A case study of a 30 year old Male Client

Diagnosed with Hepatic

Encephalopathy secondary to

Hepatitis B Infection

Priority Nursing Problems1 Disturbed Sensory Perception2 Constipation3 Risk for Injury4 Imbalance Nutrition: Less than Body

Requirements5 Self-Care Deficit6 Impaired Verbal Communication7 Impaired Social Interaction8 Knowledge Deficit9 Noncompliance to Medication Regimen

DISCHARGE PLANNINGMedication> Present to the significant others and patient about

medications giving emphasis to the therapeutic effects and suspected side effects, as well as its daily dose and proper route. This will minimize anxiety and will encourage compliance of the drug. Home medications instructed:

• Omeprazole 40 mg 1 tab OD• Aminoleban 1 sachet- ½ glass water• Lactulose 30cc OD @ HS * 7 days• Essentiale Forte 1 cap TID> Educate the patient and significant others about the

importance of taking the prescribed medications. > Inform the family to seek medical help immediately if signs

and symptoms of encephalopathy: lethargy, confusion, excitability, and asterixis (irregular flapping of forcibly dorsiflexed outstretched hands).

DISCHARGE PLANNING

Exercise>Once jaundice has cleared, encourage gradual

increase in physical activity as tolerated by the client. This may take many months.

>Encourage performing passive and active ROM exercises with the significant others’ help.

>Avoid activities that put pressure on abdominal muscles since it may also pressure the liver.

DISCHARGE PLANNING

Treatment> Tell the family that they should take part on the

treatment of the patient to strengthen the support system of the client.

> Inform the patient and his family not to self-medicate, especially when unusualities occur.

>Inform family members who had intimate contact with the patient about the risks of contracting the disease and make arrangements for them to receive HepB vaccine or HepB immune globulin.

DISCHARGE PLANNING

Health Teachings>Educate patient on the nature of the disease, its

infectiousness and possible complications.>Encourage good personal hygiene to avoid

occurrences of infection.>Adequate rest and nutrition must be ensured.>Avoid drinking alcohol.>Advise significant others to prevent exchange of

body fluids by abstinence or use of condoms

DISCHARGE PLANNING

Out patient follow-up>Emphasize the importance of keeping follow-up

appointments and participating in other health promotional activities and recommended health screenings.

>Point out the importance of good hand washing and hygiene to prevent transmission among family members and friends.

>Emphasize that most hepatitis is self-limiting but follow-ups are needed for liver function tests.

DISCHARGE PLANNING

Diet>Provide small frequent feeding of a high-

calorie, low fat diet. Proteins are restricted when the liver cannot metabolize protein by-products, as demonstrated by symptoms.

>Encourage the patient to eat meals in a sitting position to reduce pressure on the liver.

DISCHARGE PLANNING

Spirituality> Encourage family to teach patient to pray to God

always, ask for guidance, and pray for healing and restoration of health.

> Ask significant others to reflect on this Bible scripture, “For I will restore health to you and heal you on your wounds”, says the Lord. (Jeremiah 30:17)

> Provide assistance and emotional support to patient and family in dealing with its long term implications

>Encourage the patient to verbalize his feelings

PROGNOSIS

Response of the patient regarding the presence of the pain after its management

GOODOne day prior to admission patient complained of

abdominal discomfort; however assessment of symptom was not done on the succeeding days

due to his altered mental status. Patient did not complain of any discomfort or pain upon gaining

full consciousness on July 17, 2010

PROGNOSIS

Physiologic response of the body to disease processFAIR

Upon home visit, patient was able to return to his usual activities in daily living but there

were some complaints of near-sightedness, bipedal edema was noted, and an increase in

abdomen size.

PROGNOSIS

Relief of symptoms associated with the disease condition

FAIRPatient regained full consciousness and was able to

regain normal strength. Vomiting, nausea, loss of appetite and abdominal discomfort was reduced and thus relieved. However, patient upon home visit still had bipedal edema and complained of

near-sightedness. There were also complaints of increase in abdomen size.

PROGNOSIS

Performance of the daily living of the patientGOOD

Patient able to progressively perform activities of daily living and achieved independence in

his activities

PROGNOSIS

Compliance of the patient to the medication therapyPOOR

Upon hospitalization there were medications that the patient’s significant others bought but

there were also those that were not bought due to financial constraint. Home medications

were not purchased due to financial constraints.

PROGNOSIS

Adequacy of rest periods and sleepGOOD

Patient able to sleep within normal pattern. He is able to rest and wakes up feeling rested and with no complaints of discomfort. He is able to

sleep at least 8 hours a day.

PROGNOSIS

Consumption of nutrition and lifestyle changesGOOD

Patient able to adhere to dietary changes. Patient was cooperative in lifestyle

modification such as ceasing to smoke and drink.

PROGNOSIS

Patient’s and SO’s behaviour regarding health teachingFAIR

Patient and S.O. were cooperative and participative in interventions and health

teachings done by health care team; however due to financial constraints importance of

adhering to medications and stay in the hospital was ignored.

Amount of: PercentileGOOD = 4 50%FAIR = 3 37.5%POOR = 1 12.5%

Calculation:Formulaamount # of (good/fair/poor) x 100 = % (percentile)

8Impression: The patient is more likely to have a good

prognosis and is able to comply with the given criteria.