviral therapy and follow-up testing." ], "assessment": { "subjective": [ "Profound fatigue and malaise out of proportion to activity", "Anorexia, nausea, vomiting and aversion to food or cigarettes", "Right upper quadrant discomfort or fullness", "Generalized itching, worse at night", "Joint aches, low-grade fever and headache in the prodrome", "Anxiety and stigma related to diagnosis, disclosure and transmission risk" ], "objective": [ "Jaundiced sclerae and skin, dark amber urine, clay-colored stools", "Hepatomegaly with tenderness on palpation; sometimes splenomegaly", "Elevated ALT and AST, often markedly; elevated bilirubin and alkaline phosphatase", "Prolonged PT and INR and low albumin in severe or chronic disease", "Positive serologic markers identifying type and stage of infection", "Weight loss, poor intake and dehydration", "Excoriations from scratching; bruising from impaired clotting", "Asterixis, confusion or fetor hepaticus signaling fulminant failure" ], "related_factors": [ "Hepatocyte inflammation and necrosis with impaired bile excretion", "Bile salt deposition in skin causing pruritus", "Anorexia, nausea and altered metabolism of carbohydrate, fat and protein", "Impaired synthesis of clotting factors and albumin", "Impaired drug detoxification increasing sensitivity to hepatotoxins", "Knowledge deficit regarding transmission and long-term follow-up" ] }, "goals": [ "No household contact, partner or caregiver acquires the infection.", "The patient maintains weight and reports improving appetite and reduced nausea.", "Liver enzymes and bilirubin trend downward on serial labs.", "The patient reports reduced itching and skin remains intact.", "The patient names the transmission route and specific prevention steps for their type.", "The patient verbalizes complete alcohol avoidance and correct medication precautions." ], "interventions": [ { "title": "Prevent transmission", "points": [ "Apply standard precautions for all types, adding contact precautions for hepatitis A when the patient is incontinent or diapered.", "Teach fecal-oral prevention for hepatitis A and E: thorough handwashing after toileting and before food handling, safe water, avoiding raw shellfish, and not preparing food for others while infectious.", "Teach bloodborne prevention for hepatitis B, C and D: no sharing of needles, razors, toothbrushes or nail clippers, barrier protection for sex, and no blood, organ or tissue donation.", "Explain that hepatitis B and C are not spread by casual contact, sharing meals or hugging — misinformation drives isolation and shame.", "Encourage hepatitis A and B vaccination for household contacts, partners and at-risk groups, and screen infants of hepatitis B positive mothers for immediate prophylaxis at birth.", "Report cases to public health as required and support contact notification." ] }, { "title": "Promote liver rest and manage fatigue", "points": [ "Encourage rest during the symptomatic phase and increase activity gradually as energy returns; fatigue commonly persists for weeks after enzymes normalize.", "Cluster nursing care and plan activity around the patient's best energy period, which is usually morning.", "Explain that overexertion prolongs recovery, while total inactivity is not required or helpful.", "Track weight, energy level and enzyme trends together rather than relying on labs alone." ] }, { "title": "Support nutrition", "points": [ "Offer small, frequent, appealing meals with the largest portion at breakfast, when nausea is usually least.", "Emphasize high-carbohydrate, adequate-protein, moderate-fat foods; severe protein restriction is not indicated unless encephalopathy develops.", "Give antiemetics before meals as ordered and provide oral care to improve taste.", "Encourage fluids to maintain hydration and monitor intake, output and daily weight.", "Supplement vitamins as ordered, and avoid megadose supplements, which can be hepatotoxic." ] }, { "title": "Relieve pruritus and protect skin", "points": [ "Bathe with cool or tepid water and mild soap, and pat dry rather than rubbing.", "Apply emollients, keep nails short and clean, and suggest cotton clothing and cool room temperature.", "Give prescribed antihistamines or bile acid sequestrants and evaluate their effect.", "Inspect skin for excoriation and infection at each assessment." ] }, { "title": "Eliminate hepatotoxins and monitor for deterioration", "points": [ "Instruct complete alcohol abstinence during illness and recovery, and permanently in chronic disease.", "Review all prescription, over-the-counter and herbal products with the pharmacist, and enforce strict acetaminophen limits.", "Assess mental status, handwriting and asterixis each shift; new confusion in hepatitis is an emergency, not simply fatigue.", "Monitor INR, bilirubin and ammonia, and report rapid rises that suggest fulminant failure.", "Watch for bleeding from gums, stool, urine and puncture sites, and use small-gauge needles with prolonged pressure." ] }, { "title": "Support antiviral therapy and follow-up", "points": [ "Teach that direct-acting antivirals cure most hepatitis C infections with an 8 to 12 week course and that completing every dose matters.", "Review side effects and interactions before starting therapy, and reinforce that reinfection is possible after cure without behavior change.", "Explain long-term monitoring for chronic hepatitis B and C, including periodic liver enzymes, viral load and screening for hepatocellular carcinoma.", "Address stigma, disclosure decisions and mental health, and refer to counseling and support groups." ] } ], "patient_teaching": [ "Wash your hands thoroughly after using the bathroom and before handling food — this stops hepatitis A spread.", "Do not share needles, razors, toothbrushes or nail clippers, and use condoms until your provider says otherwise.", "Do not donate blood, organs, tissue or semen.", "Avoid alcohol completely while your liver heals, and permanently if your hepatitis is chronic.", "Check every medicine, vitamin and herbal product with your pharmacist; many are hard on the liver.", "Rest when tired and increase activity slowly — full energy may take weeks to months.", "Make sure household members and partners are vaccinated against hepatitis A and B.", "Report worsening jaundice, confusion, unusual bleeding or vomiting blood right away, and keep all follow-up lab appointments." ] }