Student Nurses’ Community

NURSING CARE PLAN – Hepatitis A

ASSESSMENT DIAGNOSIS INFERENCE PLANNING INTERVENTION RATIONALE EVALUATION
Independent:
SUBJECTIVE: • Monitor intake and • Provides After 8 hours of
Fluid volume, Hepatitis A, After 8 hours of output, compare information nursing
“Nagsusuka ako risk for deficient (formerly known nursing with periodic weight. about interventions, the
at madalas related to as infectious interventions, the Note enteric losses replacement patient was able to
akong dumumi excessive hepatitis), is an patient will such as vomiting need or effects of maintain adequate
simula pa losses through acute infectious maintain and diarrhea. therapy. hydration, as
kahapon ” (I’ve vomiting and disease of the adequate evidenced by
been vomiting and diarrhea. liver caused by hydration, as • Assess vital signs, • Indication of stable vital signs
experiencing evidenced by and appropriate
diarrhea for the last Hepatitis A virus, peripheral pulses, circulating
which is most stable vital signs capillary refill, skin volume or urinary output.
24 hours) as
commonly and appropriate turgor, and mucous perfusion.
verbalized by the
transmitted by the urinary output. membranes.
patient.
fecal-oral route
OBJECTIVE: via contaminated • Check for ascites for • Useful in
food or drinking edema formation. monitoring
 Restlessness water. Measure abdominal progression/
 Facial girth as indicated. resolution of fluid
grimace shifts.
 Irritability
 V/S taken as • Use small-gauge • Reduces
follows: needles for possibility of
injections, applying bleeding into
T: 37.1 pressure for longer tissues.
P: 88 than usual after
R: 18 venipuncture.
BP: 120/80
• Have patient use • Avoids trauma
cotton or sponge and bleeding of
swabs and mouth gums.
wash instead of
tooth brush.

• Observe for signs of • Prothrombin

bleeding such as levels are
hematuria, reduced and
Student Nurses’ Community

ecchymosis, oozing coagulation

from gums. times prolonged
when vitamin K
absorption is
altered in GI tract
and synthesis of
prothrombin is
decreased in
affected liver.

Collaborative:
• Monitor laboratory • Reflects
values. hydration and
identifies sodium
retention or
protein deficits,
which may lead
to edema
formation.

• Administer • Reduces fluid or

antidiarrheal agents. electrolyte loss
from GI tract.

• Provide IV fluids • Provides, fluid

and electrolytes. and electrolyte
replacement in
acute toxic shock
state.

• Administer Vitamin • To increase

K as indicated. clotting factor
and decrease
bleeding.