Hepatitis and Nursing Care Plan


Hepatitis (Inflammation of liver cells)

• Hepatitis is an infection of the liver caused by a virus

• Hepatitis is an acute inflammation of the liver marked by liver-cell destruction, necrosis.

• In most cases hapatic cells regenerate with little or no damage, however, this depends on timing and available treatment, age, and underlying disorders

Hepatitis A and B

Hepatitis is an infection of the liver which is caused by a virus

Virus A is responsible for hepatitis A

Virus B is responsible for hepatitis B

Virus C is responsible for hepatitis C

HBV is considered more serious than HAV


Problems/common reactions


Inflammation of the liver caused by hepatitis virus


• Fatigue, myalgia, malaise, photophobia, and headache

• Anorexia, dyspepsia, nausea and vomiting

• Altered sense of smell

• Fever, possible hepatomegaly


• Mild weight loss

• Dark urine, clay colored stool

• Jaundice and hepatomegaly with tenderness


• Continued fatigue

• Flatulence, abdominal pain or tenderness and dyspepsia




– Hepatitis A= Range 15 to 48 days

usual 25 to 30 days

– Hepatitis B= range from 28 to 180 days

usual 70 to 75 days

– Hepatitis C (non A and non B)=10 to 180

usual 50 to 60 days

– Hepatitis D= similar to type B



  • Hepatitis A= acute
  • Hepatitis B= insidious
  • Hepatitis C= insidious
  • Hepatitis D= present only with HBV


  • Hepatitis A = unlikely
  • Hepatitis B = Yes, but by direct transfer
  • Hepatitis C = Similar to B
  • Hepatitis D = Unknown


Usual mechanisms of transmission

  • Type A = fecal oral route (contaminated food), dirty hands
  • Type B = Percutaneous, oral-oral, direct contact, Mainly body fluids (blood transfusion) sexual contact, stool
  • Type C = Similar to HBV
  • Type D = Percutaneous (common via blood transfusion), body fluids


F e v e r

  • Type A= Common precedes jaundice
  • Type B= Less common
  • Type C =Less common
  • Type D= Less common


  • Type A=Rare in children, more in adult
  • Types B to D=Same as in Type A


Abnormal Aspartate aminotransferase (AST) OR Alanine aminotransferase (ALT)

  • Type A= transient (1 to 3weeks)
  • Type B= Prolonged (lasts from 1 to 8 mths)
  • Type C= Prolonged
  • Type D= Prolonged

Age group affected

  • Type A=Usually children and young adults
  • Type B= All age groups
  • Type C= All age groups
  • Type D= All age groups

Virus in feces

• Type A= weeks before jaundice

• Type B= no direct evidence of presence

• Type C= possible

• Type D= unknown

Virus in blood (viremia)

  • Type A = present during late incubation period and early acute phase
  • Type B = present during late incubation period and acute phase
  • may persist for months or years
  • Type C = present during entire clinical course of HBV
  • Type D = unknown


  • Type A= very low level
  • Type B= low level
  • Type C= low level
  • Type D= likely low level



Hepatitis B vaccine (active)

•1 st dose

• 2nd dose-1 month after

• 3rd dose -3 months after

Hepatitis B vaccine (passive)

– immunoglobulin

Hepatitis A vaccine (passive)

– immunoglobulin





Nursing care of a client with viral hepatitis


• Wear gown and gloves when in contact with client and waste

• Client to remain in room. The rationale for this should be explained to client and his/her family

• Use disposable dishes and utensils

• Double bag all linen

• Keep thermometer in room and discharge when client is discharged

• Discard stool carefully in toilet unless community waste system is not capable of removing pathogen

• Destroy and safely discard all needles or other materials used to puncture skin in a firm box in room

• Observe for depression that might result from elevated bilirubin in the blood stream

• Maintain bed rest; increasing ambulation as the level of jaundice decreases

• Bath skin with warm water, apply lotions and administer medications as ordered to relieve itching caused by increased bilirubin

• Administer oral hygiene twice daily

• Plan care to promote rest and conserve energy

• Assess food dislikes and likes provide client with nourishment between meals

• Reduce light in the room especially if client has photophobia

• Weigh client daily before breakfast

• Instruct client on the effects and transmission of disease


Medical treatment


• Stop further degeneration of liver

• Reduce trauma to liver cells by hepatotoxins

• Increase body’s defences to heal itself

Manage symptoms

1. No alcohol

2. No hepatotoxic drugs e.g. sedatives, opiates should be avoided

3. Rest-to conserve energy.


Health Teaching (prevention of hepatitis A)

• Obtain immune globulin when exposed to the virus; Observe standard precautions

• Perform thorough hand washing

• Avoid eating from public places without adequate hygienic practices

• Use liquid soap and hand driers rather soap and water

• Avoid placing finger and hand held objects in the mouth

• Do not share cigarettes and eating utensil

• Do not eat raw seafood

• Use mask when giving pulmonary resuscitation

• Wash hand properly after using the toilet

• Use hygienic bottled H20 in developing countries


Health teaching ( hepatitis B): Prevention

• Receive HBV vaccine especially those at risk

• Give immune globulin B to those exposed to the virus

• Observe standard precautions

• Do not recap needles; If necessary use scoop method

• Dispose needle in sharp puncture resilient container

• Use condom when engaged in sexual intercourse

• Do not share personal items like toothbrush, razor and finger tools

• Use auto blood transfusion for planned surgery

• Use mouth shield when giving mouth to mouth respiration


NURSING DIAGNOSES (Liver disorders)

• Altered nutrition less than body requirement: related to loss of appetite

• Fluid volume deficit: related to vomiting

• Activity intolerance: related to inability of the liver to metabolise carbohydrate properly

• Impaired skin integrity: related to jaundice

• Altered comfort : related to pruritus

• Altered urinary elimination pattern: related to oliguria and dark urine

• Risk for altered tissue perfusion: related to reduced packed cell volume (hematemesis, melena)

• Fluid volume excess: related to ascites and oedema

• Risk for altered sensory perception: related to high level of ammonia in the blood stream

• Knowledge deficit: related to infection transmission


Nursing care plans for Hepatitis

Altered nutrition less than body requirement: related to loss of appetite


Client’s appetite will improve and will tolerate at least ¾ of meals within a week of interventions


• Assess food likes and dislikes

• Consult dietician

• Serve therapeutic diet

• Serve small, hot, attractive meals frequently

• Give sips of nourishing fluids as tolerated

• Assess food tolerance

• Weigh client daily


Client’s appetite improved and was able to tolerate ¾ of the meals at the end of 3 days intervention

Nursing Care for  Activity intolerance


Client will be able to cope with ADL at the end of one week of interventions


• Assess client’s activity level

• Assist client with ADL

• Encourage client to undertake some activities as condition improves

• Involve relations in the client’s care

• Record activity level daily


Nursing Care for Impaired skin integrity


Client’s intact skin will be maintained and jaundice gradually clear at the end of two weeks of interventions

Nursing Interventions

• Cleanse skin gently using mild soap and apply soothing cream

• Keep finger nails short

• Teach client not to scratch

• Provide soothing bath

• Monitor jaundice


Nursing Care for Altered comfort related to pruritus


Client’s comfort will be restored evidenced by reduced scratching at the end of 72 hrs of interventions


• Give a warm soothing bath

• Apply soothing cream

• Keep bed free of creases and crumbs

• Give anti-histamine as prescribed

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