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This Concept Map, created with IHMC CmapTools, has information related to: Hepatitis, ???? Nursing Diagnosis & Nursing Interventions 1. Activity intolerance r/t fatigue, lethargy, and malaise - assess level of activity tolerance & degreee of fatigue, lethargy,& malaise when performing routine activites of daily living - Assist with activite and hygiene when fatigued. - Encourage rest when fatigued or when abd pain or discomfort occurs 2. Imbalanced nutrition: less than the body requirements r/t abdominal distention and discomfort and anorexia - Assess dietary intake and nutritional status through diet history and diary, daily weight measurements, and laboratory data. - Assist patient in identifying low sodium foods - Elevate the head of the bed during meals 3. Impaired skin integrity r/t pruritus from jandice & edema - Assess degree of discomfort r/t pruritus & edema - Note & record degree of jaundice & extent of edema - Keep patient's fingernails short & smooth 4. Risk for injury r/t altered clotting mechanisms & altered level of consciousness - Assess LOC & cognitive level - Provide safe environment (pad side rails, remove obstacles in room, prevent falls) - Provide fequent surveillance to orient patient, & avoid use of restraints. 5. Disturbed body image r/t changes in appearance, sexual dysfunction, and role function - Assess changes in appearance & the meaning theses changes have for patient & family - Encourage patient to verbalize reactions & feelings about these changes. - Assess patient's & family's previous coping strategies. 6. Chronic pain & discomfort r/t enlarged tender liver and ascites - Maintain bed rest when patient experiences abdominal discomfort - Administer antispasmodic & analgesic agents as prescribed - Observe, record, and report presence & character of pain & discomfort. 7. Fluid volume excess r/t ascites & edema formation - Restrict sodium & fluid intake if prescribed - Administer diuretic agents, potassium, protein supplements as prescribed. - Measure & record abdominal girth & weight daily. 8. Confusion r/t abnormal liver function & increased serum ammonia level - Restrict dietary protein as prescribed for transient period - Give frequent, small feedings of carbohydrates. - Protect from infection. 9. Risk for imbalanced body temperature: hyperthermia r/t inflammatory process of cirrhosis or hepatitis - Record temperature regularly (every 4 hours). - Encourage Fluid intake. - Apply cool sponges or ice bag for elevated temperature. 10. Ineffective breathing pattern r/t ascites & restriction of thoracic excursion secondary to ascites, abdominal distention, and fluid in the thoracic cavity - Elevate head of bed to at least 30 degrees. - Change position every 2 hours. - Assist with paracentesis or thoracentesis., AMETHOD Discharge A=Assessment Be alert to the following signs and symptoms: Compensated - Intermittent mild fever, vascular spiders, reddened palms unexplained epistaxis, ankle edema, vague morning indigestion, flatulent dypepsia, abdominal pain, firm - enlarged liver, & splenomegaly. Uncompensated - ascites, jaundice, weakness, muscle wasting, weight loss, continuous mild fever, clubbing of fingers, purpura, spontaneous bruising, epistaxis, hypotension, sparse body hair, white nails, gonadal atrophy. M=Medications The medication for management depends on the type of hepatitis contracted. Along with pain and antiemetic medications the client may have the following medications: Hep A - IV fluids with glucose Hep B - alpha-interferon (Pegasys) Hep C - Antiviral: Rebetol & Pegasys; Protease inhibitor: Incivek & Victrelis Hep D - Interferon alfa Medications that can lead to further liver damage include: Nydraxid, Fluothane, Aldomet, certain antibiotics, antimetabolites, & anesthetic agents. E=Environment Due to the risk of infection encourage proper community & home sanitation. Make sure the client's home is safe. If they live alone inquire into alternative support personnel that may be available to the client. If the disease is in a advanced state check to see if the client has the medical resources at home to manage his disease. Verify that support personnel the client has available to him/her at home are properly vaccinated (only certain forms of Hepatitis have vaccines). T=Treatment Other forms of treatment the client can continue at home would be: proper diet, bed rest during acute stages, routine blood lab work, taking prescribed medications routinely, & receiving proper type/amount of fluids during episodes of vomiting. H=Health -Teach the client and support personnel about proper community & home sanitation. -Educate client & support personnel regarding safe practices for preparing & Dispensing food. -For health promotion, recommend pre-exposure vaccine for family members and support personnel -Promote the use of proper safety precautions during sexual intercourse to minimize the risk of infecting partners. -Teach support personnel about the use of standard precautions when treating the client. -Teach the support personnel how to use barrier precautions in situations where blood or body fluids may be present. -Promote cleaning, disinfection, & sterilization of reusable devieces used during client care. O=Outpatient Referral -Educating the client and his support personnel about the precautions used to minimize the risk of infecting others would be a priority. -Encourage the client to inform possible partners that may have been exposed so that they may seek treatment. -Refer clients and support personnel to possible communtiy resources available to them (e.g., support groups). D=Diet Along with the diet recommendations listed in the Medical Management box the dietary management of hepatitis would include: -Carefully monitor fluid balance -Be aware that enteral feedings may be necessary if anorexia, nausea, & vomiting persist. -Instruct the client to abstain from alcohol during acute illness & for at least 6 months after recovery. -Advise client to avoid substances (medications, herbs, illicit, and toxins) that may affect liver function, such as St. John's wort in clients taking hepatitis C virus protease inhibitors. ????, AMETHOD Discharge A=Assessment Be alert to the following signs and symptoms: Compensated - Intermittent mild fever, vascular spiders, reddened palms unexplained epistaxis, ankle edema, vague morning indigestion, flatulent dypepsia, abdominal pain, firm - enlarged liver, & splenomegaly. Uncompensated - ascites, jaundice, weakness, muscle wasting, weight loss, continuous mild fever, clubbing of fingers, purpura, spontaneous bruising, epistaxis, hypotension, sparse body hair, white nails, gonadal atrophy. M=Medications The medication for management depends on the type of hepatitis contracted. Along with pain and antiemetic medications the client may have the following medications: Hep A - IV fluids with glucose Hep B - alpha-interferon (Pegasys) Hep C - Antiviral: Rebetol & Pegasys; Protease inhibitor: Incivek & Victrelis Hep D - Interferon alfa Medications that can lead to further liver damage include: Nydraxid, Fluothane, Aldomet, certain antibiotics, antimetabolites, & anesthetic agents. E=Environment Due to the risk of infection encourage proper community & home sanitation. Make sure the client's home is safe. If they live alone inquire into alternative support personnel that may be available to the client. If the disease is in a advanced state check to see if the client has the medical resources at home to manage his disease. Verify that support personnel the client has available to him/her at home are properly vaccinated (only certain forms of Hepatitis have vaccines). T=Treatment Other forms of treatment the client can continue at home would be: proper diet, bed rest during acute stages, routine blood lab work, taking prescribed medications routinely, & receiving proper type/amount of fluids during episodes of vomiting. H=Health -Teach the client and support personnel about proper community & home sanitation. -Educate client & support personnel regarding safe practices for preparing & Dispensing food. -For health promotion, recommend pre-exposure vaccine for family members and support personnel -Promote the use of proper safety precautions during sexual intercourse to minimize the risk of infecting partners. -Teach support personnel about the use of standard precautions when treating the client. -Teach the support personnel how to use barrier precautions in situations where blood or body fluids may be present. -Promote cleaning, disinfection, & sterilization of reusable devieces used during client care. O=Outpatient Referral -Educating the client and his support personnel about the precautions used to minimize the risk of infecting others would be a priority. -Encourage the client to inform possible partners that may have been exposed so that they may seek treatment. -Refer clients and support personnel to possible communtiy resources available to them (e.g., support groups). D=Diet Along with the diet recommendations listed in the Medical Management box the dietary management of hepatitis would include: -Carefully monitor fluid balance -Be aware that enteral feedings may be necessary if anorexia, nausea, & vomiting persist. -Instruct the client to abstain from alcohol during acute illness & for at least 6 months after recovery. -Advise client to avoid substances (medications, herbs, illicit, and toxins) that may affect liver function, such as St. John's wort in clients taking hepatitis C virus protease inhibitors. ????