NURSING DIAGNOSIS: Nutrition: imbalanced, less than body requirements
May be related to
- Insufficient intake to meet metabolic demands: anorexia, nausea/vomiting
- Altered absorption and metabolism of ingested foods: reduced peristalsis (visceral reflexes), bile stasis
- Increased calorie needs/hypermetabolic state
Possibly evidenced by
- Aversion to eating/lack of interest in food; altered taste sensation
- Abdominal pain/cramping
- Loss of weight; poor muscle tone
Desired Outcomes
Treatment Behavior: Illness or Injury (NOC)
- Initiate behaviors, lifestyle changes to regain/maintain appropriate weight.
Nutritional Status (NOC)
- Demonstrate progressive weight gain toward goal with normalization of laboratory values and no signs of malnutrition.
7 Hepatitis Nursing Care Plan (NCP)
- Imbalanced Nutrition — Hepatitis Nursing Care Plan (NCP)
- Deficient Fluid Volume — Hepatitis Nursing Care Plan (NCP)
- Low Self-Esteem — Hepatitis Nursing Care Plan (NCP)
- Risk for Infection — Hepatitis Nursing Care Plan (NCP)
- Fatigue — Hepatitis Nursing Care Plan (NCP)
- Impaired Skin Integrity — Hepatitis Nursing Care Plan (NCP)
- Knowledge Deficit — Hepatitis Nursing Care Plan (NCP)
Imbalanced Nutrition — Hepatitis Nursing Care Plan (NCP): Nursing Interventions & Rationale
| Nursing Interventions | Rationale |
| Monitor dietary intake/calorie count. Suggest several small feedings and offer “largest” meal at breakfast. | Large meals are difficult to manage when patient is anorexic. Anorexia may also worsen during the day, making intake of food difficult later in the day. |
| Encourage mouth care before meals. | Eliminating unpleasant taste may enhance appetite. |
| Recommend eating in upright position. | Reduces sensation of abdominal fullness and may enhance intake. |
| Encourage intake of fruit juices, carbonated beverages, and hard candy throughout the day. | These supply extra calories and may be more easily digested/tolerated than other foods. |
| Consult with dietitian, nutritional support team to provide diet according to patient’s needs, with fat and protein intake as tolerated. | Useful in formulating dietary program to meet individual needs. Fat metabolism varies according to bile production and excretion and may necessitate restriction of fat intake if diarrhea develops. If tolerated, a normal or increased protein intake helps with liver regeneration. Protein restriction may be indicated in severe disease (e.g., fulminating hepatitis) because the accumulation of the end products of protein metabolism can potentiate hepatic encephalopathy. |
| Monitor serum glucose as indicated. | Hyperglycemia/hypoglycemia may develop, necessitating dietary changes/insulin administration. Fingerstick monitoring may be done by patient on a regular schedule to determine therapy needs. |
| Administer medications as indicated:Antiemetics, e.g., metoclopramide (Reglan), trimethobenzamide (Tigan);
Antacids, e.g., Mylanta, Titralac;
Vitamins, e.g., B complex, C, other dietary supplements as indicated;
Steroid therapy, e.g., prednisone (Deltasone), alone or in combination with azathioprine (Imuran). | Given 1/2 hr before meals, may reduce nausea and increase food tolerance. Note: Prochlorperazine (Compazine) is contraindicated in hepatic disease.Counteracts gastric acidity, reducing irritation/risk of bleeding.
Corrects deficiencies and aids in the healing process.
Steroids may be contraindicated because they can increase risk of relapse/development of chronic hepatitis in patients with viral hepatitis; however, anti-inflammatory effect may be useful in chronic active hepatitis (especially idiopathic) to reduce nausea/vomiting and enable patient to retain food and fluids. Steroids may decrease serum aminotransferase and bilirubin levels, but they do not affect liver necrosis or regeneration. Combination therapy has fewer steroid-related side effects. |
| Provide supplemental feedings/TPN if needed. | May be necessary to meet caloric requirements if marked deficits are present/symptoms are prolonged. |