Impaired Liver Function | Nursing Care Plan (NCP) for Hepatitis

Nursing diagnosis: impaired Liver Function related to Viral infection, such as viruses A, B, C, D, HIV coinfection, Hepatotoxic medications—acetaminophen, statins, Substance abuse—alcohol, cocaine, Exposure to environmental toxins

Possibly evidenced by
Presence of virus or antibodies, abnormal liver function tests
Presence of jaundice, hepatic enlargement

Desired Outcomes/Evaluation Criteria—Client Will
Treatment Behavior: Illness or Injury
Demonstrate behaviors or lifestyle changes to limit effects of condition.
Be free of signs of liver failure as evidenced by liver function studies within normal limits (WNL) and absence of jaundice, hepatic enlargement, or altered mental status.

Nursing intervention with rationale:
1. Determine presence of condition(s), as listed above. Note whether problem is acute—viral hepatitis or acetaminophen overdose—or chronic—long-standing alcoholic hepatitis.
Rationale: Influences choice of interventions.

2. Review medications—sulfonamides, phenothiazines, isoniazid—for hepatotoxic drugs or OTC drug use such as acetaminophen.
Rationale: May require changes in usual medication regimen and client education about hepatic effects of OTC drugs.

3. Ascertain if client works in high-risk occupation; for example, performs tasks that involve contact with blood, bloodcontaminated body fluids, other body fluids, or sharps or needles.
Rationale: Helps in identifying source of infection—occupational high risk for exposure to HBV and HCV.

4. Assess for exposure to contaminated food or untreated drinking water or for evidence of poor sanitation practices by foodservice workers, if source is known.
Rationale: Helps in identifying source of infection—risk for exposure to enteric viruses, such as HAV and HEV.

5. Review results of laboratory tests, such as hepatitis viral titers, liver function, and other diagnostic studies.
Rationale: Identifies cause of hepatitis, influences choice of interventions, and monitors response to therapies.

6. Assist with treatment of underlying condition.
Rationale: Supports organ function and minimizes liver damage and risk of organ failure. For chronic HBV and HCV infections, in particular, the goals of therapy are to reduce liver inflammation and fibrosis and to prevent progression to cirrhosis and the associated complications (Buggs & Kim, 2006).

7. Administer medications, as indicated, for example: Antivirals, such as, amantidine (Symmetrel), famciclovir (Famvir), and entecavir (Baraclude)
Rationale: The particular or combination of medication used depends on the type of infection. Inhibit viral reproduction.

8. Lamivudine (Epivir), adefovir dipivoxil (Hepsera), tenofovin (Viread), and telbivudine (Tyzeka)
Rationale: Help reduce viral load and treat chronic active HBV. Alternative choice for individuals unable or unwilling to use interferon; or, in the presence of impaired immune function such as coinfection with HIV (Mukherjee, 2005). Note: Long-term therapy required because the virus begins to replicate when drug is terminated.

9. BMRs, such as interferon alpha-2a (Roferon A) and interferon alpha-2b (Intron A)
Rationale: Reduce viral load and treat symptoms of HCV; may lead to temporary improvement in liver function. Also used in HDV. Note: Interferons have been found to induce remission in 25% to 50% of clients with chronic HBV and in 40% of those with chronic HCV (Buggs & Kim, 2006).

10. Steroid therapy, such as prednisone (Deltasone), alone or in combination with azathioprine (Imuran)
Rationale: Steroids may be contraindicated because they can increase risk of relapse or development of chronic hepatitis in clients with viral hepatitis; however, anti-inflammatory effect may be useful in chronic active hepatitis, especially idiopathic, to reduce nausea and vomiting and to enable client to retain food and fluids. A brief course may also be useful in cholestatic HAV to shorten the illness (Buggs & Kim, 2006). 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.