NCP Hepatitis

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.


Usually at the community level. In toxic states, brief inpatient acute care on a medical unit may be required.


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.


May report: Fatigue, weakness, general malaise


May exhibit: Bradycardia (severe hyperbilirubinemia)

Jaundiced sclera, skin, mucous membranes


May report: Dark urine

Diarrhea/constipation; clay-colored stools

Current/recent hemodialysis


May report: Loss of appetite (anorexia), weight loss or gain (edema)


May exhibit: Ascites


May exhibit: Irritability, drowsiness, lethargy, asterixis


May report: Abdominal cramping, right upper quadrant (RUQ) tenderness

Myalgias, arthralgias; headache

Itching (pruritus)

May exhibit: Muscle guarding, restlessness


May report: Distaste for/aversion to cigarettes (smokers)

Recent flulike URI


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


May report: Lifestyle/behaviors increasing risk of exposure (e.g., sexual promiscuity, sexually active homosexual/bisexual male)


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.


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.


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.


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.