II. Risk Factors
• Transfusion of contaminated blood products
• Exposure to infected persons in renal transplant and dialysis units
• Parenteral drug abuse
• Toxic or drug-induced hepatitis results from chemical or medications that damage the parenchyma
III. Pathophysiology
• Hepatocellular damage results from body’s immune response to the virus or toxin is characterized by diffuse inflammatory infiltration with local necrosis. Bile flow is interrupted, antigen-antibody complexes activate the complement system, bilirtubin diffuse into tissues, bile salts accumulate, and hepatomegaly and splenomegaly occur.
IV. Assessment/Clinical Manifestations/Signs and Symptoms
Classified into three stages.
Pre-icteric stage
• The earliest symptoms are nonspecific, flulike symptoms that may include malaise, fatigue, headache, myalgias, anorexia, nausea, vomiting, and diarrhea.
Icteric stage
• Which occurs a few days to weeks after the preicteric stage, symptoms include jaundice, dark-colored urine, light-colored stool, steatorrhea, and an enlarged liver.
Post-icteric stage
• A convalescent stage lasting a few weeks, fatigue decreases, jaundice resolves, and appetite returns.
Laboratory and diagnostic study findings
• Serum liver function test results are elevated
• Serum bilirubin level is increased
• Serum antibody markers identify specific type of hepatitis.
• Urinalysis reveals increased bilirubin levels.
• Prothrombin time or partial thromboplastin time may be prolonged.
V. Medical Management
• Bed rest and restriction of activities until hepatic enlargement and elevation of serum bilirubin and liver enzymes have disappeared.
• Maintain adequate nutrition; restrict proteins when the ability of the liver to metabolize protein byproducts is impaired.
• Administer antacids and antiemetics for dyspepsia and general malaise; avoid all medications if patient is vomiting
• Convalescence may be prolonged and recovery may take 3 to 4 months; provide hospitalization and fluid therapy if vomiting persists.
VI. Nursing Diagnosis
• Activity intolerance related to fatigue, general debility, muscle wasting and discomfort
• Disturbed body image related to jaundice
• Imbalanced nutrition: less than body requirements related to nausea, chronic gastritis, decreased GI motility and anorexia
• Impaired skin integrity related to compromised immunologic status, edema and poor nutrition.
• Risk for injury and bleeding related to altered clotting mechanisms
VII. Nursing Management
Prevent the transmission of infection.
• Institute enteric and blood and body secretion standard precautions.
• Ensure proper hand washing after caring for the client, especially after handling soiled clothing and linens, after using the restroom, and before eating or handling food.
Promote adequate rest without complications.
• Encourage the client to decrease activities and stay on bed rest until enlarged liver and liver enzymes return to normal. Convalescence may be 2 to 4 months; gradually increase activity.
• Institute measures to prevent complications of prolonged bed rest, such as pressure ulcers, pneumonia, constipation and deep vein thrombosis.
Encourage proper nutrition.
• Proteins are restricted when the liver is unable to metabolize proteins.
• Provide a high-calorie, low-fat diet in small, frequent feedings.
Intervene to provide symptomatic relief as appropriate (e.g. antacids, antiemetics).
Promote client and family coping. Address the client and family’s psychosocial concerns, especially when lifestyle must be altered because of the disease process.
Provide health education concerning the:
• Mechanism of disease transmission, methods for maintaining adequate environmental hygiene
• Prophylactic immunizations
• Avoidance of blood donations by infected persons
Administer prescribed medications, which may include immunoglobulins and immunizations.