Fatigue | Nursing Care Plan for Hepatitis

Nursing diagnosis: Fatigue related to Decreased metabolic energy production, States of discomfort, Altered body chemistry—changes in liver function, effect on target organs

Possibly evidenced by
Reports of lack of energy, inability to maintain usual routines
Decreased performance
Increase in physical complaints

Desired Outcomes/Evaluation Criteria—Client Will
Endurance
Report improved sense of energy.
Perform activities of daily living (ADLs) and participate in desired activities at level of ability.

Nursing intervention with rationale:
1. Encourage bedrest and chair (recliner) rest during toxic state. Provide quiet environment and limit visitors as needed.
Rationale: Promotes rest and relaxation. Available energy is used for healing. Activity and an upright position are believed to decrease hepatic blood flow, which prevents optimal circulation to the liver cells.

2. Recommend changing position frequently. Model and instruct caregiver in good skin care.
Rationale: Promotes optimal respiratory function and minimizes pressure areas to reduce risk of tissue breakdown.

3. Do necessary tasks quickly and at one time, as tolerated.
Rationale: Allows for extended periods of uninterrupted rest.

4. Determine and prioritize role responsibilities, alternative providers and possible community resources available, such as Meals on Wheels and homemaker and housekeeper services.
Rationale: Promotes problem-solving of most pressing needs of individual and family.

5. Identify energy-conserving techniques, such as sitting to shower and brush teeth, planning steps of activity so that all needed materials are at hand, and scheduling rest periods.
Rationale: Helps minimize fatigue, allowing client to accomplish more and feel better about self.

6. Increase activity as tolerated. Demonstrate and perform range-of-motion (ROM) exercises.
Rationale: Prolonged bedrest can be debilitating. This can be offset by limited activity alternating with rest periods.

7. Encourage and instruct in stress management techniques, such as progressive relaxation, visualization, and guided imagery, as desired. Discuss appropriate diversional activities, such as radio, TV, and reading.
Rationale: Promotes relaxation and conserves energy, redirects attention, and may enhance coping.

8. Monitor for recurrence of anorexia and liver tenderness and enlargement.
Rationale: Indicates lack of resolution or exacerbation of the disease, requiring further rest and change in therapeutic regimen.

9. Administer medications, as indicated, for example, sedatives and anti-anxiety agents, such as diazepam (Valium) and lorazepam (Ativan).
Rationale: Assists in managing required rest. Note: Use of certain medications such as prochlorperazine (Compazine) and chlorpromazine (Thorazine) is contraindicated because of hepatotoxic effects.

10. Monitor serial liver enzyme levels.
Rationale: Aids in determining appropriate levels of activity because premature increase in activity potentiates risk of relapse.