Hepatitis is a widespread inflammation of the liver that results in degeneration and necrosis of liver cells. Inflammation of the liver can be due to bacterial invasion, injury by physical or toxic chemical agents (e.g., drugs, alcohol, industrial chemicals), viral infections (hepatitis A, B, C, D, E, G), or autoimmune response. Although most hepatitis is selflimiting, approximately 20% of acute hepatitis B and 50% of hepatitis C cases progress to a chronic state or cirrhosis and can be fatal.
CARE SETTING
Usually at the community level. In toxic states, brief inpatient acute care on a medical unit may be required.
RELATED CONCERNS
Alcohol: acute withdrawal
Cirrhosis of the liver
Psychosocial aspects of care
Renal dialysis
Substance dependence/abuse rehabilitation
Total nutritional support: parenteral/enteral feeding
Patient Assessment Database
Data depend on the cause and severity of liver involvement/damage.
ACTIVITY/REST
May report: Fatigue, weakness, general malaise
CIRCULATION
May exhibit: Bradycardia (severe hyperbilirubinemia)
Jaundiced sclera, skin, mucous membranes
ELIMINATION
May report: Dark urine
Diarrhea/constipation; clay-colored stools
Current/recent hemodialysis
FOOD/FLUID
May report: Loss of appetite (anorexia), weight loss or gain (edema)
Nausea/vomiting
May exhibit: Ascites
NEUROSENSORY
May exhibit: Irritability, drowsiness, lethargy, asterixis
PAIN/DISCOMFORT
May report: Abdominal cramping, right upper quadrant (RUQ) tenderness
Myalgias, arthralgias; headache
Itching (pruritus)
May exhibit: Muscle guarding, restlessness
RESPIRATION
May report: Distaste for/aversion to cigarettes (smokers)
Recent flulike URI
SAFETY
May report: Transfusion of blood/blood products in the past
May exhibit: Fever
Urticaria, maculopapular lesions, irregular patches of erythema
Exacerbation of acne
Spider angiomas, palmar erythema, gynecomastia in men (sometimes present in alcoholic hepatitis)
Splenomegaly, posterior cervical node enlargement
SEXUALITY
May report: Lifestyle/behaviors increasing risk of exposure (e.g., sexual promiscuity, sexually active homosexual/bisexual male)
TEACHING/LEARNING
May report: History of known/possible exposure to virus, bacteria, or toxins (contaminated food, water, needles, surgical equipment or blood); carriers (symptomatic or asymptomatic); recent surgical procedure with halothane anesthesia; exposure to toxic chemicals (e.g., carbon tetrachloride, vinyl chloride); prescription drug use (e.g., sulfonamides, phenothiazines, isoniazid)
Travel to/immigration from China, Africa, Southeast Asia, Middle East (hepatitis B [HB] is endemic in these areas)
Street injection drug or alcohol use
Concurrent diabetes, HF, malignancy, or renal disease
Discharge plan
DRG projected mean length of inpatient stay: 6.1 days
May require assistance with homemaker/maintenance tasks
Refer to section at end of plan for postdischarge considerations.
DIAGNOSTIC STUDIES
Liver enzymes/isoenzymes: Abnormal (4–10 times normal values). Note: Of limited value in differentiating viral from nonviral hepatitis.
AST/ALT: Initially elevated. May rise 1–2 wk before jaundice is apparent, then decline.
Alkaline phosphatase (ALP): Slight elevation (unless severe cholestasis present).
Hepatitis A, B, C, D, E panels (antibody/antigen tests): Specify type and stage of disease and determine possible carriers.
CBC: Red blood cells (RBCs) decreased because of shortened life of RBCs (liver enzyme alterations) or hemorrhage.
WBC count and differential: Leukopenia, leukocytosis, monocytosis, atypical lymphocytes, and plasma cells may be present.
Serum albumin: Decreased.
Blood glucose: Transient hyperglycemia/hypoglycemia (altered liver function).
Prothrombin time: May be prolonged (liver dysfunction).
Serum bilirubin: Above 2.5 mg/100 mL. (If above 200 mg/100 mL, poor prognosis is probable because of increased cellular necrosis.)
Stools: Clay-colored, steatorrhea (decreased hepatic function).
Bromsulphalein (BSP) excretion test: Blood level elevated.
Liver biopsy: Usually not needed, but should be considered if diagnosis is uncertain, of if clinical course is atypical or unduly prolonged.
Liver scan: Aids in estimation of severity of parenchymal damage.
Urinalysis: Elevated bilirubin levels; protein/hematuria may occur.
NURSING PRIORITIES
1. Reduce demands on liver while promoting physical well-being.
2. Prevent complications.
3. Enhance self-concept, acceptance of situation.
4. Provide information about disease process, prognosis, and treatment needs.
DISCHARGE GOALS
1. Meeting basic self-care needs.
2. Complications prevented/minimized.
3. Dealing with reality of current situation.
4. Disease process, prognosis, and therapeutic regimen understood.
5. Plan in place to meet needs after discharge.
CARE SETTING
Usually at the community level. In toxic states, brief inpatient acute care on a medical unit may be required.
RELATED CONCERNS
Alcohol: acute withdrawal
Cirrhosis of the liver
Psychosocial aspects of care
Renal dialysis
Substance dependence/abuse rehabilitation
Total nutritional support: parenteral/enteral feeding
Patient Assessment Database
Data depend on the cause and severity of liver involvement/damage.
ACTIVITY/REST
May report: Fatigue, weakness, general malaise
CIRCULATION
May exhibit: Bradycardia (severe hyperbilirubinemia)
Jaundiced sclera, skin, mucous membranes
ELIMINATION
May report: Dark urine
Diarrhea/constipation; clay-colored stools
Current/recent hemodialysis
FOOD/FLUID
May report: Loss of appetite (anorexia), weight loss or gain (edema)
Nausea/vomiting
May exhibit: Ascites
NEUROSENSORY
May exhibit: Irritability, drowsiness, lethargy, asterixis
PAIN/DISCOMFORT
May report: Abdominal cramping, right upper quadrant (RUQ) tenderness
Myalgias, arthralgias; headache
Itching (pruritus)
May exhibit: Muscle guarding, restlessness
RESPIRATION
May report: Distaste for/aversion to cigarettes (smokers)
Recent flulike URI
SAFETY
May report: Transfusion of blood/blood products in the past
May exhibit: Fever
Urticaria, maculopapular lesions, irregular patches of erythema
Exacerbation of acne
Spider angiomas, palmar erythema, gynecomastia in men (sometimes present in alcoholic hepatitis)
Splenomegaly, posterior cervical node enlargement
SEXUALITY
May report: Lifestyle/behaviors increasing risk of exposure (e.g., sexual promiscuity, sexually active homosexual/bisexual male)
TEACHING/LEARNING
May report: History of known/possible exposure to virus, bacteria, or toxins (contaminated food, water, needles, surgical equipment or blood); carriers (symptomatic or asymptomatic); recent surgical procedure with halothane anesthesia; exposure to toxic chemicals (e.g., carbon tetrachloride, vinyl chloride); prescription drug use (e.g., sulfonamides, phenothiazines, isoniazid)
Travel to/immigration from China, Africa, Southeast Asia, Middle East (hepatitis B [HB] is endemic in these areas)
Street injection drug or alcohol use
Concurrent diabetes, HF, malignancy, or renal disease
Discharge plan
DRG projected mean length of inpatient stay: 6.1 days
May require assistance with homemaker/maintenance tasks
Refer to section at end of plan for postdischarge considerations.
DIAGNOSTIC STUDIES
Liver enzymes/isoenzymes: Abnormal (4–10 times normal values). Note: Of limited value in differentiating viral from nonviral hepatitis.
AST/ALT: Initially elevated. May rise 1–2 wk before jaundice is apparent, then decline.
Alkaline phosphatase (ALP): Slight elevation (unless severe cholestasis present).
Hepatitis A, B, C, D, E panels (antibody/antigen tests): Specify type and stage of disease and determine possible carriers.
CBC: Red blood cells (RBCs) decreased because of shortened life of RBCs (liver enzyme alterations) or hemorrhage.
WBC count and differential: Leukopenia, leukocytosis, monocytosis, atypical lymphocytes, and plasma cells may be present.
Serum albumin: Decreased.
Blood glucose: Transient hyperglycemia/hypoglycemia (altered liver function).
Prothrombin time: May be prolonged (liver dysfunction).
Serum bilirubin: Above 2.5 mg/100 mL. (If above 200 mg/100 mL, poor prognosis is probable because of increased cellular necrosis.)
Stools: Clay-colored, steatorrhea (decreased hepatic function).
Bromsulphalein (BSP) excretion test: Blood level elevated.
Liver biopsy: Usually not needed, but should be considered if diagnosis is uncertain, of if clinical course is atypical or unduly prolonged.
Liver scan: Aids in estimation of severity of parenchymal damage.
Urinalysis: Elevated bilirubin levels; protein/hematuria may occur.
NURSING PRIORITIES
1. Reduce demands on liver while promoting physical well-being.
2. Prevent complications.
3. Enhance self-concept, acceptance of situation.
4. Provide information about disease process, prognosis, and treatment needs.
DISCHARGE GOALS
1. Meeting basic self-care needs.
2. Complications prevented/minimized.
3. Dealing with reality of current situation.
4. Disease process, prognosis, and therapeutic regimen understood.
5. Plan in place to meet needs after discharge.
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