HELP! I need a NANDA nursing diagnosis for hepatitis b and interventions for it!

[missmamanda2]

I have to come up with a nursing diagnosis that is from NANDA for Hepatitis B, I can only find impaired liver funtion, but no interventions to go with it! I need one that I can actually find nursing interventions and their rationals to go with them. Or if you know one and could help me by stating 4 nursing interventions to go with the rationale that would be so helpful. I am at the end of my rope, and sick of trying to find anything that makes sense. Thank you in advance for your help!!

[Daytonite, BSN, RN]

impaired liver function is not an official nanda diagnosis that i know of. there is risk for impaired liver function that is an official diagnosis, however, but that wouldn't apply here. you don't need a nursing diagnosis for hepatitis b; you need a nursing diagnosis for the patient's nursing problems caused by their hepatitis b.

when a patient has a medical disease, the first thing you need to do is assess the patient for the signs and symptoms of the disease. the idea behind a nursing plan of care is to assist the patient in how they are responding to their disease or condition--not to treat the disease or condition. that's the doctor's job. our job is to identify the patient's nursing problems and help them cope with them.

a patient with hepatitis b, depending on how advanced it is, will initially have nausea (nanda diagnosis: nausea), persistent fatigue (nanda diagnosis: fatigue, activity intolerance), low grade fevers (nanda diagnosis: hypothermia), ruq abdominal pain (nanda diagnosis: acute pain), myalgia, arthralgia, and possibly urticaria (nanda diagnosis: impaired skin integrity). eventually, they get jaundice, dark urine and hepatomegaly. they will have nutritional issues. and how would you feel about being around people if you turned yellow? and, then there are all the complications (angioedema, liver cancer, cirrhosis), tests and treatments to consider. the patient will need a lot of teaching and support through them. you must identify these things in your care plan.

you need to review what the nursing process is. it is our problem solving tool. a care plan is a list of the patient's nursing problems and strategies to do something about them:

1. assessment (collect data) - find signs and symptoms, how the patient is responding to their disease and living conditions, problems with accomplishing their adls
   
2. determine the nursing problems - the nursing diagnoses are merely names attached to the problems
   
3. write measurable outcomes and interventions - they are based on, and always relate back to, the information found in step #1
   
4. initiate the care plan
   
5. determine if outcomes have been met
   

your nursing interventions will be aimed at the signs and symptoms that support and prove each nursing problem (nursing diagnosis). just as a doctor orders treatments for the symptoms of a cold or flu, we nurses are doing the same thing with our nursing interventions. our nursing interventions are treating the signs and symptoms of a nursing problem. if your hepatitis patient is running low grade fevers, for example. . .

• problem: hypothermia
  
• etiology: hepatic virus
  
• symptoms: temps fluctuating below normal range, shivering, cool skin and tachycardia.
  
• nursing diagnosis: hypothermia r/t hepatic virus aeb temps fluctuating below normal range, shivering, cool skin and tachycardia.
  
  • your nursing interventions are going to focus on doing something about
    
    • their temps that are fluctuating below normal range
      
    • the shivering the patient is experiencing
      
    • the cool skin they are having
      
    • the discomfort of the tachycardia.
      

your rationales are why you are doing the interventions for those things. if the patient is shivering and your intervention is to put blankets on him you are, in part, doing that to make him more comfortable as well as to keep any body heat generated trapped around his body, right?

that's what should be in a nursing care plan. . .not treat the hepatitis except for what the doctor may order you to do.

[cooliegirl]

Thank you, I learned a lot!

[manchmal]

Really great reply. Helped me, too.

[msblondieg]

helped me too! And I haven't even got to any of these type patients yet

[Christine2009]

Daytonite,

You are so awesome and wish I had as much wisdom about nursing as you..I have learned so much from your posts and you help me strive to become a better nurse...

Thank you for all the help and encouragement you give us nursing students!

[cluna]

Very helpful!! Thanks Daytonite!

[art1stic]

Wow that is an excellent response. I'm going to save it. It'll help me think like a nurse when I go back to clinical!

[heavenbound]

Daytonight,

Wow, this is very helpful. I am sitting here trying to complete a care plan for the first time and was a little confused about somethings, and stumbled upon this; detailed and to the point. Thanks again.