This Nursing care plan is based on the format of Indian nursing council according in which assessment points aren't included. The hepatitis B is a most dangerous diseases condition and it's Incubation period, 2 to 3 months.Prodronal symptoms (insidious onset): fatigue, anorexia, transient fever, abdominal discomfort, nausea, vomiting, headache.May also have myalgias, photophobia, arthritis, angioedema, urticaria, maculopapular rash, vasculitis. Icteric phase occurs 1 week to 2 months after onset of symptoms.

1. NURSING DIAGNOSIS PLANNING/GOAL INTERVENTIONS RATIONAL EVALUATION
Imbalance nutrition
(less than body
required) related to
Insufficient intake to
meet metabolic
demandsanorexia,
nausea /vomiting
Aversion to
eating/lack of
interest in food;
altered taste sen
sation
Monitordietary
intake and
caloric count. Suggest
several small feedings
and offer “largest”
meal at breakfast.
Large meals are
difficult to manage
when patientis
anorexic. Anorexia
may also worsen
during the day, making
intake of food difficult
laterin the day.
Demonstrate
progressive
weight gain
toward goal with
normalization of
laboratory values
and no signs of
malnutrition
Provide supplemental
feedings and TPN if
needed.
May be necessary to
meet caloric
requirementsif
marked deficits are
present and symptoms
are prolonged.
01. NURSING DIAGNOSIS – Imbalancenutrition (less than body required) related to Insufficient intake to meet
metabolicdemands anorexia,nausea /vomiting

2. Reduce the
Abdominal pain/cram
ping
•Antiemetics: metoclop
ramide (Reglan),
trimethobenzamide
(Tigan)
Given 1/2 hr before
meals, may reduce
nausea and increase
food tolerance.
Prochlorperazine
(Compazine) is
contraindicated in
hepatic disease.
Initiatebehaviors,
lifestyle changes to
regain/maintain
appropriateweight.
Reduce the sign of
Loss of weight;
poor muscle tone
•Antacids: Mylanta,
Titralac
Counteractsgastric
acidity, reducing gastric
irritationand risk
of bleeding.
•Vitamins: B complex,
C, other dietary
supplementsas
indicated
Corrects deficiencies
and aids in the healing
process.

3. 2. NURSING DIAGNOSIS – Deficient fluid Volume relatedto Osmotic diuresis (from hyperglycemiaExcessivegastric
losses: diarrhea.
NURSING DIAGNOSIS PLANNING INTERVENTION RATIONAL EVALUATION
Deficient fluid Volume
related to Osmotic
diuresis (from
hyperglycemia)
Excessive gastric
losses: diarrhea.
Maintain bodyfluid
level and reduce the
intensity of the
symptoms of Disease
Assess patient’shistory
related to durationor
intensity of symptoms
such as vomiting,
excessive urination.
Assists in estimationof
total volume depletion.
Symptoms may have
been present for
varying amounts of
time (hours to days).
Fluid level is
maintainedand
patientfeeling
comfortable
Note orthostatic BP
changes.
Hypovolemia may be
manifested
by hypotension and
tachycardia.Estimates
of severity
of hypovolemia may be
made when patient’s
systolic BP dropsmore
than 10 mmHg from a
recumbent to a sitting
then a standing
position.
Demonstrate
adequatehydration as
evidenced by stable
vital signs, palpable
peripheralpulses,
good skin turgor and
capillaryrefill,
individually
appropriateurinary
output, and
electrolyte levels
within normal range.

4. Evaluatepain relief and
control at regular
intervals. Adjust
medicationregimen as
necessary.
Goal is maximum pain
control with minimum
interference with ADLs.
Demonstrate use
of relaxation skills
and diversional
activities as
indicated for
individual
situation.
Inform patientand SO
of the expected
therapeutic effects and
discuss management of
side effects
This informationhelps
establishrealistic
expectations,
confidence in own
abilityto handlewhat
happens.
Discuss use of
additional alternative
or complementary
therapies (acupuncture
and acupressure).
May provide reduction
or relief of pain
without drug-related
side effects.

5. 03. NURSING DIAGNOSIS -
NURSING DIAGNOSIS PLA.NNING INTERVENTION RATIONAL EVALUATION
Risk of skin integrity
related to Effects of
radiationand
chemotherapy
Immunologic deficit
Altered nutritional
state, anemia
Reduce the risk of
skin integrity.
Assess skin frequently
for side effects of
cancer therapy; note
breakdown and
delayedwound
healing. Emphasize
importance of
reporting open areas
to caregiver.
A reddening or tanning
effect (radiation
reaction) may develop
within the field of
radiation.
Participate in
techniques to prevent
complications/promot
e healing as
appropriate.
Bathe with lukewarm
water and mild soap.
Maintainscleanliness
without irritating the
skin.
Encourage patientto
avoidvigorousrubbing
and scratching and to
pat skin dry insteadof
rubbing.
Helps prevent skin
friction and trauma to
sensitive tissues.
Risk of skin integrity relatedto Effects of radiation andchemotherapyImmunologic
deficit Altered nutritionalstate, anemia

6. Protect the patient
from rubbing and
Scratch the skin
Avoidapplyingheat or
attemptingto wash off
marks or tattoos
placed on skin to
identify area of
irradiation;
Helps control
dampness or pruritus.
Maintenancecare is
required until skin and
tissues have
regenerated and are
back to normal.
Identify
interventions
appropriate for
specific condition.
Recommend wearing
soft, loose cotton
clothing;have female
patientavoidwearing
bra if it creates
pressure;
Protects skin from
ultravioletraysand
reduces risk of recall
reactions.
Apply cornstarch,
Aquaphor,Lubriderm,
Eucerin (or other
recommended water-
soluble moisturizing
gel) to area twice daily
as needed;
Reduces risk of tissue
irritationand
extravasation ofagent
into tissues.

7. 04. NURSING DIAGNOSIS - Situationallow self esteem related to Annoying/debilitatingsymptoms, confinement/isolation,
length of illness/recovery period
NURSING DIAGNOSIS PLANNING INTERVENTION RATIONAL EVALUATION
Situational low self
esteem related to
Annoying/debilitating
symptoms, confinement
/isolation, length of
illness/recovery period
Verbalization of
change in lifestyle;
fear of rejection
/reaction of others,
feelings of
helplessness
Assess effect of illness
on economic factors of
patientand SO.
Financialproblemsmay
exist because of loss of
patient’srole
functioning in the
family and prolonged
recovery.
Verbalizeacceptance of self
in situation, including length
of recovery/need for
isolation.
Offer diversional
activities based on
energy level.
Enables patientto use
time and energy in
constructive ways that
enhance self-esteem
minimize anxiety and d
epression.
Verbalize feelings.
Suggest patientwear
bright reds or blues and
blacks instead of
yellows or greens.
Enhances appearance,
because yellowskin
tones are intensifiedby
yellow/green colors.
Jaundiceusually peaks
within 1–2 wk, then
graduallyresolves over
2–4 wk.

8. Depression, lack of
follow-through, self-
destructive behavior
•Avoidmaking moral
judgments regarding
lifestyle.
Patient may already
feel upset and angry
and condemn self;
judgments from others
will further damage
self-esteem. Can also
start distrust issues
with care worker.
Identify feelings and
methods for coping
with negative
perception of self.
Make appropriate
referrals for help as
needed: case manager,
discharge planner,
social services, and/or
other community
agencies.
Can facilitateproblem
solving and help
involvedindividuals
cope more effectively
with situation.
Acknowledge self as
worthwhile;be
responsible for self.
Discuss recovery
expectations.
Recovery period may
be prolonged (up to 6
mo), potentiating
family and/or
situational stress and
necessitating need for
planning,support, and
follow-up.

9. 05. NURSING DIAGNOSIS – Deficiency of knowledge related to Lack of exposure / recall Information misinterpretation
Unfamiliaritywith resources
NURSING DIAGNOSIS PLANNING INTERVENTION RATIONAL EVALUATION
Deficiency of
knowledge related to
Lack of exposure /
recall
Information
misinterpretation
Unfamiliaritywith
resources
Teach the patientfor
Requests of
information
Statements of
concern
Assess level of
understandingof the
disease process,
expectationsand
prognosis, possible
treatment options.
Identifies areas of lack
of knowledge or
misinformation and
provides opportunity
to give additional
information as
necessary.
Identify relationship
of signs/symptoms to
the disease and
correlate symptoms
with causativefactors.
Demostrate the
patientfor Inadequate
follow-through of
instructions
Developmentof
preventable
complications
Provide specific
information regarding
preventionand transmi
ssion of disease:
contacts may require
gamma-globulin;
personal items should
not be shared; observe
strict handwashing
while liver enzymes are
elevated..
Needs and
recommendationsvary
with type of hepatitis
(causative agent) and
individualsituation.
Verbalize
understandingof
therapeutic needs.

10. Questions or
statementsof
misconception;
request for
information
•Discuss restrictionson
donatingblood.
Prevents spread of
infectious disease.
Most state laws
prevent accepting as
donorsthose who have
a history of any type of
hepatitis.
Verbalize
understandingof
disease process,
prognosis, and
potential
complications.
•Inaccurate follow-
through of
instructions;
developmentof
preventable
complications
Emphasize importance
of follow-up physical
examination and
laboratoryevaluation.
Disease process may
take several months to
resolve. If symptoms
persist longer than 6
mo, liver biopsy may be
required to verify
presence of chronic
hepatitis.
Initiatenecessary
lifestyle changes and
participatein
treatment regimen.
Review necessity of
avoidanceof alcohol
for a minimum of 6–12
mo or longer based on
individualtolerance.
Increases hepatic
irritationand may
interfere with recovery.