6 Nursing Diagnosis for Hepatitis: Comprehensive Nursing Care Plan and Interventions
Hepatitis represents a major global health concern characterized by inflammation of the liver, hepatocellular injury, and impaired liver function. The liver plays essential roles in metabolism, detoxification, immune regulation, and nutrient storage. When inflammation occurs, these functions are disrupted, resulting in significant physiological and psychological consequences for the patient. Understanding appropriate nursing diagnoses is vital to ensure accurate interventions, promote recovery, reduce complications, and improve patient outcomes.
What Is Hepatitis?
Hepatitis is defined as an inflammatory condition of the liver caused by infectious or non-infectious agents. Hepatic inflammation may be acute or chronic depending on the duration and etiology. Acute hepatitis commonly resolves with proper management, while chronic hepatitis may lead to fibrosis, cirrhosis, portal hypertension, or hepatocellular carcinoma.
The World Health Organization reports that approximately 354 million people live with chronic hepatitis B and C globally, highlighting the burden of liver-related diseases and the importance of nursing care in prevention, early detection, and management.
Types and Causes of Hepatitis
1. Viral Hepatitis
Viruses remain the most common cause of hepatitis. The primary hepatotropic viruses include:
- Hepatitis A Virus (HAV) – Transmitted via the fecal-oral route, typically from contaminated food or water.
- Hepatitis B Virus (HBV) – Transmitted through blood, sexual contact, and maternal-fetal exposure.
- Hepatitis C Virus (HCV) – Primarily acquired via contaminated needles, transfusions, or unsafe medical practices.
- Hepatitis D Virus (HDV) – Occurs as co-infection or superinfection with HBV.
- Hepatitis E Virus (HEV) – Similar transmission to HAV, common in areas with poor sanitation.
- Hepatitis G Virus (HGV) – Less understood, linked to bloodborne infections.
Clinical Example: A patient with acute HAV may present with fever, abdominal pain, jaundice, and dark urine following consumption of contaminated seafood.
2. Non-Viral Hepatitis
Hepatitis may also arise from non-infectious causes including exposure to toxins, autoimmune disorders, genetic defects, metabolic disturbances, and drug-induced hepatotoxicity.
- Chemical Hepatitis – Caused by toxins, poisonous mushrooms, chloroform, or industrial chemicals.
- Alcohol-Induced Hepatitis – Chronic alcohol consumption leads to hepatic inflammation and fatty infiltration.
- Non-Alcoholic Fatty Liver Disease (NAFLD) – Associated with obesity and hyperlipidemia.
- Metabolic Hepatitis – Results from excessive deposition of fat or copper (Wilson’s disease) in the liver.
Common Symptoms of Hepatitis
Symptoms vary depending on the type and severity of hepatitis. In early stages, hepatitis can be asymptomatic because hepatocytes possess remarkable regenerative capacity. However, as liver damage progresses, symptoms become more evident.
- Jaundice (yellow discoloration of skin and sclera)
- Dark urine resembling tea
- Unexplained weight loss
- Anorexia and gastrointestinal disturbances
- Pale or clay-colored stools
- Fatigue or generalized weakness
- Hypoglycemia due to impaired glycogen storage
- Right upper quadrant abdominal pain
- Fever and chills
- Pruritus (itching) due to bile salt accumulation
- Decreased libido and hormonal imbalance
Note: Severe unresolved hepatitis may progress into cirrhosis or liver cancer, making early nursing assessment essential.
How to Prevent Hepatitis
- Maintain personal hygiene, including frequent handwashing after defecation, shaking hands, and before meals.
- Avoid sharing needles, razors, toothbrushes, or other personal items.
- Limit alcohol consumption and avoid recreational drugs.
- Engage in safe sexual practices.
- Receive vaccinations for HAV and HBV as recommended.
- Consume balanced meals that support liver metabolism.
- Use medications only under healthcare provider supervision.
6 Nursing Diagnosis for Hepatitis
The following evidence-based nursing diagnoses are commonly identified in patients with hepatitis. They address physiological disturbances, lifestyle behaviors, and emotional responses related to liver pathology.
- Imbalanced Nutrition: Less Than Body Requirements related to anorexia, nausea, and vomiting.
- Impaired Skin Integrity related to pruritus and bile salt accumulation.
- Activity Intolerance related to fatigue and generalized malaise.
- Acute Pain related to hepatic inflammation, liver capsule distension, and tissue swelling.
- Hyperthermia related to the body's inflammatory response to invading organisms.
- Risk for Infection related to compromised immune response and invasive procedures.
Detailed Nursing Care Plan and Interventions
1. Imbalanced Nutrition: Less Than Body Requirements
Rationale: Reduced appetite, nausea, and vomiting limit nutrient intake and impair recovery. The liver plays a significant role in protein and lipid metabolism; inflammation worsens nutritional deficits.
- Provide small, frequent, high-calorie meals.
- Avoid greasy, spicy, and hard-to-digest foods.
- Monitor weight, BMI, and muscle mass.
- Educate patients on adequate protein intake to support liver regeneration.
- Refer to a dietitian when necessary.
2. Impaired Skin Integrity
Rationale: Hepatitis patients often experience pruritus due to bile salt deposition under the skin, leading to scratching, abrasions, and infection risk.
- Assess skin for excoriation and moisture level.
- Maintain short fingernails to prevent scratching injuries.
- Provide antihistamines as ordered.
- Encourage cool baths and use of mild soaps.
- Keep linens clean and dry.
3. Activity Intolerance
Rationale: Liver dysfunction reduces glycogen storage, causing fatigue and decreased energy levels.
- Assess tolerance to physical activity.
- Allow rest periods during activities.
- Encourage gradual increase in mobility as tolerated.
- Monitor vital signs during exertion.
- Educate the patient about pacing activities.
4. Acute Pain
Rationale: Liver inflammation and stretching of Glisson’s capsule cause right upper quadrant discomfort.
- Assess pain scale regularly.
- Administer analgesics as prescribed.
- Teach non-pharmacological pain relief methods (breathing exercises).
- Encourage semi-Fowler’s position for comfort.
5. Hyperthermia
Rationale: Fever is a systemic response to viral invasion and immune activation.
- Monitor body temperature every 4 hours.
- Administer antipyretics such as acetaminophen.
- Encourage fluid intake to prevent dehydration.
- Maintain environmental comfort.
6. Risk for Infection
Rationale: Patients with hepatitis have reduced immunity and may undergo procedures that increase infection likelihood.
- Use aseptic techniques in all interventions.
- Educate patient on preventing secondary infections.
- Monitor WBC count and liver enzymes.
- Encourage vaccination and good hygiene.
Conclusion
Hepatitis presents a significant challenge for healthcare professionals due to its subtle onset, diverse manifestations, and potential for long-term complications. Nursing diagnosis plays an essential role in identifying care priorities, supporting physiological stability, restoring nutritional status, preventing further liver damage, and addressing emotional needs. Through comprehensive care plans, nurses can significantly improve patient quality of life, promote recovery, and prevent future complications.
By applying evidence-based interventions tailored to patient conditions, nurses can ensure holistic care that addresses physical, psychological, and environmental factors contributing to hepatitis severity.
References
- World Health Organization. Hepatitis. 2022.
- Centers for Disease Control and Prevention (CDC). Viral Hepatitis Facts.
- Black JM, Hawks JH. Medical-Surgical Nursing: Clinical Management for Positive Outcomes.
- Porth CM. Pathophysiology: Concepts of Altered Health States.
